Attached find an application for Children’s Mental Health Wraparound (Wraparound).   Here are some things to know to expedite processing of your application:


Eligibility Criteria for Wraparound Services:

Children and youths aged 0-21 who meet the following criteria:

  1. Have mental health or co-occurring diagnoses that substantially interfere with or limit their functioning in family, school, or community activities;
  2. Are at risk of placement, or are currently placed in a psychiatric treatment facility or acute care psychiatric hospital, and cannot return home without extra support, linkage, and services provided by Wraparound; and
  3. Are emancipated or in the legal custody of their parent or caregiver.


Completion of Application:

  1. Application should be filled out with as much information as possible and they must include the signed consent and release sheet on page 2. If the application isn’t filled out or the consent and release sheet is not completed, the application will be considered incomplete and will be returned to you for completion.
  2. Contact information should be up to date and accurate including contact phone numbers and emails.
  3. Applications should be legible.


Definition of Terms Used:

  1. Parent: an individual defined as parent by law or on the basis of a biological relationship, marriage to a person with a biological relationship, legal adoption or other recognized grounds
  2. Legal or minor guardianship: the permanent relationship between a child and a caretaker, established by the order of a court having jurisdiction over the child or juvenile.


CLICK  to download referral form

New Children’s Mental Health WRAP Referral Form 100719 (1)

Send this completed referral to

Questions: Call (304) 356-4811  M-F 8:00 a.m. – 4:00 p.m. Fax Number: (304) 558-1008  ATT: Vicky Hatfield.



RESOURCE: Referral Children’s Mental Health Wraparound age 0-21