Referral Form - Community Support Team Survey

Anger Management: Programming to assist the young person to improve management of anger and stress. For example, group discussions, problem solving strategies, conflict resolution processes, de-escalation of negative behaviour, pro-social modelling.

Cognitive/Life Skills: Through the use of cognitive behavioural methods, the young person is assisted to develop pro-social functioning. Examples are: victim awareness, anti-bullying, anti-violence, anti-gang, anti-criminal thinking, problem solving, and healthy relationships development/building. Includes life skills, such as, basic hygiene, healthy sexuality, leisure counselling, cultural awareness. In addition youth are provided with information regarding community resources such as shelter, food banks, medical services, and at times provided with transportation to get to medical aid.

Substance Abuse: Programming that targets specific medical, social and behavioural issues related to substance use and addictions. Service includes programming that provides for treatment, detoxification, relapse prevention, and referrals to the clinical supports such as methadone and suboxone programs.

Employment Support: To assist the young person to achieve/maintain employment/vocational functioning. For example, job search, skills and strength assessments, interview skills, resume writing, presentation skills, job skills training etc. Provide information regarding community youth employment programs.

Education Support: To assist the young person to achieve and maintain educational functioning, for example education advocacy, education supports and alternative educational programming, participate in safety plans in conjunction with probation services and school officials.

Referral Form - Community Support Team

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1. Youth Name:

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2. Address:

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3. Date of Birth:

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4. OTIS # (if applicable):

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5. Youth Resides With (Name of Parent and/or Guardian):

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6. Phone #:

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7. Referral Agency & Address:

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8. Case Manager Name & Contact

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9. Other Stakeholder Contacts:

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10. Supporting Documentation to be emailed to CST Program following completion of referral (Please check those that are included):

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11. Reason(s) For Referral: (Required.)

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12. Other Relevant Information:

Referral Form - Community Support Team

Question Title

* 1. Youth Name:

Question Title

* 2. Address:

Question Title

* 3. Date of Birth:

Question Title

* 4. OTIS # (if applicable):

Question Title

* 5. Youth Resides With (Name of Parent and/or Guardian):

Question Title

* 6. Phone #:

Question Title

* 7. Referral Agency & Address:

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* 8. Case Manager Name & Contact

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* 9. Other Stakeholder Contacts:

Question Title

* 10. Supporting Documentation to be emailed to CST Program following completion of referral (Please check those that are included):

Question Title

* 11. Reason(s) For Referral: (Required.)

Question Title

* 12. Other Relevant Information:

1. Youth Name:

2. Address:

3. Date of Birth:

4. OTIS # (if applicable):

5. Youth Resides With (Name of Parent and/or Guardian):

6. Phone #:

7. Referral Agency & Address:

8. Case Manager Name & Contact

9. Other Stakeholder Contacts:

10. Supporting Documentation to be emailed to CST Program following completion of referral (Please check those that are included):

11. Reason(s) For Referral: (Required.)

12. Other Relevant Information: