Wellness Referral Form
To provide distressed students with immediate skills to de-escalate their emotional stress in hopes of preparing them to return to the classroom setting.
Referring Staff Member
Major Key Areas for Referral and Recommendations
Calming Strategies (ex: Anger Outbursts)
Grounding Techniques (ex: Anxiety/Panic)
Resourcing (ex: Self-esteem/Identity)
De-escalation (ex: Relational Conflict)
Coping Skills Enhancement (ex: Potential Substance Use)
Shift and Stay (ex: Refocusing of Negative Rumination)
Encouraging (ex: Discouraged/Sad)
Life-Planning/Motivational Interviewing (ex: Grief/Loss)
Decision Making Skills (ex: Poor Impulse Control/Irrational Thoughts)
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This form was created inside of New Beginnings High School.