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North Carolina Agricultural and Technical State University
Counseling Services
POLICIES AND PROCEDURES
TABLE OF CONTENTS
SECTION 1: MISSION STATEMENT 5 SECTION 2: OBJECTIVES AND GOALS 5 SECTION 3: ADMINISTRATIVE ORGANIZATION 6 SECTION 4: GENERAL OFFICE PROCEDURES 6 Hours of Service 6 Attendance 7 Scheduling and Recording Leave 7 Emergency Coverage 7 Employee Work Planning and Performance Management 7 Telephone Procedures 7 Use of Phone 8 Office Dress Code 8 SECTION 5: ETHICAL PRACTICE 8 SECTION 6: INDIVIDUAL SERVICES 9 Eligibility for Services 9 Faculty and Staff Eligibility 9 Initial Appointments 10 Intake Procedures 10 Delivery of Individual Services 10 Termination of Counseling 11 SECTION 7 CLIENT RECORDS 11 Maintaining Records 11 Confidentiality of Client Records 12 Disclosure of Confidential Information without Prior Consent 13 Release of Confidential Information to Students 13 Disclosure of Confidential Information to Third Parties 13 Disclosure Pursuant to Judicial Order 14 Disclosure for Research Purposes 14 SECTION 8 UNIVERSITY WITHDRAWAL PROCEDURES 14 Regular Withdrawal 14 Regular Administrative Withdrawal 15 Retroactive Withdrawal 15 SECTION 9 COUNSELING SERVICES: CLINICAL AND PROFESSIONAL SERVICES 15 Academic Counseling, Information and Regulations 15 Testing 16 Career Counseling 16 Changing a Major 16 Personal Counseling 16 Individual Counseling 16 Group Counseling 17 Group Services 17 New Student Orientation 17 New Student Informational/Freshman Interview Program 17 Drug/Alcohol Groups 17 Personal Growth Programs 18 SECTION 10: SPECIAL TREATMENT ISSUES 18 Hospitalization 18 Mobile Crisis Team 18 Voluntary Hospitalization 18 Procedures for Voluntary Hospitalization 19 Involuntary Hospitalization 19 Procedures for Involuntary Hospitalization 20 Student Return to the University After Psychiatric Hospitalization 22 Procedure to File Commitment 22 Mental Health Student Conference 22 Child Abuse Reporting 23 Elder Abuse Reporting 24 Responding to a Subpoena Missing Persons Procedures 25 Service Animals 25
SECTION 11: TESTING SERVICES 25 SECTION 12: CONSULTATION SERVICES 25 Consultation 25 SECTION 13: STAFF DEVELOPMENT 26 SECTION 14: RESEARCH 26 SECTION 15: QUALITY ASSURANCE 26 SECTION 16: ANNUAL REPORT 26 SECTION 15: Internship Program 26 Overview 27 Placement 27 Goals and Objectives 27 Counseling Skills 28 Assessment Skills 28 Outreach 28 Professional Development 28 Trainees’ Rights and Responsibilities 29 Reasonable Accommodation 30 Trainee Affirmation of Confidentiality 30
SECTION 16: APPENDICES 33 1. Request for Leave 2. Consent to Release/Exchange Information 3. Rights and Responsibilities of Students Using Counseling Services 4. Student Referral Form Information on Group Counseling 5. Group Interest Form 6. Intake Form 8 Section 504 of the Federal Rehabilitation Act of 1973 9 Addictive Behaviors Assessment 10 Client Satisfaction Survey 11 Practicum/Internship Form 12 Counseling Services Training Program for Master’s and Doctoral Students in Mental Health Professions 13 Internship/Practicum/Shadow Graduate Student Confidentiality Form 14 Dear Prospective Trainee letter to applicants 15 Graduate Student Shadowing Experience Attendance Roster 16 Minor Consent Form 17 Letter to parent re: minor student 18 Approved abbreviations for notes 19 Outreach Request Form 20 Sign In Sheet 21 Emergency Manual Counseling Services North Carolina Agricultural and Technical State University
Counseling Services
POLICIES AND PROCEDURES
1. MISSION STATEMENT
The purpose of Counseling Services is to assist students in accomplishing their personal, academic and career goals through counseling, testing and enrichment programs. To accomplish its mission, Counseling Services has developed set of goals that are consistent with the mission of the University and the goals of the Student Affairs Division.
2. OBJECTIVES AND GOALS
Provide high quality individual and group counseling services to students who may be experiencing psychological, academic, career or behavioral difficulties.
1* New students are contacted by Counseling Services by September 30th of each year to inform about services and upcoming significant dates. 2* Academic/career/personal counseling sessions are conducted with students on a daily basis.
Provide programming focused on the developmental needs of students to maximize the students’ potential to benefit from the academic environment.
3* Conduct four (4) one-half day life skills seminars during the academic year. 4* Serve as liaisons to Housing and Residence Life and Academic Departments.
Provide testing and evaluative assessment services to help foster student self-understanding and decision- making.
5* Plan a calendar of all testing programs indicating proctors by September l of each academic year. 6* Inform students with learning difficulties about services available to them for accommodations.
Provide professional development opportunities for staff including in-service training programs, workshops and other continuing education activities.
7* Staff is to attend at least one professional meeting, workshop or seminar for self-enrichment. 8* Hold weekly staff meetings. 9* Plan at least one In-Service Training Conference monthly during academic year. Provide consultative services to the Institution to make the environment as beneficial as possible to the intellectual, emotional and physical development of students. 10* Counselors conduct consultation sessions with departments/etc. each year (ex. Study Skills, Time Management, and other Special Programs).
11* Counselors provide training to the institution training on mental health issues impacting university community.
Conduct research, planning and training programs that will be responsive to internal as well as external needs of the university campus.
12* All outreach programs are evaluated after each presentation; and each revised or eliminated each academic year. 13* Present at professional conferences.
The counseling staff functions in accordance with the highest ethical standards. Situations presenting ethical issues or dilemmas are reviewed carefully, occasionally involving outside consultation. Ethical issues are resolved in accordance with State and Federal Statutes and relevant recognized professional ethics
3. ADMINISTRATIVE ORGANIZATION
The organizational components include the Vice Chancellor for Student Affairs who is the governing and administrative authority for all aspects of Student Services and the Director of Counseling Services who is responsible for the direct administration, clinical component, supervision and coordination of all counseling services and programs. Other responsibilities of the Director include selecting and supervising the following professional student affairs personnel to assist with the planning, organization, implementation of programs and services, and clinical services.
The Assistant Director is responsible for assisting in the management, coordination and supervision of Counseling Services functions, programs and services, and clinical services.
Clinical staff are responsible for providing counseling which includes: personal, academic, educational, and career counseling and assessments and appraisals for individual analysis.
All clinical staff assist with administrative staff responsibilities when it is necessary for the smooth operation of Counseling Services
Administrative staff responsibilities include but are not limited to assisting with phone, ordering supplies, maintaining inventory, handling cash and deposits, creating and maintaining files and records, scheduling, greeting those who enter the office, maintaining a professional atmosphere and office appearance.
4. GENERAL OFFICE PROCEDURES
Hours of Service Counselors are available to see students during the hours of 8:00 a.m. to 5:00 p.m., Monday through Friday. Information about Counseling Services is available 24/7 on the Counseling Service’s Website (http://www.ncat.edu/student-affairs/student-services/counseling/).
Attendance
All staff members are encouraged to inform the receptionist or Counselor on Duty (COD) when they leave the office area. Staff who will be late or absent from work, will call the office within a half-hour following his/her designated arrival time. In addition to calling into the front desk, staff will call, text, or email all absences to the director and/or the assistant director, if one is on travel.
For all leave or absences from the office, approval will be obtained from the Director or in her absence the Assistant Director or designee. In addition, the Receptionist will be notified. If the Director, Assistant Director or designee are away from the office, and the leave constitutes an emergency, the receptionist or a counselor is notified.
If it is necessary for a staff member to alter the time when they will not be available to provide other services, such as ongoing group times, lunch break or regular consultations staff will inform the director / assistant director to assure the change will not negatively impact Counseling Services’ operations.
Scheduling and Recording Leave
Leave may be taken (if possible) when it will least interfere with the efficient operation of the Office. The employee will submit the Request for Leave Form PD-109 (see appendix) and have it approved in advance by the Director.
Individual leave records will be recorded on the Employee Leave Record forms found in Banner and submitted monthly.
Emergency Coverage
During daytime business hours, the Director, Assistant Director, or a counselor will respond to an emergency situation. After hours, the Director and the Assistant Director are available for emergency response.
Employee Work Planning and Performance Management
In accordance with State policy, the Director will establish and maintain an annual work and performance management plan for each employee under her supervision. This is a mandatory program for all employees as directed by the State Personnel Commission.
Front Desk Procedures
Front desk staff provide professional services and creating a welcoming environment for our consumers. Common duties and responsibilities include
Log into Titanium and keep open while at front desk Check Counselor on Duty (COD) Schedule
Check to see who is absent
If clinician calls in sick, please ask COD to reschedule appointments
Speak clearly and listen carefully in order to best serve caller
Do not leave front desk unattended to look for staff
Keep conversations to a minimum when at desk
When a new student enters, please contact COD to determine appropriated paperwork
COD will inform front staff which clinician (COD/Intern) will see student / consumer
Remember, Interns are training professionals and will consult with supervisors as needed
Telephone Procedures
The appropriate procedures for answering the telephone are listed below for your convenience. Answer by saying “Counseling Services, this is [your name]. How may I help you?”
14* Always answer the telephone in a polite and courteous voice. 15* The telephone should be answered by the second ring. 16* Keep a positive tone in your voice. 17* If caller is to be placed on hold, inform caller they will be placed on hold. 18* If caller is on hold for 60 seconds, check back on them and let them know you are still assisting them. 19* If caller is kept on hold for longer than two minutes, check back and ask caller if they want to continue to hold or if they prefer being called back. 20* If caller needs to be assisted by another department, provide caller with the appropriate department telephone number and inform the caller that you will transfer them to the appropriate department (where possible) 21* Staff will take and deliver accurate messages.
Use of Phone
All staff members are expected to limit personal phone calls to those which are essential to completing their job requirements. Any personal long distance calls should be charged to a phone card or made from a personal cell phone. Should emergency circumstances arise which necessitate a personal long distance phone call, staff should notify the Director/Assistant Director and make arrangements to reimburse the State. An itemized phone bill for each phone line in the Counseling Center is obtained each month from the Telecommunications Department of the University.
Office Dress Code Although there is not a standard office dress code, professionalism will be taken into consideration when preparing for work. Overall hygiene is very important, with good grooming as the finishing touch. Appropriate dress suitable for a professional office setting is also highly recommended. Each staff member is encouraged to project a professional image that will reflect favorably on the Office of Counseling Services as well as the University.
5. ETHICAL PRACTICE
. Counselors may engage in limited private counseling practice that does not interfere with meeting obligations to the University. Counselors may not see North Carolina A&T currently enrolled students in their private practice. As part of that practice, counselors do not seek to limit, decrease or extinguish campus counseling services for the benefit of the private counseling practice and likewise, counselors do not use their employment to gain favors or special treatment for their private practices.
Counselors do not conduct private practice during their employment hours or conduct private counseling sessions with private clients in the campus office facilities, or use campus equipment in counseling private clients. Counselors never allow their private counseling duties to conflict with or prevent full discharge of responsibilities as University employees.
The Counseling Services’ staff affirms and supports policies regarding affirmative action, sexual harassment, and grievance procedures. The Counseling Services’ staff does not discriminate against clients on the basis of race, color, religion, marital status, national origin, ancestry, sex, sexual orientation, physical or mental handicap, medical condition, status as a veteran or disabled veteran, age, or citizenship.
Counseling Services Staff operate within the Ethics of North Carolina A&T State University and the ethics of their profession.
