Teras Intervention and Counseling Inc.

Alcohol and Other Drug Outpatient Treatment and DUII Diversion

Client Handbook

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 Teras AOD Treatment Philosophical Approach:
Mission Statement, Values and Guiding Principles-

Teras Interventions and Counseling Addictions Program (TICAP) Mission Statement: TICAP seeks to provide accessible,
affordable, culturally appropriate, state of the art addictions services to the people of Multnomah County and surrounding areas.
We seek to do this with the utmost respect for the self-determination of those being served, their loved ones and in full cooperation
with community partners and referring authorities. Addiction is considered a disease of the body with effects on the spiritual,
psychological, relational and communal functioning of the individual afflicted.

TICAP Values and Principals:

1. Acknowledge that the harmful effects of alcohol and other drugs creates a ripple effect to the lives of those around the client, we
encourage and promote a holistic approach to treatment, including when possible the client’s social, familial and spiritual
community to support the goals of treatment and the individual’s need to be acclimatized to a sober recovery environment.

2. Acknowledge and support that client’s problems exist at a full range of severity; from minor problems to life-threatening, we provide
abstinence-oriented treatment with individualized goals, objectives and needs. We use the most effective evidence based practices
currently known to the field of addictions.

3. Acknowledge that clients come to treatment at varying stages of readiness to change; we support the use of specific interventions
designed to meet the client at their level of motivation to seek and participate in treatment. Nobody will be turned away from
treatment because of their ambivalence or pre-contemplative stage of change (see attachment A clinical guidelines)

4. Recognizing that alcohol and drug use can have a direct impact on physical, emotional and spiritual well-being, we coordinate the
care of a client with all other appropriate treatment needs, including medical care and dual diagnosis enhanced treatment. We will
coordinate with the client’s spiritual community to enhance treatment outcomes and longevity in sobriety.

5. Recognizing and honoring that we are a culturally diverse society, we integrate the dignity of the individual’s gender, spiritual and
ethnic practices, and social values into the structure of each treatment plan. Each culture is unique with many strengths and
challenges. At all times we will maintain a humble stance towards different cultural norms and traditions.

6. Acknowledging and celebrating that clients will act in different and healthier ways upon leaving treatment, we coach them to utilize
their strengths and other reintegration skills appropriate to the individual client’s needs. We do this by using evidence-based
practices, utilizing natural community supports and validating each client as an individual capable of making changes and
functioning without the ongoing support of treatment providers once their treatment episode is done.

7. Actively demonstrate economic justice in all programs, policies and procedures. Teras’ addiction and domestic violence programs
know the cost of these behaviors on families who experience them as well as the community they live. We strive to use our
resources wisely without compromising quality service and victim safety. Our services are accessible to all regardless of income
or socio-economic status.

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 1d-2-AOD_Informed Consent for AOD Treatment

Teras Informed Consent and Privacy Practice for AOD/DUII Program

CONFIDENTIAL STATEMENT:
Teras maintains confidentiality under state and federal statute (see 42 C.F.R. handout in client packet). No
information will be released to others nor will we request information from others without your written consent.
Law requires the following exceptions to this policy: information regarding child abuse, indicating imminent danger to
self (suicidal threats) and imminent threats to others as self-reported by client,all state records audits and in cooperation
with researchers in the field of counseling. All research and audit persons have the same level of responsibility for
confidentiality as Teras staff.
While explicitly stated to all participants, confidentiality cannot be guaranteed regarding other clients divulging information
in group sessions. Participants are encouraged to disclose at the level they find to be appropriate given their trust in other
group members.
PROFESSIONAL DISCLOSURE STATEMENT:
Counselors working at Teras abide by professional ethics as prescribed by the National Association of Alcohol and Drug
Counselors (NAADAC). Counselors are certified as CADC I or CADC II by the Addictions Counselor Board of
Oregon. The primary responsibility of counselors employed at Teras is to facilitate the recovery of clients with
dignity and respect. Teras believes in promoting responsibility for personal growth without blame, shame or
violence. Your counselor will be approachable, supportive and engaging with all clients during therapy groups and other
therapeutic interventions but will not engage in exploitive relationships of any kind during or after the treatment
episode. The Teras model of treatment approaches clients in non-traditional settings, and with community engagement
techniques most local programs don't. Teras staff are not engaging in personal relationships with clients when we
use these techniques and settings and are expected to remain professional, objective and respectful of the physical
boundaries of each participant.
USE OF CONSULTANTS:
Counselors may discuss their concerns on individual clients with the Teras Clinical Supervisor and or the Teras
Medical Director. However, the Medical Director and Clinical Supervisor serves as a consultant and does not treat
the clients. The Medical Director reviews and updates medical policies and procedures, and consults with primary
care physicians if the screening and assessment process disclosure indicates.
ATTENDANCE: Since clients are encouraged to accept responsibility for outpatient treatment, it is expected that
clients will attend all scheduled treatment appointments and remain abstinent from all mind altering substances
while in treatment. Consistent failure to attend treatment appointments or maintain abstinence may result in referral
to an increased level of care either at outpatient or inpatient treatment. Indication of two or more weeks having used
drugs or alcohol is considered to be consistent use. See the attendance policy in your handbook for more specific
attendance expectations and explanations of potential for consequences from your referring agency if mandated to
treatment.
AGREEMENT TO BE TREATED:
I am applying for treatment services at Teras and agree to be treated by this program. Treatment approaches
employed at Teras may include individual and family education,group therapy educational presentations case
management, mentoring, referral to a couple'scounseling or mental health assessment, telephone check ups and
assessments for alcohol/drug abuse or dependence.I agree to maintain confidentiality as explained above. I understand
that I am responsible for the cost of my treatment determined by the current fee structure explained in the Financial
Fee Agreement, unless other funding has been pre-arranged through insurance or other funding source.
DUII AND COURT REFERRED:I understand that I am expected to maintain abstinence from all mind altering
chemicals while in treatment and that the result of ongoing positive drug screens may be a referral to residential
treatment.

Init. _____I give permission to Teras Interventions and Counseling Inc. to send my urinalysis sample for alcohol
and other drug testing to the lab Teras uses.

Init. _____I am giving Teras permission to use their Medical Director to make the decision as to whether I may need
a higher intensity of treatment. I give Teras permission to give insurance and other third party payer information
(including client identifying information, along with assignment benefits) to appropriate institution and/or physician.
__________________________________ ________
Client signature date
Client printed name:____________________________
This agreement was written by Phil Broyles BS, CADCII,Program Director and Clinical Supervisor as of 04262011.
No other agreements can be honored without the written consent of Phil Broyles or the current Program Director.
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 www.terasinc.org

TERAS INTERVENTION AND COUNSELING INC.

THERAPIST INTRODUCTION FOR NEW CLIENTS

We have prepared this brief handout because we have found that some people have
some misconceptions about groups. Please read this and if you have any questions
let me know.
Results for Group therapy are at least as favorable as for individual treatment.
There is no evidence showing that individual treatment is better than group
treatment!
Group therapy is often the treatment of choice in alcohol and drug programs.
The treatment provided by Teras is offered in a group
setting with an individualized focus. This kind of group is different from traditional
group therapy.
• You will be doing all of your assignments on an individual basis and in group activities.
• In the group, there will be a focus on your individual experiences. For example, each person will
discuss one of their high risk trigger situations in the group and feedback will be given by the
therapists and other group members. In this way, you will have an opportunity to learn how others
face and deal with problems. Group sessions are helpful, as they provide an opportunity to share
experiences with others trying to change their alcohol or drug use. Group therapy give you an
opportunity
• To exchange experiences with others
• To learn how others have dealt with their problems
• To receive support from those who have a similar problem, and
• To help others deal with their problems
Experiences in a group let you know you are not alone in trying to change your alcohol or drug
problem.
Sincerely,

Phil Broyles BS, CADCII

Executive and Program Director
501 C3 Nonprofit tax ID # 26-4575033

3945 SE
Hawthorne Blvd. PHONE: 503-719-5250
Portland, Oregon Fax: 503-715-5672 E-
97214 MAIL: info@terasinc.org

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 HOW TO BENEFIT FROM GROUPS

Group as we have discussed have several benefits over individual therapy.

