THE REFERRAL NETWORK

"The best magic words are those which come to one when one is alone out among the mountains. These are always the most powerful in their effects. The power of solitude is great and beyond understanding." Michael Harper

GOALS: 13.1: To develop ethical guidelines;

13.2: To know personal limitations;

13.3: To know how the referral network functions;

13.4: To know when to refer.

COMMENT: Ask the participants if they have any questions from the module on Problem Solving. Allow only 5 minutes for questions and if you need more time ask the participants to save their questions until the end of the module.

ACTIVITY 13.1: Presentation

TIME: 20 Minutes

TITLE: Being an Effective Referral Agent

As a peer support giver you owe it to yourself and to those you work with to develop ethical guidelines. Ethical considerations not only serve to protect you from making mistakes, but also act as a basis for structuring the interaction with others. In other words, ethical guidelines protect you and protect others. In some ways ethical guidelines are like a map, guiding you, directing you and keeping you from getting lost or overwhelmed. There are many approaches you can take as a helper, but the guidelines keep you heading in the most profitable direction. An important part of the guidelines is the referral network. This network is one of the most useful tools the effective helper can use.

Ethical Issues

Most of the professional counselling associations (AACD) suggests that the helper's main responsibility is to the person, although it is important to realize that as a peer support giver you are also responsible to yourself. Thus, you should be thinking of the following questions, which exemplify the ethical guidelines:

First, let us consider the question of whose best interests you are serving. What this means is that you put your own feelings aside on an issue when dealing with others' problems. This is sometimes difficult to do when a person’s values conflict with your own. There are no easy answers to some questions, but when in doubt talk it over with a friend. Unethical behaviour can occur when the help you offer is in your personal interests, or you try to obtain the admiration of others, or your help results in dependent behaviour.

The second question is, "What is your role as a peer support giver?" Are you serving the interest of the organization or the person? When you are asked by someone not to tell something, yet it seems that this information is important to one of the counsellors at the agency, what do you do? In some ways it is a judgment call. It is important to remember that sometimes people may tell you something in confidence, yet in some circumstances others may need to be brought into the issue. These individuals may be school counsellors, band elders, counsellors, social workers, teachers, family members, or nurses. On the other hand, some feelings and thoughts need not be shared with others. What you have to ask yourself is, "What is best for the person?" In a sense, this is being respectful. To respect another person means to treat that other person as you would like to be treated. As the commercial jingle goes, "Everybody is a somebody."

Confidentiality has always been fundamental for helpers as one of the most important ways of winning trust. All people seem to share this sense. The worst characteristic is to be thought of as gossipy. Essentially, trustworthiness is your most important characteristic after your sense of caring for others. Knowing your limitations is a very vital aspect of the peer support program. As a volunteer peer support giver you are trained in a support category--that is, when a problem is beyond your skill, you should seek professional advice. You can do this either by consulting with a professional counsellor, social worker, or nurse about a person's problem, or by referring that person to a professional. You should remember that all professional helpers consult with others when a problem is beyond their skill. Another important reason for referring is in certain situations you may find yourself feeling "in over your head". By referring the individual you are not only protecting that individual but also yourself. An effective helper, professional or nonprofessional, knows when to say no to an overwhelming burden. Therefore, you owe it to yourself to consult or refer a person when it is appropriate.

When to Refer

The referral process is an important aspect of the peer

support concept. Thus, knowing when to refer is vital. There are several conditions which may prompt you to refer the person. These are when:

When you refer the person to someone else, it is best to inform the person. The best way to do this is to own up to the seriousness of the problem. For example, you could say, "This is really beyond my training. I think you ought to see a professional about this." At this point you need to be concrete and suggest whom the person might see. For example, you could say, "I have found Rod McCormick, our counsellor at the Learning Centre, to be a very helpful person. Could I take you to see him?" Once you refer someone, you should continue to be supportive of that person. For example, you could visit the person and ask, "How did your talk go with Rod?"

