When to Refer Out — Clinical Decision Tree
Referral decisions are one of the hardest clinical calls in outpatient practice. This decision tree walks through all five referral categories with specific criteria for each, making the decision clearer and the conversation easier.
What is in this decision tree
The five referral questions — medical, psychiatric, level of care, specialist, and peer consultation. For each category: what to look for, what triggers the decision, and how to frame it.
Level of care criteria — the specific clinical indicators for IOP, PHP, residential, and inpatient, with a comparison table and the question to ask yourself for each level.
Specialist referral guide — presentations requiring specialized training (OCD, eating disorders, trauma, couples, sex therapy, pediatric, addictions) with the referral-versus-consultation distinction.
Consultation signals — specific indicators that warrant peer consultation or supervision, including countertransference signs that are often missed as clinical signals.
Referral language — how to raise each type of referral without it landing as rejection. Scripts for medical, psychiatric, level of care, and specialist conversations.
The follow-up protocol — how to track referrals as part of ongoing treatment rather than as a hand-off that ends your involvement.