What we have also found and what other clients tell us is that if you do the
following you are more likely to benefit from participating in the group.

How to Benefit From Groups

✔ ATTEND ALL SESSIONS

✔ READ THE HANDOUTS

✔ DO YOUR HOMEWORK BEFORE THE GROUP

✔ DO YOUR SELF-MONITORING EACH DAY

✔ SPEAK UP IN THE GROUP

✔ SELF-DISCLOSE: USE THE GROUP TO HELP

YOU WITH YOUR PROBLEM

Sobell & Sobell January 7, 2005

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7
1/23 8
 Teras Interventions and Counseling-Addictions Department

Effective Date Title/Description Client Rights Policy # 2.2.0

Pag
09-16-08 e 1
of 2
Revision Date Applies to: Standard
04/23/2013
Teras Intervention and Counseling ORS 415-051-0020

AOD/DV/Anger Management programs

PURPOSE: To protect each client’s rights at all times.

POLICY: Each client will be assured the same civil and human rights accorded to
other citizens. Teras Addictions Department will implement and inform
clients of written policies and procedures that protect these rights.
METHOD: Clients who enter services will be informed of their rights at the time of intake. A
summary of these rights will be provided in a client handbook. They include:

1. Client Record Confidentiality: The agency will fully comply with federal regulations
(42 CFR Part 2, 45 CFR 205.50) and state statutes (ORS 179.505 and 426.460)
pertaining to client record confidentiality. HIPAA Privacy Practices will be followed
whenever the Privacy standard is more restrictive than 42 CFR Part 2. (SEE HIPPA AND
42CFR POLICY)

2. Informed Consent: Participation in the program will be voluntary except when a

person has been involuntarily committed to treatment by an appropriate court order.
All clients will be informed of their rights and responsibilities and given a written informed
consent to treatment.

3. Allowable Restrictions: No person shall be denied services or discriminated against

on the basis of age, diagnostic, socio-economic or disability category unless
Teras Interventions and Counseling has predetermined clinical or program criteria
for service delivery that restricts these.

4. Policies and Procedures: Policies and Procedures include:

a. Protection of client privacy & dignity

b. Confidentiality of records consistent with federal and state laws;
c. Prohibition of physical punishment or abuse
d. Prohibition of sexual abuse or sexual contact between clients and staff (including
volunteers and interns/students)
e. Providing adequate treatment or care

5. Service Refusal: Clients have the right to refuse services and will be informed of the
consequences verbally and in writing.

6. Access to Records: Access to includes the right to obtain a copy of the record within
five days of requesting it and making payment for the cost of duplication. The

1
1/23 9
 Teras Interventions and Counseling-Addictions Department

client shall have the right of access to the client’s own records except:
a.When the clinical supervisor determines that the disclosure of records would be
detrimental to the client’s treatment; or
b.If confidential information has been proved to the program on the basis that the
information not be re-disclosed.

7) Informed Participation in Treatment Planning: Clients and others of the client’s

choice will be involved in the treatment planning and review process. A client
signature on the treatment plan or review will evidence this participation. Clients
have the right to refuse this process without retaliation.

8) Informed Consent to Fees for Services: Fees are disclosed in writing and will be
reviewed with the client at the time of intake.

9) Grievance Policy: Clients are informed of the grievance procedure at the time of
Intake. Grievances are filed with the Program Director. An investigation will be
conducted within five working days. Substantiated grievances will have action initiated
within 72 hours.

Documentation of the receipt, investigation and any action taken will be

documented in the client file. If deemed appropriate, Teras Interventions and
Consultant’s Board of Directors will be called upon to assist in the procedure.

10) Barriers to Treatment: Teras Addictions makes every effort to support removal of
barriers to treatment due to culture, language illiteracy or disability. For these
purposes we will:

a. Make reasonable accommodations unless doing so would fundamentally

alter the nature of the program.
b. Translate written materials to the appropriate language or method of
communication. Provide assistive devices to minimize the impact of the barrier.
c. No charge will be made for such services including interpreters as required to provide
non-discriminatory treatment.
d. Refer clients that are outside Teras Addiction’s area of specialty- if such a
referral is consistent with practices for an individual without a disability.

11) Client Work Policy: Client labor performed, as part of a treatment plan or program
expectation, shall be agreed upon in writing and conform to regulatory
requirements.

12) Voter Registration: Voter Registration cards are available in the office lobbies. Non-
partisan assistance is available with office staff.

13. Client Responsibilities/Program Expectations: Clients receive a copy of client

responsibilities and program expectations at the time of intake

2
1/23 10
 Teras Interventions and Counseling Inc.
Instructions for our
Complaint and Grievance Procedure
If at any time you believe your rights have been violated or you are displeased with the services you are receiving, we encourage you to discuss these
concerns with your counselor. If you elect to file a written complaint and need help completing the complaint form, or someone to explain the process to
you, please ask the program director and they will find someone to assist you. Complaints may be registered by phone, fax and in person.

At no time will a formally filed complaint be considered to reflect poorly on the one who filed it and until a full investigation the person it is filed against.
Unless a client alleges egregious acts of abuse, the staff member being grieved will remain in employ and at their regularly appointed position until a full
investigation is complete Any disciplinary action taken against a Teras clinician or other employee is to remain in the employee file and subject to
confidentiality of employment records policy and any applicable laws.

INSTRUCTIONS:
1. Fill out the Complaint Form as completely as you can and then give the form to your counselor, a supervisor,
or the receptionist. You may also mail your Complaint Form directly to the Director of Quality Management
(address is on the Complaint Form). Make sure that you receive a copy of your completed Complaint Form
from the staff person you give your Complaint Form to.

2. If you file a written complaint you will be contacted within two (2) working days by a supervisor to discuss your
complaint. Hopefully your complaint can be resolved with this contact. In the event that it cannot, we can
arrange for a meeting between any involved staff member, his/her supervisor, and yourself. If you would feel
more comfortable having a friend, family member or consumer advocate at the meeting or any future
meetings, we encourage you to bring this person with you. At that meeting, your concerns can be discussed
and a plan made to resolve them.

3. You will receive a written response from us dated within five (5) working days of receiving your Complaint
Form. If we have been able to address your complaint within those five (5) working days, your resolution will
appear in that letter. If we have not been able to, the letter will state why and you will receive a written
response with your resolution within thirty (30) days from the date the complaint was received.

4. If your complaint involves an emergency situation, such as the risk of deteriorating health, you may ask for an
“Expedited Response.” Your complaint must be in writing and include the reasons why your complaint must
be handled right away. The Program Director or designee will review your complaint and medical records and
contact you within two (2) business days. If the contact by the Program Director does not satisfy the issue, the
Program Director will decide whether your complaint meets the criteria for an expedited complaint process or if
it can follow the regular complaint process. The Program Director may contact the Medical Director to provide
assistance in making this determination.

5. You will receive a copy of the Complaint Form you initiated, with a written response that outlines the outcome
of the investigation and resolution. If you are dissatisfied with the resolution made to address your complaint,
you may file an appeal for a review of your concern by Teras’s Complaint and Grievance Committee. We will
give you an appeal form to complete and return to Teras within ten (10) business days of when you received
the written notice of the decision about your concern. The Complaint and Grievance Committee will make
every effort to review your concern and respond to you in writing within ten (10) business days.

