Referral Process

(The preferred method of sending referral information is via email to

1.  Placing Agency writes or calls OT-FA office or one of our couples directly to discuss the youth being referred.  A Referral Form and program information is emailed or faxed by OT-FA upon request.  OT-FA forms may be copied by referring agency for ongoing use to expedite referrals. OT-FA accepts agency produced referrals in lieu of using an OT-FA Referral Form.

2.  Placing agency faxes or emails INITIAL INFORMATION to OT-FA for Teaching-Parent couple to review:

  •  Social History, description of problems making placement necessary and specifying what the agency wants us to do.  Comprehensive information is most helpful.

  • Psychological Evaluations and any pertinent reports related to the youth’s problems and that will help us with treatment planning. 

  • School information regarding IQ, special education needs, ability, grades, social problems.  This may be in the Social History.

  • Medical and Psychiatric information that is relevant to treatment planning.

3.  Reviewing Teaching-Parent Couple will respond to placing agency in a timely manner to expedite placement.   

4.  If OT-FA and Placing Agency feel placement is appropriate we need the following:

  • Court Order Journal Entry or other legal document placing youth in agency custody or placing a youth with OT-FA couple.  The Court Order or other legal document specifies which school district is responsible for tuition and is necessary for payment of school tuition by home district and is required for enrollment in the district in which the student will attend school if different from the home district. (Our school district will not process enrollment without this document.)

  • A Social Security card is necessary for school enrollment.  A Xerox copy of the card is acceptable.

  • Birth Certificate is necessary for school enrollment.

  • School Record.  We prefer that a copy of the school record be sent to us so we can work more effectively with the youth.  The school record can be sent to school if youth is not in special classes and we do not need to do anything special.

  • Recent IEP and MFE if youth is in special education classes (an Individual Education Plan is required annually and a Multi-Factor Evaluation is required every three years for children in special education classes)

  • Immunization Record (School must have Immunization Record to enroll)

  • Medical Records (particularly psychiatric information, can be sent to our MD and psychiatrist) 

  • Insurance or Medicaid card or documentation that states the county or court which can be billed for medical costs until Medicaid is in place.

  • Consent to treat letter signed by caseworker/director.

  • Medical history stating last dental, optical, and physical appointments.

  • Current list of medications and the name, address, and phone number of the prescribing physician.

  • Court Records, Police Reports (particularly for sex offender treatment)

  • Physical within 30 days prior to placement if one is available.  ODJFS rules specify that we must have a communicable disease screening within five days of placement and ODJFS rules say we MUST have a physical within 30 days of placement.  We can take youth for physical but we need to bill for this service unless we have a current Medicaid card upon the youth’s arrival or medical billing information. Without billing information or card we will pay for physical required by ODJFS and bill the Placing Agency.

  • Normalcy and Community Integration form

  • Youth and Teaching-Parents discuss reason for placement and goals are formulated. 

  • Youth receives OT-FA handbook and signs receipt.

  • Youth reads OT-FA Client Rights document and signs a statement that these rights are understood.

  • Placement Agreements for Medical and Dental, Clothing, etc.

  • Financial Placement Agreement

  • 90 Day Service Plan within 30 days of placement that OT-FA develops from materials we receive and from discussions with interested parties.  Ideally, the case manager would develop a comprehensive request for services based on the reason for placement and post treatment plan.

  • Approved contact list-Name address and phone number of any family member with whom contact is allowed or not allowed.

  • CYW Adverse Childhood Experiences Questionnaire Teen (ACE-Q)

  • Initial clothing voucher if needed.

Click to Replace