| Does the patient meet moderate or severe criteria for self-harm or suicidal ideation?
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| Is the patient moderately or severely impaired in their daily function? (e.g. Symptoms inhibit the patient's ability to fully and completely function in their home, work, school, or other daily environment). |
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| Are there medical, addictive, or psychiatric comorbidities? (e.g. Severe/chronic medical conditions, use/abuse of addictive drugs/substances, more than one mental health diagnosis). |
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| Does the patient experience elevated risk factors compared to protective factors in their living environment? (e.g. Serious disruption, conflict, or abuse in the family or social milieu; Overwhelming demands or stress; exposure to risk factors such as excessive drug or alcohol use; Housing, financial, or other temporal instability). |
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| Three "Yes" Responses indicate that the client/patient should be referred to the IOP or PHP Program. Discuss with the client/patient and inform them that they meet criteria to be assessed for a higher level of care and document the medical necessity for the referral in the intake note. |
