Military & Family Life Counselor Form

The Military Life Counselor can be reached at 910.751.9253.

Subject:  Parent Acknowledgement and Consent Letter for Child and Youth Behavioral Military and Family Life Counseling Services

Dear Parents,

We take this opportunity to inform you of a valuable resource provided by the Department of Defense.  Due to the unique challenges military members face and the impact they have on families, the Office of Military Community and Family Policy provides Child and Youth Behavioral Military Family Life Counselors (CYB-MFLCs).  CYB-MFLCs have advanced degrees (masters or doctoral-level) in the mental health field and specialized training in child and youth development.  They support the needs of children and families by partnering with parents, faculty, counselors and staff to foster healthy growth and social skill development. The well-being and safety of your child is our top priority.  To ensure a comprehensive continuum of care for your child, CYB-MFLCS may work in collaboration with school or program professionals.

CYB-MFLCs address challenging behaviors and strengthen the capacity of staff, families, programs and systems to meet the needs of military children and youth by: 

·         Observing, participating and engaging in classroom activities

·         Developing strategies for supporting positive behavior, age-appropriate behavioral interventions to enhance coping and behavioral skills in the classrooms and at home

·         Meeting one-on-one or in groups, providing evidence-based prevention and intervention services

·         Implementing and modeling strategies for teacher and staff responses to children’s behavior

·         Conducting trainings for staff

·         Facilitating groups to increase parents’ understanding of social emotional development and positive behavior guidance strategies

·         Linking families with community resources or military family programs

·         Working with military children in settings such as field trips and other center, camp, or school sponsored activities.

·         Conducting individual sessions to address the unique challenges of school-aged military children and youth 

At no time will the CYB-MFLC meet individually with a child without being in line of sight of a teacher, staff, or a parent/guardian.  CYB-MFLCs are mandated reporters and information provided to the CYB-MFLC will be kept confidential, except to meet legal obligations or to prevent harm to self or others.  Legal obligations include requirements of law and DoD or military regulations. Harm to self or others includes suicidal thought or intent, a desire to harm oneself, domestic violence, child abuse or neglect, violence against any person, and any present or future illegal activity.  The CYB-MFLC is obligated to follow school and military child and youth programs' regulations for reporting safety concerns including problematic sexual behaviors in children and youth.

CYB-MFLCs encourage the participation of parents in decisions that affect their children and strive to empower parents with the knowledge and skills to act in their children’s best interest. CYB-MFLCs are flexible and can schedule appointments, meetings and activities after hours and on weekends, if needed, with advance notice. They are available to meet with individuals and families who have interest in seeking consultation about their child or family.

Thank you for allowing us to provide support services to your child/children.

Acknowledgement of Understanding: 

I understand the role of the CYB-MFLC and that they may work in collaboration with school or program professionals to ensure a comprehensive continuum of services. I also understand that the CYB-MFLCs are mandated reporters as outlined above.

Please select applicable boxes below: 

I understand the above CYB-MFLC program description and authorize my child to participate in CYB-MFLC direct face-to-face non-medical counseling sessions. This authorization is valid for the duration of my child’s enrollment and can be revoked at any time in writing.

I understand the above CYB-MFLC program description and authorize my child to participate and be supported as a part of a formal group focused on different topic areas.  This authorization is valid for the duration of my child’s enrollment and can be revoked at any time in writing.

Print Name of Child:                                                                      

Print Name of Parent or Guardian:                                                             

Parent or Guardian Signature: ______________________________      

Date: ______________________