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Mental Health Referrals


NOCAC Head Start will provide Mental Health referrals to ensure that support is given to staff and children and their family when mental health concerns arise. NOCAC Head Start will follow up to ensure that services have been provided and have met the identified needs.


  1. If the need for mental health services is identified, the staff or family can request an individual mental health observation for a child.
  2. Requests will be discussed with the Disabilities Services Coordinator (DSC) regarding the child’s behavior and family situation to identify the best available resource.
  3. NOCAC Head Start Staff will share, discuss, and have the parent/guardian sign the referral forms (Permission for Mental Health Observation & Four County Referral. NOCAC Head Start staff will also have the parent/guardian sign a Release of Information (ROI).
  4. With signed parent/guardian consent, the DSC will refer children for appropriate mental health support services
  5. The Early Childhood Mental Health Consultant (ECMHC) may be called upon to observe an individual child with signed parent/guardian consent.
    1. The ECMHC is available for consultation with staff and parents with regard to the identification of children with behavioral difficulties
    2. Parents of children with behavioral difficulties will have an opportunity to participate fully in any behavioral planning for the child
    3. The ECMHC will contact parents to discuss concerns and plan a time for observation
      1. The ECHMC will share the planned observation time with the DSC
      2. The ECMHC will communicate with the DSC what types of services are being requested, such as Diagnostic Assessment for Case Management
    4. The ECMHC will email a written report to the DSC within one week of the service provided.
    5. If the family decides to begin case management services, the name of the case worker will shared with the DSC and communication will occur through the Monthly Contact Form for Children Receiving Mental Health/Behavioral Treatment.
      1. All programs must have written mental health documentation for children who receive mental health services
        1. If a child is enrolled and already receiving mental health services, an ROI will be signed at the initial home visit and given to the DSC

Forms and Additional Guidance:

Mental health Internal Referral Form

Mental Health Observation Form

Consent for Mental Health Observation

Monthly Contact Form for Mental Health Treatment


This policy complies with the following

Head Start Program Performance Standard:    1302.42; 1302.45; 1302.46; 1302.53
ODJFS Child Care Manual:    
CACFP Regulation:    
Caring for Our Children:    
Other Sources:    


Effective Date:   8/17/17 Reviewed Date:   6/9/22
Approved By Policy Council:     Revision Approved By Policy Council:    
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