Grant County Community Referral Form
Referral for local early childhood resources. Families First will receive the referral and pass the information to other agencies as required. Please see the summary of services at the bottom of this referral form.
Sign in to Google to save your progress. Learn more
REFERRING PARTY INFORMATION
Agency Name *
Contact Person Name *
Phone Number *
Email *
Date of referral *
MM
/
DD
/
YYYY
FAMILY/CHILD INFORMATION
Include as much information as you have.
Parent(s) /Guardian Name(s) *
Parent(s) /Guardian Phone Number *
Parent(s) /Guardian Address
Child's Name
Child's gender
Child's due date or date of birth
MM
/
DD
/
YYYY
Child's insurance
REFERRAL TO
Please check all services for which the family/child is being referred. Email relevant medical records, ASQ, etc. to ffhvkat@gmail.com
Referral To *
Required
Please include any other information necessary to complete the referral.
SUMMARY OF SERVICES

GRANT COUNTY LACTATION SERVICES: Grant County Lactation Services offer breastfeeding support to women who are pregnant, postpartum, or breastfeeding. Certified Lactation Counselors (CLC) offer ongoing, individualized support provided in the home or at BMHD following baby’s birth. 

FAMILIES FIRST PARENT RESOURCE CENTER: Healthy Families & Parents As Teachers (PAT) are for families with children prenatal to 5 years. Families are connected to resources in the community and information on child growth and development is provided. These are evidence-based parent education and family support programs. Screenings include developmental, social emotional, hearing and vision.

Car Seat Distribution & Installation is for children prenatal to 4’9” tall. Car seats are available at a reduced price. Our certified car seat technicians will help parents choose the right car seat and install it correctly.

 Parenting class, workshop, playgroup are for all parents, grandparents, children, and educators. Parenting class series and monthly workshops are available throughout the year.

 Baby Steps Prenatal Classes are for families who will be having a baby soon. In partnership with Blue Mt. Hospital, an individual prenatal class is offered in the family’s home.

GRANT COUNTY HEALTH DEPARTMENT: Babies First! is for children conception through age 5 and pregnant mothers up to 2 years after birth.

Gestationally appropriate health and needs assessment, health education assessment, nutrition assessment and counseling related to pregnancy are provided. Prenatal and postpartum education are used to develop and implement a plan to address the client’s needs. After birth, Babies First! helps identify adverse health and developmental outcomes for child; monitors growth, completes hearing, vision, dental and developmental screenings. Referrals for care will be completed when needed.

CaCoon (Care COordinatiON Program) is for children birth to age 21 who have (or are at risk of having) a chronic health condition or disability. Liaison between tertiary services, local providers and family is coordinated as well as help to identify specialty resources if needed (including financial and educational. Services also assist with referrals, screen child for any developmental concerns, nutrition, hearing, vision or other health issues.

Women, Infants & Children (WIC) is for pregnant, postpartum, breastfeeding moms with children birth to age 5. This is a nutrition education and food supplement program that teaches families how to make healthy choices. To participate, families must have a nutritional need and a household income at or below the federal poverty level. Families are income eligible if receiving TANF, SNAP or OHP.

INTERMOUNTAIN ESD (Early Intervention/Early Childhood Special Education): Developmental screenings/evaluations and services such as speech therapy, physical therapy, occupational therapy, specialized instruction in development, autism consulting and training, hearing and vision services, etc. are provided for children birth to age 5. Home visits, preschool visits or enrollment in the ECSE preschool are available with ongoing screenings. 

UMATILLA MORROW HEAD START (John Day Center): Head Start Preschool for 3- and 4-year-old students is a developmentally appropriate preschool experience for children. Breakfast, lunch and transportation to/from school on a bus are included (John Day, Canyon City and Mt. Vernon areas only). Class is 4 days per week for 3 ½ hours a day and includes educational home visits and parent/staff conferences throughout the school year. 

Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy