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This Toolkit was developed under contract number HHSS283201200030I for the Center for Mental Health Services (CMOS), Substance Abuse and Mental Health Services Administration (SAMOSA). The views,

How to fill out school mental health referral

How to fill out a school mental health referral:

1. Obtain the referral form from your school's counseling or mental health department.
2. Fill out your personal information accurately, including your full name, grade level, and contact information.
3. Provide a brief description of your concerns or reason for seeking mental health services.
4. Specify whether you are requesting individual counseling, group therapy, or any other specific services.
5. If you have a preferred counselor or mental health provider, you may indicate this on the referral form.
6. Ensure that any required signatures or consent forms are completed by a parent or guardian, if applicable.
7. Submit the completed referral form to the designated staff member or department.

Who needs a school mental health referral?

1. Students who are experiencing emotional or behavioral challenges that are affecting their academic performance and overall well-being.
2. Students who are struggling with anxiety, depression, stress, or other mental health issues.
3. Students who have experienced trauma or are dealing with difficult life circumstances that are impacting their ability to function at school.
4. Students who may benefit from additional support or counseling to navigate personal or social challenges.
5. Any student, parent, or teacher who believes that a student would benefit from accessing mental health services.

For pdfFiller’s FAQs

What is school mental health referral?

A school mental health referral is a process through which a student is recommended to receive mental health services to support their well-being and academic success.

Who is required to file school mental health referral?

School administrators, counselors, teachers, or any other staff member who identifies a student in need of mental health support may be required to file a school mental health referral.

How to fill out school mental health referral?

To fill out a school mental health referral, you may need to provide information about the student's behavior, emotional well-being, academic performance, and any other relevant factors that indicate the need for mental health services.

What is the purpose of school mental health referral?

The purpose of a school mental health referral is to ensure that students receive the necessary support and services to address their mental health concerns and improve their overall well-being and academic performance.

What information must be reported on school mental health referral?

Information such as the student's name, age, grade, reason for referral, observations of behavior or emotional well-being, and any relevant background information may need to be reported on a school mental health referral.

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