Section 2 Practice Dimensions

PD 3 Referral


The process of facilitating the client’s use of available support systems and community resources to meet needs identified in clinical evaluation or treatment  planning.

Competency 49

Establish and maintain relationships with civic groups, agencies, other professionals, governmental entities, and the community at large to ensure appropriate referrals, identify service gaps, expand community resources, and help address unmet needs.


  • The mission, function, resources, and quality of services offered by such entities as the following:
    • civic groups, community groups, and neighborhood organizations
    • health and allied healthcare systems (managed care)
    • employment and vocational rehabilitation services
    • cultural enhancement organizations
    • faith-based organizations
    • governmental entities
    • criminal justice systems
    • child welfare agencies
    • housing administrations
    • childcare facilities
    • crisis intervention programs
    • abused persons programs
    • mutual- and self-help groups
    • advocacy groups
    • other
  • Community demographics.
  • Community political and cultural systems.
  • Criteria for receiving community services, including fee and funding structures.
  • How to access community agencies and service providers.
  • State and Federal legislative mandates and regulations.
  • Confidentiality rules and regulations.
  • Service gaps and appropriate ways of advocating for new resources.
  • Effective communication styles.
  • Community resources for both affected children and other household members.


  • Networking and communicating.
  • Using existing community resource direc- tories including computer databases.
  • Advocating for the client.
  • Working with others as part of a team.


  • Respect for interdisciplinary service delivery.
  • Respect for both the client’s needs and agency services.
  • Respect for collaboration and cooperation.
  • Appreciation of strengths-based principles that emphasize client autonomy and skills development.


Competency 50

Continuously assess and evaluate referral resources to determine their appropriateness.


  • The needs of the client population being served.
  • How to access current information on the function, mission, and resources of community service providers.
  • How to access current information on referral criteria and accreditation status of community service providers.
  • How to access client satisfaction data about community service providers.


  • Establishing and nurturing collaborative relationships with key contacts in community service organizations.
  • Interpreting and using evaluation and client feedback data.
  • Giving feedback to community resources regarding their service delivery.


  • Respect for confidentiality rules and regulations.
  • Willingness to advocate on behalf of the client.

Competency 51

Differentiate between situations in which it is most appropriate for the client to self-refer to a resource and situations requiring counselor referral.


  • Client motivation and ability to initiate and follow through with referrals.
  • Factors in determining the optimal time to engage the client in the referral process.
  • Clinical assessment methods.
  • Empowerment techniques.
  • Crisis prevention and intervention methods.


  • Interpreting assessment and treatment planning materials to determine appropri- ateness of client or counselor referral.
  • Assessing the client’s readiness to partici- pate in the referral process.
  • Educating the client about appropriate referral processes.
  • Motivating the client to take responsibility for referral and followup.
  • Applying crisis prevention and interven- tion techniques.


  • Respect for the client’s ability to initiate and follow up with referral.
  • Willingness to share decisionmaking power with the client.
  • Respect for the goal of positive self- determination.
  • Recognition of the counselor’s responsibility to engage in client advocacy when needed.

Competency 52

Arrange referrals to other professionals, agencies, community programs, or appropriate resources to meet the client’s needs.


  • Comprehensive treatment planning.
  • Methods of assessing the client’s progress toward treatment goals.
  • How to tailor resources to the client’s treatment needs.
  • How to access key resource persons in the community service provider network.
  • Mission, function, and resources of appropriate community service providers.
  • Referral protocols of selected service providers.
  • Logistics necessary for client access and followthrough with referrals.
  • Applicable confidentiality rules and regulations and protocols.
  • Factors to consider when determining the appropriate time to engage a client in the referral process.


  • Using oral and written communication for successful referrals.
  • Using appropriate technology to access, collect, and forward necessary documentation.
  • Conforming to all applicable confidential- ity rules and regulations and protocols.
  • Documenting the referral process accurately.
  • Maintaining and nurturing relationships with key contacts in the community.
  • Implementing followup activities with the client.


  • Respect for the client and the client’s needs and privacy rights.
  • Respect for collaboration and cooperation.
  • Respect for interdisciplinary, comprehen- sive approaches to meet the client’s needs.

