Refer to Our Mental Health Program

We are working hard to build a Mental Health Service Line with care access opportunities for all children in need. We currently have a high volume of requests and partner with mental health agencies outside of CHKD to ensure all children referred receive an appropriate treatment resource. Please give our team 5-10 business days to review referrals and connect families to resources.
A letter will be mailed to the family and referring provider to indicate if the family is on a waitlist or if community resources were provided to the family to best support.
If you, your families, or your staff have any questions or concerns please contact our main office number at (757) 668-4673.
If your patient has an urgent/acute mental health concern and they require immediate assessment, recommend mental health evaluation at the closest emergency room or the CHKD Emergency Department or call 911.
Please have your provider complete and submit this form.

Referral Data

1. Based on your assessment, can this patients symptoms and behaviors be managed with routine outpatient therapy and/or medication treatment?
Yes No

2. To your knowledge, in the last 30 days, has the patient experienced an increase in mental health symptoms?
Yes No

3. To your knowledge, in the last 30 days, has the patient been unable to maintain functioning in the home, school, or community setting?
Yes No

4. Has the patient recently been discharged from inpatient care?
Yes No

a. If yes, approximate date of discharge?

5. Is the patient being referred for foster care evaluation?
Yes No

6. Is the patient being referred for psychological testing?
Yes No

Additional Comments and Referral Information:

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