Confidentiality Agreement

Welcome to your support group experience! Group support can be a powerful and valuable venue for growth and self care. I truly want all to be able to benefit from all the group has to offer. In order for this to occur, we need to adhere to some guidelines groups are structured to include the following elements:

 

  • A safe environment in which you are able to feel respected and valued

  • An understanding of group goals and group norms

  • Investment by both your facilitator and members to produce a consistent group experience

  • A safe environment is created and maintained by both the facilitator of a group and its members.

  • Primary ingredients of the group and safety are mutual respect and a chance to create trust.

  • Another primary ingredient for a safe environment has to do with confidentiality. As your group facilitator, I am bound by ethics to maintain confidentiality, as group members are bound by honor to keep what is said in the group in the group.

  • We realize that you may want to share what you are learning with a significant other. This is fine as long as you remember not to talk about how events unfold in group or in any other way compromise the confidentiality of other group members.

  • LIMITS OF CONFIDENTIALITY:  If you are a threat to yourself or others, I will take action by contacting appropriate mental health or law enforcement professionals in order to keep you and others safe.

  • There are a broad range of events that are reportable under child protection statutes. Physical or sexual abuse of a child will be reported to Child Protective Services. When the victim of child abuse is over age 18, reporting is not mandatory unless there are minors still living with the abuser, who may be in danger. Elder abuse is also required to be reported to the appropriate authorities. - If a court of law orders a subpoena of case records or testimony, your facilitator will first assert “privilege” (which is your right to deny the release of your records although this is not available in all states for group discussions).

  • *Confidentiality specifically related to adoption related groups - information shared in this group may never be used or reported to any adoption agency or affiliate as the information may jeopardize an adoption already in process and could compromise a working relationship between clients and agencies.


 

I agree not to discuss any revealing information about group members to anyone outside of the group. This includes names, ages, places of employment or residence, or other information that may lead to a breach in confidentiality.

By submitting this form, I agree not to discuss any revealing information about group members to anyone outside of the group. This includes names, ages, places of employment or residence, or other information that may lead to a breach in confidentiality. I also agree to adhere to other group norms to ensure that the experience is safe and rewarding.

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