Support Group Agreement Confidentiality: • In support groups through CorsoCare, sensitive information about group members will be exchanged. To protect and promote this type of disclosure, CorsoCare follows professional guidelines to maintain confidentiality. Confidentiality, a trust of privacy of communication and information, is a shared responsibility amongst all group members and the leader(s) of the group. It is an integral part of maintaining the safety of the group. • At CorsoCare, group leaders abide by professional, legal, and ethical guidelines of confidentiality established by professional organizations and state law. Legal and ethical exceptions to confidentiality include: 1) danger and/or risk of imminent harm to yourself or specifically identified others (this may be reported to the police or appropriate authorities); (2) child, elder, or dependent adult abuse or neglect; and (3) responses to court order, or subpoena, or as otherwise required by law. • If I discuss risk factors (e.g., suicidal thoughts, homicidal thoughts, self-injury, abuse) in the group session, I am aware that the group leader(s) may follow up with additional questions about these disclosures in order to assess my current risk level. If I am uncomfortable answering these questions in the presence of the group, I can request for this assessment to be completed after the group with the group leader(s). Additionally, I understand that I may be contacted after the group for follow-up by the group leaders. Other assistance may be recommended based upon the level of risk of harm to myself or others. • Confidentiality on the part of group members is not protected by these same standards. Thus, this agreement is an attempt to provide you and your fellow group members with as much protection of confidentiality as possible. It is important to note that confidentiality cannot be guaranteed and depends on fellow group members’ adherence to the following: o What is NOT permissible: I will not disclose to anyone outside the group any information that may help identify another group member. This includes, but is not limited to, names, physical descriptions, biographical information, and specifics of interactions with other group members. o What IS permissible: I may disclose to others outside of the group the fact that I am a group member and attending the support group. I may also disclose personal information about myself with respect to my group experience, including my personal reactions, feedback I have received from other members regarding myself, and any other personal information about myself such as new skills I have learned and changes I have made. • If I breach confidentiality, I understand that I may be asked to leave the group. Participation: • I understand that it is my responsibility for sharing my story and/or reason(s) for attending the support group; no one will force me to talk or reveal anything before I am ready to do so. I also understand, however, that I will receive greater benefit from the group if I engage in regular participation. Consultation/Supervision: • I understand that in order to ensure the effectiveness of the support group, group leader(s) may discuss group material outside of the group with each other and other members of the CorsoCare clinical staff. I also understand that the work of any unlicensed staff is supervised by a licensed senior staff member. Decorum: • I agree to behave respectfully toward all group members in order to maintain the safety of the group. I understand that group members are encouraged to share aspects of their personal identity that are meaningful to them and are expected to be supportive of this sharing by others. Aspects of identity that might be discussed include race, ethnicity, language, nationality, sex, gender identity, sexual orientation, religion, ability, and socioeconomic status. • I agree that I will turn off or silence all cell phones and electronic devices while in the group since they can be disruptive of group time. • I agree to participate in group sober and not under the influence of controlled substances in order to get the most out of the group.