6. If you are dissatisfied with the results of the appeal review, you are entitled to a second appeal review by the
Teras’s Quality Improvement Committee (Board of Directors). A request for review must be in writing within
ten (10) days of date on the written response/decision from the Complaint and Grievance Committee.

7. We want to work with you to resolve your concern. However, if you have benefits through the Oregon Health
Plan, or have a mandate from the court you may also have the right to have your managed care organization
or referring entity hear your concerns if you are not satisfied with the way your concern was addressed by us.
If you wish to have your managed care organization or referral source address your concerns, our complaint
process will stop. If you are interested in more information about having your concerns addressed by your
managed care organization, please contact a Program Director or the Director of Quality Management.

8. If you have any questions about this process or need assistance completing the forms, please direct them to
your counselor or a supervisor.

1/23 11
Teras AOD C&G Client Instructions 02142011, No changes may be made to this procedure without the permission and knowledge of the Executive Director
 This Process is to be implemented after exhausting all other avenues of complaint including informal and formal meetings with
your counselor, their supervisor or program director.

Client Files
Grievance With Teras Investigation in5
working days upon
receipt

Grievance Process Flow

With Referral Response to client sent within
Source 10 working days from
date grievance was received

Investigation within
5 working days upon Program Director
notice of grievance substantiates or dismisses
from claim with explanation to
Referral Source client

If claim is unsubstantiated by Substantiated claim -Action

Program Director Response taken within 72 hours or
sent to Referral Source within earlier considering the impact
5 working days after on client safety
investigation
Grievance filed in folder
Client Satisfied with outcome
separate from Teras client and
Program Director sealed
substantiates claim

Client Unsatisfied with Teras

findings and unable to find a
Action taken within
solution
72 hours

Client Unsatisfied OR
Client Satisfied with With Action
Action

For AOD Clients Submit Complaint to

Addiction Counselor Certification Board
of Oregon (ACCBO)
information to be found on accbo.com

CASE CLOSED
File destroyed after
three years from date
of closing

1/23 12
Teras AOD C&G Client Instructions 02142011, No changes may be made to this procedure without the permission and knowledge of the Executive Director
 Teras Interventions and Counseling Inc.
COMPLAINT / GRIEVANCE FORM
Your Feedback is Welcome! To Be Completed by Client, Client Representative or Staff.
Teras Interventions and Counseling does not discriminate on the basis of a person’s age, gender, race, color, national origin, religion, disability,
familial or marital status, sexual orientation, gender identity, socio-economic status, student status, or source of income.
(Please ask staff for a copy of this completed Complaint Form, or if you need assistance)
(The Program Director can address any issues / complaints)

For Steps to Complaint & Grievance Process: See attached “Instructions for our Complaint & Grievance Procedure”

Name: Date:
Address (include city, state, and zip):
Phone: Site:
Please identify when and where we can contact you:
Current Insurance Provider, if applicable:
[Insurance Information is requested so that Teras can share general information with your Managed

Care Organization; your personal identifying information will not be shared.]

Date & place of incident:

Your Complaint Type [please check one]:
Informal (Has been taken care of by discussion with staff) Formal (Has not been taken care of by discussion with staff)
Please use the back of this form and/or attach another sheet of paper if more writing space is needed.

Concern or complaint (include names of staff involved):

Have you shared your concerns with this staff person? Yes No
Do you feel the staff person was accountable for their part of the dispute? Yes No (ex: blaming you and claiming to
be right no matter what you said, making excuses for their behavior, denying or minimizing any problem exists between the
two of you.)

Did they communicate respectfully in an egalitarian manner (no sarcasm, threats, defensiveness, anger, etc) Yes No

Does the nature of your complaint involve risk to health and physical safety requiring a review (within 2 days)? Yes No

If yes, please explain:

Your ideas to resolve issues:

Do you want to bring this to the attention of your referring authority? Yes No
DISCLAIMER: If yes is checked, you consent for Teras to share this document with the county of referral. Teras assumes no liability for breach of
confidentiality of third party agencies whether a formal contractual relationship exists between Teras or not.
Client signature (or Representative):

WHERE TO SEND THIS FORM Please turn in to a supervisor or mail to:

Executive Director C/O Teras Interventions DVIP, 1821 SE Cesar E. Chavez Blvd., Portland, OR. 97214
For Internal Purpose Only:
Received from Client by: Date:
RECEIVING STAFF: Upon receipt of this Complaint, please provide client with a copy
Sent to (for Review/Response): Date:
RESPONDING STAFF: Executive Director must receive a COPY of the Written Response with this Complaint Form
Routing Instruction for Responding Staff: ORIGINAL  Grievance Charts ; COPY  1) Appropriate Program Manager and/or Program Director

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Teras AOD C&G Client Instructions 02142011, No changes may be made to this procedure without the permission and knowledge of the Executive Director
 1AOD-d.

TERAS INTERVENTIONS AND COUNSELING NOTICE OF PRIVACY PRACTICES & CONFIDENTIALITY

OF MENTAL HEALTH CLIENT RECORDS
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT
CAREFULLY.

I. Who We Are
This Notice describes the privacy practices of Phil Broyles DBA Teras Interventions and Counseling It applies
to services furnished to you at any site or off site location.
II. Our Privacy Obligations
We are required by law to maintain the privacy of your health information (“Protected Health Information” or
“PHI”) and to provide you with this Notice of our legal duties and privacy practices with respect to your
Protected Health Information. When we use or disclose your Protected Health Information, we are required to
follow by the terms of this Notice.
III. Permissible Uses and Disclosures Without Your Written Authorization
In certain situations, which we will describe in Section IV below, we must obtain your written authorization /
consent in order to use and/or disclose your PHI. However, unless the PHI is Highly Confidential
Information (as defined in Section IV.B below) and the applicable law regulating such information imposes
special restrictions on us, we may use and disclose your PHI without Your Authorization for the following
purposes:
A. Treatment, Payment and Health Care Operations. We may use and disclose PHI, in order to treat
you, obtain payment for services provided to you and conduct our health care operations as detailed
below:
 Treatment. We use and disclose your PHI to provide treatment and other services to you. In
addition, we may contact you to provide appointment reminders or information about
treatment alternatives or other health-related benefits and services that may be of interest to
you. We may also disclose PHI to other providers involved in your treatment.
 Payment. We may use and disclose your PHI to obtain payment for services that we provide
to you from the Mentor Brokerage program or another governmental program that arranges or
pays the cost of some or all of your health care.
 Health Care Operations. We may use and disclose your PHI for our health care operations,
which include internal administration and planning and various activities that improve the
quality and cost effectiveness of the care that we deliver to you. For example, we may use
PHI to evaluate the quality and competence of our psychologists, social workers and other
health care workers. We may disclose PHI to our Quality Management Director in order to
resolve any complaints you may have and ensure that you are comfortable receiving services
from us.
NOTE: If you are not present, or the opportunity to agree or object to a use or disclosure cannot practicably be provided
because of your incapacity or an emergency circumstance, we may exercise our professional judgment to determine
whether a disclosure is in your best interest. If we disclose information to a family member, other relative or
Page 1 of 4

1/23 14
 1AOD-d.

a close personal friend, we would disclose only information that we believe is directly relevant to the person’s
involvement with your health care or payment related to your health care. We may also disclosure your PHI in order to
notify (or assist in notifying) such persons of your location, general condition or death.

