Work behind the work (WBW): reflective practice group informed consent agreement The Work Beneath the Work (WBW): Reflective Practice Group Informed Consent AgreementGuidance Documents(Required) I have read the WBW Guidance & Overview Document and understand it. Thoughtful Participation, Professional Discernment, and Self-Support(Required) I understand that WBW is designed to support honest reflection, connection, and professional growth among Change, Inc. clinicians. I also understand that because this space exists within an employment setting, participation requires thoughtful discernment. I agree to be mindful about what I share, how much I share, and how I engage with others, recognizing that healthy vulnerability is welcome, while also respecting the purpose and limits of the group. Finally, I understand that the group is not intended to replace personal therapy, serve as a grievance forum, or create a space where disclosures are entirely separate from my professional role at Change, Inc. I agree to care for myself before, during, and after group as needed, including by using supervision, consultation, personal therapy, reflection, or other supportive resources.Confidentiality and Appropriate Use of Group Content(Required) I understand that WBW is intended to be treated as a confidential professional space within Change, Inc. What is shared in group should not be shared with anyone outside Change, Inc., and should not be repeated or discussed casually with other Change, Inc. staff or group members outside the group itself. I also understand that group confidentiality has appropriate limits. Group-related material may be discussed in individual supervision when it is relevant to my own clinical or professional development, and limited portions of sharing may appear as part of post-group reflection or evaluation, consistent with the purpose and boundaries of WBW. I understand that confidentiality may also need to be limited if a disclosure raises concern about serious risk of harm to self or others, suspected abuse or neglect of a minor, elderly person, or dependent adult, or serious impairment in a clinician’s functioning with clients or within the Change, Inc. environment.Shared Understanding and Agreement(Required) I understand that WBW works best when participants share a clear understanding of its purpose, expectations, boundaries, and confidentiality limits. By signing below, I acknowledge that I have reviewed these expectations and agree to participate in a thoughtful, respectful, and professionally appropriate manner. I understand that I will receive a copy of this agreement after submission, which may be used as a shared point of reference if questions or concerns arise later.Clinician Digital Signature(Required)Type Full NameClinician Email(Required) Enter Email Confirm Email Today's Date(Required) Date of WBW to Which Consent Applies(Required) Δ
