Eligibility Criteria & Referral Form

Children's Mental Health Brochure
Who Do I Call For Help or to Make a Referral?

To request an application for Children's Mental Health Case Management, call Le Sueur County Intake at (507)357-8228.  An intake screener will talk with you about your child's needs and advise you of the application process for voluntary county services. For crisis services and non-county resources, please refer to our "Resources" page on the left-hand navigation of your page.

To initiate the referral process, you may also complete the Le Sueur County Child/Adult Voluntary Services Referral Form(PDF).
Le Sueur County DHS Authorization for Release of Information

To qualify for Children’s Mental Health Case Management through Le Sueur County, children must be determined, by a mental health professional via a Diagnostic Assessment, to meet the Severe Emotional Disturbance criteria listed below.

Severe Emotional Disturbance: A child with severe emotional disturbance means a child who has an emotional disturbance (see below) and meets one of the following criteria:

  1.  Admitted within last three years or at risk of being admitted to inpatient treatment or residential treatment
  2. MN resident receiving inpatient treatment or residential treatment through interstate compact
  3. Child has one of the following as determined by mental health professional:
  • psychosis or clinical depression
  • risk of harming self or others
  • symptoms resulting from being a victim of physical or sexual abuseor psychic trauma within the past year.

   4.  Child has significantly impaired functioning (home, school, or community) that has lasted at least one year or that in the written opinion of a mental health professional presents risk of lasting at least one year.

Emotional disturbance: An organic disorder of the brain or a clinically significant disorder of thought, mood, perception, orientation, memory, or behavior that:

  1. Is listed in the clinical manual of International Classification of Diseases (ICD-9-CM) code range 290.0 to 302.99 or 306.0 to 316.0 or corresponding code in the American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders
  2. Seriously limits a child’s capacity to function in primary aspects of daily living such as personal relations, living arrangements, work, school, and recreation

Diagnostic Assessment: a written evaluation by a mental health professional that includes:

  • The child's current life situation and sources of stress, including reasons for referral.
  • The history of the child's current mental health problem or problems, including important developmental incidents, strengths, and vulnerabilities.
  • The child's diagnosis including a determination of whether the child meets the eligibility criteria listed above.
  • The mental health services needed by the child.  (MN Statute 245.4871, Subd. 11)