Community Health Aide Program Certification Board



Applicant Name:76962004445FOR OFFICIALUSE ONLYReceivedAction00FOR OFFICIALUSE ONLYReceivedAction(Full Legal Name)LastFirstMIOnly complete the section for the level of certification you are applying for.BEHAVIORAL HEALTH AIDE IAlternative Training for Behavioral Health Aide I. In lieu of completing the requirements listed in CHAPCB 2.40.100(d) BHA I Work Experience and CHAPCB 2.40.100(a) BHA I Specialized Training Program a person may satisfy the training course requirements for certification as a BHA I by successfully completing one of the alternative courses of study* identified below.Date CompletedMM/DD/YYYYHoursCompleted Complete OneAA/AS degree in: NABA/BS degree in:NAMA/MS degree in: NACounselor Technician certification training approved by the Alaska Commission for Behavioral Health Certification plus 1,000 hours of work experience.** University of Alaska Rural Human Services year one training plus 1,000 hours of work experience.** I?isa?vik College BHA year one training plus 1,000 hours of work experience.** Complete AllGeneral Orientation (28 hours)Introduction to Behavioral Health (24 hours)Introduction to Documentation (12 hours)Crisis Intervention (16 hours)BEHAVIORAL HEALTH AIDE IIAlternative Training for Behavioral Health Aide II. In lieu of completing the requirements listed in CHAPCB 2.40.200(a) Prerequisites, CHAPCB 2.40.200(e) BHA III Work Experience, and CHAPCB 2.40.200(b) BHA II Specialized Training Program a person may satisfy the training course requirements for certification as a BHA II by successfully completing one of the alternative courses of study* identified below.Date CompletedMM/DD/YYYYHoursCompleted Complete OneAA/AS degree in: _____________________ plus 1,000 hours of work experience**.BA/BS degree in: NAMA/MS degree in: NAUniversity of Alaska Rural Human Services Certificate plus 1,000 hours of work experience.** Complete AllGeneral Orientation (28 hours)Psychophysiology and Behavioral Health (16 hours)Intermediate Therapeutic Group Counseling (16 hours)Crisis Intervention (16 hours)BEHAVIORAL HEALTH AIDE IIIAlternative Training for Behavioral Health Aide III. In lieu of completing the requirements listed in CHAPCB 2.40.300(a) Prerequisites, CHAPCB 2.40.300(e) BHA III Work Experience, and CHAPCB 2.40.300(b) BHA III Specialized Training Program a person may satisfy the training course requirements for certification as a BHA III by successfully completing one of the alternative courses of study* identified below.Date CompletedMM/DD/YYYYHoursCompletedComplete OneAA/AS degree in: ____________________ plus 2,000 hours of work experience**.BA/BS degree in: _____________________ plus 500 hours of work experience**.MA/MS degree in:NAComplete All General Orientation (28 hours)Documentation and Quality Assurance (16 hours)Child Development (20 hours)Crisis Intervention (16 hours)BEHAVIORAL HEALTH PRACTITIONERAlternative Training for Behavioral Health Practitioner. In lieu of completing the requirements listed in CHAPCB 2.40.400(a) Prerequisites, CHAPCB 2.40.400(e) BHP Work Experience, and CHAPCB 2.40.400(b) BHP Specialized Training Program a person may satisfy the training course requirements for certification as a BHP by successfully completing one of the alternative courses of study* identified below.Date CompletedMM/DD/YYYY HoursCompleted Complete OneAA/AS degree in: ____________________ plus 4,000 hours of work experience**.BA/BS degree in: ____________________ plus 1,000 hours of work experience**. MA/MS degree in: NAComplete All General Orientation (28 hours)Issues in Village-Based Behavioral Health Care (20 hours)Competencies for Village-Based Supervision (16 hours)Child-centered Interventions (20 hours)Crisis Intervention (16 hours)I attest that I have successfully completed the alternative courses of study related to the training requirements for the level of certification being sought and have completed the behavioral health related work experience as required. Signature of ApplicantDateSignature of Clinical SupervisorDateClinical Supervisor’s Credential****A degree must be from an accredited college or university with a major in human services, addictions and chemical dependency, behavioral health, psychology, social work, counseling, marriage and family therapy, or nursing with a behavioral health specialty, or a related field.**Must have provided village-based behavioral health services under the direct supervision of a licensed behavioral health clinician or behavioral health professional.***Clinical Supervisor as defined in CHAPCB 2.40.010(a) Clinical Oversight. ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download