Navigating the Adolescent Years/Open Referral

We accept referrals from community agencies, parents and self referrals. Please fill out the form, we follow up on all referrals we receive.

Youth name

First Name Last Name

Date of birth

Date

Guardian(s) Name:

First Name Last Name

Guardian(s) Contact Phone Number:

- Area Code Phone Number

Name of Referring Agency:

First Name Last Name

Contact name:

First Name Last Name

Contact Phone Number

- Area Code Phone Number

Reason for referral:

Expected completion date:

Select Class for referral:

Navigating Life: Co-ed ages 13-15/16-18 - This program will explore the dangers of using illegal drugs and alcohol. The class also addresses: life consequences and use, abuse and addiction, facts about chemical dependency, the law when using drugs and alcohol, taking risks, consequences of using, and alternative solutions. Seven weeks of 45 minute classes. Power of Conversation: Co-ed ages 13-15/16-18 - Power of Conversation gives students an opportunity to practice communication skills. Students will learn how to better understand their peers, how to identify unhealthy communication that contributes to bullying and anger, how to manage difficult emotions and improve empathy skills. Seven weeks of 45 minute classes. Young at Heart: Co-ed ages 8-12 This program is instrumental in building character skills so youth are equipped to make important decisions that they may face when entering society at a young age. Topics include behavior, conflict resolution, personal identification and values within today’s culture. Seven weeks of 45 minute classes. Life Stages Class: Ages 16-18 - Life Stages is an educational program for youth who require more intensive programming. Interactive instruction to students provides detailed information about life consequences and provides motivation enhancement strategies (e.g., health as a value). Class structure incorporates the instruction of active listening, effective communication skills, stress management/coping skills, techniques, self-control, and decision making to counteract risk factors relevant to older teens. Ten weeks of 45 minute classes. A Young Woman’s Journey: Girls ages 13-15/16-18 - Specific to girls, this class curriculum includes healthy decision making skills, leadership development, school cliques, cyber bullying and aggression. The class gives young women opportunities to systematically explore why healthy relationships are critical in their lives. In addition, each girl will learn how to focus on her individual needs, understand how to be safe in the world today, and strengthen her relationships with family, peers, community and society to transform the world she will live in. Ten weeks of 45 minute classes. Setting Real Boundaries: This class addresses Setting boundaries with teens to help reduce the risk for unwanted behavior or actions. Included in this class are components of effective communication that include: providing empathy and validation of feelings, active listening, setting appropriate boundaries, and using “I-Statements.” Six weeks of classes. Bridging Communication Between Households: This class focuses on communication strategies for kids who have multiple households. It addresses problem solving techniques, practicing consistent and predictable parenting skills between both homes, providing empathy and patience, practicing open communication between parents, and how to create routines/structure and consistent messaging about rules/expectations in both homes. Six weeks of classes. Pathway to sobriety: This five month, gender- specific, intensive, substance abuse program offers substance abuse evaluation, instruction of a four step program, and case supervision for youth at the center. This program is based on a 4-Step model and focuses on life skills, enhancement, diet, nutrition, eating disorders, resiliency, group instruction and the development of self-esteem.

*Program rates will be assessed by sliding scale based on annual household income.