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C-SPOA Referral Applications I & II

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:

  • Send via email to: Erie.ChildrensMentalHealth@erie.gov
  • Or Fax to: (716) 858- 7492
  • Or Mail to:
    Erie County Department of Mental Health
    ABP/C-SPOA/Suite 356
    P.O. Box 
    Buffalo NY 14201
  • Referral Applications can also be dropped off in person to:
    Appletree Business Park 
    Suite 356
    2875 Union Road
    Cheektowaga, NY 14227

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

 

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)

 

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.