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Find the Right Support for a Young Person

REFERRALS & ADMISSIONS

BWI works with referring agencies, care teams and families to identify the right level of support for each young person. Complete the referral form below and our team will review the information and follow up to discuss next steps.

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SECTION 1 — REFERRAL INFORMATION

SECTION 2 — CHILD/YOUTH INFORMATION

SECTION 3 — SERVICE REQUESTED/REASON FOR REFERRAL

Service Requested
Staff Ratio Requested
Medical Needs
Special Placement Considerations

SECTION 4 — SUPPORT, HEALTH, & SAFETY NEEDS

Allergies
Support, Health, & Safety Needs

SECTION 5 — PERSONAL/DAILY LIVING INFORMATION

Cell Phone #
CHECK THOSE THAT APPLY
Smoking/Vaping
Birth Control

SECTION 6 — EDUCATION & COLLATERAL INFORMATION

CHECK ALL THAT APPLY

SECTION 7 — FAMILY CONTACTS & APPROVED FAMILY MEMBERS

SECTION 8 — LEGAL/JUSTICE INFORMATION

Currently on Probation
Current/Pending Charges
StreetReach Involvement

WHAT HAPPENS NEXT?

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From Referral to the Right Support

01 — REFERRAL SUBMITTED

The referring worker completes and submits the BWI referral form.

 

02 — REVIEW & CONSULTATION

Our team reviews the referral and connects with the referring worker to discuss the young person’s needs.

 

03 — SUPPORT PLANNING

Together, we identify the appropriate BWI program, level of support and next steps.

 

04 — ADMISSION & INDIVIDUALIZED PLAN

When BWI is the right fit, we coordinate admission and develop an individualized plan around the young person’s needs, strengths and goals.

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