Christian Mental Health Organizations: Christian organizations that provide counseling or mental health services.

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2 What is Sozo? Sozo is a network of professional counselors, churches/organizations offering support groups, churches/organizations offering ministerial/lay counseling, and Christian mental health organizations that offer services from a Christian faith-based perspective. Information about all service providers in the Sozo Network will be included on the Sozo website and in Sozo promotional materials which will serve as a resource to those seeking Christian counseling or emotional support services. Who can join the Sozo Network? Sozo is a network comprised of the following types of service providers: Professional Counselors: Individuals who have received professional level training in counseling and hold at least a master s degree in a clinical field. Professional counselors must carry liability/malpractice insurance, and either be licensed or receiving appropriate supervision. Organizations/Churches Offering Support Groups: Churches/organizations that oversee the facilitation of a support group. The group facilitator is a person the church/organization authorizes to facilitate the group, but s/he may or may not have a degree in counseling. Christian Mental Health Organizations: Christian organizations that provide counseling or mental health services. Ministerial/Lay Counseling: Ministerial/lay counseling offered through a church that provides emotional support and/or Biblical counseling to individuals. These counselors are authorized by the church/organization and receive training and at least monthly supervision through the church/organization; however, they are not individuals who have received a master s degree in a clinical field. In order to join the Sozo Network service providers must a) provide Christian faith-based services, b) offer their services to the community, and c) be in agreement with the Sozo statement of faith and values. Friend of the Sozo Network: An individual/church/organization that does not meet the above criteria but would like to receive updates on Sozo and/or participate in Sozo events such as trainings/workshops, meet and greets, opportunities for clinical peersupport and supervision can become a Friend of the Sozo Network. Why should I join the Sozo Network? Many pastors, Christian leaders, and Christian counselors in CT have expressed a need for a referral source which identifies Christian counselors and emotional support service providers. Often individuals desire Christian counseling, but have a difficult time locating a Christian counselor. The Sozo Network will be a tremendous resource to the Christian community because it will identify Christian counselors and communicate information about their services through the Sozo website and promotional materials. Further, information about this network will be broadly communicated to churches in Greater Hartford. By being part of the Sozo Network, more people will learn about the services you offer and you will have opportunities to meet other Christian counselors. Sozo (σώζω)is the Greek word for salvation, healing, and wholeness. This word is used throughout scripture to describe our salvation in Christ (e.g. Acts 2:47, Ephesians 2:8) and the wholeness that comes through healing (e.g. Mark 5:23, Luke 8:36, Matthew 9:21). It is our prayer that this network helps connect the community to quality Christian counselors and service providers, and that these providers assist people in their journey towards healing and wholeness. How do I join the Sozo Network? Applicants must complete and mail or fax the following forms to the Urban Alliance office (1) Sozo Application Form, (2) Church Reference Form (for professional counselors only), (3) signed Sozo s Statement of Faith, (4) signed Sozo s Values Statement, (5) Types of Sozo Participation Form. Sozo c/o Urban Alliance 750 Main St, Suite 1208 Hartford, CT Fax If you have questions about the Sozo Network please contact Dr. Jessica Sanderson, Director of Research at Urban Alliance at Jessica@UrbanAlliance.com or call ext. 14.

3 Types of Sozo Network Participation Please read the requirements for each type of Sozo Network participation. Indicate how you would like to participate in the Sozo Network (check all that apply): 1. PROFESSIONAL COUNSELOR 2. CHURCH/ORGANIZATION OFFERING A SUPPORT GROUP 3. CHURCH/ORGANIZATION OFFERING MINISTERIAL/LAY COUNSELING 4. CHRISTIAN MENTAL HEALTH ORGANIZATION 5. FRIEND OF THE SOZO NETWORK Professional Counselor: Sozo Member Requirements Master s degree in a clinical field Carry liability/malpractice insurance Either licensed or receiving appropriate clinical supervision Offer Christian faith-based counseling Offer clinical services to people in the community Be in agreement with Sozo s statement of faith Be in agreement with Sozo s values Church/Organization Offering a Support Group: Sozo Member Requirements Be a church/organization that oversees the facilitation of a support group Provide support/supervision to the support group facilitator Offer the support group from a Christian faith-based perspective Open the support group to people in the community Be in agreement with Sozo s statement of faith Be in agreement with Sozo s values Church/Organization Offering Ministerial/Lay Counseling: Sozo Member Requirements Be a church that oversees ministerial/lay counseling Provide support/supervision/training to ministerial/lay counselors Offer counseling from a Christian faith-based perspective Offer counseling to people in the community Be in agreement with Sozo s statement of faith Be in agreement with Sozo s values Christian Mental Health Organization: Sozo Member Requirements Appropriately credentialed organization Offer Christian faith-based counseling/clinical services Offer clinical services to people in the community Be in agreement with Sozo s statement of faith Be in agreement with Sozo s values Friend of the Sozo Network An individual/church/organization that does not meet the criteria to join the network as a professional counselor, organization/church offering a support group, organization/church offering ministerial/lay counseling, or a Christian mental health organization, but would like to receive updates on Sozo and/or would be interested in participating in Sozo events such as trainings/workshops, meet and greets, opportunities for clinical peer-support and supervision etc. Printed Name Signature

