WOMEN S RECOVERY CENTER 25 Beulah Road New Britain, Pennsylvania VOLUNTEER APPLICATION NAME: DATE: ADDRESS: TELEPHONE: EDUCATION:

Size: px
Start display at page:

Download "WOMEN S RECOVERY CENTER 25 Beulah Road New Britain, Pennsylvania. 18901 VOLUNTEER APPLICATION NAME: DATE: ADDRESS: TELEPHONE: EDUCATION:"

Transcription

1 25 Beulah Road New Britain, Pennsylvania VOLUNTEER APPLICATION NAME: DATE: ADDRESS: TELEPHONE: EDUCATION: WORK EXPERIENCE: 1.) Why do you want to become a volunteer in the Recovery Center? 2.) How would you like to use your abilities and talents? Are there things that you would not like to do? (Please specify) 3.) How much time do you see yourself having available? When? (Day time, evenings, weekends, etc. 4.) How will a commitment to the Recovery Center fit into your personal schedule? 5.) Do you have previous volunteer experience? If so where? 6.) What reservations do you have about working in the Recovery Center? 7.) Are you in recovery and if so for how long?

2 2. Please list three references: NAME: ADDRESS: PHONE NUMBER: RELATIONSHIP: MAY WE CONTACT THEM? YES NO NAME: ADDRESS: PHONE NUMBER: RELATIONSHIP: MAY WE CONTACT THEM? YES NO NAME: ADDRESS: PHONE NUMBER: RELATIONSHIP: MAY WE CONTACT THEM? YES NO Please return to: Women s Recovery Center C/O Judie Weiss Signature

3 25 Beulah Road New Britain, Pennsylvania PLEDGE OF CONFIDENTIALITY I, do hereby pledge to maintain strict standards of confidentiality and professional ethics. I understand it is the policy of Bucks County Council on Alcoholism and Drug Dependence (The Council) that client information should be respected and protected under all circumstances in order to insure privacy for clients. I am also aware of the provision of the Privacy Act of 1974, and that I may be subject to disciplinary action and criminal prosecution for knowing and willful violations of the Act. I realize that questions about whether someone is or has ever been a client, when asked must be answered noncommittally. I will consult with a supervisor prior to taking any action where there is doubt whether such action in compliance with the Privacy Act. I have been informed that clients who desire information sent to other agencies must so stipulate in writing on a release agreement exactly which information is to be released and that no blanket consent documents will be used. I will make disclosure of client records only to a Council employee who has a legitimate need to know the information in the course of his/her official duties. I know that violations are punishable by fines up to $ for the first offense and that any violation will be cause to terminate my relationship with The Council. I have read and fully understand the above. Signature Signature of Council Representative Date Date

4 25 Beulah Road New Britain, Pennsylvania REFERENCE QUESTIONNAIRE Name of Applicant 1.) How do you view this person s ability to interact with other in a non-judgmental manner? 2.) In your opinion, what are this person s strengths? 3.) What concerns might you have for this person s effectiveness? 4.) Absolute confidentiality is a must. What is you view of this person s ability to work within this framework? 5.) Other comments that would be helpful in placing this individual in our Program? Thank you for your participation in a very necessary process. Please return to: Judie Weiss Delaware Valley Women s Recovery Center 25 Beulah Road New Britain, Pennsylvania

5 25 Beulah Road New Britain, Pennsylvania VOLUNTEER CONTRACT, a Women s Recovery Center Volunteer, and, Women s Recovery Center Manager, do hereby enter into contractual agreement in order to reach the following goals: A. To provide a general understanding of the organization of the Bucks County Council on Alcoholism and Drug Dependence, as well as the Women s Recovery Center. B. To use the skills and resources of the volunteer to the best advantage. In attaining the stated goals, the Women s Recovery Center will provide the volunteer with a network of resources. The Women s Recovery Center staff will: A. Give all volunteers comprehensive education in listening and referral skills. B. Provide training in self-awareness. C. Be available to listen and provide assistance when a problem arises. D. Place the volunteer in tasks that will be rewarding. E. Maintain a supportive relationship with volunteers. F. Will listen to ideas of the volunteer, and be willing to share together in the planning of objectives. The volunteer will help in the attainment of these goals by: A. Attending all required training sessions. B. Attending monthly meetings. C. Demonstrating a sense of responsibility by showing up at agreed times to work. D. Bringing any problems to the Center staff, or the monthly meeting, so that they may be dealt with constructively. E. Developing and maintaining a working relationship with Center and Council staff. F. Sharing ideas and suggestions for the improvement of the program. G. Agreeing to attend workshops and seminars which relate to the skills required of a Women s Recovery Center volunteer whenever possible. H. Being aware that any breach of confidentiality will result in the volunteer s immediate dismissal from the Women s Recovery Center. This contract is subject to review and renewal at regular intervals or at other times desired by either of the undersigned persons. Women s Center Volunteer: I have received a copy of this contract and a copy of the Purpose, Policy and Procedures, and Pledge of Confidentiality. Women s Recovery Center Manager Date

6 PURPOSE, POLICIES AND PROCEDURES PURPOSE: The purpose of the Women s Center Volunteer is to provide residents and community women with a trained network of volunteers who will be able to listen, support, educate and refer those in need of further assistance to the most appropriate resources. POLICY I The Women s Center volunteers will treat all people with dignity and respect, empathy and compassion. Procedure: Volunteers will be: Disciplined Volunteers will maintain an attitude toward all people that reflects their training and commitment. Aware Humble Discreet Volunteers will understand the warning signs of distress and will be knowledgeable of the resources available to help. Volunteers will be aware that there is a perceived power inherent in this Position, and care and caution are needed when working with vulnerable people. Maintaining confidentiality is as important to the integrity of the group as it is to the integrity and dignity of the total program. Volunteers will not discuss persons, cases or contacts openly in the presence of others. POLICY II- CONFIDENTIALITY Volunteers will maintain the trust of the population served, fellow volunteers and Women s Recovery Center staff by keeping information confidential and sharing information ONLY WITH THOSE WHO HAVE A NEED TO KNOW. All volunteers will read, understand and sign a Pledge of Confidentiality. Volunteers will create a friendly and trusting atmosphere where people feel comfortable enough to talk freely. Volunteers will never discuss a particular case with anyone other than professional staff. Such discussions should be for the purpose of problem solving or to share pertinent information. Any outside professionals seeking information about participants or residents will be referred to the Program Manager.

