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Intensive In Home

- At Youth Haven, we recognize that families are a crucial element of a child's world. We value the whole family and understand the need to treat the whole family. It is our philosophy that families must be involved in the treatment of a child for that child to be fully successful. IIH services are delivered in the community and in the home.
  
  Intensive In Home Services are provided by a team of licensed and qualified mental health professionals who are available 24 hours a day 7 days a week and work with children and their caregivers to build strong, healthy and lasting relationships. By teaching crisis resolution, parenting skills, coping and social skills, we are able to help families stay together and support each other through difficult times. Our goal is to prevent out of home placement and keep families together and successful!
  
  At our last yearly outcomes measures, over 98% of caregivers rate our IIH service as good or excellent and 82% of our discharged youth remained successfully in their natural home at three months post discharge.
- YHS Referral Form
  
  The maximum number of form submissions has been reached. This form is currently not available.
  
  REFERRAL SOURCE
  
  AGENCY NAME REQUIRED Please fill out this field. Please enter valid data.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  PLEASE CHECK (BELOW) YOUR PREFERRED LOCATION REQUIRED Rockingham County Office Stokes County Office Guilford County Office Caswell County Office Please fill out this field.
  
  Name of Person for Whom Services are Requested
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Guardian's Name
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Guardian's Contact Information (email, phone, etc.) REQUIRED Please fill out this field. Please enter valid data.
  
  Why are you seeking services? REQUIRED Please fill out this field.
  
  Primary Insurance REQUIRED Please fill out this field. Please enter valid data.
  
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