B. Public Health Activities. We may disclose your PHI for the following public health activities: (1) to
report health information to public health authorities for the purpose of preventing or controlling
disease, injury or disability; (2) to report child abuse and neglect to the Oregon Department of Children
and Family Services or other government authorities authorized by law to receive such reports; and
(3) to report information to your employer as required under laws addressing work-related illnesses
and injuries or workplace medical surveillance (if you fall into this category we well discuss with your
prior to the initiation of services).
C. Victims of Abuse, Neglect or Domestic Violence. If we reasonably believe you are a victim of
abuse, neglect or domestic violence, we may disclose your PHI to the Oregon Department of Children
and Family Services, the Oregon Department of Human Services or other governmental authority,
including a social service or protective services agency, authorized by law to receive reports of such
abuse, neglect, or domestic violence.
D. Health Oversight Activities. We may disclose your PHI to a health oversight agency that oversees the
health care system and is charged with responsibility for ensuring compliance with the rules of
government health programs. [164.512(d)]
E. Judicial and Administrative Proceedings. We may disclose your PHI in the course of a judicial or
administrative proceeding in response to a legal order or other lawful process. Further, unless
specifically authorized by a court order, we may not use or disclose PHI identifying you as a recipient
of substance abuse program services if the purpose is to initiate or substantiate any criminal charges
against you or to conduct any investigation of you.
F. Law Enforcement Officials. We may disclose your PHI to the police or other law enforcement officials
as required or permitted by law or in compliance with a court order or a grand jury or administrative
subpoena.
G. Decedents. We may disclose your PHI to a coroner or medical examiner as authorized by law. [ORS
432.307(3)]
H. Health or Safety. We may use or disclose your PHI to prevent or lessen a serious and imminent
threat to a person’s or the public’s health or safety. [164.512(j)]
I. Specialized Government Functions. We may use and disclose your PHI to units of the government
with special functions, such as the U.S. military or the U.S. Department of State under certain
circumstances. [164.512(k)]
K. As Required by Law. We may use and disclose your PHI when required to do so by any other law not
already referred to in the preceding categories.

Page 2 of 4

1/23 15
 1AOD-d.

IV. Uses and Disclosures Requiring Your Written Authorization

For any purpose other than the ones described above in Section III, we only may use or disclose your PHI
when you give us Your Authorization on our authorization form.
A. Private Payers. We must obtain Your Authorization to disclose PHI to your HMO, health insurer or
other private payer.
B. Uses and Disclosures of Your Highly Confidential Information. In addition, federal and Oregon law
imposes special privacy protections for “Highly Confidential Information”), which is Psychotherapy
Notes and the subset of Protected Health Information that is related to: (1) treatment of a mental
illness; (2) alcohol and drug abuse treatment program services; (3) HIV/AIDS testing; (4) child abuse
and neglect; (5) sexual assault; and (6) genetic testing. In order for us to disclose your Highly
Confidential Information for a purpose other than those permitted by laws regulating Highly
Confidential Information, we must obtain your authorization.

V. Your Rights Regarding Your Protected Health Information

A. For Further Information; Complaints. If you desire further information about your privacy rights, are
concerned that we have violated your privacy rights or disagree with a decision that we made about
access to your PHI, you may contact our Executive Director. You may also file written complaints with
the Director’s Office for Civil Rights of the U.S. Department of Health and Human Services. Upon
request, the executive Directors’s Office will provide you with the correct address for the Director. We
will not retaliate against you if you file a complaint with us or the Director, nor will be tolerate retaliation
from any staff member.
B. Right to Request Additional Restrictions. You may request restrictions on our use and disclosure of
your PHI (1) for treatment, payment and health care operations, (2) to individuals (such as a family
member, other relative, close personal friend or any other person identified by you) involved with your
care or with payment related to your care, or (3) to notify or assist in the notification of such individuals
regarding your location and general condition. While we will consider all requests for additional
restrictions carefully, we are not required to agree to a requested restriction. If you wish to request
additional restrictions, please obtain a request form from the Site Administrator, receptionist or the
Privacy Office and submit the completed form to the Privacy Office. We will send you a written
response.
C. Right to Receive Confidential Communications. You may request, and we will accommodate, any
reasonable written request for you to receive your PHI by alternative means of communication or at
alternative locations.
D. Right to Revoke Your Authorization. You may revoke Your Authorization, except to the extent that we
have taken action in reliance upon it, by delivering a written revocation statement to the Privacy Office
identified below.
E. Right to Inspect and Copy Your Health Information. You may request access to your medical record
file and billing records maintained by us in order to inspect and request copies of the records. Under
limited circumstances, we may deny you access to a portion of your records. If you desire access to
your records, please obtain a record request form from a clinician, receptionist, site administrator or
the Privacy Office and submit the completed form to the Privacy Office. If you request copies, we will
charge you $0.50 for each page. We will also charge you for our postage costs, if you request that we
mail the copies to you. If you request a summary of your PHI, we will charge you a quoted fee per
hour based upon the hourly rate for the individual’s time to complete the summary.
Page 3 of 4

1/23 16
 1AOD-d.

F. Right to Amend Your Records. You have the right to request that we amend Protected Health
Information maintained in your medical record file or billing records. We will comply with your request
unless we believe that the information that would be amended is accurate and complete or
other special circumstances apply. In such cases, we will allow you to place any statements into your
chart to accompany the document/statement you wish to amend.
G. Right to Receive An Accounting of Disclosures. Upon request, you may obtain an accounting of
certain disclosures of your PHI made by us during any period of time prior to the date of your request
provided such period does not exceed seven years after discharge/termination from service and does
not apply to disclosures that occurred prior to November 1st 2007. If you request an accounting more
than once during a twelve (12) month period, we will charge you $0.50 for each page of the
accounting statement.
H. Right to Receive Paper Copy of this Notice. Upon request, you may obtain a paper copy of this
Notice.
VI. Effective Date and Duration of This Notice
A. Effective Date. This Notice is effective on April 14, 2003.
B. Right to Change Terms of this Notice. We may change the terms of this Notice at any time. If we
change this Notice, we may make the new notice terms effective for all Protected Health Information
that we maintain, including any information created or received prior to issuing the new notice. You
also may obtain any new notice by contacting the Privacy Office.

Teras Interventions Confidentiality Policy:

The confidentiality of Mental Health, Disability, Alcohol and Drug or Criminal records maintained by Teras
Interventions and Counseling are protected by State and Federal laws and regulations. Generally, this agency
may not acknowledge to a person outside the agency that a client is receiving services of any kind or disclose
any information identifying a person as a client unless:
1. The client consents in writing by signing valid releases giving permission to communicate with an identified
person or organization;
2. The disclosure is allowed by court order;
3. The disclosure is made to medical personnel in a medical emergency;
4. The disclosure is made to qualified personnel for research, audit or program evaluation;
5. The disclosure is made to qualified service organizations or business associates who provide services to
the agency’s treatment, payment or healthcare operations.
6. The client commits or threatens to commit a crime either at the program or against any person;
7. The client threatens to seriously harm himself / herself;
8. The client is suspect of abusing or neglecting a child, elder, nursing home resident, person with mental
illness, or developmentally disabled person. Under State law, such suspicions must be reported to
appropriate State and local authorities.
8. Or if a client is part of a Domestic Violence program and the victim is being notified of your participation
and completion of the program requirements as per state regulations.

Page 4 of 4

1/23 17
 5-DV-AOD

Teras Intervention and Counseling Inc.