7 POLICY III As a member of the Recovery Center Team, volunteers must remain mindful of NOT WORKING IN ISOLATION. There is a team approach to the care of all participants. Any information that is life threatening or that may, in your judgment, put someone in danger, should be reported to the Women s Center staff immediately. For data collection purposes, volunteers will keep an activity log that will be submitted on a monthly basis. It is incumbent upon all volunteers to create close working relationships with the Women s Center staff so that issues and concerns that fall under the category of mandated reporting are appropriately addressed. POLICY IV - REFERRALS When participants and/or clients are in need of outside referrals, volunteers should discuss resources with the Center staff. It is our policy to give clients three (3) referrals so that people have the opportunity to select resources that are appropriate to their individual circumstances. All volunteers will be given a list of referral resources. Prior to giving out referral information, other than one that is listed, the volunteer must have Center approval. POLICY V - RESPECT, RESPONSIBILITIES AND BOUNDARIES Volunteers are asked to treat each other with respect and loyalty. A volunteer s association with the Women s Recovery Center places volunteers in a trusted and respected position in the community. The reputation of the Women s Recovery Center, in part, rests with the attitudes and behaviors that the volunteers and staff members display while in the community. Procedure: Volunteers are encouraged to bring concerns about another volunteer directly to that person. Resolving problems within the group prevents splitting of loyalties. The Program Manager is available to resolve problems with staff or volunteers. Recognize that if your public behavior reflects the goals of the program, to which you belong, it may reflect negatively on the group as a whole and lead questions to the trustworthiness and credibility of the program. Such circumstances as: Serving alcohol to minors, exhibiting personal abuse of chemicals or alcohol, exhibiting personal instability, or imposing one s personal, religious and/or political views, while associated with the Recovery Center, is inappropriate. THESE CONCERNS COULD JEOPARDIZE THE SUCCESS AND INTEGRITY OF THE PROGRAM. Volunteers should always be mindful of their surroundings. We recommend that you not put yourself in any position where your safety can be jeopardized. It is also recommended that a

8 volunteer not make contact with the children of anyone at the Center, outside of the Women s Recovery Center. Protocol: When a volunteer suspects a case of child abuse, verbal abuse, physical abuse or sexual abuse or neglect, the volunteer must verbally report all details to the Women s Recovery Center Program Manager within 24 hours of obtaining the information. The Program Manager will make the determination as to the reporting of this information to the proper authorities.

9 TRAINING PLAN: For Recovery Coach Positions 1.) ORIENTATION: What is a recovery coach? What is a Life Skills facilitator? Getting acquainted with The Council Purpose, policies and procedures Contract (sign-off) Scheduling, keeping track of your time Daily Activity Log What are the benefits of being a Recovery Center volunteer Review of the Life Skills Program Transportation 2.) TRAITS OF AN EFFECTIVE COACH 3.) EMPATHY VS. SYMPATHY 4.) ACTIVE LISTENING AND COMMUNICATION SKILLS 5.) HOW TO DEAL WITH DIFFICULT PEOPLE 6.) RECOGNIZING THE NEED FOR REFERRAL 7.) RELAPSE PREVENTION Taking care of yourself 8.) BOUNDARIES- professional vs. personal 9.) RESOURCES 10.) WOMENS SPECIAL NEEDS Abuse issues/domestic Violence Legal, custody issues Stigma of motherhood and addiction Childcare issues Employment for one parent family The trainings will be held at the convenience of the majority of volunteers. The total training hour commitment is 24 hours. This could be completed in one weekend, two Saturdays or over a period of 2 weeks at the rate of 2 hours per night, for the initial group of volunteers. Subsequent volunteer trainings will be scheduled throughout the year as needed. No volunteer will begin service until all of the trainings listed above have been completed. A certificate of completion will be given for each training. Each volunteer will be responsible for giving this certificate to Recovery Center Staff for placement in their volunteer file.

10 BENEFITS FOR VOLUNTEERS WOMEN S RECOVERY CENTER Gain satisfaction from helping others Accept a challenge Meet new people Make a difference Learn something new Create change Have fun Discovery your skills and talents Support recovery Give back Feel pride Reinforce your recovery Improve your self-esteem For those working in the chemical dependency field, gain credit hours Instill hope

BATTERER INTERVENTION PROGRAM APPLICATION FOR PROVIDERSHIP

BATTERER INTERVENTION PROGRAM APPLICATION FOR PROVIDERSHIP BATTERER INTERVENTION PROGRAM APPLICATION FOR PROVIDERSHIP Date: / / Name of Program: Address: Telephone Number: ( ) Fax Number: ( ) Email Address: Areas To Be Served: (Counties or Cities) TERMS AND CONDITIONS:

More information

How To Be A Social Worker

How To Be A Social Worker Department of Social Work Standards of Professional and Ethical Behavior The Department of Social Work at the Metropolitan State University of Denver is mandated by the Council on Social Work Education

More information

3. Use and/or abuse of substance is a detractor from the school s primary function of educating its students.

3. Use and/or abuse of substance is a detractor from the school s primary function of educating its students. 1992 6152/7321 POLICY Policy on substance abuse Personnel SUBJECT: POLICY ON SUBSTANCE ABUSE Introduction As our country struggles to combat the growing problem of substance abuse, school systems across

