No results

About Us
Get Help
Learn
Get Involved
Collaborate
Careers
Contact

Donate

Caregivers & Families
Community Partners
Job Seekers
Board Portal

About Us
Get Help
Learn
Get Involved
Collaborate
Careers
Contact

Donate

Uncategorized

CALM News, Uncategorized

CALM Widens Home Visitation to Reach More Local Families

Santa Barbara

1236 Chapala Street

Santa Maria

210 E Enos Drive, #A

Lompoc

110 S C Street

Contact

Get the latest from calm

Phone

This field is for validation purposes and should be left unchanged.

Name

First Last

Email(Required)

Solicitud de servicios

CALM ofrece un continuum de servicios para niños, jóvenes, padres/guardián (incluyendo prenatal), y proveedores comunitarios. CALM no ofrece consejería para parejas ni servicios de comportamiento para el trastorno del espectro autista o el trastorno por déficit de atención e hiperactividad. Por favor, visite el sitio web de CALM para obtener más información: www.calm4kids.org

Información del Proveedor de Referencia

Fecha de Referencia(Required)

¿A quién se está refiriendo?(Required)

Estoy refiriendo a mi hijo(a)

Me estoy refiriendo a mí mismo(a) (joven/adulto)

Estoy refiriendo a un(a) niño(a) como proveedor(a) de la comunidad

Estoy refiriendo a un(a) adulto(a) como proveedor(a) de la comunidad

¿Dónde prefiere el/la cliente recibir los servicios?(Required)

Santa Barbara

Santa Maria

Lompoc

Nombre del cliente referido(Required)

Nombre Apellido

Fecha de Nacimiento(Required)

Identidad de género

Escuela (si aplica)

Idioma preferido(Required)

Número de teléfono del cliente(Required)

¿Está bien dejar un mensaje de voz?

Horario preferido para llamar

Hours

Minutes

AM/PM

Dirección

Calle Ciudad Estado

Seguro médico (marca todas las opciones que correspondan)(Required)

Sin seguro

Seguro privado

Medi-Cal

Para procesar su solicitud, por favor cargue una copia de su(s) tarjeta(s) de seguro.

Drop files here or

Max. file size: 256 MB, Max. files: 3.

Nombre del seguro privado:

Medi-Cal CIN#

Servicios de Interés

Marca todas las opciones que correspondan:(Required)

EDUCACIÓN Y APOYO PARA PADRES: Brinda orientación para ayudar a padres y cuidadores de niños de 10 años o menos a fortalecer sus habilidades de crianza, mejorar las relaciones familiares y crear entornos seguros y afectivos para los niños.

VISITAS AL HOGAR: Ofrece apoyo en el hogar para padres y cuidadores de bebés menores de un año, incluso durante el embarazo, promoviendo un desarrollo saludable, fortaleciendo el vínculo afectivo y conectando a las familias con recursos comunitarios.

TERAPIA: Proporciona servicios de salud mental basados en evidencia para niños, padres y familias, con el fin de atender el trauma, los desafíos conductuales y el bienestar emocional.

Motivo de la referencia (síntomas actuales, factores de estrés)(Required)

¿Se están recibiendo servicios similares en otro lugar?

Sí

¿Qué tipo de servicios y dónde?

Información del Padre/Madre o Cuidador(a)

Nombre del Padre/Madre o Cuidador(a)

Nombre Apellido

Teléfono(Required)

¿Está bien dejar un mensaje de voz?

Sí

¿Está bien enviar mensajes de texto?

Sí

Horario preferido para llamar

Hours

Minutes

AM/PM

Dirección

Calle Ciudad Estado

Relación con el niño(a)?

(si aplica)

Idioma preferido(Required)

¿Desea agregar otro(a) padre/madre o cuidador(a)?

Sí

Nombre adicional del Padre/Madre o Cuidador(a)

Nombre Apellido

Teléfono

¿Está bien dejar un mensaje de voz?

Sí

¿Está bien enviar mensajes de texto?

Sí

Dirección

Calle Ciudad Estado

Relación con el niño(a)?

(si aplica)

Idioma preferido

Información del Proveedor Comunitario que Refiere

Referido por:

Nombre Apellido

Organización

Teléfono

Correo electrónico

Consentimiento

Esta referencia se realizó con el consentimiento del posible cliente.

Santa Barbara
Teléfono: (805) 965-2376

Santa Maria
Teléfono: (805) 614-9160

Lompoc
Teléfono: (805) 741-7460

Request for Services

CALM offers a continuum of services for children, youth, parents/caregivers (including prenatally), and community-based providers. CALM does not offer couples counseling or behavioral services for autism spectrum disorder or attention deficit hyperactivity disorder. Please visit CALM’s website to learn more: www.calm4kids.org.

Referral Information

Date of Referral(Required)

Who is being referred?(Required)

I am referring my child

I am referring myself (youth/adult)

I am referring a child as a community provider

I am referring an adult as a community provider

Where does the client prefer to receive services?(Required)

Santa Barbara

Santa Maria

Lompoc

Name of referred client(Required)

First Last

Date of Birth(Required)

Gender Identity

School (if applicable)

Preferred language(Required)

Client's Phone Number(Required)

Okay to leave voicemail?

Yes

Preferred time to call

Hours

Minutes

AM/PM

Address

Street Address City State

Insurance (check all that apply)(Required)

No Insurance

Private Insurance

Medi-Cal

To process your request, please upload a copy of your insurance card(s).

Drop files here or

Max. file size: 256 MB, Max. files: 3.

Name of Private Insurance:

Medi-Cal CIN#

Services of Interest

Check all that apply:(Required)

PARENT EDUCATION & SUPPORT: Provides guidance to help parents and caregivers of children 10 years and younger strengthen parenting skills, improve family relationships, and create safe, nurturing environments for children.

HOME VISITATION: Provides in-home support for parents and caregivers of children under one year old, including prenatally, promoting healthy development, strengthening bonding, and connecting families to community resources.

THERAPY: Delivers evidence-based mental health services for children, parents, and families to address trauma, behavioral challenges, and emotional well-being.

Reason for Referral (current symptoms, stressors)(Required)

Are similar services being received elsewhere?

Yes

What type of services and where?

Parent/Caregiver Information

Parent/Caregiver Name:

First Last

Phone(Required)

Okay to leave a voicemail?

Yes

Okay to text?

Yes

Preferred time to call

Hours

Minutes

AM/PM

Address

Street Address City State / Province / Region

Relationship to child?

(if applicable)

Preferred language(Required)

Would you like to add another parent/caregiver?

Yes

Additional Parent/Caregiver Name:

First Last

Phone

Okay to leave a voicemail?

Yes

Okay to text?

Yes

Address

Street Address City State / Province / Region

Relationship to child?

(if applicable)

Preferred language

Referring Community Provider Information

Referred By:

First Last

Organization

Phone

Consent

This referral was made with the prospective client’s permission

Santa Barbara
Phone: (805) 965-2376

Santa Maria
Phone: (805) 614-9160

Lompoc
Phone: (805) 741-7460

Growing Together Request for Services

CALM's Growing Together Program provides infant and early childhood mental health consultation in partnership with early care and education providers. The program supports staff, families, and children by promoting social-emotional well-being, addressing challenging behaviors, and strengthening relationships and practices that help buffer against stress and trauma. To request services, please complete this form.

Referral Information

Date of Referral(Required)

Address of the School/Center

Street Address Address Line 2 City ZIP / Postal Code

Referred By(Required)

First Last

Organization

Phone(Required)

Email(Required)

I'm requesting support for:

A specific child (i.e. behavior intervention planning, persistent behaviors that interferes with learning or social-emotional development)

Classroom-wide or program-wide (i.e. staff culture, classroom-wide social emotional learning, parent-teacher relationships, etc.)

Reason for Request(Required)

CALM's Growing Together Program offers a variety of tailored services.

Please indicate services that you are interested in learning more about.

Check all that apply:

Trauma-Informed Trainings for Staff

Reflective Practice

Coaching and Support for Classroom Management

Strategies to Promote Social-Emotional Well-being

Parent Education Workshops

Programmatic Consultation to Inform Policies and Procedures

Behavior Intervention Planning and Individualized Support

If this request is for a specific child, please complete the following section.

If this request is for classroom or programmatic support, please leave the rest of the form blank.

Was this referral made with the parent/caregiver's permission?

Yes

Does the student have an IEP or IFSP?

Yes

Is the child of focus receiving services elsewhere? If so, what type and where?

Parent/Caregiver Information

Parent/Caregiver Name:

First Last

Phone

Okay to leave a voicemail?

Yes

Okay to text?

Yes

Preferred time to call

Hours

Minutes

AM/PM

Relationship to child?

