For a Subacute, PRTS, Day Treatment or ICTS/IOP referral, please provide:
- Psychiatric assessment
- Clinical assessment
- Last three notes from the psychiatrist or PMHNP
- Current diagnosis
- Current medications
- Recent treatment history – for example was the youth recently at another treatment facility, recently in the hospital, receiving IOP but recently stopped, etc
- Information about current functioning – this would include things such as:
- Aggression and if so what type (property or person), to who and frequency
- Any recent trips to the ED
- Any recent self-harm
- Any recent suicide attempts
- Any recent suicidal ideation
- Any sexualized behavior and if so, information about types of behaviors
- Any major medical conditions – such as diabetes, seizures or other
- Any drug and/or alcohol use and if so information about drugs used and frequency
- Other agency involvement –EASA, Juvenile Dept, DHS, Developmental Disabilities, etc
- Psychological assessment (if available – this is not required)
- Current living situation
- Any other information that provides information about the youth’s current functioning and reason for referral
- Contact information for the guardian
- Health insurance information
- Please send the above information to Access Services:
Fax: (503)205-0190
For an Equine Program referral, please provide:
- Current treatment plan from outside provider, including current diagnosis, with equine treatment goals
- Contact information for the guardian
- Any other information that provides information about the youth’s current functioning and reason for referral
- Health insurance information
- Referral from CCO/county representative, if necessary (this will vary by county/CCO)
- Please send the above information to Access Services:
Fax: (503)205-0190
For a Skills Training referral, please provide:
- Current treatment plan from outside provider, including diagnosis, with skills training treatment goals
- Contact information for the guardian
- Current living situation
- Any other information that provides information about the youth’s current functioning and reason for referral
- Health insurance information
- Referral from CCO/county, if necessary (this will vary by county/CCO)
- Safety plan
- Indication of what amount/what skills training is being requested
- Please send the above information to Access Services:
Fax: (503)205-0190
For an Outpatient Therapy referral, please provide:
- Information that provides information about the youth’s current functioning and reason for referral
- Contact information for guardian
- Current living situation
- Health insurance information
- For a Portland Metro Outpatient referral, please send the above information to Virginia Wallace, Metro Outpatient Coordinator:
Email: vwallace@TrilliumFamily.org
Fax: (503)813-7781 - For a Mid-Willamette Valley Outpatient referral, please send the above information to Access Services:
Fax: (503)205-0190