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Admission Information

- ADMISSION INFORMATION
  
  The children referred to Saint Joseph's exhibit a variety of serious concerns including physical and sexual abuse or parental neglect, depression and suicide attempts, oppositional behavior and defiance of authority, runaway and substance abuse problems, excessive fear and anger, aggressive or sexually inappropriate behavior, and involvement with the juvenile court system. Saint Joseph's exists to help residents identify challenges and develop the action plans necessary to assist in resolving problems. Support for the transformation of our residents into productive adults flows from openness, honesty, encouragement, and providing all the tools necessary for this to occur.
- ADMISSION FORM
  
  (Downloadable fillable pdf) The pdf will not directly "submit" unless it is downloaded and filled out through the Adobe Acrobat Standard DC program. You can fill out the form and save it as filled to a desktop, but the submit button will not work unless the document is opened within "Adobe Acrobat Standard DC." You can then save the file and email to [email protected] attaching the completed doc to your email.
  
  SOCIAL HISTORY FORM
  
  PARENT HANDBOOK
  
  INFORMATION RELEASE FORM
Admission Criteria
- CRITERIA FOR ADMISSION
  
  Youth with primary mental health and secondary chemical dependency diagnosis
  
  Must have a history and current problems with mental health or dysfunctional behaviors which cannot be successfully treated in an outpatient or less restrictive residential setting
  
  Must be cognitively and emotionally capable of participating in individual, group and family therapy
  
  Must be ambulatory and physically healthy
  
  Must have a minimal IQ of 70
  
  Dependent upon the type of admission, youth must meet medical necessity requirements according to Medicaid, CMS, or third party insurance company
  
  CRITERIA FOR EXCLUSION
  
  Severely developmentally impaired
  
  Actively suicidal or homicidal
  
  Significant Conduct Disorder diagnosis
  
  In need of specialized treatment (i.e. eating disorder, sexual offender, etc.)
  
  Involved in extreme self-harming behaviors, arson, a juvenile sexual predator
  
  Do not have a mental health or behavior diagnosis that severely interferes with daily functioning in school, home/family or the community
Admission Process
- ADMISSION PROCESS
  
  Contact Staint Joseph's Director of Admission to discuss a possible referral
  
  Fax or mail available information to support the admission criteria (see Information requested for Preadmission Review located below)
  
  Material is then reviewed by the Admission Team
  
  The referral source is contacted regarding the decision of the Admission Team, if admission is to occur
  
  The admission materials available on this website are completed by the referral source and the youth's parents or primary caregiver and are submitted to Saint Joseph's (may fax or email and follow-up by sending originals in the mail)
  
  Director of Admissions and Referral Source work together to coordinate admission date, time, unit placement, medications, admission documents, and transportation arrangements.
  
  INFORMATION REQUESTED FOR PRE-ADMISSION REVIEW
  
  Available psychiatric evaluations and/or psychological evaluations
  
  Information regarding prior placements including psychiatric hospitalization
  
  Information regarding academic progress
  
  FINANCIAL/INSURANCE INFORMATION
  
  Title XIX number and Equality card (Medicaid)
  
  Private Insurance Card
  
  A legible photocopy of front and back of card, social security number, home address and date of birth of primary card holder.
Documents & Forms Checklist
- DOCUMENTS AND FORMS FOR ADMISSION
  
  Admission Application (Signature Required)
  
  Consent and Authorization (Signature Required)
  
  Restraints and Seclusions (Signature Required to verify that you were informed)
  
  Professional Disclosure Statement (Signature Required verifying that you were informed)
  
  Notice of Information Practices Acknowledgement (Signature Required to verify that you received the information)
  
  Authorization of Release of Information for Psychiatrist (Signature Required and witnessed)
  
  Authorization of Release of Information (Signature Required and witnessed)
  
  Permission for Visitation (Signature Required)
  
  Consent for Religious Activities (Signature Required)
  
  Suggested Clothing List (No signature required - yours to keep)
  
  Child Behavior Checklist (CBCL) (Will be sent separately; to be completed by a parent or most recent caregiver)
  
  Proof of legal guardianship
  
  Custody Order
  
  Social History (Must be completed by a parent or relative)
  
  Please complete all forms and return them to St. Joseph's Children's Home as soon as possible. If you have questions or want further clarification on the use/purpose of any of the forms, contact:
  
  Director of Admissions
  PO Box 1117
  Torrington, WY 82240
  Email: [email protected]