Psychiatric Rehabilitation Program

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Program Overview

Our Psychiatric Rehabilitation Program (PRP) supports children, adolescents, and adults living with mental illness by helping them build the skills and confi dence needed to lead more independent, stable lives. PRP services complement clinical treatment by focusing on life skills, social-emotional development, and goal-setting that support long-term recovery and daily functioning.

What Our Program Includes

PRP services are delivered through structured, one-on-one visits and activities tailored to the individual’s needs and treatment goals. Services are available in-person, in the community, or via telehealth.

Key areas of focus include:

Rehabilitation assessments and individualized rehabilitation plans
Life skills development: cooking, budgeting, hygiene, time management
Social and interpersonal skills building
Leadership and decision-making skills
Conflict resolution and behavior management
Medication management education
Physical health and nutrition awareness
Vocational and educational support

A bearded man sitting with his head in his hands, looking thoughtfully down.

Who Is Eligible

Minors (Ages 5–17)

Must have a mental health diagnosis and be engaged in clinical treatment (e.g., therapy or psychiatry)
Referral must come from treating mental health provider
Eligible youth receive 3–4 one-hour visits per month, either at home, school, or in the community
Medicaid recipient

Adults (Ages 18+)

Must have a qualifying mental health diagnosis and an active mental health treatment plan.
Must have a mental health diagnosis and be engaged in clinical treatment (e.g., therapy or psychiatry). Referral must come from treating mental health provider
Eligible adults receive 6 one-hour visits per month.
Medicaid recipient

Program Goals

Increase participants’ independence and functioning
Improve emotional regulation, social interactions, and coping skills
Promote success in home, school, work, and community settings
Support adherence to treatment and reduce risk of crisis or hospitalization
Enhance quality of life through skill-building and self-advocacy

Why It Matters

Living with a mental illness can affect all areas of a person’s life, not just their emotional health.

Psychiatric Rehabilitation Program (PRP) services are essential because they bridge the gap between therapy and daily life, giving individuals the tools and support they need to thrive beyond the clinical setting.

By working alongside therapists, families, schools, and community partners, our PRP team helps clients build a foundation for long-term stability and success.

Psychiatric Rehabilitation Program Service Request Form

Please fill out the form below if the eligibility requirements above have been met.

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This field is for validation purposes and should be left unchanged.

REFERRER INFORMATION

Date of referral(Required)

Name(Required)

First Last

Email address(Required)

Phone number(Required)

Fax number

Credentials(Required)

What is the Provider's Individual NPI #? If the provider has no NPI #, what is the Supervisor's Individual NPI #?(Required)

Confirm # with NPI lookup here

Organization/Agency(Required)

Referring provider is(Required)

an independently licensed clinician (MD, PhD, LCPC, LCSW-C, CRNP, APRN)

not independently licensed

Full name of referring provider's supervisor (if not independently licensed; required for referring therapists with graduate licensure, i.e. LGPC, LMSW)(Required)

First Last

Credentials of referring provider's supervisor if not independently licensed (required for referring therapists with graduate licensure, i.e. LGPC, LMSW)(Required)

I have VERIFIED the NPI # for myself OR my supervisor using the Medicaid Enrollment Verification (link below). I understand that ALL Referrals require an approved NPI# verified through Maryland Medicaid.(Required)

Yes

Maryland Enrollment Verification link

List Name and VERIFIED NPI # for referring provider or supervisor. To apply for an INDIVIDUAL NPI # go to NPI Create New Account (link below) AND to apply as a Medicaid Provider go to Maryland Medicaid Enrollment (link below).(Required)

*Providers must be fully licensed to practice independently to apply for Medicaid Enrollment.

NPI Create New Account link | Maryland Medicaid Enrollment link

How did you hear about us?

CURRENT THERAPIST INFORMATION (if applicable)

Name

First Last

Email address

Phone number

Credentials

Organization/Agency

CLIENT INFORMATION

Name(Required)

First Last

Email address

Phone number(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Location or jurisdiction of address(Required)

Baltimore County

Baltimore City

Harford County

Other

Client is(Required)

a Minor

an Adult

Date of birth(Required)

Gender(Required)

Race/Ethnicity(Required)

Marital Status(Required)

Sexual Orientation(Required)

Current Living Situation(Required)

Has the client been homeless in the last 6 months?(Required)

Yes

Employment status(Required)

Highest level of school completed(Required)

Is the client a veteran?(Required)

Yes

Client's number of arrests within past 30 days?(Required)

If "other" selected above, explain(Required)

Preferred appointment location

Baltimore County (Nottingham)

Baltimore City

Harford County (Abingdon)

Telehealth

PARENT/GUARDIAN INFORMATION

Name(Required)

First Last

Relationship to client(Required)

Email address

Phone number(Required)

Address (if different from client)

Street Address Address Line 2 City State ZIP Code

Location or jurisdiction of address (if different from client)

Baltimore County

Baltimore City

Harford County

Other

DIAGNOSTICS/MEDICAL HISTORY

Client's substance use/dependence scale(Required)

