Referral Packet Cincinnati Children s Diiviissiion off Chiilld & Adollesscentt Pssychiiattrry Contact Cincinnati Children s Admissions Intake Coordinator Referrals (513) 636-0820 or 1-866-304-8761 x 60820 Fax: (513) 636-0810 Email CollegeHillCampus@cchmc.org Cincinati Children s Division of Child and Adolescent Psychiatry 5642 Hamilton Avenue Cincinnati, OH 45224 Main Number: 513-636-0800 or 1-866-304-8761 www.cincinnatichildrens.org/psychiatry www.cincinnatichildrens.org/residential
Cincinnati Children s A Division of Child and Adolescent Psychiatry Referrals: (513) 636-0820 Fax: (513) 636-0810 The residential treatment program at the of Cincinnati Children s Hospital Medical Center is a place where youth who need psychiatric care over extended periods of time can receive therapeutic treatment. The program helps children and adolescents make healthy decisions and express their emotions through appropriate communication. The residential treatment program is for both males and females, ages 9to 18. Length of stay is between one to 12 months with the average length of stay around 120 days. The psychiatry treatment staff utilizes an interactive collaborative approach and continually focuses on Family-Centered Care. The trained / certified staff partners with youth and families in order to: Teach new thinking and behavioral skills to improve overall functioning abilities Improve parent / guardian abilities to manage difficult behaviors and improve family satisfaction Program Environment Youth are under constant supervision in a secure, safe environment. Cincinnati Children s College Hill Campus is located on 25 acres of peaceful, wooded land in a Cincinnati suburb called College Hill. The residential treatment program offers a living area with a home-like atmosphere that includes a kitchen on each unit, bedrooms and private baths. An educational wing and indoor and outdoor recreation areas are also provided. The is under constant CCTV monitoring. It is important to understand that all persons, entering and exiting are videotaped. Program Focus The residential treatment program helps children and adolescents express their emotions through appropriate communication and behaviors to enable them to make healthy, positive decisions. Treatment is geared toward helping the youth develop self awareness and self-esteem and ultimately increasing their ability to be an active, productive member in their community. The focus of the program is essential behavioral treatment, intense family involvement, educational and vocational rehabilitation, milieu and experiential therapy and community re-entry services. Treatment at is provided by many different professionals including Board Certified Psychiatrists, Registered Nurses / Licensed Practicing Nurses, Pharmacists, Therapists, Lead Mental Health Specialists, Recreational Therapists, Behavioral Specialists, Chaplain Services and teacher aids provided by Cincinnati Public School District. Many other services and professionals are available for consultation within the Cincinnati Children s Hospital Medical Center located 6.4 miles from Cincinnati Children s. Admission Criteria Meets DSM-IV criteria for a diagnosed psychiatric illness The pattern of severe impairment is due to a psychiatric illness Ages 9 to 18: Males and females Demonstrated developmental capabilities to respond to structured behavioral program History of sexual perpetration, fire-setting, pre-meditated or potential violent behavior and/or substance abuse requires an additional evaluation prior to admission and cannot be the youth s primary reason for referral to Cincinnati Children s Partners in Care Proper and timely communication is essential with referring physicians, agencies and families. The psychiatry staff at Cincinnati Children s is committed to the continuum of care each youth receives. Ongoing communication will occur throughout the treatment process and will include frequent verbal communication and written reports.
