Continuity of Care
Level of Care, Referral, and Continuity
Determining what level of care a client needs, routing them there, and making the handoff actually hold.
What sets the level of care
Level of care follows acuity, risk, functional impairment, medical need, and the supports available around the client. It does not follow symptom severity alone, and it does not follow whether treatment has worked so far.
A client who has not improved after two months of counseling but is engaged, safe, and functioning does not need a higher level of care. She may need a psychiatric evaluation, a revised formulation, or a different intervention. Escalating level of care is the wrong response to a stalled treatment.
The method: ASSESS, PRIORITIZE, DETERMINE, REFER, HANDOFF, FOLLOW UP
ASSESS acuity, risk, function, medical status, and support.
PRIORITIZE. When several needs compete, medical safety generally sets the floor for what is possible.
DETERMINE the least restrictive level of care that can safely meet the need.
REFER, with the client's participation rather than as a disposition applied to them.
HANDOFF. With authorization, transfer your assessment and your read of the client. Information is most useful before the receiving appointment, not after.
FOLLOW UP. A referral is complete when the client has engaged with it, not when it was made.
Medical questions come first
Some findings must be evaluated medically before any counseling plan proceeds. Morning tremor relieved by alcohol indicates physiological dependence, and unsupervised cessation carries real risk, so withdrawal assessment precedes any reduction plan.
Rapid weight loss with restriction and excessive exercise can produce cardiac and electrolyte consequences that determine what level of care is even safe. In both cases, the counselor's job is to recognize the finding and route it, not to manage it.
Common mistakes
Escalating level of care because treatment has stalled rather than because acuity changed.
Treating a name and phone number as a referral.
Discharging at the moment of transition, which is when clients are most likely to fall out of care entirely.
Contacting family without authorization where no emergency exception applies.
Issuing an ultimatum to a reluctant client, which usually ends contact with the one provider they had agreed to see.
Assuming care has transferred the moment a referral is made.
Practice this skill
Apply what you read with a hands-on Route the Client drill, instant feedback on every scenario.
