• ADAPT: Anger & Domestic Abuse Prevention and Treatment (This page)
• Orientation & Registration
• ADAPT Schedule 2018-2019
• Prevencion y Tratamiento del Enojo y del Abuso Domestico
• Orientacion y Matricula en el Programa ADAPT en Espanol
• Fee Policy and Payments
• Staff / Contacts
• Anger Management & Batterer Intervention Programs
• ADAPT Application Instructions
• ADAPT Group Information
• Directions / Locations
• Frequently Asked Questions [FAQ]
• Information for Service Providers
• Partner - Family Information
• How To Complete Online Forms
ADAPT: Anger & Domestic Abuse Prevention and Treatment
Website & Enrollment Information
Please scroll down the home page to find the information you are looking for. Alternatively, you may select posts on the left side of the screen and select the interested If you are interested in learning more about the program than this site provides, you are invited to a free walk-in orientation and registration [O&R] session that is offered several times per week at various locations. You may bring a friend or family member to this informational session. At the O&R, you will have the opportunity to learn more about the program and to decide whether you are ready to enroll in this 18-week group program. You will also have the opportunity to ask questions to help determine your readiness for the program. ALL PROGRAM ENROLLMENTS OCCUR THROUGH O&R SESSIONS. While the staff does its best to avoid canceling O&R sessions, at times there are situations which may require us to cancel the scheduled O&R as late as date of the O&R session. We will post cancellations at our Intake and Registration line at 703-968-4052 [option 4]. Please check this line before coming to an O&R Session. For The directions to each site are available in other posts below. This information is also repeated at the ADAPT Intake and Registration line at 703-968-4052. The O&R sessions are currently offered:
Free Walk-In Program Orientation and Registration Sessions
Las sesiones de orientacion y de Matricula son las siguientes:
ADAPT Program Fee Policy
Thank you for your enrollment in the ADAPT Program. The ADAPT program fees are as follows:
Fees for County Residents: Intake-$150, Group-Program Fee -$300
Fees for Non-County Residents: Intake-$200, Group-Program Fee-$400
Reduced Fees for County Residents with Documented Financial Need: Intake-$50, Group-Program Fee-$100
NOTE: All Group-Program Fees are due after the fourth group session and must be paid by the start of the Fifth (5th) group session.
Do not make first payment prior to completing your 90-120 minute intake with an ADAPT Staff Person
To remain active in treatment, both fees must be received, in full, no later than the due date. Payments may be made by:
· Mail - Check or Money Order (NO cash), made payable to “The ADAPT Program”. For your intake fee, please bring the check or money order to the intake and we will give you an envelope you can use to mail it to our admin staff. For the group-program fee, it is your responsibility to mail it early enough that it reaches the address below by the due date:
· Online – To pay by Credit Card or Checking Account Transfer (ACH) go to https://www.fairfaxcounty.gov/familyservices/domestic-sexual-violence/anger-domestic-abuse-prevention-treatment and in the fee section click on the highlighted sentence “make an online credit card payment for the ADAPT program.” If you pay online, you must bring a printed receipt to intake (for the intake fee) and to the 5th group session (for the program fee).
There are NO REFUNDS for program services; however you may withdraw from the program prior to the fifth group session without incurring the $300 group-program fee. Non-payment of the group-program fee by the fifth group session will otherwise result in program suspension. If you wish to continue program services, you may re-enroll in a new group as long as you are compliant with treatment recommendations and have requested a group restart within ninety (90) days of your last attended group session.
Please note: A $30 administrative fee will be added to all delinquent accounts. Payments that are 180 days or more past due may be referred to the County’s outside collection agency. The collection agency’s fees (an additional 20% of the total amount due) will be added to the customer’s total delinquent balance and is retained by the collection agency.
If you are unable to pay for program services due to financial hardship, please request, complete and forward the ADAPT Program Fee Subsidy Worksheet and associated income documentation. Fee subsidy requests are based on income and family size according to current Federal Department of Health and Human Services Poverty Guidelines.
All services are provided regardless of race, gender, ethnicity, national origin, age, disability, religion, or sexual orientation.
