Referral Systems for Sexual and Reproductive Healthcare Services

Steps to Developing a Referral System and Integrating it into Current Programs

• Define Goals of the Referral System

  When determining the goals of the referral system, consider what resources are available to implement and maintain the system. Ideally, you would be able to build a referral network with formal agreements, collaborative relationships, and warm referrals. This can require a lot of resources. Consider what you can do to optimize the likelihood of a client receiving person-centered care in a timely manner.

  Your goals could include:

  • Number of referral partners
  • Client satisfaction with care
  • Percent of referrals with follow-ups and 
  • Other measurable outcomes
• Build Referral Network

  There are 2 parts to building a referral network.

  First, consider who your ideal partners are. Some things to look for in a partner include:

  • Cultural and language representation similar to your client population

  • Value alignment

  • Distance

  • Appointment availability

  • Types of coverage/payment accepted

  You might already have relationships with other organizations as part of your current programs - start with them!

  
  

  Next, consider what the partnership will look like. This might not be the same for each partnership depending on their engagement and ability to collaborate. Effective partnerships require consistent interaction and relationship building.

  Partnership activities could include:

  • Meeting with key people at the partner organization to develop a collaborative relationship

  • Creating a formal or informal contract laying out what the referral partnership involves

  • Assessing partners to ensure their care is trauma-informed

  • Cross-training with providers at the partner organization to ensure quality, unbiased, person-centered care for clients

  • Developing agreements around access to appointments for clients. For example, the partner clinic could save weekly appointments for clients from your organization

  • Building a shared referral and follow-up process with partners so referrals are easy for them to receive. If possible, you could consider using a shared electronic system for referrals

• Develop Referral Guide

  The purpose of a referral guide is to have an online, electronic, or paper list of vetted referral partners that staff members can reference when making referrals. Aunt Bertha/Find Help is a great online option that is free for some organizations. There are other paid online options available too, like Unite Us and Charity Tracker. If your organization uses the same online system as your referral partners, you may be able to streamline the referral and follow-up process.

  Your referral guide should include all of the information necessary to make a personalized referral. This includes basic information like phone number, hours, website, and services offered. It should also include information about each partner that could impact their ability to provide person-centered services such as cultural competency, intended population, trauma-informed practices and anything else that may help staff members determine if they are a good fit for their client.

  Evaluating organizations for their ability to provide person-centered care requires relationship building, highlighting the importance of building a strong referral network.
  

  Once the referral guide is created, it needs to be frequently updated and maintained. We recommend selecting a point person for this task so the information stays accurate.
  

• Document the Referral Process

  Developing a standardized process for making referrals helps make sure that clients are receiving quality referrals, and makes it easier to train new staff members.

  When creating or adapting an existing referral process, consider the steps involved in the process and who is responsible for each step. Is the same staff that makes the referrals also having RLG conversations? Try to get as detailed as possible.

  Take a look at the resources in the box below for sample processes and referral templates.
  

• Follow Up with Clients

  It’s important to follow up with clients and even referral partners to see if clients receive the care they were seeking. We recommend following up with clients 1-2 weeks after making the referral.

  If a client wasn’t able to receive care from a referral partner, it can lead to mistrust in your organization. Checking in and helping the client address any barriers that prevent them from getting care can build trust and ensure that your client gets the care they want and deserve.

  Also, following up and getting feedback from clients provides you with important information about your referral partners and allows for continuous quality improvement.
  

• Track Referrals and Outcomes

  Tracking referrals and their outcomes lets you monitor trends over time, improve your referral process, and fix other issues.

  Your data may show that many referrals are not leading to care because of client transportation issues, or the partner you frequently refer to for IUDs is consistently out of stock. This type of information can help you identify and address barriers, while also providing useful information for funders and grant applications.

  Come up with a process for tracking and reviewing data. Consider what information will be collected, how it will be collected and stored, and who is responsible for evaluating the data.
  

Making Referrals for Specific Populations

There are certain considerations to keep in mind when making referrals for clients from specific populations, especially historically marginalized populations. Continue reading to review these considerations and learn how to best make referrals for members of these populations.

Remember, every individual is unique and has multiple parts to their identity that impact their lived experience. When working with members of the following populations, keep these considerations in mind, but avoid making assumptions.

To learn about having RLG conversations with specific populations, including many of the those mentioned below, take a look at the e-learning module we developed here.

