Non-Licensed Non-Certified Psychotherapist Public Disclosure
All sections of this public disclosure must be completed, even if one puts not applicable. All pages need to be included as well.
Every document below is part of public disclosure and must be given to each client no later than the third office visit and must be submitted to this Office as part of your public disclosure.
Board of Allied Mental Health Practitioners.
Disclosure Document for Non-licensed and Non-certified Psychotherapists
First Name: Amelia
Middle Initial: P.
Last Name: Lincoln
Formal Education
Name of Institution: Northern Vermont University/Southern New Hampshire University
Dates Attended: August 2017 - August 2020
Degree(s) awarded if any: M.S. Clinical Mental Health Counseling
Name of Institution: New England College
Dates Attended: May 2008 - June 2009
Degree(s) awarded if any: M.S. Education
Training
Title of Training Program: Upper Valley Educators Institute
Names & Addresses of trainer and/or institution: 194 Dartmouth College Highway Lebanon, NH 03766
Dates Attended: August 2006 - June 2007
Subject and/or content: Middle and High School Social Studies Education
Credential(s) awarded, if any: Teaching Certification
Title of Training Program: New England Institute of Addiction Summer School
Names & Addresses of trainer and/or institution: NEIAS PO Box 742, Augusta, ME 04332
Dates Attended: June 6-8th, 2015 and June 6-9, 2016
Subject and/or content: Substance Use Prevention Ethics, Anger Management for Youth, Motivational Interviewing
Credential(s) awarded, if any: N/A
Experience
Description of Practice: Student Assistance Professional, White River Valley School District Substance use prevention, supportive counseling, screening and referral for substance use and mental health concerns for middle and high school students.
Location: City/State/Zip: Royalton, Vermont 05068
Duration: November 2014 - Dec. 31, 2020
Status: Full-time
Receive supervision or peer consultation? Yes
How often? Weekly
Description of Practice: HALO Educational Systems - providing counseling, some with court-ordered clients with addiction issues and for those in Medically Assisted Treatment (MAT) for opiate addictions.
Location: City/State/Zip: 44 Roberts Road, Canaan, NH and 1 School Street, Lebanon, NH 03776
Duration: January 2020 - Present
Status: Part-time
Receive supervision or peer consultation? Yes
How often? Weekly
Description of Practice: Clara Martin Center, School-Based Clinician, Rochester School, counseling with students in K-12 at school and Recovery Staff at Safe Haven/Chris’ Place, a residential home and crisis bed unit for those recovering from acute mental illness and substance addictions
Location: City/State/Zip: Rochester, Vermont, and Randolph, Vermont 05060
Duration: Sept. 2014 - November 2015
Status: Part-time
Receive supervision or peer consultation? Yes
How often? Weekly
Scope of Practice
Therapeutic Operation: Person Centered, CBT
Area of Specialization: at-risk youth and those affected by developmental trauma
Treatment Methods: Cognitive Behavioral Therapy and Motivational Interviewing
My practice is also governed by the Rules of the Board of Allied Mental Health Practitioners. It is unprofessional conduct to violate those rules. A copy of the rules may be obtained from the Board or online.
Client’s Disclosure Confirmation
My signature acknowledges that I have been given the professional qualifications and experience of (Name, Name), a listing of actions that constitute unprofessional conduct according to Vermont statutes, and the method for making a consumer inquiry or filing a complaint with the Office of Professional Regulation. This information was given to me no later than my third office visit.
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