Fairfax County is committed to nondiscrimination on the basis of disability in all county programs, services and activities. Reasonable accommodations will be provided upon request. For information, call the Office for Women & Domestic and Sexual Violence Services at 703-324-5730, TTY 711.
Q. 1) The court sent me. Why are there fees?
While most of the over $250,000 program cost for the ADAPT program is provided by Fairfax County Govenment through tax dollars, most citizens believe that individuals referred for services should cover a significant portion of the costs, not unlike other programs such as the Alcohol Safety Action Program [ASAP].
Q. 2) Why is the program so expensive; Can't you charge less?
The program's current fees still average less than $24 per session including (18 group treatment sessions and a two hour intake assessment). The cost per hour is less than $12 per hour for high quality educational/therapeutic services provided by teams of Masters Degree prepared mental health professionals and trained program volunteers. In the Fall of 2012, the fee structure changed and reduced fees were offered for clients who demonstrate financial hardship as well as increased fees for out-of-county residents.
Q. 3.) How long does it take to start the group?
After you enroll in the program by coming to a free walk-in orientiation meeting (See link at right), you will be offered an intake appointment, generally within two weeks. At this appointment, a counselor will help you form a treatment plan which may possibly involve other services in addition to ADAPT 18-week groups. In most cases, group is scheduled in approximately one month. The program generally starts new groups every month but at some sites (Reston and Chantilly), new group starts are alternated and the average wait time may be closer to two months. We also offer a day-time "open group" format which can be attended with a rolling admission although group spaces are limited and capped to maintain a reasonable group size at 15 or less clients.
Q. 4.) Why do you need to contact my current or former partner? And what types of information will you be sharing with them?
A: Per state certification BIP guidelines, we are required to contact current or former partners regarding client enrollment status in our program. We share as minimal information possible with partners regarding our clients in order to meet our certification requirement while protecting the confidentiality of our clients. If you have any additional or specific concerns regarding this contact, please communicate these concerns during your intake interview.
Q. 5.) Is there any way to complete the program at an accelerated pace and be finished sooner than the 18 week period?
A: There is no way to finish the program at an accelerated pace. Certification guidelines require that treatment cover an 18 week period.
Q. 6.) Since I am court ordered to your program, does that guarantee that I am accepted into your program?
A: No. As ethical counseling practitioners, we carefully assess each individual during our intake process to determine whether or not that individual will benefit from our treatment program. Regardless of a court order, if we believe an individual will not benefit from our treatment program, we will not enter that individual into treatment. However, when those situations arise, we make other treatment referrals when necessary; and additionally, we communicate with the court(s) our decision to deny treatment and make other treatment recommendations when applicable.
Orientación y Matrícula en el Programa ADAPT en Español
Si quiere tomar el próximo paso para matricularse en el Programa ADAPT en Español, le invitamos a asistir a una reunión de orientación y matrícula.
La sesión de Orientación y Matrícula se lleva a cabo los miércoles a las 5:00 p.m. en la siguiente dirección: 8221 Willow Oaks Corporate Drive, Oficina L-532, Fairfax, Virginia 22031.
Durante esta reunión se le ofrecerá información, responderemos a sus preguntas, y nos aseguraremos de que los servicios del programa y sus necesidades están de acuerdo. Estas reuniones son gratuitas y están abiertas al público, las parejas de los clientes interesados, miembros de la familia, y profesionales. Si usted quiere matricularse en el programa, podrá hacerlo al final de la sesión de información y podrá obtener una cita para una entrevista de evaluación individual con personal del programa. También se le dará información para llenar la solicitud de servicios en un sitio seguro en la internet para que complete el proceso de matrícula. Se sugiere que complete esa solicitud en su casa o en la Biblioteca Pública. Si usted no puede completar esta solicitud en la internet, por favor déjeselo saber al facilitador de la reunión de información.
NOTA DE CANCELACION: Antes de asistir a una reunión de Orientación y Matrícula, por favor chequé esta página otra vez en caso de que por alguna razón la reunión haya sido cancelada. Si hemos tenido que cancelar la reunión, pondremos una notificación en esta página.
