When

Tuesday, November 22, 2022 at 4:30 PM CST
-to-
Tuesday, December 20, 2022 at 5:30 PM CST

Add to Calendar

Where

ATSA

600 W 22nd Street
Suite 250
Oak Brook, IL 60523-8864

Contact

Practice Coordinator
Advanced Therapeutic Solutions
630-230-6505
info@advancedtherapeuticsolutions.org

"Come Play" Therapy Group Nov/Dec 2022 Tuesdays

Come Play Group is an introduction to groups for children with selective mutism and/or social anxiety. The purpose is to move beyond the verbal relationship your child has with his/her Individual Therapist and develop a verbal relationship with a Group Therapist. This is the first step on the ladder for group therapy at ATSA.

* Required information

Parent Information

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  • Fee

    Type Fee
    $525.00

Child Information

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Agreement

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    CONSENT: ATSA anticipates conducting a program to treat social anxiety, selective mutism and/or other anxiety symptoms present when interacting in groups, using therapeutic support to facilitate verbal interaction (the "Program"). The Program, which ATSA calls Come Play Group Therapy, consists of 1 preview session and 4 group sessions. Parent presents to ATSA that Parent is lawfully authorized to enroll ("Child") in the Program, and Parent hereby consents to so enroll Child.

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    CONDITIONAL ENROLLMENT: Child's participation in the Program will depend on: (a) ATSA enrolling enough children to make the program viable, in ATSA's sole opinion, and (b) ATSA has enough Counselors who are, in ATSA's sole opinion, suitable to help ATSA conduct the Program. As soon as possible, ATSA will notify Parent whether the foregoing have occurred, but ATSA reserves the right to cancel Child's enrollment at any time if the foregoing do not occur.

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    GROUP THERAPY SESSIONS: The group therapy sessions shall occur as scheduled by ATSA at a facility to be determined by ATSA. During the group therapy sessions, Child will have 10-min warm-up time with Parent, 45-min guided play with peers facilitated by the group facilitator, and 5-min debriefing with Parent.

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    COUNSELORS: Counselors shall: (a) interact individually with Child as needed by Child and to increase Child's verbal output/social interaction, and (b) reinforce Child's verbal communication and/or prosocial interaction through rewards, and through other immediate encouragement.

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    EXPECTATIONS: 5 sessions (1 preview session and 4 group sessions) are included in the fee. There may be homework following the group sessions. Parents are expected to: reinforce the message that practicing before doing something new helps to calm fears; reinforce group themes as identified by ATSA therapist; continue social exposures with their children.

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    FINANCIAL OBLIGATIONS: Upon registering, Parent shall pay ATSA the enrollment fee of $525. If ATSA cancels the Program, ATSA's sole obligation to Parent shall be to refund the enrollment fee.

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    TERMINATION: Child must arrive and depart from all sessions strictly on time because the schedules of all the children enrolled in the Program, their parents, and the Counselors are interdependent. ATSA may terminate Child's participation in the Program if Child is not consistently on time, regardless of the reasons; or if Parent does not pay the fees required by this agreement, and in those cases the enrollment fee is non-refundable.

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    WITHDRAWAL: At Parent's sole discretion, Parent can withdraw Child from the Program at any time. If withdrawal occurs before the Preview Session, Parent will be refunded the enrollment fee less a $25 administrative fee. If withdrawal occurs after the Preview Session takes place and before the Group Sessions begin, ATSA will refund the enrollment fee less $105 for the Preview Session. The enrollment fee is non-refundable after the group sessions begin, regardless of the circumstances.

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    PRIVACY POLICY: Parent has received a copy of ATSA's privacy policy, and Parent consents to ATSA's privacy policy. Parent also acknowledges that due to the nature of the Program, treatment given to Child as part of the Program will often occur in the presence of others.

Registration and Insurance

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    As a condition to enroll Child in the Program, Child must have completed ATSA's customary intake evaluation, consisting of a Diagnostic Interview with Parent(s), a Child Observation and Parent Training session, and a Parent Feedback session. If these sessions have not been completed, Parent acknowledges that Parent will contact the main clinic number 630-230-6505 to make appointments for these sessions. Parent acknowledges receipt of materials from ATSA concerning insurance reimbursement.

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    Release of Liability: Except to the extent covered by insurance of ATSA or its vendors, if any, Parent hereby releases ATSA, the Counselors, and ATSA’s vendors, and Parent will indemnify, not sue, and hold ATSA, the Counselors, and ATSA’s vendors harmless from all claims for any personal injury to Child caused by: (i) the ordinary or gross negligence of ATSA, Counselors, or ATSA’s vendors, or (ii) another child or another adult who is not employed by ATSA.

Entire Agreement

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    This Agreement contains and constitutes the entire agreement between ATSA and Parent regarding the subjects of this Agreement. In making this Agreement, neither ATSA or Parent have relied on any promise or statement by the other, including the contents of ATSA’s web site, that is not specifically stated in this Agreement or in ATSA’s privacy policy, registration form, or insurance reimbursement materials.

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    Please select all that apply:

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    I have read, understand, and agree to Advanced Therapeutic Solutions stated policies. I agree that my child's protected health information may be disclosed for the purposes of treatment, payment, and healthcare services. I have read and understand the HIPAA Notice of Policy and Practices in full and have had sufficient opportunity to ask questions/seek clarification.

Group Dates for Tuesdays

Item Qty. Max Limit Price

Nov/Dec Group

4:30pm-5:30pm 11/22 (Preview Session), 11/29, 12/06, 12/13, 12/20. Please enter "1" under Qty to indicate that you have acknowledged the preview session and group dates. The fee will be captured below.

1 Free
$9,999.99

Payment

Payment Method

  • Please make check payable to:
    Advanced Therapeutic Solutions
    600 W 22nd Street
    Suite 250
    Oak Brook, IL 60523-8864

Payment Summary


Yes, I would like to know about other social skills groups.

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