Parent/Guardian School Social Worker Referral:
We are here to support you and your child during these uncertain times. School-based student support services will be offered in accordance with the academic calendar (i.e. services will not occur during scheduled school breaks). We can support students though check-ins and/or school-based short-term counseling to reduce barriers to learning and achieve greater academic success. Credentialed school social workers (SSW) and/or social work interns, under the supervision of a credentialed SSW while accruing internship hours, may provide student support (e.g. SMUSD email, zoom, calls and once in person instruction resumes in person meetings).

It is important that you are aware of some additional information regarding virtual student support. Please read this document and complete the box at the end to confirm that you give your consent for the School Social Worker or Social Work Intern to have a check-in/meeting.

Virtual Supports this year will include student check-ins, short-term individual counseling, skill-based groups (on topics such as emotional regulation, social skills, self-esteem, etc.), socialization opportunities (such as virtual lunch bunch), targeted classroom social-emotional lessons/supports (in addition to weekly social-emotional lessons provided on a weekly basis to all grade-levels), restorative practices (classroom community circles or for conflict mediation purposes), teacher/parent consultation, and outside referrals for more intensive and ongoing needs or community resources. These will be similar once we return to in-person learning.

A Student Check-in Is: a short conversation with a student to check-in on how they are doing, an opportunity to connect and express empathy or discuss coping strategies, a method to monitor their stress reaction, and available to all students. Short-term School-Based Counseling will be available based on severity of need. Long-term and consistent counseling or therapeutic services should be obtained outside of the school district.

Please be mindful that groups will treated similar to a classroom setting with a focus on learning and developing skills. Counseling services related to topics such as divorce, grief/loss, and other trauma-related issues that require more personal information to be shared and processed should be obtained outside of the school district. Some students have and will continue to share personal information but will be redirected for the purpose of protecting confidentiality as privacy cannot be assured in a virtual setting.

I will set up virtual meetings using the Zoom platform as needed to address questions and provide check-ins.

Please know, we are unable to provide crisis care. If urgent support is needed, contact the Access and Crisis Line at 1-888-724-7240, the National Suicide Prevention Lifeline at 1-800-273-8255 or the Crisis Text Line by texting 741-741 from anywhere in US.
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Email *
In order to receive services for student check-ins or short-term group/individual counseling, you will need to READ AND CHECK ALL of the following information about potential risks and expectations when utilizing virtual support services: *
Required
In addition to virtual considerations for student supports, please READ AND CHECK ALL of the following information about potential risks and expectations when utilizing support services in both virtual & in-person settings: *
Required
Student's First Name: *
Student's Last Name: *
Student's Teacher: *
Student's Grade: *
Assistance Needed (Check all that apply): *
Resources: referrals or resources to community resources. Student Check-In: Child is in need of a check-in for social/emotional support. Consultation: Consultation - need some suggestions or help with child's behaviors, emotional state, or other concern at home.
Required
Level of Need (at time of Referral) *
Has your student experienced any of the following family changes (please check all that apply)? *
Required
Reason for Referral (please check at least 1 box) *
Required
Brief Description of Concern/Need: *
Best number to reach you at *
Availability (Please leave some options for days/times that you would be available to talk further) *
Please note that office hours are typically 8:15-3:45. There is more flexibility in a virtual setting, but days/times may be restricted during in-person learning because I split days between San Elijo Elementary and Discovery Elementary.
Parent/Guardian Name. Please note that this will be considered your electronic signature for consent of services. *
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