Puede llamar a Sonia Valenzuela para información de los servicios ofrecidos en Español al 703-207-6979
Prevención y Tratamiento del
Enojo y del Abuso Doméstico
ADAPT esta certificado por el estado como un programa de intervención para las personas que han abusado a otros. Este programa emplea un aproche de grupo sicoeducativo con una duración de 18 semanas. ADAPT enseña técnicas de regulación emocional a adultos residents del Condado de Fairfax y de las ciudades de Falls Church y Fairfax quienes hayan tenido comportamientos fisica, emotional, or sexualmente abusivos con sus parejas, niños, padres, u otros miembros de la familia.
Se cobra una tarifa for este programa.
El grupo en Español se ofrece los martes por la noche de 6:00 p.m. a las 8:00 p.m. o los jueves de 4:30 p.m. a las 6:30 p.m.
8221 Williow Oaks Corporate Drive, Oficina L-532
Fairfax, Virginia 22031
Para Información del Programa
703-968-4052, TTY 703-324-5706
La VIOLENCIA DOMESTICA O ABUSO FAMILIAR ocurre cuando una persona trata de controlar o lastimar a otra a traves de comportamientos o amenazas que pueden incluir abuso físico, sexual, verbal, o sicológico. Personas de todas las edades, niveles económicos , religiones, orientación sexual, género, y niveles educativos pueden sufrir de la violencia doméstica o familiar.
Metas del Programa
LOS PARTICIPANTES DE ADAPT aprenden a prevenir el abuso a travez del desarrollo de la compasión de sí mismos y de otros.
ADAPT ayuda a los participantes del programa a aprender a:
La Experiencia del AbusoFamiliar
Promesa de Seguridad para los Participantes de ADAPT
Servicios Contra el Alcol y las Drogas
8221 Willow Oaks Corporate Drive
Fairfax, Virginia 22031
703 383-8500 TTY 711
Programas Multiculturales de Servicios Humanos-Servicios Familiares del Norte de Virginia
701 Broad St., Suite 305, Falls Church, VA 22046
Servicios de Protección a los Niños
703-324-7400 o 1-800-552-7096
Corte Juvenil y de Relaciones Domésticas del Condado de Fairfax
4000 Chain Bridge Rd., Fairfax, VA 22030
703-246-3040; TTY 703-273-3713
Artemis House Albergue de Violencia Doméstica
703-435-4940; TTY 703-435-1235
Oficina para la Mujer y Servicios Contra la Violencia Domestica y Sexual
Línea de Ayuda de 24 Horas
703-360-7273; TTY 703-324-5706
Red Comunitaria del Cuidado de la Salud del Fairfax
Norte del Condado 703-689-2180;
Sur del Condado 703-704-5333; TTY 703-704-6680
Salud Mental del Condado de Fairfax
703-481-4230; TTY 703-207-7737
Sevicios de Emergencia de Salud Mental Woodburn 703-573-5679
Servicios Familiares del Norte de Virginia
Clases para Padres de Familia del Condado de
703-324-7745; TTY 703-222-9452
Policia – Sin Emergencia 703-691-2131
All phone numbers use TTY 711, unless otherwise noted.
El Condado de Fairfax está comprometido a la no decrimininación basada en discapacidades en todos los programas, servicios y actividades del condado. Acomodaciones rasonables serán ofrecidas si son solicitadas. Para pedir esta información en una forma alterna, llame al 703 324-5870; TTY 703 222-9452.
ADAPT 18-week English Speaking Groups
* Merrifield Center: Thursdays, 7:00 - 9:00 p.m.
* South County Human Services Building: Tuesdays, 6:30 - 8:30 p.m. and Thursdays, 6:30 - 8:30 p.m. and Noon-2pm (starting May 2019)
* Reston Mental Health: Tuesdays, 6:00 to 8:00 p.m.
* Chantilly Mental Health: Thursdays 6:00 - 8:00 p.m.
