Lake Zurich High School >
Student Assistance Program
> Referral Process
Referral Process
Initial Student Assistance
Program Referral Form |
Guidelines for Completing Referral FormI. An Initial Referral Form is filled out by teacher/staff
person for any concern related to possible substance abuse or any
academic, behavior or emotional problem. The form is turned into
one of the School Social Workers, the School Nurse, or
Assistant Principal for Student Services. Forms are located in the
guidance department and the health office. Or you can click
here
to fill and print out a form online.
II. SAP Core Team reviews referral information and makes
determination as to whether the case may be a C.I.T. referral
due to possible substance abuse problems. If it is, then the
following steps are taken.
1. A C.I.T. Case Manager is assigned to gather
information and bring it back to the team. 2. The C.I.T.
reconvenes to review and assess information gathered.
3. Action plan is determined.
a. If there is no evidence other than one
teacher’s report:
The case manager will review results with the
referral source.
The referral will be kept on file. The referral
source and other teachers will be
encouraged to keep the team, informed of any new pertinent
information.
b. If the C.I.T. has determined that there is a concern for
possible substance abuse, then
a parent will be contacted by a member of the C.I.T. team to set up
a meeting.
4. A confidential conference will be held with the members
of the C.I.T. and the parent(s).
Outside referral resources will be
offered as well as resources within the school (not to be
considered a replacement for the
outside help, rather supplemental).
5. The case manager will send a Status Form to the original
referral source.
6. Re-entry procedures will be followed upon return if
hospitalized.
III. If a C.I.T. referral is not indicated, then the Core Team
will assign a SAP Case Manager and the following steps will be
taken:
1. The assigned SAP Case Manager is responsible for
completing all information contained in
the SAP Referral Record.
This includes student information, data collection, team
recommendations and evaluations.
Relevant information will be
gathered as it pertains to a student’s situation, which may
include the following:
a. Attendance
b. Behavior
c. Discipline
d. Grades/Teacher reports
e. Health
f. Other observations from teachers, staff, and
administrators
g. Police records
h. Social Work input
2. The SAP Case Manager will assume the following
responsibilities:
a. Present findings at the next scheduled SAP
meeting. The Student Assistance Team
will determine appropriate interventions based on the findings.
b. Initiate the intervention steps and will monitor
progress of student.
c. Update SAP team at weekly meetings as necessary.
d. Complete evaluation section of SAP referral
record
e. Resume responsibility if the same student is
referred again at any later time.
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