What Happens Before, During, and After an IBHS Referral

When a child begins struggling with behavior, emotional regulation, communication, or everyday routines, families often start with traditional outpatient counseling. For many children, that support is enough. Sometimes, however, challenges continue at home, at school, or in the community even after therapy begins.

When this happens, families or professionals may suggest Intensive Behavioral Health Services (IBHS). These services are designed to support children directly in their everyday environments so clinicians can observe behaviors in real time and help families build practical skills.

Families who are unfamiliar with this level of care can first read What Is IBHS? A Guide for Parents and Schools.

Understanding the IBHS referral process for children can make the experience feel less overwhelming.. While every child’s situation is different, most families move through similar stages before services begin.

Before an IBHS Referral: What Families and Schools Are Often Seeing

IBHS is typically considered when a child needs more support than weekly office-based therapy can provide.

Parents and teachers often notice that challenges are happening in the child’s natural environments. These may include home routines, classroom settings, or social interactions with peers.

Some common signs that lead to an IBHS referral include:

• A child refusing to attend or participate in traditional therapy sessions

• Behaviors happening at home or school that are difficult to observe in an office setting

• Ongoing behavioral concerns that affect school participation or family life

• Parents reporting behaviors that therapists cannot fully see during sessions

Families who are unsure whether their concerns may indicate a need for this level of care can read Signs Your Child May Benefit from IBHS.

Because IBHS focuses on the child’s real-life environment, clinicians can observe these behaviors directly and help families practice strategies where the challenges actually occur.

Referrals can come from several sources, including:

• Parents or caregivers

• School staff or counselors

• Outpatient therapists or psychologists

• Pediatricians

• Early intervention programs

At this stage, families often have questions about how the process works. Some parents assume services will begin right away. Others expect behavior changes to happen quickly.

Another common misconception is that services will work without active caregiver involvement. In reality, family participation plays an important role in helping children succeed.

How IBHS Differs From Outpatient Counseling

Outpatient counseling and IBHS can both provide meaningful support, but they work differently.

Outpatient counseling generally takes place in an office or through telehealth and often focuses on processing emotions, discussing concerns, and practicing coping strategies during scheduled appointments.

IBHS takes place more frequently and may occur in the home, school, daycare, or community. This allows clinicians to observe challenges and practice skills during everyday routines.

Families comparing these options can learn more in Outpatient Counseling and IBHS: Understanding the Differences in Care.

During the IBHS Referral Process: Step by Step

When a family contacts Laurel Life to ask about IBHS services for children, the first step is Completing a referral form gathering basic information about the child and reviewing insurance coverage.

Next, the family is scheduled for a written order or best practice evaluation. This evaluation helps determine whether IBHS is the appropriate level of care. It can take place at Laurel Life’s outpatient office.

If IBHS is recommended, the written order is valid for one year and allows the process to move forward.

When IBHS services begin, clinicians complete a referral form during the initial appointment and begin gathering information about the child’s needs. Several evidence-based assessments may be used to better understand the child’s strengths and areas where additional skill development may be helpful. This process is separate from the Written Order and Behavioral Health Evaluation (WO/BPE) that occurs prior to the start of IBHS services.

The intake and assessment phase is regulated by the state and is typically completed within about 45 days. This allows clinicians to create an individualized treatment plan based on the information collected.

Schools may also play a role during this stage. In some cases, teachers or school counselors are the ones who first recommend IBHS. Once services begin, clinicians may communicate with school staff or conduct classroom observations to better understand the child’s behavior in that environment.

For many families, the most confusing part of the process is simply learning how the system works. Insurance requirements, referrals, and the differences between services like IBHS and Outpatient Therapy can feel overwhelming at first. Laurel Life staff help guide families through each step and answer questions along the way.

After Approval: Preparing for the First Day of Services

Once services are approved and a clinician is assigned, families begin preparing for the first phase of IBHS support.

During the first week, clinicians usually meet with caregivers to review concerns and discuss treatment goals. They may also begin observing the child in their natural environment so they can see how behaviors occur throughout the day.

