Therapeutic Services & Support
The Cultivate Community provides developmentally appropriate therapeutic and supportive services for children, teens, and families navigating medical experiences, illness, injury, grief, loss, and related emotional or life stress. Services may include counseling, music therapy, child life support, group programming, and caregiver sessions. Our goal is to create a compassionate environment where children and families feel safe processing experiences, building coping skills, and strengthening emotional well-being.

Our Therapeutic Approach
Providers at The Cultivate Community use evidence-informed, developmentally appropriate approaches based on each clinician’s training and the unique needs of each child and family. Goals, approaches, and recommendations are discussed collaboratively throughout the assessment and care process. Therapy can be meaningful and sometimes challenging. While outcomes cannot be guaranteed, our clinicians are committed to supporting emotional growth, resilience, and a sense of security. Services are therapeutic and supportive in nature and are not intended as medical, legal, or forensic evaluations. If services outside our scope are needed, we are happy to help connect families with appropriate resources.

Caregiver Involvement & Communication
Caregivers play an important role in supporting a child’s progress. Providers may offer general updates, guidance, and recommendations throughout services. As children grow, it may be clinically appropriate to provide space for private therapeutic conversations. Providers use professional judgment to balance caregiver involvement with each child’s emotional safety and developmental needs. If safety concerns or mandated reporting obligations arise, caregivers will always be notified as required by law. Families are encouraged to schedule caregiver check-ins whenever additional communication or support would be helpful. The Cultivate Community provides therapeutic support but does not offer crisis or emergency services. If immediate support is needed, please call 911 or visit your nearest emergency room.

Confidentiality & Privacy
Confidentiality is an essential part of therapeutic care. Information shared in sessions is kept private unless written authorization is provided or disclosure is required by law. Situations that may require disclosure include risk of harm to self or others, suspected abuse, neglect, or exploitation, or court orders, subpoenas, or legal requirements. When coordination with schools, medical providers, or other professionals is desired, a written Authorization to Release Information is required.

Telehealth Services
Services may be provided in person or through secure telehealth platforms when clinically appropriate. Telehealth sessions follow the same confidentiality and ethical standards as in-person care, though technology-related interruptions or privacy limitations may occasionally occur. Families are encouraged to participate from a private, safe location.

Group Services (If Applicable)
When participating in group programs, families and participants are expected to respect the privacy of others. While clinicians emphasize confidentiality and respectful group boundaries, confidentiality outside of sessions cannot be guaranteed. Families are asked not to share identifying information about other participants or group discussions.

Records & Documentation
Clinical records are maintained in accordance with professional standards and legal requirements to support continuity of care. Records may include attendance, treatment planning, and brief session summaries. Documentation is intended for therapeutic purposes and is not designed to serve as forensic evaluations or legal documentation. Families may request access to records in accordance with privacy laws and practice policies.

Continuity of Care & Provider Availability
While we strive for consistent care, providers may occasionally be unavailable due to illness, family leave, or professional obligations. When possible, families will receive advance notice, and options such as rescheduling, temporary coverage, or referrals may be offered. Because services are not crisis-based, The Cultivate Community does not provide 24/7 coverage. Families are encouraged to maintain appropriate emergency supports outside scheduled sessions.

Professional Boundaries & Community Privacy
To protect confidentiality, providers do not engage with clients through personal social media accounts and will not acknowledge therapeutic relationships publicly unless families choose to do so first. If you encounter a provider in the community, you are always welcome to say hello. However, clinical conversations will not take place outside scheduled sessions in order to maintain privacy and emotional safety.

Voluntary Participation & Continuation of Services
Participation in services is voluntary, and families may choose to end services at any time. The Cultivate Community may also pause or discontinue services when clinically appropriate, including situations involving extended attendance gaps, financial concerns, or when services are no longer the best fit. When possible, referrals or transition support will be provided. Most families begin with a brief phone consultation so we can better understand your child’s needs, answer questions, and determine whether our services are the best fit.

Policy Updates
Policies and procedures may occasionally be updated to reflect professional standards, legal requirements, or practice needs. The most current information is always available through our office.

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

I. Our Pledge Regarding Health Information
The Cultivate Community understands that health and personal information about your child and family is private and sensitive. We are committed to protecting this information while providing high-quality therapeutic and supportive services.

We maintain clinical records to support continuity of care, ensure quality services, and comply with legal and ethical standards.

This Notice explains how your child’s protected health information (“PHI”) may be used and disclosed and outlines your rights regarding that information.