More information

P. O. Box 1520 Columbia, South Carolina 29202. Effective date of implementation: January 1, 2005. Domestic Violence

P. O. Box 1520 Columbia, South Carolina 29202. Effective date of implementation: January 1, 2005. Domestic Violence SOUTH CAROLINA DEPARTMENT OF SOCIAL SERVICES P. O. Box 1520 Columbia, South Carolina 29202 STANDARDS OF CARE FOR BATTERERS TREATMENT Effective date of implementation: January 1, 2005 Domestic Violence

More information

Certified Recovery Support Practitioner (CRSP)

Certified Recovery Support Practitioner (CRSP) Certified Recovery Support Practitioner (CRSP) Applicant Name The Certified Recovery Support Practitioner (CRSP) credential is for mental health consumers who are working or seeking to work in the mental

More information

CALIFORNIA ASSOCIATION FOR ALCOHOL/DRUG EDUCATORS CODE OF ETHICS. Certified Addictions Treatment Counselor (CATC, CATC-I, REGISTRANT, CPS, CCS)

CALIFORNIA ASSOCIATION FOR ALCOHOL/DRUG EDUCATORS CODE OF ETHICS. Certified Addictions Treatment Counselor (CATC, CATC-I, REGISTRANT, CPS, CCS) CALIFORNIA ASSOCIATION FOR ALCOHOL/DRUG EDUCATORS CODE OF ETHICS Certified Addictions Treatment Counselor (CATC, CATC-I, REGISTRANT, CPS, CCS) The following Code of Ethics applies to the following individuals:

More information

Fiscal Policies and Procedures Fraud, Waste & Abuse

Fiscal Policies and Procedures Fraud, Waste & Abuse DORCHESTER COUNTY, MARYLAND Fiscal Policies and Procedures Fraud, Waste & Abuse Adopted August 11, 2009 SECTION I - INTRODUCTION The County Council of Dorchester County, Maryland approved on August 11,

More information

Ridgewater College Student-Athlete Handbook and the Policies and Procedures Manual of the Athletic Department.

Ridgewater College Student-Athlete Handbook and the Policies and Procedures Manual of the Athletic Department. Ridgewater College Student-Athlete Handbook and the Policies and Procedures Manual of the Athletic Department. PHILOSOPHY Membership on an athletic team at Ridgewater College is considered a privilege.

More information

Pacific Medical Centers HIPAA Training for Residents, Fellows and Others

Pacific Medical Centers HIPAA Training for Residents, Fellows and Others Pacific Medical Centers HIPAA Training for Residents, Fellows and Others Summary of Critical Pacific Medical Centers (PMC) HIPAA Policies and Procedures For additional information or questions, please

More information

WHAT HAPPENS NEXT? A guide to the NORTH DAKOTA CHILD PROTECTION SERVICES. This guide is made available by

WHAT HAPPENS NEXT? A guide to the NORTH DAKOTA CHILD PROTECTION SERVICES. This guide is made available by WHAT HAPPENS NEXT? A guide to the NORTH DAKOTA CHILD PROTECTION SERVICES This guide is made available by NORTH DAKOTA CHILD PROTECTION SERVICES CHILDREN AND FAMILY SERVICES North Dakota Department of Human

More information

Child Abuse, Child Neglect:

Child Abuse, Child Neglect: Child Abuse, Child Neglect: What Out of Home Caregivers Should Know if They Are Investigated Written by South Carolina Appleseed Legal Justice Center With editing and assistance from the Children s Law

More information

STUDENT INTERNSHIP MANUAL

STUDENT INTERNSHIP MANUAL Drug and Alcohol Studies CITY COLLEGE OF SAN FRANCISCO HEALTH EDUCATION DEPARTMENT DRUG & ALCOHOL CERTIFICATE PROGRAM STUDENT INTERNSHIP MANUAL HEALTH 79A: BEGINNING FIELDWORK HEALTH 79B: ADVANCED FIELDWORK

More information

PEER MENTOR/ PEER RECOVERY COACH DESIGNATION

PEER MENTOR/ PEER RECOVERY COACH DESIGNATION The Texas Certification Board of Addiction Professionals presents The Texas System for Designation of PEER MENTOR/ PEER RECOVERY COACH DESIGNATION APPLICATION PACKAGE March 2013 TEXAS CERTIFICATION BOARD

More information

3.1. The procedure shall be applicable to all University employees.

3.1. The procedure shall be applicable to all University employees. LINCOLN UNIVERSITY Procedure: Confirmatory Testing for Substance Abuse Procedure Number: HRM 113p Effective Date: October 2008 Revisions: Review Officer: Chief Human Resources Officer 1. Purpose 1.1. It

More information

Code of Conduct. 3. SCOPE: All PHI Air Medical Personnel

Code of Conduct. 3. SCOPE: All PHI Air Medical Personnel Page No. 1 of 8 1. POLICY: This policy defines the commitment that PHI Air Medical, L.L.C (PHI Air Medical) has to conducting our activities in full compliance with all federal, state and local laws. Our

More information

CPRS. Application GRANDPARENTING. VCB P.O. Box 27672 Richmond, VA 23261. Certified Peer Recovery Specialist

CPRS. Application GRANDPARENTING. VCB P.O. Box 27672 Richmond, VA 23261. Certified Peer Recovery Specialist CPRS Certified Peer Recovery Specialist Application GRANDPARENTING VCB P.O. Box 27672 Richmond, VA 23261 VCB CPRS Grandparenting Application April 17, 2015 July 17, 2016 1 DIRECTIONS/CHECKLIST Prior to

More information

Dynamic Physical Therapy & Rehabilitation Center: Employee Records Update Packet Page 1 of 16 Revised: October 6, 2003

Dynamic Physical Therapy & Rehabilitation Center: Employee Records Update Packet Page 1 of 16 Revised: October 6, 2003 Dynamic Physical Therapy & Rehabilitation Center: Employee Records Update Packet Page 1 of 16 Revised: October 6, 2003 The following Employee Records Update Packet is information that is required by our

More information

The way we do business.