ADAPT 18-week Spanish Speaking Groups
* Reston Mental Health: Tuesdays, 6:30 - 8:30 p.m. (Starting 2019)
* Merrifield Center: Thursdays, 6:30 - 8:30 p.m.
*South county Human Services Building: Mondays, 6:00-8:00 p.m. (Deferred until Winter 2019/2020)
Note: Please be aware that these two types of programs are not the same; Domestic Violence programs or what are often called batterer intervention programs [BIP's] are intended for individuals who have had some type of family or domestic abuse incident or would like to prevent the same. In Virginia, individuals referred to programs by Juvenile & Domestic Relations District Courts for charges of assaulting a household or family members are generally referred to certified BIP's. Some BIP's provide both domestic violence and anger management services. Anger management programs can be appropriate where anger problems have not manifested in family violence or abuse but, for example, may involve angry outbursts with strangers, non-family members, on-the-job conflicts, "bar-room brawls", or aggressive driving. In general if anger problems are expressed in the family or couple, the BIP type of program is generally more appropriate. If you are unsure of which type of program you are looking for, you may call any of the programs or staff below and they should be able to help sort out which type of program is most appropriate.
Virginia programs that meet certification standards for Batterer Intervention Programs… http://vabipboard.org/
Anger Management Services
Sam Bachman, MSW, LCSW. ADAPT program coordinator may be reached at 703-324-9497.
Vacant. ADAPT Staff Therapist. This counselor schedules intakes and provides case managment and group treatment for the ADAPT Program (particularly in Spanish) at our Merrifield Center . 703-207-6979. Hablo español.
Jennifer Perkins, M.S., LPC. ADAPT staff therapist/substance abuse prevention specialist. Schedules and provides intakes and group treatment for ADAPT at the Northwest Center (Chantilly) for Community Mental Health. 703-968-4017.
Heather Potter, M.Ed. ADAPT staff therapist. Heather provides intakes, case management and group services at the Merrifield and the South County Human Services sites. 703-207-7767. Hablo español.
JD Miller, C-PPG, MAC. ADAPT staff therapist. Schedules and provides intakes and group treatment for ADAPT at the South County Human Services Building in Alexandria. 703-704-6235.
Andréa Nunes-Gardner, M.A. LPC, ADAPT staff therapist. Schedules and provides intakes and group treatment for ADAPT at the Merrifielld and Northwest Center for Community Mental Healty- Reston sites. 703-207-7776. Hablo español. Fala português.
Nadia Hoonan, OFWDSVS Volunteer Coordinator (includes ADAPT). 703-324-9495.
Mery Juarez, OFWDSVS Administrative Manager. Amy provides administrative support to the ADAPT program. 703-324-5721.
ADAPT Program Volunteers. ADAPT groups are co-led by a team of well trained volunteer co-facilitators, under staff supervision, who provide this critical public service. ADAPT volunteers receive considerable support and training throughout their service. Intial and ongoine traininginvolves classroom study, independent study, in-service training, court-observation, continuing education, live supervision, annual safety check-ins and group observation and group debriefing. Volunteers have provided this service since the program's inception in in 1983 and many have provided over ten years of such important community service. ADAPT program volunteers have had extensive background checks, and commit to continuing education each year. We are very proud of our volunteer group leaders and ADAPT could not provide the quality of care and quantity of services to Fairfax County citizens without thier continuing support. Please contact the program for more information about becoming a volunteer if you are interested.
ADAPT Program Interns. ADAPT frequently works with undergraduate and graduate interns in psychology, social work, pyschological services, and family counseling over the summer and academic year. Interns function as program staff under the supervision of primary ADAPT therapists. Please contact the program if you are seeking a rewarding internship and ADAPT's mission "calls to you".
TDD for All ADAPT Program Services - 711
FAX for All ADAPT Program Services - 703-653-7006
ADAPT requires all clients with compulsory attendance requirements to be professionally referred to the ADAPT Program. This may include courts, probation officers, family service workers, child protective service workers, mental health or substance abuse providers, EAP providers, etc.