3945 SE Hawthorne Blvd. Portland, OR 97214
P:503-719-5250 f:503-715-5672 info@terasinc.org

WRITTEN NOTICE OF REVOCATION OF

AUTHORIZATION TO USE AND DISCLOSE PROTECTED HEALTH INFORMATION
Written Notice Not Required: Clients Enrolled in A&D Treatment
Written Notice Required: Clients in DV program for DV information only
Teras Interventions cannot guarantee a client revocation will not cause repercussions with the referral source. By
completing and signing this form you agree to hold Teras harmless for any negative consequences as a result of
this revocation.
Individual's Name:
_____
Last First Middle

Home Address: _______________ _____________________

City State zip
Home Telephone:
Date of Birth:

I hereby revoke the authorization created by me on ____________________

[date of Authorization]

which authorizes exchange of information with

I understand that this revocation will not be valid where Teras has already acted in reliance
upon my authorization. I also understand the limitations of disclosure of this information.

Signature of Client Date

Printed Name of Client

Personal Representative Relationship to Client (as necessary):_______________________

Instructions to Client (or Personal Representative):
Mail, Email, Fax or bring this Written Notice of Revocation form to the location on the header of
this form (ATTN: Executive Director Phil Broyles ).

For Teras’s Internal Use Only:

CLIENT WRITTEN REVOCATION:
The date on which this Written Notice of Revocation was received by Teras is: .
A copy of this Written Notice of Revocation shall be placed in the patient’s medical record. 1) Staple this form to
the appropriate Release of Information Form; 2) Line through the appropriate Release of Information Form; 3)
Write “REVOKED”, and 4) Add the date of revocation.
CLIENT VERBAL REVOCATION: After receiving a verbal request for revocation from client: 1) Line through the
appropriate Release of Information; 2) Write “REVOKED”, 3) Sign your name, 4) Add date of revocation; 5) Reflect
client’s request for revocation in Progress Note.

Written Notice of Revocation/Last Update on

1/23 01232014 by Phil 18
Broyles Executive Director
Purpose: To ensure confidentiality in communication with clients that occurs through a
social media website and fully inform individuals of the limits of confidentiality of social
media.

Policy: Social Media Policy

Procedure(s): All Teras staff, contractors and volunteers will read and sign the policy
before interacting with clients or within 30 days of hire whichever occurs first. The policy
will be made available to clients as part of the Teras client policy manual.
This document describes use of social media by Clinicians and other staff members,
of Teras Intervention and Counseling Inc. We encourage you to discuss questions
about the policy if you have any questions. Any changes made to this document, will
be updated in writing and provided to all clients participating in the program at the
time of the update.
Please print, read, and sign this document

FACEBOOK/LINKEDIN FRIENDING
Clinicians and other staff members do not accept friend or contact requests from
current or former clients on any social networking site (Facebook, LinkedIn, etc.).
Having clients as friends or contacts can compromise your confidentiality and our
respective privacy. It may also blur the boundaries of the therapeutic relationship.
Teras Intervention and Counseling Inc., maintains a professional Facebook page to
allow people to share blog posts and inspirational messages with other Facebook
users. All of the information shared on this page is publicly available for viewing by
anyone on Facebook. You are welcome to view and "Like" the professional Facebook
page and read or share articles there, but Teras clinicians and other staff do not
accept clients as members of their personal pages. You are welcome to join the page
but commenting publicly or mentioning involvement at Teras in a public forum creates a
likelihood of compromised client confidentiality. In addition generally established
professional ethics codes prohibit using testimony from current clients.

FOLLOWING ON TWITTER
Some Teras staff and clinicians may publish a blog on a website or post other related
news on Twitter. We have no expectation that you as a client will want to follow a
blog or Twitter stream. If you follow Teras on Twitter, we have no way of
guaranteeing your privacy. Our primary concern is your privacy and safety.
Note: Teras staff and clinicians will not follow you back. We only follow other health
professionals on Twitter and we do not follow current or former clients on blogs or
Twitter. We believe casual viewing of clients’ online content outside of the therapy
hour can create confusion about whether it’s being done as a part of your treatment or
to satisfy the clinician or staff member's personal curiosity. Our relationship needs to
take place in the therapy session in order to maintain its integrity and its focus on your

1/23 19
 healing. In addition, viewing your online activities without your consent and without our
explicit arrangement towards a specific purpose could potentially have a negative
influence on our working relationship. If there are things from your online life that you
wish to share with us, please bring them into sessions where we can view and explore
them together, during the therapy hour.
Sometimes clinicians will assess your recovery environment by viewing your Facebook
or other social media page. Doing so is only in the context of assessing your safety
and severity of dependence on substances or the extent of your abusive behavior if in
the domestic violence program. No clinicians or staff should contact you through the
social media now or in the future after your treatment is over.

CONTACTING TERAS
Do not use messaging on Social Networking sites such as Twitter, Facebook, or
LinkedIn to contact Teras staff and clinicians. These sites are not secure. In addition,
w e may not read these messages in a timely fashion. Do not use Wall Postings on
Facebook, @replies or other means of engaging us publicly online. Doing this could
compromise your confidentiality
After you have signed the Teras Intake agreement it means that we have established
a client-therapist relationship. It will create the possibility that these exchanges
become a part of your legal medical record and will need to be documented and
archived in your chart. If you need to contact us between sessions, we prefer you do
so by phone.

USE OF SEARCH ENGINES

If we have a reason to suspect that you are in danger and you have not been in touch
with u s via our usual means (coming to appointments, phone, or email), there might
be an instance in which using a search engine (to find you, find someone close to
you, or to check on your recent status updates) becomes necessary as part of
ensuring your welfare. It is NOT a regular part of our practice to search for clients on
Google or Facebook or other search engines. Extremely rare exceptions may be
made during times of crisis. These are unusual situations and if we decide that it is in
the interest of your protection to do so, we will fully document it and discuss it with
you when we next meet.

EMAIL
We prefer using email only to arrange or modify appointments. Please do not email us
with content related to your therapy sessions, as email is not completely secure or
confidential. If you choose to communicate with us by email, be aware that all emails
are retained in the logs of your and our Internet service providers. While it is unlikely
that someone will be looking at these logs, they are, in theory, available to be read by
the system administrator(s) of the Internet service provider. We cannot guarantee

1/23 20
 your privacy while viewing emails because there is no encryption. You should also
know that any emails we receive from you and any responses that we send to you
become a part of your legal health record.

BUSINESS REVIEW SITES

Be aware that if you use social media to communicate indirectly with us about your
feelings about our work, it is likely that we will never see it. If we are working together,
we hope that you will bring your feelings and reactions of our work directly into the
therapy process. This can be an important part of the therapy, even if you decide we
are not a good fit. You may find our agency on sites that list businesses and have a
forums in which users rate their providers and add reviews. Many of these sites comb
search engines for business listings and automatically add listings regardless of
whether the business has added itself to the site. If you should find our listing on any
of these sites, please know that our listing is NOT a request for a testimonial, rating,
or endorsement from you as our client.
If you do choose to write something on a business review site, we hope you will keep
in mind that you may be sharing personally revealing information in a public forum. If
you decide it is critical that you do this, we encourage you to create a pseudonym that
is not linked to your regular email address or friend networks for your own privacy and
protection.
CHEMICAL DEPENDENCY AND MENTAL HEALTH TREATMENT
CONFIDENTIALITY
We encourage you to take your privacy as seriously as we take our commitment of
confidentiality to you. None of this is meant to keep you from sharing that you are in
therapy with us wherever and with whomever you like. Confidentiality means that we
cannot tell people that you are our client and our ethics code prohibits us from
requesting testimonials from you currently. However you are more than welcome to
tell anyone you wish that you are enrolled in Teras or who your therapist is or how
you feel about the treatment we provided to you, in any forum of your choosing at
any level you feel comfortable. We cannot tell you where and when to discuss your
relationship with Teras.

