Referral Sources Guidelines
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 At the outset, we want to point out that Guidelines for Marketing and Promotion on the one hand and Guidelines for Referral Sources on the other are really two sides of the same coin.  The first four paragraphs of both articles are almost identical for that reason.  To complete your understanding of our Guidelines for Referral, it is important that you also consider our Guidelines for Marketing and Promotion and our Guidelines on Conflict of Interest.

In initially preparing those two Guidelines Articles, we found ourselves constantly writing on one topic while writing in the opposite article.  We have sorted that out to some degree, but the issues are not entirely separable.  So we urge the reader of this article to read the article on Guidelines for Marketing and Promotion as well in order to get a full view if the topic.

Marketing corruption and referral corruption stand and fall together.  Corrupt marketing practices are of limited impact when professional referral sources are not corruptible.  We believe that there are both marketing and professional referral sources that act only in the client’s interest and do so as objectively as possible.  We also believe that there are people of good will in both marketing and referral who intend to have very clean, operations who participate in activity that we believe clouds judgment in the long run.  We hope to promote a re-examination of some of those practices. 

Although two sides of the same coin, marketing and referral that is truly in the client interest differ on one essential point:  Marketing by its nature promotes a particular school or program or group of schools or programs; Professional referral sources appropriately have no interest in any particular school or treatment center and are only interested in meeting the needs of their clients.  Marketing disguised as objective professional referral is, in our opinion, corrupt by nature, even if not illegal. 

Referral sources need to understand what we call the systems of recovery, be knowledgeable about the facilities to which they refer, knowledgeable about the people they are referring, and as free from conflict of interest as possible.  This includes Educational Consultants such as our consultant and educational consulting firms such as FamilyLightsm.  When conflict of interest is unavoidable it needs to be fully disclosed. 

"Understand . . . the systems of recovery" refers to the fact that the value of residential treatment or a special school is that it can help prepare a person for the growth and recovery process that must take place when they leave the structured and protected environment of the residential environment.  (More about this in our Guidelines on Case Management, Transition Services, and Guidelines on Family Participation

We want to emphasize our discomfort with "school search" model of consulting where special needs children are involved.  No specialized school or program stands alone in healing or "fixing" a child or young adult with special problems. The thought of sending a young person away to a school or program expecting that person to come back "fixed" is totally wrong.  We believe that appropriate referral sources, including educational consultants, have a responsibility to get that message across forcefully if necessary.  We believe the task of a person referring for behavioral change or therapeutic reasons is to look at the long term potential outcome, look at the best way to reach that outcome, and help devise a plan that in many cases will include residential resources. 

We would not object to a "school search" model in a case in which another competent person is looking at the big picture and case managing the efforts competently.  In that limited situation, an educational consultant stepping in for the very limited purpose of  a "school search" makes sense, but that rarely occurs.  The "school search" model is a vestige of educational placements, school and college, for high functioning young people who are not facing handicaps of any kind.  Unfortunately, many educational consultants who began their careers working only with high functioning young people are currently selling "school searches" without understanding what is different when behavioral and psychological handicaps enter the picture.  We believe that this kind of approach by too many demeans our profession. 

Before there were many educational consultants working with "special needs" (educational consultants' term for people with behavioral, emotional, and psychiatric issues) populations, the paradigm for the work of educational consultants was doing school searches, which means the job is done when a the young person enrolls in a school, or perhaps when a list of school names is given to the parents.  This paradigm is not, in our opinion, effective with special needs populations.  A student going to college or a conventional boarding school does not need to be thinking in terms of a larger system a that time, and therefore the "school search" paradigm works for those consultants.  We do not believe that paradigm carries over to special needs clients.  In saying that, we believe that many well regarded educational consultants will disagree with us.

However in the case of special needs, the first thing an effective referring professional needs to think about with a client with emotional, behavioral, or psychiatric issues, is "What does this person need in order to be healthy (or to function at best efficiency with a handicap)?"  An effective referring professional must think about the total system, not just what the school or program might solve the problem by itself. The total system may include, among other things, the methods and personalities that will be necessary to get the job done, including some anticipation of what needs to happen when the young person leaves the structure and protection of residential service, and  what the family needs to be doing while their son is in residential if the hoped-for results are to be achieved. 

We don't object to some referring professionals transparently offering a more limited role than taking on the task of being a case manager, and limiting to helping with facility selection, so long as they address the fact that there is a task that is necessary to positive results that includes consideration of the larger systems issues and that facility selection needs to be in the context of thinking about the larger system.