• Adolescents

  It’s often difficult for adolescents to access reproductive healthcare services, including contraception. Some challenges they face may include:

  • Lack of awareness of Title X clinics
  • Difficulty understanding the confusing policies around confidentiality and paying for services
  • Lack of transportation to get to a clinic
  • Not legally being able to receive their first choice method without permission from their parents or guardians
  • Inconvenient clinic hours - some clinics are only open during school hours, adding another barrier, especially for adolescents who don’t have parental support
  • Feeling intimidated to visit a clinic alone, and not all clinics prioritize making adolescents comfortable

  Given these challenges, having referral partners that can help address them is really important. We also recommend staying up to date on confidentiality laws in your state and educating adolescents on the types of birth control they can access over the counter, including some types of emergency contraception.
  

• People Experiencing Homelessness or Unstable Housing

  Because people who are experiencing homelessness or unstable housing often have more urgent needs than reproductive healthcare, partners that offer free and easy to access services may be their only option to receive care.

  Your client may feel that they have other needs that have to be met that may or may not be housing-related before they can think about getting reproductive healthcare services. Try to help them meet those needs, and discuss if there are ways to consider their reproductive life goals without immediately visiting a clinic. For example, a client who wants to get pregnant could begin tracking their period to figure out when they ovulate, or a client hoping to get an IUD in the future could be provided with condoms and emergency contraception to prevent pregnancy.
  

• People with Concerns Accessing Care Due to Immigration Status

  Accessing healthcare services can be scary for people who are undocumented because free or low-cost services are often funded by the government. It’s always valuable to develop trust with clients, but for this population, it can determine whether or not they receive care.

  Title X clinics should be safe for people with immigration concerns. Know which other partners provide a safe and supportive environment for people with immigration concerns. Work to find partners that have bilingual staff or offer translation services. 
  

• People with Substance Use Disorders

  The stigma associated with substance use disorders may prevent people from accessing care due to fear of judgment from healthcare providers, or previous traumatic experiences with the healthcare system. If you serve clients with substance use disorders, make sure that the clinics you refer to have experience providing unbiased, client centered, non-coercive care to this population.

• LGBTQIA2S+ Clients

  LGBTQIA2S+ stands for (L) lesbian, (G) gay, (B) bisexual, (Q) queer or questioning, (I) intersex, (A) asexual or aromantic, (2S) Two Spirit, and (+) plus refers to other sexualities or gender expressions not already included in the abbreviation. You may be unfamiliar with some of the terms used to describe trans, queer, and gender-diverse experiences. The Trans Language Primer is an excellent resource for understanding the current and evolving language around LGBTQIA2S+ experiences.

  While LGBTQIA2S+ clients may have medical needs that not every clinic can meet—such as gender transition-related care for transgender, Two Spirit, and other gender non-conforming clients — the foundation of providing for and referring LGBTQIA2S+ clients to other providers for high-quality care is treating them with basic dignity and affirming their gender and sexual identities.

  How this can look in practice:

  • Use referral forms that ask about a client’s pronouns, gender identity, and sexual identity. (“Gender identity” and “sex” or “sex assigned at birth” are different categories.) Include a wide range of choices for all three of these questions. Also include an option where someone can write in their own answer. Instead of labeling this blank section “Other,” use something like “Another pronoun/identity not listed here” which generally feels more affirming.

  • Ask your client if there is anything they would like for you to communicate to a clinic about their sexual orientation, gender identity, or pronouns.

  • Practice asking if a client is comfortable sharing their pronouns! This can be as simple as asking, “Would you be comfortable sharing your pronouns with me? If not, that’s totally okay!”

  • Pride flags and other décor or signs that communicate an affirming stance can help ease clients’ anxieties before a conversation even begins.

  • If you make an honest mistake, such as using the wrong pronouns, just offer a quick apology and move on! Mistakes happen and no one is perfect.

  Only about 40% of people who are transgender are ‘out’ to medical providers because they are afraid of, or have previously experienced, discrimination—and many people who are LGBTQIA2S+ have negative experiences seeking care. It is important to refer to clinics and providers that are affirming of LGBTQIA2S+ people as much as possible, even if specialized medical services such as transition-related care are not offered. Especially if you serve a high number of LGBTQIA2S+ clients, consider holding trainings for referral partners on how to provide client-centered, affirming care for these clients. Lastly, remember that treating a client with dignity and affirming who they are in simple ways can make a big impact on their ability to access care.
  

• Survivors of Trauma and Intimate Partner Violence

  For people who have experienced trauma or intimate partner violence, confidentiality, and warm referrals with trusted partners are extremely important. Ask about their preferences for communication and follow up, whether it’s by email, phone, mail, calling in, or another way.

  For clients currently experiencing relationship violence, confidentiality and preferred methods of communication are issues of safety. We encourage developing strong relationships with local advocates to assist clients that are interested.

  We also suggest taking a look at this resource: CUES: Addressing Domestic and Sexual Violence in Health Settings