Treatment Components The Division of Child and Adolescent Psychiatry at Cincinnati Children s utilizes the College Hill Campus facility to provide many different therapeutic opportunities through the residential treatment program. The treatment program includes: Individualized assessments Individual therapy Milieu therapy Expressive therapy Family therapy Issue-focused groups Life skills training Behavior modification Parenting / support groups Animal therapy Recreation therapy Vocational rehabilitation Cincinnati Public School education services Progression/merit system 24-hour nursing and medication management Community reintegration services Non-denominational spiritual opportunities Outreach, Educational and Support Services Our outreach and support services include helping families contact available resources for children and adolescents within Cincinnati Children's Hospital Medical Center and throughout the Cincinnati area. For more information on Cincinnati Children's and community resources, please call 513-636-4124 or 1-800-344-2462 ext. 64124 or check out our website information at www.cincinnatichildrens.org/psychiatry www.cincinnatichildrens.org/residential Licensing and Accreditation Ohio Department of Mental Health License to Operate a Private Psychiatric Hospital Mental Health Agency Certification License to Conduct a Residential Care Facility Joint Commission on Accreditation of Healthcare Organization Behavioral Health Accreditation Funding Title IV E Federal Participation Certified Agency Commercial Insurance Medicaid Certified (Pharmacologic Management, Behavioral Therapy, Diagnostic Assessment) For further funding and /or contract questions, please contact: Debbie Brown Financial Senior Representative III Cincinnati Children s 513-636-0813 Fax: 513-636-0810 debbie.brown@cchmc.org Gregory Renzenbrink Business Director / Contracts Cincinnati Children s 513-636-9262 Fax: 513-636-0810 gregory.renzenbrink@cchmc.org
CINCINNATI CHILDREN'S A Division of Child and Adolescent Psychiatry Referrals: (513) 636-0820 Fax: (513) 636-0810 CHECKLIST FOR REFERRERS Please submit the following documents listed below Initial Referral Information Referral Application DAF: Current or Past documentation (Diagnostic assessments, Summaries, Treatment Plans) Health Related Documentation Psychiatric Evaluation Psychological Evaluation with IQ Medication History Complete drug/alcohol assessment (within 6 months if youth is using) Discharge Summaries from prior placements/hospitalizations Immunization Record / Vaccine and Health Information Most Recent Physical Exam/Dental Exam History/Evaluation of OT, PT and Speech Therapy Social Service and Legal Documentation Social History Legal History Educational Documentation Educational information: current IEP, MFE, 504 Plan, SBH, etc. statement of special educational needs. Must send copy of IEP or 504 Plan The home school district is required for payment of residential educational services. Must send a copy of court order if applicable Billing Information Funding source (agency contract, Medicaid, insurance, etc) All insurance/medicaid information (photocopy of front/back of card) Copy of your last paycheck stub Copy of your unemployment check, child support or alimony check Copy of any other official government or income form (SSI, etc.) Number of dependents Cincinnati Children s Referrals: 513-636-0820 Attention: Admission Intake Coordinator Fax: 513-636-0810 5642 Hamilton Avenue Toll Free: 1-800-304-8761 Cincinnati, OH 45224
Cincinnati Children s A Division of Child and Adolescent Psychiatry DATE Name (Last, First, MI) Previous Referral (Yes/No) PATIENT INFORMATION Social Security # DOB Male/Female County Address (street, city, state, zip) Parent/Guardian Name(s) Home Phone (area code) Parent's School District Work/Cell (area code) Current Grade Current School Placement IEP or 504 (circle) School Contact School Address (name / title, number) FUNDING SOURCE (Please include front and back copy of Insurance or Medicaid card) Funding Source (i.e. Insurance / Medicaid card, agency billing information) REFERRING AGENCY INFORMATION Parent/Guardian Name(s) Address (street, city, state, zip) Business Phone (area code) Fax Number (area code) Additional Agencies/Providers involved with youth: (name / title, address, contact number) MULTI/AXIAL CLASSIFICATION (ICD-10/DSM-IV) 1. Primary Psychiatric Disorder 2. Developmental/Personality Disorders 3. IQ 4. Medical Problems 5. Social Problems Presenting Problem Expectations of Residential Treatment - Please submit the Patient Referral Information page to Cincinnati Children s Referrals: 513-636-0820 or 1-866-304-8761 Attention: Admission Intake Coordinator Fax: 513-636-0810 5642 Hamilton Avenue Cincinnati, OH 45224