MATERNAL AND CHILD HEALTH BRANCH

Thank you for partnering with us to connect families to vital services and resources. To make the referral process as simple and efficient as possible, please follow the steps below.

Community Partner Referral

If you are making the referral on behalf of the family, the process is as follows:

1. 1. Check for Program Availability.
      Before completing the referral form, confirm that a home visiting program is available in the family’s community and that the child is in the target age range. Information for each community is below.
   2. Obtain Participant Consent.
      Ensure the participant consents to having their information shared with the Your Ohana Network to receive a referral to our program. Please ensure families are aware that they will receive a follow-up from our program.
   3. Complete the Referral.
      There are three ways to submit a referral to Your ʻOhana programs:
      • Submit an online referral form to the program.
      • Submit a paper referral form to the program.
      • Call the program directly and conduct the referral over the phone.

      Contact information for all options for each community are provided in the table below.

   4. Next Steps.
      After the referral is submitted, the information is transmitted directly to the local program serving the family’s community, and the program will contact the family to complete the intake process.

The contact information for each community is here:

Oʻahu Downtown-Kalihi, Waiʻanae, Wahiawā Catholic Charities Hawaii Service Area Map Age Range: 0-2 (Downtown-Kalihi, Waiʻanae) 0-4 (Wahiawā) Online Form | Paper Form Phone: (808) 527-4690 | (808) 527-4681	Hawaiʻi County East Hawaiʻi YWCA of Hawaiʻi Island Service Area Map Age Range: 0-2 Online Form | Paper Form Phone: (808) 930-5727 West Hawaiʻi Keiki o Ka ʻĀina Service Area Map Age Range: 0-4 Online Form | Paper Form Phone: (808) 699-7416
Maui County Wailuku-Lāhainā Keiki o Ka ʻĀina Service Area Map Age Range: 0-4 Online Form | Paper Form Phone: (808) 699-7416 Molokaʻi Institute for Native Pacific Education and Culture (INPEACE) Service Area Map Age Range: 0-2 Online Form | Paper Form Phone: (808) 560-0335 Ext. 335 Lānaʻi (Not accepting new families at this time)	Kauaʻi Kōloa Keiki o Ka ʻĀina Service Area Map Age Range: 0-4 Online Form | Paper Form Phone: (808) 699-7416

Family Self-Referral

Families may also refer themselves using this process:

• 1. Check for Program Availability.
     Before completing the referral form, confirm that a home visiting program is available in your neighborhood. Maps are available for this purpose here.
  2. Complete the Referral Form.
     Open the specific referral form for your community and enter the basic contact information needed for programs to follow up with you. Links to these forms are available on our family portal.
  3. Confirm Family Consent and Submit
     Before submitting, please review the language at the bottom of the form indicating that you consent to having your information shared with and be contacted by Your ʻOhana. If you consent, answer “Yes” to the consent question and type your initials. Then you can click “Submit.” The form should take about two minutes to complete.
  4. Next Steps.
     After the referral is submitted, the information is transmitted directly to the local program serving your community, and the program will follow up with you to complete the intake process.