Consent for Services
This document contains important information about our practices and services provided. Please read it carefully. Your behavior analyst will be glad to review it with you and answer any questions you may have.
Applied Behavior Analysis Services
Dr. Shea, LLC provides applied behavior analysis services. Applied Behavior Analysis (ABA) is an approach to changing and managing behavior. The goal of ABA is to reduce undesired behaviors and increase desired (appropriate) behaviors.
ABA services include, but are not limited to:
Assessing behaviors of concern and identifying appropriate replacement behaviors.
Developing treatment strategies to decrease behaviors of concern and increase desired behavior(s).
Training clients/caregivers to implement treatment strategies.
Training caregivers to teach self-care, daily-living skills, social and academic skills, as necessary.
The benefits of ABA may include decreases in undesired behaviors and increases in appropriate behaviors. Behavior analysis services typically require effort on the part of the client/caregiver and may result in temporary increases in interfering behavior. Behavior analysts closely monitor behavior to minimize that risk.
Active Participation
Your participation in this service is voluntary. You may choose not to participate or withdraw your consent (choose to stop participating) at any time. Caregiver participation is vital to successful behavior change and management. Therefore, your active participation in services is necessary to achieve beneficial outcomes for the Individual. Choosing not to participate or withdrawing your participation from this service will likely result in the termination of services.
Missing, rescheduling, and/or canceling three (3) consecutive appointments or four (4) total appointments may result in the loss of behavioral services from this program. Persistent failure to participate in services or implement behavioral recommendations may also result in the termination of services.
Questions About Services
If you have any questions or concerns about these services, please contact Shannon Shea at (561) 320-3240. A voice messaging system is always available. Messages are returned during business hours. If an emergency arises because of problem behavior, you should call 911 and then call the behavior analyst during normal business hours.
Service Records
Service records are kept as required by law and professional standards. Clients are entitled to a copy of their records upon request and with appropriate signed release. All service activities, including service visits, telephone contacts and missed, canceled, or rescheduled appointments, will be documented.
Confidentiality
Information obtained during behavioral services is protected by confidentiality rules and can only be given to others with written permission from the client’s legal guardian. However, there are exceptions including:
We are required to report service activities to APD representatives. This includes, but is not limited to, appointments, telephone contacts, letters, behavioral assessments, behavior programs, and data on individual progress and caregiver participation.
Service records and/or behavior analyst testimony may be subpoenaed for legal proceedings.
Behavior analysts are required by law to report suspected abuse or neglect of children, the elderly, and individuals with disabilities.
The behavior analyst may seek professional consultation with others to better serve the client. Identifying information will be withheld during such consultations, and the consultant is ethically bound to keep the information confidential.
Consent and Signature
Review the consent statement below, complete the applicable client and guardian information, and sign the form.