CONCLUSION
Thank you for taking the time to review our Social Media Policy. If you have questions
or concerns about any of these policies and procedures or regarding our potential
interactions on the Internet, do bring them to our attention so that we can discuss
them.

I have read and understand

Teras Intervention and Counseling's
Social Media Policy

Print Name Signature Date

1/23 21
Document Adapted from © Keely Kolmes, Psy.D. – Social Media Policy
Philosophy of Treatment/ Purpose of the Group/FAQ's about diversion
Our Approach: At Teras we look at the whole person; your physical, social, relationships,
environment, spiritual life and family in order to know who you are-not just what is wrong with
you.
No Labels: When something we do impacts our lives and those around us feelings of shame
and guilt often follow. We tend to take on the label of our behaviors and identify with them
instead of with who we really are. Instead of a person with an addiction we become “the
addict”.
Purpose of this group: When people are mandated to treatment by another person or
authority it’s perfectly normal for them to react with emotions; anger, resentment, confusion
and fear. If you have some of these feelings and reactions this group will help you come to
terms with your situation and take some control back over your choices and independence.
The changes you make are up to you.

FAQ's by people who are attending treatment for DUII Diversion

Abstinence is a requirement of the DMV and Court – not for discharge from the Teras
treatment program. Discharge from treatment is dependent upon demonstrating completion of
objectives in your treatment plan. Sometimes people who have never been in treatment and
are in diversion for the first time get the requirements of the court diversion program confused
with their treatment plan discharge criteria. We have provided this frequently asked questions
guide to explain the differences in expectations of the court and this treatment agency for your
convenience.
There is a place to sign at the bottom of these FAQ's to acknowledge you read and understand
these frequently asked questions.
Q: When will I know I am done with the treatment program?
A: Your exit session is the last time you are required to attend treatment. Discharge from
the program is based on your treatment plan goals. Complete your goals and then attend
the exit session. During the exit session you will demonstrate you have completed your
goals for treatment and document abstinence by giving one last urine sample. The results of
your exit session UA must be negative to complete diversion and the treatment program.

Q: I am done with treatment and provided my 90 consecutive days of documented

abstinence- can I now use alcohol or other drugs?
A: NO. The 90 days of abstinence is required by the DMV for your license to be reinstated
and to comply with diversion. You are required to maintain abstinence for an entire year if
on diversion whether you are in a treatment program or not. If your last urine sample at the
exit session is dilute you will be required to come back and give another one to document
abstinence. If you have used alcohol or other drugs between the times you exited the
program and redoing your exit UA you will be required to start over.

1/23 22 2
 Q: Isn't there a certain number of groups to attend and then I am no longer required to
attend groups?
A: NO. You are required to attend weekly groups until your exit session.

FAQ's about the requirement to document abstinence and urine testing.

Q: I drank alcohol and may get a positive drug screen. Will I get in trouble with the court
and lose my diversion?
A: That depends upon what court, if you have prior convictions for DUII, and other factors
outside your participation in treatment. Generally diversion participants who get positive
results on drug screens and who continue in treatment until completing the last 90
consecutive days of abstinence are able to complete diversion successfully. Being honest
about your alcohol and other drug use is the only sure way to get through this successfully.

Q: I have completed my goals on the treatment plan and have 90 consecutive days of
abstinence documented; do I have to keep going to community support groups and my
group at Teras?
A: Yes. You are required to remain in contact with the treatment agency on a weekly basis
until your exit session. That means continue with your treatment plan goals and activities
until you exit the program

Q: I tried real hard to stop drinking but can't right now. Am I going to get in trouble with
the court and get convicted?
A: Not usually. We use the American Society of Addiction Medicine's placement criteria to
determine your level of care. That means if you are unsuccessful at abstinence AND remain
in treatment we can refer you to a higher level of care and you can remain in the circuit
court diversion program. If you complete treatment prior to the diversion time allotment
ending then completing diversion successfully may still be possible.

Q: I have to go out of town for a couple of weeks. Can I take a leave of absence without
having to start my 90 consecutive days of abstinence documentation over?
A: No. You can take a leave of absence from treatment and still be in diversion but we
cannot guarantee the integrity of documenting your abstinence if you are gone from
treatment for more than four days in a row whether you notify us in advance or not. If
possible take the leave of absence at the beginning of treatment before the orientation
groups and abstinence documentation begins. Or wait until after treatment is over.

Q: What if I am not able to make it within 24 hours for a random UA when called? Will I
have to start my consecutive days of abstinence over?
A: Yes. If you have not notified the treatment program of your unavailability prior to leaving
the area and we call you to come in for a UA and you are not able to get here in 24 hours we
cannot assume you were abstinent and will not compromise the integrity of the process. If
you know you are going to be unavailable to submit urine for testing for more than 24 hours
the best way to cover yourself is to fill out the online absence request form at terasinc.org.
1/23 23 3
 Q: What if I drink too much water and my urine sample is diluted?
A: If you get three dilute urine results in a row we have to start your abstinence
documentation over at the date of the next negative, legitimate urine drug screen result. If
your urine looks like water it probably won't pass testing at the lab. If you can, we
recommend you come back later that same day or within 24 hours and give another sample
that is not dilute. We don't want to turn in a urine sample that we are pretty sure will be
dilute and then have to charge you for another one.

Q: What if I can't wait after group is over and need to leave before giving a urine sample?
Will my UA be automatically positive if I can't go at the time requested?
A: Not always. If you can't urinate when requested but return within 24 hours of the request
it will not count as a positive UA.

Q: I forgot to give my urine sample when I was here for group and didn’t return within 24
hours- Does that mean I have an automatic positive UA and have to start documenting
abstinence over at day one?
A: Yes. If you "forget" to give a urine sample and do not come back within 24 hours we
cannot document your abstinence with integrity. Please don't ask the group counselor to
make exceptions.

Q: What if I complete treatment and owe a balance- Can I do my exit session and come
back later to pay off the rest?
A: No. The exit session is your last appointment while in treatment. Paying what you owe for
treatment up the time of exit is necessary to be eligible to do your exit session. Ideally you
will not get too far behind (more than two weeks) in payments. If you are experiencing
financial difficulty towards the end of treatment and are behind a couple of payments you
will still be required to have contact with the program. We will still require abstinence
documentation and support group participation even if you are not going to groups at Teras.
State regulations require we remain in contact a minimum of 30 days or we must close out
your treatment episode.

Signing below I am acknowledging I have read and understand these frequently asked questions and have
a full understanding of the differences between treatment expectations for discharge and court required
documented abstinence and will not expect to be discharged after 90 consecutive days of abstinence
without having completed all treatment plan objectives and activities.