The way we do business. a b The way we do business. Our Code of Conduct and Ethics. Our Code of Conduct and Ethics In this Code, the Board of Directors and the Group Executive Board set out the principles and practices that define

More information

THE CHILD ABUSE ASSESSMENT:

THE CHILD ABUSE ASSESSMENT: THE CHILD ABUSE ASSESSMENT: A Guide for Foster Parents Iowa Foster and Adoptive Parents Association Acknowledgements This publication was developed under the guidance of an advisory committee comprised

More information

The Texas Certification Board of Addiction Professionals PEER RECOVERY SUPPORT SPECIALIST

The Texas Certification Board of Addiction Professionals PEER RECOVERY SUPPORT SPECIALIST The Texas Certification Board of Addiction Professionals Presents The Texas System for Certification of PEER RECOVERY SUPPORT SPECIALIST APPLICATION PACKAGE Revised September 2015 Texas Certification Board

More information

Drug and Alcohol Testing

Drug and Alcohol Testing Drug and Alcohol Testing Original Implementation: July 14, 1998 Last Revision: April 15, 2014 It is the policy of Stephen F. Austin State University to promote a safe, healthy and productive learning and

More information

Certified Alcohol & Drug Counselor (CADC) Appendix B. Code of Ethical Standards

Certified Alcohol & Drug Counselor (CADC) Appendix B. Code of Ethical Standards Certified Alcohol & Drug Counselor (CADC) Appendix B Code of Ethical Standards Certified Alcohol & Drug Counselor (CAC) Code of Ethical Conduct Principle 1: Non-Discrimination The counselor shall not discriminate

More information

Certified Tobacco Treatment Specialist

Certified Tobacco Treatment Specialist Certified Tobacco Treatment Specialist Applicant Name The CERTIFIED TOBACCO TREATMENT SPECIALIST is not an independent clinical practice credential and should only be used for work within health care or

More information

MODULE E. Objectives. Laws. Laws and Ethics. N.C. Nurse Aide I Curriculum. Are rules made by the government to help protect the public

MODULE E. Objectives. Laws. Laws and Ethics. N.C. Nurse Aide I Curriculum. Are rules made by the government to help protect the public DHSR/HCPR/CARE NAT I Curriculum - July 2013 1 N.C. Nurse Aide I Curriculum MODULE E Laws and Ethics Objectives Describe ethical conduct. Describe a resident s rights in the nursing home. Give examples

More information

Letter from the Chief Executive Officer and Chairman and the Group Medical Director

Letter from the Chief Executive Officer and Chairman and the Group Medical Director Letter from the Chief Executive Officer and Chairman and the Group Medical Director Every day, millions of people put their trust in International SOS to help them wherever they live or travel. We remain

More information

Family Willows Co-Occurring Substance Abuse and Trauma Treatment Center

Family Willows Co-Occurring Substance Abuse and Trauma Treatment Center Family Willows Co-Occurring Substance Abuse and Trauma Treatment Center Intensive Outpatient Program Participant Handbook Table Of Contents: Welcome..... Page 1 Introduction. Page 1 Staff Page 1 Informed

More information

Client Rights and Responsibilities of the Israeli Social Service Agency (JSSA)

Client Rights and Responsibilities of the Israeli Social Service Agency (JSSA) I. Client Rights and Responsibilities Client Consent and Acknowledgements The Jewish Social Service Agency ("JSSA") is pleased to provide you with services. We will do our best to serve you well. As a

More information

13.4 PHI Air Medical Code of Conduct

13.4 PHI Air Medical Code of Conduct I. PURPOSE PHI Air Medical continually strives to provide high quality emergency care and medical transportation services to our patients, and to maintain high standards of integrity in our dealings with

More information

VETERANS RESOURCE CENTERS OF AMERICA CORPORATE COMPLIANCE PLAN

VETERANS RESOURCE CENTERS OF AMERICA CORPORATE COMPLIANCE PLAN VETERANS RESOURCE CENTERS OF AMERICA CORPORATE COMPLIANCE PLAN COMPLIANCE STATEMENT Veterans Resource Centers of America (VRCOA) is committed to provide the highest quality behavioral health prevention

More information

BOARD CHAIR: 3.0 PROCESS: 3.1 Process for Disclosure 3.1.1 The Hospital will retain the services of an external Ethics Helpline Provider.

BOARD CHAIR: 3.0 PROCESS: 3.1 Process for Disclosure 3.1.1 The Hospital will retain the services of an external Ethics Helpline Provider. 1 of 8 SECTION: TOPICS: Governance APPROVED: Governance: Sept. 29, 2008 APPROVED: Board of Directors: Oct. 6, 2008 MOST RECENT DATE: NEW OR SUPERSEDES: BOARD CHAIR: NEW 1.0 POLICY STATEMENT: It is the

More information

BABCP. Standards of Conduct, Performance and Ethics. www.babcp.com. British Association for Behavioural & Cognitive Psychotherapies

BABCP. Standards of Conduct, Performance and Ethics. www.babcp.com. British Association for Behavioural & Cognitive Psychotherapies BABCP www.babcp.com Standards of Conduct, Performance and Ethics British Association for Behavioural & Cognitive Psychotherapies 2 YOUR DUTIES AS A MEMBER OF BABCP The standards of conduct, performance

More information

Jane Beresford, Psy.D. Licensed Psychologist PSY 16618 (310) 551-8535 Info@DrBeresford.com 15300 Ventura Boulevard, Suite 301

Jane Beresford, Psy.D. Licensed Psychologist PSY 16618 (310) 551-8535 Info@DrBeresford.com 15300 Ventura Boulevard, Suite 301 Patient Information (PLEASE PRINT) Patient Name: _ Today s Date: Patient s SSN: - - DOB: / / Age: Sex: Marital Status (circle): Single Married Separated Divorced Other: Home Address: Email: OK to leave

More information

The Superintendent or designee shall provide training regarding the reporting duties of mandated reporters.

