Working together towards a common goal: How referrals can benefit clients and counselors

Abstract

Mental health professionals offer a great service; however, there are some instances in which a referral to a different counselor is required to most effectively assist the client. Referral services are a wonderful tool to utilize, as long as the appropriate measures are taken to protect both the client and current counselor. The primary goal in mental health counseling should be the mental well-being of the client, which may include admitting that the counselor does not have the needed skills and specialization to address issues that may come up during sessions. There are several considerations to keep in mind when referring a client to another provider, including specialization, scheduling, and ethical concerns. 

Team approach

The mental health care system is often comprised of several key players, each with their own brand of specialty they bring to the table. Some of these include social workers, psychologists, child and adolescent therapists, and counselors, each providing a key role in the mental health care of their clients. Team-based care, considered one of the best ways to ensure access and integration of services (Drake & Latimer, 2012), involves the bringing together of information garnered through interactions with each of the mental health care providers, and can be a bit daunting, but it is possible. However, there are certain ethical idiosyncrasies involved when working with a group of treatment providers, which must be addressed in order to prevent possible harm to both the client and provider.



Guidance for treatment team members can be found in the American Counseling Association’s (ACA) Code of Ethics, Standard D, which addresses the ethical considerations regarding the relationships between treatment team members. When working with a variety of specialties, it is imperative to abide by the rules set forth, in order to provide the best treatment, while still adhering to the confidentiality and ethical clauses to protect the client. One key in providing such services can be found within the informed consent that is provided to the client at the beginning of services, which states the limits of confidentiality and when a breach is required (ACA, 2005, Standard D.2.d.). However, it is imperative that all members of the treatment team are aware of the importance of maintaining confidentiality, as the actions of adhering to the legal and ethical obligations can been perceived as alienation and an inability to cooperate by other healthcare providers (Birky, Sharkin, Martin, & Scappaticci, 1998).

Collaboration case study

The case of a 31-year-old single mother of three children includes a variety of team members, including a child therapist, fellow counselor, a psychologist, and a social worker, who all play a key role in the mental health care of the family. The children rage in ages from three to nine, and some of their behavior has indicated a concern to the child therapist involved in the case. Since the therapist has met with the children a limited number of visits (three), there is not much to compare the recent actions with, other than the behavior exhibited during the previous sessions. 

        Comparing the behavior to that of “typical” adolescents would not be effective, or ethical, as the children are individuals. However, some of the behavior may indicate a need for further investigation regarding their home life, interactions with their mother, and their behavior in school. Two of the children are currently enrolled in school, and the mother has inquired via the assigned social worker, about day care for the youngest. A letter sent by the children’s therapist to the school counselor requesting any documentations regarding possible abuse or incidents experienced by the children may be useful. By collaborating with the school counselor, the treatment team is working to discover how to serve the clients, which is covered under the ACA Code of Ethics (ACA, 2005, Standard D.1.c.).  

Several of the treatment members have disclosed that the mother is often impaired, possibly by alcohol, and her actions were somewhat erratic. The offer of psychological assessments was extended to the mother; however, she has not followed through with the exams. The reluctance to complete the assessments provided by the psychologist is not uncommon, as an estimated 70% of all dropouts from mental health treatment occur after the first couple of visits. However, if the mother can agree to meet with a psychiatrist, her risk of dropout reduces dramatically (Olfson et al., 2009). The stigma of obtaining mental health treatment may play a role in the mother’s hesitation, which is detrimental to the wellbeing of herself as well as her children. The barrier imposed by the stigma can also diminish self-esteem and prevents the client from participation in treatment (Corrigan, 2004).  


Sharing of information within the treatment team is an exemption to the confidentiality clause and does not violate privileged communication guidelines. However, it is still wise to obtain written permission from clients prior to collaboration (Remley & Herlihy, 2010). In cases where there is a risk of possible abuse or neglect, the counselor has an obligation to notify the appropriate agencies and the confidentiality agreement is considered void (Remley & Herlihy, 2010). 

        When considering a referral, it is important to include the client in the decision, as in the aforementioned case study. Having the mother play an active role in her mental health treatment can lead to a higher rate of attrition and program adherence (Olfson et al., 2009). Having a working relationship with the treatment team and familiarity with the psychiatrist employed at the community mental health center would make the referral process smoother for the client and the treatment team involved. Sharing of relevant information would also assist the psychiatrist in an evaluation, however, it is important to provide case notes and documentation that is objective, as to not sway the possible diagnosis. 

Conclusion

Effective communication within and between treatment team members is essential to obtaining the best treatment possible for the client. Referrals to a professional who has received specialized training in a certain area of expertise may be necessary at times, and should be made with input from the client involved. A letter addressing such a request can be found in the Appendix. Guidelines for the appropriate ethical and legal steps to take during referrals are available for counselors and should be consulted when making such decisions.

**References available upon request