Missouri Comprehensive Guidance
And Counseling Program:
Responsive Services
PROFESSIONAL SCHOOL COUNSELOR
SMALL GROUP COUNSELING GUIDE
A Professional School Counselor’s Guide to
Planning, Implementing & Evaluating
School-Based Counseling Groups
Developed by Missouri Professional School Counselors and Counselor Educators
with support from the
Missouri Department of Elementary & Secondary Education and the
Missouri Center for Career Education
May, 2015
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Small Group Counseling Module
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Missouri Comprehensive Guidance & Counseling Programs: Linking School Success to Life Success
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May 2015
MISSOURI COMPREHENSIVE GUIDANCE AND COUNSELING PROGRAM
RESPONSIVE SERVICES: SMALL GROUP COUNSELING MODULE
TABLE OF CONTENTS
Introduction ……………………………………………………………………………….………….. 3
Part 1: Overview of Small Group Counseling Module .......................................................... 4
Part 2: Review of School Based Small Group Counseling ..................................................5
Part 3: Organizing the Small Group Counseling Experience ................................................9
Documents for Small Group Counseling Module: .......................................................................................... 12
Document 1: Information for School Personnel
.......................................................................................... 13
Document 2: Needs Assessment/Student Referral Forms (3 Samples)
.................................................... 15
Document 3: Assessment of Students’ Perceived Needs
.......................................................................... 18
Document 4: Student Behavior Rating Form
................................................................................................ 19
Document 5: Action Plan Template
............................................................................................................... 20
Document 6: Screening/Selection Procedures
........................................................................................... 21
Document 7: Informed Consent Forms
......................................................................................................... 24
Document 8: Participant Guidelines/Ground Rules
. .................................................................................... 26
Document 9: Student Passes (3 samples)
.................................................................................................... 27
Document 10: Unit Template
.......................................................................................................................... 30
Document 11: Session Template
................................................................................................................... 31
Document 12: Teacher/Parent/Guardian Follow-up Form
.......................................................................... 32
Document 13: Student Post-Group Follow-Up Interview Form
.................................................................. 33
Document 14: Teacher Pre/Post-Group Perception Form (2 Samples)
..................................................... 34
Document 15: Parent/Guardian Post-Group Perception Form
................................................................... 36
Document 16: Student Post-Group Perception Form
................................................................................. 38
Document 17: Group Summary Form ........................................................................................................... 39
Document 18: Small Group Counseling Guidelines Poster ........................................................................ 40
Part 4: Small Group Counseling Resources ........................................................................ 41
Part 5: Small Group Counseling Sample Units and Sessions ............................................ 43
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May 2015
MISSOURI COMPREHENSIVE GUIDANCE AND COUNSELING PROGRAM
RESPONSIVE SERVICES: SMALL GROUP COUNSELING MODULE
Introduction
The content of the Missouri Comprehensive Guidance and Counseling Program (MCGCP) is based on
the Comprehensive Guidance Curriculum Framework components which include Personal/Social
Development, Academic Development and Career Development. The framework guides all program
activities and follows the premise that student competency in the components strengthens student
achievement and complements learning in other core curriculum areas.
The MCGCP Responsive Services component provides direction for responding to needs within the
school community. Those needs include school, community, state, or national crisis/emergency
situations as well as individual circumstances that require a response. Professional School Counselors
(PSCs) may work with students as a part of the district’s emergency management plan. PSCs may work
with students individually or in small groups. In some situations, it may be necessary for an individual
student to be referred for outside counseling.
The following Responsive Services modules are available: Individual Counseling, Small Group
Counseling, School-Wide Emergency Management; and Referral Policies, Processes, and Procedures.
All materials are available via the DESE Missouri Comprehensive Guidance and Counseling eLearning
Center on the Missouri Center for Career Education (MCCE) website.
(http://missouricareereducation.org/curr/cmd/guidanceplacementG/elearning/
)
The Small Group Counseling Module includes:
Part 1: Overview of Small Group Counseling Module: An explanation of how small group
counseling fits within the Responsive Services Component of Missouri Comprehensive
Guidance Program (MCGCP).
Part 2: Review of School Based Small Group Counseling: Key factors to consider when working
with students in small groups.
Part 3: Organizing the Small Group Counseling Experience: A step-by-step guide to planning,
implementing, and evaluating small groups. Included are forms, documents, and
informational materials to assist in the implementation of each step.
Part 4: Small Group Counseling Resources. This section contains print and electronic materials
for facilitating small groups.
Part 5: Small Group Counseling Units and Sessions: Examples of topic-specific small group
counseling strategies. The sample Units and Sessions provide structured small group
counseling experiences addressing 15 topics of relevance to K-12 students in the three
strands of the Comprehensive Guidance Program: Personal/Social, Academic and
Career Development.
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May 2015
PART 1: OVERVIEW OF SMALL GROUP COUNSELING MODULE
Small group counseling provides students with assistance to improve skills in the areas of
personal/social, academic and career development. Working with students in small groups is one
strategy for helping students become more successful. Students who will benefit from working with the
Professional School Counselor (PSC) in small groups may be recognized through observations during
classroom guidance activities, self-referral, or referral by parents, teachers, and peers.
Small group counseling units and sessions address topics related to personal/social, academic and
career development. The ultimate goal of small group counseling is to assist students with developing
awareness of interpersonal issues, to develop strategies and skills to positively impact their school
achievement and to increase appropriate social interaction skills.
Table 1: Topics of Sample Small Group Counseling Units and Sessions
CONCEPTUAL CATEGORY: PERSONAL AND SOCIAL DEVELOPMENT
Units/Sessions: Personal and Social Development
Pre-K-Grade 2
Grades 3-5
Middle School (6-8)
High School (9-12)
Anger Management
Anger Management
Anger Management
Anger Management
Coping with Life
Changes Unit 1
Coping with Life
Changes Unit 1
Coping with Life
Changes
Coping with Life
Changes
Coping with Life
Changes Unit 2
Coping with Life
Changes Unit 2
Self Awareness
Self Awareness
Self Control
Self Control
New Student (K-12)
CONCEPTUAL CATEGORY: ACADEMIC DEVELOPMENT
Units/Sessions: Academic Development
Pre-K-Grade 2
Grades 3-5
Middle School (6-8)
High School (9-12)
Study Skills
Study Skills Unit 1
Study Skills
Study Skills
Study Skills Unit 2
CONCEPTUAL CATEGORY: CAREER DEVELOPMENT
Units/Sessions: Career Development
Pre-K-Grade 2
Grades 3-5
Middle School (6-8)
High School (9-12)
Career
Career
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May 2015
PART 2: REVIEW OF SCHOOL BASED SMALL GROUP COUNSELING
Types of Groups
The Association for Specialists in Group Work (ASGW) has defined four types of groups:
Task Groups
: application of group strategies that promote the accomplishment of group tasks and
goals, e.g., curriculum development, developing individual educational or social learning plans.
Psycho-educational Groups: application of group strategies that promote typical growth and/or
prevent/remediate transitory difficulties in personal/social, academic, career development
Counseling Groups: application of group strategies to address problems of living that arise in the
lives of students
Psychotherapy Groups: application of group strategies to address consistent patterns of
dysfunctional behaviors and/or distortions.
Psycho-educational and Counseling Groups are the two types of groups addressed by the Responsive
Services Small Group Counseling Module.
Format Considerations for School-Based Groups
Structured vs. Unstructured Groups:
Small groups may be structured or unstructured. School-based groups usually follow a structured
format; the units/sessions in Part 5: Small Group Counseling Units and Sessions
of the Small Group
Counseling Module provide samples of structured groups.
Structured groups are time-limited. They are scheduled for a specified number of sessions, focus
on a single topic, follow a pre-established agenda, and membership is closed. The structure is
pre-set; students provide the content based on their experiences with the topic and the changes
they wish to make in their lives.
Unstructured groups may or may not have a pre-set topic or agenda; the counselor applies a broad
range of techniques to facilitate the process of the group. The groups are usually on-going with
no set begin/end date and membership is open. Unstructured groups require advanced group
leadership skills.
