Download Referral Criteria for - BC Children`s Hospital

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Referral Criteria for: Mood & Anxiety Disorders Clinic
Referral Criteria
What are the age criteria?
Between the ages 6-18 years old
What are the gender criteria?
Who can refer?
A General Practitioner or Medical Physician of any type can make a
Is there a form that needs to be filled out?
The Child & Adolescent Mental Health Outpatient Programs Referral
Form needs to be filled out.
How do you submit this form?
The Child & Adolescent Mental Health Outpatient Programs Referral
form and a detailed consult letter with copies of all reports (all prior
assessments occupational therapy/speech language
pathology/psychology, children and youth mental health, physician
consult reports,etc) plus name, address, all contact telephone
numbers, Personal Health Number and birth date can be mailed or
faxed to 604-875-2099
If there is no form that needs to be filled
out, then who does the referrer need to
The full address of where service is
BC Children’s & Women’s Health Centre of BC
4500 Oak Street
Vancouver, BC V6H 3N1
We serve children and youth:
Description of target audience.
1. Clearly Tertiary: Referrals from Child and Youth Mental Health or
Psychiatrists/Pediatricians for consultation for complex patients with
symptoms consistent with major depression, bipolar disorder or severe
anxiety disorder.
2. “Secondary” General Practitioner referrals in the following
moderate to severe symptoms; require consultation but limited
local resources
Patients who are not responding to initial medication and
psychotherapeutic interventions
Medication review/reassessment of mood or severe anxiety
case previously seen in clinic or other mental health resource
Symptoms consistent with early stages of serious mood
disorder, in context of strong family history, but not necessarily
meeting criteria for acute referral to community mental health.
Examples: severe anxiety and sleep disturbance, extreme mood
swings, recurrent brief depressive episodes, unexplained
hallucinations, chronic or temperamental anxiety symptoms interfering
with function without the acuity that would allow them to access
community mental health resources.
3. Other teaching or research cases: Less complex cases that live in
the local area as needed to fill teaching/research mandate.
Who is the service not appropriate for?
4. Group Referrals:
Referrals to existent group programs from treating clinicians.
This service is not appropriate for adults, Autism assessments, longterm treatment, medical legal issues, psycho-educational/occupational
therapy/ speech language pathology assessments, custody/
access/court reports and children involved with other agencies.
Before or after care restrictions or
Is there anything else you need to know
about the referral process?
We do not see children and youth that:
Have not engaged in appropriate community treatment closer to
home prior to referral (tertiary referral unlikely to be necessary at
this stage)
Already in active treatment with another resource which is not
requesting 2nd opinion (i.e duplication of service)
Have another primary diagnosis (such as an Eating Disorder,
undiagnosed Autism or Attention Deficit Hyperactivity Disorder)
that is likely to be responsible for the presenting symptoms
Before care considerations:
If a timely community mental health referral is more appropriate, rather
than waiting for assessment with us, then referral to a community team
for re-assessment and treatment is recommended
All referrals are reviewed by the clinic director and team members at a
weekly intake meeting. If a referral is not accepted, the family and
referring physician will be informed by letter and recommendations for
more appropriate resources will be provided.
Once a referral is accepted, pre-assessment questionnaires are sent
home for the family and the child's school to complete. These
questionnaires must be returned by mail before the first appointment,
as they provide helpful information for the clinician in the assessment.