The Superintendent or designee shall provide training regarding the reporting duties of mandated reporters. CHILD ABUSE REPORTING PROCEDURES BP 5141.4 The Governing Board recognizes that the district has a responsibility to protect students by facilitating the prompt reporting of known and suspected incidents

More information

Code of Ethics and Conduct

Code of Ethics and Conduct Introduction: Vale s mission is to transform natural resources into prosperity and sustainable development, aiming to be the number one global natural resources company in creating long term value, through

More information

NDSU Community Counseling Services Clinic

NDSU Community Counseling Services Clinic NDSU Community Counseling Services Clinic Handbook Of Policies and Procedures Developed Fall 2005 By Doctoral Seminar Students Reviewed and edited By Counseling Program Faculty and Adopted on April 1,

More information

Glasgow Kelvin College. Disciplinary Policy and Procedure

Glasgow Kelvin College. Disciplinary Policy and Procedure Appendix 1 Glasgow Kelvin College Disciplinary Policy and Procedure Document Control Information Status: Responsibility for Document and its implementation Responsibility for document review: Current version

More information

Criminal Justice Counselor

Criminal Justice Counselor Criminal Justice Counselor Applicant Name Scope of Service: The Criminal Justice Counselor is designed for the entry-level counselor. Courses required for the CJC can count towards a CADC. It is not a

More information

CODE OF CONDUCT I. POLICY

CODE OF CONDUCT I. POLICY CODE OF CONDUCT American Ambulance continually strives to provide high quality emergency care and medical transportation services to our patients, and to maintain high standards of integrity in our dealings

More information

155 McDonald Drive SW Shirley E. Charette, MS, PA-C

155 McDonald Drive SW Shirley E. Charette, MS, PA-C LAKELAND FAMILY MEDICINE Dennis J. Charette, M.D. 155 McDonald Drive SW Shirley E. Charette, MS, PA-C Carri A. Meiler, MS, PA-C Phone: 330-308-8999 Fax: 330-308-8016 www.lakelandfamilymedicine.com PATIENT

More information

Certified Substance Abuse Counselor (CSAC) Code of Ethics Principle 1: Non-Discrimination Principle 2: Responsibility Principle 3: Competence

Certified Substance Abuse Counselor (CSAC) Code of Ethics Principle 1: Non-Discrimination Principle 2: Responsibility Principle 3: Competence Certified Substance Abuse Counselor (CSAC) Code of Ethics (Adopted from the Code of Ethics of the National Association of Alcoholism and Drug Abuse Counselors - Revised 5/20/95) Principle 1: Non-Discrimination

More information

The guidance 2. Guidance on professional conduct for nursing and midwifery students. Your guide to practice

The guidance 2. Guidance on professional conduct for nursing and midwifery students. Your guide to practice The guidance 2 Guidance on professional conduct for nursing and midwifery students Your guide to practice The Nursing & Midwifery Council Vision, mission and values Our vision To safeguard the public by

More information

Guidance on professional conduct. For nursing and midwifery students

Guidance on professional conduct. For nursing and midwifery students Guidance on professional conduct For nursing and midwifery students 1 We are the nursing and midwifery regulator for England, Wales, Scotland, Northern Ireland and the Islands. We exist to safeguard the

More information

CONSULTANT BIOGRAPHY 2013-2014

CONSULTANT BIOGRAPHY 2013-2014 Junior Achievement of Alaska, Inc. 639 W. International Airport Rd., Suite 38 Telephone: 1(907) 344-0101 Toll Free: 1-888-578-0101 Fax: 1(907) 349-5158 aellis@ja-alaska.org CONSULTANT BIOGRAPHY 2013-2014

More information

Riegler Shienvold & Associates (717) 540-1313 2151 Linglestown Road, Suite 200 Harrisburg, PA 17110

Riegler Shienvold & Associates (717) 540-1313 2151 Linglestown Road, Suite 200 Harrisburg, PA 17110 Riegler Shienvold & Associates (717) 540-1313 2151 Linglestown Road, Suite 200 Harrisburg, PA 17110 PROVIDER-PATIENT SERVICES AGREEMENT Welcome to Riegler Shienvold & Associates (RSA). This document (the

More information

Our vision. A company where the best people want to work.

Our vision. A company where the best people want to work. Code of Conduct Our vision A company where the best people want to work. The world leader in chemical distribution, providing unparalleled connectivity between customers and suppliers. 2 Univar s guiding

More information

The faculty of BGSU reaffirms that the following are an accepted part of their responsibilities as teacher-scholars:

The faculty of BGSU reaffirms that the following are an accepted part of their responsibilities as teacher-scholars: Page 1 of 7 SECTION E: ETHICAL RESPONSIBILITIES Faculty members shall follow professional ethical standards in conducting the affairs of the University. These standards are articulated in the Statement

More information

Policies & Procedures

Policies & Procedures 2.2 Drug Free Work Place Adopted 1.24.2003 Revised 3.28.2004; 5.26.2006; 3.2.2011 Reference: WAC 388.805.200(3) POLICY In accordance with "The Drug Free Workplace Act of 1988, The Healing Lodge prohibits

More information

The Code. Professional standards of practice and behaviour for nurses and midwives

The Code. Professional standards of practice and behaviour for nurses and midwives The Code Professional standards of practice and behaviour for nurses and midwives Introduction The Code contains the professional standards that registered nurses and midwives must uphold. UK nurses and

More information

Guidelines Applicability... 2. Guidelines Statements... 2. Guidelines Administration... 4. Management Responsibility... 4

Guidelines Applicability... 2. Guidelines Statements... 2. Guidelines Administration... 4. Management Responsibility... 4 Guidelines Applicability... 2 Guidelines Statements... 2 Guidelines Administration... 4 Management Responsibility... 4 Administrative Data Ownership... 4 Data Custodian Responsibilities... 4 Data User

