Eldorado High School

Crossroads Counselor

Substance Abuse Prevention and Intervention

Eldorado High School Crossroads Counseling Referral Form.docx

Referral Form

Refer a friend, student, or yourself. Use this form. Directions are on the form and confidentiality is part of the process.

The form can be downloaded and filled out and then scanned and emailed for your convenience!

Individual referrals for Crossroads support can be made by anyone: teacher, student (self or friend), parent, social worker, school counselor, principal, nurse, security, or any other staff member. A referral can be made confidentially if a teacher (or anyone) suspects substance use by a student. As evidenced by: observable physical signs (i.e.-dilated pupils, fatigue, extreme anxiety, hyperactivity), drug talk by student, or notable change in baseline behaviors of a student. Example: A very sociable student starts to suddenly withdraw from others, is absent more and grades drop. An early referral for a student suspected of drug use can help prevent the problem and/or a future drug offense that will result in more severe consequences. Referrals can also be made to provide additional support to students with substance use in the home. Services are provided to the students CONFIDENTIALLY, unless there are safety or legal concerns.

The objectives of this program are to prevent and reduce alcohol, tobacco, other drug use, and to improve academic performance. Our program consists of several components to include: 1) Individual support 2) Group support 3) Classroom presentations 4) Working with community agencies for proper therapeutic or rehab referrals 5) Parent Involvement Program (PIP-An evening/weekend program for parents and students who have incurred alcohol and/or drug violations) 6) Community outreach. Collecting student data and implementing the program with fidelity are also program requirements. Our focus this year is to provide direct services to our students, increase community outreach, interact with incoming 8th graders at feeder schools to aid them in transitioning to high school, and to provide the PIP program to all APS High Schools.