The CSA 1 form is a referral tool used by Eliot Community Human Services. It connects youth in Massachusetts with Community-Based Health Initiative (CBHI) behavioral health services. The form captures information across 5 key areas of each youth's life.
The document collects the following information:
The form also documents the youth's strengths and interests. This supports a strengths-based care model. Families and guardians provide key details throughout the document.
A team reviews the completed CSA 1 referral. That team may include a primary care provider, therapist, DCF case worker, DMH representative, and psychiatrist. Together, they coordinate a plan that addresses both immediate needs and long-term wellbeing goals. The form also records any prior assessments, active medications, and existing diagnoses across 3 axes (AXIS I, II, and IV).
| Question | Answer |
|---|---|
| Form Name | Csa Form 1 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | FormCSA eliot community human services csa form |