Program Target: Residential Level II, Level I or Specialized Step-Down; Youth Transitioning Program; or the Chaffee Scattered Site Transitional Living Program, CBT or Socially Necessary Services.
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Anticipated Discharge Plan from our Program (return to family, independence, foster care, etc.)
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Targeted placement discharge date from current placement (as applicable if in out-of-home care)
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Date(s) of upcoming MDT and/or Court Hearing (please invite Stepping Stones, Inc. to all MDT's, planning & Treatment Plan meetings)
REQUIRED REFERRAL INFORMATION
In addition to the DHHR Referral Form
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Reason for Out-of-Home Care Referral
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Current Psychological/Psychiatric
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Placement History
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Custody/Court Records
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Current/last placement Discharge Information
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Placement Treatment Plan updates/reviews
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CAPS (if applicable)
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Community-Based Service History
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Medication Information
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Educational/IEP Records
ADDITIONAL REFERRAL INFORMATION - Youth with High Risk Behaviors
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Current Specialized Assessments
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Safety or Relapse Prevention Plans
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Individual/Group Counseling Summary
WE NEED THE FOLLOWING RELEASE OF INFORMATION CONSENTS:
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Release to contact primary staff of current Provider (In-State or Out-of-State provider)
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Release to contact the anticipated School system to expedite youth's school placement
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Release to share information with collaborating agencies (as applicable)
