What Happens Before, During, and After an IBHS Referral

When a child begins struggling with behavior, emotional regulation, or communication, families often start with traditional outpatient therapy. For many children, that support is enough. But sometimes challenges continue at home, 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.

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

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.

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.

These tools may include:

AFLS (Assessment of Functional Living Skills): Evaluates everyday life skills such as communication, self-care, and independence.

ABLLS (Assessment of Basic Language and Learning Skills): Measures foundational learning and communication abilities.

PEAK Assessment System: An evidence-based assessment and curriculum framework used to identify missing skills and guide treatment planning.

Clinicians choose the tools that best match the child’s needs.

Ongoing IBHS Services For Children: What They Are Learning

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

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

• Social skills and peer interaction

• Communication skills

• Emotional regulation

• Following directions

• Personal space and safety awareness

• Sitting and participating in structured activities

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

Progress looks different for every child. In the first one to two months, families may notice small improvements such as shorter tantrums, improved communication, or better participation in routines.

Treatment plans are reviewed at least every six months. During these reviews, clinicians look at data, feedback from parents, and input from schools. Goals may be updated based on the child’s progress or new areas that need support.

Common Concerns About IBHS

Families sometimes feel nervous when they first hear about IBHS or Applied Behavior Analysis (ABA). Much of this concern comes from misinformation about how these services work.

Some parents worry the therapy will feel rigid or that their child will lose their individuality. In reality, the goal of IBHS is to help children develop skills that allow them to succeed in their natural environments while still being themselves.

Breaking skills into smaller steps can sometimes look structured, but those steps help children learn gradually and build confidence over time.

When a Child No Longer Needs IBHS

IBHS services are not meant to last forever. Over time, many children learn the skills they need to function more independently.

Clinicians use behavioral data, assessment results, and feedback from parents and schools to determine when services may no longer be necessary.

If a child consistently demonstrates the skills needed to succeed at home and school, services may be reduced or concluded.

What Parents Often Feel During the Process

Every family experiences the IBHS referral process differently. Some parents feel hopeful and eager to learn strategies that will help their child. Others may initially feel uncertain about what to expect.

It is also important to know that progress does not always happen in a straight line. Sometimes behaviors briefly increase when routines change or when new expectations are introduced. This is called an extinction burst, and it can happen when children test boundaries while learning new skills.

With consistent collaboration between families, clinicians, and schools, IBHS can help children develop lasting skills that improve their daily lives.