IN HOME THERAPY REFERRAL FORM
Please fill out the form below to complete your referral. If you’d prefer, you can download the form by clicking here and mail it to us.
Please Note that all of the following criteria are necessary for participation in this level of care:
A comprehensive behavioral health assessment inclusive of the MA Child and Adolescent Needs and Strengths indicates that the youth’s clinical condition warrants this service in order to enhance problems-solving, limit-setting, and risk management/safety planning and communication; to advance therapeutic goals or improve ineffective patterns of interaction; and to build skills to strengthen the parent/caregiver’s ability to sustain the youth in their home setting or to prevent the need for more-intensive levels of service such as inpatient hospitalization or other out-of-home behavioral health treatment services
The youth resides in a family home environment (e.g., foster, adoptive, birth, kinship) and has a parent/guardian/ caregiver who voluntary agrees to participate in In-Home Therapy Services
Outpatient services alone are not or would not like bu sufficient to meet the youth and family’s needs for clinical intervention/treatment
Required consent is obtained. The service needs identified in the treatment plan/care plan are being fully met by similar services. The youth is placed in a residential treatment setting with no plans for return to a home setting
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