Adding more categories to Referrals to Interventions
Add this question before Date Family Notified: Has the family been informed that you are making a referral?
Add the ability to customize and add distinctive Sections and Categories. Here is an example:
Make first section: Student Strengths.
(Edit or add check boxes to include)
- Able to problem-solve
- Articulates feelings/needs
- Attentive in class
- Respectful to adults
- Cooperates with others
- Demonstrates sense of humor
- Enjoys school
- Helpful to others
- Maintains friendships
- Participates in class
- Regular Attendance
Make Second Section; Prior Interventions
(edit or add check boxes to include)
- Behavioral Interventions
- Classroom modifications
- Instructional modifications
- Offered Tutoring
- Met with Student
- Called parent/guardian : Date______
ADD Section - District interventions:
- SST Date
- Active IEP
- Special Ed. Assessment
- SART
- SARB
- Risk Assessment
- Other ______________
ADD new section:
Reasons for Referral (Please Check All that apply)
Add Categories with check boxes:
- Academic/School
- Attendance Truancy
- Academic concerns
- Behavior in class
- Motivation concerns
- Attention issues
- Suspension
- Other____
Emotional/Behavioral
- Anger management
- Self-esteem/image
- Depression
- Anxiety
- Self-injury
- Suicidal thoughts
- Trauma
- Grief/Loss
Social Needs
- Family stressors
- Dating/partner issues
- Gender/sex identity
- Sexualized behavior
- Gang involvement
- Peer conflict/bullying
- Immigration
- Substance use
Health/Basic Needs
- Housing
- Eating concern
- Medical
- Vision
- Dental
- Sexual health issue
- Food security
We'd like it to look similar to the attached picture
tholman
shared this idea
