In March 2014, Souhegan High School contracted with The Youth Council to provide
specialized screening and intervention services for students who are struggling with
stressors that may lead or have led them to use alcohol and other drugs.
Lindsey Bergeron, MA, LCMHC, CPS joined The Youth Council as an intern in 2007
providing an array of assessment and referral services and individual and group
counseling for teens. After graduation, Lindsey was invited to stay on to work in
several agency programs such as the Child Assault Prevention Program, CHINS and
Court Diversion programs and to facilitate Active Parenting classes.
Since that time, Lindsey has developed expertise in substance abuse prevention, intervention and treatment and
has also been certified as a Community Prevention Specialist. Lindsey will be on site on Fridays through June at
Souhegan High School and is also available at her office in downtown Nashua for additional services.
In order to help your son or daughter achieve maximum success, Souhegan High School staff would like to refer
your student to Lindsey to set goals and develop an action plan for improving his/her success. Recommendations
may include linking him/her to school- and community-based services, participating in a comprehensive clinical
assessment to determine any additional concerns, as well as attending short-term school-based counseling,
groups and/or check-in appointments.
Please contact Lindsey directly with any questions at:
(603) 673-9940 ext. 6311  lbergeron@theyouthcouncil.org  Room A101
If you are interested in participating in Student Assistance Program (SAP) Services, please review
the Informed Consent information below and return the signature section to Lindsey or your
child’s guidance counselor.
Informed Consent, Client Rights & Responsibilities for Student Assistance Program
TO PARENTS AND STUDENTS:
You are receiving this information because you may be interested in participating in the Student Assistance
Program ("SAP") at Souhegan High School. The SAP Program is designed to help students develop skills to cope
with the pressures of high school ultimately leading to increased academic success. The Program is offered by the
Schools in conjunction with a counselor from The Youth Council. The School and The Youth Council are committed
to providing quality services to students. To avoid any confusion or misunderstandings, this form provides
important information about all aspects of the SAP Program. In addition, The Youth Council Counselor can provide
you with some basic information about the services. Parents and students should read this information carefully
and discuss any questions you have before signing below.
The Youth Council  112 West Pearl Street  Nashua, NH 03060
1. QUALIFICATIONS AND SCOPE OF PRACTICE
As a Mental Health Counselor, I, Lindsey Bergeron, MA, LCMHC, CPS, am governed by the Code of Ethics
of the American Mental Health Counselors Association. A copy of the Code of Ethics is available upon
request.
As stated above, the SAP Program is a short-term assessment and referral program designed to assist
students in developing coping skills and achieving academic success. SAP Program Counselors are
trained to initially assess students to determine what services would best assist the student in achieving
these goals. After the initial assessment, the SAP Program Counselor may refer the student to one of the
following:
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In school group counseling
In-school short term individual counseling
Services with an agency outside of the school
Parents and students should be aware that the SAP Program is designed to provide only short term, goal
specific counseling. Please also be aware that SAP Program Counselors may communicate with the
school guidance counselors as appropriate in order to provide the best service to the students.
Although the SAP Program Counselors are committed to helping students, some students will require
services that are beyond the scope of the SAP Program. You may choose to obtain more extensive
services from someone outside of the School. You also have the choice not to obtain any services at all.
If you have any questions, please discuss all services and recommendations with the SAP Program
Counselor.
2. MENTAL HEALTH BILL OF RIGHTS
Pursuant to the New Hampshire Mental Health Bill of Rights, clients have certain rights. A copy of the
Mental Health Bill of Rights is attached to this document and is displayed in the offices of the SAP
counselor. If you have any questions about the Mental Health Bill of Rights or this document, please
discuss them with your counselor.
3. CONFIDENTIALITY AND PRIVACY
The Youth Council and the School will make every effort to protect the privacy of students enrolled in
the SAP Program. Since trust between the student and SAP Counselor is a crucial component to your
child’s success in the program, The Youth Council and the School ask that parents respect the privacy of
students who may not wish to share certain information about their counseling. Please be aware that
students who share any information pertaining to alcohol and other drugs are protected by Federal laws
and regulations (42 C.F.R. Part 2). This information cannot be disclosed to anyone, including parents,
without written consent from the student. If you have concerns about the limits of privacy or
confidentiality, please discuss them with your counselor before starting counseling.
4. REPORTING REQUIREMENTS
Parents and students are reminded that Souhegan High School requires certain information to be
disclosed by the SAP Program Counselor to employees or agents of the School, as well as to parents, as
required by mandatory reporting laws. Under New Hampshire law, counselors are required to report
certain information including, for example:
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A serious threat of harm to yourself, someone else, or property;
A suspicion of abuse or neglect of a child or incapacitated adult;
Knowledge of student hazing, bullying, and sexual harassment;
Suspicion of a student under the influence of alcohol or other drugs;
Witnessing or having information from a victim of a criminal act in a safe school zone.
Counselors will disclose only the minimum information necessary, on a need to know basis.
5. PROFESSIONAL BOUNDARIES
Counselors are obligated to establish and maintain appropriate professional boundaries (relationships)
with students at all times. Do not hesitate to raise any questions you may have regarding professional
boundaries. Reports of misconduct should be directed to the New Hampshire Board of Mental Health
Practice, 121 South Fruit Street, Concord, NH 03301, 603-271-6762.
6. LIMITS OF AVAILABILITY & PROVISIONS FOR EMERGENCY COVERAGE
SAP counselors do not provide any emergency services. If an emergency should arise while a student is
attending school, the situation will be handled by school personnel. SAP counselors are only available
when school is in session.
Please return the form below:
ACKNOWLEDGEMENT AND ACCEPTANCE
My signature below indicates that I have read and understand this document and agree to
abide by its terms.
I, ____________________________________ (parent/guardian), give permission for my
son/daughter, _______________________________________, to receive SAP services.
OR
I, _________________________, as an adult, consent to voluntarily participate in SAP
services.
This agreement will stay in effect until SAP services are completed or if permission is revoked
either verbally or in writing.
_______________________ _______
Signature of parent/guardian Date
_____________________ ________
Signature of client
Date