Number of Sessions/Length of Sessions/Scheduling:
The number, length and scheduling of small group counseling sessions will be determined by the
parameters of the school setting. In general, the following guidelines will apply:
Number of sessions
:
Typically six to eight
Length of sessions will depend upon
:
Developmental level/attention span of participants
Schedule of the school
Flexibility of students’ schedules
Factors to consider when scheduling groups
Consult with classroom teachers to establish times for groups
Consider school activities students may miss, such as lunch/recess
Minimize classroom interruptions
Note: The following section serves as a reminder of the elements of school-based small group
counseling. Refer to the group work textbooks you used in your counselor education program for
more detailed information. In addition, you are encouraged to read current small group counseling
literature (see Part 4: Small Group Counseling Resources).
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Group Composition:
Group composition refers to the number and characteristics of participants.
Heterogeneous groups
:
Participants have different needs/problems or characteristics
Develop more slowly and tend to be less cohesive
Homogeneous groups
Participants have same or similar needs/problems or characteristics
Develop more quickly and tend to be more cohesive
Group Size
Recommended group size ranges from 4-10 participants, depending on age of participants and
space available
Commonalities of School Based Small Group Counseling Groups
The structure and composition of school-based groups will be determined by the needs of students;
however most school-based small groups are:
Structured in nature (pre-set structure/strategies designed to address a specific topic)
Homogeneous in terms of participant issues
Homogeneous with respect to the ability to participate in the task and goals of the group
Heterogeneous in terms of personal characteristics
Screening and Selection of Group Members:
Screening
: screening and consideration of student abilities is essential. Some students are not
ready/able/willing to adhere to the norms/expectations of group work. Seek alternative
interventions to meet the needs of students who are not selected
Role Models: each group has at least one positive role model
Age difference: consider maturity of participants
Diversity: include students who have different backgrounds and perspectives
Gender: include both sexes unless topic or developmental levels indicate same-sex group would
be more effective
Compatibility: seek participants who are willing to work with others
Strive to Avoid:
Placing siblings or close relatives in the same group
*Selecting students with behavioral histories that could interfere with the group’s benefits to
other members, e.g., extreme aggression or extreme shyness, deep hostility or
destructiveness (unless the specific behavior is the focus of the group)
*Selecting students who have experienced recent trauma or crisis (unless the trauma or crisis is
the focus of the group)
*These students’ needs may better be met by another type of intervention
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May 2015
Group Dynamics: The Stages
All groups are unique, but the stages of a group are predictable.
Stage 1 Getting acquainted/setting norms/building trust: Participants find their places and grow to
trust themselves, each other and the leader. Psychological safety and connections are two keys
to building trust. Conflict may precede trust, which may be demonstrated by “acting-out” or testing
the leader as part of the process in the first stage. Stage 1 is sometimes called the
“Storming/Norming Stage.”
Stage 2 Working together to accomplish individual and group goals. Two keys to accomplishing
goals are valuing self and others, and believing the group will make a difference. Cohesiveness
and productivity have been established. Stage 2 is sometimes called the “Performing Stage.”
Stage 3 Ending the Group: Closure is attained by reflecting on individual and group
accomplishments. Plans for future growth are enhanced by projecting independent application of
knowledge and skills gained as well as identifying supports to sustain changes. Stage 3 is
sometimes called the “Mourning Stage” because the group members mourn the loss of the group.
The PSC’s leadership responsibilities include:
Facilitating group progress from stage to stage
Understanding the importance of each stage of group development
Protecting and promoting group members’ psychological safety, privacy, and trust
Group Dynamics: Group Norms
There are two types of expectations regarding the interaction of the members and the leader:
Explicit: leader, with members, define specific rules and guidelines
Implicit: unwritten rules or patterns that develop into expectations
The PSC’s leadership responsibility includes:
Acting as the reinforcing agent charged with setting up and maintaining group norms
Modeling group norms
Conducting the Sessions
The PSC’s leadership responsibilities include:
Attending to what’s happening within the group both overtly and covertly
Processing activities and interpersonal interactions
Modeling behaviors
The First Session:
*Session structure may differ depending upon the nature of your group
This is the most important session, when group members either “buy-in” or “opt-out”.
The PSC’s leadership responsibilities include:
o Developing mutual understanding of confidentiality: group members understand that
confidentiality cannot be guaranteed, even though it is an expectation
o Reviewing the purpose and individual goals of the group
o Helping group members determine changes they want to create in their lives
o Encouraging dialogue among group members
o Discussing voluntary participation, policies and procedures
o Ensuring individual group members gain knowledge, skills and strategies: connection
with peers, identifying with the issue, and a sense of belonging
o Establishing the expectation that group members will be completing homework outside
of the group setting
o Processing the experience: What was group like for you? What did you learn about yourself?
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The Middle Sessions:
The trust and safety of group members is maintained.
The PSC’s leadership responsibilities include:
Reviewing confidentiality and ground rules
Checking-in with each group member
Introducing each session’s purpose
Relating new content to past content and improvements group members are experiencing
Processing session and work for next session
Preparing for end-of-group issues
The Last Session:
Group members decide how to apply the skills and information they have learned during the group
process.
The PSC’s leadership responsibilities include:
Reviewing confidentiality: Reinforce that it must continue after the group ends
Resisting the temptation to continue group sessions
Planning time to process: Make a plan for continuation of newly learned skills
Set up a post-group follow-up session (4-6 weeks later) to encourage accountability for goals and
allow the opportunity to share success stories.
Saying good-bye to group members: Plan carefully for processing because there may be a
temptation to minimize the importance of this process. Remember that, even though group members
will continue to see each other, they are saying good-bye to the dynamic that made the group
meaningful for them.
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May 2015
PART 3: ORGANIZING THE SMALL GROUP COUNSELING EXPERIENCE
This section of the Small Group Counseling Module provides steps for planning, implementing, and
evaluating small group experiences for students at all levels. Sample documents are included. It is
important to modify these documents to meet the needs and policies of your district.
The following steps will be helpful when organizing for small group work:
STEP 1. Survey Small Group Counseling Needs and Identify Potential Group Members:
The purpose of a needs assessment is to determine group topics that will benefit students. Three
kinds of surveys will help identify group topics:
1. Teacher/staff surveys to assess their perceptions of student needs
2. Student surveys to assess perceptions of their needs
3. The Missouri Comprehensive Guidance and Counseling Program (MCGCP) Needs
Assessment (See MCGCP Manual).
When needs have been identified, teachers and other school staff are surveyed to identify
students who would benefit from participating in the groups. These hyperlinked documents will
assist you in the small group membership selection process:
Document 1: Information for School Personnel
Document 2: Needs Assessment/Student Referral Forms
Document 3: Assessment of Students’ Perceived Needs
Document 4: Student Behavior Rating Form
STEP 2. Develop Topic-Specific Small Group Counseling Action Plan: Develop a small group
action plan for each group. The Action Plan includes detailed information concerning the group:
description, purpose, rationale, objectives, logistics, risks and safety issues, implementation
procedures, and evaluation. The Action Plan puts in writing the subtle considerations of the
specific group; the PSC uses the plan to guide development and/or selection of units and
sessions. The Action Plan is also an informational document for supervisors and others who may
have questions about school-based small group counseling.
Document 5: Action Plan Template
STEP 3. Publicity: Disseminate information about the small groups to various audiences (e.g.,
teachers, administrators, parents, counselors, students, custodians, bus drivers, school nurse).
Methods of communication may include daily announcements, flyers, newsletters, personal
invitations, e-mails, and/or website postings. Information and forms may also be distributed and
completed at faculty meetings, made available in teacher workroom, faculty lounges, placed in
teacher mailboxes, or placed on the district website as appropriate. See links in Step 1.
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STEP 4. Conduct Pre-Group Interview/Screening: This process informs the student of the
purpose of small group counseling, assesses the student’s readiness and level of interest in
group participation and helps determine group membership. Pre-group screening interviews are
important. Screenings may be conducted individually or as a group discussion.
The purposes of the group screening process may include:
Informing students about the group
o Describe the group.
o Tell students what they may gain from being in the group.
o Tell students about group expectations, including participation and confidentiality.
o Inform students of alternatives if they are not selected for the group
Gauging students’ level of interest and commitment
o Ask students if they are willing to follow expectations and ground rules.
o Ask students to rate their level of interest.
Identifying participants
o Is the student a willing participant?
o Hypothesize whether the student will be satisfied with
Group focus as it relates to personal needs and goals
Other members of the group
The process of working in a group
STEP 5. Select Group Members: The screening interview leads to the selection of participants.