While clients may register for the ADAPT program and complete application materials to request an intake appointment, courts and probation staff are encouraged to forward referral information to the program directly and include [when possible]: 1) the index incident police report, 2) a recent criminal background history/search, 3) any related or completed lethality or risk assessment information, 4) any information concerning client history or needs relating to trauma, substance use and/or mental health concerns (presentence reports), 5) a copy of any current or recent civil/criminal orders to include civil orders of protection (and associated affidavits), 6) the orders stipulating participation in community programming and 6) a current consent to release/exchange confidential client information naming the referral source and the ADAPT Program.
Referral information may be sent by secure, encrypted, HIPAA compliant email (if available), or faxed to 703-653-7006.
Information for Friends and Family of ADAPT Clients
ADAPT is an 18-week, skills-based, domestic abuse intervention program. ADAPT teaches emotional regulation skills that are useful for perpetrators and victims of domestic abuse. ADAPT participants are taught to stop abuse through the development of compassion for themselves and others.
The goal of ADAPT is to help program participants:
Regulate anger and shame
Let go of harmful blame
Accept not being in control of another person or situation
Develop safe and compassionate solutions to family conflicts
Assess the role of substances on thoughts, feelings, and behavior
It is important to focus attention on your own safety and well being, as well as that of your children because treatment is not effective for everyone. If you experience harassment, threats, or any other form of abuse at any time, contact the police.
We empower individuals to develop compassion to promote family and community safety.
Equality and Compassion among individuals;
Growth-promoting environments within families; and
Safety and Accountability in communities.
Main line: 703-968-4052, 703-435-1235 TTY.
What is domestic violence?
Domestic Violence or family abuse occurs when one person attempts to control or hurt another through actions or threats that can include physical, sexual, verbal or psychological abuse; harassment, or forceful detention. People of all ages, income levels, faiths, sexual orientation, gender, and education levels can experience domestic or family violence. Domestic violence occurs between married, non-married, and same-sex partners, as well as, between members of the same family or household*.
Definitions of abusive behavior: Any action or spoken threat to hurt others with emotional, psychological, physical, or sexual violence.
Threatening behavior and Intimidation Destroying property and harming pets: Punching walls, breaking things, hitting objects, knocking things over etc.
Emotional abuse: Hurting the other person’s feelings by saying demeaning things and name-calling. This is also defined as verbal abuse. Behaviors designed to control and subjugate another human being, through the use of force, fear, humiliation, intimidation, or guilt. Anything the abusive person says of does that causes the other person to feel afraid, lower the self-esteem, manipulates or controls other’s behavior.
Psychological abuse: Abuse that causes fear and confusion in the victim. This includes “mind games,” intimidation and attacks aimed at destroying the other’s self-worth. After the first act of physical or sexual abuse, all threats and emotional violence become psychological abuse because the victim feels especially scared and does not know when the abuser will stop.
Physical abuse: Any forceful or violent physical action.
Sexual abuse: Any sexual act or behavior not fully agreed to by both partners without coercion; any unwanted or disrespectful sexual touch.
Can sexual violence take place in a relationship?
YES! Forced sexual contact is a crime, also if committed by a spouse, partner, or dating partner. The state of Virginia recognizes two forms of marital sexual abuse sexual assault and rape. An individual may be found guilty of sexual assault against his or her spouse if: (i) he or she engages in sex, oral sex, anal sex, or inanimate object penetration with his or her spouse; and if (ii) the sexual act is accomplished against the spouses will by the use of force or a present threat of force or intimidation of or against the spouse or another person.
A spouse may be found guilty of marital rape of a spouse if he or she engages in the above sexual acts with his or her spouse and the act is accomplished against the spouses will by the use of force or a present threat of force or intimidation of or against the spouse or another person, if at least one of the following applies: (i) the spouses are living separate and apart at the time of the act; or (ii) the spouse to be charged with the crime caused bodily injury to the other spouse, by the use of violence.
Cycle of Violence. Domestic violence usually happens in cycles with periods of calm and peace following abuse, but this does not mean the abuse has stopped for good. The following are signs that the abuser is not making permanent changes or that violence could be on the horizon:
He/she tries to control your actions or spy on you.