In particular, any effective referring professional will nullify marketing efforts by schools and programs that suggest that they can "fix" a young person during a residential stay in that facility, without considering the system beyond that facility.

“Knowledgeable about the facilities to which they are referring,” suggests that the referring professional should not just be thoroughly familiar with the schools and programs to which they will refer, but also knowledgeable about the field of competition and able to speak comparatively to other schools and programs that might be considered.  It is our experience that clinicians who refer to specific facilities generally have some knowledge of the school or program to which they refer but usually do not know the alternatives to that school or program.   When your son or daughter’s psychiatrist or therapist suggests  a specific school or program, the first question to ask it what other schools or programs suggest themselves that would be second and third choice. If they are not familiar enough with the context of the school or program suggested, compared to other offerings, they are not knowledgeable enough to help.  That is, if they recommend school A, they should know why it is a better choice than school B and school C that serve similar populations.

Our experience is that most clinicians, in fact almost anyone whose primary occupation is not dominated by referral and does not provide for extensive travel to visit and assess schools and programs simply cannot competently make these referrals.

The second question to ask is what is it about the that school or program that makes it more appropriate for your son or daughter than would be true for some other young people  -- and for your son or daughter, better than some other programs.  They should be able to answer that question both ways.  If they can’t answer they probably don’t know enough about schools and programs to be suggesting the referral.

“Knowledgeable about the people they are referring” suggests that the referring person should have in-depth knowledge of the person referred.  This means knowing the person to be referred personally, something that cannot be accomplished without meeting face to face. (There are very rare instances in which an in-person meeting would likely trigger a suicide attempt or a dangerous runaway, but these are truly rare)  In addition, a psychological evaluation based upon formal testing,  a very detailed history, and all existing educational and therapeutic records, are all part of diligent effort to get to know the person to be referred.   We at FamilyLightsm will not accept a client relationship where we do not have the opportunity to meet the young person who is the object of concern.   Rarely does the young person turn out to be just as pictured from the written records.  We have had too many instances in which a decision based upon records alone or records plus parent and clinician description would have been a wrong decision. 

“Knowledgeable about the people they are referring” also means knowing the person at the time of the enrollment. We don’t mean that the referring person and the person referred must meet in person at that particular moment.  We are addressing the practice of some educational consultants (actually some of the very highest fee consultants) and other referring professionals referring a young person to a short term program, perhaps a wilderness program then at that time designating the program or school that young person should attend after the short term program.  There is no possible way to do that competently. We believe IECA is remiss in not prohibiting this practice among its member consultants in its Principles of Good Practice. The appropriate venue for a client of a consultant or other referring professional following a short term program can only be determined after considering the manner in which the client adjusts to the short term program and hearing the assessment of the young person’s needs by the short term program.  Any referring professional crossing this line is operating very substantially outside our guidelines, and we believe is demonstrating a level of contempt for a clients best interest that we believe is an embarrassment to the entire profession of consulting. 

“As free of conflict of interest as possible” means that at the very least any relationships between the referring professional and the facility to which a referral might be made need to  be fully disclosed to the person being referred, to the parents of that person when that person is a minor,  and to those who would finance the referral, and other professional advisors to those people. 

Freedom from concealed conflict of interest is a complex topic that also applies to Guidelines for Marketing and Promotion, so we have created a separate article on Guidelines on Conflict of Interest.  For further insight into that topic, please read both of those pages, as some information related to referral guidelines is found in both of those links.    

Feedback is invited. We will publish selected feedback. 
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Disclaimer: No  program review, no matter how positive, is a blanket endorsement. No criticism is a blanket condemnation.  When we express our level of confidence in a school or program, that is our subjective opinion with which others might reasonably disagree.  When we assert something as fact, we have done our best to be accurate, but we cannot guarantee that all of our information is accurate and up to date. When we address compliance with our guidelines, you need to remember that these are only OUR guidelines -- not guidelines from an official source.  We have also set the bar very high, and do not expect any school or program to be in total compliance.  It is not appropriate to draw a conclusion of impropriety (or even failure to live up to conventional wisdom) from our lack of confidence in a school or program or from less than perfect conformity to our guidelines.  Some will say we expect too much. Readers are responsible for verifying accuracy of information supplied here prior to acting upon it. We are not responsible for inaccuracies.

Last updated 2-15-09

 
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