Referrals

A referral is a formal process that directs a client to another agency, professional, health service provider, or other person for a service or treatment. The referral process connects clients with the resources they request or need for success.

You will make referrals to and receive referrals from other health providers, ICWA workers, and agencies, including federal, state, or tribal courts. The purpose of referrals is to support the client’s presenting problems, medical necessity, strengths, self-determination, and choice. Base your referral decisions on the needs and wants of the client. Make referrals to local providers when possible.

A successful referral involves effective communication. Share the reason for the referral with the client and the provider. Always be sure a Release of Information is in place before communicating with the other provider.

Good client practice may sometimes include escorting clients to the referred provider to help the client feel comfortable with the new service or provider. This is sometimes referred to as a "warm handoff." Helping clients form the new connection may increase their confidence, which is an important contributor to health and wellness.

Any referral you make or receive should be documented in the client's record. How much supervision you need for referrals will depend on your certification level, your professional experience, and the policies and procedures of your organization. If you need assistance with any aspect of a referral, consult your supervisor. See Chapter B-7: Supervision and Support for additional guidance on working with your team to provide quality client care.

COMMON REFERRAL SOURCES FOR BHA/P SERVICES
Referral Source	Common Reasons for Referral
Court System	Evaluation and treatment for alcohol and substance abuse. Domestic violence. Client’s ability to participate in court proceedings. Danger to self or others (e.g., threatening suicide or to harm someone). Client education (e.g., anger management).
Office of Children's Services (OCS) or Tribal Courts	Assessment/evaluation for substance abuse and mental health. Treatment for abuse, behavioral problems, or depression. Parenting, special needs, or safety issues.
Law Enforcement	Crisis intervention assistance. Assessment or assistance (e.g., suicide risk, aggressive behaviors).
Schools	Behavioral problems at school such as poor attention, class disruption, bullying, or violence. Poor peer relations. Poor school performance. Developmental problems and learning or cognitive disorders.
Health Service Provider	Assessment or evaluation resulting from observed or suspected behavioral health problems. Developmental delays.
Other Behavioral Health Provider	Continuing care in the home community. More culturally appropriate services.
Residential Treatment Facility	Continuing care in the home community after discharge. Access to mentors or sponsors who can support and reinforce positive ways of change and coping strategies.
Clergy or Spiritual Leaders	Assessment or evaluation resulting from observed or suspected behavioral health problems.
Self	Feeling lonely or isolated. Interpersonal problems with romantic relationships, family, and friends. For children, a sense of connection to the referred provider, possibly as a result of prevention activities or presentations at schools.
Family	Concerns about topics such as substance abuse, suicidal thoughts, or depression.

As a BHA/P, you are both a comprehensive community resource and a provider with specific training and a defined scope. Always refer your client to an appropriate provider if his needs are beyond what you are trained and certified to do.

Check with your supervisor if you have any questions about a referral you think you need to make and review your employer's specific requirements and procedures for referrals.

Make sure you have a signed Release of Information (ROI) form or HIPAA authorization form.

• This gives approval for you to communicate with the referral source about a client for a specific period of time. ROIs can permit written communication, spoken communication, or both, so pay close attention to what type(s) of communication each specific ROI allows. See Chapter B-4: Confidentiality and Release of Information.
• It allows you to get client information from the referral source that may help you in your work with the client.
• The ROI for any minor child (under age 18) must be signed and dated by a parent, guardian, or other legally authorized authority. For more information, see Chapter B-3: Consent to Treatment.

General tips regarding referrals:

• Any delay between when a referral is made and when the client receives services can affect the client's motivation to pursue treatment.
• Be careful to remain in your helping role rather than becoming involved in forensic or custody-related assessment referrals.
• Stay in communication with the client if there is a waiting period for services. This helps build the client's trust in the behavioral health process.
• When you receive law enforcement or village safety referrals, only conduct work when the individual's behavior is stable and the scene is safe. If this is a crisis referral, request that the law enforcement staff remain with you and the client. See Working with Difficult Clients in Chapter C-5.
• Find out what documentation is required; some types of referrals involve special documentation, such as court ordered services and/or substance abuse treatment.

If a client has been referred to you:

• Review the referral form to understand the reasons for the referral, including the client's presenting problem and what service is being requested.
• Before communicating with the referral source, make sure you have a Release of Information in place. See Chapter B-4: Confidentiality and Release of Information.
• Communicate with the client about why the referral was made to ensure that you and the client are on the same page about what the client wants and needs from you as a provider.
• Do everything you can to make the client feel calm and comfortable.
• If the referral source did not explain the referral request or referral process to the client, do your best to explain this in a way that your client will understand.

There are many reasons why you will refer clients out. Here are some possibilities:

• The client’s needs are beyond your training or experience.
• The client requests a counselor of a different gender.
• The client has a different cultural background and needs a counselor who understands her culture.
• The client requests a different counselor based on personal preference. The client always has the right to request this and you should not take it personally.
• There are safety reasons that somebody else should see the client.
• The client has a physical health issue that requires a different type of provider (CHA/P or doctor). You may work in partnership with this provider if the client has overlapping behavioral health and medical problems and signs a Release of Information .
• You have a dual relationship with the client (such as being close family members) and a referral would best serve the client.
• The client needs services, such as residential treatment, that your community or THO do not provide.

Through observation, listening, and experience, you will gain awareness about when and how to make referrals. It is your ethical responsibility to refer clients to the appropriate level of care when you know that you are unable to provide them with what they need. Referring a client is not a sign of failure on your part. Instead, making the referral shows clients that you want the best for them.

The changes that come with a referral may be difficult for the client. Be honest with the client about your concerns and explain why the referral will help. Be caring and gentle. Answer questions from the client or caregiver about what a referral means to future services and listen to any concerns about the transition.

Start by talking to your supervisor about the referral if needed. This may be necessary due to the complexity of the referral, your certification level, and/or your organization's policies and procedures.

Discuss the reason for the referral with the client. If your client is a minor, talk to the parent/guardian about why you are making the referral.

Get a signed Release of Information from the client, guardian, or legally authorized representative.

Gather the information required for the referral. You will need to:

• Describe the chief complaint and document all relevant information about the client for the referral agency.
• State the purpose of the referral:
  • Describe the client's needs and why you are making the referral.
  • Describe your impression of the course of treatment and what you believe could benefit the client.
  • Indicate if the client needs a behavioral health assessment , medical or medicinal evaluation, or continued treatment.
• Include whether the client plans to continue seeing you or will return to you for services after further treatment is completed.
• Find out if there are criteria for admission. Some agencies will need a health screening or medical clearance.
• Discuss how the client will pay for the services and transportation needs.
• Make sure that the paperwork follows the client to the referral agency.
• Prior to the client's first meeting with the new provider or agency, schedule a meeting with yourself, the client, and the referred provider or agency by phone or in person to make introductions. This "warm handoff" is helpful in improving rapport and treatment outcomes.

Follow up on the referral:

• Make sure you provide your contact information to the person you are making the referral to.
• Set a timeline for follow-up between yourself and the other provider. 30 days is standard, but the timeline may vary according to client needs.
• This follow-up is important for you and the relationship with the referral person or agency.

The Referrals Resource List is a downloadable, editable Word file where you can list organizations and contact numbers for easy reference.