Early sessions often focus on something called pairing. This means building a positive connection between the clinician and the child.

Clinicians often ask parents about the child’s favorite activities or interests. For example, if a child loves Paw Patrol, the therapist may use Paw Patrol toys or conversations about the show to help the child feel comfortable.

During this stage, clinicians avoid giving too many instructions right away. The goal is to help the child feel safe and build trust before beginning structured skill work.

Assessments That May Be Used After Services Begin

Clinicians may use different assessment tools depending on the child’s needs.

These may include:

Assessment of Functional Living Skills

The Assessment of Functional Living Skills, or AFLS, evaluates everyday skills such as communication, self-care, independence, and participation in daily routines.

Assessment of Basic Language and Learning Skills

The Assessment of Basic Language and Learning Skills, or ABLLS, measures foundational communication, learning, and skill-development areas.

PEAK Assessment System

The PEAK Assessment System is an assessment and curriculum framework that may help clinicians identify missing skills and guide treatment planning.

Clinicians select the tools that best match the child’s strengths and needs.

What Children May Work On During Ongoing IBHS Services

Once the assessment period is complete, IBHS focuses on teaching skills that help children succeed in daily life.

Depending on the child’s needs, treatment may focus on:

• Social skills and peer interaction

• Communication

• Emotional regulation

• Following directions

• Coping with transitions

• Personal space and safety awareness

• Participating in structured activities

• Independence during daily routines

• Asking for help

• Managing frustration

Clinicians collect data throughout treatment to measure progress and track changes. This information helps guide treatment decisions and ensures goals remain appropriate for the child.

Progress looks different for every child. During the first several weeks or months, families may begin noticing changes such as shorter emotional outbursts, improved communication, smoother transitions, or better participation in routines.

How ABA May Be Used Within IBHS

Some families hear about both IBHS and Applied Behavior Analysis (ABA) during the referral process.

ABA may be used within IBHS to help clinicians understand behavior, teach practical skills, and measure progress. Treatment is individualized based on the child’s strengths, needs, goals, and environment.

Families can learn more about this connection in What Is ABA Therapy and How Is It Used in IBHS?

The goal of ABA-based support is not to remove a child’s personality or individuality. It is to help the child communicate, participate, build independence, and function more successfully in everyday situations.

Skills may be broken into smaller steps so children can practice gradually and build confidence over time.

How Progress Is Reviewed

Treatment plans are reviewed regularly. During these reviews, clinicians may consider:

• Treatment data

• Progress toward goals

• Feedback from parents or caregivers

• Information from schools or daycare providers

• New concerns or changes in the child’s needs

• Whether the frequency or type of support should change

Goals may be updated as the child develops new skills or as new areas of need appear.

Caregiver participation remains important throughout treatment. Families learn strategies and practice them between sessions so children can use their skills outside of direct treatment time.

When a Child No Longer Needs IBHS

IBHS is not intended to continue forever.

Over time, many children develop the communication, coping, social, and independence skills they need to function more successfully with less intensive support.

Clinicians use treatment data, assessment results, caregiver feedback, and information from schools to determine when services may be reduced or concluded.

A child may be ready to transition out of IBHS when they consistently demonstrate the skills needed to succeed at home, in school, and in the community without the same level of direct support.

What Parents May Feel During the Process

Every family experiences the referral and treatment process differently.

Some parents feel hopeful and eager to learn strategies that may help their child. Others may initially feel uncertain, overwhelmed, or unsure about what to expect.

Progress does not always happen in a straight line. Children may have difficult days, especially when routines change or new expectations are introduced.

With consistent collaboration between families, clinicians, and schools, IBHS can help children build lasting skills that improve daily life.

Learn More About Starting IBHS

The IBHS referral process includes several steps, but families do not have to navigate them alone. Laurel Life can help explain eligibility, evaluations, insurance considerations, assessment, and treatment planning.

Learn more about Laurel Life’s Intensive Behavioral Health Services for children and families, including available locations and how to get started.