6. INDIVIDUAL SERVICES
Eligibility for Services
Counseling Services offers a variety of services to help all currently enrolled North Carolina A&T State University students address challenges and difficulties they may face. Our services are designed to help students understand themselves better, create and maintain healthy relationships, improve their academic performance and make satisfying career and life choices. All enrolled students who are taking at least one class on campus are entitled to one session, at which point we will determine whether or not their needs can be met in our system. Students who are exclusively distance learning and have not paid a student fee are not eligible for services We are dedicated to helping our students by providing brief counseling from a wide spectrum of services. Those include individual and group counseling, outreach and consultation, training and supervision, teaching, psychological testing, and research. If more intensive or specialized care is needed, we will assist with making referrals to healthcare providers in the community. Some of the issues that are commonly addressed through referral to services outside of the Counseling Center include: A desire to be seen more than once a week or for long-term therapy, or a need for such as indicated by: History of multiple hospitalizations Chronic suicidality and/or self-injurious behaviors; history of repeated suicide attempts Indication that short-term therapy may be detrimental or non-beneficial Evidence or risk of progressive deterioration in mental or emotional functioning, requiring intensive intervention Manifestations of psychotic symptoms without willingness to remain on medication for stabilization of symptoms Inability or unwillingness to provide the necessary information to thoroughly assess symptoms Students who need specialized services not available through the Counseling Center as indicated by: Presence of significant drug and/or alcohol problems such substance dependence, primary substance abuse, and/or past failed treatments Presence of significant or long-standing eating disorder with no period of remission, no previous treatment, or that may pose a medical danger Request for psychological evaluation for the purpose employment clearance or other nonacademic purpose Services to fulfill students' court-mandated assessment or treatment requirements
With a signed consent form (see appendix), family members of currently enrolled NC A&T’s students are eligible for a 1-2 time family consultation(s) with the student when the rendering of such service is advantageous to the welfare of the student. The family member(s) are not eligible for individual or couple counseling, but may meet with a counselor for purposes of obtaining a referral.
For reasons of professional responsibility, in the case of students who have just separated from the University, eligibility may be extended for no more than three (3) sessions. Any such extensions of eligibility must be clearly justified.
Faculty and Staff Eligibility:
Counseling Services is designed for use by NC A&T SU students, however there are situations when faculty and staff usage is appropriate.
22* Faculty and staff may consult with or be consulted by the counseling staff regarding generalized student concerns or specific situations involving students (subject to the policy on confidentiality). 23* Faculty and staff may be seen on an emergency basis for one interview for personal crisis intervention or consultation, or referral to community resources.
General Public Eligibility Inquiries and requests for service made by the general public usually come by telephone. Such calls are handled carefully as a public service, and for the sake of positive public relations. Callers are usually directed to appropriate agencies or other community referrals. On occasion, as dictated by humanitarian aims and professional ethics, a staff member may offer a consultation to a non-eligible person who is in crisis and distress, with the goal of assisting for an appropriate referral to community resources. This very infrequent situation may occur when a confused and distressed person suddenly appears or telephones for help.
Appointments
Established students usually schedule appointments in advance by visiting or telephoning Counseling Services. Walk-in and emergency appointments are also available. For initial appointments students are requested to read the Confidentiality/Rights and Responsibilities Information and complete the Intake Form (See Appendix).
Intake Procedures The receptionist will assist walk-in students. When students arrive at the office requesting services, the receptionist will enquire about the students service need (e.g. testing, withdrawal, counseling) and inform the counselor-on-duty (COD) of the student’s service request. Students will be asked to complete the required intake paperwork. When the intake paperwork is complete, the receptionist will give the completed paperwork to the COD (see Maintaining Records for information on paperwork). The COD will meet with the student to determine the student’s needs, and if crisis intervention is indicated. If crisis intervention is not indicated the student is scheduled for an intake session.
Delivery of Individual Services
Students are not charged fees when they are counseled, there may be fees associated with certain forms of testing.
If the student requests to see a specific counselor, that request will be honored to the extent possible within scheduling limitations.
Students who are referred, or who walk-in on an emergency basis, will be seen immediately by the COD or first available counselor. The Director/Assistant Director may be consulted in determining a course of action.
If the student has had one or more sessions with a counselor and requests a different therapist, the counselor will attempt to determine the reason for the request. The request is typically granted. On some occasions a student may be put on the schedule of a counselor different than their established therapist by administrative staff. If this occurs, the new therapist will attempt to determine the reason for the requested and if appropriate will initiate the transfer. If the student requests another transfer within a few sessions the student should meet with the Director/Assistant Director before a third transfer is initiated. The purpose of this meeting is to determine if it is likely that the student may benefit from seeing a new therapist. Therapists may also present student requesting a transfer. If a counselor determines that a psychiatric evaluation, medical evaluation or consultation is indicated, the counselor will consult with colleagues or the Director/Assistant Director and make appropriate referrals to Sebastian Student Health Center or other psychiatric facility.
If a counselor determines that a student needs services not provided by the University, it is incumbent upon the counselor to locate the appropriate service provider in the community and make a referral. Efforts may be taken to make sure that the student makes contact with the referral agency.
Counseling Services Staff document referrals using the Student Referral Form (See Appendix)
Assessment of Benefit
Part of the intake process involves the administration of the Counseling Center Assessment of Psychological Symptoms (CCAPS). This instrument measures student’s level of distress across multiple dimensions and compares this with other students who are seeking services at counseling centers. The CCAPS is re- administered after the third session in order to assess the benefit students are receiving from therapy.
Counselor Safety
Counselors are provided with a “panic button.” This button is to be used if the counselor believes he or she is in danger and there appears no other way to notify staff of the situation. This button triggers a silent alarm with campus police.
Panic Button Procedures and Guidelines
Duress alarms are carried by all clinical staff and are mounted to the receptionist desk It is important you carry your alarm with you whenever using other office spaces.
If the alarm is pressed Campus Police will be immediately notified and will respond.
IMPORTANT: Under no circumstances should anyone working at CS attempt to physically intervene with a student who might be dangerous. We are not trained for such actions, and we are likely to make the situation worse if we do try to intervene. The Duress Alarm notifies the police; it is their responsibility to make the direct intervention.
1. When to use the Duress Alarm: whenever you believe immediate police intervention is necessary a) your physical safety is in danger b) your client has already harmed himself c) you overhear or otherwise learn that someone else on site is in danger/at risk d) in the event of a medical emergency (e.g., collapse, heart attack, seizure, etc.) e) a potentially dangerous person takes flight
2. Roles and Responsibilities When An Alarm Is Triggered a) Front Desk a.i) Once the duress alarm is triggered, the Police will be on their way. You must be ready for their arrival with the following information: (a.i.1) Which room? (a.i.2) Name of Client? (a.i.3) Make sure that the entry to the unit is clear (instruct people to move out of the doorway etc.) a.ii)Contact University Police by phone to verify that the Duress Alarm has been received and inform the Dispatcher of any pertinent information: Screams or other noises coming from the area, Gunshots, Injuries, Direction of Flight etc. a.iii) Notify all of the following, whether or not they are on-site: Dr. Barnette, Chief Newell, & Dr. Pierce. Inform them which office/who has sounded the alarm. a.iv) If the above people are not available, notify available UPD, Dr. Rashid and Mrs. Kim Sowell Carry out any other instructions given to you by the staff.
b) Staff b.i) The senior-most staff person who is on-site, or his/her on-site designee, will be in charge of the incident, until arrival of the Police. b.ii) Someone must contact the office in question by phone to assess the situation, if possible. Please be aware that it is possible that the counselor will not be able to answer the phone. Yes/No questions to ask: (b.ii.1) “Is there a weapon involved?” (b.ii.2) “Is anyone injured” (b.ii.3) “Do you want a staff member to enter now” (b.ii.4) “Should we wait for police?” (b.ii.5) Entering the room? (b.ii.5.a) The senior-most staff person who is on-site will make the decision to enter or not to enter based on the totality of the situation, remembering that CS staff members are not trained for intervention with potentially violent individuals, and they may make the situation worse if they do try to intervene in those circumstances. If there is no contact made with the counselor in the room NO ONE WILL ENTER THE ROOM UNTIL THE POLICE ARRIVE. If there are any indications of violence occurring in the room then the rest of the unit will be evacuated. b.iii) A staff member should look up the client in Titanium to see if there are any instructions or crisis plans in place. If there are specific instructions or crisis plans in place, that information must be available to the Police officers responding. b.iv) Someone needs to be at the front door to direct UPD, and provide additional information if we have any. Must have basic information for the arriving police officers: Which room? Name of Client? Also the Front Desk Personnel should make sure that the entry to the unit is clear (instruct people to move out of the doorway etc.) b.v) Two staff members should be available by the door of the office in case they are needed.
c) Trainees and others c.i) Be aware of the location of the duress alarm in the office/interview room you are using. The duress alarms in the interview rooms are in the same spot: clipped to the tray on the table. c.ii)Trainees should not be expected to intervene in these situations. c.iii) The hallways should be kept clear.
3. After the Event a) Debriefing with all those involved should occur as needed as soon as possible following the event. Additional debriefing with entire CS staff should also be considered. University Police Supervisory staff from the incident should probably be included in this de-briefing. (Consider having A&T’s EAP or UNC-G Counseling Center do the debriefing rather than doing it ourselves since we were involved). b) Accurate information should be distributed to all CS personnel as soon as possible. Control of rumor and misinformation is important. c) An incident review should be conducted by the Administrative Team (Pierce, Barnette, Rashid, Newell, Williams (legal).
4. Additional Things To Consider a) Keep your office door UNLOCKED when with a client. Police officers need to be able to gain access to your room. b) There is a 2-second delay before the duress alarm is activated. This is to minimize accidental presses of the button. You need to hold the button down for two seconds before it is activated. c) Tips for dealing with potentially dangerous person: c.i) put or keep something between you and the individual c.ii)try to position yourself closest to the door iii if the potentially violent person attempts to flee, do not put yourself in harm’s way; get a description and direction of travel and inform the appropriate authorities
Termination of Counseling
Services may be terminated for the following reasons:
24* Student’s need cannot be met by existing services. In such cases, every effort will be made to provide appropriate referral. 25* Student meets the criteria described in issues that are commonly addressed through referral to services outside of the counseling center listed above. 26* Student has used services to the limits as currently structured, 20 or less sessions during the academic year. In such cases there should be a consultation with the Director. 27* If a student has failed to attend two scheduled appointments without appropriate notification in a single semester, the student will be ineligible for scheduled therapy for the remainder of that semester. The student is still eligible for crisis services. Counseling services can be reinstituted the following semester once the student has discussed the missed appointments with his/her counselor and a clear commitment to attending additional sessions have been established. 28* Student is concurrently in treatment with another mental health provider, and efforts to coordinate treatment are not successful.
Termination Practices A termination note is drafted for each student who has been scheduled for an intake, completed more than two academic or career counseling sessions, and/or initiated the learning disability assessment process. At the time of termination, a student is removed from the assigned counselor’s case load and is removed from the roster of active clients in Titanium Schedule, the center’s electronic health records software. Completion of a termination note and delisting as an active client may take place immediately upon the decision to discontinue counseling or may be postponed until the end of the current semester. All students who were not assigned to a counselor’s caseload, but were nonetheless served (i.e., had only phone/e-mail, screening, consultation, or withdrawal appointments) are delisted as active clients at the end of each semester by the Titanium administrator. Students who have committed to returning for sessions in the following semester may remain on the list of active clients. Should the student not return for additional sessions, the file will be closed.
7. CLIENT RECORDS
Maintaining Records
Client Files A file is created for all students seen for an intake interview for the following reasons: 1. Individual counseling (academic, career, personal, life skills/personal growth) 2. Psychological Testing and assessment services 3. Group Counseling 4. Client Consultation Record
A file will not be generated for students seeking Withdrawal services. Withdrawal services are the responsibility of the Registrar's office, however; Counseling Services staff may choose to help with this process if a student has been referred to Counseling Services erroneously. The Withdrawal process is considered an administrative procedure, not a counseling procedure. A copy of the Official Student Withdrawal Form is made if Counseling Services is involved with the withdrawal process. A copy of the Withdrawal Form is kept for ten (10) years as record of the withdrawal after the withdrawal has been completed and processed.
At times, a student may be seeking counseling during the withdrawal process. Under these circumstances, the withdrawal process is considered a counseling session. A session note is generated and a file is created. A copy of the Withdrawal Form is included in the file.
Filing Procedures All personal client files should be kept in the central filing cabinet located in the main office. Files or any materials that belong in the files are not to be removed from campus. Files are locked at the end of the work day and over weekends.
Electronic File Contents- When students are seeking counseling services (personal, academic, career, etc.), the electronic record will contain the following forms: Client Demographics Screening Form Diagnosis Mental Status Evaluation and Report Checklist of Suicide Risk Factors, Suicide Risk Assessment Summary Chemical Uses Care Formulation Correspondence Progress Notes Consent to Release/Exchange Information Termination Summary Non-client consultation notes are also filed electronically. *Contact list is generated by Titanium. All forms are provided in Titanium.
Confidentiality of Client Records This policy follows and is subject to the general University Policy.
Records are collected and maintained to aid in serving clients, while at the same time protecting clients’ privacy and fulfilling the professional responsibilities of confidentiality. No information is a matter of public record, including the names of clients utilizing counseling services. Official records of the service may include the following information:
29* Appointment records for individual, couple, and group sessions 30* Demographic data supplied by the client on the Personal Data Form 31* Intake assessment provided by the counselor on the Intake Report 32* Summary notes of each client contact, dated and signed by the counselor 33* Any release of information signed by the client and copies of correspondence pursuant to that release of information 34* Copies of any correspondence with or about the client 35* Any document required by law
Counseling services are confidential, in keeping with State and Federal laws and the ethics of their profession. No information is released to outside parties without the client’s written consent, except as noted in the Disclosure of Confidential Information without Consent section below.
