Admissions

Call for a free screening (over the phone) to see if the program is a good fit for your teenager. Then complete the intake documentation listed below.

Admissions Criteria

The Maples serves teenage females ages 13-18 who are struggling with mental health disorders, substance use, disordered eating, and trauma.

Your teen may qualify for The Maples Residential Psychiatric Program if she…

Has had a mental health professional recommend residential treatment programs
Experiences symptoms of eating disorders, self-harm, suicidal thoughts, depression, anxiety, or trauma
Would benefit from round the clock care as she works towards stability

For a free over the phone assessment, please contact Tanya Stuart, LCSW-BACS, LAC at 225-771-9980.

Insurance and Payment Information

We are in-network with Blue Cross Blue Shield. We also work with each individual insurance provider to set up a single case agreement or out-of-network option. Please call us and we will give you options and verify eligibility.

What should I pack for residential treatment at The Maples?

What TO bring:

Basic unopened toiletry and hygiene products (soap, toothpaste, toothbrush, floss, shampoo, conditioner).
2 books (must be approved)
TShirts (10) (no v-neck or revealing shirts)
Shorts (10) (decent length)
Sweatpants, leggings, jeans, long pants (5)
Jacket/Sweatshirt (2)
Socks (7)
Tennis shoes (1), slippers (1), boots (1)
Underwear (10)
Bras without wire ex: sport bras/tank tops, wireless bralettes (4) -pjs/nightclothes (3)
A journal or notebook (no wires)
Photos of your loved ones (10)

What NOT to bring:

Drugs or alcohol
Weapons
Any drugs or products containing alcohol (mouthwash)
Cash
Hand sanitizer
Any valuables (jewelry, electronics)
Electronics (telephone, video games)
Tobacco items (vapes, e-cigs, cigarettes)
Magazines
Perfumes, candles, essential oils or scented lotions

Fill Out the Intake Form

Name *

First

Last

Client Name *

First

Last

Client Date of Birth *

Client Home Address:

Client Allergies or Food Restrictions

Caregiver Name *

First

Last

Caregiver's Phone Number: *

Caregiver's Email Address: *

Referral Source:

Race:

With whom does the patient live:

Are you currently in school?

Tell us more about your school:

Name of School, Address of School, Contact Person in School, Phone Number of School, What Grade You're In

Has the client ever run away from home or school?

How many times have they run away?

When was the last time they ran away?

Do you have any mobility issues/concerns?

Are you ambulatory?

Presenting Problem/Crisis/Precipitating Events leading to seeking treatment at this time:

Contributing Factors Leading to Seeking Treatment:

Outpatient Provider Information: Psychiatrist, Therapist/Counselor, PCP/Other Specialist

Names of Treating Providers, Phone Numbers and/or Locations, Last Visit (Month/Year)

Treatment History:

Facility (include Location), Treatment Dates, Level(s) of Care, Length of Treatment, Outcome, How long did they stay in abstinent?

Current Medical Conditions:

Current Medications:

Medication, Presibed for, Dosage & Frequency, Prescribed by, Last Visit, Compliant, Able to bring in?

Allergies:

Psychiatric Conditions

Substance Abuse History

List all drugs including alcohol

How often? When were you aware of the onset of use?

History of High Risk/Severe Withdrawal Symptoms:

Sleep Patterns:

Good
Fair
Poor

Hours per Night:

Sleep Interruptions:

Appetite:

Good
Fair
Poor

Unanticipated weight gain?

Unanticipated weight loss?

Loss or gain over the following time period?

Suicidal Ideation:

How long has the client had these thoughts?

Numbers

Does the client have a plan?

Past history of suicide attempts?

How was the attempt made?

Homicidal Ideation?

History of Violent Behavior (describe)

Does patient have a history of self harm?

How and where does client typically disfigure him/herself?

Eating Disorders:

Father:

Family History

Mother

Family History

Siblings:

Family History

Other:

Family History

Rationale for Treatment Admission:

Click here to access your Primary Care Form

Give us a call or fill out the form and one of our team members will reach out to you as soon as possible.

Admissions Criteria

Insurance and Payment Information

What should I pack for residential treatment at The Maples?

What TO bring:

What NOT to bring:

Fill Out the Intake Form

Allowing individuals and families to address their needs in a safe, nurturing environment, providing an increased level of self-esteem, self-worth and emotional regulation.

If Your Loved One Is In Need, We're Here To Help

Important Information