Social Emotional Support

Students

If you need help, and it is not a life threatening emergency, fill out the referral form below. Help will be provided by the next school day.

24 Hour support is also available:
Crisis Text Line Text "HOME" to 741741
Call or text 988

If you are currently having thoughts of suicide, immediately tell an adult or call 911. If you are unable to do that, dial 988 for the Suicide & Crisis Lifeline or call the Yolo County Behavioral Health 24-hour access line at 888-965-6647.

Parents/Guardians

If you are concerned about your student's social emotional well-being, and have been for two weeks or more, please complete the referral form below.

If this is an emergency, please call 911 or take your student to the nearest hospital. If you are unsure if this is an emergency please visit the Association for Children’s Mental Health website or visit the DJUSD Mental Health Resources page for more information.

Teachers/Staff

If you are concerned about a student's social emotional well-being, submit a Request for Assistance form to your school’s Coordinated Services Team (CST).

If you believe that a student is at risk for self-harm, immediately contact your school counselor and principal.

Referrals are confidential and are forwarded by email to the administrative team in the Student Support Services Department. Only those individuals with a need to know will be informed of the referral.

All referrals will be responded to within 24 hours or the next school day.

Full Name
School
Grade
Student's School Counselor
Person Making the Referral	Self Parent/Guardian/Family Member Friend Teacher/Staff Member Other
Phone Number (Include Area Code)
Contact Email
Please select all that apply:	Anxiety Depression Impulse Control Behavioral Changes (i.e. drastic changes in behavior or personality) Eating disorder Unexplained Weight Loss Mood swings Intense feelings for no reason (i.e. overwhelming fear - enough to interfere with daily activities) Physical symptoms (i.e. often complain of stomach aches or headaches) Self-Injurious Behavior (deliberately harming one's self) Suicidal thoughts/feelings (If current, call 911) Suicide attempt Substance use/abuse Social isolation Excessive sleep Not enough sleep Poor hygiene Verbal defiance Physical agression Victim of name-calling/insults/teasing Not participating in Distance Learning Other
Please describe what you or the student is experiencing:
Have you or the student previously been treated for a mental health condition?	Yes No Unknown
If yes to the previous question, what condition and which services have been provided?