All persons using Counseling Services are advised in writing of the specific legal limits of confidentiality.
A confidential clinical record documenting the student’s treatment is kept for a period of ten (10) years after treatment has terminated. ACA, NASW, and APA guidelines are followed for documenting clinical notes.
Disclosure of Confidential Information without Prior Consent
Information may be released from client records to appropriate persons in connection with an emergency if the knowledge of such information is necessary to protect the health and safety of a client or other persons.
36* Counselors have a legal responsibility (Tarasoff vs. Regents of the University of California) to follow procedures for dealing with potentially violent behavior on the part of the client. 37* Counselors have an ethical responsibility to follow procedures for dealing with potentially suicidal behavior on the part of the client. 38* Counselors have a legal responsibility to report to the local police authority and juvenile police authority or to the county child protective services, any cases of child abuse reported by clients. 39* Counselors have a legal responsibility to report suspected dependent adult or elder abuse. 40* The guidelines for releasing information under these special circumstances are outlined in Section 8 “Special Treatment Issues”.
Release of Confidential Information to Students
Client access to records: Within a period of five (5) working days following receipt of a client’s written request, the client may inspect or obtain copies of his or her official record unless it is determined that there could be a substantial risk of significant adverse consequences if the client has access to the record or specific portions of the record.
Disclosure of Confidential Information to Third Parties
Consent to Release/Obtain Information Form is provided for clients requesting release of information gathered in the course of counseling to other appropriate mental health professionals. The form is valid for a maximum of one year from the date signed and includes:
41* The individual or agency to who the information is to be made available. 42* The data or information to be released. 43* The client’s signature. (Telephone requests for release of data will not be honored; however, email requests from students will be honored).
Disclosure Pursuant to Judicial Order
Confidential information may be released if properly subpoenaed pursuant to a judicial proceeding. In such proceedings, the University notifies the student prior to compliance. Every effort will be made to retain the confidentiality of records in the client’s best interest.
Disclosure for Research Purposes
Students participating in research studies conducted by Counseling Services will be informed of the safeguards against disclosure in the research design. Research studies of this nature demand proper student knowledge and consent.
8. UNIVERSITY WITHDRAWAL PROCEDURE
Withdrawal services are the responsibility of the Registrar’s office
9. COUNSELING SERVICES: CLINICAL AND PROFESSIONAL SERVICES
Academic Counseling, Information and Regulations
Academic counseling is provided to students who report that they cannot concentrate, do not know how to study, are failing courses, have poor academic averages and seek assistance in discovering and overcoming the causes of such difficulties. Clinical Counselors in the office of Counseling Services will provide academic skills training.
Testing Course credit may be granted for the successful completion of standardized tests under the College Level Examination Program (CLEP), as approved for specific courses by University departments. Fees for CLEP and other standardized examinations are determined externally, rather than by the University, however a Counseling Services Examination Fee is assessed by Counseling Services. These credits are treated as transfer credits. Those who wish to take the CLEP complete the CLEP registration process as outlined on the test publisher’s web site, http://www.clep.rog. Administration and proctoring at Counseling Services is secured by submitting the CLEP Registration and Information sheet available on the Counseling Services web site or at the Counseling Services Office and payment of a non-refundable Counseling Services Examination Fee at the university Cashier’s office before the appointment is scheduled. The Counseling Services Examination Fee may be transferred to a future CLEP administration if the scheduled individual notifies Counseling Services at least two days in advance and schedules another exam at that time. Questions about the program may be addressed to the Office of Admissions or the Office of Counseling Services.
Learning disability and ADHD assessment are conducted to determine if specific learning disability(ies) and or attention impairment warrant special attention or accommodation.
Career Counseling
Career counseling is available to students who wish to appraise their talents and interests and to select a program of study or major appropriate to their career or personal objectives. Clinical Counselors assist students in choosing an appropriate major, changing majors, and finding occupational information related to the major through utilization of interest inventories, and printed and computer materials, to assess interests, values and aptitudes.
Changing a Major
Counseling Services can offer students assistance by administering a career Interest Inventory to identify career interests and discussing the reasons for the switch in majors, i.e., the student’s strengths and weaknesses, long-range goals, desired standard of living concerns, such as job location, etc..
Personal Counseling
Personal counseling is available to students who have personal concerns and emotional difficulties that may interfere with effective learning. Counseling Services provides a safe, confidential environment where students can explore issues of concern, gain awareness and insight, and become increasingly active in taking charge of their life.
Individual Counseling
Individual counseling is the core component of the Office of Counseling Services. Most students require only short-term counseling (5-7 sessions), but others continue for long-term therapy. The availability of long term therapy will be determined by therapist/student based on need and resources.
Group Counseling When several students present similar concerns, a counselor may choose the group approach. Group counseling is provided on an ongoing basis with groups being formed as needed (see appendix for Group Interest Form and information on Group Counseling).
Group Services
New Student Orientation
New student orientation provides services and assistance which aid new students in their transition to the University, expose new students to the broad educational opportunities of the University, and integrate new students into the life of the University. The Vice Chancellor for Enrollment Management, who is responsible for Orientation, designates the Director of Orientation, to plan and coordinate the Orientation Program and appoints an Orientation Committee, inclusive of staff from Counseling Services, to assist in the implementation and evaluation of the Orientation Program.
In addition to the Orientation Program conducted at the beginning of the fall semester, the University offers Summer Orientation Programs. The advantages of attending summer orientation are many. Counseling Services provides an overview of services and informational brochures. Students can meet faculty persons who will help them select courses, register for classes prior to fall, discuss financial aid matters and pay fees.
New Student Informational Session
New freshman students face a variety of challenges during the first year. In an effort to help these students make the transition to college, counselors schedule personal information sessions with the students to assess their adjustment to college life.
Drug/Alcohol Groups Drug/Alcohol Groups are offered periodically. The Drug/Alcohol Program focuses on four components:
Orienting members to the group (see Appendix) 44* Assessing level of usage and potential for addiction (see Appendix). 45* Providing education on the physical and mental effects of the substance. 46* Recognizing and preventing potential addiction. 47* Creating awareness of available rehabilitative services. 48* Making Referrals to outside providers for treatment as needed (see Appendix)
Professional standards of confidentiality are observed.
Personal Growth Programs
Counseling Services sponsors four student seminars per year on developmental topics. This programming requires that counselors leave their office to venture into the academic and student community to provide relevant activities, programs and services to meet the needs of the student. Outreach programming consists of personal growth seminars on topics such as: Skills for Student Success, Drug and Alcohol Issues, Relationships, Skills for Career Success, Communication, Diversity, Domestic Violence, Sexual Assault Prevention, and Time/Stress Management. Workshop topics are relative to national college trends. In addition to student seminars, counselors conduct special workshops or presentations for campus and community groups.
10. SPECIAL TREATMENT ISSUES Counseling Services acts in accordance with Section 504 of the Federal Rehabilitation Act of 1973 (See Appendix)
Hospitalization
There are times when the treatment and/or level of care provided by Counseling Services are not sufficient to meet the needs of our students. When students need a higher level of care than Counseling Services is able to provide, having the student treated at an area hospital becomes a clinical consideration.
Cases in which Counseling Services may we may consider hospitalization include, but are not limited to: 1. A student is contemplating suicide or is threatening to seriously harm or kill self. 2. A student is presenting with delusional or psychotic thinking and is displaying behavior that is grossly irrational or grossly inappropriate to the situation, or whose insight and judgment is impaired to the point that he/she is unable to care for him/herself. 3. The student has threatened to kill or seriously harm another individual. 4. A student’s mental and/or emotional state has de-compensated to a point in which they are disabled and poses a threat to functioning in their daily life.
Mobile Crisis Team
The Guilford-Sandhills Center for MH/DD/SAS: 910-673-9111 or 1-800-256-2452. Will go to meet with a person in the community free of charge within a 2 hour window. Additionally, they will provide transportation to a hospital and do an involuntary commitment,
Voluntary Hospitalization
When a counselor has a reasonable belief that a person is a danger to self or others or gravely disabled, and the student is willing to be voluntarily admitted to a hospital, the counselor will assist the student in arranging for appropriate hospitalization.
As a rule, Counseling Services discusses the option of inpatient hospitalization when a student reaches a threshold in which the department is unable to provide an appropriate level of care and the student is believed to be in danger of greater harm if the student does not receive a higher level of care. It is Counseling Services’ belief that individuals are left more empowered when they, and sometimes along with their families, make the decision to admit themselves into a hospital. During these critical times, Counseling Services will often obtain a release from the student and include families in the decision making process.
Procedures for Voluntary Hospitalization
1. If, in the clinician’s judgment, a student requires hospitalization for psychological reasons, immediately consult with the Director of Counseling, the psychiatrist, or the Assistant Director. If neither of these individuals is available, consult with another senior staff member for a consultation. 2. Attempt to gain agreement from the student that hospitalization is necessary and that the student is willing to voluntarily go for assessment. 3. There are several steps taken in order to facilitate a student’s hospitalization. Moses Cone Hospital is the local agency of choice for in-patient hospitalization. Moses Cone Hospital will assess the student as well as secure a hospital bed. a. Have student complete a Consent to Release/Exchange Information form, naming the Moses Cone Hospital as the agency that is allowed to exchange release and exchange information. Copy this form, keep the original and send a copy with the student. b. Call Campus Police and request an officer be sent to transport a student to the Moses Cone Hospital, unless family or friend is available to transport. c. If the student has insurance, have the information ready for the Intake specialist at the Moses Cone Hospital. If the student does not have insurance, inform the intake specialist. d. Call the Moses Cone Hospital to notify them that we are sending a student for assessment and provide information about the case. 4. Have Campus Police transport student to the Moses Cone Hospital. 5. Document event and include all discussions about options shared with the client, decision made based on what information, notes regarding consultation, and contact with other agencies.
Involuntary Hospitalization
There are times when a student will decide not to admit him/herself, yet present an imminent threat to self or others. That is, the student has made it clear that the student intends to commit suicide, commit homicide, or engage in an activity that poses a threat of serious harm to self, others or the University facilities. During these times, Counseling Services may make the clinical decision to involuntarily commit the student.
When a counselor has a reasonable belief that a person is a danger to self or others or is gravely disabled, and that person is not willing to be voluntarily hospitalized, the counselor must initiate involuntary hospitalization procedures for 72-hour treatment and evaluation. The counselor will first consult with the Director or Assistant Director of Counseling Services. If the Director and Assistant Director are not on-site, contact with University Psychiatrist for consultation will be attempted.
The process of involuntarily hospitalizing an individual is a serious matter, and the decision to initiate involuntary hospitalization is made after careful consideration. This process involves the loss of civil freedom and rights of the hospitalized individual. This process is always used as a last resort and only after all other reasonable measures and steps have been taken and/or considered. Involuntary hospitalization is used only as a means to preserve and protect a student’s life, the life of other individuals, or property.
N.C. General Statute 122C-262 permits, when a student is: (1) mentally ill, (2) dangerous to self or others AND (3) requires immediate hospitalization to prevent harm to self or others, that student may be transported, without a petition for commitment or a magistrate or court order, directly to a hospital to undergo an examination by a physician or eligible psychologist. This emergency hospitalization option should be used only in clear cases of the need for immediate action to prevent harm.
Procedures for Involuntary Hospitalization In order to be involuntarily hospitalized, a student must be dangerous to self or dangerous to others.
1. Assessment
A) Client is assessed as being a danger to self or others.
B) Client is not able to commit to a written or verbal Crisis Response Plan or safety plan that the Counseling Services therapist (in consultation with colleagues) believes would enable the client to maintain safety.
C) Client does not agree to be transported to Moses Cone Behavioral Health, , Moses Cone Hospital Emergency Department, or Wesley Long Hospital Emergency Department for assessment regarding voluntary admission to an inpatient facility.
2. Actions (use as indicated during the assessment process)
A. Inform other Counseling Services therapists and front desk staff that the client is in crisis and safety options are being developed, and enlist assistance to make phone calls or stay with the client as indicated.
B. Call A&T University Police (phone - 336-334-7128). The University Police will come to our office when called and help the client maintain safety (including preventing the client from leaving) while safety options, including voluntary or involuntary hospitalization, are being developed.