_________________________________ ____________________
Signature Date

1/23 24 4
 HEALTH INFORMATION HANDOUTS

1/23 25
HEPATITIS C
General Information
Can Hepatitis C be prevented?
Yes. To reduce the risk of becoming
infected with the Hepatitis C virus:
■ Do not share needles or other
equipment to inject cosmetic
substances, drugs, or steroids
■ Do not use personal items that may
have come into contact with an
infected person’s blood, such as
razors, nail clippers, toothbrushes,
or glucose monitors
■ Do not get tattoos or body piercings
from an unlicensed facility or in an
informal setting
Is there a vaccine for
Hepatitis C?
Although there is currently no vaccine
to prevent Hepatitis C, research is being
conducted to develop one.
1/23
What is hepatitis?
“Hepatitis” means inflammation of the liver. The liver is a vital organ
that processes nutrients, filters the blood, and fights infections. When
the liver is inflamed or damaged, its function can be affected.
Hepatitis is most often caused by a virus. In the United States, the
most common types of viral hepatitis are Hepatitis A, Hepatitis B, and
Hepatitis C. Heavy alcohol use, toxins, some medications, and certain
medical conditions can also cause hepatitis.
What is Hepatitis C?
Hepatitis C is a contagious liver disease that Progression of
results from infection with the Hepatitis C Hepatitis C
virus. When first infected, a person can For Every
develop an “acute” infection, which can range
in severity from a very mild illness with few or
100
People Infected
no symptoms to a serious condition requiring with the
Hepatitis C Virus
hospitalization.
Acute Hepatitis C is a short-term illness
75–85
that occurs within the first 6 months after Will Develop
someone is exposed to the Hepatitis C virus. Chronic Infection
OV E R TIM E
For reasons that are not known, 15%–25%
of people “clear” the virus without treatment. 60–70
Approximately 75%–85% of people who
Will Develop Chronic
Liver Disease
become infected with the Hepatitis C virus
develop “chronic,” or lifelong, infection. 5–20
Will Develop
Cirrhosis
Chronic Hepatitis C is a long-term illness that
occurs when the Hepatitis C virus remains
in a person’s body. Over time, it can lead to
1–5
Will Die of Cirrhosis
serious liver problems, including liver damage, or Liver Cancer
cirrhosis, liver failure, or liver cancer (see chart).
How is Hepatitis C spread?
Hepatitis C is usually spread when blood from a person infected
with the Hepatitis C virus enters the body of someone who is not
infected. Today, most people become infected with Hepatitis C by
sharing needles or other equipment to inject drugs. Before widespread
screening of the blood supply began in 1992, Hepatitis C was also
commonly spread through blood transfusions and organ transplants.
Although uncommon, outbreaks of Hepatitis C have occurred from
blood contamination in medical settings.
Can Hepatitis C be spread through sex?
Yes, although scientists do not know how frequently this occurs.
Having a sexually transmitted disease or HIV, sex with multiple partners,
or rough sex appears to increase a person’s risk for Hepatitis C.
There also appears to be an increased risk for sexual transmission of
Hepatitis C among gay men who are HIV-positive.
Can a person get Hepatitis C from a tattoo or piercing?
There is little evidence that Hepatitis C is spread by getting tattoos in
licensed, commercial facilities. Whenever tattoos or body piercings are
given in informal settings or with non-sterile instruments, transmission
of Hepatitis C and other infectious diseases is possible.
26

How is Hepatitis C treated?
Since acute Hepatitis C rarely causes
symptoms, it often goes undiagnosed
and therefore untreated. When it
is diagnosed, doctors recommend
rest, adequate nutrition, fluids,
and antiviral medications. People
with chronic Hepatitis C should be
monitored regularly for signs of
liver disease. Even though a person
may not have symptoms or feel
sick, damage to the liver can still
occur. Antiviral medication can be
used to treat some people with
chronic Hepatitis C, although not
everyone needs or can benefit from
treatment. For many, treatment can
be successful and results in the virus
no longer being detected.
What can people with
Hepatitis C do to take care
of their liver?
People with chronic Hepatitis C
should see a doctor regularly.
They also should ask their health
professional before taking any
prescriptions or over-the-counter
medications—including herbal
supplements or vitamins—as they
can potentially damage the liver.
People with chronic Hepatitis C
should also avoid alcohol since it
can accelerate liver damage.
1/23
Publication No. 21-1075
How common is Hepatitis C?
An estimated 3.2 million people in the United States have chronic
Hepatitis C. Most are unaware of their infection. Each year, about
17,000 Americans become infected with Hepatitis C.
How serious is Hepatitis C?
Chronic Hepatitis C is a serious disease that can result in long-term
health problems, including liver damage, liver failure, and liver cancer.
Approximately 12,000 people die every year from Hepatitis C-related
liver disease.
What are the symptoms of Hepatitis C?
Many people with Hepatitis C do not have symptoms and do not know
they are infected. Even though a person has no symptoms, the virus
can still be detected in the blood.
If symptoms occur with acute infection, they can appear anytime from 2
weeks to 6 months after exposure. Symptoms of chronic Hepatitis C can
take up to 30 years to develop. Damage to the liver can silently occur
during this time. When symptoms do appear, they often are a sign of
advanced liver disease. Symptoms for both acute and chronic
Hepatitis C can include fever, fatigue, loss of appetite, nausea,
vomiting, abdominal pain, dark urine, grey-colored stools, joint pain,
and jaundice.
How is Hepatitis C diagnosed?
Doctors can diagnose Hepatitis C using specific blood tests that are
not part of blood work typically done during regular physical exams.
Typically, a person first gets a screening test that looks for “antibodies”
to the Hepatitis C virus. Antibodies are chemicals released into the
bloodstream when a person becomes infected. The antibodies remain
in the bloodstream, even if the person clears the virus. If the screening
test is positive for Hepatitis C antibodies, different blood tests are
needed to determine whether the infection has been cleared or has
become a chronic infection.
Who should get tested for Hepatitis C?
Testing for Hepatitis C is recommended for certain groups, including
people who:
■ Currently inject drugs
■ Injected drugs in the past, even if it was just once or occurred many
years ago
Have HIV infection
■
■ Have abnormal liver tests or liver disease
■ Received donated blood or organs before 1992
■ Have been exposed to blood on the job through a needlestick or
injury with a sharp object
■ Are on hemodialysis
For more information
Talk to your health professional, call your health department, or
visit www.cdc.gov/hepatitis.
DEPARTMENT OF HEALTH & HUMAN SERVICES
Centers for Disease Control and Prevention
Division of Viral Hepatitis
27
www.cdc.gov/hepatitis June 2010
Teras Interventions and Counseling HIV/HEP C handout to go with the infectious disease risk assessment

Where call and make an appointment for Hepatitis C and HIV testing

Multnomah Co. HIV/STD Test site

Submitted by halstead on Wed, 02/11/2009 - 15:39
503-988-3700
Anonymous, confidential counseling and testing. Call for appointment, walk-ins welcome.
9 a.m.- 4:30 p.m., Monday, Tuesday, Thursday, and Friday; 11:15a.m.-4:30 p.m., Wed.
Multnomah Co. HIV/STD Test site
426 SW Stark St. 6th floor
Portland, OR, 97204-2347
United States
See map: Google Maps
Transit: Fareless square

SHOP (Supporting Healthy Options for Prevention)

5525 SE Milwaukie Avenue
Portland
OR
97202
503-230-1202
Call for more information and an intake appointment.
Transit: 19, 33, 70
This is a program set up for HIV+ persons and those of unknown status to openly discuss and explore
their behaviors in terms of HIV transmission risk. This is a one on one program and does not require that
clients make any particular changes in their behavior unless they feel ready and want to make changes.
Can be done in person or by phone. The program is no-cost and confidential in nature. Incentives are
available for each session completed, up to 6 sessions.

MLK & Killingsworth

5411 NE MLK Jr. Blvd.
Portland
OR
503-280-1611
http://www.co.multnomah.or.us/health/cd/hivhcv/working.shtml
3-6 p.m., Mon.; 4-6 p.m., Thurs.; 10 a.m.- 12 p.m., Fri.

Last updated on 10262010 by Phil Broyles BS, CADCII Executive Director of Teras Interventions and
Counseling Inc.