This step aids in predicting the effectiveness of a small group counseling experiences for all
members. There may be pressure to select a particular student for a group, however, the decision
to involve students in any group should be based on the student’s needs and readiness. Offer
other services to students who are not selected.
Document 6: Screening/Selection Procedures
STEP 6. Obtain Informed Consent: Although local policy will determine the level of informed
consent and when it occurs; it is ethical professional practice to obtain informed consent for all
participants in a group. While parental consent is required for minors, it is expected that PSCs
obtain student assent as well.
The informed consent step may occur prior to screening interviews. The consent form should
provide specific information about the small group so that the student/parent/guardian can make
an informed decision about whether or not to participate. Professional school counselors are
ethically required to maintain current knowledge about state/national legislation, local school
board policy, and the American Counseling Association (ACA
), the American School Counselor
Association (ASCA) and Association for Specialists in Group Work (ASGW) Ethical Standards for
legal and ethical guidelines.
Document 7: Informed Consent Forms
Document 8: Participant Guidelines/Ground Rules
STEP 7. Collect Pre-Group Data: Planning ahead for data collection is critical. Before the group
begins, determine the data to collect. Data may be objective (e.g., grades, attendance, office
referrals) and/or subjective (e.g., observations, parental reports, student interviews). Data
collection allows the PSC to design group sessions based on the needs of group members and
also provides information for results-based evaluation. (For more information on data collection
see: The Missouri Comprehensive Guidance and Counseling Program Manual
)
Document 4: Student Behavior Rating Form
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STEP 8. Conduct Sessions:
Document 8: Participant Guidelines/Ground Rules
Document 9: Student Passes (3 samples)
Document 10: Unit Template
Document 11: Session Template
Document 12: Teacher/Parent/Guardian Follow-Up Form
Part 5: Small Group Counseling Sample Units and Sessions
STEP 9. Collect Post-Group Data: Post-group data, in conjunction with pre-group data, measures
individual and group changes. In order to compare data effectively, it is critical to use identical
pre- and post-group data collection criteria and procedures. For example, if you used
Document
4: Student Behavior Rating Form to collect pre-group data, it should be utilized to collect post-
group data as well.
STEP 10. Conduct Post-Group Follow-Up: The follow-up session (4-6 weeks later) encourages
accountability for goals and allows group members the opportunity to share successes and
develop further strategies for working on issues.
Document 13: Student Post-Group Follow-Up Interview Form
STEP 11. Conduct Evaluation: The evaluation may include a comparison of pre- and post data, as
well as results of the follow-up session and surveys of parent and teacher perceptions of the
effectiveness of the group. The PSC may also use data to evaluate the small group counseling
action plan and effectiveness of the unit. A brief report may be useful when reporting results to
teachers, administrators, parents, students, and other stakeholders. (See:
The Missouri
Comprehensive Guidance and Counseling Program Manual for information about evaluation
procedures).
Document 14: Teacher Pre/Post-Group Perceptions Form
Document 15: Parent/Guardian Post-Group Perceptions
Document 16: Student Post-Group Perception Forms
Document 17: Group Summary Form
Adapted from Morganett, R. S. (1990) Skills for living: Group counseling activities for young adolescents.
Champaign, IL: Research Press.
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Documents for Small Group Counseling Module
Document 1. Information for School Personnel
Document 2. Needs Assessment/Student Referral Forms (3 Samples)
Document 3. Assessment of Students’ Perceived Needs
Document 4. Student Behavior Rating Form
Document 5. Action Plan Template
Document 6. Screening/Selection Procedures
Document 7. Informed Consent Forms
Document 8. Participant Guidelines/Ground Rules.
Document 9. Student Passes (3 samples)
Document 10. Unit Template
Document 11. Session Template
Document 12. Teacher/Parent/Guardian Follow-Up Form
Document 13. Student Post-Group Follow-Up Interview Form
Document 14. Teacher Pre/Post-Group Perception Form (2 Samples)
Document 15. Parent/Guardian Post-Group Perception Form
Document 16. Student Post-Group Perception Form
Document 17. Group Summary Form
NOTE: The documents in this module parallel the documents within each of the small group units. Various
components were developed by different teams of professional school counselors over a period of time, and
editing changes made. Therefore, slight differences may be noticed in similar forms, and slight variations may
occur in titles.
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DOCUMENT 1:
INFORMATION FOR SCHOOL PERSONNEL
To: School Personnel
From: ________________, Professional School Counselor
Re: Small Group Counseling
Date: _________________
Complete and return the attached form to the Guidance and Counseling Office no later than
__________.
Our district’s Comprehensive Guidance Program (CGP) helps all students develop skills in the
areas of personal/social, academic, and career development. For those students who need
additional support, we offer individual and/or small group work.
Small group counseling opportunities are offered throughout the year. The groups help students
remove the barriers to their school success, they support and enhance students’ development of
social skills and support and promote students’ educational achievement. I need your input as I
organize groups. As you get to know your students and specific needs arise, small group
counseling may meet the unique needs of individual students.
Please complete the attached form (Document 2: Needs Assessment/Student Referral Forms)
to identify relevant group topics and recommend students for participation in specific groups.
Feel free to suggest additional topics that will benefit your students and their school success.
Please note that small group counseling may not be the best way to meet the needs of every
student. The screening process will help determine the appropriateness of small group
counseling for each student.
Possible small group topics:
Family Changes: Intended for students whose barriers to school success include challenges
related to such life events as divorce, separation, blending families, death, loss, moving, injury,
incarceration, or military deployment. Groups will focus on helping students identify thoughts
and feelings, develop coping strategies and identify support systems that exist in their
environment.
Healthy Choices: Intended for students whose barriers to school success include challenges
related to personal choices such as time management, stress management, personal hygiene,
and unhealthy behaviors. Groups will focus on identifying triggers, building self-esteem and
resilience, and making healthier, alternative choices.
Note: Document 1 may to be used to remind school personnel of the scope of the Comprehensive Guidance
Program and provide descriptions of group topics. Please modify the information to fit the needs of your local
district and development level of your students. It is suggested that Document 1 and
Document 2: Needs
Assessment/Student Referral Forms be used together.
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Interpersonal Issues: Intended for students whose barriers to school success include
relationship challenges related to issues such as bullying, harassment, friendship, conflict
management, respect for individual and group differences, dating and intimacy, dealing with
authority, teen parenting and leadership. Groups will focus on building skills to help students
identify thoughts, feelings and triggers, make healthy choices, exercise tolerance and develop
self-awareness and self-control.
Intrapersonal Issues: Intended for students whose barriers to school success include inner
challenges related to issues such as anger management, stress, test anxiety, grief, depression,
school phobia, esteem, self-acceptance and identity development (gender, culture, sexuality,
values). Groups will focus on developing resilience/coping skills, self-advocacy skills, stress-
reduction techniques and skills to improve self-awareness.
Academic Success: Intended for students whose barriers to school success include
challenges related to academic achievement such as study skills/habits, attendance, decision-
making, problem-solving, goal-setting, and transitions/adjustment to new situations. Groups will
focus on problem-solving techniques; steps involved in goal-setting and decision-making; finding
a connection with school; improving study skills, organizational skills and time management;
decreasing test anxiety; and adapting to change.
Career Exploration: Intended for students whose barriers to school success include
knowledge and understanding of the world of work including: awareness of resources available,
aspirations/goal setting, personal planning, work values, self-assessment, decision-making,
transition, communication styles, work readiness, and work habits. Groups will help students
develop awareness and usage of resources now and in the future. Group activities will help
students gain skills to enter the world of work successfully.
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DOCUMENT 2:
NEEDS ASSESSMENT/STUDENT REFERRAL FORMS
(SAMPLE 1 OF 3)
Teacher’s Name: _____________________________________________________________
Grade Level/Subject: ________________________ Planning Time _________________
As a part of the Responsive Services component of our Comprehensive Guidance and Counseling Program, we
will begin organizing small groups.
Please list the names of students you believe would benefit from any of the following groups. Feel free to suggest
additional topics that will meet the needs of specific students. After we have identified group topics and potential
participants, screening for group membership will begin and members will be selected. Some students may not
be ready to participate in small groups; other interventions may be offered for them. The groups will meet in
the _____________ for approximately ___ weeks. Thank you for your assistance in serving the needs of our
students.
