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.