Substance Abuse Referral – Tips On How And
Often thinking about referring a client to a higher level of care is anxiety provoking for both the client and clinician. Client’s initial reaction is one of fear and anxiety. The clinician is concerned that they may scare the client away and they will not receive any treatment at all. It’s a delicate topic and one that begins with this question. “How do you think your therapy is going?” The client will know the answer to this, and the clinician can gently point out the inconsistencies with treatment and progress. Now it’s the clinicians responsibility to offer referrals that they themselves have toured and have met the staff and understand the services they offer. I often believe in calling the referral with the client to help decrease their anxiety.
Referring a patient in private practice, especially when just establishing the business, can be humbling and challenging. I think learning, early on, that referring patients is a necessity for all practitioners makes the process more acceptable. Below are 4 tips I can offer when learning when and how to refer patients who have needs that I am not qualified or do not have the expertise in addressing. 1. Identify your areas of expertise. Know the topics or skill sets that you are confident that you can offer that can assist a patient in reaching their goals. Many psychologists will describe themselves as eclectic, using a variety of theories or techniques, however eventually we have to identify our strengths and build upon them. We cannot be all things to all patients and be our best in all areas. 2. Oftentimes the referral will be in addition to utilizing your services. For example a referral to meetings would be in conjunction to the services you offer, as well as a referral to a medical doctor or psychiatrist. 3. Refer most patients for a physical to rule out any physical concerns that may be causing psychological symptoms or addictive behaviors. Blood work and a consultation with a medical doctor can address any physical conditions and be the beginning of the road to recovery. 4. Identify the resources needed by doing a thorough assessment. Have resources in many areas to refer patients with a variety of needs, meeting schedules, AA, NA, CODA, OA, meditation classes, self help classes, chiropractors, day programs, nutritionist, trainers, churches, etc. healing is a mind, body and spirit approach. This can be done by networking and setting up meetings to assess the referrals being effective. Patients like to be given a referral to a place that is recommended by someone that they trust or already have established a rapport with. If I do not have a resource available I will search online with my patient during session and email the results with a commitment to follow through and take action.
I work with physicians as a trusted partner to help restore them to better health. A confidential network available to health care providers or their family members seeking a peer to talk with about alcoholism, addiction, recovery and related concerns. The patient referral system today is broken, rampant with issues and roadblocks that can definitely be corrected, but before that happens the problems need to be identified clearly. Today‚ the practice of paying for referrals is often justified the same as ‚ heads on a bed at any cost was. The common refrain is‚ we are trying to help those who otherwise might not get help. No matter the motive for their practices, providers created and continue to create serious legal problems for themselves. The result for the centers then were federal investigations that resulted in numerous corporations being forced out of business due to their illegal business practices. The result today is an increase in lawsuits against providers. My fear is, if we do not get our own house in order quickly, we will see more criminal investigations and insurance company law suits against providers. With the result for patients and their families more restrictions on the availability of addiction treatment programs. The practice of paying for referrals gets calls into question our integrity. If examined closely by the media or the justice system, it is inevitable that families will lose faith in our ability to help their loved ones. The result will be another collapse of treatment centers across the country. Once our integrity is compromised, it will be a long and difficult road back to respectability. It is time for us to understand the law, and examine the practices many view as acceptable. It is common practice today for many independent intervention and marketing professionals to be paid by several treatment centers at once. This independent relationship in and of its self is most likely not a violation of the law. The key test to apply is whether or not the payment is either adjusted upward or downward based upon the number of admissions. If the dollar value of the payment changes based on the number of referrals, then it is illegal. The bottom line is that referrals must not be induced by considerations other than the best interests of the patients (i.e., by promise of financial remuneration). The State of California has several laws that expressly prohibit paying for referrals. These are the critical moments in your practice, when the care you’ve already provided may not be enough and requires a shift in services. There are many reasons why you could be contemplating a health care referral for drug or alcohol addiction. Whatever the reason, I have the resources. Providing patients the tools needed to experience lifelong recovery. Because we treat addiction and its root cause, our patients get the opportunity to heal emotionally and move forward toward greater well-being. When you contact me as a referring professional, you can expect: – A prompt response – A streamlined process to determine the best programming fit for your client – Help in addressing any special concerns or needs you or your client may have regarding services – Guidance for your clients in accessing the maximum health insurance benefits available – Ongoing collaboration with you in your client’s treatment plan and discharge recommendations to ensure continuity of care
I know it’s time to consider a referral once I’m outside of my scope of practice. I am an ACE Certified Health Coach & Personal Trainer. I am NOT a psychiatrist or therapist. I would be wasting my clients money and time and destroying my reputation if I were to pretend I’m something I’m not. Over the last 8 years I have found that if I am honest and admit to a client that what they require is beyond me, it forms a stronger bond with them. They trust me. They appreciate that we are both human and both have limitations. They recognize the power that comes from working together. I also find that they always come back to me when they need my services again. The ultimate goal for the entire health care ‘team’ is what is ultimately best for a client.
The mark of a true professional is to know when you don’t know. Unfortunately this is the exception not the rule. The childlike fear of so many is losing a patient. The reality is that you are in legal jeopardy if you fail to refer. Medical complications necessitate a referral, medications necessitate a referral.
If a patient’s health appears to be headed in the wrong direction, it may be time to refer them for treatment. Discuss the topic gently and pose it as a suggestion. It’s also helpful to ask them what they think about it to see where their head is at.
I believe it is time to refer a patient to a treatment center when a person’s patterns, behavior or habits is interfering with a healthy balanced lifestyle, peace of mind, career and/or with personal relationships. It is best to approach this situation with compassion and gentleness so the patient feels supported and inspired to receive treatment and ultimately heal.
If you are an MD, psychologist, psychiatrist, therapist or doing any kind of social or mental health work, you may face with a client struggling with a substance abuse problem. You may also have a loved one dealing with a substance abuse problem who needs a high level of treatment. If you are a service provider, it is important that you assist your patient with accessing specialized treatment, selecting a treatment facility (i.e.location, insurance, orientation, specialty) and helping your client navigate barriers to treatment. As part of supporting your patient and helping them guide through the process, you can take the first step by calling treatment centers. When you call treatment centers, asking about these specific areas will help your patient gain insight into what to expect and will help you better educate your patient about what might be expecting them: -Admission criteria -Insurances accepted by the program -Daily client schedule (i.e.program hours, activities, psychotherapy groups and other activities.) -Treatment planning and treatment team (therapists, case managers, counselors and other staff). -Discharge/Aftercare planning (What happens when patients complete the program?) The crucial point to consider for referring a patient to treatment is to consider that the patient may be in need of a higher level of care than what they are currently received and they may be in need of a more structured environment where they will be monitored by staff and attend daily group and individual therapy sessions in addition to access to medical services.
What I have learned in my years of teaching and coaching people, is that there are times when I feel a patient’s issues are out of my league. I do not want to go beyond my scope of practice. But this is tricky because often a person has come to you expecting you to be able to solve all their problems and they have developed trust in you. So handling the referral carefully and with the consent of the person you are seeing is critically important.
What I have learned in my years of teaching and coaching people, is that there are times when I feel a patient’s issues are out of my league. I do not want to go beyond my scope of practice. But this is tricky because often a person has come to you expecting you to be able to solve all their problems and they have developed trust in you. So handling the referral carefully and with the consent of the person you are seeing is critically important.
I refer current clients for two main reasons: one, when they are relocating and want to find a therapist in another geographical area and two, when they have issues that might require medication. If a client is moving, I would ask my colleagues for their recommendations for appropriate therapists in the new locale and provide my client with referrals based on those recommendations. If a client is having issues, such as depression, that might be helped with medication, I would have a conversation with the client about the possibility of consulting a psychiatrist. Or, at times, a client may volunteer an interest in seeing a psychiatrist as an adjunct to talk therapy. In either case, I would determine a client’s specific needs and preferences and refer a psychiatrist according to specialization, location, gender, and any other relevant specifics.
Most things in today’s are complex. And developing care for a client who faces a complex situation often prompts me to set up appropriate referral: When I meet with a potential new client, I take a detailed, holistic assessment and intake that ranges from questions about physical health and history, to clients background story and their sexual evaluation (if the reason for a visit includes a sexual question or concern). Such detailed assessment is vital to gain understanding of how to best serve the client. If, for example, a complex physical history becomes apparent, a referral to a medical specialist is indicated- as I work in a network of providers who all love supporting the clients as comprehensively as possible. For example, a client with sexual pain is referred to a a physical therapist specializing in pelvic pain. Another common example is to refer out in order to assess the client’s hormonal health. In the case of an addiction, my addiction related specialization allows me to access addiction assessment tools to diagnose if an addiction is present. High addiction scores on the assessment tools and my intake forms tell me that it’s time to switch on a village of support to best support my clients by sending him/her to a higher level of care. Every client is worth a referral to set up treatment for success!
My first reason I would refer is knowing when my patient needs more or different help than I can provide. Our ethical responsibility to do what is best for our clients which may be to refer to other providers always needs to be considered at intake and throughout treatment. Each session my clients fill out mood surveys so I can know how they are doing and if a client is unable to stay sober on their own I would recommend to a treatment center to have more structured care.
Many people have asked me how do you know when it’s a time to consider referring myself or someone to therapy? My general answer to that is that therapy can be a safe and confidential space for anyone that is looking for emotional and mental support and want it. Sometimes we may not even have the words or understanding of why we feel a certain way or why relationships are in the state we are in. Most people that walk through my doors, are seeking support because their areas of concern are impacting their life functioning. This could look like impacting their overall mood(sad, irritable, angry, anxious), sleep, relationships, school/work, concentration, and overall outlook on life.
When looking at patient care, there are a number of things to consider. The most important of which is to determine if the client’s needs match the scope and ability of the treating facility. When we find that the needs of the client overwork the staff or the client is decompensating, there is a good chance a referral is needed. Referrals present in many forms, for instance a client may have an unstable living environment that poses a risk to their stability. In this case, a client should be interviewed to determine their barriers and an appropriate list of referrals should be provided which may include sober housing, group homes, and other options. In the case of a mental health referral a client needs to be assessed for severity of presenting condition. When a healthcare referral is needed a number of factors should be included. The main component remains, what are the client’s needs. Does the program offer the appropriate intensity, services, types of providers, is the program financially feasible, does the client require a facility that is in-network with their insurance, does the client have state or federally managed insurance. All of these and many other things should be taken in to account during the referral process.
How do you know when it’s time to consider a referral? When you’ve served the client to the best of your skills and expertise and sought consultation, but your client still isn’t making any progress.
It’s hard to let a client go. We invest a lot of energy in building a connection, an alliance, and trust with our clients. My red flags are raised when I notice my clients start to disengage because they can’t let go of negative feelings about me (transference issue) or feel frustrated by the lack of progress (treatment issue). These flags are waving when, no matter how much we try, we come back to these areas to the point where it becomes the focus of our session. When we reach this point, I introduce the idea of working with another therapist. This offer gives the client some control over the relationship. They have permission to work with someone new. If they choose to stay, there is renewed commitment towards therapy. Either way, there is movement and this alone can be benefit the client.
It would be important to refer a client out when I feel the client needs more supervised or in-depth care, something more than a 50 minute session weekly. Psychotherapy can trigger a profound emotional response, which understandably may be too destabilizing for some people. It can be safer and more effective for some people to work with specialists and groups in an in-patient setting so they are safe to feel their feelings without being a risk for self-harm. As a Psychotherapist, it is imperative to make sure my clients are safe and stable before we work on certain issues (trauma, addiction). There are times it can be better to refer to inpatient treatment to address these needs. Not always – but definitely when I am concerned the client would have the risk of self-harm.
The key to referring a client is when someone is stuck in an impasse because they are not able to handle a certain vibration such as fear or no boundaries. Then referring them to a therapist who is able to hold that vibration. if the therapist can’t do that there is no therapy dynamic nor is there any therapy, and the therapist and client just end up occupying mutual space.
Deciding whether or not to refer a patient to an addiction center is a judgement call based on both the patient and the practitioner. These are a couple rules of thumb when considering a referral. It may be time to refer if: 1) The patient is unable to follow your treatment plan due to their addiction, this obstacle to cure must be dealt with before you can effectively work together. 2) If you feel, for any reason, the case is over you head then it is a good time to refer to an addiction center or another well-qualified practitioner. Patient safety is the first priority. 3) If the patient’s words or actions trigger you; your response may get in the way of your ability to treat the patient and indicate there is an unhealed aspect in you. Physician heal thyself is fundamental to our medicine, which is why I have created my course. My rule is – If I feel any of the above or a patient keeps me awake at night because I may not have the capacity to handle their case- I refer . Spirit is always at work and every intervention is divine even it is perceived as negative given my belief in soul contracts.
As a therapist who specializes in treating eating disorders it is super important that someone who is struggling with an eating disorder work with a professional with the specialty. Eating Disorders are incredibly complex and very sneaky. Treatment and recovery from an eating disorder often needs a treatment team that consists of a therapist, dietitian, psychiatrist, and primary care physician. Unfortunately eating disorders have an extremely high mortality rate and Anorexia Nervosa has the highest mortality rate of all mental illnesses. Through my experience working with eating disorders at all levels of care full recovery is possible and having professionals that understand the disorders creates safety for the individuals to allow themselves to be vulnerable about the harder things and incorporate change. This is a process and take times and this is also a big importance of why recommending someone with the specialty. Patience, healthy boundaries and relationship work is vital. The work is not just around food, weight, and body image but more importantly healing the relationship with yourself which helps heal the eating disorder and lead you into a recovered life.
Many therapists are what one might consider a generalist practitioner, meaning that they see many people with a large array of challenges. This is great, in that they have the ability to work on a broad range of issues for their clients and get to employ a variety of different interventions to improve the client’s situation. And for many clients, this is exactly what is needed. However, there are times when a client would benefit from seeing a specialist. Consider the scenario of a visit to the doctor’s office. Imagine you go and see your doctor for a rash you developed. They look at it, prescribe you something and then send you on your way. You apply the ointment as directed but the rash doesn’t go away and keeps growing. At this point, your doctor, who is very likely a general practitioner, may send you to the allergist or dermatologist because the issue warrants a depth of analysis, experience, and insight that a field specialist brings. Typically a specialist charges more than a generalist. But the client has a higher probability of achieving their desired outcome more quickly when working with the specialist and this often translates into savings in the client’s pocketbook. Referring a client out to a specialist is advisable when you’ve been working with them for 3-6 months and no progress is made or if new information during the initial stage of therapy was gained that warrants the need of a specialist.
Because I provide in-home therapy, usually I’m able to make good progress fairly quickly. However, sometimes there are cases where the patient makes limited to no progress. If this occurs after I’ve tried all the interventions I know to be effective, then that’s when I know it’s time to consider a referral. The patient likely needs something I’m unable to provide, and a different therapist or treatment center might be able to.
When To Refer A Patient To A Substance Abuse Rehab Center