Thank you for referring your client or patient to the McLean Trauma Continuum of Care at Hill Center.
**If you are the person seeking treatment, please ask your referring provider to initiate the referral process using the link you used to access this form.**
We are currently accepting referrals to the Partial Hospital/Day Treatment Service.
However, we are not accepting community (McLean providers and programs can still use this form to submit step-down referrals for outpatient services) .
The Trauma Continuum offers a Partial/Day Treatment services for individuals with histories of trauma who are currently struggling with PTSD, dissociation, and other trauma-related symptoms.
Our services are NOT designed to treat primary personality disorders such as Borderline Personality Disorder (BPD) and Narcissistic Personality Disorder (NPD). Our program DOES NOT emphasize distress tolerance, emotion regulation or other Dialectical Behavior Therapy (DBT) skills acquisition or practice.
Our services are inclusive for individuals of all identities/affinities and we are dedicated to maintaining a safe, healing space for all. This means that groups include individuals with any gender identity, race, sexual orientation, ability status, age, religion, socioeconomic status, etc. We no longer offer 'women's only' or 'men's only' services.
In order to direct you to the appropriate referral form, please answer the following:
* must provide value
I am a clinician in the community, private practice or other facility referring one of my clients/patients
I am referring the client/patient from a McLean unit/program
I am a clinician in the community, private practice or other facility referring one of my clients/patients
I am referring the client/patient from a McLean unit/program
How did you access our referral form?
* must provide value
Emailed to Me
Psychology Today Profile
McLean Website
Other
Emailed to Me
Psychology Today Profile
McLean Website
Other
Please specify:
* must provide value
Please enter the patient's name and email address below. An email with a link to their portion of the referral form will be sent to the email address you provide once you submit your referral form. Please encourage the patient to complete their portion of the referral form as soon as possible. We won't be notified that the referral is completed until the patient submits their portion of the referral form.
Patient First Name
* must provide value
Patient Last Name
* must provide value
Patient Email Address (patient referral form will be sent to this address)
* must provide value
What is your relationship to the patient/role in treatment?
* must provide value
Primary Therapist or Prescriber
Inpatient, Residential, or Partial Case Manager/Clinician
Emergency Room Clinician
Other (specify)
Primary Therapist or Prescriber
Inpatient, Residential, or Partial Case Manager/Clinician
Emergency Room Clinician
Other (specify)
Please specify:
* must provide value
Does the patient you are referring prefer to participate in-person or via virtual/telehealth? Please let the patient know that we may not be able to accommodate their preference and that it will be discussed further at their intake meeting.
* must provide value
Preference for In Person Only
Preference for Virtual Only
Open to Either
Preference for In Person Only
Preference for Virtual Only
Open to Either
Are you referring your patient to Partial Hospital or Outpatient services? We will also assess at the time of the initial consultation and make recommendations.
* must provide value
Partial Hospital services (M-F, 9a-2p, 15 or 20 days total)
Outpatient services (once a week, individual/group, 3-6 months total)
Please assess further and discuss directly with patient.
Partial Hospital services (M-F, 9a-2p, 15 or 20 days total)
Outpatient services (once a week, individual/group, 3-6 months total)
Please assess further and discuss directly with patient.
Referring McLean Clinician's Name
* must provide value
Referring Clinician's Email
* must provide value
Medical Record Number (MRN)
* must provide value
Unit/Program at McLean
* must provide value
Anticipated Discharge Date
* must provide value
Below are some of the factors we consider when determining whether a patient might benefit from treatment with our Partial Hospital and/or Outpatient services. Please offer additional information as requested based on your responses so that we can most accurately assess fit. We will also conduct a brief chart review and follow up with any questions or next steps.
Does the patient have a trauma history, PTSD, dissociative disorder or related condition? (No) - Please Explain Reason for Referral Further:
* must provide value
Please provide names and contact information for the patient's treatment team (treaters have seen patient before and will be willing to provide after hours coverage and aftercare once leaving the Partial Hospital Program at Hill Center):
* must provide value
Does the patient have an intact treatment team and therapist able to provide support as needed outside program hours? (No) - Please Explain Further (e.g., patient will be starting with new providers after discharge (therapist name and contact info) or still working on finding treaters and will update you as soon as we have more information):
* must provide value
If needed, does the patient have access to the required technology to attend virtual programming (laptop or tablet, stable wifi or internet, etc.)? (No) - Please Explain:
* must provide value
Does the patient have a safe, stable living situation and ability to meet from a private location in the state of Massachusetts? (No) - Please Explain:
* must provide value
Does the patient have an emergency contact that our staff can reach out to if needed for absences, safety issues, or help with hospitalization? (No) - Please Explain:
* must provide value
Is the patient able to manage being in front of a screen for multiple hours daily (e.g. if has a condition that is exacerbated by screen time, such as migraines, it is well controlled)? (No) - Please Explain:
* must provide value
Is the patient medically stable (acute and chronic conditions are managed to allow patient to fully participate in group programming)? (No) - Please Explain:
* must provide value
Is the patient able to demonstrate personal safety and not be experiencing acute suicidal ideation or planning? (No) - Please Explain:
* must provide value
Is the patient able to utilize skills to not engage in self-injury? (No) - Please Explain:
* must provide value
Does the patient have psychotic symptoms? (Yes) - Please Explain:
* must provide value
Is the patient able to maintain their own ADLs? (No) - Please Explain:
* must provide value
Is the patient able to manage their own medications (if applicable)? (No) - Please Explain:
* must provide value
Does the patient have any open legal charges/cases/court hearings? (Yes) - Please Explain:
* must provide value