Client's disability status(Required)

Difficulty concentrating, remembering, or making decisions due to physical, mental, or emotional condition

Difficulty doing errands alone such as doctor's appointments, shopping, etc. due to a physical, mental, or emotional condition

Serious difficulty walking or climbing stairs

Difficulty dressing or bathing

Deaf or serious difficulty hearing

Blind or serious difficulty seeing with glasses

None

Other

If "other" selected above, explain(Required)

Is the client pregnant?(Required)

Yes

N/A

Does the client smoke cigarettes?(Required)

Yes

Client's diagnosed medical condition(s)(Required)

If "other" selected above, explain(Required)

Current diagnoses with F codes

FOR ADULTS must include a Priority Population Diagnosis from list above; FOR MINORS their diagnosis DOES NOT need to be on this list.

Current frequency of treatment(Required)

At least 1x/week

At least 1x/2wk

At least 1x/mo

At least 1x/3 mo

At least 1x/6mos

How long has this individual been engaged in active, documented outpatient treatment?(Required)

Most recent blood pressure reading (if available)

Is client on medication?(Required)

Yes

List current medications and dosages(Required)

Client's ability to take prescribed medications

Independently

With Reminders

With Daily Supervision

Refuses Medication

Client is not on medication and it has(Required)

Not been considered

Been considered and ruled out

Been initiated and withdrawn

What evidence exists to show that the current intensity of outpatient treatment for this client is insufficient to reduce the client's symptoms and functional behavioral impairments resulting from their mental health diagnosis/diagnoses?(Required)

In the past 3 months, how many ER visits has the individual had for psychiatric care?(Required)

None

One in past 3 months

Two or more in past 3 months

History of hospitalizations(Required)

SOCIAL/ENVIRONMENTAL INFORMATION

Client has these social/environmental challenges(Required)

If "other" selected above, explain(Required)

Please write 3 or more detailed sentences about what evidence exists to show how selected social/environmental challenges above are impacting the client's mental health functioning?

Is the Client benefiting from PRP Services?(Required)

Yes

Reason for referral(Required)

If "other" selected above, explain(Required)

MEDICAL NECESSITY CRITERIA (for minors)

In order to be eligible for PRP services, the client must demonstrate impairment in at least one of the three following areas(Required)

Having a clear, current threat to their ability to maintain their customary setting

An emerging risk of safety to the self or others

Significant psychological or social impairments causing serious problems with peer and/or familial relationships

Within the last 3 months, the client's emotional disturbance resulted in a clear, current threat to the client's ability to be maintained in their customary setting?(Required)

Yes

Provide details on how the youth's functional impairment has created a current threat to the client's ability to maintain their customary setting(Required)

Within the last 3 months, the client's emotional disturbance resulted in an emerging risk to the safety of the client and/or others?(Required)

Yes

Provide details on how the youth's functional impairment has created an emerging risk to the safety of the client and/or others(Required)

Within the last three months, has the client experienced significant psychological or social impairments causing serious problems with peer relationships and/or family members?(Required)

Yes

Provide details of how client's mental health symptoms have created significant psychological or social impairment with peers and/or family members(Required)

How will PRP serve to help this client get to age appropriate development, more independent functioning, and independent living skills?(Required)

OCCUPATIONAL (for adults)

Is client employed?(Required)

Yes

Does client wish to be employed?(Required)

Yes

Client's Supportive Employment status(Required)

MEDICAL NECESSITY CRITERIA (for adults)

Criteria #1: Does the client demonstrate marked inability to establish or maintain competitive employment in areas such as task completion, time management, interpersonal interactions, stress tolerance, adaptation to workplace demands, etc.?(Required)

Yes

If you selected Yes for Criteria #1, please write 3 or more detailed sentences describing how the client's mental health diagnosis and symptoms impair functioning in this area, including specific examples. If you selected No, please type "N/A". You must select Yes for at least 3 of the 7 criteria.(Required)

Criteria #2: Does the client demonstrate marked inability to perform instrumental activities of daily living (ADLs) such as shopping, meal preparation, laundry, housekeeping, medication management, transportation, money management, etc.?(Required)

Yes

If you selected Yes for Criteria #2, please write 3 or more detailed sentences describing how the client's mental health diagnosis and symptoms impair functioning in this area, including specific examples. If you selected No, please type "N/A". You must select Yes for at least 3 of the 7 criteria.(Required)

Criteria #3: Does the client demonstrate marked inability to establish or maintain a personal support system such as relationships with family, friends, peers, or community resources?(Required)

Yes

If you selected Yes for Criteria #3, please write 3 or more detailed sentences describing how the client's mental health diagnosis and symptoms impair functioning in this area, including specific examples. If you selected No, please type "N/A". You must select Yes for at least 3 of the 7 criteria.(Required)

Criteria #4: Does the client have marked deficiencies in concentration, persistence, or pace leading to failure to complete tasks such as following instructions, finishing daily activities, or sustaining attention in work or school settings?(Required)

