Short-term Respite Care for Youth in Crisis Application

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Short-term Respite Care for Youth in Crisis Application

Name of agency or individual *

Point of contact for this application

Full name *

Email *

Phone *

Address *

Website

Describe your background and experience providing shelter, respite, or other residential care to youth experiencing mental health or behavioral health crisis. *

Describe your knowledge and experience in trauma informed care or related areas. *

Describe any related training you have received that is relevant to this population and care. *

Why do you want to provide respite care to youth in crisis? *

Ramsey County values equity and inclusion. What is your definition of equity? Please explain what skills or experience you possess that would enhance your ability to relate, support and effectively serve people from diverse backgrounds. *

Do you currently hold a contract with Ramsey County? If yes, explain. *

Do you currently operate a licensed home or facility? If so, what license(s) do you hold? *

Respite Service requirements

In order to participate in the program, respite care providers must have the ability to meet the following service specifications. Please answer “Yes” or “No” for each of the following statements to indicate if you are able to fulfill the program’s service requirements:

Are you able to respond in a timely manner to phone calls from case managers, clinical staff, and program administration? *

Are you able to add additional case duties by receiving copies of statutorily required reports regarding their clients that require court review and be available to discuss the content of these reports with their clients? *

Are you able to provide programmatic and financial information reasonably required for effective monitoring of services within a reasonable time period as established in the contract? *

Are you able to agree to submit monthly invoices in the specified format providing necessary tracking and recording data for the clients, auxiliary charges, etc. per the contracted rates of the agreement? *

Are you able to accept referral contacts between 8 a.m. and 9 p.m.? *

Are you able to accept referral contacts 365 days a year? *

Are you able to provide safe shelter and support to youth? *

Are you able to accept youth experiencing mental and/or behavioral health crisis? *

Are you able to deny acceptance only in the following circumstances: 1. Youth in need of medical care requiring hospital admission. 2. Youth with treatment needs requiring inpatient care for sexually problematic behavior. *

Deny acceptance only in the following circumstances: • Youth in need of medical care requiring hospital admission. • Youth with treatment needs requiring inpatient care for sexually problematic behavior.

Are you able to provide applicable licensure, and follow additional licensure requirements? *

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Short-term Respite Care for Youth in Crisis Application

Point of contact for this application

Respite Service requirements

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Short-term Respite Care for Youth in Crisis Application

Point of contact for this application

Respite Service requirements