C. If Step C under Assessment is reached; contact the Magistrate to initiate the Involuntary Commitment Process.
1. Between 8:30 and 3:30 Monday-Friday, work with the Civil Magistrate in Greensboro. Phone: 412-7855 OR 412-7862 Fax: 412-7856. Location: Guilford County Courthouse Room #214. Directions from A&T: West on E Market toward N Laurel St. Market Street, Right becomes E Friendly Ave.8 miles turn LEFT onto N Eugene Street. Courthouse (#201 S. Eugene St.) will be on your left. Take a left into public parking lot (metered lot, bring quarters). Approach building from the parking lot; go up the external stairs that start on S. Eugene St. side of parking lot, take left at top of stairs into courtyard, then left into entrance of courthouse. You will go through security/metal detectors. You have entered on main level. Magistrate’s office is on second floor, #214.
After 3:30 and on weekends, work with the Criminal Magistrate's office. Phone: 412-7879 Fax: 412-7871. Location: Lower level of the jailhouse, 401 W. Sycamore Street. This is the building that contains the Sheriff’s Department; park in the same parking lot as stated above. Cross S. Eugene St., Sycamore Street is across from Courthouse. If the client is actually in High Point, call the High Point Magistrate's office.
2. Call the Magistrate's office to apprise them of the situation.
3. Fax or present in person to the Magistrate’s office: a. A cover sheet, including the client's location in detail (required), and whether the client has any weapons or (threatening) animals. b. A completed Affidavit and Petition For Involuntary Commitment form. Notarize the form here; the Magistrate's office does not do that.
If the person completing the form is a Licensed Psychologist (HSP-P) or a Physician (M.D.), and the form has been notarized, the Affidavit and Petition form may be faxed to the appropriate Magistrate’s office (depending on time of day). The Magistrate will then issue the Custody order and send out the Greensboro Police (if student is within city limits) or the Sheriff’s Department (if in county limits). They may coordinate with the A&T University Police, but the Custody order and transportation is ultimately up to the Magistrate’s discretion and coordination.
If the criteria of an HSP-P or M.D. completing the form, and having the form notarized, are not met, do not fax the form over. You must go to the Magistrate’s Office in person and dictate the form to them.
Individuals who are not an M.D., HSP-P (such as an MSW, MA, Ph.D. in Counseling, etc.), MUST go to the Magistrate’s office in person and dictate to the Magistrate the Affidavit and Petition form. You may fill out the Affidavit and Petition form at Counseling Services to use as a rough draft when you go to the Magistrate’s office to assist with remembering pertinent information.
Forms are available in the folder file that contains the Emergency Operations Plan, and on the following web site: www.nccourts.org
On www.nccourts.org website, go to Forms tab, then enter form # AOC-SP-300 to obtain electronic version of Affidavit and Petition for Involuntary Commitment form that you can type up online and print out. Direct link to this form is www.nccourts.org/Forms/Documents/661.pdf
4. When the Magistrate issues a Custody Order, the police will pick up the client and take him or her to The Guilford Center for assessment and placement to a hospital bed. The Custody Order is valid for 24 hours and then ceases to have effect. The Findings and Custody Order Involuntary Commitment Form, AOC-SO-302, can be found on www.ncourts.org if you would like to review the form. We do not fill out this form, but you can view it for informational purposes.
5. Call The Guilford Center Counselor to communicate our safety concerns about the student in detail and answer questions to facilitate hospitalization. In addition, complete the Counseling Services Hospital Referral Form. 24 hour Emergency number = 1-336-641-4993 24 hour Appointments number = 1-800-853-5163
Student return to the university after a psychiatric hospitalization
Upon return to the University after a voluntary or involuntary psychiatric hospitalization, the student may be asked to attend a Mental Health Conference to discuss concerns about the student’s return .
Mental Health Conference 1. The Director of Counseling Services and/or the University Psychiatrist may, based on their clinical assessment, initiate a t Mental Health Conference. The focus of this conference will be to determine if the student is ready and able to undertake the psychological, emotional, social and academic rigors of the unstructured and sometimes stressful university environment. The conference will typically include the Director of Counseling Services, the University Psychiatrist, the Dean of Students, and the Director of Disability Services. The student may or may not be asked to be a part of this conference.
2. The Dean of Students may require a student to participate in a Mental Health Conference when an alleged violation of the Student Conduct Regulations (misconduct prohibited by the University) has occurred in which the student demonstrates evidence of a physical and/or emotional condition which would preclude an effective resolution of the situation through the judicial conduct process. Any student who participates in a Mental Health Conduct Conference is entitled to the same rights and has the same responsibilities as any other student who participates in any other judicial conference, hearing or appeal. All university judicial procedures and guidelines apply to Mental Health Student Conferences.
Once a determination is made by the Dean of Students (based on the incident report) to refer the student to a Student Mental Health Conference, the conference will be scheduled with the student. The Director of Counseling Services, the University Psychiatrist and the Director of Disability Support Services, all of whom typically serve as hearing officers. The Dean of Students will preside over the conference.
Counseling Services is informed about alleged violations of Conduct Violations by a sanction letter sent from the Dean of Students Office. Information from the sanction letters is stored on Counseling Services “P” drive.
If it is determined that the student accepts responsibility or is found responsible for the violation(s), the Dean of Students in collaboration with the University Psychiatrist and or a representative from Counseling Services will determine an appropriate intervention/sanction(s). The Dean of Students may impose any sanction provided for in the Student Conduct Code. A student found responsible for violating the Code of Student Conduct after a Student Mental Health Conference may appeal the decision to the Vice Chancellor for Student Affairs in the same manner as provided in the Student Conduct Code (see basis for Appeal and Appellate Procedures in Student Handbook).
Child Abuse Reporting Counselors have a legal responsibility to follow these procedures when they become aware of child abuse. In accordance with NC state law, a counselor who knows or has reasonable suspicion of child abuse, shall report that knowledge or suspicion to a child protective agency immediately, or as soon as practically possible by telephone, and shall prepare and send a written report thereof within 36 hours of receiving the information concerning the incident. Abuse is understood to include physical injury, sexual molestation, willfully causing or permitting a child to suffer unjustifiable physical pain or mental suffering or willfully causing or permitting such child to be placed in a situation that endangers the child’s person or health.
Any ambiguous reporting situation, including the decision to report past abuse of a person who is now an adult, will initiate a phone consultation with the Child Abuse Registry.
As a part of the assessment of child abuse and the reporting requirement, the counselor will consult with the Director. This consultation will be documented and the documentation will be retained by the Director in the Confidential Administrative File.
If it is concluded that there is indeed a duty to report, the counselor will also notify the client at the time of disclosure. Any exception to this policy will be discussed and documented with the Director.
Reporting Procedures are dictated by the Guilford County Department of Social Services and are as follows: a. A verbal report is made to Child Abuse & Neglect (336) 641-3795 as soon as practically possible. b. The Report of Suspected Child Abuse form will be completed by Child Protective Services.
The report shall include the name of the counselor making the report, the name of the child, his or her whereabouts, the nature and extent of the injuries or molestation, if known, and any other information requested by the child protective agency, including what led the counselor to suspect child abuse. The official reporting form will be used, and a copy retained in the Confidential Administrative File.
Elder Abuse Reporting North Carolina State Law mandates the reporting of physical abuse to an elder adult (65 years of age and over) and dependent adults 18 to 64. It encourages persons to make reports of exploitation, neglect and abandonment of any elderly or dependent adult 18 years of age and over. Mandated reporters include psychologists, psychiatrists, licensed clinical social workers, and marriage, family, and child counselors.
When there is suspicion of elder abuse, the counselor will consult with the Director to determine whether a report should be made. In any ambiguous case, the Elder Abuse Hotline will be called and consulted regarding the reporting responsibility.
Reporting procedures are dictated by the Guilford County Department of Social Services and are as follows: a. A verbal report is made to Adult Abuse and Neglect (336) 641-3137 as soon as practically possible. b. The Report of Suspected Dependent Adult/Elder Abuse form will be completed by Adult Protective Service.
Responding to a Subpoena
In such cases, advice will be sought from the Vice Chancellor for Student Affairs and University Legal Counsel. The goal of every such response will be to protect the client’s right to confidentiality.
Missing Persons Procedures In the event that a student is discovered to be missing for a period exceeding 24 hours a report should be made to one of the following university officials University Police Department Dean of Students Vice Chancellor for Student Affairs Director of Housing and Residence Life
Following receipt of a missing student report, university officials will notify the A&T University Police Department who will follow their own investigation procedures. If the student has designated an emergency contact person with the university, the university will notify that individual within 24 hours of receiving a report that the student is missing. North Carolina A&T students can confidentially designate an emergency contact person by completing an Emergency Contact Registration form at http://www.ncat.edu/student- affairs/housing/assets/downloads/forms/personal-data.pdf or residence hall students may fill one out when they check in the residence hall. By law, the parent/guardian of students who are under 18 and not legally emancipated will be notified in the event that the student has been reported as missing for 24 hours Service Animals
North Carolina A&T State University Animal Policies Service animals are animals trained to assist people with disabilities in the activities of normal living. The Americans with Disabilities Act (ADA) definition of service animals is “…any dog individually trained to do work or perform tasks for the benefit of an individual with a disability, including, but not limited to, guiding individuals with impaired vision, alerting individuals who are hearing impaired to intruders or sounds, providing minimal protection or rescue work, pulling a wheelchair or fetching dropped items.” If an animal meets this criteria, it is considered a service animal regardless of whether it has been licensed or certified by a state or local government or training program. Their service for the individual with a disability entitles them to access of public places and common areas. Under the new ADA standards, miniature horses are recognized as service animals. They must meet the same criteria as service dogs. Individuals with disabilities who use a service animal on campus are not required to register with Disability Support Services, but students who wish to have an assistance animal in student housing must make a formal request for this accommodation through Disability Support Services.
Expectations for Service Animals Because service animals are in close proximity to students and others, they must be quiet, obedient and well- groomed. Specifically: The service animal must be up-to-date with check-ups and vaccinations.
Vaccination and license tags must be displayed on the animal.
All service animals must be well-behaved.
Service animals must be under the control of the user at all times.
Service animals must be clean, groomed, and free of ticks, or other pests.
Animals are to relieve themselves in designated locations only.
The animal user is responsible for promptly cleaning up after the animal. The animal user is responsible for any property damage caused by the animal.
Service animals may be prohibited from areas that may be hazardous to the animal or its owner (mechanical equipment rooms, laboratories, etc.)
To assist the campus population in recognizing a service animal it is highly encouraged that service animals be identified by a marked harness or cape but not required.
NCAT Housing Assistance Animals North Carolina A&T State University residence halls are covered under the Fair Housing Act and the U.S. Department of Housing and Urban Development (HUD), and Section 504 of the Rehab Act in addition to the Americans with Disabilities Act. Following is how the FHAct addresses Assistance Animals: An assistance animal is not a pet. It is an animal that works, provides assistance, or performs tasks for the benefit of a person with a disability, or provides emotional support that alleviates one or more identified symptoms or effects of a person’s disability. Assistance animals perform many disability-related functions, including but not limited to, guiding individuals who are blind or have low vision, alerting individuals who are deaf or hard of hearing to sounds, providing protection or rescue assistance, pulling a wheelchair, fetching items, alerting persons to impending seizures, or providing emotional support to persons with disabilities who have a disability-related need for such support. For purposes of reasonable accommodation requests, neither the FHAct nor Section 504 requires an assistance animal to be individually trained or certified. While dogs are the most common type of assistance animal, other animals can also be assistance animals. The Office of Disability Support Services will evaluate a request for a reasonable accommodation to possess an assistance animal in a residence hall using the general principles applicable to all reasonable accommodation requests. 1. Does the person seeking to use and live with the animal have a disability as defined by the ADA: a physical or mental impairment that substantially limits one or more major life activity?
2. Does the person making the request have a disability-related need for an assistance animal?
o Does the animal work, provide assistance, perform tasks or services for the benefit of a person with a disability, or provide emotional support that alleviates one or more of the identified symptoms or effects of a person’s existing disability?
Where the answers to questions (1) and (2) are “yes,” the FHAct and Section 504 require the university to modify or provide an exception to a “no pets” rule or policy to permit a student with a disability to live with and use an assistance animal(s) in all areas of the premises where students are normally allowed to go, unless doing so would impose an undue financial and administrative burden.
The request may also be denied if:
1. The specific assistance animal in question poses a direct threat to the health or safety of others that cannot be reduced or eliminated by another reasonable accommodation, or 2. The specific assistance animal in question would cause substantial physical damage to the property of others that cannot be reduced or eliminated by another reasonable accommodation. Breed, size, and weight limitations may not be applied to an assistance animal. A determination that an assistance animal poses a direct threat of harm to others or would cause substantial physical damage to the property of others must be based on an individualized assessment that relies on objective evidence about the specific animal's actual conduct — not on mere speculation or fear about the types of harm or damage an animal may cause and not on evidence about harm or damage that other animals have caused. Conditions and restrictions that housing providers apply to pets may not be applied to assistance animals. For example, if Residential Life requires applicants or residents to pay a pet deposit, they may not require applicants and residents to pay a deposit for an assistance animal.
Please Note: Many of the same expectations that are in place for service animals apply to assistance animals.
The assistance animal must be up-to-date with check-ups and vaccinations.
Assistance animals must be clean, groomed, and free of ticks, or other pests.
Animals are to relieve themselves in designated locations only (when applicable).
The animal user is responsible for promptly cleaning up after the animal.
The animal user is responsible for any property damage caused by the animal.
The animal must not be disruptive to others in the residence hall.
The owner is responsible for the animal at all times.
Please refer to Residential Life policies for more specific information. Pets Students are not permitted to have pets in residence halls except for fish in aquariums and those students needing the assistance of a service animal. Aquarium size is limited to a 10 gallon tank per room. RATIONALE: The residence hall environments are not designed for the proper care of pets. The presence of pets affects the health of other residents, has the potential for property damage and inconvenience to other residents.
11. TESTING SERVICES
Counseling Services provides individual tests in personality, achievement, learning disabilities, aptitude and career interest; conducts university testing in cooperation with school deans, department heads and faculty; provides national admissions tests, and provides application and information for students pursuing graduate and professional schools. Counseling Services is an official testing center for national testing programs. Some testing programs included are: 49* College Level Examination (CLEP) 50* National League of Nursing (NLN) In addition to national testing programs, Counseling Services conducts testing programs that may be required or desired by the University and individual departments. Current programs include:
51* Veteran & Disability Support- Learning Disabilities and ADHD Assessments.
When administering and proctoring testing programs, counselors: 52* are responsible for the preparation of facilities and test administration for the room assigned. 53* are thoroughly familiar with all test administration procedures and adhere to those procedures. 54* are present at all times in each testing room. 55* account for both used and unused test materials during and after testing. Testing materials are housed in a secure area. 56* follow testing administration procedures. 57* start test in a timely manner. 58* complete all forms, files, and reports and return them to the center supervisor. 59* answer examinees questions; check identification, direct examinees to specific seats; distribute and collect test materials, walk around the room quietly and frequently to guard against misconduct and ensure that examinees are following directions.
12. CONSULTATION AND TRAINING SERVICES
Consultation
Counseling Services provides and secures relevant information and resources through the use of local, state and regional professional consultants. The Director and Counseling staff serves as consultants to the University and the local community.
13. STAFF DEVELOPMENT
60* Counseling staff are encouraged to maintain and improve their counseling skills to enhance their effectiveness in providing services to students. 61* At least monthly, a special in-service program is arranged on a topic of relevance to current development needs. 62* Counseling staff are encouraged to attend professional seminars, workshops and conferences relevant to their work functions. Release time is approved by the Director. 63* Counseling Services endorses a philosophy of employee development, and encourages support personnel to become involved in appropriate development opportunities such as: training offered by human resources and local conferences. Ongoing, twice yearly as needed, training/review of confidentiality and ethics are conducted by Counseling Services clinical staff. 64* All staff are encouraged to attend the various seminars, discussions, presentations, etc. that are offered on campus; work schedules may be adjusted to accommodate attendance.
14. RESEARCH
Special statistical reports, surveys, and studies are conducted by the Counseling Services Office to provide analytical assessments of student characteristics and staff performance. A survey to assess drug use on the University campus is IRB approved, and is administered every two years. 15. QUALITY ASSURANCE
It is the policy of Counseling Services to attend to the quality of care provided to students. 65* Supervision is a large component of Quality Assurance. 66* Surveys of student satisfaction and counselor evaluations are conducted 2-4 times per year to assess and determine need for changing patterns or techniques of service delivery (See Appendix). Participants are recruited in one of two ways. As students present for services, administrative or clinical staff may request participation after providing a brief explanation of the purpose, typical time to complete, and voluntary nature of participation. Additionally, clinical staff may recruit participants by e-mail. A blind copied e-mail including an explanation of the survey’s purpose, the typical time to complete, the voluntary nature of participation, and a link to the survey may be sent to those who have agreed to be contacted via e-mail on screening paperwork. 67* Twice yearly a review of policies and procedures is accomplished at staff meetings to assure that counselors are aware of and comply with policies. 68* Policies are reviewed and, if necessary, revised during the summer months of each year.
16. ANNUAL REPORT
At the end of the fiscal year, the Director incorporates descriptive data on the Counseling Services program into an Annual Report. Data are compared with that of previous years to detect trends, program strengths and weaknesses, and suggestions for future goals and activities. This report is submitted to the Vice Chancellor for Student Affairs and is available to the public.
17. INTERNSHIP / TRAINING PROGRAM
The Counseling Services Office serves as a training laboratory for graduate students, particularly those from the Department of Human Development and Services, and others who desire to complete their internship and practicum experiences within a professional counseling setting. Students from surrounding colleges and universities also participate in this program.
Interested students should submit required documentation to Training Coordinator. Requirements for these students will be determined by their program instructors and supervisors.
Intern/Practicum/Shadow Graduate Student Confidentiality Form (see Attachment) Conflicting Relationship acknowledgement Form (see Attachment)
Overview
Counseling Services’ Practicum/Internship Training Program is geared toward assisting the counselor trainee in developing a core of professional competencies or skills that would enable the trainee to function effectively as an entry level counselor. Request for placement should be submitted to Office of Counseling Services by November 1st for Spring semester and May 1st for the Fall semester.
Placement
To be considered for placement the following is required:
1. Copy of Departmental Application for Field Placement 2. Resume/Vitae 3. One page description of professional objectives you desire during field placement 4. Copy of Department’s “On-Site Supervisor’s Qualifications, Rights and Responsibilities” 5. Copy of Liability Insurance 6. Interview with Site Supervisor and Director
Goals and Objectives
The goals of the Practicum/Internship Program in Counseling are:
1. To expose the trainee to various counseling tools, techniques and strategies. 2. To expose the trainee to various assessment techniques and strategies. 3. To assist the trainee in his/her professional development. 4. To increase awareness of issues related to diversity and ethics. 5. To learn outreach approaches for prevention (alcohol/drugs, suicide, etc.) on a college campus. 6. To develop skills in group therapy through observation and possible co-leadership.
Specific training and performance objectives for the practicum/internship in counseling are as follows:
Counseling Skills
1. The trainee will counsel at least five (5) clients with personal/social, academic or career concerns and be able to demonstrate use of the following skills: the ability to listen effectively; the ability to respond to verbal and nonverbal behavior; the ability to communicate time limits, confidentiality, expectations for client behavior and expectations for the counseling process; the ability to develop mutually agreed upon expectations and goals for counseling; the ability to keep/update adequate clinical notes and records the ability to make appropriate referrals; and the ability to effectively terminate the relationship
2. The trainee will conduct a follow-up of each client's progress and discuss the observed behavioral changes with a professional counselor.
Site Supervisor’s observation, review of audiotape and Trainee documentation shall be used to evaluate these skills.
Assessment Skills
1. The trainee will administer and score at least five (5) career or personality assessments, profile and interpret to client if possible, and provide a demonstration of such skills.
2. The trainee will participate in at least one (1) standardized testing program and be able to administer and/or assist others in the administration of standardized tests. Outreach
1. The trainee will provide at least one (1) presentation on topic assigned by site supervisor. This may include stress, study skills, relationships etc. in classroom or personal growth program.
2. The trainee will assist with at least one (1) Counseling Services outreach initiative.
Professional Development
1. The trainee will attend at least one (1) counseling related professional meeting, seminar, workshop or program and present information regarding the program's content.
2. The trainee will attend at least two (2) Counseling Services in-service training conferences if provided and all staff meetings unless officially excused.
3. The trainee will study community and University services and resource guides relevant to student needs and demonstrate an ability to make appropriate referrals.
4. The trainee will become familiar with the University's Student Affairs (Student Personnel) Organizational Structure and be able to identify where each of the various areas, especially Counseling Services, fall under the umbrella-like structure.
5. The trainee will become familiar with the Office Computer System and be able to log intake data, locate information from the Student Master File and run office software.
6. The trainee will demonstrate or develop at least one (1) new way of promoting or increasing student awareness of Counseling Services.
All Practicum/Intern Trainees will work closely under the supervision of the Site Supervisor, Counseling staff and the Director of Counseling Services.
Trainees’ Rights and Responsibilities
Rights
The trainee has the right:
to a quality training experience to know the criteria for evaluation in the Internship to know the expectations/procedures of the Internship to know procedures for handling emergencies to receive supervision to request and receive additional supervision to receive feedback from site supervisor to ask questions regarding the counseling process and the correct handling of cases to confidentiality to reasonable accommodations Responsibilities
The trainee has the responsibility:
to become familiar with the requirements for the Practicum/internship for attendance and punctuality at site and supervisory sessions. to be prepared for supervisory sessions to act professionally at all times. for maintaining hours and logs and providing a copy for Site supervisor on a weekly basis. to request additional supervision as needed to inform the supervisor of client emergencies to follow professional ethical standards to obtain written consent from at least one(1) client for audiotape and/or observation by Site Supervisor for trainee evaluation to maintain the confidentiality of clients to explain confidentiality and its limitations to client
Reasonable Accommodation
In accordance with ADA regulations, trainees will be given reasonable accommodation(s) according to his/her disability. It is understood that trainees with disabilities will request accommodation(s) upon acceptance of placement.
Trainee Affirmation of Confidentiality
Counseling services are confidential, in keeping with ethical standards of the American Counseling Association, and/or the American Psychological Association, and applicable national and state laws. No information is released to outside parties without the client's prior written consent. All persons using Counseling Services are advised in writing of the specific legal limits of confidentiality. (See Appendix for Intern/Practicum/Shadow Graduate Students’ Forms). Section 17: APPENDICES
NORTH CAROLINA AGRICULTURAL AND TECHNICAL STATE UNIVERSITY
REQUEST FOR LEAVE
EMPLOYEE:______DATE: ______
Leave is hereby being requested for the period specified below. This form is to be filed with departmental leave information and made available for review by this office for audit purposes. Information on leaves taken should be submitted to the Department of Human Resources on the PD-113 or PD-110.
VACATION LEAVE: DATES ______TOTAL HOURS ______(FROM) (THRU)
If less than a day indicate time: TIME ______(FROM) (THRU)
SICK LEAVE: DATES ______TOTAL HOURS: ______
If less than a day indicate time. TIME ______(FROM) (THRU)
BONUS LEAVE: DATES ______TOTAL HOURS:______
If less than a day indicate time. TIME: ______(FROM) (THRU)
OTHER LEAVE: ______DATES: ______TOTAL HOURS:______
______Applicant’s Signature Supervisor’s Signature Date
LEAVE MUST BE REQUESTED AND APPROVED BY SUPERVISOR IN ADVANCE; EXCEPTION- EMERGENCIES. VACATION LEAVE May be taken by permanent employees in units of not less than 15 minutes. Accumulated on a monthly basis, leave in excess of 240 hours on December 31 will revert to sick leave on January 1 of each calendar year. May be used for personal leave, vacation, and absences as a result of adverse weather conditions.
SICK LEAVE May be taken by permanent employees in units of not less than one hour. No maximum accumulation, it is cumulative indefinitely. May be used for illness or injury, medial appointment, and temporary disability connected with child bearing. May be used for death in the immediate family. (Family is wife, husband, mother, father, sister, brother, daughter, son, mother-in-law, father-in-law, daughter-in-law, son-in-law, grandmother, grandfather, granddaughter, grandson, stepmother, stepfather).
BONUS LEAVE Bonus leave should be taken only upon authorization of the agency supervisor/department head. Full-time employees who work less than 12 months receive a pro rata amount of the 80 hours. Permanent part-time employees (half-time or more) receive a pro rata amount of the 80 hours. Bonus leave may be used for any purpose for which regular vacation leave is used. Bonus leave should be charged in units of time consistent with regular vacation leave guidelines. The employee should determine whether to charge approved leave to regular vacation leave or bonus leave.
REMINDER
LEAVE OR TIME TAKEN IN EXCESS OF ACCUMULATION WILL BE LEAVE-WITHOUT PAY AND DEDUCTED FROM SALARY CHECKS. THIS MAY CAUSE DELAYS IN PAYROLL CHECKS OR CANCELLATION OF CHECKS.
CONTACT YOUR SUPERVISOR FOR QUESTIONS Or
HUMAN RESOURCES 334-7862 North Carolina A&T State University-Counseling Services
Consent to Release/Exchange Information
This form cannot be used for the re-release of confidential information provided to Counseling Services by other individuals or agencies. Such requests should be referred to the original individual or agency.
I ______authorize NC A&T State University to: Name DOB
Release to: Obtain from: Mutually exchange with people listed on the attached page:
Name ______
Address ______
______
Phone ______
The following information pertaining to myself will be disclosed/exchanged: o Treatment summary o History/intake o Diagnosis o Psychological test results o Psychiatric evaluation/medication history o Dates of treatment attendance o Other (specify) Group consultation
I understand that the information will be used for the purpose of: o Evaluation/assessment and/or coordinating treatment efforts o Referral o Contact with Psychiatrist or Physician o Other (specify) Interpersonal communication
This consent will automatically expire one (1) year after the date of my signature as it appears below.
I understand I have the right to refuse to sign this form, and that I may revoke my consent at any time (except to the extent that the information has already been released). ______Signature of Client Date
______Signature of Witness Date
03/07 North Carolina A&T State University Rights and Responsibilities of Students Using Counseling Services
I. Rights As a client of Counseling Services, you have certain rights, among which are the rights to respect, prompt service, and confidentiality.
a. Appointment: We are committed to providing quality services to all enrolled students.
b. Prompt Service: Counseling Services will schedule an initial appointment with a counselor as soon as possible, usually the same day. Failure to attend scheduled appointments, or repeated cancellations, will result in the closure of your case.
c. Respect: The counselors in Counseling Services are expected to treat all clients with respect regardless of race, ethnicity, age, gender, sexual orientation, lifestyle, creed, or religion. Counselors may convey this respect by keeping appointments, by giving you complete attention during sessions, by avoiding interruptions during sessions, and by providing effective counseling.
d. Treatment Participation: Counseling is a participatory activity. In order for it to be effective, you must actively participate in establishing and working on treatment goals, completing assignments, and discussing difficult issues. If the counselor feels that you are not actively participating in treatment, (s)he can discontinue sessions until you are more ready to focus on your treatment issues. Similarly, if you feel that the time is not right for you to focus on your treatment issues, you can discontinue treatment or select another counselor of your choice. If you choose to discontinue treatment prematurely, we ask that you inform your counselor of your intentions.
e. Confidentiality: All counseling involves the sharing of sensitive, personal, and private information by clients with their counselors. Recognizing this, several federal and state laws, as well as a code of professional ethics, protect the confidentiality of information shared in counseling. In addition, no information about whether or not you are being seen at Counseling Services; or about your actual counseling, will be released to an outside agency or person without written permission from you. There are, however, a few carefully agreed upon exceptions to confidentiality which we believe you should know about before you begin counseling. These exceptions are as follows:
Staff Consultations and Supervision: The staff of Counseling Services operates as a team. Therefore, from time to time, your counselor may consult with other staff members or receive supervision from another member. These consultations are for professional and training purposes only and are aimed at providing the best possible care for all clients.
Abuse of Children: If your counselor has reason to believe that a child under the age of 18 is being abused or neglected, (s)he is legally obligated to report this situation to the appropriate state agency.
Abuse of Elderly Individuals or Other Vulnerable Adults: If your counselor has reason to believe that a vulnerable adult (i.e., elderly or a person over 18 years old who lacks the physical or mental capacity to provide for his/her daily needs) is being abused, (s)he is legally obligated to report this situation to the appropriate state agency.
Imminent Harm to Self: ` If your counselor has reason to believe that you are in danger of physically harming yourself, and if you are unwilling or unable to follow treatment recommendations, (s)he may have to seek your involuntary admission to a hospital and/or contact a family member or another person who may be able to help protect you. Imminent Harm to Others: If your counselor has reason to believe that you are actually threatening physical violence against another person, or if you are an actual threat to the safety of another person, (s)he may be required to take some action to insure that the other person is protected (e.g., contacting the police, notifying the other person, seeking involuntary hospitalization).
Court Order to release Information: We are legally required to release client information to the courts if a judge court orders your record. If such a situation arises, we will make every attempt to inform you of the court’s request and the nature of the request.
The confidentiality exceptions described in “e” are extremely rare. If, however, they should arise, it is our policy that whenever possible, we will discuss with you any action contemplated as fully as possible. However, you should know that we are not legally obligated to inform you, or seek your permission, especially if such a discussion would prevent us from securing your safety or the safety of others. If disclosure of confidential information does become necessary, we will release only the minimal information necessary to protect you and/or another person.
f. Your Record: According to State of North Carolina regulations for professional counselors, client records must be maintained for a period of ten (10) years. Consistent with these regulations, Counseling Services keep both our paper and electronic records within a locked structure for the designated time period. The bulk of your record is stored electronically with access restricted to the appropriate staff members. Both paper and electronic files are destroyed after ten years of inactivity. Your counseling records are not part of your academic record.
II. Responsibilities
Your active participation in the counseling process is necessary for progress to be made. Therefore, along with your rights as a client, you have certain responsibilities that include:
a. Promptness: Keeping to appointment times will allow you to take full advantage of your counseling sessions. Arriving promptly for your sessions will allow you to make the most of your time.
b. Attendance: Once you have been scheduled for an appointment, it is your responsibility to keep the appointment. If an emergency arises, please cancel your appointment by calling the office staff at the Center, giving as much advance notice as possible. Again, failure to attend sessions, or repeated cancellations, will result in the closure of your case.
PLEASE LET YOUR THERAPIST KNOW IF YOU HAVE ANY QUESTIONS ABOUT THE ABOVE INFORMATION
Signature: ______Date: ______
Information on Group Counseling
Group Counseling at NC A&T State University
Group counseling offers unique therapeutic possibilities to address a variety of student concerns. The goal of this handout is to answer some frequently asked questions about group counseling so that you may learn more about this frequently recommended form of therapy.
What Is Group Counseling Really Like?
Groups are typically composed of 5-8 members who meet weekly for 1 ½ hours. The issues discussed in the group are generated by the group members, with guidance and facilitation by trained group leader(s). Some of our groups are time- limited and topic-focused. Other groups are open-ended and not focused on a particular topic. Confidentiality among group members is always required.
What Are The Advantages Of Group Counseling? A group provides opportunities to learn with and from other people and to understand your own patterns of thoughts and behaviors (as well as those of others). Other people can often see attitudes and behavior patterns that are limiting and that may be difficult to see in yourself. A group is an opportunity to receive genuine support, honest feedback, and useful alternatives from peers. A group is an opportunity to experiment with and work toward new attitudes and new ways of coping with life's stressors. A group may also help individuals deal with relationship concerns and general difficulties in dealing with other people.
For What Types Of Concerns Is Group Counseling Most Helpful?
Group counseling is especially helpful for the following types of student concerns:
"My relationships with others are unsatisfactory, very frustrating, and/or disappointing."
"People don't react to me the way I would like them to."
"I feel stuck in a particular pattern or role in my relationships with others."
"I feel lonely and unsupported. Others don't seem to understand me."
"I lack assertiveness. I either don't address differences and disagreements or my disagreements with others turn into hostile conflict."
"I want to change my way of thinking and feeling about myself."
Group counseling is one of the most direct ways to provide the type of contact needed to work through these concerns.
One Last Thing To Note Students often feel a bit nervous or uncomfortable with the idea of joining a group. It's important to remember that the group leader is aware of this and will work with the group to make the environment supportive and safe. Remember that pursuing or confronting the things that make us most anxious can sometimes be the most beneficial way to help us change. GROUP INTEREST FORM
North Carolina A&T State University’s Counseling Services has an extensive group therapy program. Many students overlook groups, feeling that they will not be able to have their needs met through this format. You are strongly encouraged to consider one of the many groups offered at Counseling Services, and, more often than not, you can begin ongoing counseling in a group with little wait. If the issues you are struggling with are interpersonal (relational) at all, many times group therapy is the preferred mode of treatment and can address your needs in ways individual therapy cannot. Please check any group or groups you might be interested in joining. If you would like Counseling Services to offer a group that is not listed, please offer your suggestions at the bottom of this form.
RELATIONSHIP GROUPS Interpersonal Issues Group Dysfunctional Family Lesbian Interpersonal Group Couples Enhancement Women's Relational Group Dating Managing Relationship Conflict Gay Men's Concerns M en's Issues Group
SUPPORT GROUPS Dissertation Thesis Women Of color Men of Color Inter-Racial Couples First Generation College Students International Students Chronic Pain/Disabilities Non-Traditional Students Single Parenting Bi-Sexual Support Group New Directions (Drug & Alcohol Transgender Support Group reduction)
ISSUES Sexual Abuse Sexual Assault Obsessive Compulsive Disorder Adult Children of Alcoholics Bereavement/Grief Depression Management Anxiety Stress Management/Relaxation Training Phobias (Shyness, Public Speaking, etc.) Eating Disorders / Body Image Issues Bipolar Disorder Anger Management Attention Deficit Disorder Combating Perfectionism GENERAL GROUPS/CLASSES/WORKSHOPS Life-skills: Stress Management & Multicultural Leadership Self-Esteem Eating Awareness Workshop Visualizing Success Personal Issues
Other Suggestions for Groups :
If you would like someone to contact you about a group, please leave us your name and e- mail address.
Name and e-mail address :
Many thanks on behalf of the Counseling Services. North Carolina A&T State University-Counseling Services Intake Form
SECTION I:
Name: ______Today’s Date: ______
What do you prefer to be called? ______Banner ID#: ______Date of Birth: ______Age: ______Sex: ______Email: ______Okay to leave message □ Local Address: ______
Permanent Address: ______
Local Phone: ______Cell Phone: ______Other Phone: ______Okay to leave message □ Okay to leave message □ Okay to leave message □
Class: FR SO JR SR Grad Major: ______
Ethnic Background: African American Hispanic Native American Caucasian Asian International Biracial Other______
Sexual Orientation: Heterosexual Lesbian Gay Bisexual Questioning Other Prefer not to Answer
Marital Status: Single Married Separated Divorced Widowed Partnered Renamed
How did you hear about the Counseling Center? Orientation Previous Client Friend/roommate RA/GA
Brochure Counseling Program Professor/Advisor ______
Current/Prior Military Service Yes or No Pending Court/Legal Issues Yes or No
SECTION II:
Have you received services from Counseling Services previously? ___Yes ___ No If yes, when: ______
Are you in good physical health?_____ Yes_____ No
Are you currently taking any medication? _____Yes _____ No
If yes, list medications: ______
Have you ever been in counseling/psychotherapy? _____ Yes _____ No
If yes, when were you last treated and by whom? ______
Briefly state why you came to the Counseling Center. ______
When did you first become aware of this concern? ______
Number of nights per week that you consume alcohol: _____ Number of drinks per night: _____ Number of nights per week that you use mood-altering substances: _____
Substance(s) of choice and amount used: ______
______
Have you ever tried to stop, cut down, or control gambling? Yes No
Have you ever lied to family members, friends, or others about how Yes No much you gamble or how much money you lost on gambling? Have there ever been periods of 2 weeks or longer when you spent Yes No a lot of time thinking about your gambling experience, or planning out future gambling ventures or bets? ______Are you currently having any thoughts about killing yourself? Yes No
Have you made attempts to kill yourself in the past? Yes No
Are you currently engaging in any self-injurious behavior? Yes No
Have you engaged in self-injurious behavior in the past? Yes No
Do you hear things or see things that other people do not? Yes No
Father’s Age: _____ Occupation: ______
Mother’s Age: _____ Occupation: ______Parent’s Marital Status: ______
Number of sister: _____ Their ages: ______
Number of Brothers: _____ Their ages: ______
Partner’s Age: _____ Occupation: ______
Number of Children: _____ Their ages: ______
List any family members who have substance-abuse problems (e.g., brother-marijuana, step- father-alcohol):
______PLEASE CHECK ALL THAT APPLY TO YOU: 1. Dislike campus rules and regulations 2. Worry about my eating habits 3. Not adjusting well to a new situation 4. Worry about my drinking, smoking, or drug use 5. Having difficulty trusting other people 6. Do not get along with my parents or my family 7. Feeling depressed or unhappy 8. Cannot seem to control my thoughts or behavior 9. Thinking about killing myself 10. Nervous or anxious much of the time 11. Having fears, which seem unrealistic 12. Worry about past physical or sexual abuse 13. Bothered by insomnia or sleep difficulties 14. Very anxious in social situations 15. Feeling tired, dizzy and/or weak 16. Sexual needs unsatisfied 17. Wishing I could be different 18. Having trouble studying 19. Grades too low 20. Upset by recent death 21. Unsure about my future plans 22. Having money problems 23. Concerned about my marriage 24. Disappointed by relationships 25. Upset about a physical problem 26. Confused by my sexual role 27. Having headaches, indigestion, or other 28. Other physical problems PLEASE LIST THE NUMBERS OF YOUR 3 MAIN CONCERNS: 1._____ 2._____ 3._____
SECTION III:
Name of person to contact in emergency: ______
Relationship to you: ______Phone: ______
Signature: ______Date: ______Section 504 Section 504 of the Federal Rehabilitation Act of 1973 This Act affects the use of a mandatory withdrawal for students with mental disorders and prohibits dismissing a student solely because of a mental disorder. However, a student may be recommended for voluntary hospitalization or subject to involuntary hospitalization for psychiatric reasons if the Director of Counseling Services concludes, on the basis of clear and convincing evidence, that: (1) the student is mentally ill, as defined by the current American Psychiatric Association Diagnostic and Statistical Manual or its equivalent, AND (2) the student has acted in such a way in the relevant past as to show that the student a. Is dangerous to self because: a.i. the student would be unable, without care, supervision, and the continued assistance of others not otherwise available, to exercise self-control, judgment, and discretion in the conduct of the student’s daily responsibilities and social relations, or to satisfy the student’s need for nourishment, personal or medical care, shelter, or self-protection and safety; AND a.ii. there is a reasonable probability of the student suffering serious physical debilitation within the near future unless adequate treatment is given. A showing of behavior that is grossly irrational, of actions that the student is unable to control, of behavior that is grossly inappropriate to the situation, or of other evidence of severely impaired insight and judgment shall create a prima facie inference that the student is unable to care for him/herself; OR a.iii. the student has attempted suicide or threatened suicide and that there is a reasonable probability of suicide unless adequate treatment is given.
