Referrals to other health professionals or services are sometimes required to provide specialised support or address more complex issues beyond the capabilities of health professionals within multidisciplinary team. A combination of activities, rather than any single intervention by itself, is also likely to be the approach required.64 Referral may be indicated to meet a need for specialist intervention or to help manage specifically identified risk factors or needs such as:22
- People socially or financially at risk
- People from culturally and linguistically diverse backgrounds
- People from Aboriginal and Torres Strait Islander backgrounds
- People experiencing:
- Perceptions of hopelessness
- Persistent physical symptoms
- Pre-morbid mental health issues.
Referral should be evidence-based and contextualised to the individual’s needs and situation. Protocols and / or guidelines may assist clinicians make evidence-based referrals.20, 26, 65, 66 Structured referral sheets are useful checklists that can be completed at the time of screening or assessment. The referral checklist can include prompts regarding the criteria for referral and include suggestions for referral linked to these criteria. The Psychosocial Care Referral Checklist67 is an example of a tool to identify factors contributing to the distress experienced by the individual and to document a referral plan. Further examples of referral resources are available on the Supportive Cancer Care Victoria website.68
It has been recommended that services establish referral networks and develop contact lists of local services and resources in line with evidence-based principles to support referrals. Referral opportunities may also be dependent on regional and site specific constraints, training of staff and availability of resources.58
General Practitioners (GPs) are in a key position to make referrals to supports in the community and to facilitate access to services covered by Medicare through the GP mental health care plan or chronic and complex care plan. For further information, access:
Specific considerations / strategies to facilitate the process of effective referral include:20, 69
- the patient must consent to the referral. They must have a choice if they want to be referred and where they would like to be referred (within the boundaries of service availability)
- prioritise referrals – some patients may be experiencing worry and fears which are exacerbated by other concerns.
- consider risk factors when referring – e.g. If the patient is experiencing financial problems, you may consider referral to a private psychologist inappropriate due to associated costs.
- introduce the concept of the multidisciplinary approach to care as an accepted standard
- normalise the need for referral to other disciplines
- provide individually tailored information about the benefits of referral
- coordinate appointments if able
- consider the timing of the referral and suggest referral at another appropriate time if not accepted initially.
Watch Scenario 3: Making referrals and complete the following.
Identify the communication strategies the clinician used.
Identify two referrals you would suggest for Jane? How are these referrals supported by the evidence?
Identify factors you need to consider in making appropriate referrals for Jane?
- Identify key recommendations to promote effective supportive care screening and referral.
- Discuss how these research findings may inform processes in your practice setting.