Referral Systems for Sexual and Reproductive Healthcare Services
Providing clients with quality referrals to appropriate sexual and reproductive health services that align with their goals and values is one of the intended outcomes of reproductive life goals conversations. This page of the “No Wrong Door for Reproductive Life Goals Conversations” toolkit shares how to create a referral system and integrate it into current programs. It includes information on:
Building a referral network
The activities involved in making quality referrals
The STAR model for quality referrals
Things to consider when making referrals for specific populations
Provide a standard list of clinics to the client.
Provide a customized list of clinics to the client based on healthcare coverage, services needed, social/cultural needs, etc.
Make the appointment for, or with, the client at an appropriate clinic based on the client's healthcare coverage, services needed, social/cultural needs, etc.
Make a warm referral and follow up with the client and/or clinic afterward. This is called closing the loop.
Make a warm referral, close the loop, arrange transport, and address any other barriers that may prevent the client from attending the appointment.
Bookmark this interactive checklist to use while making referrals or use as a guide when creating a checklist specific to your organization’s referral process.
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 engaged
- 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
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 electronic or paper list of vetted referral partners that staff members can reference when making referrals. Aunt Bertha is a great online option that is free for some organizations. There are other paid 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 and doing follow-ups? 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.
It’s often difficult for adolescents to access reproductive healthcare services, including contraception. Adolescents might not know about Title X clinics, understand the confusing policies around confidentiality and paying for services, or have transportation to get to a clinic. If they are hoping to get birth control and don’t have permission from their parents, they may not legally be able to receive their first choice method. Some clinics are only open during school hours, adding another barrier, especially for adolescents who don’t have parental support. It can also be really intimidating 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.
Learn best practices for having RLG conversations with adolescents here in the toolkit.
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.
This could look like a client who wants to get pregnant starts tracking their period to figure out when they ovulate but doesn’t go for a prenatal visit yet. For a client who wants to prevent pregnancy and knows they would like to get an IUD in the future, you might provide them with free condoms and emergency contraception.
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.
Know which 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+ 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.
Learn best practices for having RLG conversations with members of this population here in the toolkit.
We also suggest taking a look at this resource: CUES: Addressing Domestic and Sexual Violence in Health Settings
The content on this page was written and reviewed in June 2023.