How to Refer a Child
Forms for Referral | Funding | State of Iowa PMIC's
Professionals referring children to our Psychiatric Medical Institute for Children program are asked to fax or mail the following information to our Admissions Office:
- A DHS case plan
- Reports from prior service providers, youth counselors or child psychologists
- School information including: grade level, academic performance, and special education services if applicable
- Psychological testing
- A copy of the most recent court order
The admissions staff are available for consultation. Those who would like more information or wish to make a referral are invited to contact an Admissions Coordinator to learn more about the program and, if appropriate, initiate a referral. In order to refer a child to Orchard Place, the Referral Application, the Bio/Psycho/Social Assessment and the Placement Agreement need to be completed by the parent or guardian. Campus tours are available.
Our Admissions Coordinators can be contacted by phone or e-mail:
Joe Criger, Director of Admissions
Amy White, Admissions Coordinator
Lori Dawson-Weeks, Admissions Coordinator
The Authorization for Release of Professional Information form must be completed for current and previous treatment or services providers and for all insurance and/or Medicaid. The form allows us to obtain records for the child and to contact insurance companies regarding benefits. Please complete one for each professional or agency who has worked with the child including the county DHS office (i.e. Polk County DHS) or Juvenile Court Office (i.e. Warren County Juvenile Courts). They are considered the Health Care Provider and Orchard Place is the recipient. You may also sign a release at the office of the other treatment provider. Records can be faxed or mailed to us, please visit our contact page for details.
As you consider placing your child in a Psychiatric Medical Institute for Child program, we suggest you contemplate the following:
- What are the credentials of the child psychologists, psychiatrists, therapists and other staff members who will be working with my child?
- What kind of background checks are done on staff members?
- How do staff members handle consequences for misbehavior and behavioral emergencies?
- What kind of training does the direct care staff have?
- How often will my child see his/her therapist and psychiatrist?
- How will I be kept informed of my child's progress?
- If a medication or dosage change is recommended, will I be consulted?
- What happens if my child's behaviors become worse?
- What happens after my child is discharged?