Referral indicators include:

• Demonstrates psychological distress in the form of suicidal ideation without intent or plan
• Intense interpersonal confict with resulting narrowly focused, select aggression against property or person such that needs intervention to prevent above.
• Demonstrates need for assessment and stabilization following a crisis which cannot be adequately performed in the community
  but does not require the intense management of a secure, inpatient setting.
• Demonstrates impaired social functioning accompanied by psychological impairment which inhibits the adolescent from functioning in a less acute setting. The assessment also indicates that the behaviors identifed do not represent a pattern of criminal behavior or delinquency.
• Would beneft from a ‘step down’ after an inappropriate placement in an inpatient level of care when the sub acute unit was the appropriate level of care initially.

Contraindications for referral include:

• Suicidal adolescents who have acted to harm themselves, with serious intent, in the immediate past, or who demonstrate imminent risk in suicidal thinking or plan
• Adolescents who are intoxicated if it impairs their cognitive capacity to follow rules or if aggressive or medically unstable
• Adolescents experiencing signifcant symptoms of reality impairment, disorientation, hallucination, or delusion
• Adolescents with behavioral, cognitive or mental disturbance that would impede their ability to lodge safely in an unlocked setting with little capacity to provide individual supervision
• Adolescents with a history of criminal or delinquent behavior such that they might represent a general threat to others in the form of aggression, crime against property, or sexual acting out
• Adolescents who are waiting for placement in residential treatment programs, regional treatment centers, foster care, or other longterm care facilities
• Adolescents who are medically fragile, requiring consistent nursing and physician intervention and observation
• Use of the service as a step down from inpatient care, with the goal of testing whether stability from symptoms has been achieved prior to discharge
• Involuntary patients (those on legal holds)