More information

VOLUNTEER CAMP COUNSELOR/ HEALTH PROFESSIONAL APPLICATION

VOLUNTEER CAMP COUNSELOR/ HEALTH PROFESSIONAL APPLICATION VOLUNTEER CAMP COUNSELOR/ HEALTH PROFESSIONAL APPLICATION Name: Last First Middle Nickname Home Address: Street Address City State Zip Code Male/Female Birthday Age Ethnicity Driver s License Number State

More information

PRINCIPAL APPLICATION PACKET

PRINCIPAL APPLICATION PACKET Archdiocese of Mobile Office of Catholic Schools PRINCIPAL APPLICATION PACKET OFFICE OF CATHOLIC SCHOOLS Archdiocese of Mobile 352 Government Street, Mobile, AL 36602 251.438.4611 Dear Applicant: Thank

More information

PERFORMANCE MANAGEMENT & CORRECTIVE ACTION GUIDELINES

PERFORMANCE MANAGEMENT & CORRECTIVE ACTION GUIDELINES PERFORMANCE MANAGEMENT & CORRECTIVE ACTION GUIDELINES As a supervisor, one of your primary roles is to help employees succeed in their position and coaching them to high levels of performance. Whenever

More information

Once you have read this page, please remove it from the application and keep for your personal reference.

Once you have read this page, please remove it from the application and keep for your personal reference. WELCOME TO NATIONAL CENTER ON INSTITUTIONS AND ALTERNATIVES (NCIA) As you consider a career with NCIA and to gain a better understanding of our agency, please take few minutes to read the following information.

More information

Chatham County Schools Network Acceptable Use Policy Agreement Policy and Forms 3225/7320

Chatham County Schools Network Acceptable Use Policy Agreement Policy and Forms 3225/7320 ACCEPTABLE USE OF VOICE, VIDEO AND DATA NETWORK Policy Code: 3225/7320 Chatham County Schools offers electronic network access for students, teachers, and staff within the school system. A component of

More information

CODE OF CONDUCT FOR PROBATION OFFICERS

CODE OF CONDUCT FOR PROBATION OFFICERS CODE OF CONDUCT FOR PROBATION OFFICERS Probation officers are an extension of the Indiana Judiciary and as such, shall be held to the highest standards of conduct that promote an independent, fair, and

More information

HIPAA Orientation. Health Insurance Portability and Accountability Act

HIPAA Orientation. Health Insurance Portability and Accountability Act HIPAA Orientation Health Insurance Portability and Accountability Act HIPAA Federal legislation enacted in 1996 to improve the efficiency and effectiveness of electronic information transfers used in the

More information

Job Description. Alcohol and Drug Counsellor. Alcohol and Drug Counselor 5/30/2005 Page 1

Job Description. Alcohol and Drug Counsellor. Alcohol and Drug Counselor 5/30/2005 Page 1 Job Description Alcohol and Drug Counsellor 5/30/2005 Page 1 PURPOSE OF THE POSITION (The main reason for the position, in what context and what is the overall end result) The Alcohol and Drug Counsellor

More information

Job Description. Community Social Worker

Job Description. Community Social Worker Job Description 5/30/2005 Page 1 PURPOSE OF THE POSITION (The main reason for the position, in what context and what is the overall end result) The Community Social Services Worker (CSSW) is responsible

More information

Social Media. The Good, The Bad, The Really Ugly

Social Media. The Good, The Bad, The Really Ugly Social Media The Good, The Bad, The Really Ugly Hospitals Using Social Media No longer a luxury it s a necessity Bottom Line It expands our reach to a broader audience Allows us to disseminate health information

More information

Mental Health Resources, Inc. Mental Health Resources, Inc. Corporate Compliance Plan Corporate Compliance Plan

Mental Health Resources, Inc. Mental Health Resources, Inc. Corporate Compliance Plan Corporate Compliance Plan Mental Health Resources, Inc. Mental Health Resources, Inc. Corporate Compliance Plan Corporate Compliance Plan Adopted: January 2, 2007 Revised by Board of Directors on September 4, 2007 Revised and Amended

More information

Sample. Drug and Alcohol Prevention Program. Industrial Code Rule 60

Sample. Drug and Alcohol Prevention Program. Industrial Code Rule 60 Sample Drug and Alcohol Prevention Program Industrial Code Rule 60 Workplace Safety & Loss Prevention Program Building 12, Room 167 W. Averell Harriman Campus Albany, NY 12240 0 TABLE OF CONTENTS Required

More information

Addiction Treatment Strategies

Addiction Treatment Strategies Patient Registration Legal Name First Middle Last Birth Date Address Street City State Zip Phone(s) Home Cell Work Is it ok to contact your cell? Yes No SSN Email (Used for appointment reminder) Known

More information

Basic Manual. Life Skills English version

Basic Manual. Life Skills English version Basic Manual Life Skills English version Contents Preface 5 Why life skills? 6 Why should a WorldCoach care about life skills? 7 How can a WorldCoach contribute to life skills? 8 What role can a WorldCoach

More information

Policy for the Protection of Elders and Dependent Adults

Policy for the Protection of Elders and Dependent Adults Called to Right Relationship Policy for the Protection of Elders and Dependent Adults The Episcopal Diocese of California www.diocal.org/safechurch Policy for the Protection of Elders and Dependent Adults

More information

The Child Abuse Assessment: A Guide for Foster Parents

The Child Abuse Assessment: A Guide for Foster Parents The Child Abuse Assessment: A Guide for Foster Parents Acknowledgements This publication was developed under the guidance of an advisory committee comprised of foster parents, representatives of the Iowa

More information

College Safety Offices. www.ecc.edu 716-851-1ECC

College Safety Offices. www.ecc.edu 716-851-1ECC College Safety Offices North Campus Spring Student Center Room 5 Phone 85-4 South Campus Building 5 Room 5 Phone 85-6 City Campus Main Building Room Phone 85- For emergencies call 76-7-4545 or 9 www.ecc.edu

More information

Children/Youth Workers Application

Children/Youth Workers Application Children/Youth Workers Application Thank you for your interest in working with our children or youth in the Children/Youth Ministries. Please read the enclosed information carefully and complete: After

More information

JEWISH FAMILY SERVICE NOTICE OF PRIVACY PRACTICES

JEWISH FAMILY SERVICE NOTICE OF PRIVACY PRACTICES Jewish Family Service takes pride in treating our clients and each other with respect and dignity. Protecting your health information is very important to us. We want you to have a clear understanding

More information

Providing support to vulnerable children and families. An information sharing guide for registered school teachers and principals in Victoria

Providing support to vulnerable children and families. An information sharing guide for registered school teachers and principals in Victoria Providing support to vulnerable children and families An information sharing guide for registered school teachers and principals in Victoria Service Coordination Tool Templates 2006 reference guide Providing

More information

Policy Statement Regarding an Alcohol and Drug-Free Workplace

Policy Statement Regarding an Alcohol and Drug-Free Workplace Policy Statement Regarding an Alcohol and Drug-Free Workplace Date Revised Date Reviewed Date Issued October 1, 2013 Functional Responsibility Human Resources on the Stockton campus is responsible for

More information

VOLUNTEER PROFILE. Name: (First) (Last) Address: City: State: Zip: Preferred Contact (please check one): Phone: (Home) (Cell) _.

VOLUNTEER PROFILE. Name: (First) (Last) Address: City: State: Zip: Preferred Contact (please check one): Phone: (Home) (Cell) _. Date: VOLUNTEER PROFILE Name: (First) (Last) Address: City: State: Zip: Birthday: Preferred Contact (please check one): Phone: (Home) (Cell) _ Email: Emergency Contact Name: Phone: Relationship to volunteer:

More information

SEXUAL ASSAULT POLICY

SEXUAL ASSAULT POLICY SEXUAL ASSAULT POLICY California State University, Stanislaus is strongly committed to the establishment of an educational environment in which students, faculty, and staff can work together in an atmosphere

More information

Certified Canadian Addiction Counsellor (CCAC) APPLICATION CHECKLIST

Certified Canadian Addiction Counsellor (CCAC) APPLICATION CHECKLIST Certified Canadian Addiction Counsellor (CCAC) APPLICATION CHECKLIST Please complete all the application materials as listed below. The application must be typed or carefully printed, and all requested

More information

AT&T s Code of Business Conduct

AT&T s Code of Business Conduct August 2015 AT&T s Code of Business Conduct To All AT&T Employees Worldwide: The most basic commitment we make to our customers, our shareholders, and each other is to always conduct ourselves in an ethical

More information

Administrative Policy and Procedure Manual. Code of Conduct Effective Date: 1/2005 Scope: Organizationwide Page 1 of 9

Administrative Policy and Procedure Manual. Code of Conduct Effective Date: 1/2005 Scope: Organizationwide Page 1 of 9 Scope: Organizationwide Page 1 of 9 I. Purpose The purpose of this policy is to provide direction to staff members to assist in carrying out daily activities within appropriate ethical and legal standards.

More information

What Happens Next? A PARENTS' A PARENTS GUIDE TO NEW YORK STATE CHILD PROTECTIVE SYSTEM

What Happens Next? A PARENTS' A PARENTS GUIDE TO NEW YORK STATE CHILD PROTECTIVE SYSTEM What Happens Next? A PARENTS' A PARENTS GUIDE TO NEW YORK STATE CHILD PROTECTIVE SYSTEM Revised: April 2012 Adapted by Prevent Child Abuse New York, Inc. from a piece of the same name by Margo Hittleman,

More information

BREINING INSTITUTE 8894 GREENBACK LANE ORANGEVALE, CALIFORNIA USA 95662-4019 TELEPHONE (916) 987-2007

BREINING INSTITUTE 8894 GREENBACK LANE ORANGEVALE, CALIFORNIA USA 95662-4019 TELEPHONE (916) 987-2007 BREINING INSTITUTE 8894 GREENBACK LANE ORANGEVALE, CALIFORNIA USA 95662-4019 TELEPHONE (916) 987-2007 Advanced Credential for the Addiction Professional Forensic Addictions Counselor (FAC) Credential The

More information

Assessing Risk in Social and Behavioral Sciences

Assessing Risk in Social and Behavioral Sciences Tracy Arwood, MS Clemson University Sangeeta Panicker, PhD American Psychological Association Assessing Risk in Social and Behavioral Sciences Assessing Risk in Social and Behavioral Sciences Content Authors

More information

EXECUTIVE ORDER 01.01.1991.16 State of Maryland Substance Abuse Policy

EXECUTIVE ORDER 01.01.1991.16 State of Maryland Substance Abuse Policy 01.01.1991.16 EXECUTIVE ORDER 01.01.1991.16 State of Maryland Substance Abuse Policy A. Definitions. In this Executive Order the following words have the meanings indicated: (1) "Substance" means alcohol

More information

Strategies for occupational therapists to address elder abuse/mistreatment

Strategies for occupational therapists to address elder abuse/mistreatment Strategies for occupational therapists to address elder abuse/mistreatment Provincial Legal Information: Quebec Prepared by the Canadian Association of Occupational Therapists August 2011 This project

More information

Certified Clinical Supervisor (CCS)

Certified Clinical Supervisor (CCS) Certified Clinical Supervisor (CCS) SCOPE OF SERVICE: The Certified Clinical Supervisor credential is intended for use within licensed alcohol and drug counseling programs. The CCS is not a clinical practice

More information

The job performance of each Kennesaw State University staff member should be appraised:

The job performance of each Kennesaw State University staff member should be appraised: Grievances like concerns or complaints regarding allegations of harassment or discrimination on the basis of the criteria listed under the EEO Office should be referred directly to the Kennesaw State Office

