Referrals

As community service workers you will often find yourself in situations where you can’t provide an appropriate or on-going service to your clients. This might be because your agency policies state that you can only assess clients, or work with clients for a specified timeframe. It also might be because you don’t have the skills necessary to deal with certain issues such as child abuse, sexual assault, marital issues, loss and grief and so on. It is important to realise that acknowledging you haven’t the necessary skills isn’t a sign of failure but rather a professional assessment of your strengths and weaknesses. By referring a client on to someone who can help them with their particular issue you are effectively meeting your client’s need and thus helping them move a step closer to resolve whatever is troubling them.

As a general principle regarding when to make referrals, make them if:

• you are in doubt of your own capabilities,
• you’re over-identifying with your client
• you know or suspect that another agency or professional is more appropriate for a particular client.

Referral means putting people in touch with services that have the resources to help them achieve their goals. It is not just about handing out a number. You are responsible for bringing the person and the service together.

When we make a referral, we are basically sending a person to another professional who specialises in working with particular needs or problems. Referring a client to another professional doesn’t mean that we stop working with that client but rather that we work as part of a team to best meet all that person’s needs.

Professionals to whom we might refer a client

Examples of professionals to whom we might refer a client are:

Doctors are trained to assess symptoms and make a diagnosis based on their knowledge and ability to understand the signs and symptoms that a patient is experiencing. Many doctors focus on particular areas of medicine and are called specialists. Specialists who often work with people with a disability are neurologists (brain and nervous system), ear nose and throat (ENT) specialists, ophthalmologists (eyes), orthopaedic specialists (bones), psychiatrists (mental health) and paediatricians (children).

Occupational therapists work with people on activities of daily living, and develop treatment plans to help people gain skills. They also assess what equipment and modifications to the environment might help people to go about their daily activities more easily.

Physiotherapists help people to gain more physical control of their bodies so that they can move more easily or improve their muscle control or strength. Helping people to use aids such as walking frames and crutches is another focus of physiotherapists as is teaching people how to prevent further damage to muscles.

Social workers work with individuals, couples, families, groups and communities. They work to empower people who are disadvantaged or marginalised in and by society. They provide specialist counselling, help people to learn new skills and strategies, and they attempt to make changes to policies and systems that traditionally disempower people.

Psychologists are trained in psychometric testing—this means that they can assess (using certain tests) a person’s intelligence or where they may be experiencing some damage to the brain. Some psychologists work in special schools and can provide educational assistance to children with a disability. Other psychologists specialise in counselling.

Podiatrists look after people’s feet. They treat feet problems as well as assess why people have certain problems affecting their feet. They may suggest (and make) orthotics (inserts that go inside shoes) unique to their patient’s foot or feet.

Orientation and mobility instructors teach people with a visual impairment the skills necessary to move safely about their physical environment. They may teach people how to use a white cane or a guide dog as well as how to use other mobility aids.

Audiologists assess whether or not someone has a hearing loss, what type of hearing loss they have and the degree of loss.

Employment consultants assist people to locate and maintain employment.

TAFE teacher/consultants support students to access and complete their studies at TAFE.

As a worker in this industry it is vital to get to know the range of agencies out there so that you can give the best possible service to the person you are working with.

When to make a referral

Usually you would refer the person who you are working with to another professional when:

• the client asks you to
• you need specialised information
• you do a needs assessment and realise that they need specialised assistance to make sure that their needs are met
• your agency does not provide all the services that they need
• you are concerned about their physical, social or emotional state or well-being and want a specialised opinion or intervention
• there is a change in a person’s physical, emotional or social situation and you need a specialised assessment to get new, different or more services
• the person is moving to a new area and needs to be linked to new workers and agencies
• you have ethical concerns about working with an individual and believe that someone else would be able to provide a more suitable service.

It is really important to remember that we do not refer clients because we have had enough of them and are finding them difficult to work with. While this is always a tempting option, especially when times are tough, it is not fair to the person and will not help them or their situation. It is much better to try and sort out why problems are happening and what can be done to help rather than ‘passing the buck’.

Steps in making a referral

How to make a referral

The following list of things to remember should help you when you are making referrals for a client:

1. Make sure you know what policies and procedures your agency has for making referrals.
2. Always know the agency or person to whom you make the referral. Don’t send a client off to someone or some organisation you know nothing about. Remember, your clients will probably already be feeling anxious about seeking help, so to send them on to an ‘unknown’ will no doubt increase their unease.
3. Contact the agency or worker you are thinking about referring your client to and see who their target group is, what services they provide and what their criteria for access is (that is, who they will accept and what information they need). Don’t give out any identifying details about your client at this stage.
4. Explore the readiness of your client to be referred. Open and honest discussion about referral and the reason for it will enable your client to feel more in control of the situation. If there is a choice of services available, make sure your client has information about each service and can make an informed choice for themself.
5. Discuss the possibility of referral with the other organisation or person before suggesting it to your client. Of course, you need to do this without breaching confidentiality. If you don’t check out the possibility of referral, you may have encouraged your client to move on, only to discover this is not possible.
6. Explore with your client where she or he may have already sought help. It’s no use referring on a client who has already been on the ‘merry-go-round’ of agencies. This would be extremely disempowering.
7. Talk with your client about the fact that you want to refer them to another worker or agency and why. Give them some information about the new agency or worker and give them time to ask questions and talk through the referral process.
8. Be very aware of confidentiality issues. Get your client’s consent for you to contact the agency or worker and give their details to the new worker. Remember that they must give informed consent (know what it is that they are consenting to and the consequences of giving such consent).
9. Let your client make the appointment, rather than making it for them. Again, this is more empowering.
10. Help prepare your client for their first appointment—talk through with them what information they will have to provide, how to get to the appointment and what they will have to take (if appropriate). Some clients may want you to go with them as an advocate or as support.
11. Maintain your relationship with your client until the referral process is complete. It’s no use, for example, referring a client to an organisation for an appointment in six weeks time and then leaving them without support in the interim. Sometimes, it’s useful to continue support work with a client even though they may be receiving other services. This type of collaborative work is often useful in community services work as each worker has different areas of expertise that they can offer a client.

If the relationship between you and the client is particularly difficult or tense you might not be able to do all of this and you might just give them information about what other services are available. Regardless of how difficult things might be between you and the client it is important to remain professional, respectful and polite at all times, even though you might not want to!

Remember that every referral you make should be aimed at improving the person’s quality of life and opportunities for increased independence. The referral process should be aimed at empowering the person so remember to give them as much information as is appropriate to their level of functioning and allow them to do as much as possible for themselves.

To ensure that you meet your duty of care and professional requirements make sure that you document everything that you have done. In the case notes you should provide an objective summary of what happened and why and what you did. So if a complaint is made you will have all the information necessary to show what you have done and why.

The referral letter

When you refer a client to another service you will need to write a letter of referral. The referral uses the parts of a letter combined with the introduction, body and conclusion of a report. The headings ‘introduction’ and ‘conclusion’ are not usually used; however, section headings are frequently included. Using a letterhead means that the report is written by you, representing your service.

Look at this example (.doc 32 KB)

Writing a good referral takes practice and the task becomes easier the more you write. Some good advice to new report writers is to spend time planning because this will save you time in the long run.

Activity: Writing a referral report letter

Write a referral letter to the Salvation Army shelter incorporating the following points. Use the example given above as a guide. Points to incorporate in the referral letter:

• Martin 37 years old
• divorced three years, no children
• unemployed, previously a taxi driver
• depressed
• long history of alcohol abuse
• recently in detox and currently not drinking
• homeless and needing accommodation
• no history of violence
• well motivated to attend AA.

Referring clients when there is a conflict

Often as community service workers we have people come to see us who are in conflict. This conflict can be within families, within neighbourhoods, at work, with friends etc. There are times when conflict can get out of control and the people involved are unable to resolve it themselves or we are unable to work with them successfully. When this happens it is time to seek help from qualified professionals or community service agencies which provide conflict resolution services. There is a whole range of agencies that can help when a conflict gets out of control, including unions, non-government agencies, advocacy support services, private consultants, mediators and counsellors.

At the moment governments are focusing a lot of resources on mediation services. This is because they recognise that when people are in conflict they find it hard to resolve their differences properly and either resort to violence or the courts. Neither option is great or that helpful! As a result there are more services available to refer clients to and a greater acceptance that mediation is a useful process for people to go through.

Identifying specialist conflict resolution and mediation services

How might you go about finding specialist conflict resolution and mediation services available in your local area? You could:

• ask another worker or someone you know who works in the industry
• contact your professional association
• look up a community directory or data base.

If you want to use a professional or agency to help you resolve a conflict or to refer conflicting parties to, always check them out first. For example, do they use qualified people, are they a recognised service, do they have well developed policies and procedures, and are they approachable? You will also have to consider cost and accessibility. Never call in a professional without doing your homework first.

Activity: Finding a mediation service

Referrals and confidentiality

As well as maintaining confidentiality within the agency, it is essential to ensure that client privacy is protected when referring clients to other organisations.

Services should ensure with all referrals, that appropriate and accurate information is provided. The only information that needs to be shared is basic contact details for the client, the reason for the referral, the extent and nature of your involvement with the client and your role in the future.

This means sticking to facts and keeping your opinion and any judgemental comments to a minimum. Let the worker meet the client and form his or her own relationship without influencing the worker’s perception by your own experience or opinion.

Under the Freedom of Information Act, clients are within their rights to request to see their client file. Any written correspondence in relation to the client is kept in this file. So, if you have written a referral letter for a client that you would not want them to see, think about why.

• Have you stated something that is making a judgement on the client (such as ‘the client is unmotivated’)?
• Have you referred to some aspect of your involvement with the client that you have not discussed with the client (such as ‘the client didn’t get on with other clients while in our service’)?

It is much more appropriate to share the client’s perception of their difficulties with other workers, than your own opinion (which could be deemed biased).

The golden rule is, wherever possible, work in close partnership with your client, initiate the referral together and agree on what information needs to be shared.

However, another important consideration in sharing information is not withholding information that the service should know, if they are to fulfil their duty of care to the client and other clients within the service. For instance, if your client has a violent background (they may have been charged by Police), and you are referring them to an accommodation service, then the service has a right to know that information. This is for the safety of other clients in the service. Similarly, if your client has a mental illness, the service may need to know so they can ensure the client receives adequate care and access to a specialist service if required.

Client permission must be gained (preferably in writing) before sharing information. It is a good idea to discuss with the client what you are going to talk about with the other agency. Also, be sure that the client understands the policy and criteria of the service to which they are being referred.

Activity: Referral

Aidan Smith, aged 15 years, has been attending your youth centre for the past few months. Initially, he experienced a lot of difficulty ‘fitting in’ with the kids at the centre. His parents had separated just prior to him coming along to the group and he had a lot of anger initially, lashing out at staff and other kids in frustration.

Aidan has received a lot of support from the youth workers and his inappropriate expression of his feelings is now under control. Aidan is in Year 9 at high school and is moving out of your area to live with his grandmother. His mother has remarried and Aidan doesn’t want to live with his step-dad. His academic ability is very poor. Aidan showed you his latest school report.