Bereaved Grandparents Consent Form

Date(s)

Group Program – five (5) sessions throughout the year
*This is subject to change and participants will be notified.

Purpose of the Program

This group program aims to provide peer support under the guidance of the facilitator(s). The purpose of this consent form is to ensure you understand what participation involves so you can make an informed decision.

Nature of Participation

• This program may involve psychological education, group discussion and opportunities for peer support.
• Participation is voluntary. You may choose not to actively participate (just listen) or answer certain questions. You are able to withdraw any time from participating in this group and this will not impact upon access to other services or the group in the future.
• This program is not a substitute for individual therapy.
• I understand that I do not have to attend all four (4) sessions for the year and that I can attend the sessions that are the most relevant to me.
• I understand that there may be Master of Psychology students who may attend as part of their placement with the Childhood Cancer Association.

Potential Benefits

• Increased understanding of grief and loss
• Development of new coping strategies and skills
• Peer support from group members.

Potential Risks

• Discussions may involve sensitive or personal topics.
• You may experience emotional discomfort during sessions.
• While all group members are asked to maintain confidentiality, absolute confidentiality cannot be guaranteed in a group setting.
• If you experience distress, you may request a break or follow-up support.

Confidentiality

All personal information gathered during the provision of the group program will remain confidential and secure except when:

1. A court subpoena or other disclosure is required or authorised by law.
2. If there is unauthorised access to data held by the Association, some limited information may need to be shared with the Office of the Information Ombudsman.
3. Failure to disclose the information would place you or another person at risk of harm.
4. You have provided your consent to share your information for a specific reason and purpose.
5. You would reasonably expect your personal information to be disclosed to another professional or agency, and disclosure is directly related to the primary purpose for which it was collected.
6. Clinical consultation with another professional is required to provide better services. If your information is shared in this context, all care is taken to de-identify your information in such a way that you remain anonymous.

Group participants will be reminded to keep shared information private; however, confidentiality between participants cannot be enforced.

Data Collection and Storage

Information collected as part of the program (e.g., attendance, feedback) will be securely stored at the Childhood Cancer Association Office. It is only accessed by the facilitators and as required, by authorised staff and personnel engaged by the Childhood Cancer Association. Your information is stored either in a physical filing cabinet at the Childhood Cancer Association office, and/or on a secure cloud-based storage system.

Consent to Participate

I have read and understand the contents of this consent form and the information provided to me during the consent process. I agree and consent to the above conditions for the attendance of the Bereaved Parents Group provided by the Childhood Cancer Association.