In Regards to Referrals

 By Keith Morris

If I were to ask you whether your program does referrals, would you be able to answer that question without a qualifier?  “Yes, and we even do warm handoffs if we can.” “No, but we still give every client at least one phone number for another service.”  Do you see the problem here?   

Several years ago, in Michigan, we did a survey as part of the Model Approaches to Senior Legal Services where we asked legal providers and aging service providers about their policies and practices for referrals.  We immediately realized that not everyone uses the term “referral” the same way that we would.  

What the data found was that many programs, legal and nonlegal, had a policy to provide referrals.  Beyond that, it was all over the board.  About half the programs just provided contact information to the client, while in varying degrees, other programs did the warm transfer/handoff, tried to call the other organization and talk with them about the case to make sure they knew what the client was dealing with, and even some still faxed a referral.  But there was no common understanding of what a referral would or should consist of. 

In each of these referrals, there was a reliance on a database that the program itself maintained.  This database would reflect the other organizations and their services, contact information, and maybe some notes about the program.  The data in the program was updated once a year at best, and involved quite a bit of effort.  I even know of a few programs that still used a paper list as their source of information. 

Despite having this internal resource, many of the people who responded to our survey reported that they didn’t always give referrals when they normally would.  The results showed that there were four main reasons that they didn’t do these referrals: 

  1. They didn’t know what services were available to help their clients. 
  2. They didn’t know who was providing a particular service they wanted to refer the client to. 
  3. They didn’t know whether there was any capacity to take new clients in these programs. 
  4. They didn’t know what happened to previous referrals that they had done.  

Do you see the pattern here?  It is all about a lack of information.  Everyone in your organization that works with clients wants to give the client useful and correct information.  If that information isn’t there to begin with, it is highly unlikely that the referrals that are needed are being made. 

On a related note, think about what happens when you do make an incorrect referral by giving the client a phone number to contact.  The client will either be told “sorry, that’s not what we do,” or “sorry, our waiting list is closed,” or maybe even hear those awful tones when you dial a wrong number.  If you are a client that waited several days to get up the courage to call the hotline, and then got the advice on how to proceed, but was given a wrong number, how will you handle the situation? 

It seems that in the past few years, there has been a realization of the value of the referral.  Healthcare systems have invested millions of dollars to try and figure out a way to connect their patients with other services.  The Veteran’s Administration has an app to help veterans connect to appropriate services.  Several large companies have made commitments to help social service organizations become better connected with each other.  The Department of Justice’s Vision 21 report pointed out that the community referral network is essential.   

Many states have legal services programs that can refer to each other.  There is an effort in Florida to bring into the case management system information about community resources so that the advocate always has the most current information available.  Openreferral.org is trying to standardize the referral elements to make it easy to report changes, use information for intake, etc. 

As some of you know, we have been working on a referral system in Michigan.  The state has now integrated an almost identical functionality into their online benefits system.  What this process has done for me is expose me to the whole field of healthcare referrals.  Several services like Now Pow, Aunt Bertha, and HealthLeads USA are way ahead of what we are creating in the community services arena.  

So, where does your program fit into a referral system in your state?  Are you willing to make referrals and receive referrals with non-legal programs?  How are you planning to keep your information updated?  Is there a sharing of information opportunity? 

There are still quite a few ethics challenges to work through with some of the more advanced systems.  However, I was reminded that in most states, the ethics are behind the technology by a decade or so. Doesn’t solve the dilemmas, but it at least gives me perspective about why there is an ethical problem with providing limited information about a client, who gave consent for me to do so, to find her more services. 

We are CERA are going to be looking at referrals over the next few months.  We will be sure to post our information on our blog and in an upcoming newsletter.  Stay tuned for a discussion on placing a value on the referral, how much is empowerment versus removing barriers, and how to determine what type of referral policy your program should consider.