He/she keeps refusing to accept responsibility for abuse.
He/she might apologize for abuse but makes excuses or hints that you are to blame for the abuse or for calling the police.
He/she still sometimes loses his/her temper when you do something he/she dislikes.
He/she makes any kind of threats, however vague or subtle.
The Experience of Family Abuse. Individuals in relationships where there has been a history of abuse may:
Over-function in the relationship.
Assume responsibility for the abuse.
Experience symptoms such as frequent periods of sadness and crying, anxiety, trouble sleeping, repetitive thoughts, and confusion or impaired decision-making.
Have low self-esteem.
Abuse alcohol or other substances.
Have been abused as a child or witnessed parental abuse.
Feel controlled in spending and other activities.
Have been abused in prior relationships.
ADAPT offers with the partners, former partners and/or alleged victims of the clients the following services or referrals for services:
Initial phone contact. ADAPT staff contacts the alleged victims, as appropriate, when a client registers in the program.
Orientation Sessions for Partners. Partners and/or former partners/alleged victims of clients are invited to attend an information session, separate from the client .
Consultation. They can also talk privately with ADAPT staff about their partner, and he/she will not be involved nor informed.
Telephone Counseling is available 24 hours a day through the Victim Assistance Network (VAN) Hotline (703) 360-7273.
Individual Counseling is available for survivors of sexual or domestic abuse through VAN.
Supportive and Educational Groups are available for survivors of sexual assault, domestic abuse, and for parents whose children have been sexually assaulted through VAN.
*Family or household members include (regardless of whether he or she resides in the same household):
Persons spouse, former spouse, persons parents, stepparents, children, stepchildren, brothers, sisters, half-brothers, half-sisters, grandparents, grandchildren, and any individual who has a child in common with the person.
To be considered a family or household member, the following must reside in the same household at the time of the incident:
Persons mother-in-law, father-in-law, sons-in-law, daughters-in-law, brothers-in-law, sisters-in-law, and any individual who within the previous 12 months cohabitated with the person, and any children of either one of them then residing in the same home with the person.
Where to get more information or help if you are a victim of domestic violence or sexual assault:
ARTEMIS HOUSE is a safe house for victims of domestic violence and their children. The shelter serves both male and female victims but houses men and women at separate locations. The shelter is at an undisclosed location in the county. In addition to providing a safe haven for survivors of domestic violence and their children, services for residents include:
Free transportation to the shelter if needed.
Court accompaniment for protective orders and assault hearings.
Referrals for child care, benefits, housing, employment, legal services, medical care, on-going counseling, and others as needed.
YOU CAN CONTACT THE SHELTER (24 HOURS) AT 703-435-4940/
Survivor Services Counseling offers a 24-hour telephone counseling program free of charge for people in abusive or potentially abusive situations, and for victims of sexual assault and their families and friends.
Emergency information and assistance with financial, legal, and human service resources.
Referral and linkage to other service providers.
Support groups for women to meet with others who share similar concerns.
Personal, supportive counseling.
Accompaniment and advocacy to magistrates, courts and other services.
Community education presentations.
YOU CAN CONTACT SURVIVOR SERVICES (24 HOURS) AT 703-360-7273 / TTY 703-799-8253
Parenting Education Programs
ACCESS—Mental Health Referrals and Evaluations (703) 481-4230
Fairfax County Police Department, Victim Services Section (VSS) (703) 246-2141/ TTY (703) 204-2264
National Domestic Violence Hotline: 800-799-SAFE/ TTY 800-787-3224
Alcohol and Drug Services: (703) 359-7040
Northern VA Family Services-Multicultural Programs: (703) 533-3302
Child Protective Services: (703) 324-7400 or 1-800-552-7096
Fairfax County Juvenile and Domestic Relations Court: (703) 246-3040
Police Emergency: 911
Police Non-Emergency: (703) 691-2131
For more information on domestic violence resources see: www.fairfaxcounty.gov/dsm/dviolence
Welcome and thank you for taking the time to contact the ADAPT Program to enroll in this innovative program. You are taking the next step in developing compassionate and satisfying relationships built on a foundation of safety and self-responsibility. As you have registered for the program, the next step is to complete the online application.
