Mobile Psych Rehab (MPR) Form
Chartiers Center’s Mobile Psych Rehab (MPR) Program promotes recovery, full community integration, and an improved quality of life for individuals who have been diagnosed with any mental health condition that seriously impairs their ability to lead meaningful lives. Services focus on helping individuals develop skills and access resources needed to increase their capacity to be successful and satisfied in the living, working, learning, and social environments of their choice. To access services, a referral to Chartiers Center Mobile Psych Rehab (MPR) must be completed and submitted to Karen O’Keefe. To begin the process please print, complete and fax the MPR Referral Form to fax # 412-561-5902. If you have questions related to the program and/or the referrals process please call Karen O’Keefe 412-561-3390 ext.213
Service Coordination Referral Form (select from Adult or Child form below)
Service Coordination helps individuals (18+) diagnosed with a mental health disorder find and connect to supports in their communities during their recovery journey. Service Coordinators help individuals apply for benefits like Social Security, find affordable housing, return to the workforce, continue education, volunteer, coordinate care with a primary care physician, register to vote etc. Service Coordinators can meet individuals in their home or in the community, in places like coffee shops, in an office or outside. Service Coordinators can actively assist with the resolution of a crisis or emergency, including providing access to other crisis services.
Depending on the age of the person you are referring, complete the adult referral form or child referral form (child form is for anyone under 18 years of age) and FAX to (412) 257-2008. Please remember:
- Only one service provider can be requested at a time.
- All sections of this document must be thoroughly completed and legible in order to make a determination of services. Items should not be left blank-please indicate N/A where appropriate. Also, a current psychiatric evaluation (completed by MD) within past 12 months, and a list of the most recent medications must be attached with the referral. Incomplete referrals will not be accepted.
- The signature of the person being referred is required indicating that they understand that a referral is being made. If the person is unable to sign, the referral source must state if it is due to current symptoms, physical limitations, or other.
Training and Social Rehabilitation (T&SR)Referral Form
T&SR program provides social rehabilitation to adults with behavioral health challenges. Clients participate in a shared community setting that builds self-esteem and confidence and fosters independence through group activities and community activities and events. To qualify for the program individuals must be 18 years of age and in mental health treatment, either at Chartiers Center or another facility. A referral requires a recommendation by the treatment team if the client is participating in Chartiers Treatment Services. If the client is involved with an external provider, a copy of the psychiatric evaluation is required and must be dated within the year. Once obtained, the completed referral form and psychiatric evaluation, if appropriate, should be forwarded to the Assistant COO of RTS. For more information review the referral form or contact AMY RANDAL, Social Rehabilitation Coordinator at firstname.lastname@example.org, (phone) 412-561-3390 (fax) 412-561-5902
T&SR Referral Form
IDD Referral Form
For ISC’s looking to make a referral, there are open spots within our day program and we are accepting referrals. Chartiers Center’s IDD Program has streamlined our referral process and the intake packet. To begin the process please complete the new 1 page referral form.
IDD Referral Form
If you have questions related to the program and/or the referrals process please call Bryan Reis (412) 344-7155.