Screening Criteria for Admission into Intensive In-Home Program
Individuals requesting services must meet at least two of the following criteria on a continuing or intermittent basis:
Child is:
- Have difficulty in establishing or maintaining normal interpersonal relationships to such a degree that they are at risk of hospitalization or out-of-home placement because of conflicts with family or community.
- Exhibit such an inappropriate behavior that repeated interventions by the mental health, social services or judicial systems are necessary.
- Exhibit difficulty in cognitive ability such that they are unable to recognize significantly inappropriate social behavior.
Child is:
- At risk of being moved into an out-of-home placement due to a documented medical need of the child, or
- Is being transitioned to home from out-of-home placement due to a documented medical need of the child.
How to Make a Referral to KCCM Services
Phone referrals can be made by contacting our main office directly or by faxing the attached referral forms provided. Also complete the form in its entirety. The completed form can be sent via the confidential fax at 757-966-9255. If you have any questions regarding the form or eligibility criteria, please contact our office at (757) 535-9153. Office hours are Monday-Friday from 9am-5pm.
Authorization Process
All Kaleidoscope Counseling & Case Management LLC Services will require a Clinical /Intake Assessment by a licensed Clinician. This psychosocial assessment can take up to 2 hours and is required by Medicaid for service authorization. In order to expedite this process, the following items should be available depending on service specification.
Kaleidoscope Counseling & Case Management (KCCM), LLC will also request that the individual, authorized representative or legal guardian complete a release of information/consent form for the purposes of Service Coordination with all third-party entities.
Upon the completion of the Assessment and Intake a request for authorization will be submitted within 72 hours to the designated insurance company. Once the approval is authorized by the insurance company which can take up to 14 days the individual and family is notified and assigned a Qualified Mental Health Professional or Qualified Paraprofessional in Mental Health to conduct weekly sessions in the home and/or community.
Please feel free to call Kaleidoscope Counseling & Case Management, LLC at 757-535-9153 for additional assistance.
- Medicaid Card
- Social Security Card
- Individual Education Plan (IEP) from child’s school (if available for IIHS)
- List of prescribed & over-the-counter medications (past & current)
- History of prior hospitalizations or treatment providers (medical, psychiatric and mental health)
- Letters from teachers, coaches, etc.
- Outpatient Counselors letters/ assessments
- Letters of expulsion/suspensions/probation
- Emergency contact information
Kaleidoscope Counseling & Case Management (KCCM), LLC will also request that the individual, authorized representative or legal guardian complete a release of information/consent form for the purposes of Service Coordination with all third-party entities.
Upon the completion of the Assessment and Intake a request for authorization will be submitted within 72 hours to the designated insurance company. Once the approval is authorized by the insurance company which can take up to 14 days the individual and family is notified and assigned a Qualified Mental Health Professional or Qualified Paraprofessional in Mental Health to conduct weekly sessions in the home and/or community.
Please feel free to call Kaleidoscope Counseling & Case Management, LLC at 757-535-9153 for additional assistance.
