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Making A Referral


How to Make a Referral to Second Wind Fund of Metro Denver

In order to be considered for a referral by the Second Wind Fund of Metro Denver (SWFMD), the individual must be 19 or under, at-risk for suicide, and face a financial barrier to receiving therapy on their own. A youth must be referred to our program by a Qualified Referral Source (QRS), which may include but is not limited to school counselors, social workers, psychologists, members of the clergy, nurses or family practitioners, and probation officers.

All therapists in the Second Wind Fund of Metro Denver program are licensed by the State of Colorado, maintain malpractice insurance, have experience with teens at-risk for suicide, and have agreed to see Second Wind clients at a drastically reduced hourly rate.

Second Wind Fund of Metro Denver will pay for a student to visit a program therapist up to a maximum of 12 times. Eight visits are automatically approved at the time of the initial referral. More visits require additional information after therapy has begun from the therapist and the QRS.

If you are concerned about a Denver Metro child or teen, please follow the steps below:

1.Once it is determined that the youth may be eligible to receive therapy through Second Wind Fund of Metro Denver, the school mental health staff or Qualified Referral Source contacts our office at 303-988-2645.

2. When the qualified referral source calls Second Wind Fund, these are some questions that will be asked

  • Have parents been notifed of the risk of suicide and possible referral to Second Wind Fund?
  • What is the families insurance situation?                                  
  •  Do they have health insurance?                                            
  •  Are they underinsured (family has health insurance but no mental health coverage or they cannot afford the co-pay)            
  •  Do they have Medicaid? - if so, therapy is available at their county mental health agency.                                                    
  •  Do they have CHP+?  If so therapy is available through their CHP+ HMO (Kaiser,  Colorado Access or Denver Health Medical Plan. 
  •  Narrative concerning suicide risk.

3. After collecting basic information as well as answering the questions above, when the youth meets our guidelines, Second Wind Fund of Metro Denver authorizes a referral number for the student.

4. Two forms must be completed by the qualified referral source and parents at the time of the referral.  Parental consent should be obtained by the QRS if the youth is under 18.  Scroll down this page to find your county and print both forms in either English or Spanish:

  •      Referral Form - filled out by the school mental health staff or QRS
  •      Release of Information/Waiver of Liability Form - signed by the  parents and youth.
  •      Three copies of both forms are made for the school mental health staff or QRS, the family, and the therapist the family selects from the SWFMD List of Approved Therapists below.
  •       The youth and their family are encouraged to directly contact one of our 100 plus therapists to schedule an appointment within seven days of when the referral is initiated.

SWFMD - List of Approved Therapists - used by all Metro Denver Counties.

SWFMD-Provider Specialty List

SWFMD Brochure for Parents and Youth - prints on legal size paper

SWFMD - list of specialties indicated by SWFMD Providers

Download Forms After Referral is Authorized

Adams County
Release of Information and Liability Waiver - Adams 12
Release of Information and Liability Waiver - other Adams
Release of Information and Liability Waiver (Spanish)
Referral Form
Referral Form (Spanish)

Arapahoe County
Release of Information and Liability Waiver
Release of Information and Liability Waiver (Spanish)
Referral Form
Referral Form (Spanish)

Broomfield County
Release of Information and Liability Waiver
Release of Information and Liability Waiver (Spanish)
Referral Form
Referral Form (Spanish)

Denver County
Release of Information and Liability Waiver

Release of Information and Liability Waiver (Spanish)

Referral Form

Referral Form (Spanish)

Douglas County

Release of Information and Liability Waiver

Release of Information and Liability Waiver (Spanish)

Referral Form

Referral Form (Spanish)

Jefferson County
Release of Information and Liability Waiver
Release of Information and Liability Waiver (Spanish)
Referral Form
Referral Form (Spanish)

Grand County

Release of Information and Liability Waiver

Release of Information and Liability Waiver (Spanish)

Referral Form

Referral Form (Spanish)

Park County
Release of Information and Liability Waiver
Release of Information and Liability Waiver (Spanish)
Referral Form
Referral Form (Spanish

 

To request a referral in Boulder County, please visit the Second Wind Fund Affiliates website.


Resources for SWFMD Therapists

There are several forms frequently used by SWFMD  therapists.  They are included below:

Release of Information and Waiver of Liability Form

Release of Information and Waiver of Liability Form (Spanish)

Therapist Claim Form

SWFMD - Follow-up Resources Guide