Waiver of Confidentiality
Promise to Maintain Confidentiality
Drug and Alcohol Assessment
As a client of Affordable Counseling and Educational Services
I understand that:
I am responsible and accountable for all acts or threats of violence against another including the identified victim.
I am required to participate in on - going same gender - based group sessions for the period of time determined by the court.
I have been provided a copy of the definitions of physical , emotional, sexual, economic and verbal abuse and the techniques for stopping these types of abuse.
I am aware that the victim will be made aware via the US Mail of my participation in this batterer’s intervention program and they will be provided with a list of community resources to assist them in their recovery.
I am aware that I must attend each session free of the influence of alcohol and drugs and sign a statement regarding such
I am aware that among other things my program will address the issues of gender roles, socialization, the nature of violence, the dynamics of power and control and the effects of abuse on children and others as described and outlined in the course text, Domestic Violence and Anger Management Handbook .
I am aware there is no requirement for concurrent couple or family therapy OR both while in the program.
I am aware that the program will make an initial determination of program benefits at the time of intake for my inclusion in the program, but also on on - going assessment of program benefit for the client. If it is determined the client’s not making satisfactory progress in the program or is detrimental to t he other group members , they may be terminated and referred back to the court for review and referral elsewhere. This determination cannot be based upon the client’s ability to pay as outlined and described on the County approved sliding scale.
I understand that I must adhere to the program policy of attendance requirements as determined by my referring county. If I exceed the number of allowable absences I will be terminated by the program and it will be necessary to be re - referred back into the program before I can resume attending. Further I understand that if terminated I may be required to begin my program anew and not given credit for classes already attended.
I understand that groups are confidential and I am not to divulge the identities of participants or identifying information about them outside of the group. To do so could jeopardize my standing in the program and expose me court/probation sanctions.
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