Topic: Family Changes Topic: Healthy Choices Topic: Interpersonal Issues
Students’ Names: Students’ Names: Students’ Names:
____________________________ ____________________________ __________________________
____________________________ ____________________________ __________________________
____________________________ ____________________________ __________________________
Topic: Intrapersonal Issues Topic: Academic Success Topic: Career Exploration
Students’ Names: Students’ Names: Students’ Names:
____________________________ ____________________________ __________________________
____________________________ ____________________________ __________________________
____________________________ ____________________________ __________________________
Suggested Topic: ____________ Suggested Topic: ____________ Suggested Topic: __________
Students’ Names: Students’ Names: Students’ Names:
____________________________ ____________________________ __________________________
____________________________ ____________________________ __________________________
____________________________ ____________________________ __________________________
Preferred Days/Times for students to participate in small group counseling:
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Note: Document 2 includes three samples of Needs Assessment/Student Referral Forms. Any one of the three
may be used in conjunction with Document 1: Information for School Personnel. The samples provide starting
points for you and are intended to be modified to fit the needs of your district. The needs assessment and
referral might be done separately. For example, first conduct a needs assessment to determine priority topics.
After topics are selected, request referrals. This is the first of the three samples.
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DOCUMENT 2:
NEEDS ASSESSMENT/STUDENT REFERRAL FORMS
(SAMPLE 2 OF 3)
We (school counselors) are in the process of organizing small counseling groups and we need your
input. Please identify the topics and students who might benefit from participation in the groups. Small
group counseling topics and meeting times will be determined after reviewing the completed forms.
Each group will meet for approximately _________ minutes, once a week for __________ weeks
Teacher’s Name: _____________ Grade Level/Subject: __________ Planning Time ______
Please list any students who could benefit from the groups listed. Please rate each student’s need; add
comments as appropriate.
Rating Scale: 1 Extremely concerned
2 Moderately concerned
3 Mildly concerned
Name of Group (Description)
Student Name
Rating
Comments
Name of Group (Description)
Student Name
Rating
Comments
Name of Group (Description)
Student Name
Rating
Comments
Name of Group (Description)
Student Name
Rating
Comments
Please list days/times that are convenient for students to be out of your classroom:
_____________________ ___________________ ___________________
_____________________ ___________________ ___________________
Please complete and return to Guidance and Counseling Office by ___________________.
Thank you!
________________________________________________, Professional School Counselor
Note: This is the second of three sample Needs Assessments/Student Referral Forms. Any one of the three
may be used in conjunction with Document 1: Information for School Personnel. This sample is designed for
you to be able to add your own descriptions of each group. In addition, space is provided for the referring
individual to provide a rating of the level of need and to add comments.
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DOCUMENT 2:
NEEDS ASSESSMENT/STUDENT REFERRAL FORMS
(SAMPLE 3 OF 3)
Complete and Return to Guidance and Counseling Office by ______________
Teacher’s Name: _____________________________________________________________
Grade Level/Subject: _____________________________ Planning Time ______________
Please indicate students who may be experiencing barriers to school success in the following areas:
Family Changes: (e.g.,
divorce, separation, blending families, death, loss, moving, injury, incarceration,
or military deployment)
___________________________________________________________________________________
___________________________________________________________________________________
Healthy Choices: (e.g., time management, stress management, personal hygiene, and unhealthy
behaviors)
___________________________________________________________________________________
___________________________________________________________________________________
Interpersonal Issues: (e.g., bullying, harassment, friendship, conflict management, respect for individual
and group differences, dating and intimacy, dealing with authority, teen parenting and leadership)
___________________________________________________________________________________
___________________________________________________________________________________
Intrapersonal Issues: (e.g., anger management, stress, test anxiety, grief, depression, school phobia,
esteem, self-acceptance and identity development)
___________________________________________________________________________________
___________________________________________________________________________________
Academic Success: (e.g., study skills/habits, attendance, decision-making, problem-solving, goal-
setting, and transitions/adjustment to new situations)
___________________________________________________________________________________
___________________________________________________________________________________
Career Success: (e.g., awareness of resources available, aspirations/goal setting, personal planning,
work values, self-assessment, decision-making, transition, communication styles, work readiness, and
work habits)
Note: This is the third of three sample Needs Assessments/Student Referral Forms. Any one of the three
may be used in conjunction with Document 1: Information for School Personnel. This sample provides
referring individuals with examples of problems students might face in each of the group topic areas. This
sample offers the convenience of not having to refer back to Document 1: Information for School Personnel.
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DOCUMENT 3:
ASSESSMENT OF STUDENTS’ PERCEIVED NEEDS
SCHOOL DISTRICT NAME
SCHOOL NAME
GUIDANCE AND COUNSELING
Dear Students:
We need your ideas! We are preparing for the group counseling topics to be addressed this year. Counseling
groups are an opportunity for 4-10 students to come together to learn new skills and/or address concerns about
such areas as relationships, making healthy decisions, dealing with divorce in families, study skills and career
choices. What groups would you be interested in joining? What groups do you think your friends/peers might need
or be interested in joining?
RETURN FORM TO GUIDANCE AND COUNSELING OFFICE BY ________________
Provide Name Only If You Want To Participate In A Group
First/Last Name __________________________________________ Grade Level _________
Group Topics
Please check group topics of interest or need and indicate the
groups in which you want to participate.
This would be a
helpful group
for students
I am interested in
participating in
this group
1. Family Changes (e.g. divorce, re-marriage, birth of a sibling)
2. Self-Control
3. Friendship
4. Anger Management
5. Grief/Loss
6. Courage to Make Healthy and Safe Personal Choices
7. Conflict Resolution
8. Relationships with Adults (parents/teachers/others)
9. Belief in Myself
10. Confronting the Bully
11. Study Skills
12. Motivation to Study and Do My Homework
13. Organizing Myself for Studying and Improving My Grades
14. School Success
15. Decision-makingNow and for the Future
16. Questions about “life”and Growing-Up
Other Topics of Interest (use back if necessary)
Your thoughts and comments about groups:
Thanks for Your Input!
Note: This document is an example of an assessment of students’ perceived needs and/or interest for themselves and their
peers. It may be used in conjunction with a modified version of Document 1: Information for School Personnel. The preferences
indicated by students will be helpful as you determine small counseling group topics to be offered during the current school year.
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DOCUMENT 4:
STUDENT BEHAVIOR RATING FORM
(Adapted from Columbia Public Schools Rating Form)
STUDENT______________________GRADE ________TEACHER __________________________DATE______
Teachers: please indicate areas of concern in the left
hand column.
Counselor: use columns on right side.
Performance Indicators:
(+) = Excellent (/) = Satisfactory (-) = Area of Concern
Teacher
Concerns
(mark with
X)
Student Work Habits/Personal Goals Observed
Counselor
(Modify to fit school marking periods
(e.g. quarters, trimesters)
Marking
Period 1
Marking
Period 2
Marking
Period 3
Marking
Period 4
Marking
Period 5
Academic Development
Follows directions
Listens attentively
Stays on task
Compliance with teacher requests
Follows rules
Manages personal & school property (e.g., organized)
Works neatly and carefully
Participates in discussion and activities
Completes and returns homework
Personal and Social Development
Cooperates with others
Shows respect for others
Allows others to work undisturbed
Accepts responsibility for own misbehavior (e.g., provoking fights, bullying,
fighting, defiant, anger, stealing)
Emotional Issues (e.g., perfectionism, anxiety, anger, depression, suicide,
aggression, withdrawn, low self-esteem)
Career Development
Awareness of the World of Work
Self-Appraisal
Decision Making
Goal Setting
Add Other Concerns:
External Issues (e.g., divorce, death, abuse, socio-economic, incarceration,
deployment)
Other
School Record Data (To be completed by PSC)
Attendance: # of days absent
Attendance: # of days tardy
Discipline: # of referrals
Grades
Note: (See also Document 14: Teacher Pre/Post-Group Perception Form). This document is not limited to a single purposeit may be used in
several ways. In the Small Group Counseling Module, it is suggested as a pre-and post-group measure of students’ behavior. Used in this way,
it forms the basis for evaluating the effectiveness of the group experience. In addition, the form may be used for referral when a referring
individual has multiple concerns about an individual student. The listing of behaviors is valuable in consultation with other professionals, parents
AND students. Modify to fit your needs!
