In order to make a referral, a worker from the sponsoring agency (County DSS, OCFS or school CSE) must supply us with the following information. Caseworkers are encouraged to call or email the Admissions Department before making a referral. Please note that we are currently serving males between the ages of 12 and 17 at the time of admission who are in 7th-12th grade and females between the ages of 12 and 17 at the time of admission who are in 9th-12th grade.
- A cover letter that includes: DOB, gender, current location, contact information for caseworker, date of the disposition hearing (if disposition has already occurred, the date it occurred and the child’s disposition status, i.e. PINS, JD, A/N).
- Documents characterizing the circumstances leading to placement (PDI, supplemental summary to the court, police reports).
- Documents characterizing the child’s living circumstances and social history (PDIs and/or psychological evaluations are often sufficient; in their absence, please add a paragraph to the cover letter).
- Current IEP (if classified) and current transcript or report card.
- Discharge summaries from previous placements, psychiatric hospitals or rehabs.
- Adjustment reports from detentions, if available.
- Psychological and other evaluations (educational, substance abuse, neuropsychological, medical or psychiatric).
- Psychiatrist’s reports indicating current diagnosis and treatment recommendations, including medications.
- Medical documentation of any impairing conditions.
Referral documentation should be emailed to our Admissions Department at firstname.lastname@example.org.
After a child has been formerly accepted for admission to our program, the forms in the downloadable packet below need to be completed and returned to the Admissions Department at or before the scheduled admission.
The Admission Form is for the referring county/agency to complete; the rest are customarily completed by the family, though the referring county/agency is empowered to complete them as well. Please supervise for completion of lines seeking information, not just signatures.
In addition to the forms and consents included in this packet, copies of the following documents are required:
- Child’s official immunization record; this can be from the school or physician
- A physical exam and a TB tine test will be administered upon admission. If either of these have been performed in the last few months, an official copy of the record may be attached.
- Child’s primary insurance coverage and/or Medicaid card (front and back)
- Birth certificate
- Social security card
- Court order
- Child’s current medication order
- Proof of child’s COVID-19 vaccine (if applicable)
Danielle Chase, LCSW, CASAC
Acting Director of Admissions, Director of Operations
Tiffany Sherman, LMSW
Assistant Director of Admissions
Office Manager, Admissions Department