Positive Connections

2753 W. Central Ave, Toledo, 419-243-1119 		| REFERRALS | CONTACT US | SITE SEARCH  

Children...Understanding Parents. Supporting One Another. Building Confidence.

A place for kids to share their thoughts, feelings, and dreams.

Children...Understanding Parents. Supporting One Another. Building Confidence.
Home 		Positive connections works with kids under 18 who have a parent or caregiver with a mental illness.
How can we Help 		EDUCATION ABOUT MENTAL ILLNESS, PEER SUPPORT, ONE-TO-ONE MENTORING RELATIONSHIPS
How do we work 		To get started, call Big Brothers Big Sisters at (419) 243-4600. Ask for Positive Connections. We will provide you with training to help you understand the special needs of these children.
Get involved

Positive Kids 		Use the links to visit other positive sites.
Other Websites
Please note that contact referrals will be placed on our waiting list to be contacted accordingly & group participation is based on ability to participate. Please ensure parents are aware that you are making this referral. Thank you.
Click here to print and fax the Referral Form
Referral Date: 9/8/2010

Parent/Guardian’s Name:       
Who in the child's life is struggling with Mental emotional, behavioral symptoms (give diagnosis)?: Parent Sibling Other

Child’s level of awareness regarding love ones illness?:       
Child's Name: 
Diagnosis:       
Age:                
Gender:          
Race:               Write in: 
Child’s level of awareness of own diagnosis?: 

Address:                                 
City:                                        
Zip:                                         
County:                                    

Phone:                                     
Cell:                                        
Other:                                    

Does this family have access to transportation?(Please indicate type): 

Is the custodian of this child different from above?: Yes No
Child in foster care?: Yes No

CSB worker & #:  
Is parent/guardian aware that we will be contacting them re: this referral?: Yes No
If yes explain:

What is the family's level of commitment to group completion?

If the child is under 8, do you think they can manage and learn within a group setting?

Please identify attributes that we should know about to increase group participation? (Reading/learning, behavior difficulties, learning style, likes/dislikes etc)

If applicable, how does the sibling group get along at home & in social settings?

Do you think they will do well in a group together?: Yes No
Referring Agency: 
Contact Name:      
Contact Number:  

Positive Connections Children...Understanding Parents. Supporting One Another. Building Confidence.

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