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DOCUMENT 5:
ACTION PLAN TEMPLATE
ACTION PLAN FOR ______________________ GROUP
Group Description and Rationale
Group Topic: Purpose:
Demonstrated Need for Group:
Group Objectives/Key Points (Clear and measurable)
Unit Objectives:
1.
2.
3.
Session Objectives/Key Points
Session 1 Objectives & Key Points
Session 2 Objectives & Key Points
Session 3 Objectives & Key Points
Session 4 Objectives & Key Points
Session 5 Objectives & Key Points
Session 6 Objectives & Key Points
Logistics
Beginning Date: Ending Date: Minimum/Maximum number of participants:
Time(s) and Day(s) of the Week: Length of each session Number of Sessions:
Location: Room Arrangement:
Legal/Ethical/Moral Considerations, Risks and Safety Issues (Refer to ACA, ASCA, and ASGW
Ethical Standards/Best Practices for guidelines)
Psychological Risks (change is always a risk): What specific risks are inherent in this group?
Informed Consent (Necessary? [Yes] How obtained? From Whom?):
Confidentiality (Even though we cannot guarantee confidentiality when group members leave group sessions, we
can encourage it.: To the extent possible, how will confidentiality be addressed and maintained? What will happen
if the trust of confidentiality is broken?)
Document 8: Participant Guidelines/Ground Rules
Procedures
Techniques to be utilized (e.g. role playing, board games, discussion, team-building activities, journaling)
Results-Based Evaluation of Group’s Effectiveness
Results Based Data Collection Procedures: pre/post results & perceptual data; data analysisHow? By whom?
Report Results: Format? (e.g. Narrative, PowerP
oint) To Whom? (e.g. faculty, Board of Education,
Administration)
Note: Develop an Action Plan for each group to be offered. In addition to helping you feel confident as you begin the
groups, written plans prepare you to answer with confidence and competence the hard questions others may ask about the
group process. The Action Plan will prepare you to answer questions from parents, teachers, and administrators. As with all
other forms, modify this to fit your specific situation. (Note: As you type within the template, the “boxes” will expand.)
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DOCUMENT 6:
SCREENING/SELECTION PROCEDURES
This document presents information that is most relevant to screening/selection of members for voluntary
school-based small group work. It is beyond the scope of this document to present all aspects of the
screening/selection process. Consult group work literature for a more complete review. As you plan for
the selection of group members consider the following
:
Your ethical responsibility throughout the screening/selection process.
Not every student will benefit from small group counseling. There may be pressure to select a
particular student for a group, however, the decision to involve students in any group is at the
discretion of the PSC and should be based on the student’s needs and readiness. Consider
offering other services to students who are not selected.
Groups present the opportunity for personal growth.
Groups may have the potential for negative effects.
Individuals who are selected as group members must be able to benefit from group experiences
as well as help others benefit.
Individuals who have the potential for hurting themselves or others must have their needs
addressed in another way.
Preparation
Before you screen or interview new members, it is important to be clear about the following:
Group topic
Group goals
Group tasks
Procedures for accomplishing tasks
Target group (for whom is the group intended?)
Group composition (participants’ grade level, gender, learning style)
Structured versus unstructured group facilitation (see Part 3: Organizing the Small Group
Counseling Experience)
Membership: open versus closed (see Part 3: Organizing the Small Group Counseling
Experience)
Group Action Plan, it will help develop clarity about the group
**For more information on group processes, refer to Part 4: Small Group Counseling Resources
.
Note: The information in this document will guide you through the selection of group members.
Screening/selecting group members is a critical step. It is the PSCs responsibility to educate others about the
need to choose group members carefully. PSCs must strive to ensure that all students will have a successful
group experience. PSCs should also offer alternatives to students who are not selected as group members.
Before you begin: Read/Review: ACA / ASCA / ASGW
Ethical Standards/Best Practices, especially ACA
Standard A.8 Group Work; ASCA Standard A-6 Group Work; and ASGW Best Practices Standard A.7 Group
and Member Preparation. The links will take you to the complete ethical standards/best practices documents for
each organization. If you are not familiar with the Association for Specialists in Group Work (ASGW), you are
encouraged to familiarize yourself with the Training Standards as well as the best practices.
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Pre-Group Screening Interviews
Keep two assumptions in mind throughout the screening process:
The group is an agent of change
Group members’ interactions produce therapeutic results, for self and for other members.
When the group begins, the PSC and each group member must:
Understand and accept the ground rules
Agree to maintain confidentiality
Understand group member responsibility with regard to confidentiality
Understand leader responsibility with regard to confidentiality
Goals of Screening:
To select individuals who will contribute to a climate that maximizes open interaction
between and among group members.
To select individuals who will actively work toward individual and group goals.
Not all students will meet selection criteria. Students who are not selected may feel rejected. It is your
ethical responsibility to talk with them about their non-selection and provide an alternative.
Rosemarie Smead, a leader in school-based group work, has developed the TAP-In” process for pre-
group screening interviews (Morganett, 1990):
Tell student about the group.
Ask student about his or her level of interest/commitment to expectations of group,
Pick participants.
The following lists are examples of the topics you might address during screening. All factors will be
considered when it comes time for the final selection. A “positive” or “negative” response to a question
does not automatically indicate inclusion/exclusion of an individual. Your goal is to pick students who will
benefit themselves as well as others in the therapeutic process of meeting the goals of the group.
ell about the Group:
Describe the group:
Group topic
Meetings: day, time, length of each session, total number of sessions
Expectations of participants: attend every meeting unless there is an illness or an emergency
Reason student is being considered for membership in group .
Participation in the group is voluntary/involuntary.
Tell student what he or she will gain from being in the group
Goals/outcomes
Meet new people and get to know others better
Work on individual as well as group goals.
Learn new skills
Being in a group can be fun.
Tell the student about the expectations of members of a small group.
Attend the group every week
He or she is expected to maintain confidentiality about what occurs in the group.
Everything said in the group stays in the group.
PSC keeps information confidential unless:
Someone (outside the group) is hurting a participant
T
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A group member is hurting someone
A group member is thinking about hurting himself or herself
He or she is expected to participate.
PSC will make sure everyone gets a chance to talk
Listening is a part of participation
Members help others in the group
Members respect and value each other’s situation.
sk the student about his or her interest and commitment
Ask student to explain his or her understanding of what you have said about the group
Ask student what questions he or she has about any part of the group process
Ask student if he or she is interested in the group, and why or why not
Ask if student is seeing another counselor, inside or outside school
Ask if student is willing to adhere to expectations/ground rules (e.g. attendance, confidentiality,
cooperative participation, sharing information about thoughts and feelings related to topic).
Ask student what his or her goals for growth are (or might be).
Ask student to rate his or her interest in participating in the group on a scale of 1-10.
ick members
Is the student willing to participate in the primary tasks of the group?
What is the student’s reason for wanting to be in the group?
Hypothesize whether student will be satisfied with:
The group focus and being able to meet personal needs or goals
Other members in the group
The process of working in a group and an overall enjoyment of group work
Will student be able to apply/transfer group experiences to other life areas/relationships?
Has student experienced a recent crisis or situation that would block participation in this group?
During interview, was student able to interact with you on a personal level?
Are student’s expectations aligned with stated group outcomes/other members’ expectations?
On a scale of 1-10, how motivated is student to participate fully in the group experience?
Final Selection
Unfortunately, there is not a magic formula that will predict any one student’s effectiveness as a group
participant. The T-A-P questions (Morganett, 1990) provide direction and information that must be
balanced with what you know about the group, the student, yourself, your professional wisdom and
intuitive reaction.
Reference:
Morganett, R. S. (1990). Skills for living: Group counseling activities for young adolescents. Chicago: Research
Press.
A
P
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DOCUMENT 7:
INFORMED CONSENT FORMS
(SAMPLE 1 OF 2)
Dear Parent/Guardian:
Our district’s Comprehensive Guidance and Counseling Program emphasizes the importance of academic and life
success for every student. During the school year, students have the opportunity to participate in small groups.
Small group counseling is an excellent way for students to learn skills, develop self-awareness and confidence,
practice new behaviors, and better understand how to effectively deal with some of the issues/concerns life
presents. We have found that when we work with students in groups, they gain support from others who are
experiencing similar situations or who have adjusted well after experiencing a similar situation in the past.
Your child has expressed an interest in participating in a group called __________ which will begin on __________.
