How to Refer
1.) Identify
Parents, teachers and school staff, social service and community
agency staff, physicians, health care workers and others identify
IMPACT participants. Once identified, the person wishing to make
the referral should contact the IMPACT program or contact and discuss
the option with the parents or caregiver of the child/adolescent
and have appropriate releases signed so that contact can be made
by the program staff.
Special Note: When a referral is made, the parents
of the child/adolescent need to be contacted first.
The parents must sign the release (at the bottom of the Referral
Form) before the school or other agency can contact the IMPACT program
staff. A typical referral might be a child who has a history of difficult
behavior or has had special school programming such as LD, ED, at-risk
or other special services provided by the school. Very often, there
are more issues for this child/adolescent, especially in the areas
of other mental health treatments including outpatient, inpatient
or in-home mental health services. There may also have been contact
with the juvenile justice or social services systems.
2.) Complete Referral Form
Once the child and family have been informed of the intention to
refer to the program and have agreed to an interview, the referral
form is completed and forwarded to the IMPACT program staff.
A downloadable copy of the referral form is here on the website.
Select the community nearest to the child’s home: Ashland,
Hayward, Rhinelander.
3.) Inform The Parent
The parent must then be informed that they will be contacted by a
member of the IMPACT treatment team to set up an initial assessment
of the needs of the child/adolescent. The referral source or designee
will be identified as the contact person for the referring agency
and will be included in the treatment plan.
4.) Interview
When IMPACT receives the referral, an interview will be arranged
with the parents and the child/adolescent to go over the purposes
and objectives of the program, to determine the benefits of the
program to the child/adolescent and to learn about the contents
of the program and if and how they will fit the child/adolescent’s
needs.
5.) Assessment
The child/adolescent will be assessed for appropriateness in the
program. If deemed appropriate, an initial treatment plan will
be written within 3 days of the child/adolescent’s interview.
The treatment plans will be reviewed on a quarterly basis and revised
to account for areas of progress and areas of continued need.
 Download
A Referral Form
Choose the community closest to the child’s
home.
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