Last Reviewed

Establishing and Providing Effective Referrals for Clients: A Toolkit for Family Planning Providers

Toolkit/Guide
Linkages to Primary Care and Other Services

Welcome to the Toolkit

Many individuals describe publicly funded family planning centers as their “usual source of care.” In this regard, family planning service sites are often an entry point for other services needed by their clients, and visits may include provision of, or referral to, other preventive health services. Quality care for Title X clients sometimes includes providing referrals for medical and social needs beyond a site’s scope of services, ensuring access to the full range of services that clients may need.

Picture of provider sitting at table with client

The purpose of this toolkit is to support Title X grantees’ ability to provide effective referrals. It has also been designed to help with oversight of subrecipients in their network who provide referrals. This toolkit provides guidance on setting up systems for consistent provision of referrals. It includes sample policies and strategies, such as a memorandum of understanding, for providing high-quality supportive and effective referrals. The toolkit also contains resources for training subrecipients and service sites.

Providing appropriate referrals is a Title X program requirement, as described in Section 9, Project Services and Clients, of the Program Requirements for Title X Funded Family Planning Projects that states, “Projects must provide for comprehensive medical, informational, educational, social, and referral services related to family planning for clients who want such services.”

Title X grantees, subrecipients, and/or service sites are expected to develop and implement plans to coordinate with and refer clients to other providers of health care and social services, optimally with signed, written collaborative agreements.

  • Providers of other health care services not provided on-site (e.g., primary, prenatal care)
  • Health services projects supported by other federal programs
  • Chronic care management providers
  • Emergency care
  • HIV/AIDS care and treatment
  • Infertility specialists
  • Hospitals
  • Local health and welfare departments
  • Voluntary agencies (e.g., domestic violence, crisis intervention, Alcoholics Anonymous)
  • Child care agencies
  • Transportation providers
  • WIC programs

Title X grantees are expected to have a written policy that requires subrecipients and service sites to have policies for providing needed referrals.

Action Steps Supportive Resources

Develop written policies for providing needed referrals. Sample policy templates can be modified with agency or site-specific information.

9.4 Availability of Social Services Sample Policy Template

9.5 Availability and Use of Referrals Sample Policy Template

9.7 Provision of Family Planning and Related Services Sample Policy Template

Referrals should be provided when a clinician determines that a client has either medical or social service needs beyond the scope of the clinic’s services. Not all referrals, however, require the same level of support to the client.

Referral-making encompasses a spectrum of potential information-giving and supportive behaviors. These range from providing information on specific services to follow-up on service utilization and outcomes and continuous assessment and improvement of referralmaking quality. “Cold” and “warm” are often used to describe referral behaviors at two points along this spectrum.

A cold referral refers to providing information to the client about another agency or service. This means that it is the client’s responsibility to contact the agency or service (for instance, after giving the client a business card or name and phone number for a local resource).

A warm referral involves contacting another agency or service provider on the client’s behalf. This means calling and making an appointment for the client, providing support to overcome barriers to care, and following up to determine if the appointment is kept.

Agency policies should indicate the type of referral that is usually most appropriate for each service. Referral type may also depend on the client’s individual circumstances, so providers should use their best judgement.

A cold referral may be appropriate for services like:
  • Alcoholics Anonymous
  • Weight management treatment
  • Food stamps
  • WIC
A warm referral may be appropriate for services like:
  • Syphilis treatment
  • Evaluation of a palpable breast mass
  • HIV-positive test result
  • Prenatal care
A cold referral may be appropriate for clients who:
  • Have reliable internet/phone access, transportation, and housing
  • Can communicate in English (if services are limited to this)
  • Have access to social, financial, and other supports
A warm referral may be appropriate for clients who:
  • Lack reliable internet/phone access, transportation, and housing
  • May experience language barriers/ challenges
  • Lack access to social, financial, and other supports

Title X agencies should identify other health care and social service agencies serving the same target population, to explore whether having an informal or formal relationship may be mutually beneficial.

Action Steps Supportive Resources

Develop a list of local resources, including key contacts at each organization.

Local Resource List

Verify referral information (contact information, hours, location) on an annual basis to ensure that it is current.

Local Resource List

Initiate conversations with key specialists, hospitals, and community services around mutual expectations for referrals. Be prepared to discuss the value of partnering with a Title X agency.

Value Proposition Template

Determine the value-add of potential referral partnerships.

Primary Care Partnership Video

A memorandum of understanding (MOU) is a written document, generally not legally binding, that outlines a voluntary agreement between parties. It can facilitate inter-agency communication, coordination of services, and continuity of care for clients. A MOU does not need to include complicated legal conditions, exclusions, indemnifications, etc. It should support the work of the collaboration, not inhibit it.

Action Steps Supportive Resources

Meet with leadership and/or program managers to discuss referral needs and request collaboration.

Sample MOU Introductory Letters

Develop a written mutual referral MOU, if during the meeting this is determined to be appropriate.

Sample MOU Template

Mail a cover letter and draft MOU, requesting a response with signatures to indicate approval of the collaboration.

Sample MOU Introductory Letters

Providing high-quality referrals involves assessing individual clients’ circumstances, identifying potential barriers, and helping them to problem-solve and reduce all barriers, therein increasing their ability to access referral services. Without support, clients may receive referral information, but still not access services. Some of the many barriers Title X clients face in accessing services are related to: 

  • Finances
  • Language
  • Transportation
  • Lack of child care
  • Age-based consent issues
  • Legal and policy
  • Fear of a lack of privacy
  • Fear of judgement
  • Fear of scorn, intimidation, coercion, or threats
  • Fear of disclosing immigration status

Ensure staff have adequate training and support to help clients with ways to overcome these barriers so they can access the services they need.

Staff must be prepared to provide appropriate referrals and training, identify roles, and develop processes to ensure consistent implementation. 

Action Steps Supportive Resources

Ensure all clinic staff and administration understand the need for and skills related to providing effective referrals.

Providing Effective Referrals Training Guide

Provide frontline staff with an opportunity to practice skills such as:

  • Identify referral needs
  • Speak directly to the referral provider (as appropriate)
  • Provide a verbal and/or written handoff (with the person’s consent)
  • Manage difficult situations
  • Follow up with the client about the referral

Referral Quality Staff Observation Activity, Instructions, and Handouts

Designate staff roles to provide referrals, along with a process for communicating that referrals have been made.

Ensure that referrals and associated processes are well-documented. Close the communications loop for high-priority referrals by establishing clear expectations for client-centered communication while respecting client autonomy and confidentiality. Assess periodically how effective agency referrals are and adjust accordingly.

Action Steps Supportive Resources

Clearly document referrals. Use a standard protocol and consistent documentation for referrals in the medical record. The reason for referral, informed consent of the client, and any correspondence with the referral provider/ organization should be included.

Develop shared referral tools and processes for services that you regularly refer to (and those that regularly refer to you).

Referral Form Template

Close the loop. Determine preferred and acceptable methods of communication and set clear expectations with the client at the time of making the referral.

Track referrals. Use referral management software, EHR downloads, or manually keep a record to ensure effective management of referrals.

If a referral isn’t completed, talk to the client during the next visit to find out why, and document the response. Clients are not obligated to follow up with referral recommendations.

Periodically assess the effectiveness of referral services. Ask clients about their referral experience, and ask the partner agencies about their experience giving and receiving your client referrals.

Patient Experience Improvement Toolkit