(if applicable)

Preferred language

Child Information

Child's Name

First Last

Date of Birth

Gender

Classroom

Children’s Legacy Society Newsletter Signup

This field is for validation purposes and should be left unchanged.

Email(Required)

Ambassador's Network Newsletter Signup

This field is for validation purposes and should be left unchanged.

Email(Required)

Jon Clark

Jon Clark serves as President of the James S. Bower Foundation, a local grant maker focusing on early childhood education, end of life care, and the environment. He previously held leadership roles with Community Environmental Council, the Wendy P. McCaw Foundation, and has served on boards for several local organizations. Raised in Santa Barbara and an active leader in the community, Jon was named Man of the Year by the Santa Barbara Foundation in 2017.

Solicitud de servicios

Información del Proveedor de Referencia

Fecha de Referencia(Required)

Consent(Required)

Esta referencia se hizo con permiso

Referido por(Required)

First Last

Organización

Teléfono(Required)

Correo electrónico(Required)

Referred to(Required)

Santa Barbara

Santa Maria

Lompoc

Santa Barbara
Teléfono: (805) 965-2376

Santa Maria
Teléfono: (805) 614-9160

Lompoc
Teléfono: (805) 741-7460

Áreas de Interés

Programas de Salud Mental

Educación para Padres

Visita Domiciliaria

Terapia

Razón para la Referencia(Required)

Comentarios del Proveedor de Referencia(Required)

¿El cliente prospectivo está recibiendo servicios en otro lugar? Si es así, ¿qué tipo y dónde?

Información del Padre/Guardián

(requerido para programas de salud mental)

Nombre del Padre/Guardián

First Last

Número de Teléfono

Fecha de Nacimiento

¿Se puede dejar un mensaje de voz?

Sí

¿Se puede enviar un mensaje de texto?

Sí

Hora preferida para llamar

Hours

Minutes

AM/PM

Dirección

Street Address Address Line 2 City ZIP / Postal Code

¿Relación con el niño?

(si aplica)

Idioma preferido

Nombre del Padre/Guardián

First Last

Número de Teléfono

Fecha de Nacimiento

¿Se puede dejar un mensaje de voz?

Sí

¿Se puede enviar un mensaje de texto?

Sí

Hora preferida para llamar

Hours

Minutes

AM/PM

Dirección

Street Address Address Line 2 City ZIP / Postal Code

¿Relación con el niño?

(si aplica)

Idioma preferido

Información del Niño

(si se refiere para servicios)

Nombre del Niño

First Last

Fecha de Nacimiento

Escuela

Género

Seguro Primario

Medi-Cal

Seguro Privado

Sin Seguro

Para agilizar su solicitud, cargue una foto de su tarjeta de seguro.

Drop files here or

Max. file size: 256 MB, Max. files: 3.

Medi-Cal Miembro ID#

Request for Services

Referral Information

Date of Referral(Required)

Consent(Required)

This referral was made with the prospective client’s permission

Referred By(Required)

First Last

Organization

Phone(Required)

Email(Required)

Referred to(Required)

Santa Barbara

Santa Maria

Lompoc

Santa Barbara
Phone: (805) 965-2376

Santa Maria
Phone: (805) 614-9160

Lompoc
Phone: (805) 741-7460

Areas of Interest

Clinical Programs

Parent Education

Home Visitation

Therapy

Reason for Referral(Required)

Referring Provider Comments(Required)

Is prospective client receiving services elsewhere? If so, what type and where

Parent/Caregiver Information

(required for clinical programs)

Parent/Caregiver Name:

First Last

Phone

Date of Birth

Okay to leave a voicemail?

Yes

Okay to text?

Yes

Preferred time to call

Hours

Minutes

AM/PM

Address

Street Address Address Line 2 City ZIP / Postal Code

Relationship to child?

(if applicable)

Preferred language

Parent/Caregiver Name:

First Last

Phone

Date of Birth

Okay to leave a voicemail?

Yes

Okay to text?

Yes

Preferred time to call

Hours

Minutes

AM/PM

Address

Street Address Address Line 2 City ZIP / Postal Code

Relationship to child?

(if applicable)

Preferred language

Child Information

(if referred for services)

Child's Name

First Last

Date of Birth

School

Gender

Primary Insurance

Medi-Cal

Private Insurance

No Insurance

To expedite your request, please upload a photo of your insurance card.

Drop files here or

Max. file size: 256 MB, Max. files: 3.

Medi-Cal Member ID #