Informed+Consent-Group+G

Consent-Group G

** INFORMED CONSENT FOR TREATMENT ** ** FIRST COAST HIGH SCHOOL ** **INTRODUCTION** The School Counseling program at First Coast High School aims to positively influence students for success in postsecondary education or work force. Our mission is to empower all students to meet their potential. School counselors provide support to all students’ academic achievement. Our program offers planning and guidance services to help students achieve academic and career goals through a partnership with students, parents, community, faculty, and staff. **ABOUT THE COUNSELOR** Our counselors here at First Coast High School have graduated with an M.Ed. is School Counseling from an accredited university. Each counselor also holds a license through the Florida Department of Education. Our counselors promote lifelong learning to aid students in becoming productive and successful member of society. Students' learning needs are the primary focus of any decision affecting the school. We will always follow guidelines as set by the American School Counselor Association. Each of our counselors have been trained to provide quality services in the best interest of the student. **ABOUT THE COUNSELOR PROCESS** Students may work with counselors in individual or group settings over a period of six sessions. Should your student need more sessions, they will be referred to a local counselor for further treatment. Working with our counselors may provide many benefits for students in need. These services are highly recommended to encourage student success.

**RIGHTS AND RESPONSIBILITIES OF THE CLIENT** The counseling department makes every effort to follow the American School Counseling Association’s Code of Ethics in keeping your information confidential.

Examples of when we must share your information:


 * When you give us permission


 * When we are required to release information by law and/or the code of ethics
 * For example:


 * If we believe you are at risk of harming yourself or someone else
 * If we believe someone is trying to hurt you
 * If a judge orders us to provide information in court
 * If a law is broken


 * When we must consult with other professionals to help you.

**RESPONSIBILITIES OF THE COUNSELOR** Colleague Consultation Before entering into a consultation relationship with other mental health professionals seeing that student, the counselor will get written permission from at least one parent. The school counselor will share necessary information with school colleagues on a "need to know" basis. Dual Relationship Socializing outside of the school counseling relationship is not recommended. The counselor will not be part of social networks with students online or other social situations in the community.
 * Closing Statement:** I have read and understand the information contained within this document. The counselors have discussed each item and I understand that I am entitled to ask questions. I give my permission to receive counseling services at First Coast High School in the 2011-2012 school years.

Client’s Signature Date

Parent/Guardian’s Signature Date (If client is a minor)

Counselor’s Signature Date

Curtis, E., Smith, R., Gall, C. (2011) Informed consent. Unpublished manuscript, School of Education, Liberty University, Lynchburg, VA.