Consent is given to implement strategies to address psychological and behavioral problems identified by the individual and his/her informants. I understand that these services are based on the Positive Behavior Supports Model and will be provided by a trained Behavior Consultant. Behavioral Services provides support to children and adults with intellectual disabilities and mental health or behavioral issues. We will focus on your strengths and will take a pro- active approach to behavioral challenges and emotional wellness.

We will complete a Functional Analysis of the targeted or problem behaviors, which breaks down the possible causes or reasons for the behavior and what you are attempting to gain from the behavior. The strengths assessment of the Functional Analysis helps us gain insight into your strengths, motivation, unique desires, abilities and goals in life. We will collect baseline data, which list the frequency of the targeted or problem behavior. We will develop a Behavior Support Plan (BSP) based on the information gathered. Training will be provided to family, direct support staff and team members on positive ways to prevent or minimize the likelihood of behavioral issues and also ways to address behavior issues effectively when the occur. Ongoing monitoring of the BSP and data collected will help in any redesign of the BSP and training.

Behavioral Services can have benefits and risk. Because feelings will be explored, you may experience sadness, guilt, anger, frustration, loneliness and helplessness. Behavioral Services can also have benefits such as better relationships, solutions to specific problems, and significant reduction in feelings of distress. There are no guarantees of what you may experience.

Any behavior support techniques the limit the individual's human or civil rights must be approved by the person centered planning team and Noble's Human Rights Committee. No aversive techniques may be used.

If you decide to terminate services, the Behavior Consultant will discuss with you and/or the team any needs, and provide appropriate pre-termination services. Suggestions for alternative service providers will be given, and we will take reasonable steps to facilitate a transfer of responsibility to another provider if you need one.

As a Behavior Consultant, I participate in case consultations and supervision to provide excellence in the services I give and in accordance with acceptable professional behavior. I am required to keep records of services I provide. You have a right to a copy of your file at any time. You have the right to request that a copy of your record be made available to anyone at any time at your written request. Your records are maintained in a secure location. Please refer to our Client Rights for more information on record keeping.

Communications between you and I as your Behavior Consultant will be kept confidential. There are specific and limited exceptions to this confidentiality (which include the following) that all clinicians have the duty to report:

1. When there is risk of imminent danger to myself or to another person, the clinician is ethically bound to take necessary steps to prevent such danger.

2. When there is suspicion that another person is being sexually or physically abused or is at risk of such abuse, the clinician is legally required to take steps to protect the child or the adult, and to inform the proper authorities as well as Child Protective Services or Adult Protective Services.

3. When a valid court order is issued for medical records, the clinician and the agency are bound by law to comply.