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