Service Request Please take a moment to fill out the following service request form. We will be in touch within 1-2 business days. Name * First Name Last Name Company Name Email * Phone * (###) ### #### Which services are you interested in? Check all that apply. Ecological Behavioral Counselors / Positive Behavioral Interventions and Supports (PBIS) Integrative Ecological Counselors / Community Integration Counseling (CIC) Living Skills Trainers / Independent Living Skills Trainers (ILST) Staff Training / Agency In-Service Other TBI/NHTD SERVICES QUESTIONS If you are a Service Coordinator (SC), how many participants need the service(s) you are interested in today? 1-5 6-10 10-15 16-20 Other Will services be in-person or telehealth? Telehealth OK In-Person required In-Person and/or telehealth, as appropriate What county/borough does the participant(s) live in? Please list all that apply. If known, how many hours per week of service does the participant(s) request? (If unknown, we can help you assess). TRAINING SERVICES QUESTIONS Our curriculum can be adapted to meet the needs of your team regardless of their level of experience. We work with family members and natural supports, direct-care workers and paraprofessionals, counselors and psychotherapists, and other licensed clinicians. Please let us know what trainings you may be interested in, and/or let us know more about your specific needs. Common Behavioral Challenges following Traumatic Brain Injury (TBI) Traumatic Brain Injury (TBI) 101 Ethics of Direct Care Creating a Culture Of Care: Fostering Therapeutic Environments Where is the CEO? Dysexecutive Syndromes and the Frontal Lobes Crisis Intervention With the Brain-Injured Client Who am I and who are you? Consciousness, Self-Consciousness, and Theory Of Mind (ToM) Ecological Psychology and The Social Model Diversity, Pluralism, and Cultural Competence: Brain & Mind Sex, Gender, and Sexuality: Brain & Mind Ableism in Contemporary Culture Behavioral Intervention, Classic and Contemporary Approaches From Rapport to Therapeutic Alliance Common Neurocognitive Presentations from a Psychogenic Standpoint: TBI & Mental Health Comorbidities Anosognosia, Hemi Neglect, and Other Fascinating Symptoms and Signs Common Factors and The Generic Model: Applications for Brain & Mind Models and Orientations: Psychotherapy Applications for Brain & Mind Independence and Autonomy: Present and Future Goals Mindfulness Based Strategies and Acquired and Traumatic Brain Injury Other How many people do you need trained? 1-5 6-10 11-15 16-20 Other Anything else? Please share any other information or questions you may have here. Thank you for your submission! We look forward to working together. This is a confirmation that your ‘Service Request’ has been received by Phineas Brain & Mind. Thank you for reaching out. We will review and be in touch within 24 hours. We look forward to working with you.
