Information for Referrals

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

  • Other agency involvement –EASA, Juvenile Dept, DHS, Developmental Disabilities, etc

  • Psychological assessment (if available – this is not required)

  • Clinical documentation from your current mental health providers that clearly documents your child’s active treatment needs, including information about self-harm and aggressive behaviors, and information about any significant medical conditions, substance treatment needs, or other behavioral symptoms

  • Current living situation

  • 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

  • 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

  • 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