4 PROFESSIONAL COUNSELOR APPLICATION 1. Name: 2. Business Address: 3. Phone: 4. Demographic Information 5. Age: 6. Ethnicity: 7. Languages Spoken: 8. Educational Background (school, degrees earned, year): Clinical Information: 9. Types of Service Provided (check all that apply): Individual Therapy Couple/Marital Therapy Family Therapy Group Therapy/Support Groups Psychoeducation Forensic Psychology/Evaluations Other 10. What types of clinical issues, special populations, age groups do you specialize in or feel competent to work with? Clinical Issues: Special Populations: Age Groups: 11. Are there any types of clients you are not comfortable working with? If so, why? 12. Describe more specifically what you do as a counselor. What is your theory of change or the models/theories you use as you work with clients?

5 13.Are you currently licensed? If yes, what license do you hold? Yes No License Type: License Number: 14. Do you currently accept insurance? Yes No If so which policies? 15. Have there ever been any disciplinary actions taken against you as a counselor? Yes No If yes, please explain. 16. Do you carry professional liability/malpractice insurance? Yes No 17. How did you hear about the Sozo Network? 18. What do you hope to offer to and receive from your involvement in it? 19. Indicate which of the following are true about your practice (check all that apply) : I accept Husky (state insurance) My practice is located in an under-resourced area I provide training to lay-ministers or pastors I offer pro bono work I accepting Volunteers In Psychotherapy (VIP) I have received CEU s or trainings that address issues relevant to under-resourced settings or cultural and contextual sensitivity My practice is located on a bus route 20. What types of opportunities would interest you? Workshops/training related to Christian counseling Meeting Christian counselors/service providers Peer-support from other Christian counselors Clinical supervision from a Christian counselor Meeting pastors from local churches looking for referral sources Other:

6 SOZO S STATEMENT OF FAITH Sozo will be guided by our faith-based principles, which are essential to our treatment philosophy and ministry. We believe that THE BIBLE is the inspired, the only infallible, inerrant, authoritative Word of God. We draw from both counseling principles and Scripture as both are important to bringing health and wholeness. We believe that GOD is eternally existent in three persons: Father, Son, and Holy Spirit. He Created the world and humankind and has revealed Himself through his creation, through the Scriptures, and in Jesus Christ. He is Sovereign, Holy, Good, Infinite, Unchanging, All-Knowing, All-Powerful and Everywhere present. We believe in the person and work of JESUS CHRIST, including His deity, virgin birth, sinless life, humanity, miracles, substitutionary death, bodily resurrection, ascension to heaven and His coming personal return. We believe in the present ministry of the HOLY SPIRIT in salvation and by whose indwelling the Christian is enabled to live a godly life and to grow in the knowledge of God, to walk in joy and peace and love and practice of the principles of Scripture. We believe that HUMANITY is created in the image of God, that he rebelled against GOD and is now a sinner by nature and choice. We believe in the resurrection of both the saved and the lost the saved to the resurrection of life eternal with God and the lost to punishment and eternal separation from God. We believe that SALVATION is only by grace through faith in Christ as Savior and King. He is the sole mediator between God and humanity. Good works are a result of and not the means of obtaining God s grace, love and forgiveness. We believe in the UNITY OF BELIEVERS in our Lord Jesus Christ and in the importance of the church community for worship, growth, service and relationships. Please sign below if you agree with this statement of faith. Printed Name Signature

7 SOZO S VALUES Sozo will be guided by our values, which are essential to our treatment philosophy and ministry. Relationship: Relationships matter. By engaging with each other we learn to acknowledge and appreciate our diversity and grow together in unity. Through relationship we develop trust and learn to work together. Accessible Services: Services are not equally accessible to all people. We strive to understand barriers to accessing counseling and mental health services and develop strategies that make services accessible to all people. Supporting Marriage: We value marriage and will work to support, preserve, and enhance marriage between a man and a woman as God s design for the home and society. The Sanctity of Life: We will vigorously work to protect and highly value every person. Please sign below if you agree with these values. Printed Name Signature

8 CHURCH REFERENCE FORM As a Christian Counseling Network it is important that there is a church leader that can attest to your faith in Jesus Christ. Therefore, we include this reference form as part of our application packet. Please have a pastor or significant church leader complete this reference form and mail it to the address listed below. 1. Name of Sozo Network applicant: 2. Name of pastor or church leader completing this form: 3. How many years have you know this applicant? 4. Does the applicant attend your church? Yes No a. If yes, how frequently? 5. To your knowledge, has the applicant ever made a profession of faith and accepted Jesus as their personal Savior? Yes No 6. Does the applicant attempt to consistently live a Christ-centered life? Yes No a. Explain (optional). Signature of person completing this form Please return completed reference form to: Sozo c/o Urban Alliance 750 Main St, Suite 1208 Hartford, CT