Skip to content
Child and Family Agency

Child and Family Agency

Strong | Safe | Supported

  • Services
    • Counseling
      • Outpatient Care
        • Adult Outpatient Treatment
        • Open Access Hours
      • Community-Based Services
    • School-Based Health Centers
      • Enrollment
      • Where we Operate
    • Community Bridge Clinic
    • Child Welfare Programs
    • EARLY CARE And EDUCATION
    • family resource Centers
    • Telehealth
    • Forms
    • Billing and Insurance
    • Pay Your Bill
    • Patient Portal
  • About
    • Mission & History
    • Leadership
    • Advocacy
    • 2022-2024 Strategic Plan
    • 2021 Annual Report
    • 2021-2022 Impact Report
    • 2021 – 2022 Audit
    • CT State Single Audit
    • Press Releases
    • Our Corporate Partners
    • Our Affiliations
  • Contact
    • Press Inquiries
  • Careers
  • Events
  • Donate
    • Legacy Giving
    • Corporate Partner Opportunities
    • 2022 a la carte Event Sponsorships

Forms – CBITS Bounce Back


CBITS Bounce Back (rev 20221116)

  • Cognitive Behavior Interventions for Trauma in Schools (CBITS)/ Bounce Back Participation Form

  • MM slash DD slash YYYY
  • Based on a recent screening of students we found that your child could benefit from Cognitive Behavior Interventions for Trauma in Schools (CBITS) group. We would like to offer your child the ten week group focused on helping him/her to express his/her thoughts and feelings about the stressful event(s) and lower the traumatic stress. As a part of the program, we will meet 1-2 times with your child for individual sessions, as well as the weekly in-person groups that will include peers from the school community. We will also schedule two parent meetings (via phone or telehealth) to give you any helpful information about your child’s progress and experience in the group.

    *This group can also be tailored to the developmental needs of younger children and is called Bounce-Back.

    By signing below, I understand and acknowledge the following

    • I give permission for my child to participate in CBITS or Bounce Back group.
    • If I have any questions about disclosure of my protected health information I may contact the agency Privacy Officer, Caitlyn E. Ogilvie, LCSW- 860-437-4550.
  • MM slash DD slash YYYY
  • Facebook
  • Instagram

Stay Connected

Select list(s) to subscribe to


By submitting this form, you are consenting to receive marketing emails from: Child and Family Agency of Southeastern Connecticut, 255 Hempstead Street, New London, CT, 06320, http://www.childandfamilyagency.org. You can revoke your consent to receive emails at any time by using the SafeUnsubscribe® link, found at the bottom of every email. Emails are serviced by Constant Contact
  • Service
  • About
  • Careers
  • Covid Updates
  • events
  • Contact
  • Donate
© Pena Theme by Anariel Design. All rights reserved