Yes

If you selected Yes for Criteria #4, please write 3 or more detailed sentences describing how the client's mental health diagnosis and symptoms impair functioning in this area, including specific examples. If you selected No, please type "N/A". You must select Yes for at least 3 of the 7 criteria.(Required)

Criteria #5: Does the client have marked inability to perform or maintain self-care such as making safe and healthy decisions for mental and/or physical health, coping with stress, accessing medical care, structuring daily life, managing mental health symptoms?(Required)

Yes

If you selected Yes for Criteria #5, please write 3 or more detailed sentences describing how the client's mental health diagnosis and symptoms impair functioning in this area, including specific examples. If you selected No, please type "N/A". You must select Yes for at least 3 of the 7 criteria.(Required)

Criteria #6: Does the client have marked deficiencies in self-direction such as difficulty organizing, initiating tasks, setting goals, making decisions, or following through on plans without external support?"(Required)

Yes

If you selected Yes for Criteria #6, please write 3 or more detailed sentences describing how the client's mental health diagnosis and symptoms impair functioning in this area, including specific examples. If you selected No, please type "N/A". You must select Yes for at least 3 of the 7 criteria.(Required)

Criteria #7: Does the client have marked inability to procure financial assistance to support community living, such as applying for benefits (SSI, SSDI, SNAP, Medicaid), gathering documentation (ID, SS card, transcript, driving record), attending appointments independently, advocating for themselves, problem-solving, or communicating effectively with agencies?"(Required)

Yes

If you selected Yes for Criteria #7, please write 3 or more detailed sentences describing how the client's mental health diagnosis and symptoms impair functioning in this area, including specific examples. If you selected No, please type "N/A". You must select Yes for at least 3 of the 7 criteria.(Required)

Please write 2 or more detailed sentences to explain how PRP services will help develop, restore, and maintain the client's overall independent living skills?(Required)

Please write 2 or more detailed sentences to describe the client's relationship with family members, friends, peers, and community members.(Required)

ADDITIONAL HEALTH RELATED INFORMATION

Does the client have insurance at this time?(Required)

Yes

Unsure

Provide client's 11 digit Medical Assistance ID #(Required)

Indicate recommendations for Crisis Planning for this individual(Required)

CERTIFICATION

By typing my name below, I certify that I am the mental health professional listed in the REFERRER INFORMATION section, and I acknowledge that this is my e-signature(Required)

Psychiatric Rehabilitation Program

Program Overview

What Our Program Includes

PRP services are delivered through structured, one-on-one visits and activities tailored to the individual’s needs and treatment goals. Services are available in-person, in the community, or via telehealth.

Key areas of focus include:

Who Is Eligible

Program Goals

Why It Matters

Living with a mental illness can affect all areas of a person’s life, not just their emotional health.

Psychiatric Rehabilitation Program Service Request Form

Please fill out the form below if the eligibility requirements above have been met.

REFERRER INFORMATION

CURRENT THERAPIST INFORMATION (if applicable)

CLIENT INFORMATION

PARENT/GUARDIAN INFORMATION

DIAGNOSTICS/MEDICAL HISTORY

SOCIAL/ENVIRONMENTAL INFORMATION

MEDICAL NECESSITY CRITERIA (for minors)

OCCUPATIONAL (for adults)

MEDICAL NECESSITY CRITERIA (for adults)

ADDITIONAL HEALTH RELATED INFORMATION

CERTIFICATION

OFFICES

Harford County

Baltimore City

Baltimore County

If you, or someone you know is struggling or in crisis, help is available. Call or text 988 or chat at 988lifeline.org.

Psychiatric Rehabilitation Program

Program Overview

What Our Program Includes

PRP services are delivered through structured, one-on-one visits and activities tailored to the individual’s needs and treatment goals. Services are available in-person, in the community, or via telehealth. Key areas of focus include:

Who Is Eligible

Program Goals

Why It Matters

Living with a mental illness can affect all areas of a person’s life, not just their emotional health.

Psychiatric Rehabilitation Program Service Request Form

Please fill out the form below if the eligibility requirements above have been met.

REFERRER INFORMATION

CURRENT THERAPIST INFORMATION (if applicable)

CLIENT INFORMATION

PARENT/GUARDIAN INFORMATION

DIAGNOSTICS/MEDICAL HISTORY

SOCIAL/ENVIRONMENTAL INFORMATION

MEDICAL NECESSITY CRITERIA (for minors)

OCCUPATIONAL (for adults)

MEDICAL NECESSITY CRITERIA (for adults)

ADDITIONAL HEALTH RELATED INFORMATION

CERTIFICATION

OFFICES

Harford County

Baltimore City

Baltimore County

If you, or someone you know is struggling or in crisis, help is available. Call or text 988 or chat at 988lifeline.org.

PRP services are delivered through structured, one-on-one visits and activities tailored to the individual’s needs and treatment goals. Services are available in-person, in the community, or via telehealth.

Key areas of focus include: