CASRA Presenter Application

CASRA 2021 Fall Conference

Course Content & Instructor Form

Instructor(s) Information

Name	Email	Phone	Qualification

Workshop Information

Title of presentation:

Level of presentation:

Length of time for the presentation:

Workshop Description:

Workshop Goals:

Learning Objectives:

Course outline:

Which of the following is the course content based upon (check all that apply):

Methodological knowledge base (i.e. the methods that people use, e.g., interviewing techniques, in-take form methods, hypnosis, communication training, techniques and interventions)

Theoretical knowledge base (i.e. the writers and theorists in literature, e.g. Linehan, Copeland)

Research knowledge base (i.e. research on the topic that you or others have done that you used to create your course content, including test groups, statistical evaluations)

Practice knowledge base (actual clinical experience that you and others have related to the specific subject matter)

Please provide information (as shown in italics above) to support the methodological, theoretical, research, and/or practice knowledge base for the sample course content. Information provided should help demonstrate the knowledge base being utilized as the foundation of the training.

Course Information:

Indicate which of the following requirements the sample course content meets (check all that apply):

Demonstrates credibility through the involvement of the broader mental health practices, education, and science communities in studying or applying the findings, procedures, practices or theoretical concepts

Is related to ethical, legal, statutory or regulatory policies, guidelines, and standards that impact each respective practice

Explain how the content meets the specific requirement(s):

References: Provide a minimum of 3 representative citations that were used to develop the course content and support your claims. Must be full citations in an acceptable format such as APA Style: (Example: Author, A. (Year of Publication). Title of work. Publisher City, State: Publisher).

Post-Test with answer key: Please provide 3-5 brief true/false questions along with the answer key

Code of Ethics: CASRA subscribes to the Code of Ethics developed by the Commission for the Certification of Psychiatric Rehabilitation Practitioners (CPRP). We are attaching a copy with this application and request that you read it in full. The code is based on the values and principles of the psychiatric rehabilitation field and profession, including respecting the worth, dignity, and uniqueness of all persons, as well as their rights, opportunities, and obligations within a safe, caring environment. This includes our training programs as well. We ask our presenters to incorporate the concepts of treating all clients in an ethically and clinically sound manner, which is recovery-focused and culturally informed, within the context of your training. Click here for the link to the CPRP Code of Ethics.

I have read the CPRP Code of Ethics and have integrated ethical considerations into my presentation

Please check the following to indicate your agreement

I have completed all required items

I agree to register for the conference If I intend to attend additional workshops besides my presentation

I understand that checking this box constitutes my electronic signature