Flyer/Email for Group Announcement to Parents and Faculty:

Dear Parents and Faculty,

I have been developing a Psychoeducational Support Group called the,
Family Changes Group, for children Grades 3 rd through 5th at ______
Elementary School. It is to help children struggling and adjusting to parental
separation or divorce. Because this is a hard topic for children to understand
and go through, I have developed a group for those who are struggling to
gain helpful problem solving skills, coping skills, stress management skills,
and learn healthy ways to express hard feelings that they may be going
through.
This is done through a developmentally careful way of play therapy,
music, open group talking, and activities. This will benefit them by having
peer support, building stronger relationships with others, and overall raising
their self-esteem or helping their post-divorce/separation adjustment by
learning that they are not alone.
If you would like to make a referral for your child/student or have any
more questions about this group, please feel free to email me at

Dana.ramalho@fakeemail.com or contact my office phone at (570)fakephone.

*(All children will meet with me to see if they are ready for a group but, cannot be guaranteed
in).

**( All children must receive parental permission to be screened for the group and must take a
survey).

Parental Permission/ consent Form:

_________ Elementary School
Family Changes Group Permission Form

Dear Parent/Guardian,
One of the services provided by your Elementary Professional School Counselors
is small group counseling. Your child has expressed interest or has been invited to be in
the, Family Changes Group. This is a Psychoeducational Support Group to help your
child adjust to parental separation, remarriage, or divorce. I will be working with children
grades 3rd through 5th who are going through these family changes. This can be a hard
topic for children to understand and go through but, children are given the opportunity to
interact with peers who have similar needs and interests. It is a positive and effective way
to help children deal with specific issues in their lives and learn to express themselves in
a safe and positive environment.
The purpose of the group is foster support, trust, and a safe area for children to
appropriately express their emotions from the divorce/separation and realize that they are
not alone. They are to learn ways to healthily express themselves through feelings,
thoughts, and behaviors. Objectives are to learn healthy problem solving skills, coping
skills, and stress management skills. Ultimately, they will come out of the group having
peer support, building stronger relationships with others, raising their self-esteem, and
improving their post-divorce/separation adjustment through developmentally safe
activities and group talk.
The group will meet once a week for eight weeks and is generally from
1:00pm to 1:30 during school hours with an extra 15 minutes afterwards if patience
is good that day. It is a closed group for eight weeks and, once done, a new group
will be formed allowing another group of children to gain the benefits of the Family
Changes Group. Children must stay in the group during the sessions and can choose
to stop group at anytime during the eight weeks. PLEASE NOTE: This group is for
any child who has had this divorce/separation/remarriage experience at any time. In order

to be considered for the group, every child must take a self-esteem survey and be
screened individually in my office. *this form does not guarantee access into the
group.
If your child is in the group, all information is confidential and will not be
spoken about outside of the group unless the child is a harm to himself/herself, others, or
is in harms way. We ask parents to please be respectful and not inquire any information
of other students within the group because this is a breach of confidentiality. You may
inquire about your childs own progress but, please be respectful of their privacy as they
progress in the group and build trust. Parent/child meetings can be scheduled.
If you would like to have your child considered for the Family Changes Group,
please indicate your interest below while mentioning any special concerns or information
you feel might be helpful for me to know regarding your child. If there is joint custody
of your child, both parents must sign for permission. Please return this slip to your
childs teacher and let your child know that he or she may be visiting the school
counselor. If you have any further questions, Please feel free to email me at
Dana.ramalho@fakeemail.com or contact my office phone at (570)fake-phone.
Sincerely,
Ms. Dana Ramalho
BA, The University of Scranton, 2014
MS, The University of Scranton, 2016
--------------------------------------------------------------------------------------------------Please include (Student Name)_______________________________
Teacher _____________________
in the Family Changes, psychoeducational support group, session 1 running from
(Dates) Example: Feb 2nd- March 23rd 2015
Important information you should know about my
child:___________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
____________
I will allow my child to be screened and potentially participate in group _____
I will NOT allow my child to be screened and potentially participate in group ____
Parent Name:_____________________ Signature___________________________
Phone:___________
ParentName:______________________Signature___________________________
Phone:____________

JOINT CUSTODY :(check: Yes___ or No___)

Informed Consent Form for children 3rd-5th grade:

About the Family Changes Group

My name is Ms. Dana Ramalho and I am your Elementary School

Counselor.
About The Group:

This group is a small counseling group that talks about

your feelings about your parents, family, and school.

Changing families from divorce, a new marriage, or

leaving, can sometime make you sad, angry, or confused
but this is okay.

In a small private group with 4-6 other students, we will all

talk about your feelings and issues with your family
changing or separating.

You will learn ways to be happier and have students share

with you their stories that are similar to yours.

Goals:

Goals of the group is to build your self-esteem and

confidence.

Help build your relationships with peers, school, and

parents.

Learn how to problem solve family issues.

Learn how to manage stress.

Learn how to express hard feelings through play activities,

drawing, journaling, music, and talking.

Rules and Privacy:

You cannot talk about others outside of the group. Please treat
others the way you want to be treated.

Everything you say will stay private unless you are going to
hurt yourself, are going to hurt others, or somebody is hurting
you. (please be aware that your teachers or parents may ask
me general information about how your are doing in the
group).

You may choose to stop being in the group at any time.

Time and place of group:

From 1:00pm to 1:30 with an extra 15 minutes just in case the

group needs it. This is during class time and you will be
excused.

Group is once a week for 8 weeks.

Group will be in an empty classroom where privacy is ensured

and safe. No windows or doors will be open.

-----------------------------------------------------------------------------------------------------------(Being in the group is your choice and you do not need to be in it if you do not want to)
I want to be in the Family Changes Group:

YES____

Sign Name Here: __________________________

NO____