Parents/Carers/Social Workers/Teachers Information and Consent Form
for
Face-to-Face and Online Session Working Agreement
Within our service, it is usual for the counsellor / practitioner and the client to have an agreement when working together. The purpose of this is to make sure both the client and the counsellor / practitioner are clear about what to expect. For children who are under the age of 13, this information needs to be shared with the parent/carer/social worker who will be required to sign this consent form for sessions to take place. This form provides you with the agencies policies that will help you understand our processes in supporting your child. Please read the following information. If you have any questions, please feel free to ask the counsellor / practitioner or contact Service Six at the address at the bottom of the page.

Confidentiality and Limits of Confidentiality
Everything discussed within the sessions remains confidential. However, on occasions information will have to be shared with other professionals if:
•	Your child shows intent to seriously harm themselves or others
•	Your child informs their counsellor / practitioner something that leads them to believe that your child is being harmed, or to believe that another child/vulnerable adult is being harmed or is at serious risk of being harmed
•	Your child discloses during their session that they or someone they know has committed a serious crime or show intent to commit a crime
•	Service Six is ordered by a court to disclose information about your child
•	If your child reveals intent to commit an act of terrorism or are dealing in drugs or laundering money or knows of a person who is
You will be made aware of any concerns your child’s counsellor/ practitioner has whenever possible and any subsequent plan of action to deal with the situation. All staff members will follow Service Six Policy regarding safeguarding. This is in line with GDPR 2018 and the BACP Ethical Framework for the Counselling Professions 2018.

                                                        Supervision
Service Six staff members discuss their work with their Supervisor and their Line Manager. This is essential and part of good practice.

                                                         Records & Note Keeping
Service Six staff are required to keep brief notes of ongoing sessions with clients. These are electronic and all files are securely encrypted and stored in accordance with GDPR 2018. After the Support has ended Service Six is legally required to keep client records for 7 years, after which they are destroyed.  If you hold parental responsibility, you have the right to access your child’s notes under the Freedom of Information Act (2000) please contact the referrals email below who will send you a ‘subject access request form’.

                                                         Sessions Face to Face

Each session will be 50 minutes long for face-to-face sessions and the sessions will be on a time and date agreed by yourself and the counsellor/practitioner. If you arrive late for an appointment, the staff member will not be able to extend the time of the session. 
Online Counselling/ Emotional Support
If your counsellor/practitioner must self-isolate, face-to-face sessions will be transferred online. This can be offered online in school if school, online in our Wellingborough offices or in your home.
Online is also offered as a choice for any clients.
You would be agreeing to sessions by telephone call, zoom call or WhatsApp Video call, these will be once a week at a pre-arranged time for up to 45 minutes. 
We will be working from remote locations; we are able to ensure that we are in a confidential space and that each practitioner will not be overheard. We encourage you to think about how you may create a quiet space in a separate room for yourself to be able to take a call.
If during a call, our practitioner is concerned for your safety/wellbeing, we will ask you to seek crisis support and we will offer guidance on how to do this. If you are unable to seek help and we do not feel you are safe, we may need to seek help on your behalf. All staff members will follow Service Six Policy regarding Safeguarding. This is in line with GDPR 2018 and the BACP Ethical Framework for Counselling Professions 2018. 
Missed or Cancelled Appointments
If you need to cancel your child’s appointment, please phone, or text the counsellor/practitioner or the administrative team at Service Six as soon as possible. You will not lose a session if you give us 24 hours’ notice of cancellation. Unless there are exceptional circumstances clients who miss or cancel two sessions with less than 24 hours’ notice will not be offered further sessions and will have to seek a re-referral. 

                                                                     Meeting out of sessions
If you or your child should meet your counsellor / practitioner outside of sessions, they will not speak to you. This is to maintain your child’s confidentiality.
                                                                    Personal conduct
Sessions cannot take place if the client arrives at the session under the influence of alcohol or illegal drugs, nor will sessions continue if a client becomes threatening or violent towards the counsellor/practitioner or intentionally damages any contents of the building.

Consent
I give my permission for my child’s appointed practitioner to consult with, give information to, and receive information from, supervisors and staff at Service Six. I consent for my child to be referred to appropriate persons or organisations by Service Six if additional support is needed. Service Six will always inform you prior to any onward referral. Sometimes we are requested to use photos of client’s artwork/sand play to evidence within reports. All identification is carefully removed.

If you are satisfied with the terms of this agreement, we have discussed, please sign below.
Service Six will keep a copy of this for our records and provide you with a copy for your information.

Parent/Carer/Social Workers Name:	 		

Young Person’s Name:	

		
Signature:

Date:

Service Six Staff Member:

Signature:

Date:

Service Six has a Complaints Policy.
This can be accessed on our Website www.servicesix.co.uk or by leaflets at Sassoon Mews, Wellingborough, NN8 3LT or via email referrals@servicesix.co.uk. Any complaint is responded to within a five-day period. Please contact the Service Six Service Hub team if you require any further information.

Service Six, 15 Sassoon Mews, Wellingborough, Northamptonshire, NN8 3LT W: servicesix.co.uk E: referrals@servicesix.co.uk T: 01933277520/273746 Company Number: 6740611 registered Charity Number: 1132490