The group will focus on helping students identify and understand common thoughts and feelings associated with
the experience of ________________, developing positive coping strategies and learning from the shared
experiences of other students in similar circumstances. This group will meet _____________ for approximately
_________ weeks for _______________ each week. We will meet at different times during the school day to
minimize the content missed in each class. Classroom requirements will take precedence over group participation.
Please understand that participation in the group is completely voluntary and student confidentiality is addressed
and respected. The exception to this is my legal and ethical responsibility to take appropriate action in the case of
an individual intending to do harm to self or others; if abuse or neglect is suspected, if illegal activity is reported to
me or if I am required to do so by a court of law. Please contact me at (____) _________ if you have questions or
desire further information about the group.
In order for your child to participate in this group, district policy requires your signed consent. Please sign, date the
following form and return it to the Guidance and Counseling office by ______________________.
Educationally,
__________________________, Professional School Counselor
Phone Number (___) ________Email Address ____________________Web Site: ______________________
- - - - - - - - - - - - - -cut here, return bottom portion and keep the top portion for your records-
- - - - - - - - - -
Consent/Non-Consent to Participate In Group
Please return to the Guidance and Counseling office by ________________________
I have read the information provided by the Professional School Counselor and have had an opportunity to ask
questions about small group counseling for my child.
___ I give consent for my child to participate in the___________________
group. I understand that participation
is completely voluntary and that classroom requirements take precedence over group participation.
___ I do not give consent for my child to participate in the _______________________________
group.
__________________________________________ ____________________________
Student Name Date
____________________________________ ________________________________ ____________
Parent/Guardian Name Parent/Guardian Signature Date
Note: Document 7 includes two sample documents for obtaining the consent of parents/guardians. The two samples are
similar and offer you the opportunity to modify one or the other or to combine the two. When considering informed consent,
it is important to remember that parents and guardians have the (legal) right to be the guiding voice in students’ lives (Stone,
2005). If a parent does not give consent, accept the decision. It is their right. This is the first of the two samples.
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DOCUMENT 7:
INFORMED CONSENT FORMS
(SAMPLE 2 OF 2)
School Name
Comprehensive Guidance and Counseling Program
Dear Parents/Guardian/Student,
Our district’s Comprehensive Guidance and Counseling Program includes the opportunity for students to
participate in small group counseling experiences. We will be beginning this year’s groups on _______.
Each group will meet once a week for approximately ________ minutes each week. We will rotate the
times that we meet to follow-through on the district’s goal of maximizing your son’s or daughter’s
academic progress. Even though the small group counseling experience will have a positive effect on
your child’s progress, the immediacy of classroom requirements will take precedence over group
participation.
(PSCAdd description of group heree.g.: The anger management group is designed for high school
students who are having trouble managing their anger. We will be discussing not only what triggers
angry outbursts, but also positive ways to control this anger.)
Please note that participation in the group is completely voluntary and confidentiality will be addressed
and respected. Please sign the form below to indicate your consent (or non-consent). Please include
comments that might be beneficial when working with your son or daughter. Complete and return the
consent portion to the Guidance and Counseling office no later than __________. You may contact me
for more information at the number below.
______________________________________, Professional School Counselor
Phone Number: (_____) ______-__________
Email Address _______________________________ Web Site _______________________________
- - - - - - - - - - - - - - - - - - - -- - - - - - - - cut here and return lower portion - - - - - - - - - - - - - - - - - - - - - - - - - -
Consent for Participation in: __________________Group
Please Return to the Guidance and Counseling Office by: ____________________
__________________________________ _____________________________________
Student Name Student Signature* Date
*Students age eighteen and over may or may not be required to have a parent/guardian signature.
I give my consent for my son or daughter to participate in the _____________ Group.
I do not give my consent for my son or daughter to participate in the ____________ Group.
Parent/Guardian (please print
) ___________________________ Phone ______________ e-mail ________
__________________________________________________ __________________
Parent/Guardian Signature Date
Note: This is the second of two samples of informed consent. Note that this sample includes a place for the student’s
signature. In the case of a student who is 18 or older, parental permission may or may not be required. It is incumbent upon
high school PSCs to familiarize themselves with local/state law when considering informed consent for participation of
married students, emancipated students, 18 or older students who are considered dependents by tax code.
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DOCUMENT 8:
PARTICIPANT GUIDELINES/GROUND RULES
Participant Guidelines/Ground Rules for Our Group
The following ground rules are suggestions to help generate additional group ground rules. Group members will
delete and/or add items. It is anticipated that the ground rules will be slightly different for each topic group. The
“Looks Like” and Sounds Like” columns are included in order to allow group members to express in their own
words what each rule means.
“Looks Like”
“Sounds Like
1. All group members understand and respect
confidentiality.
a. Professional School Counselor
b. Group members
2. One person speaks at a time.
3. Everyone has an opportunity to participate
and share.
4. Use only respectful words and responses
5. All group members will treat each other with
respect.
6. Make every effort to be on time
7. All group members are encouraged to
actively participate
8. Group members have the right to pass on an
issue
9. Group members will be encouraged to have
an open mind and accept where other group
members are in their development.
10. Group members will have the opportunity to
develop other guidelines.
11.
12.
Note: Commonly understood ground rules provide group members and the PSC with parameters for monitoring
participation. Ground rules are most effective when they are posted and reviewed at the beginning of each
session. Referencing ground rules helps maintain their importance. Encouraging group members to monitor
participation creates a sense of ownership and facilitates group members’ mutual responsibility for the
effectiveness of the group.
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DOCUMENT 9:
STUDENT PASSES
(SAMPLE 1 OF 3)
Name of District/School
Comprehensive Guidance and Counseling Program
Student Hall Pass
The following student has permission to participate in small group counseling on____________
Date
at ____________ in the Guidance and Counseling Office.
Time
Student’s Name: __________________________________ Class _______________________
Classroom Teachers Name & Signature ____________________ ___________________
Time Student Left Guidance and Counseling Office ________________
Professional School Counselor’s Signature __________________________________________
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Name of District/School
Comprehensive Guidance and Counseling Program
Student Hall Pass
The following student has permission to participate in small group counseling on____________
Date
at ____________ in the Guidance and Counseling Office.
Time
Student’s Name: __________________________________ Class _______________________
Classroom Teacher’s Name & Signature ____________________ ___________________
Time Student Left Guidance and Counseling Office ________________
Professional School Counselor’s Signature __________________________________________
Missouri Comprehensive Guidance and Counseling Programs: Linking School Success with Life Success
Note: This document includes three sample passes. The passes serve three primary purposes: 1. to validate
students’ participation, 2. to serve as a reminder of group meeting times, 3. to verify that students attended the
group session. They may be put in teachers’ mailboxes on the day of the group session. If your district has a
standard form to be used as a “hall pass,” consider other means for reminding teachers and students of group
sessions. (Consider printing the form on brightly colored paper. Use the same color for all passes/reminders of
appointments in the Guidance and Counseling Office.)
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DOCUMENT 9:
STUDENT PASSES
(SAMPLE 2 OF 3)
Name of District/School
Comprehensive Guidance and Counseling Program
Date ______________
To: __________________________ Class/Teacher ___________ ___________________
Please come to your counseling group at ____________ on _________________
(Time) (Date)
Comments:
____________________________________________________________________________
____________________________________________________________________________
Thank you, _________________________________________, Professional School Counselor
PSC’s initials _________________ Time student left group session___________________
Missouri Comprehensive Guidance and Counseling Programs: Linking School Success with Life Success
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Name of District/School
Comprehensive Guidance Program
Date ______________
To: __________________________ Class/Teacher ___________ ___________________
Please come to your counseling group at ____________ on _________________
(Time) (Date)
Comments:
____________________________________________________________________________
____________________________________________________________________________
Thank you, _________________________________________, Professional School Counselor
PSC’s initials _________________ Time student left group session___________________
Missouri Comprehensive Guidance and Counseling Programs: Linking School Success with Life Success
Note: This document differs from the first sample because it specifies participation in small group counseling
and provides a space for your comments and/or reminders of group materials to take to session.
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DOCUMENT 9:
STUDENT PASSES (SAMPLE 3 OF 3)
Name of District/School
Comprehensive Guidance and Counseling Program
Date ______________
To: __________________________ Class/Teacher ___________ ___________________
Please come to:
The Guidance & Counseling Office today at __________ with your teacher’s permission.