We are required by law to:

• Maintain the privacy of your child’s protected health information

• Provide you with this Notice of our legal duties and privacy practices

• Follow the terms of the Notice currently in effect

• Update this Notice if changes occur, with revised versions available upon request, in our office, and on our website

II. How We May Use and Disclose Health Information
The following categories describe ways in which The Cultivate Community may use or disclose your child’s health information. Not every example is listed, but all permitted uses and disclosures fall within these categories.

For Treatment and Care Coordination
Federal privacy regulations allow providers to use or disclose health information without written authorization for purposes of treatment, payment, and healthcare operations.

For example, we may coordinate care with your child’s physician, therapist, school support team, or other professionals involved in your child’s well-being when clinically appropriate.

Treatment includes:

• Coordination between providers

• Consultations and referrals

• Communication necessary to support your child’s care

For Practice Operations and Safety
The Cultivate Community may use video surveillance in common or public areas of the practice (such as the waiting room, entryway, or hallways) for safety and security purposes.

Cameras are not used in therapy rooms or private clinical spaces. Surveillance footage is not part of the clinical record and is not used for treatment purposes. Footage is accessed only when necessary for safety, security, or operational concerns.

III. Uses and Disclosures That Require Your Written Authorization

Certain uses and disclosures of information require your written permission.

Psychotherapy Notes
In limited circumstances, a licensed mental health provider may maintain psychotherapy notes, which are given special protection under HIPAA. Psychotherapy notes are kept separate from the standard clinical record and generally require written authorization for release, except as permitted or required by law.

Most documentation at The Cultivate Community consists of standard clinical records, such as attendance, treatment planning, and session summaries. These standard records support continuity of care and are not considered psychotherapy notes.

Marketing and Sale of Information
The Cultivate Community does not use or disclose your child’s health information for marketing purposes and does not sell protected health information.

IV. Uses and Disclosures That Do Not Require Authorization

We may use or disclose health information without prior written authorization when permitted or required by law, including:

• Reporting suspected abuse, neglect, or exploitation

• Preventing or reducing a serious threat to health or safety

• Health oversight activities such as audits or investigations

• Judicial or administrative proceedings (such as court orders or subpoenas)

• Law enforcement purposes as required by law

• Appointment reminders or service-related communication

V. Disclosures Where You Have the Opportunity to Object

In certain situations, we may share limited information with a parent, legal guardian, caregiver, or other designated support person involved in your child’s care or payment for services, unless you request otherwise.

This may include scheduling communication, care coordination, safety-related information, or general information needed to support services.

If you prefer that information not be shared with a particular individual, please notify us in writing or speak with your provider so we can document your preferences. We will honor these requests whenever possible unless disclosure is required by law, necessary for safety, or supported by legal custody documentation.

In emergency situations, consent may be obtained retroactively when appropriate.

VI. Your Rights Regarding Health Information

You have the following rights regarding your child’s protected health information:

• Request restrictions on how information is used or disclosed

• Request confidential communication methods or locations

• Access electronic or paper copies of records (reasonable fees may apply)

• Request corrections or amendments to records

• Receive a copy of this Notice at any time

VII. Questions or Complaints

If you have questions about this Notice of Privacy Practices, or if you believe your privacy rights have been violated, you may contact:

The Cultivate Community
Phone: (214) 444-8539
Email: info@thecultivatecommunity.com

You also have the right to file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights without fear of retaliation.

We will not penalize or retaliate against you for filing a complaint.

Financial Policy & Payment Information

At The Cultivate Community, we aim to keep financial expectations clear so families can focus on care without unnecessary stress. Detailed financial agreements are reviewed during intake; the information below provides a general overview.

Private Pay Practice
The Cultivate Community is a private-pay practice and does not bill insurance directly. Payment is the responsibility of the family at the time of service unless other arrangements have been made in advance.

If requested, we can provide documentation for families who wish to pursue possible out-of-network reimbursement independently. Reimbursement is determined solely by your insurance provider.

Service Rates
Rates vary depending on service type, provider credentials, and session structure. Typical ranges include:

Initial Assessments: approximately $150–$225
Ongoing counseling, music therapy, or child life sessions: approximately $125–$175 per session
Caregiver consultation sessions: approximately $100 per session

Telehealth sessions are billed at the same rate as in-person services. Our current rate sheet is available upon request, and specific rates are always confirmed prior to scheduling. Rates may be adjusted periodically with advance notice.

Group services, collaborative care options, and off-site services may have different pricing, which will always be discussed before scheduling.

Additional Support Services
Occasionally, services outside scheduled sessions may involve additional fees, such as extended consultations or completion of certain forms. Details are reviewed during intake.

