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Washington County School District and Southwest Behavioral Health have partnered with local mental health agencies to provide supportive access to counseling services. Students who choose to participate in counseling sessions will have the opportunity to address their mental health needs, learn healthy coping and social skills and access positive resources. Utilizing this program will allow your student to receive the following one time benefit:

One (1) Mental Health Assessment (Approximately 1 hour)
Four (4) counseling services for the student or family (time?)

Services can be chosen from a list of providers in the community, and services can be provided at the facility chosen by the parent, or via telehealth.

*Additional services beyond what is listed above will be the financial responsibility of the parent/guardian and may involve insurance options, access to medicaid, etc.

After submitting the form below, a representative from Southwest Behavioral Health Center will contact you to set up the Mental Health Assessment and make arrangements for the four counseling services.

Parent Information Form

* Indicates required field

Name of Student *

First

Last

Name *

First

Last

Name *

First

Last

Name *

First

Last

Date of Birth *

Age *

School *

Name of Parent *

First

Last

Parents Phone Number *

Parents Email *

Brief description of student/family issues/need *

Which provider would you like to see? Click the orange link above for the list of providers you can choose from. If you do not choose a provider, one will be selected for you. (If you have Medicaid insurance, a separate list of providers can be given to you after an initial assessment). *

Name of insurance provider, if you have one: (Your insurance will not be billed for this program, but may help determine the best provider options for you). *

I understand that these sessions are voluntary and not mandated by WCSD. These sessions will not be part of a student’s IEP or 504 plans. Southwest Behavioral Health Center is simply the provider working with WCSD as a vendor connecting counseling services. *

Yes, I understand.

Submit

WCSD MENTAL HEALTH Assistance Program

Parent Information Form

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