Appendix B
Massachusetts Suicide Prevention Resource Guide
Order Form
This Guide contains national, state and local information on suicide prevention
resources which include: understanding suicide, state prevention plans, education
and training programs, hotlines, crisis lines, mental health providers and
much more.
The goal of this guide is to help professionals, survivors, friends, family
and loved ones locate existing suicide prevention services and resources and
assist the Massachusetts Department of Public Health in identifying gaps in
services and programs.
Prepared by:
Massachusetts Department of Public Health
Injury Prevention and Control Program, Suicide Prevention Program
Bureau of Family and Community Health
Copies are available free of charge.
If you would like to obtain a copy of this guide, please complete the section
below and mail or fax the form to:
Alan Holmlund
MA Department of Public Health
250 Washington Street, 4th floor
Boston, MA 02108-4619
Phone: (617) 624-5476
Fax: (617) 624-5075
TTY: (617) 624-5992
Date ___________________________________________________________________
Name___________________________________________________________________
Agency__________________________________________________________________
Address_________________________________________________________________
City_________________________________ State__________Zip__________________
Phone _________________
|  | Massachusetts Department of Public Health
Suicide Prevention Program Presents
“New Developments in Understanding and Treating Self-Injury”
Thursday, November 1, 2007
Crowne Plaza, Pittsfield, MA
9:00 a.m. to 12:00 noon
OR
Thursday, December 13, 2007
College of Holy Cross, Hogan Campus Center, Worcester, MA
9:00 p.m. to 4:00 p.m.
Check One: November 1, 2007, Crowne Plaza, Pittsfield (Half Day)
December 13, 2007, Holy Cross, Worcester (Full Day)
Name/Title:________________________________________________________________
School/Agency:____________________________________________________________
Address:__________________________________________________________________
City, State, Zip:____________________________________________________________
Phone:_____________________
(*Print clearly) E-mail________________________________________________________
Registration Fee: Non-refundable fee of $20.00
CEUS available
Check must be made out to: AdCare Educational Institute, Inc.
Check and Registration Mailed to:
AdCare Educational Institute, Inc.
5 Northampton Street
Worcester, MA 01605
For further information contact: Laura Guida at AdCare Educational Institute by phone; (508) 752-7313 or by email; Laura@adcare-educational.org
SPACE IS LIMITED
*Registration will be first come, first served and will be confirmed by e-mail ONLY one week prior to the training.
Registration begins one hour before training.
Continental breakfast (and lunch for full day) or refreshments will be provided.
Co-sponsored by AdCare Educational Institute, Inc.
Important Continuing Education Information on Next Page:
Continuing Education:
Continuing Education Units will be offered for Licensed Alcohol Drug Counselors (LADC I, LADCII, and LADC Assistants), Certified Alcohol and Drug Abuse Counselors (CAC/CADAC), Certified Addiction Specialists (CAS), Nurses (RN/LPN), Social Workers (SW) and Licensed Mental Health Counselors (LMHC). AdCare Educational Institute, Inc., is recognized by the National Board for Certified Counselors to offer continuing education for National Certified Counselors (NCC). We adhere to NBCC Continuing Education Guidelines. To ensure state credentials, contact your local board of certification. For Social Work CEUs, contact AdCare Educational Institute to determine if an authorization number has been secured.
AdCare Educational Institute, Inc. is approved by the American Psychological Association to sponsor continuing education for psychologists. AdCare Educational Institute, Inc. maintains responsibility for the program and its content.
Continuing Education:
License #: ___________ _________________________________
LADC
CAC/CADAC
CAS .RN/LPN
NCC
SW
PSYCH
|