Payment & Billing Expectations
Families are asked to maintain an active payment method on file. If payments become significantly overdue or unresolved, scheduling may be paused until the account is current. Our team will always communicate proactively if concerns arise.

Legal & Court-Related Matters
Services at The Cultivate Community are therapeutic in nature, and we do not provide custody evaluations, forensic services, or legal opinions. If legal involvement arises (such as subpoenas or court-ordered requests), additional policies and fees will apply. These are reviewed in detail during intake.

Continuity of Services
Timely payment supports continuity of care. If services need to be paused for financial or clinical reasons, we will provide reasonable notice and, when appropriate, referrals to support ongoing care.

Cancellation Policy

Your appointment time is reserved specifically for your child and family. When sessions are canceled late or missed, it limits our ability to offer that time to another family who may be waiting for support.

We ask for at least 24 hours’ notice if you need to cancel or reschedule. Appointments canceled with less than 24 hours’ notice or missed appointments will be charged the full session fee. This policy applies to both in-person and telehealth sessions.

We understand that unexpected situations arise. Each family is allowed one late cancellation per calendar year without charge as a courtesy. Exceptions may also be made for medical emergencies or unforeseen circumstances at the clinician’s discretion.

If you are running late, sessions will still end at the originally scheduled time. If more than 15 minutes pass without communication, the appointment may be considered a no-show and billed accordingly.

Attendance & Continuity of Care

Consistent attendance supports therapeutic progress and continuity of care. Repeated missed appointments, late cancellations, or extended gaps between sessions may impact our ability to hold a recurring appointment time.

In some cases, services may be paused or transitioned if attendance becomes inconsistent. If a client has not been seen for three months or longer, a new initial assessment may be recommended before resuming services.

Good Faith Estimate Notice (No Surprises Act)

Under the federal No Surprises Act, individuals who do not have insurance or who choose not to use insurance have the right to receive a “Good Faith Estimate” of expected charges for healthcare services.

This estimate is based on the information known at the time and may include expected costs for scheduled services, including therapy sessions, assessments, or other requested support.

You have the right to request a Good Faith Estimate at any time prior to scheduling or receiving services.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you may dispute the bill.

For questions or to request a Good Faith Estimate, please contact:

The Cultivate Community
214-444-8539
info@thecultivatecommunity.com

Services at The Cultivate Community are provided for therapeutic and supportive purposes only. We do not provide custody evaluations, forensic assessments, legal opinions, or documentation intended for court proceedings.

If legal involvement arises during services, we will discuss appropriate next steps with your family. In many cases, this may include transitioning care to a provider whose role is specifically designed for legal or forensic involvement, and therapeutic services with our team may be concluded to protect the integrity of the therapeutic relationship.

Additional details regarding legal involvement are reviewed during intake.

The Cultivate Community is committed to providing high-quality, ethical, and transparent care. The following information is provided to help families understand their rights, available resources, and applicable consumer protections.

Notice to Consumers (Texas Law)

In accordance with Texas law (House Bill 4224 and Section 181.105 of the Texas Health and Safety Code), the following information is provided to help consumers understand their rights and available resources.

Requesting Health Care Records

You have the right to request a copy of your child’s mental health records.

To request records, please submit a written request to your treating clinician or to the practice directly. Requests may be made via email, secure client portal, or in writing. Records will be provided in accordance with Texas law and applicable privacy regulations.

If you have questions about accessing records, please contact our office.

Regulatory Boards and Complaint Resources

Contacting the Texas Behavioral Health Executive Council (BHEC)

The Texas Behavioral Health Executive Council regulates licensed mental health professionals in Texas.

If you have questions about licensure or professional standards, you may contact BHEC directly:

Texas Behavioral Health Executive Council (BHEC)

https://bhec.texas.gov/contact-us/

Filing a Consumer Complaint

If you wish to file a consumer complaint regarding mental health services, you may do so with the Texas Office of the Attorney General:

Office of the Attorney General

https://www.texasattorneygeneral.gov/consumer-protection

Other Resources

Certification Board for Music Therapists (CBMT)

Toll Free: 1.800.765.CBMT (2268)

Phone: 1.610.269.8900

Email: info@cbmt.org

https://www.cbmt.org

American Music Therapy Association (AMTA)

Ethics Boardamtaethics@hushmail.com

https://www.musictherapy.org

Child Life Certification Commission (CLCC)

https://www.childlife.org/certification

Association of Child Life Professionals (ACLP)

https://www.childlife.org

Questions or Concerns

If you have any questions about your rights, privacy practices, professional standards, or consumer resources, you may contact:

The Cultivate Community

Phone: 214-444-8539

Email: info@thecultivatecommunity.com

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