Uses of The Competencies

In New England, The Competencies serves as the foundation of the nationally recognized ATTC-New England (NE) Distance Education program. The Competencies has been an outstanding and essential tool used in the development and delivery of more than 220 online presentations during the past 8 years. Instructors use The Competencies in all ATTC-NE trainings. In addition, the ATTC- NE training staff has designed a Web-based course (Core Functions of Addiction Counseling) that focuses entirely on The Competencies. This training has been delivered at least 10 times to partici- pants from all sectors of the treatment field including counselors, physicians, correctional person- nel, judiciary staff, those in the educational field, and government personnel. The Competencies continues to be a guiding force in course development, and the Web-based training is provided to participants from New England and other regions.

The Competencies was used in the development of a B.S. program in chemical dependency and addiction studies at Rhode Island College. It has been used in designing curriculum and developing course content.


Competency 53

Explain in clear and specific language the necessity for and process of referral to increase the likelihood of client understanding and followthrough.


  • How treatment planning and referral relate to the goals of recovery.
  • How the client’s defenses, abilities, personal preferences, cultural influences, personal resources, presentation, and appearance affect referral and followthrough.
  • Comprehensive referral information and protocols.
  • Terminology and structure used in referral settings.


  • Using language and terms the client easily understands.
  • Interpreting the treatment plan and how referral relates to progress.
  • Engaging in effective communication about the referral process: negotiating, educating, personalizing risks and benefits, and contracting.


  • Awareness of personal biases toward referral resources.

Competency 54

Exchange relevant information with the agency or professional to whom the referral is being made in a manner consistent with confidentiality rules and regulations and generally accepted professional standards of care.


  • Mission, function, and resources of the referral agency or professional.
  • Protocols and documentation necessary to make the referral.
  • Pertinent local, State, and Federal confidentiality rules and regulations; applicable clients’ rights and responsibilities; client consent procedures; and other guiding principles for exchange of relevant information.
  • Ethical standards of practice related to this exchange of information.


  • Using oral and written communication for successful referrals.
  • Using appropriate technology to access, collect, and forward relevant information needed by the agency or professional.
  • Obtaining informed client consent and documentation needed for the exchange of relevant information.
  • Reporting relevant information accurately and objectively.


  • Commitment to professionalism.
  • Respect for the importance of confidential- ity rules and regulations and professional standards.
  • Appreciation for the need to exchange relevant information with other professionals.

Competency 55

Evaluate the outcome of the referral.


  • Methods of assessing the client’s progress toward treatment goals.
  • Appropriate sources and techniques for evaluating referral outcomes.


  • Using appropriate measurement processes and instruments.
  • Collecting objective and subjective data on the referral process.


  • Appreciation for the value of the evaluation process.
  • Appreciation for the value of interagency collaboration.
  • Appreciation for the value of interdisciplinary referral.

Uses of The Competencies

In January 2001, a counselor performance assessment system was published by the Northwest Frontier (NF) ATTC based on The Competencies. Developed by a noted educational psychologist, the publication identifies a series of benchmarks that indicate a counselor’s progress toward mastery of each competency for the developing, proficient, and exemplary clinician. Work is underway to add competencies for the entry-level counselor.

Another NFATTC publication based on The Competencies is called Proficiency Levels for Graduates of Academic Degree Programs. The document establishes proficiency targets for each knowledge, skill, and attitude included in The Competencies at the associate’s, bachelor’s, and master’s levels.

In addition, NFATTC developed a 21-hour Clinical Supervision I course and a 14-hour Clinical Supervision II course based on The Competencies. The courses orient supervisors to The Competencies, introduce methods for assessing proficiency, and teach specific strategies for enhancing counselor knowledge, skills, and attitudes. Recent projects in treatment agencies in Idaho, Oregon, and Washington have looked at infusing The Competencies into the agencies’ clinical supervision practices. The Competencies is used by each agency to develop specific learn- ing plans for counselors. Idaho endorsed the NFATTC Clinical Supervision model and requires each treatment agency in the State system to use that model.


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