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Continuing Education & Ethical Resources For Mental Health Professionals

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Checklist – Informed Consent for Minor to Receive Counseling/Therapy in School Setting

CHECKLIST FOR INITIAL STUDENT CONVERSATION
(This can then be placed in the file as documenttion of the discussion.)

Using clear language, geared to the child’s level of understanding:

1. INFORM STUDENT ABOUT:
_____ Who are you, and why are you establishing a relationship with the student ?
_____ Nature of the relationship (e.g., including rules, roles, boundaries, as appropriate)
_____ Confidentiality and its Limits (i.e., when will you disclose, “no matter what?”)
_____ Who will receive what information from you? (e.g., parents, teachers, others)
_____ Does the child have any control over the confidentiality rules?
_____ Possible outcomes of your contacts (e.g., evaluations, follow-ups, future services, etc.)

2. PROVIDE OPPORTUNITY FOR QUESTIONS
_____ Invite questions
_____ Clarify misunderstandings about ________________________________________
3. OBTAIN STUDENT ASSENT/CONSENT TO PARTICIPATE
_____ Make every effort to secure student’s voluntary participation
_____ Inform student of outside contacts about him, as consented to by parents

4. OTHER (as required by local policies)
_____
_____
_____

*This must be tailored to fit the policies of your school setting.
For adolescents entering therapy, also see, on this website, an Adolescent Informed Consent Form
that can be signed by both the adolescent and parent(s)

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CE Courses Are Approved By:

continuing education for American Psychological Association The Center for Ethical Practice is approved by the American Psychological Association (APA) to sponsor continuing education for psychologists. The Center maintains responsibility for this program and its content.


continuing education for National Board for Certified Counselors (NBCC) The Center for Ethical Practice has been approved by National Board for Certified Counselors (NBCC) as an Approved Continuing Education Provider (ACEP No. 6768). The Center is solely responsible for all aspects of the programs. Programs that do not qualify for NBCC credit are clearly identified.


continuing education Association of Social Work BoardsThe Center for Ethical Practice (provider 1287), is approved as an ACE provider to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Regulatory boards are the final authority on courses accepted for continuing education credit. ACE provider approval period: 3/21/2021-3/21/2024.

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