Referral Information

HOW TO MAKE A REFERRAL

Children can be scheduled for a trauma assessment by submitting the referral documentation to our main office. An appointment cannot be scheduled until all of the paperwork is fully completed and submitted.

Referrals for children who are considered wards of the state or otherwise under the jurisdiction of the Department of Health and Human Services (DHHS) must come from the child’s agency worker or DHHS monitor. Private referrals can be made by the child’s legal guardian. The processes for making a referral are outlined below.

Once we receive the completed forms, our clinical team will review the referral request. We will then contact the referring person in order to schedule the assessment or to provide guidance on next steps if the referral was not approved. 

Agency Referrals
To make a referral for children currently under the jurisdiction of DHHS, please complete and submit the following forms. Documents should be mailed to CTAC, 1000 Oakland Dr. 3rd floor, Kalamazoo, MI 49008-5361.

  • The assessment referral form - printable referral form
  • A copy of the child’s birth certificate
  • Department of Health and Human Services (DHHS) petition for removal, Initial Service Plan (ISP) and most current Updated Service Plan (USP)
  • Copies of any prior assessments, results and evaluation reports
  • Two payment authorizations:

         1. DHHS 93 for $700 (coded psychiatric 0031)
         2. DHHS 93 for $100 (coded psychological 0034)

Private Referrals
Legal guardians can make a private referral for children to receive an assessment. Please complete and submit the following forms. Documents should be mailed to CTAC, 1000 Oakland Dr. 3rd floor, Kalamazoo, MI 49008-5361.

  • A copy of the child’s birth certificate
  • Any prior assessment or evaluation results or reports

SCHEDULING INFORMATION

Once all referral information is received and reviewed by CTAC’s clinical team, CTAC staff will contact the referring person to schedule an appointment by phone. The assessment will be scheduled on the next available date. Children can also be placed on the cancellation list in the event that an earlier appointment becomes available. 

Thirty days before the scheduled appointment:

  • CTAC office staff will contact the referring person to verify that the assessment is still desired and to obtain the child’s current placement information.
  • A packet will be sent out to the current caregiver with information and forms for the assessment. Forms must be completed and brought with the child on the day of assessment.
  • A letter will be sent to the child’s biological parents (if he or she is not currently in their care), notifying them of the appointment.

Five days before the scheduled appointment:

  • CTAC staff will call the caregiver with a reminder about the appointment date.
  • CTAC staff or interns will contact caregivers (and possibly DHHS staff) to conduct a brief phone interview in order to collect additional information about the child that is necessary for the assessment process. 

If the assessment is no longer desired, it can be cancelled at any time. If you have any questions, please call our office at (269) 387-7073.

Payment information