Note: if you have not registered for ADAPT by attending a registration & orientation meeting, please refer to the links on the right for information on these free, walk-in informative sessions. During these sessions, you will learn about the program and have the opportunity to enroll in the program.
This application is comprised of a number of forms for you to finish and electronically sign. Please allow about 30 minutes to complete these forms. Please be candid and honest with your responses, so that we can better assess your needs and plan for your treatment.
All forms must be filled in completely in order to submit your online application. Do not leave any spaces or fields blank. On each item give the response that seems most accurate, even if you are not totally sure. Respond with N/A only when an item truly does not apply to you. Note that some forms require completion via your electronic "signature" which is represented by your secure password.
During application completion, please don't hesitate to save a form in "draft" format prior tosignature if you are not able to complete the form in its entirety. You may call any ADAPT staff for guidance on forms completion at any time prior to your intake.
We encourage you to read the privacy information on this secure website via the link on the bottom right of your screen and how ADAPT, as a program of Fairfax County Government maintains the privacy of your confidential information. ADAPT uses this secure website, hosted by CarePaths, to manage clinical records. CarePaths maintains HIPAA-compliant, confidential, and secure web-based eRecords and will treat your record information with the same level of privacy and security applicable to medical records. Please dont hesitate to call us if you have any questions or concerns regarding privacy, confidentiality, consent for service or consent to exchange information.
Specific Instructions for Secure Log-in and Forms-Application Completion
Login to the "Client Login" section with the login credentials set on your registration phone call with ADAPT Staff and you will be taken to the HOME screen where you will see your forms to complete at the top. The home page for this website is http://www.adapt.clinicprn.org Please click on each form link on your home screen. Once you have read the required form scroll down to the bottom of the page and enter your password (if required) and click "SIGN AND COMPLETE DOCUMENT."
Instructions for Password Changes
-Even though you have set your initial password with staff, you may change it at any time. Once logged in, you may change your password by clicking on "change password" on the left top portion of the screen. In order to get back to the main page to continue with the "To Do List", click the" back" button at the bottom of each form.
Specific Form Instructions (Please Read Carefully)
1)READ ME First-Introductory Statement: This is the first form you should review. It provides a summary of each form as also appears below.
2) ADAPT Treatment Request & Supplemental Information: This form collects additional information about your: living situation, children/stepchildren,employment, court status, referral contacts/details as well as relevant victim information (often your current or former partner).
3) Multiple-Interagency Authorization to Use/Disclose Confidential Information: This form requests your consent to exchange information between the ADAPT Program, the Fairfax-Falls Church Community Services Board [CSB], your referral source/contact person/court/probation officer, the alleged victim and any other relevant service providers. This consent is necessary because ADAPT program services are typically provided at mental health centers which are CSB sites and CSB administrative staff are employed to support fiscal and administrative program functions. In addition, if you have a mental health or substance abuse problem and/or are involved in any kind of mental health or substance abuse treatment orif you are referred for evaluation or treatment by your referral source, probation officer or ADAPT clinician, you will also need to provide the consent so that staff of the ADAPT program may collaborate with CSB staff in the office of Mental Health Services and/or the office for Alcohol and Drug Services.
4) ADAPT Program Client Contract & Consent for Services: This form describes the expectations for participants wishing to complete the ADAPT Program. It details policy expectations regarding attendance, homework, payment of fees, etc.
5) Patient Record Information: This formcollects basic address, contact, demographic, educational and financialinformation.
6) ADAPT Informed Consent-Outcome Evaluation: This form requests your voluntary consent for us to contact you and your partner or involved family member up to two (2) years following your treatment completion so that we may ascertain the durability of the positive changes youll make during the program after the program completes. This information will help us to assess the long term effectiveness of the program and suggest areas for improvement.
7) Mental Health Advisor-30: This is a psychological screening tool to assist you and program staff to better assess your needs. It may alsodemonstrate personal and psychological change when taken over multiple sessions during and/or after the programhas been completed.