1/23 28
Teras Interventions and Counseling HIV/HEP C handout to go with the infectious disease risk assessment

Multnomah County Outreach Van (Clackamas)

8800 SE 80th
(at Cornwell, next to Johnson Creek Fred Meyer)
Portland
OR
97206
503-280-1611
http://www.co.multnomah.or.us/health/cd/hivhcv/working.shtml
2:30-4 p.m., Thursday
Transit: 72
Multnomah County Outreach Van (downtown)
503-280-1611
http://www.co.multnomah.or.us/health/cd/hivhcv/working.shtml
2:30- 3:30 p.m. Monday at SE 82nd & Ash St. (off Burnside), 1:30- 3:30 p.m .Tuesday at SE 6th Ave
between Burnside & Ankeny, 3:30-5 p.m. SE 190th Ave (1/4 mile north of Division St)

Outside-In Syringe Exchange

1132 SW 13th Ave.
Portland
OR
97205-1703
971-544-1574
http://www.outsidein.org
1-6 p.m., Monday-Friday. 1219 SW Main St. WHITE VAN Monday 2p.m.-3:30p.m. SE 82nd Ave. & Ash St-
One Block off of Burnside. Tuesday1:30p.m.-3:30p.m. Look for white van around SE 6th & SE Ankeny.
Wednesday 3:30p.m.-5p.m. SE 190th Ave, between Division & Yamhill St. Thurs. 2:30p.m.-4p.m.
Clackamas Service Center, 8800 SE 80th Ave, off 82nd & Cornwell. Friday 2p.m.-4p.m. NE MLK &
Killingswort, behind Mid-K; 7:30p.m.-9p.m. SE 82nd & Ash St, one block off Burnside.
Transit: Fareless square.
Syringe Exchange works to prevent the spread of HIV and other diseases among adult drug injectors.
Participants receive counseling, safer sex information and supplies, free and anonymous HIV testing,
free Hepatitis C testing, as well as drug treatment and other referrals. Last year, this program kept
nearly 450,000 used syringes off the streets

Hepatitis A, B and C

Last updated on 10262010 by Phil Broyles BS, CADCII Executive Director of Teras Interventions and
Counseling Inc.

1/23 29
Teras Interventions and Counseling HIV/HEP C handout to go with the infectious disease risk assessment

What are hepatitis A, B and C?

Hepatitis means “inflammation or swelling of the liver.” Liver swelling is caused by many things,
including drinking alcohol and exposure to certain viruses. Hepatitis A, B, and C are separate viruses;
each of these viruses causes liver inflammation. Over time, swelling of the liver can lead to “stretch
marks” or scar tissue which can impact the liver’s ability to function. Learn more».

What do I need to know about the hepatitis A and hepatitis B vaccine?

The CDC has information on everything you need to know about the hepatitis A vaccine and hepatitis B
vaccine.

Talking to Sex and Drug Partners

From http://web.multco.us/health/talking-sex-and-drug-partners

Talking about HIV, STDs and Hepatitis

Talking about sex, drug use, and preventing diseases with a current or future sex/drug use partner is
important for making informed choices. To start a conversation, consider asking questions or sharing
information. Some questions to ask might be: “Have you been tested for HIV, Hepatitis C or STDs and
what is your status? Do you (or do you plan to) have sex or use drugs outside of our relationship? What
do you think about condoms, birth control or using sterile drug gear?" Sharing information about your
HIV, hepatitis, or STDstatus can also open the door for talking. Examples: “I tested positive for Hepatitis
C years ago. I don’t want to give it to you so we need to use our own gear,” or “I got tested for HIV and
other STDs and am negative. I want to stay that way so let’s talk about condoms.”
It’s best to be alcohol and drug free and have some privacy to talk. If you feel it might be unsafe to talk
directly to partners or you need support, call 503-223-AIDS or 800-449-6940 (Español) to talk to a
trained counselor.
Telling your partner(s) you have HIV or another STD
If you have HIV or another STD and need to notify your partner, there are options:
 Tell them yourself. We can help and support you. Tell them in person, by email (with or without
your name) at inSPOT, or another way that works for you.
 Have us tell them. We NEVER give out names or identifying information about you. Our staff
help your partner(s) get tested, treated, and answer questions about their health. Learn more or
call 503-988-3780 to speak to a Disease Intervention Specialist (DIS).

*This list of resources is not exhaustive and is only intended as a starting point for our clients to educate
themselves about the risks associated with certain types of drug and alcohol use.

Last updated on 10262010 by Phil Broyles BS, CADCII Executive Director of Teras Interventions and
Counseling Inc.

1/23 30
 HOW MUCH IS TOO MUCH?

ɸ¿¬ ½±«²¬- ¿- ¿ ¼®·²µá

regular beer = malt liquor = table wine = 80-proof spirits

alcohol alcohol alcohol alcohol

ر© ³¿²§ ¼®·²µ- ¿®» ·² ½±³³±² ½±²¬¿·²»®-á

regular beer malt liquor table wine 80-proof spirits or “hard liquor”
1 1½ 1
1 2 5 1 or more
2 2½ 4½
3 4½ 8½
17

1/23 31
RethinkingDrinking.niaaa.nih.gov
 ر© ³«½¸ ·- ¬±± ³«½¸á
1. On any day
yes no

yes no

typical week:

days a week

drinks X

Can you “hold your liquor”?

If so, you may be at greater risk.

1/23 32
 ɸ¿¬ ¿®» -§³°¬±³- ±º ¿² ¿´½±¸±´ «-» ¼·-±®¼»®á

more, or longer
more than once wanted to cut down or stop
increased
your chances of getting hurt

had to drink much more than you once did to get the effect
that your usual number of drinks had much less effect
depressed or anxious or
another health problem memory blackout
lot of time
trouble with your family or
friends
interfered with taking
care of your home or family job school
given up or cut back on activities

arrested
legal problems
withdrawal
symptoms

If you don’t

If you do

Diagnostic and Statistical Manual (DSM) of Mental Disorders

1/23 33
RethinkingDrinking.niaaa.nih.gov
 Social support

include

other members for assistance.

Feeling depressed or anxious?

1/23 34
RethinkingDrinking.niaaa.nih.gov
 λ-±«®½»-
Professional help Mutual-help groups
Your regular doctor. Primary care and Alcoholics Anonymous (AA)
mental health practitioners can provide www.aa.org
effective alcoholism treatment by combining 212–870–3400 or check your local
new medications with brief counseling phone directory under “Alcoholism”
visits. See “Helping Patients Who Drink Too Moderation Management
Much” at www.niaaa.nih.gov/guide or call www.moderation.org
301–443–3860. 212–871–0974
Specialists in alcoholism. For specialty Secular Organizations for Sobriety
addiction treatment options, contact your www.secularsobriety.org
doctor, health insurance plan, local health 323–666–4295
department, or employee assistance program.
SMART Recovery
Other resources include
www.smartrecovery.org
Medical and non-medical 440–951–5357
addiction specialists
Women for Sobriety
American Academy of Addiction www.womenforsobriety.org
Psychiatry 215–536–8026
www.aaap.org
401–524–3076 Groups for family and friends
American Psychological Al-Anon/Alateen
Association www.al-anon.alateen.org
1–800–964–2000 (ask for your state’s 1–888–425–2666 for meetings

with addiction specialties) Adult Children of Alcoholics

www.adultchildren.org
American Society of Addiction
310–534–1815
Medicine
301–656–3920 (ask for the phone
Information resources
number of your state’s chapter)
National Institute on Alcohol Abuse
NAADAC Substance Abuse
and Alcoholism
Professionals
www.niaaa.nih.gov
www.naadac.org
301–443–3860
1–800–548–0497
National Institute on Drug Abuse
National Association of Social
www.nida.nih.gov
Workers
301–443–1124
www.helpstartshere.org
(search for social workers with National Institute of Mental Health
addiction specialties) www.nimh.nih.gov
1–866–615–6464
Treatment facilities
National Clearinghouse for Alcohol
Substance Abuse TTreatment
and Drug Information
Facility Locator
www.ncadi.samhsa.gov
1–800–729–6686
1–800–662–HELP

1/23 35