«Sections 1-8 offer an overview of some of the main issues. Section 9 explores in greater details some of the practical challenges to establishing and ...»
Signposting, Referral and Referral Networks -
This document is not a definitive briefing on signposting and referral networks. It is
rather a discussion document for further exploration of some of the issues involved, and
aims to help provide a framework in which to develop practice around referral networks.
Sections 1-8 offer an overview of some of the main issues.
Section 9 explores in greater details some of the practical challenges to establishing
and running a successful referral network Sections
1. Access to advice and the role of referral networks
2. Signposting and referral defined
3. What is a referral network?
4. What makes an effective referral network?
5. Organisational challenges and barriers to referral
6. Overcoming organisational barriers
7. Electronic referral systems
8. Case study: Advice Services Coventry
9. Key questions to consider and possible answers
1. Access to advice and the role of referral networks The vision of a “seamless service” of advice provision was a founding principle of the Access to Justice Act, 1999, which gave rise to the Community Legal Service (CLS): anyone seeking advice on a social welfare1 law problem should be able to gain access to the entire spectrum of advice services. A referral network formalises this vision at a local level.
In practice, definitions of service levels such as “general help” or “specialist help” may mean little to people needing advice and clients will often approach a service – whether an advice 1 welfare benefits, debt, housing, employment, immigration and asylum, education, community care 1 agency or a community-focused organisation – with which they are already familiar. Research shows that acute access problems are experienced by certain “hard to reach” groups. There is convincing evidence, for example, that young people2 don’t make clear distinctions between what may be deemed legal problems and other types of personal or social problems and may prefer to seek advice from organisations which cater specifically for their needs rather than from traditional advice services. For this reason, a referral network should aim either to include a wide range of community-based and “problem-noticing” organisations (such as GPs or social workers) or at least to incorporate a procedure by which these types of organisations can make direct referrals to advice services.
A referral network serves several purposes, both for the client and the member oganisations, as outlined in this discussion document. Not least of these is that, in creating a genuinely seamless service, it may be the best defence against inappropriate top-down solutions being imposed on services.
2. Signposting and Referral defined Signposting and referral are crucial to an effective network, ensuring that the client gets the fullest and best possible service towards a resolution of their enquiry. But, in practice, there is some confusion between the two activities, and it’s important for organisations to be clear about the differences.
Signposting is about the client taking (or being given) responsibility for contacting other organisations to help them resolve their problem.
Organisations providing telephone helplines may undertake a lot of signposting. An information worker or receptionist who deals with initial queries from clients may also signpost extensively. Advisers undertake signposting and discuss alternative sources of help with clients when they have identified that the organisation cannot assist any further.
This may take place before an organisation has started in-depth work with a client. In many organisations, though, advisers will see a particular client many times and on some occasions will signpost them.
Referral is about the adviser taking at least partial responsibility for contacting other organisations when, for whatever reason, they are no longer able to assist the client. A referral usually involves the adviser making contact with the organisation to arrange an appointment and make any other necessary arrangements to ensure that the case continues smoothly.
This may take place after the adviser has begun the case and seen the client for the second or third time about the same issue. Sometimes, however, it will be necessary to do a referral on the first visit, eg if the client is vulnerable.
The problem falls outside the adviser’s (and organisation’s) subject area/level of expertise • The client falls outside the organisation’s target group – e.g. BME groups, those with • specific access needs, older people, homelessness etc There is a breakdown of trust between the client and adviser • There is a conflict of interest • Capacity issues generally •
3. What is a referral network?
A referral network is a group of organisations that has focused on how clients can be referred both within and outside the network, often thinking about relationships between frontline advisers or structures for ensuring that referrals take place effectively. Referral networks are established to enable advice organisations to concentrate on their own areas of expertise and refer to another agency where necessary, thereby maximising the combined capacity of the network.
4. What makes an effective referral network?
In order for a referral network to exist, a number of underlying conditions need to be in
Trust: A prerequisite for the successful operation of a referral network is trust between the member organisations, in terms of the quality of service they provide, their ability and willingness to accept and deal with referred clients in a timely fashion and to provide feedback to the referring agency on the progress in the case. A shared quality assurance system may help ensure that all services in a referral network are providing services to a minimum level of quality.
Clarity on services provided: Crucial to the effectiveness of a referral network is absolute clarity amongst members of the services each other provide and to what level. Without this, there is a risk of inappropriate referrals, poor service for clients and a potential breakdown in trust between network members.
Management and coordination: To ensure that a referral network functions effectively and efficiently, it is essential that the operation of the network is carefully managed and coordinated and its policies and procedures are reviewed regularly. Referral works best where there is an agreed protocol between referral network members and some means of servicing the network (such as the paid time of an employee of a participating organisation). It is crucial that problems or difficulties in the operation of the network are identified and resolved at the earliest possible opportunity. Failure to do so can have serious consequences for trust between member agencies. The use of standardised referral forms or an online electronic 3 booking system is common practice to ensure that the necessary information is shared between the agencies making and receiving the referral (see Electronic referral systems).
Acknowledgement of extent of competency: If appropriate referrals are to be made, it is important that organisations are clear when they have reached the upper limits of their level of competence and refer clients to an organisation with the appropriate competency to deal with the case – for example referring a client to a specialist agency/solicitor. This is also relevant to making referrals external to the network where the appropriate expertise does not exist within the network.
Systems for handling inward referrals from external organisations and problem noticers: As well as having clear systems on how referrals are made between referral network members, it is important that clear systems are in place to deal with referrals from external organisations and problem noticers, such as social workers, schools, health workers.
Clear information on these types of services and levels of expertise of the different organisations is essential if appropriate referrals are to be made.
Capacity: It is important to recognise that the success of any referral network is predicated on the capacity within the network as a whole to deal with the client that presents seeking advice. Insufficient capacity cannot be overcome though referral networks, but a network can be a mechanism for collecting data on unmet need, thereby making a persuasive case to funders for additional advice services.
5. Organisational challenges and barriers to referral The operation of a good referral system is part of a comprehensive and good quality service.
Unfortunately, when a referral needs to be made there may be barriers for an organisation to getting the client access to an appropriate advice service.
Lack of clarity about the remit of the service provided Advice organisations may feel under pressure to take on more clients or continue with cases that go beyond their service specification and therefore their expertise. A challenge for small under-resourced organisations is to ensure that all staff are trained sufficiently to provide accurate information.
The client may not want to be referred Organisations providing a service to deal with a specific target group, eg women, disabled people, a particular ethnic minority etc, may come under particular pressure from clients who approach them repeatedly. This is because they may have built up trust and confidence in the organisation’s ability to meet their needs.
Culture and language A specific difficulty for many small community organisations when making referrals is the language barrier. Black and minority ethnic and refugee organisations, whose clients may speak little or no English, may need an interpreter to ensure the success of a referral.
4 Staff or management committee resistance Staff or management committee members may see referral as a failure. Clarity about when referrals must be made and the reasons for doing so in a particular case can help in convincing reluctant staff and trustees.
Finding a suitable referral agency with capacity In the current climate of scarce funding and competition between advice organisations, this can be seen to be one of the biggest barriers to making successful and timely referrals. There can also be concerns about an organisation that should be able to handle the referral, but where the adviser and/or client has had negative experiences of that organisation’s work.
6. Overcoming organisational barriers There are a number of actions that an organisation can take to try and overcome some of the barriers to referral mentioned above.
Good diagnostic skills: It is good practice to have a person with good diagnostic skills on the reception desk of your organisation, or to ensure that all the advisers dealing with clients are able to quickly work out what the client needs and whether the organisation can provide it. It is better to signpost a client to the best service for them as quickly as possible.
Good training in advice skills: All workers need to have the skills to diagnose a problem and provide options to the client. The ability to do this consistently will minimise time wasted for a client who may need a different service.
Supervision and back-up support during advice sessions: This can ensure a quicker turnover of clients and the necessary support for an adviser when a client needs to be referred on.
Provide the fullest service possible before signposting or referring on: It is important for organisations to check that they have done everything they can to make referrals successful. This includes checking that the adviser has followed the organisation’s procedure correctly and that the client was supported effectively and had all the information they needed.
Clear referral procedure: If the client needs to be referred on, the process needs to be clear and consistent. Ideally it should be a written procedure that all advisers use consistently.
What if the client is unwilling to be referred? Advisers may need to discuss other options, including how much continued support it is possible for them to give the client. The boundaries of any ongoing support must be agreed so that the client’s expectations of the service are not raised beyond the remit or expertise of the adviser or the organisation.
Providing a supported referral service: Clients may need support to enable them to access the service they are referred to. There may be scope for working with referral organisations to support the client. Such support could include accompanying the client to the 5 initial interview with the new agency, helping the client to get there physically (eg finding the place and help with travel) and providing an interpreter.
Building up-to-date knowledge of suitable providers: It’s important to make contact with and find out about other local services, and to regularly update lists for signposting and referral.
Build relationships with other providers: Participation in an advice forum, or becoming part of a network of providers can help increase an organisation’s awareness of other local advice providers and identify complementary services. Forums provide the opportunity for relationships between advice services to be formed and sustained, as well as for identifying gaps in local provision.
7. Electronic referral systems
It is good practice, and a requirement of the CLS Quality Mark, to keep a central record of referrals. This allows for tracking the progress of and monitoring of referrals, including demand for service, effectiveness of referrals and where it has been impossible to identify a referral organisation. This information can then be fed into any review of the advice service.
The central record can be paper based, for example placing referral forms in a file, or electronic, for example recording information from referral forms in spreadsheets.