More information

Child Abuse, Child Neglect. What Parents Should Know If They Are Investigated

Child Abuse, Child Neglect. What Parents Should Know If They Are Investigated Child Abuse, Child Neglect What Parents Should Know If They Are Investigated Written by South Carolina Appleseed Legal Justice Center with editing and assistance from the Children s Law Center and the

More information

8 Wakeman Rd Fairfield, CT 06824 (203) 255-5078

8 Wakeman Rd Fairfield, CT 06824 (203) 255-5078 Southern Connecticut Christian Counseling Center, Inc. dba R E N E W C O U N S E L I N G A S S O C I A T E S Christian therapists committed to serving you, your family, and your community 8 Wakeman Rd

More information

SAN MATEO COUNTY MENTAL HEALTH SERVICES DIVISION. Assaults on Clients: Suspected or Reported

SAN MATEO COUNTY MENTAL HEALTH SERVICES DIVISION. Assaults on Clients: Suspected or Reported SAN MATEO COUNTY MENTAL HEALTH SERVICES DIVISION DATE: March 22, 2001 MENTAL HEALTH POLICY: MH 01-03 SUBJECT: Assaults on Clients: Suspected or Reported AUTHORITY: California Welfare and Institution Codes

More information

Policy Academy on Cross Boundary Corrections Information Exchange Washington, DC June 17, 2014

Policy Academy on Cross Boundary Corrections Information Exchange Washington, DC June 17, 2014 Privacy Issues for Justice and Health Exchanges: Separating Fact from Fiction Kate Tipping, JD Public Health Advisor, Health Information Technology Center for Substance Abuse Treatment Substance Abuse

More information

Disciplinary and Dismissals Policy

Disciplinary and Dismissals Policy Policy Purpose/statement/reason for being Disciplinary and Dismissals Policy E.G - MIP is designed to strengthen the effectiveness of individual s contribution to the Council s success. Purpose The Disciplinary

More information

Policy and Procedure for Internet Use Summer Youth Program Johnson County Community College

Policy and Procedure for Internet Use Summer Youth Program Johnson County Community College Policy and Procedure for Internet Use Summer Youth Program Johnson County Community College This Policy and Procedures for Internet Use booklet has been prepared for Summer Program students with access

More information

Information about mental wellbeing services in Leeds

Information about mental wellbeing services in Leeds 2013 update Information about mental wellbeing services in Leeds sunny low pressured depressed moderate high cloudy cold stormy thundery changeable settled fine Support in Leeds for you, your friends and

More information

AP 417 Information and Communication Services

AP 417 Information and Communication Services AP 417 Information and Communication Services Background Access and use of information and communication services (ICS) are an integral component of the learning and working environment. The ability for

More information

DIOCESE OF DALLAS. Computer Internet Policy

DIOCESE OF DALLAS. Computer Internet Policy DIOCESE OF DALLAS Computer Internet Policy October 2012 Page 1 ROMAN CATHOLIC DIOCESE OF DALLAS COMPUTER SYSTEMS AND INTERNET USE POLICY Summary Definitions: 1. The term Communication(s) Assets as used

More information

Education Code 26.0091; Family Code 261.111(1)

Education Code 26.0091; Family Code 261.111(1) ANTI- VICTIMIZATION PROGRAM The District shall provide child abuse anti-victimization programs in elementary and secondary schools. Education Code 38.004 DUTY TO REPORT BY ANY PERSON Any person who has

More information

SAN BERNARDINO CITY UNIFIED SCHOOL DISTRICT Employee Technology Acceptable Use Agreement

SAN BERNARDINO CITY UNIFIED SCHOOL DISTRICT Employee Technology Acceptable Use Agreement SAN BERNARDINO CITY UNIFIED SCHOOL DISTRICT is providing employees access to the district s electronic network. This network includes Internet access, computer services, videoconferencing, computer equipment

More information

HIPAA Compliance. 2013 Annual Mandatory Education

HIPAA Compliance. 2013 Annual Mandatory Education HIPAA Compliance 2013 Annual Mandatory Education What is HIPAA? Health Insurance Portability and Accountability Act Federal Law enacted in 1996 that mandates adoption of Privacy protections for health

More information

6.9 Social Media Policy

6.9 Social Media Policy Policy Statement It is the policy of the to encourage clear and effective communication with all Nova Scotians using a variety of accepted tools, including social media. Social media is helping government

More information

Code of Conduct. Code of Conduct

Code of Conduct. Code of Conduct Code of Conduct Code of Conduct Alberta Health Services Code of Conduct Table of Contents Message from the Alberta Health Services Governing Body and the President and Chief Executive Officer...3 A Guide

More information

KEYHAM LODGE SCHOOL CHILD PROTECTION POLICY

KEYHAM LODGE SCHOOL CHILD PROTECTION POLICY KEYHAM LODGE SCHOOL CHILD PROTECTION POLICY Date Reviewed: December 2010 Endorsed by Governors 25/11/09 Review date: Autumn term 2011 Consultation: Dissemination: Headteacher, Deputy Head, Assistant Heads,

More information

5530 SUBSTANCE ABUSE (M)

5530 SUBSTANCE ABUSE (M) Haddonfield 5530 / Page 1 of 10 5530 SUBSTANCE ABUSE (M) The following procedures are established in implementation of Policy No. 5530, Substance Abuse. A. Definitions 1. Evaluation means those procedures

More information

Certified Criminal Justice Professional (CCJP) International Certification and Reciprocity Consortium (IC&RC) Reciprocal Credential

Certified Criminal Justice Professional (CCJP) International Certification and Reciprocity Consortium (IC&RC) Reciprocal Credential Certified Criminal Justice Professional (CCJP) International Certification and Reciprocity Consortium (IC&RC) Reciprocal Credential Applicant Name Scope of Service: The CCJP is an IC&RC reciprocal credential,

More information

Technical Assistance Document 5

Technical Assistance Document 5 Technical Assistance Document 5 Information Sharing with Family Members of Adult Behavioral Health Recipients Developed by the Arizona Department of Health Services Division of Behavioral Health Services

More information