The Guidance & Counseling today the last _____ minutes of ______ hour with your
teacher’s permission.
Your counseling appointment at ______________ on ___________________________.
(Time) (Date)
Comments:
____________________________________________________________________________
____________________________________________________________________________
Thank you, ___________________, Professional School Counselor
PSC’s initials _________________ Time student left session ______________________________
Missouri Comprehensive Guidance and Counseling Programs: Linking School Success with Life Success
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Name of District/School
Comprehensive Guidance and Counseling Program
Date ______________
To: __________________________ Class/Teacher ___________ ___________________
Please come to:
The Guidance & Counseling Office today at __________ with your teacher’s permission.
The Guidance & Counseling today the last _____ minutes of ______ hour with your
teacher’s permission.
Your counseling appointment at ______________ on ___________________________.
(Time) (Date)
Comments:
____________________________________________________________________________
____________________________________________________________________________
Thank you, ___________________, Professional School Counselor
PSC’s initials _________________ Time student left session ______________________________
Missouri Comprehensive Guidance and Counseling Programs: Linking School Success with Life Success
Note: This sample may be used as a “generic” pass to the Guidance and Counseling Office.
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DOCUMENT 10:
UNIT TEMPLATE
GROUP TITLE/THEME:
Grade Level(s):
Small Group Counseling Description:
Number of Group Sessions:
Session Titles/Materials:
Session # 1:
Materials needed:
Session # 2:
Materials needed:
Session# 3
Materials needed:
Session # 4
Materials needed:
Session # 5
Materials needed:
Session # 6
Materials needed:
Missouri Comprehensive Guidance and Counseling Program Domain:
Missouri Comprehensive Guidance and Counseling Program GLS:
American School Counselor Association (ASCA) National Standard:
Show-Me Standards: Performance Goals (check one or more that apply)
Goal 1: gather, analyze and apply information and ideas
Goal 2: communicate effectively within and beyond the classroom
Goal 3: recognize and solve problems
Goal 4: make decisions and act as responsible members of society
Outcome Assessment (acceptable evidence):
Summative assessment relates to the performance outcome for goals, objectives and concepts (GLSs).
Assessment may be survey, whip around, action plan, role play and/or other means for students to
demonstrate their ability to apply the concepts in new situations.
Follow Up Ideas & Activities
Implemented by counselor, administrators, teachers, parents, community partnerships
Note: This document (Unit Template) and the next (Session Template) will guide in the planning of counseling
groups. It is a companion to Document 5: Action Plan Template. A written plan guides the development of the
details of issues related to the overall logistics and ethical/legal considerations, while the Unit and Session
templates guide the development of the details of the group-in-action. There may be some overlap; however,
each serves a unique purpose and all three are important to the successful implementation of group counseling
experiences for students. (Note: As you type within the template, the “box” will expand.)
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DOCUMENT 11:
SESSION TEMPLATE
GROUP TITLE:
Session Title: Session # ______of _____
Grade Level: Estimated Time:
Small Group Counseling Session Purpose:
Missouri Comprehensive Guidance and Counseling Domain:
Missouri Comprehensive Guidance and Counseling Program GLS:
American School Counselor Association (ASCA) National Standard:
Materials (include activity sheets and/or supporting resources)
Session (Formative) Assessment
Session Preparation
Essential Questions:
Engagement (Hook):
Procedures
Professional School Counselor Procedures:
1.
2.
3.
4.
Student Involvement:
1.
2.
3.
4.
Follow-Up Activities (Optional)
PSC will provide suggestions for follow-up activities to be implemented by counselor, administrators, teachers,
parents, community partnerships
Counselor reflection notes (completed after the lesson)
STUDENT LEARNING: How will students’ lives be better as a result of what happened during this lesson?
SELF EVALUATION: How did I do?
IMPLEMENTATION PROCEDURES: How did the session work?
Note: This template provides guidelines for developing counseling group sessions outlined in the Unit Template and your
Action Plan. (Note: As you type within the template, the “box” will expand.)
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DOCUMENT 12:
TEACHER/PARENT/GUARDIAN FOLLOW-UP FORM
GROUP TOPIC: _____________________________________ Session # _________
GROUP TOPIC: ___________________________________________ Session # _________
Student’s Name: ___________________________________ Date: ____________________
Today I met with my school counselor and other group members.
Session Goal: _______________________________________________________________
Today we talked about the following information during our group:
Circle one or more items.
Friendship Study Skills Attendance
Feelings Behavior School Performance
Family Peer Relationships Other ________________
Group Assignment:
I will complete or practice the following at school and/or at home before our next session:
_____________________________________________________________________
Our next group meeting will be:
Date: ____________________________ Time: ____________________________
Additional Comments:
Please contact ___________________________, Professional School Counselor at
_____________ if you have further questions or concerns.
Note: The Professional School Counselor has the option of sending this form to teachers/ parents/guardians
after each group session to keep these individuals informed of student’s progress in the group.
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DOCUMENT 13:
STUDENT POST-GROUP FOLLOW-UP INTERVIEW FORM
Follow-up Interviews/Session with Students
Potential Interview Questions:
How are things going?
What specific skills are you practicing now that the group is over?
What was the most useful thing you learned from the group?
What skills would you like to practice?
How are things different for you now?
What is better?
What is in need of improvement?
What progress have you made toward the goals you set for yourself at the end of our group
meetings?
How are you keeping yourself accountable?
What suggestions do you have for future groups?
Rank your overall experience on a scale from 5 1 : ______
5 = Most positive activity in which I have participated for a long time
4 = Gave me a lot of direction with my needs
3 = I learned a lot about myself and am ready to make definite changes
2 = I did not get as much as I had hoped out of the group
1 = The group was a waste of my time
What contributed to the ranking you gave your experience in the group? What could have made
it better?
Note: This document serves as an example of a way to follow students’ success in maintaining changes. It may also be
used as a means for gathering data about students’ perceptions of the effectiveness of the group. Students who participate
in follow-up sessions after a group ends are more likely to maintain the gains made. The Professional School Counselor
(PSC) should make arrangements to talk with group members individually and hold at least one more group session 4-6
weeks after the group has ended. The follow-
up session will enable the PSC to assess how students are doing on their
goals and the successes they are experiencing as a result of the group. Follow-up sessions provide data that will
demonstrate the proven effectiveness of small group counseling.
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DOCUMENT 14:
TEACHER PRE/POST-GROUP PERCEPTION FORM
(SAMPLE 1 OF 2)
Note: The classroom teacher completes Part 1 of this document before students begin group sessions and completes Part 2
after the group has been completed. This process will provide the school counselor with follow up feedback about individual
students who participated in the group.
Sample 1: Individual Student Behavior Rating Form
(Adapted from Columbia Public Schools’ Student Behavior Rating Form)
STUDENT___________________________GRADE __________TEACHER ____________________
DATE: Pre-Group Assessment ___________ Date: Post-Group Assessment _______________
Part 1 - Please indicate rating of pre-group areas of
concern in the left hand column.
Part 2 - Please indicate rating of post-group areas of
concern in the right hand column.
Pre-Group Concerns
Rank on a scale of 5
1
(5=Extreme
3=Moderate
1 = None)
Student Work Habits/Personal Goals Observed
Colleagues, please help
evaluate the counseling
group in which this student participated. Your opinion
is extremely important as we strive to continuously
improve our effectiveness with ALL students.
Post-Group Concerns
Rank on a scale of 5
1
(5=Extreme
3=Moderate
1
= None)
5 4 3 2 1 5 4 3 2 1
Academic Development
Follows directions
Listens attentively
Stays on task
Compliance with teacher requests
Follows rules
Manages personal & school property (e.g., organized)
Works neatly and carefully
Participates in discussion and activities
Completes and returns homework
Personal and Social Development
Cooperates with others
Shows respect for others
Allows others to work undisturbed
Accepts responsibility for own misbehavior (e.g., provoking
fights, bullying, fighting, defiant, anger, stealing)
Emotional Issues (e.g., perfectionism, anxiety, anger,
depression, suicide, aggression, withdrawn, low self-
esteem)
Career Development
Awareness of the World of Work
Self-Appraisal
Decision Making
Goal Setting
Add Other Concerns:
Note: Samples 1 & 2 of Document 14 provide you with examples of two ways to gather data about teachers’ post-group
perceptions of the effectiveness of the group. Sample 1 measures teachers’ perceptions of the changes the student made as a
result of the group experience. Sample 2 measures the teacher’s perceptions of the counseling group as a whole. An
advantage to using form 2 is that it parallels Document 15: Parent/Guardian Post-Group Feedback Form and Document 16:
Student Post-Group Perception Form; thus, making it possible to compare teacher, parent and student perceptions of the group
experience.
