Individual Admission

CIS & H Inc Eligibility For Services Protocols

The Program Administrator and Admission Team coordinates and approves admissions

ADMISSION

The Admissions Committee is comprised of the Program Administrator, Agency Nurse, Program Specialist and House Manager.  The Committee reviews the Admission Package and other information to determine child’s eligibility for placement.

CIS&H, Inc. does not discriminate on the basis of race, color, national origin, religion, creed, age, sex, sexual orientation, marital status, ancestry, or physical or mental disability.

  • Must be above 21 years old
  • Must be diagnosed with MR
  1. Referring party makes contact
    1. Mail:
      1. Admissions committee reviews information, (Admission Package)
      2. Determine eligibility, based on admission’s criteria and individual’s needs
      3. If placement is not approved, referring party is notified in writing or verballly.
      4. If placement is possible, notify referring agency of request for interview
    2. Phone:
      1. Referring party provides synopsis of the completed application package
      2. An interview is scheduled, if admissions criteria are met
      3. The placement/referring agency is asked to forward Admission Package which includes most recent psychological, medical, and other helpful information and assessments
      4. The Admissions committee reviews information to determine eligibility and notifies placement/referring agency by phone or in writing.
  2. Interview
    1. Visit is scheduled during active program hours if at all possible so the applicant is able to observe operation
    2. Interview includes discussion of applicant’s interests and service needs, and tour of the facility
      1. Admissions Committee provides the Program Service Plan and our contact information.
      2. Discuss with individual, Parents or Legal guardians, CIS&H Inc. Visitation policy and phone policy.
  3. Acceptance Within 30 days
    1. A review individual’s record and service needs is done to help establish preliminary services
    2. Agency Nurse completes initial assessment
      1. Examine individual
      2. Documents in the individual's case record any illness, fever, rash, bruise, or injury
      3. Take appropriate action as necessary
      4. Completion of CIS&H Inc. Admission documents as needed
    3. Admission ITM is scheduled.
    4. Individual Plan
      1. DSAT, PCP, Cost Detsils and SIP are drafted prior to ITM meeting
      2. PCP (IP) date is determined (can be date of ITM meeting or considered an addendum to a previous PCP (IP))
      3. PCP (IP ) is implemented within 20 days of ITM

We accept private and out of state children with developmental or Behaviour problems. The admission Requirements and FORMS to be completed and Faxed to us, by the CCS or the person making the referral are Listed bellow:

The following information should be included with the application for admission:

  1. Recent (last 12 months) Psychiatric Evaluation
  2. Recent (last 12 months) Psychological Evaluation including DSM II-R Diagnosis
  3. Recommendation from Therapist stating the program desired is the least restrictive environment for the applicant
  4. Court Report if any
  5. Progress report from prior placements
  6. Discharged summaries from prior placements
  7. Birth Certificate
  8. Social Security Card
  9. Immunization Record
  10. Consent for Treatment Form
  11. Prior Medical Exam information
  12. Medical Insurance information
  13. Any additional information that may be helpful in determining the appropriateness of the applicant for the program
  14. CCS's Phone Number, Cell Phone Number, Fax Number and Email Address

Please Note:
According to Therapeutic Group Home regulations, A statement based on clinical evaluation by a licensed or certified mental health professional stating that the applicant otherwise meets applicable admission criteria, should be included for CIS & H Inc. referrals:

Some Required Docouments:

(1) Admission Documents Checklist
(2) Individual's Contacts while in Program
(3) CISH Parent Handbook
(4) Consent for Treatment Form
(5) Fire Safety Assessment Form
(6) Intake Assessment Form
(7) Nonresident Student Enrollment