NEW- Welcome & Scheduling for RCCMHC

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Hello! Your family was referred to RCCMHC or you submit a self referral. This form will tell you about our services and help you set up an intake.
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Most people call us their "collab family."

Our staff have lived experience with mental health, trauma, and/or poverty. We will support you without judgement. We will work hard to earn your trust so that we can partner together. If there is anything that we can do to make you feel welcome, please let us know.
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RCCMHC offers FREE "Whole-Family" Support

Resource navigation

Therapy appointment setting and referrals

Care Team Coordination (school, county, primary care, local healers and providers)

Classes and programs or parents/caregivers
"Moodie Monday" skills groups for ages 6-11 and 12+

Resilience coaching and peer support

Leadership opportunities

Resource events- "one stop shopping"

All new families are eligible to receive free CALM toolkit supplies and a Family Care Organizer.

Our family support staff are mostly BIPOC. We speak English, Spanish, Somali, and Hmong. All of our staff have lived experience with youth mental health, trauma, and/or poverty.
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RCCMHC Connects to Therapeutic Services

3 Rapid Access sessions are FREE and do not require a Diagnostic Assessment.

Individual or family therapy will be billed through insurance.

Languages: English, Hmong, Spanish, Arabic and Lao.

Wide variety of cultural providers, specialty therapies etc.

Therapists meet with children and/or families in-clinic, virtually, or at home. With school permission, some therapists are able to meet in the school building (virtually or in-person).

Our local therapists can typically see RCCMHC families without wait lists. They also commit to the care team process and work with us to reduce barriers.
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What services are you interested in?
Resource navigation for basic needs or other family services
Appointment setting and referrals for therapy or other therapeutic supports
3 Free Rapid Access sessions for therapeutic support (no diagnostic assessment needed)
Care Team coordination (helping your family's providers to work together)
Peer support and resilience coaching
Virtual classes and programs for adults
Virtual skills groups for kids/teens
Family programs and Resource events
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Name of Primary CUSTODIAL Parent/Caregiver
First Name
Last Name
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ELIGIBILITY
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Eligibility- Do you have at least one child or teen who is struggling with emotions or behaviors?* This field is required.
YES- I am the parent, foster parent or guardian of a child/teen who has a mental health diagnosis is struggling with emotions or behaviors that may put them at risk for a mental health diagnosis in the future
NO
Other
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Eligibility- Do you meet Ramsey County criteria? (pick one.)* This field is required.
My child that is struggling with emotions/behaviors currently lives in Ramsey County
My child that is struggling with emotions/behaviors attends a school affiliated with Ramsey County
We are homeless but still getting some services in Ramsey County
Other
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TERMS AND CONDITIONS
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Cost: All RCCMHC services are free and voluntary. Referrals to external agencies may result in charges to your insurance/health care plan, co-pays or other fees. We will help you find services you can afford.* This field is required.
I understand these terms and conditions.
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Programs and Supplies: New families are eligible to receive a CALM toolkit and Family Care Organizer. Throughout the year, we also give away gift cards and CALM Toolkit supplies with programs and classes. You must be present for the full program and you must place your order for supplies within 30 days. Gift cards are delivered through email or text message. Supplies are delivered to your home (for example; by Amazon.)* This field is required.
I understand these terms and conditions.
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Information Sharing: Our staff are NOT county employees but we do work closely with the county, schools, hospitals, therapists, local healers and family service providers. RCCMHC will not share your information without your permission. If you need us to share information, you will sign a form called Authorization to Exchange and Disclose Information.* This field is required.
I understand these terms and conditions.
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Mandated Reporting: If we think you or your child are in danger or if you say that you or your child are planning to hurt yourself or someone else, we will do our best to get you help right away. This means that RCCMHC staff might have to consult their supervisor or connect you with emergency supports.* This field is required.
I understand these terms and conditions.
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Calls and Texting: We offer phone and text message services related to the programs above. If you opt in for this service, message and data rates may apply. To stop getting text messages from us, you must reply STOP.* This field is required.
I understand these terms and conditions.
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Custody: Parents/guardians who have permanently lost custody of their child are not eligible to get services through RCCMHC. Parent/guardians must let RCCMHC know if they lose permanent custody.* This field is required.
I understand these terms and conditions.
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SIGNATURE
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NAME: By signing your name here, you are stating that your eligibility information is true. You are also stating that you understand RCCMHC's terms and conditions and you consent to terms, conditions, and services as described.* This field is required.
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Would you like to schedule an intake with RCCMHC?
YESNO
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How would you like to meet? The intake usually takes 1 hour. Your child/teen is not needed for this meeting.
Zoom
Phone
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What days/times are you available to meet? Click on the blue "ADD ROW" button to select more options.
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How would you like us to contact you?
Text Me
Call me
Email me
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Phone Number for CUSTODIAL Parent/Caregiver
Please enter a valid phone number.
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Email Address of CUSTODIAL Parent/Caregiver
example@example.com
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Next Steps:

We will schedule your intake.

If you requested a zoom meeting, we will send you the link.

To help with appointment setting, please do your best to bring insurance cards to the meeting.

We will ask you questions about your child and your family.

After intake, you will be scheduled for therapy and/or other family supports. We will also deliver your CALM Toolkit and/or Family Care Organizer.
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Please select SUBMIT

to send us your responses.
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