Previous episodes of dangerousness to self, when applicable, may be considered when determining reasonable probability of physical debilitation, suicide, or self-mutilation.
b. Is dangerous to others because:
Within the relevant past, the student has inflicted or attempted to inflict or threatened to inflict serious bodily harm or another, or has acted in such a way as to create risk of serious bodily harm to another, or has engaged in extreme destruction of property; and that there is a reasonable probability that this conduct will be repeated. Previous episodes of dangerousness to others, when applicable, may be considered when determining probability of future dangerous conduct. ADDICTIVE BEHAVIORS ASSESSMENT
Please answer yes or no to the following questions.
Section I
1. Have you ever been arrested on a MIP (Minor In Possession) charge or been at a party broken up by police?
2. Have you ever been suspended from school activities for using alcohol/drugs or skipping classes?
3. Do you have a poor attitude about school and/or family life?
4. Have you dropped activities that used to be important to you?
5. Do your friends drink or smoke marijuana?
6. Have you ever experienced a hangover or bad trip due to alcohol/drug use?
7. Have you ever lied to others about your alcohol/drug activities?
8. Have you made excuses about your drinking/using behavior (i.e.: I only do it at parties or when I’m stressed)?
9. Have you made excuses about drinking/using behavior of your friends?
10. Have you experienced any unexplainable mood changes or emotional ups and downs that seem excessive to you?
Section II
11. Have you ever been arrested for shoplifting, vandalism, driving while impaired (DWI), or possession of alcohol/drugs?
12. Have you ever been suspended from school possession of alcohol/drugs or fighting?
13. Have any of the following occurred frequently: sleeping in class, declining grades, or skipping classes?
14. Have you changed friends from those who don’t use alcohol/drugs to those who do?
15. Have you experience significant weight loss or gain? 16. Do you have a more difficult time paying attention than you used to?
17. Do you feel less motivated than you used to?
18. Have you experienced memory lapses (times when you couldn’t remember going somewhere or doing something? 19. Have you experience feelings of depression, hopelessness, or worthlessness?
20. Do you strongly defend your right to drink or use drugs?
Section III
21. Have you ever been arrested for robbery, drug dealing, assault and battery, vandalism or prostitution?
22. Have you been suspended from school more than once or expelled?
23. Have you been fired from a job?
24. Have you gotten physically violent with your parents or other family members?
25. Have you gotten violent with your friends?
26. Have you started avoiding your friends to the point where they have begun expressing concern?
27. Do you blame other people for your problems?
28. Do you feel angry a lot of the time?
29. Have you ever made suicide plans, left notes or actually attempted suicide?
30. Have you experienced feelings of paranoia?
Section IV
31. Have you often found yourself thinking about gambling [e.g., reliving past gambling experiences, planning the next time you will play or thinking of ways to get money]?
32. Have you needed to gamble with more and more money to get the amount of excitement you are looking for?
33. Have you become restless or irritable when trying to cut down or stop gambling?
34. Have you gambled to escape from problems or when you are feeling depressed, anxious or bad about yourself?
35. After losing money gambling, have you returned another day in order to get even?
36. Have you lied to your family or others to hide the extent of your gambling?
37. Have you made repeated unsuccessful attempts to control, cut back or stop gambling? 38. Have you been forced to go beyond what is strictly legal in order to finance gambling or to pay gambling debts?
39. Have you risked or lost a significant relationship, job, educational or career opportunity because of gambling?
40. Have you sought help from others to provide the money to relieve a desperate financial situation cause by gambling?
Reviewed 05/2012 kdeane
Client Satisfaction Survey Text of Survey Distributed Through Qualtrics
Counseling Services routinely requests feedback from those who have visited our center. The survey used to collect feedback takes approximately 5-7 minutes to complete and is anonymous in nature.
Gender (select one) Male Female Transgender
Race/Ethnicity (select one) African-American/Black Anglo-American/White Asian-American/Pacific Islander Hispanic/Latino Native American More than one ethnicity Prefer not to say
Additional demographics (check all that apply) Student-Athlete Veteran International student Transfer student
Sexual orientation (select one) Heterosexual/Straight Lesbian Gay Bisexual Questioning Queer Other Classification Freshman Sophomore Junior Senior Graduate Non-degree seeking Counselor's Name Vivian Barnette Calena Creft Victoria Dalton LaKisha Ellison Anthony Greenidge Roy Hamilton Daniel Paredes Sammy Ngetich What is your major? [write in]
Number of sessions 1 (15-minute screening only) 2-4 5-7 8 or more Type of service your received Individual counseling Educational testing (LD/ADHD) Career assessment Couples counseling Group counseling
Please rate your AGREEMENT with the following [Strongly Agree – Agree – Disagree – Strongly Disagree]
My counselor was respectful of who I am as an individual (culture, religion, ethnicity, sexual orientation, etc.)
My counselor helped me feel like I could share my thoughts, concerns, or questions
My counselor was able to understand my problems and concerns
Counseling Services has helped me to improve my academic performance
Counseling Services has helped me remain enrolled in school
Please rate your AGREEMENT with the following statements Strongly Agree – Agree – Disagree – Strongly Disagree]
Counseling Services has helped me cope better with the concerns that brought me in
My counselor was knowledgeable of how to help me
My counselor was effective with the ways she/he worked with me
Please rate your SATISFACTION with our general office and other staff [Very Satisfied – Satisfied – Neither satisfied nor dissatisfied - Dissatisfied – Very Dissatisfied]
Counseling center location convenient/accessible
Privacy in the reception area
Comfort in the reception area
Politeness of staff in the reception area
Helpfulness of staff in the reception area
Relevance of written materials in the waiting area
Please rate your AGREEMENT with the following Strongly Agree – Agree – Disagree – Strongly Disagree]
Overall, I am satisfied with the counseling I have received
I would seek services again at Counseling Services, if needed
I would refer a friend to Counseling Services
If you could change one thing about Counseling Services, what would it be? [write in]
Please list any groups or topics that you would like Counseling Services to cover/offer [write in]
Additional comments for us [write in] ACCESSIBLE
Comfort in the reception area
Privacy in the reception area
Politeness of staff in the reception area
Helpfulness of staff in the reception area
Ease of appointment scheduling
Relevance of written materials in the waiting area
Please rate your AGREEMENT with the following
Overall, I am satisfied with the counseling services I have received.
Counseling Services has helped me to improve my academic performance.
Counseling Services has helped me remain enrolled in school
Counseling Services has helped me cope better with the concerns that brought me in
Counseling Services has positively impacted my relationships.
I would seek services again at Counseling Services if needed.
I would refer a friend to Counseling Services. If you could change one thing about Counseling Services what would it be?
Please list any groups or topics you would like Counseling Services to cover/offer
Additional comments for us
Once you have completed the survey, click on the SUBMIT button below. Let our staff know when you are done.
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Counseling Services Training Program for Master’s and Doctoral Students in Mental Health Professions
Overview
The training program at Counseling Services is focused on helping participating students develop competencies and skills necessary for the next step in their professional development. Students from various mental health professions are invited to apply for acceptance into the training program. Requests for placement at Counseling Services should be submitted to the Practicum Coordinator or Internship Coordinator no later than 1 November for Spring semester participation and 1 May for participating in the subsequent Fall semester.
Placement
To be considered for placement the following is required:
1. Copy of Counseling Services Form 2. Copy of Department’s “On-Site Supervisor’s Qualifications, Rights and Responsibilities” 3. Copy of Liability Insurance
Following review of submitted materials, an interview with Counseling Services training staff may be required. Completion of a Counseling Services confidentiality agreement is required prior to acceptance.
Training Program Goals and Objectives
The goals of the Training Program to:
1. expose the trainee to various counseling tools, techniques and strategies. 2. expose the trainee to various assessment techniques and strategies. 3. assist the trainee in his or her professional identity development. 4. increase awareness of issues related to diversity and ethics. 5. learn outreach approaches for prevention (alcohol/drugs, suicide, etc.) on a college campus. 6. develop skills in group therapy through observation and possible co-leadership. Specific training and performance objectives for the trainee’s field experience will be established as supervision goals at the outset of the trainee’s time at Counseling Services.
Supervision, Peer Consultation, & Professional Development
Participants in the training program will be required to participate regularly in supervision or peer consultation, and professional development meetings. The frequency and duration of meetings will vary depending on trainee educational requirements, Counseling Services staff availability, and needs identified during the trainee’s development. As a general rule of thumb, trainees are provided one hour of individual supervision per week and participate in one 30-minute “journal club” professional development meeting per week.
Recording of Sessions
Practicum/Internship participants who have received permission from their Counseling Services supervisor may audiotape sessions, with the appropriate consent from the client(s). Audio files should be stored in the secure file cabinet used to store client files. A computer will be provided for trainees to routinely back-up their recorded sessions on an external media device that also will be kept in a secure file cabinet. Sessions being submitted to the university supervisor should be transferred onto a disc or thumbdrive containing only that session to limit the exposure of other clients in the event the disc or thumbdrive is lost. Video recording is not permitted at Counseling Services.
All copies of recorded sessions will be destroyed at the end of each academic semester.
Affirmation of Confidentiality Counseling services are confidential, in keeping with ethical standards of the American Counseling Association, and/or the American Psychological Association. No information is released to outside parties without the client's prior written consent. All persons using Counseling Services are advised in writing of the specific legal limits of confidentiality. (See Appendix for Intern/Practicum/Shadow Graduate Students’ Forms
NORTH CAROLINA A&T STATE UNIVERSITY – COUNSELING SERVICES GRADUATE STUDENT SHADOWING EXPERIENCE
ATTENDANCE ROSTER
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64 COUNSELING SERVICES Minor Informed Consent
STATEMENT OF INFORMED CONSENT FOR PARENTS AND GUARDIANS
A North Carolina A & T State University college student for whom you are legally responsible, and who is a minor, has requested counseling services at the North Carolina A & T State University Counseling Services. Individuals who are under 18 years of age cannot legally give informed consent for treatment or referral beyond the intake process. However, please be advised that in an emergency situation, we may be compelled to offer treatment or referral prior to obtaining your informed consent. You are asked to carefully read the information contained on this sheet and to sign it in the appropriate space on the back. If you have any questions about this information or about the services offered by Counseling Services, please do not hesitate to contact us at the number noted below.
This document is designed to provide some basic information about the counseling process. Please review carefully and sign it in the appropriate space if you agree to allow a minor for whom you are legally responsible to participate in counseling.
ELIGIBILITY FOR SERVICES C urrently enrolled North Carolina A & T State University students are eligible for Intake services at the University Counseling Services facility. Following the intake process, it will be determined whether the University Counseling Services facility is the appropriate place for the student to receive ongoing counseling. Please be assured that if it is determined that Counseling Services is not the appropriate place for the student to receive treatment, a referral to an appropriate mental health treatment provider will be made. All services at Counseling Services are offered free of charge. TYPES OF COUNSELING SERVICES OFFERED The University Counseling Center offers individual, couples and group counseling. Typically, clients are seen for one session per week; the duration of each session is approximately 50 minutes. Counseling takes place in the context of a helping relationship in which the counselor and the client work together to resolve a problem, change behavior or foster personal growth and awareness. CONFIDENTIALITY In keeping with professional standards and legal requirements, the client’s records, and the information the client discloses to a counselor, are confidential. The client’s records at Counseling Services consist of the client’s contact card and other intake documents, session notes and a termination report. Records are kept for the client’s benefit and, therefore, the client may have access to his or her record, unless the information it contains is determined to be detrimental to the client. In that case, the client may request a summary of the information contained therein. If the client is under 18 years of age, his or her parent or guardian holds the privilege of confidentiality.
