Process improvement for behavioral health

Guide Referrers to Make Appropriate Referrals


Referrers do not refer clients that are suited to your treatment program.


Guide referrers, especially if they are not providers of addiction treatment services, to screen for substance abuse problems. Guide all referrers so they know how to refer clients to your program with minimal effort.

Featured Stories

Acadia Hospital in Bangor, Maine increased the show rate for referrals from the emergency department by 15 percent by creating an assessment tool that the emergency department now uses to determine if patients need addiction treatment. It also includes instructions about where clients should go at 7:30 a.m. on weekdays to begin treatment. After working with the emergency department, the substance abuse unit used the same approach with local physicians’ offices and other referral sources. They found that training the nurses to use the tool was more effective than training doctors. See the Acadia Direct Admissions Checklist for referrals to Acadia Hospital’s intensive outpatient substance abuse program.

Signal Behavioral Healthcare in Denver, Colorado calls for pre-authorization for outpatient treatment prior to the client’s discharge from the intensive outpatient program.

Lessons Learned

  • Create an assessment tool to help referrers identify the need for addiction treatment and explain what to do next.
  • Guide referrers to monitor funding and benefits to ensure that they refer to the next level of care before coverage ends.

Tracking Measures

Cycle Measure

Percentage of referred clients admitted

Data Collection Forms



  • 1. Select one referral source.
  • 2. Decide how to guide that referrer to make appropriate referrals.
  • 3. Collect baseline data for the percentage of referred clients who were admitted for two weeks.


  • 4. Train several people from the selected referrer to use the guidelines.
  • 5. Test use of these guidelines for the next two weeks.
  • 6. Track the percentage of referred clients who were admitted after using the guidelines.


  • 7. Check the fidelity of the change. Was the change implemented as planned?
  • 8. Evaluate the change:
    • What feedback did the referral source provide about the guidelines?
    • Did the number of referrals from the selected referrer increase?
    • Did the percentage of referred clients that were admitted increase?


  • 9. If this change was an improvement:
    • Adopt this change or adapt it for more improvement and re-test it with the same referral source.
    • Expand the use of this process to other referral sources.
    • Document the processes that resulted in an improvement so that you can continue to use them efficiently.
    • Test other, related promising practices that apply to your setting.

If this change was not an improvement and you can’t make it work, abandon this practice and test other promising practices that might be more successful in your setting.

Related Information

The CRAFFT Questions provide a brief screening test for adolescent substance abuse.