There are two forms to be completed. You are currently completing the Critical Support Registration page. At the end, select "Submit" and you will be automatically taken to the Protective Factors Survey form. Upon completion of the second form, selecting "Submit" will send your registration to the Family Educator.

Program Description:  The Mindful Nurturing Parenting Critical Support program is designed to provide individualized education and support to parents/guardians of children ages 0-18. Parents will work with a Family Educator who will guide their participation in the program. An initial consultation will include a strengths and needs assessment to identify goals and objectives for the family. The Family Educator will conduct private one-on-one sessions to assist parents with meeting their goals and offering support when challenges arise. The number of sessions will be limited by the referring agency.

The Family Educator will provide support based on the unique and individualized needs of each family. This may include assisting with identifying sources of stress and creating a plan to improve self-care and coping methods. It may also involve education for dealing with emotions, trauma, and personal growth. The Family Educator may provide coaching and modeling techniques for effective communication, positive discipline, and establishing structure and consistency within the family. The parents may be asked to complete homework assignments to practice specific skills and techniques, and may receive handouts and resources to assist with parenting education and support.

Plumas Rural Services (PRS) Mindful Living – Mindful Nurturing Parenting Critical Support provides private one-on-one counseling and support services to parents to strengthen and build positive parenting practices.  We have a responsibility to all participants to maintain confidentiality.  This includes addresses, phone numbers, records and information shared during counseling sessions with PRS.  PRS has a legal and ethical obligation to protect this information.  A written consent to exchange and/or release information will be obtained any time it is necessary to share/exchange information with other agencies/programs.  There are limited restrictions on confidentiality and these exceptions are listed below:

1.  Mandated Reporting Laws - In the following circumstances, all PRS staff members are required by law to inform legal authorities and potential victims so that protective measures can be taken:

If the PRS staff member believes that the participant is in danger of harming themselves or others;
If the PRS staff member feels there is a reasonable suspicion that a child has been abused or neglected;
If the PRS staff member feels there is a reasonable suspicion that a senior or dependent adult has been abused or neglected

2.  Agency Personnel - Support staff may be privy to client information through case management and scheduling. 

3.  Funding Sources - Mindful Living – Mindful Nurturing Parenting Critical Support is funded through the Plumas County Department of Social Services Child Protective Services which requires periodic reports and audits to ensure compliance.

4.  Court Order - It is our policy to never release client records however; this may be unavoidable under some circumstances.  If you are involved in a court action, you agree to consult with your attorney regarding how this may affect your confidentiality. 

All written and spoken material from any and all sessions is confidential unless written permission is given to release all or part of the information to a specified person(s) or agency (with the exceptions noted above). 

Small Town Concern:  Since this is a small community and counseling is confidential, awkward situations can arise when clients see personnel out in public.  Agency personnel cannot acknowledge clients outside of the office.  This is not meant to be rude or hurtful but rather to protect your privacy.  In the same respect, we would also appreciate privacy out in public, at events, etc.  In addition, if you know people who come to the agency for services, please respect their confidentiality and privacy. 

Cancellation and Missed Appointment Policy:  Scheduled appointment times are reserved especially for you.  If you are unable to keep a scheduled appointment, please cancel at least 24 hours in advance.  If you accumulate 3 no-show appointments or 3 late cancellations your enrollment in this program may be closed.  If chronic cancellations occur, your eligibility will be reassessed and your enrollment in this program may be closed.  We understand life is not always predictable, and having to miss or cancel an appointment is inevitable; please stay in contact regarding your circumstances.  Our office does not provide appointment reminders. 

Not Therapists or Legal Advisors

The Family Educators have extensive training in a wide variety of topics and they each have several certifications and areas of expertise. Their years of providing peer support, teaching, and counseling, along with personal life experience provides them with extensive knowledge of proven techniques, strategies, and lessons learned. However, they are not licensed therapists and they do not provide legal consultation or advice.

Text Messaging Authorization:

By initialing after this paragraph, I authorize PRS staff to communicate with me utilizing text messaging through the cell phone number listed above in my contact information. I understand text messaging is not a secure form of communication as defined by HIPAA and that I do have the right to communicate with PRS staff without using text messaging.  I further understand PRS staff may not read or respond to text messages promptly and I agree to not use text messaging in emergency situations; instead, I will call 911 or visit the nearest emergency room. 

Authorization for Release of Confidential Information

I, {name}, authorize Plumas Rural Services Mindful Living staff to disclose my confidential information to the following individuals and/or agencies: 

I understand the exchange of information will disclose the fact that the named client has received services with Plumas Rural Services and/or the exchanging agency. The exchange of information is required in order to communicate details of the client case plan, mandated requirements, and evaluation of progress and outcomes.

This consent may be revoked only by the undersigned in writing at any time and, if not earlier revoked, this consent expires on:

We would like to know how you currently feel about how things are working in your family.  In the spaces below, please answer all of the questions to the best of your ability and as honestly as possible.  Thank you.

In your own words, please answer the following questions: