Referral

This page aims to help you to consider your role boundary around drug issues. The development of agency protocols and policy can greatly assist this decision making.

Options include managing the case yourself with or without consultancy support, handing one specific aspect of the case to another agency, handing the whole case over to another agency or shared-case management.

Further information on referral options can be obtained at Agency Resources.

Contents

Referral out
Indications for not referring
Indications for referring
12 Referral Steps
Referral options

Referral out

The development of reciprocal agreements and procedures between drug agencies and generic agencies will aid in determining boundaries, roles and mutually supportive structures around referral and shared-case management.

If a client is referred to a drug agency or specialist within the generic agency for intervention, the intent of that referral needs to be clear for the client, the referral agency/specialist and the referring worker. Some key questions which would need to be answered regarding referral include:

		What other agencies or professionals are currently involved in the case?
		Has the specific nature of the referral request been made clear? (e.g. for relapse prevention work, drug assessment, detoxification etc.)
		Is the case being totally handed over to the drug agency with the expectation that they will become the case manager, or will referring agency maintain case management, or will there be shared-case management?
		Does the referral agency understand or have any obligations regarding their management of statutory cases?
		Are there statutory conditions related to the referral?
		Have confidentiality issues been managed regarding the sharing of information between agencies?
		What information is being provided to the referral agency and what information would be expected back? Has this been made clear?

Indications for not referring

The current trend in dealing with drug use issues is for them not to be seen necessarily as a specialist only area. Rather, given that the majority of drug users do not have serious dependencies or difficult complications, generic workers should be able to deal with many of their cases using brief intervention techniques. These techniques are largely based on generic counselling skills already possessed by most workers.

Indications for consideration of maintaining the case and not referring include:

		Low degree of dependence and few drug-related problems;
		Already successfully engaged in a change process (however, maintenance referrals may still be appropriate here);
		Client unwilling to change drug use behaviour;
		Client unwilling to engage in referral options;
		Agency policy and resources (e.g. a large generic agency may choose an internal referral to a clinical psychologist rather than a drug agency with no clinical psychologist where anxiety and anger management are key features of drug use);
		Availability of consultancy supports for worker; and
		Unavailability of service: lack of child care facilities, non-gender specific (or language or Aboriginal, or age specific), proximity to client, client transport, cost and waiting lists can all reduce possibility of effective referral.

Indications for referring:

Indications for consideration of referring to a drug agency include:

		High degree of drug dependence with multiple drug-related problems;
		Client choice to attend a specialist agency;
		Co-existing psychiatric disorders such as schizophrenia or clinical depression;
		Pregnancy or lactating mother (consultancy may be all that is required in some situations);
		Former positive experience with a drug agency or drug specific support (eg AA, NA, Parents and Friends Group, etc.);
		Detoxification required;
		Difficulty in determining accuracy of information because of statutory issues (however, the drug agency may have similar problems);
		Unsuccessful management of drug issues within current agency;
		Client's family or friends involved in the case may require specialist drug specific information and supports.

Tick Box

12 Referral Steps (checklist)

Linked to assessment steps. (ie referral should be considered during assessment)

Ask the client who else has been involved in the case.

If other professionals involved, seek written permission from client to contact them to discuss their case (i.e. release of information). You may invite the client to be present when this discussion takes place to reinforce trust.

Discuss and negotiate any referral options with client. Include any bottom-line positive and negative consequences if related to statutory issues.

Discuss any obstacles to referral and benefits of referral.

Identify and use any protocols developed between drug and other agencies.

Identify with client and subsequently referral agency, whether client will continue to see the the referring worker, and if so who will be overall case manager, or how shared case management will proceed.

Organise referral while client is present if possible. Either client or counsellor to make initial call, however, most drug agencies will want to hear from the client if possible during this call. If there are child protection or other statutory requirements, these need to be made clear at this time.

Client or counsellor writes referral details for the client to take home.

Reminders: If suspicion of unreliability, problem solve this with client. Solutions may include: a reminder call from the counsellor on the appointment day; putting a note on the refrigerator; or if necessary, arranging for the worker to pick up and accompany the client to the first appointment.

Where possible, a referral is written stating the purpose of the referral and relevant information. If a drug assessment has already been completed, this should be included unless the counsellor is seeking an alternative, external view. This is either given to the client to deliver or sent directly to the referral agency depending upon the situation. Note confidentiality.

Follow-up with client and/or agency how referral went.

Referral Options

See: Agency Resources)

Telephone (e.g. ADIS, help lines: click here for help-line numbers);

Professional services (e.g. Drug agencies, private counsellors, hospital psychologists, etc.);

Non-professional (e.g. AA, NA, Al-Anon, Nar-Anon);

Detoxification: outpatient or inpatient

Drug maintenance therapy: Methadone, Naltrexone...

Drug testing services: Laboratory testing services or drug agency

Specific drug counselling: Assessment, motivational interviewing, relapse prevention, other;

Group work: (e.g. outpatient client groups or family and friends groups at drug agencies);

Long-term residential rehabilitation

Non-drug physical and psychological (e.g. Medical examination, psychological intervention for anger, anxiety, depression, phobia, pain management, or psychiatric assessment for psychotic symptoms)

Other non-drug referrals - where other issues impact on drug use behaviour: (e.g. accommodation, recreation, education, employment, parenting, social security, etc.). Inclusion and exclusion criteria regarding drug use should be considered regarding non-drug referrals: (does the accommodation or other service tolerate any drug use?).

See also: Agency Resources