Informed+Consent+-+Group+E


 * INFORMED CONSENT FOR TREATMENT **
 * Introduction –Greeting from the Local High School Counseling program, we provide many different services to best reach the students and support their academic success. We are seeking to implement a school counseling program that address academic, career, and personal/social development for all students according to the American School Counseling Association (ASCA) standards.  **

ABOUT THE COUNSELORS
Ø ** Credentials ** – Daniel Casey has a B.S. in History, experience working with students and working towards M.Ed. in School Counseling. Mark James has a B.S., Q.M.H.P., Level 2 Examiner and working towards M.Ed. in School Counseling. Nathan Tongel has B.S. in Business Administration and a Provisional License in School Counseling. Shonna Young has a B.S. and working towards M.Ed. in School Counseling. Ø ** Licensing Regulations ** – All counselors are working toward licensure for School Counseling from Liberty University, 1971 University Blvd**//.,//** Lynchburg, VA 24502. Ø ** Supervisory Relationship **// – // Supervision will be given by the Guidance Counselor Supervisor as well as Liberty University’s Department of Education Supervisors. Supervision is given for interns to provide support and provide guidance. Ø ** Ethical Guidelines ** –Counseling Interns will follow the ASCA Ethical Guidelines. These ethical guidelines can be found on the ASCA website: [|www.schoolcounselor.org].

ABOUT THE COUNSELING PROCESS
Ø ** Counseling Approach/theory- ** Solution-focused brief therapy will be used, this theory focuses on what students want to achieve through the counseling sessions and how they would like the future to be. This assists students to focus on the solution and not on their past experiences or problems. Ø ** Voluntary Participation ** – The students involved in counseling support is voluntary and can be terminated at any time. Ø ** No Guarantees ** – The School Guidance Program seeks to help students find solutions to their problems however will are unable to guarantee perfect solutions and answers//.// Ø ** Risks and Benefits Associated with Counseling ****// – //** During the counseling process the student may experience emotional discomfort and the awareness of underlying issues. The student may acquire replacement skills to deal with future problems as they arise in academic, career, personal/social development. Ø **// L //**** ength of Therapy and Termination ** – Counseling services will be used up to six sessions in which termination will occur//.// Ø ** Interruptions in Therapy ** – If the assigned counseling is unavailable in a particular day the other counselors are available for support or in crisis. The client will be provided with an after-hours emergency line. The counselor will inform the client through the secretary in an unplanned emergency and will reschedule the appointment as soon as possible. The client will let the counselor know the best way to contact the client in an unplanned absence. Ø **// C //**** ounselor involvemen//t// ****// – //** Sessions will be limited to 30 minutes or less, unless in a crisis situation. Late arrivals for scheduled appointments will be completed at scheduled time. Ø ** Client Involvement ** – While the client is meeting with counselor the client should be attentive, honest and willing to participate. Electronics will not be permitted during the session. = RIGHTS AND RESPONSIBILITIES OF THE CLIENT  = Ø ** Confidentiality and Privilege ** – Our school counseling program upholds a no secret policy, the counselor will keep information confidential unless it is in the best interest of the student or for the safety of others to notify authorities. Although we recognize the students right to privacy, no information will be given unless harm to others or harm to self is indicated. We work in the best interest in the student to provide confidentiality. Confidentiality may be breeched if subpoenaed by a Judge. Information can be released to third parties only with the written consent of the client. Ø ** Exceptions of Confidentiality and Privilege **// - // The exceptions to confidential and privileged information are the following: · Subpoenaed by a Judge, · Suggesting intent to harm self, or others, · When necessary steps are taken by guardians, · Or if it is in the best interest of the student per school policy and ASCA standards. Ø ** Counseling and Financial Records **// – // The counselor will document sessions with the student. The notes will be kept locked in a file cabinet in the counseling office. The records will be kept for three years after they leave the school and will be shredded after the length of time noted. Ø ** Disputes and Complaints ** – In case of complaint please contact the School Counseling Program Coordinator or the Principal. =  = =  RESPONSIBILITIES OF THE COUNSELOR  = Ø ** Colleague Consultation ** – We may need to consult with other counselors in order to benefit the student to maintain the students’ best interest. The confidentiality of the student will be maintained unless in the exception of intent to harm self or others. Ø ** Tape Recording or Videotaping of Sessions ** – Sessions will not be recorded or taped. Ø ** Dual Relationships ** – Interaction outside of the counseling session will be initiated by the client. No counseling details will be communicated outside of the counseling setting. Gifts will only be accepted for improve the school or on behalf of the school. ** Closing statement – ** I, _______________ have read and discussed the above information the details of the school counseling program. I have asked any questions pertaining to the counseling process. I give consent to the terms above for the counseling process and agree to enter in the counseling relationship. Client's Signature __________________________________________ Date ________________ Parent/Guardian's Signature __________________________________ Date ________________ (If client is a Minor) I have discussed and explained the above information with the client. Counselor's Signature _______________________________________ Date _______________ Davidson County Schools. (n.d.) //School Counselor Student Services Job Description.// Retrieved July 20, 2010 from []. Szapkiw, A.J.R. (2010). //Informed Consent Template// [Template]. Retrieved from Liberty University website: [|www.liberty.edu].