At times, it may be necessary to consult with other professional staff within Counseling Services about clients in order to provide the best possible service. However, we will not share information about clients outside of the Center without the client’s written authorization, which allows us to communicate with specific others. Be assured that a client’s visit to the Counseling Center are not noted in their official school record. If the client is under 18 years of age, his or her parent or guardian must provide written authorization to share information with others outside of Counseling Services. You should be aware that there are exceptions to the privilege of confidentiality. A counselor must disclose information when it is necessary to protect the client or others from harm, in cases where child or elder abuse is suspected, upon court order, or as required by law. ROLE OF THE COUNSELOR Although the counselor will not and should not tell the client what to do, she or he will assist with generating solutions to problems and concerns. Also, the counselor will be a caring and attentive listener, which many clients find helpful in and of itself. In addition, the counselor can be an advocate for the client within the university, contacting deans or professors, whenever necessary or appropriate.
ROLE OF THE CLIENT The client’s active participation in the counseling process is necessary for progress. Therefore, clients are strongly urged to attend all scheduled sessions. If a client must miss a session, he or she should notify us as early as possible by calling 336-334-7727. Should the client fail to keep two (2) consecutive appointments without notifying us to cancel the session, he or she will no longer be considered an active client at the Center. However, students are welcome to schedule an appointment at another time.
CRISIS RESPONSE PLAN If a client experiences a crisis (including thoughts about hurting oneself or someone else) that takes place during regular business hours, please contact the client’s counselor by phone at Counseling Services (336- 334-7727). You should let the person answering the phone know that this is an emergency. If the counselor is not immediately available, ask to speak to another counselor. Clients should not e-mail their counselors for any situation that requires an immediate or urgent response. At times when the Center is closed and you believe that your child is experiencing a crisis, please go directly to the emergency room at your local hospital or call 911 for assistance. If the student is an on-campus resident, please notify a member of the Residential Life staff to inform them that your child needs immediate assistance or call 336-334-7675 for the University Police and Public Safety Department.
RISKS INVOLVED Although the benefits of engaging in the counseling process can be enormous, there may be some risks, as well. For example, sometimes people feel worse before they feel better. This is because, at times, painful feelings emerge that must be worked through and resolved. Also, the feelings and issues that arise in the counseling process may be intense enough to distract one from other things that demand one’s attention, important activities such as school work. If feelings do become too painful and distracting, clients and/or parents should let their counselor know.
66 EXPECTATIONS ABOUT COUNSELING The counseling process often takes time. Therefore, it is probably not realistic to expect that one’s problems will be solved after one or two sessions. Because counseling is a process, it is wise to give it a few weeks before one decides whether or not it is working. However, if after a few weeks, one continues to feel that counseling is not helping, or that one has not made a good connection with the counselor, there are steps that can be taken. The client can speak openly and candidly with the counselor about these concerns. The counselor can alter what he or she is doing or refer the client to another counselor. If speaking directly to the counselor is too uncomfortable, the client can ask the secretary of Counseling Services to set up an appointment with another counselor. However, whenever possible, it is best to speak with the counselor first.
GIVING INFORMED CONSENT TO COUNSELING Your signature below indicates that you have read the information contained in this document and that you agree to allow a minor for whom you are legally responsible to participate in the counseling process. Student please note that your signature below indicates that you have read and understand all the information contained in this document.
Please Print (Parent / Guardian) Date
Signature (Parent / Guardian) Date
______Please Print (Student) Date
______Signature (Student) Date Letter to parent re: minor student
November 26, 2017
Dr. XXX XXX XXXXXXX Valley Drive XXXXXX, NC 27301
Dear XXX. XXX:
XXXXX has contacted the Counseling Services at North Carolina A & T State University for assistance. Because she is a minor, it is necessary for us to have your written consent in order to provide our services to her. This permission would extend until her 18th birthday. Attached is an Authorization to Release and/or Obtain Confidential Information form that she has signed for this purpose.
68 Approved Abbreviations
#YO Years older #YY Years younger AEB As evidenced by APPT Appointment CBT Cognitive Behavioral therapy CLT Client D Direction DO Disorder DOS Dean of Students DX Diagnosis ED Emergency department GF Grandfather GM Grandmother HI /SI Homicidal ideation/suicidal ideation HPW Hours per week HS High school HX History I Impression I/DD Intellectual and developmental disability INDV Individual JND Just noticeable difference LGBT M Maternal MGM Maternal grandmother MH Mental health MI Motivational interviewing MSC Multicultural Student Center NOS Not otherwise specified Office of veteran and disability support OVDSS services PM Per month P Paternal PGM Paternal grandmother PW Per week PX Problem ROI Release of information SX Symptoms T Theme TCF Telephone call from... TCT Telephone call to... TMF Telephone message from... TMT Telephone message to... TX Treatment VM Voice mail WNL Within normal limits UPD University Police Department
70 Drug/Alcohol Groups Drug/Alcohol Groups are offered periodically. The Drug/Alcohol Program focuses on four components:
Orienting members to the group (see Appendix) 69* Assessing level of usage and potential for addiction (see Appendix). 70* Providing education on the physical and mental effects of the substance. 71* Recognizing and preventing potential addiction. 72* Creating awareness of available rehabilitative services. 73* Making Referrals to outside providers for treatment as needed (see Appendix)
Professional standards of confidentiality are observed.
Personal Growth Programs
Counseling Services sponsors four student seminars per year on developmental topics. This programming requires that counselors leave their office to venture into the academic and student community to provide relevant activities, programs and services to meet the needs of the student. Outreach programming consists of personal growth seminars on topics such as: Skills for Student Success, Drug and Alcohol Issues, Relationships, Skills for Career Success, Communication, Diversity, Domestic Violence, Sexual Assault Prevention, and Time/Stress Management. Workshop topics are relative to national college trends.
In addition to student seminars, counselors conduct special workshops or presentations for campus and community groups. Section 17: APPENDICES
Appendix actual FORM PD-109 DIVISION OF HUMAN RESOURCES REVISED 10/02
NORTH CAROLINA AGRICULTURAL AND TECHNICAL STATE UNIVERSITY
REQUEST FOR LEAVE
EMPLOYEE:______DATE: ______
Leave is hereby being requested for the period specified below. This form is to be filed with departmental leave information and made available for review by this office for audit purposes. Information on leaves taken should be submitted to the Department of Human Resources on the PD-113 or PD-110.
VACATION LEAVE: DATES ______TOTAL HOURS ______(FROM) (THRU)
If less than a day indicate time: TIME ______
(FROM) (THRU)
SICK LEAVE: DATES ______TOTAL HOURS: ______
If less than a day indicate time. TIME ______(FROM) (THRU)
BONUS LEAVE: DATES ______TOTAL HOURS:______
72 If less than a day indicate time. TIME: ______(FROM) (THRU)
OTHER LEAVE: ______DATES: ______TOTAL HOURS:______
______Applicant’s Signature Supervisor’s Signature Date
LEAVE MUST BE REQUESTED AND APPROVED BY SUPERVISOR IN ADVANCE; EXCEPTION- EMERGENCIES.
VACATION LEAVE May be taken by permanent employees in units of not less than 15 minutes. Accumulated on a monthly basis, leave in excess of 240 hours on December 31 will revert to sick leave on January 1 of each calendar year. May be used for personal leave, vacation, and absences as a result of adverse weather conditions.
SICK LEAVE May be taken by permanent employees in units of not less than one hour. No maximum accumulation, it is cumulative indefinitely. May be used for illness or injury, medial appointment, and temporary disability connected with child bearing. May be used for death in the immediate family. (Family is wife, husband, mother, father, sister, brother, daughter, son, mother-in-law, father-in-law, daughter-in-law, son-in-law, grandmother, grandfather, granddaughter, grandson, stepmother, stepfather).
BONUS LEAVE Bonus leave should be taken only upon authorization of the agency supervisor/department head. Full-time employees who work less than 12 months receive a pro rata amount of the 80 hours. Permanent part-time employees (half-time or more) receive a pro rata amount of the 80 hours. Bonus leave may be used for any purpose for which regular vacation leave is used. Bonus leave should be charged in units of time consistent with regular vacation leave guidelines. The employee should determine whether to charge approved leave to regular vacation leave or bonus leave.
REMINDER
LEAVE OR TIME TAKEN IN EXCESS OF ACCUMULATION WILL BE LEAVE-WITHOUT PAY AND DEDUCTED FROM SALARY CHECKS. THIS MAY CAUSE DELAYS IN PAYROLL CHECKS OR CANCELLATION OF CHECKS.
CONTACT YOUR SUPERVISOR FOR QUESTIONS Or
HUMAN RESOURCES 334-7862
74 What Is Group Counseling Really Like?
Groups are typically composed of 5-8 members who meet weekly for 1-1 ½ hours. The issues discussed in the group are generated by the group members, with guidance and facilitation by a trained group leader(s). Some of our groups are time-limited and topic-focused. Other groups are open-ended and not focused on a particular topic. Confidentiality among group members is always required.
What Are The Advantages Of Group Counseling? A group provides opportunities to learn with and from other people and to understand your own patterns of thoughts and behaviors (as well as those of others). A group is an opportunity to receive genuine support, honest feedback, and useful alternatives from peers. A group is an opportunity to experiment with and work toward new attitudes and new ways of coping with life's stressors. A group may also help individuals deal with relationship concerns and general difficulties in dealing with other people.
For What Types Of Concerns Is Group Counseling Most Helpful?
Group counseling is especially helpful for the following types of student concerns:
"My relationships with others are unsatisfactory, very frustrating, and/or disappointing."
"People don't react to me the way I would like them to."
"I feel stuck in a particular pattern or role in my relationships with others."
"I feel lonely and unsupported. Others don't seem to understand me."
"I lack assertiveness. I either don't address differences and disagreements or my disagreements with others turn into hostile conflict."
"I want to change my thoughts and feelings about myself."
Group counseling is one of the most direct ways to provide the type of contact needed to work through these concerns.
One Last Thing To Note Students often feel a bit nervous or uncomfortable with the idea of joining a group. It's important to remember that the group leader is aware of this and will work with the group to make the environment supportive and safe. Remember that pursuing or confronting the things that make us most anxious can sometimes be the most beneficial way to help us change. GROUP INTEREST FORM
North Carolina A&T State University’s Counseling Services has an extensive group therapy program. Many students overlook groups, feeling that they will not be able to have their needs met through this format. You are strongly encouraged to consider one of the many groups offered at Counseling Services, and, more often than not, you can begin ongoing counseling in a group with little wait. If the issues you are struggling with are interpersonal (relational) at all, many times group therapy is the preferred mode of treatment and can address your needs in ways individual therapy cannot. Please check any group or groups you might be interested in joining. If you would like Counseling Services to offer a group that is not listed, please offer your suggestions at the bottom of this form.
RELATIONSHIP GROUPS Interpersonal Issues Group Dysfunctional Family Lesbian Interpersonal Group Couples Enhancement Women's Relational Group Dating Managing Relationship Conflict Gay Men's Concerns Men's Issues Group
SUPPORT GROUPS Dissertation Thesis Women Of color Men of Color Inter-Racial Couples First Generation College Students International Students Chronic Pain/Disabilities Non-Traditional Students Single Parenting Bi-Sexual Support Group New Directions (Drug & Alcohol Transgender Support Group reduction)
ISSUES Sexual Abuse Sexual Assault Obsessive Compulsive Disorder Adult Children of Alcoholics Bereavement/Grief Depression Management Anxiety Stress Management/Relaxation Training Phobias (Shyness, Public Speaking, etc.) Eating Disorders / Body Image Issues Bipolar Disorder Anger Management
76 Attention Deficit Disorder Combating Perfectionism
GENERAL GROUPS/CLASSES/WORKSHOPS Life-skills: Stress Management & Multicultural Leadership Self-Esteem Eating Awareness Workshop Visualizing Success Personal Issues
Other Suggestions for Groups :
If you would like someone to contact you about a group, please leave us your name and e- mail address.
Name and e-mail address :
Many thanks on behalf of the Counseling Services.
Outreach Request Form
* Required
Title and description of the event (i.e., panel discussion, presentation, etc.) *
Date & Time of Event* : Location*
Duration of the program (i.e., 50 mins)*
Sponsoring organization or department*
Approximate number of attendees expected*
Number of counselors requested
Contact person name*
Contact person e-mail address* Contact person telephone number*
Other Comments
78 NORTH CAROLINA A&T STATE UNIVERSITY – COUNSELING SERVICES Sign-in Sheet
Please Print Legibly C NAME L EMAIL ADDRESS Banner Id # A S S F r. S o p h . J r. s r. G r a d . 21 @aggies.ncat.edu 950 .
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