Family Session Note (Athlete Support System)

Date of Service: [Date of service]

Start/Stop Time: [Session start and stop times]

Modality: [in-person / video / audio-only]

Provider: [Provider name, credentials]

Athlete: [Athlete name, DOB, sport/team if relevant]

Athlete Present: [Yes / No]

Participants & Consent Framework

Participants:

• [Participant name or identifier; relationship to athlete; presence status; role in session] (Add additional list items for each participant)

Identified Patient/Client for This Session: [athlete with supporters as collaterals / family system as unit]

Consent Basis: [written ROI / verbal consent / standing policy] (Specify who granted consent, scope, and any time limits)

Information-Sharing Limits: [What may be shared and with whom; any topics excluded or restricted] (If athlete is absent, specify whether authorization exists to discuss their care)

Confidentiality Parameters: [Agreed rules for information flow between athlete-only sessions and supporter sessions; any ROI with external parties including authorized parties, scope, and purpose]

(If previously documented and unchanged, state: "Consent and confidentiality parameters previously established; no changes today.")

Subjective

Reason for Session & Agenda: [Brief reason for this session; 2–4 agenda items]

Supporter Perspectives: [Current concerns; recent examples of communication or boundary issues; questions or requests] (Attribute clearly, e.g., "Parent reports...")

Athlete Input: [Athlete goals for supporter involvement and communication preferences] (If athlete not present, omit this field)

Objective

Engagement & Affect: [Observations of participants' engagement, mood/affect, and responsiveness]

Interactional Patterns: [Interruptions, escalation/withdrawal cycles, repair attempts, alignment or conflict between supporters]

Mental Status Exam: [Brief MSE: appearance, behavior, speech, mood/affect, thought process/content, insight/judgment] (Include only if athlete present for clinical psychotherapy encounter; otherwise state: "Athlete not present; MSE not assessed.")

Assessment

Formulation of Support-System Dynamic: [Concise pattern: trigger → escalation/withdrawal → consequence; maintaining factors; protective factors/strengths]

Progress: [Brief status update since last session] (Omit if initial session)

Safety: [Concerns assessed, findings, and mitigation plan] (If no concerns raised or observed, state: "No acute safety concerns endorsed or observed.")

Plan

Communication Rules of Engagement: [Specific timing, tone, channel, and de-escalation steps with owners]

Boundary Agreements & Role Clarity: [Defined roles, responsibilities, and limits]

Between-Session Practice: [Assigned exercises or skills with owners and frequency] (Omit if none assigned)

Coordination: [Who will communicate what information to which providers/athletics staff, under what authorization] (Omit if no external coordination needed)

Follow-Up: [Next appointment; whether athlete will attend; contingency for escalation or crisis]

Clinician Signature: [Signature, credentials, date/time]