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DOCUMENT 14:
TEACHER PRE/POST-GROUP PERCEPTIONS
(SAMPLE 2 OF 2)
TEACHER PRE/POST-GROUP PERCEPTIONS FORM
One or more of your students participated in a small counseling group about _____________. We are
seeking your opinion about the effectiveness of the group e.g., students’ relationship with the
professional school counselor and other participants in the group and your observations of students’
behavioral/skill changes (positive or negative). We appreciate your willingness to help us meet the
needs of all students effectively. The survey is anonymous unless you want us to contact you.
Teacher’s Name (optional): ___________________________________________ Date: _____________
Professional School Counselor’s Name: ___________________________________________________
Small Group Title: ____________________________________________________________________
Before the group started, I hoped students would learn:
___________________________________________________________________________________
___________________________________________________________________________________
While students were participating in the group I noticed these changes in their behavior/attitude
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Using a scale of 5 to 1 (5 =strongly agree and 1=strongly disagree), please circle your opinion about the
following
What do you think?
5=Strongly Agree
3= Neutral
1=Strongly Disagree
Overall, I would rate my students’ experience in the counseling
group as positive.
5
4
3
2
1
Students enjoyed working with other students in the group.
5
4
3
2
1
Students enjoyed working with the counselor in the group.
5
4
3
2
1
Students learned new skills and are using the skills in school
5
4
3
2
1
I would recommend the group experience for other students.
5
4
3
2
1
Additional Comments for Counselor:
Note: This document measures the teacher’s perceptions of the effectiveness of the group as a whole. The
teacher could complete this form after the last group session has been completed.
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DOCUMENT 15:
PARENT/GUARDIAN POST-GROUP PERCEPTION FORM
.
Parent/Guardian Feedback Form
Your student participated in a small counseling group about _____________. Was this group
experience helpful for your student? Following is a survey about your observations of changes (positive
or negative) your student made at home while participating in the group at school and since the group
ended. The survey will help us meet the needs of all students more effectively. The survey is
anonymous unless you want to provide your name for the school counselor to contact you. We
appreciate your feedback.
Professional School Counselor: _____________________________________ Date: _______________
Small Group Title: ____________________________________________________________________
Before the group started, I hoped my student would learn _____________________________________
___________________________________________________________________________________
I’ve noticed these changes in my student’s behavior and/or attitude as a result of participating in the
group:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Using a scale of 5 to 1 (5 =strongly agree and 1=strongly disagree), please circle your opinion
about the following:
What do you think?
5=Strongly Agree
3= Neutral
1=Strongly Disagree
Overall, I would rate my student’s experience in the
counseling group as positive
5
4
3
2
1
My student enjoyed working with the other students in
the group.
5
4
3
2
1
My student enjoyed working with the counselor in the
group.
5
4
3
2
1
My student learned new skills and is using the skills in
and out of school.
5
4
3
2
1
I would recommend the group experience to other
parents whose students might benefit from the small
group.
5
4
3
2
1
Additional Comments:
Note: This cover letter and parent feedback form may be sent home with students after the last group session.
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DOCUMENT 16:
STUDENT POST-GROUP PERCEPTION FORM
(Sample 1 of 2)
STUDENT FEEDBACK FORM
We want your opinion about the effectiveness of your group. We appreciate your willingness to help us
make our work helpful to all students. The survey is anonymous unless you want us to contact you.
My Name (optional): ___________________________________________ Date: __________________
Professional School Counselor’s Name:___________________________________________________
Small Group Title: ____________________________________________________________________
Before the group started, I wanted to learn _________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Because of the group, I have noticed these changes in my thoughts, feelings, actions:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Using a scale of 5 to 1 (5 =strongly agree and 1=strongly disagree), please circle your opinion
about the following:
What do you think?
5=Strongly Agree
3= Neutral
1=Strongly Disagree
Overall, I would rate my experience in the counseling group as:
5
4
3
2
1
I enjoyed working with other students in the group
5
4
3
2
1
I enjoyed working with the counselor in the group.
5
4
3
2
1
I learned new skills and am using the skills in school
5
4
3
2
1
If other students ask me if they should participate in a similar
group, I would recommend that they “give-it-a-try”
5
4
3
2
1
Additional Comments for the Counselor:
Note: This student feedback form may be sent home with group members after the last group session. This
form measures the group member’s perceptions of the overall effectiveness of the group using the same
questions as teachers and parents answer on their feedback forms. Group members complete during the last
session (or the follow-up session if you have one). This is the secondary level form.
click to sign
signature
click to edit
click to sign
signature
click to edit
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DOCUMENT 16:
STUDENT POST-GROUP PERCEPTIONS
(Sample 2 of 2)
STUDENT FEEDBACK FORM
Directions: Please complete the Student Feedback Form after the last group session.
Name: ___________________________________ (optional) Date: ____________________
When I started the group, I wanted to learn about ___________________________________.
Topic of Group
Instructions: Read each sentence. Put a circle around the face that shows how you think and
feel right now about what you learned in the group.
= I agree = I’m not sure = I disagree
_________________________________________________________________________________________
1.
Overall, I would rate my experience in the counseling group as:
= I agree = I’m not sure = I disagree
2.
I enjoyed working with other students in the group
= I agree = I’m not sure = I disagree
3.
I enjoyed working with the counselor in the group.
= I agree = I’m not sure = I disagree
4.
I learned new skills and am using the skills in school.
= I agree = I’m not sure = I disagree
5.
If other students ask me if they should participate in a similar group, I would recommend that they give
it a try
= I agree = I’m not sure = I disagree
Additional comments you would like to share with the counselor:
Note: This feedback form may be sent home with group members after the last group session. This form
measures the group member’s perceptions of the overall effectiveness of the group using the same
questions as teachers and parents answer on their feedback forms. Group members complete during the
last session (or the follow-up session if you have one). This is the elementary level form.
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DOCUMENT 17:
GROUP SUMMARY FORM
(Print on SCHOOL LETTERHEAD)
Comprehensive Guidance and Counseling Program
Small Group Counseling topic/title: ______________________________________________________
Student’s Name ________________________________ Teacher’s Name ________________________
Date: ____________________________________
Dear ____________________________________,
I have enjoyed getting to know your student in our small group counseling sessions. This week was the
last session for our group. During the group sessions we shared information related to a variety of
topics. Below is a list of topics discussed during the group sessions.
Session 1: _______________________________________________________________________
Session 2: _______________________________________________________________________
Session 3: _______________________________________________________________________
Session 4: _______________________________________________________________________
Session 5: _______________________________________________________________________
Session 6: _______________________________________________________________________
Comments from the school counselor about your student’s progress:
Thank you for your support. Please contact me if you have questions or concerns.
Sincerely,
Professional School Counselor
Note: This letter may be sent home with students after the last group session.
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
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DOCUMENT 18:
Small Group Counseling Guidelines Poster
Small Group Counseling Guidelines
1. All participants observe confidentiality.
a. Counselor
b. Student
2. Everyone will be an active listener.
3. Everyone has an opportunity to participate and
share.
4. Use positive language.
5. All participants will treat each other with
respect.
Note: This list may be used as best meets the students’ age/grade level. It could be posted in the room, handed
out to the students, or turned in to a worksheet with space for each group to add their own guidelines.
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Part 4: SMALL GROUP COUNSELING RESOURCES
I. Web Pages for Agencies/Organizations
Missouri Department of Elementary and Secondary Education (DESE):
Guidance and Placement
http://dese.mo.gov/divcareered/guidance_placement_index.htm
Information about career education/guidance in the State of Missouri; site
includes links to other DESE Divisions and national resources.
Missouri Center for Career Education (MCCE)
http://www.missouricareereducation.org/for/content/guidance/responsive.php
Materials related to the Missouri Comprehensive Guidance Program. Check
back often because new resources are added as they become available.
Missouri School Counselor Association (MSCA): State association for
Professional School Counselors (PSC)
http://www.moschoolcounselor.org/
Information and materials related to PSCs and the profession. Includes links to
Missouri Comprehensive Guidance Program