
Forms
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Intensive Behavioral Health Services
Intensive Behavioral Health Services (IBHS) is an array of therapeutic interventions and supports provided to a child, youth, or young adult in the home, school, or other community setting. Under IBHS, qualified and licensed providers can offer individual, group, ABA, and evidence-based treatments for children and youth. OMHSAS has created an IBHS website and training link where you can find recordings of OMHSAS trainings, links to forms, and important information about becoming a licensed IBHS provider, as well as frequently asked questions. Providers are encouraged to check this IBHS website for up-to-date information.
Please reference the IBHS Packet Checklist below for timeframes and packet requirements.
Intensive Behavioral Health Services
Discharge Summary
FBA Certification Update
Substance Use Disorder (SUD) Services
SUD Case Management Referral
SUD Precertification Template
SUD Continued Stay Review Template
SUD Discharge Template
Community-Based Adolescent SUD Treatment Service Referral Form
SUD Case Notification Form
Mental Health Partial and 2.5 PHP (Substance Use Partial) Services
2.5 PHP Services (Substance Use Partial)
Mental Health Partial Program Notification: Adult
Non-Acute Child/Adolescent Partial ISPT Meeting Attendance Request
Mental Health Partial Program Notification: Child/Adolescent
Family Based Mental Health Services (FBMHS)
FBMHS are evaluation and treatment services provided to a specific child in a family, but focuses on strengthening the whole family system to increase their ability to successfully manage their child's behavioral and emotional issues. Services are provided by licensed agencies employing a mental health professional and a mental health worker as a team to provide treatment and case management interventions. Services are provided in the home of the family.
Precertification
Prescription Letter
Residential Treatment Facility (RTF)
RTF services are comprehensive mental health treatment services for children with severe disturbances or mental illness. These services are provided in Residential Treatment Facilities (RTF's) which must be licensed by OCY&F under Chapter 3800. The facility must have a service description approved by OMHSAS, be certified by OMHSAS through annual on-site review, have a utilization review plan in effect and be enrolled in the MA program.
Life Domain BP Format for Evaluations
Guidelines for Addendums to Evaluations
Plan of Care Form and Directions
ISPT Invitation Form
ISPT Sign In Sheet
ISPT Summary
Family Choice Notification
Attachment 8
Discharge Summary
RTF Family Roles & Responsibilities
CRR Host Home Family Roles and Responsibilities
ALDA
Allegheny County Drug & Alcohol forms