Full Service Community School Informed Consent for Mental Health Care Services.
Please understand that the School, Administrative staff, and School Nurse are paramount in the school and all emergencies are handled by the Board of Education triage plan and rules and regulations. The FSCS Health Center is a referral-based, appointment-driven environment. Therefore, please read and consent to the following if you wish to register yourself and or your child below for Health Care Services:
I hereby authorize the FSCS Health Center, administrated through Health N Wellness Services, LLC and its Mental Health Staff, to provide me or my minor child whose name appears below, diagnostic evaluation, mental health assessment, and group or individual therapy.
This consent is given in advance of any specific treatment to encourage the Clinical Staff to exercise their best judgment as to the requirements of evaluation, therapy or referrals whichever may be necessary. I acknowledge that no guarantees have been made to me as to the results of the described evaluations and treatment.
A therapist's notes are always kept confidential by the therapist and will not be revealed to others unless there is prior written consent. However, there are exceptions which are listed below:
1. Please note that all Behavioral Health services are for up to 12 weeks. At the end of 12 weeks, your child’s case will be re-evaluated and you will be contacted to discuss whether services will be continued, or discontinued and/or the case may be referred to another agency or clinician.
2. The therapist is required by law to report suspected child abuse or neglect. If a report is made by a clinician the Principal of the school will be notified.
3. If you tell a therapist that you or your child’s intent to harm another person, the therapist must try to protect that person. This may involve telling that person, calling the police or another health care provider and or school administration. Similarly, if you threaten to harm yourself or your child threatens to harm him/herself, the therapist will try to protect you by telling others, like the police, relatives, or other health care providers who can assist in protecting you.
4. If you are involved in certain court proceedings, the therapist may be required by law to reveal information about your or your child’s treatment. These situations include, but are not limited to, child custody disputes, cases where a therapy patient’s psychological condition is an issue, lawsuits or formal complaints against the therapist, civil commitment hearings, and court-ordered treatment.
5. If your health insurance or managed care plan will be paying for the therapist's treatment, you will be required to waive confidentiality so that the therapist can give them information regarding treatment.
6. There will be occasions where the therapist will exchange information with the school administration, teachers, guidance or child study team if they determine the information can benefit the child in the classroom i.e. suggesting techniques that the child can incorporate during the school day s. ( Please understand that your therapist will try to discuss this specific situation with you before any confidential information is revealed) and will reveal only the minimum amount of information that is necessary to foster academic success.
7. Case files may be transferred among clinicians within the Full-Service Community School Health Center.
8.The Full Service Community Schools Health Center work with masters level interns at several universities and colleges in the area including Rutgers, Ramapo, NYU and Columbia, and as such utilizes these interns- who are supervised at the universities and colleges as well as FSCS- to help provide individual and group counseling to the Full Service Community.