De-identified name of student (i.e. a different name): *

Age / Grade *

School *

Your Email *

Term *

Year *

1. Background of Student *

Possible items to include: Family situation (including family members if relevant, health issues, mental health issues, socioeconomic issues, CALD background etc), length of time at school (i.e. if they have attended since Prep or have just transferred). For example: Jess comes from a single parent family and has 3 younger siblings. Her father lives interstate and she rarely sees him. Her mum has bi polar and Jess often takes on care responsibilities within the family when mum is not coping with her mental health issues

2. How student presented prior to inclusion in the program

Possible items to include: Presenting issues and reason for referral (anxiety, attendance issues, behavioural issues, communication issues, emotional regulation issues, peer issues, engagement with curriculum etc). External supports involved, care plans, other involvement in support programs etc. Observations prior to inclusion in program. For example. Jess attended school regularly and was a model student until Grade 5 when she started to become anxious in class. For Terms 1 and 2 2017, Jess missed a total of 17 days in Grade 5. She has had 5 appointments with wellbeing staff (including the SSS psychologist) during this period and has spoken about struggling with her anxiety. Sometime in class she becomes so anxious that she vomits. Mum has refused to access a mental health care plan for Jess so that she can access a psychologist outside of school. Jess often seems overwhelmed with the curriculum and class activities and never asks for help. Her interactions with peers have also suffered and she often spend lunchtimes on her own.

3. Observations of student participating in program sessions and external to sessions while the program was run

Possible items to include: Attitude to initial session, number of sessions missed if any, participation in activities, interactions with dog, tutor, peers, observations of impact on presenting issues whilst in sessions, observations of changes in behaviour/wellbeing outside of sessions (i.e. in classroom, yard etc). For example. Jess was initially apprehensive about attending the sessions, however after her first meeting with ‘Oscar’ she quickly began to look forward to them. She has greatly enjoyed the sessions and often asks if she can see Oscar outside of the session times. Jess found the mindfulness activities especially useful and was observed physically relaxing while engaging in these activities. In the first session Jess was quite anxious and described feeling like she wanted to vomit. During the remaining sessions she did not mention this again. Jess was observed mixing more with her peers during sessions and built a lovely friendship with another participant, Koby. Jess was also observed mixing more with her peers at lunchtime and during class.

4. Observations of the student post program

Possible items to include: Observations post program in class, yard etc. Impact on presenting issue. For example. Jess’s classroom teacher has commented that since her inclusion in the program, she has not voiced her feeling of wanting to vomit. She asks questions more when she is confused and mixes more with peers. She seems more relaxed and has been observed utilising some of the relaxation strategies that were presented during the sessions.