Community Counseling Solutions' Chemical Dependency Treatment Program is committed to working with those who want help for alcohol, drug and/or other addictive behaviors. Although you may not have voluntarily chosen to be here, we want you to know that what you take with you at the end of your program is entirely up to you. We have found that many of our program participants acknowledge their problems and use the information learned during treatment to positively change their life styles; others appear indifferent to treatment and do not seem to take treatment seriously. We do know one certainty, only you can change your attitude and behaviors.

Chemical dependency is a progressive, chronic, and treatable disease that affects both the identified client and others with whom the client lives and works. While the chemically dependent person is not responsible for his/her illness, he or she is responsible for doing everything possible to ensure recovery. Each client is responsible for his or her own recovery. While every member of the treatment staff is here for you, we want you to be aware that you may do with your life whatever you choose. Change may occur during treatment but only because you choose to change.

On the day of your admission, you will be assigned a counselor who will work with you throughout treatment. Your counselor will help you develop a treatment plan that will determine both length and frequency of your treatment sessions. If you have any questions about your program, or if you want to discuss your progress in treatment, please contact your counselor to schedule an individual appointment. If you find questions arising during treatment or if your status changes during treatment, please contact your counselor immediately.

At time of your enrollment, you will be expected to sign a treatment contract. (Please refer to the Treatment Contract found in this packet.) Please read the terms of the contract and be familiar with the content before your first treatment session.

You will be charged a fee for services. Fees will be based on "Clinic Cost" for one hour of treatment.

At the time of your intake appointment, you must have proof of income. This may take the form of two consecutive pay stubs, unemployment verification, Social Security stubs, AFS monthly report, etc… If you do not have the appropriate documentation at the time of your intake appointment, the intake may proceed, but no further services will be provided until the appropriate documentation is received.

At the time of your intake appointment, you will be charged an assessment fee. You may qualify for a reduced fee based on income. Please see the secretary for more information.

Clients are responsible for payment of treatment. Community Counseling Solutions will bill the following agencies:

• Oregon Health Plan
• Title XIX/Medicaid
• Third Party Insurance

In the event you assume all responsibility for the cost of services, you will be expected to pay for each individual or group session before the session begins. Failure to bring your payment may result in your termination from treatment as noncompliant and your referral back to the referring agency (Court, DHS, Parole and Probation, etc).

To assure success in your program, it is important that you attend every session. If for any reason you must miss a group, it is asked that you contact this agency and explain the reason for your absence.

Anyone participating in treatment will submit to a minimum of two urinalyses during the course of treatment. Random U.A.'s can be at the discretion of your counselor. All U.A. fees are in addition to treatment fees.

In order to benefit from treatment, all participants are expected to refrain from the use of alcohol and other drugs. If you are referred to treatment as part of a Diversion Agreement, Oregon Administrative Rule mandates that you "must demonstrate continuous abstinence for a minimum of 90 days prior to discharge as documented by urinalysis and other evidence." OAR 415-51-130(2). If you are found using alcohol or other drugs while enrolled in treatment, you may be terminated from treatment. If you come to the clinic under the influence of alcohol or other drugs, or refuse to submit to testing, you will be terminated from treatment. If a physician has prescribed any medication before or during your treatment, please notify your counselor of the type and dosage.

As a client of this agency you are responsible for keeping appointments, paying fees, and complying with your treatment plan. If you are involved with the criminal justice system, you are expected to abide by any conditions that have been imposed.

This agency reserves the right to discharge clients who fail to meet these responsibilities. Threatening staff or another client with physical harm will not be tolerated and may be grounds for immediate termination from further treatment.

Federal law and regulations protect the confidentiality of alcohol and drug abuse client records maintained by this agency. The agency may not say to a person outside the agency that a client attends the program, or disclose any information identifying a client UNLESS:

• The client consents in writing
• The disclosure is allowed by a court order, or
• The disclosure is made to medical personnel in an emergency or to qualified personnel for research, audit, or program evaluation.

The agency is also prohibited from disclosing any information about a client's actual or perceived HIV infection without specific written authorization signed by the client.

If you have been referred to treatment by the Department of Human Service or as a condition of probation or parole, your counselor will ask you to sign a release which allows the agency to share the following information with DHS or Corrections:

• Use of alcohol or other drugs
• Attendance records
• New crimes

Federal law and regulations do not protect any information about a crime committed by a client either at the program or against any person who works for the program or about any threat to commit such a crime.

Federal law and regulations do not protect any information about suspected child abuse or neglect from being reported under State law to appropriate State or local authorities. (See 42 U.S.C. 290dd-3 and U.S.C. 290ee-3 for Federal laws and 42 CFR Part 2 for Federal regulations.)

If you have been convicted of a DUII and you are planning on doing your treatment through Community Counseling Solutions, you will need to submit certain documents before being admitted to the program:

• Current driving record from Department of Motor Vehicles
• Court documents