All C-SPOA Referral Applications have been updated to fillable PDF format. This means they can be downloaded (use "Save As") and completed electronically or printed for manual completion.
For instructions and / or video assistance with completing the C-SPOA Referral Applications visit: C-SPOA How-To-Complete Applications Part I & Part II
NOTE: Any pages requiring signature must be printed and manually signed for the referral to be processed.
Please send completed Referral Applications through one of the following methods:
Children’s-Single Point of Access (C-SPOA) Application Part 1
This application is for referring a youth and their family for C-SPOA coordination. C-SPOA Coordinators help coordinate access to services and supports for youth with unmet mental health needs. There is a C-SPOA Coordinator in every county. This application asks for general information about a youth’s demographics and mental health needs.
Children's SPOA Referral Application - Part 1
Solicitud del Punto Único de Acceso para Niños - Parte 1
(Children's SPOA Referral Application - Part 1 in Spanish)
C-SPOA Application Part 2: Accessing Youth Assertive Community Treatment (ACT), Children’s Community Residence (CCR), and Residential Treatment Facility (RTF)
This application is for referring a youth for Youth ACT, CCR or RTF services. The application requests more detailed information around a youth’s mental health needs and provides the requirements for documentation to support any needs noted.
Children's SPOA Referral Application - Part 2
(Part 2 Application includes the RTF Authorization Release)
Solicitud del punto único de acceso para niños - Parte 2: solicitud de remisión a ACT,
CCR y RTF para jóvenes de la OMH
(Children's SPOA Referral Application - Part 2 in Spanish with RTF Authorization Release)
Children's Community Residence (CCR) Program - Information for Caregivers
Información para cuidadores sobre el programa
(Spanish version of Children’s Community Residence (CCR) Program Information for Caregivers)
Residential Treatment Facility (RTF) - Information for Caregivers
Información para cuidadores sobre el programa
(Residential Treatment Facility (RTF) Program Information for Caregivers)
Inquiries
For general inquiries regarding SPOA, please call: 716-858-8349 and ask to speak to a C-SPOA representative.
For inquiries/updates regarding pending SPOA Referral Applications (this would include HFW, RTF or CR admission criteria or denials, system barriers around accessing appropriate levels of care, concerns/complaints about current OMH service providers), please call: 716-858-8349 and ask to speak to a CSPOA representative.