Steps to Referring

I have been told by one counsellor of First Nations people that "no problem is too small to someone who is troubled." What this means is that a problem to one person may be a trivial to another. Therefore, when you feel there is a problem requiring a professional, take the time to see the professional. When you do this, you should be concrete and specific about the problem. Do not be vague or present the problem in a "roundabout way." Start by stating what bothers you or what you need from the professional. This is best done by using "I" statements. For example, "I have a little problem I would like to discuss with you. I have been working with Mrs. Jones and I am not sure what to do about it . . . ."

Knowing which professional to consult depends on the problem. Obviously all health matters should be taken to health professionals. Problems involving emotional well-being should be taken to a counsellor, social worker, etc. Problems concerning practical aspects, like finances or housing, should be taken to an acquaintance, the family, or a homemaker service. Referring someone is considered a natural and responsible action for a peer support giver.

Remember:

You are most effective when you:

1. when a problem is beyond your skill level;

2. if the helping process is not going anywhere;

3. when you are not sure what to do next;

4. when the helping process is too stressful.

COMMENT: After the lecture, ask the participants if they have any questions. Be sure not to spend too much time on answering questions, because the modeling and practice enable the participants to learn the most.

ACTIVITY 13. 2: "Renewal Valley"

TIME: 10 Minutes

DIRECTIONS: The purpose of this activity is to provide the participants with a sense of encouragement. Ask for one or two volunteers who have had a stressful day and would like to go through the "renewal valley." Each of these "visitors" will go one at a time. Ask everyone, except the "visitor," to line up in two parallel lines facing each other. The middle of the two lines is the "Renewal Valley." As the "visitor" goes through the "valley," the others pat the person on the back and say some words of encouragement. Remind the participants to make their encouraging statements personal and enthusiastic.

ACTIVITY 13. 3: Helping Circle

TIME: 60 Minutes

DIRECTIONS: Everyone should be sitting in a circle during this activity. Start by explaining that you will ask a volunteer to role play someone with a problem that needs to be referred (e.g. alcohol or suicide). The purpose of the activity is to provide the group with ideas on how and when they should refer someone who might be reluctant to see a professional helper. Some of the reasons for the referral can be:

l. the problem is serious or complex;

2. the helping process seems to be going nowhere and you are just not sure what to do next;

3. personal feelings begin to interfere with the helping process;

4. the stress of helping begins to affect your well being (physically, emotionally, socially or spiritually).

During the interaction any of the helping skills can be utilized. But remember the one important ingredient is that you are providing information as well as support. You may want to establish a speaking order by using a "speaking stick" or eagle feather. The role of the facilitator, is to keep the process on task and to ensure people are provided with feedback at the end of the activity (allow about 20 minutes at the end for this purpose). The idea is not to solve the problem, in a short time, but to provide the participants with the opportunity to work together.

ACTIVITY 9.4: Modeling

TIME: 15 Minutes

DIRECTIONS: Ask one of the participants to role play a person who has a severe problem or issue which needs professional assistance (e.g. alcohol, suicide, etc.). Then demonstrate how you will talk to the person, using any of the helping skills and how you would refer the person (the modeling does not have to be longer than 3-5 minutes). Ask for feedback or suggestions on the process you demonstrated.

ACTIVITY 13.5: Individual Practice

TIME: 30 Minutes

DIRECTIONS: Ask the participants to get into a triad, with each participant taking one of the following roles: helper, person, and observer. The helper is to use the ethical guidelines and referral process, the person is to present an issue or problem, and the observer is to give feedback using the feedback guidelines. The observer should also be the time keeper, with the role play lasting 5 minutes and the feedback 5 minutes. After 10 minutes ask the participants to change roles, until everyone in the triad has had a turn in each role. You may have to give the participants some suggestions on issues to present. Some possibilities that would require referral are:

1. someone who is abusing alcohol;

2. someone who is talking about suicide;

3. someone suffering from extreme and prolonged grief.

ACTIVITY 13.6: Creating a Code of Ethics

TIME: 20 Minutes

DIRECTIONS: Start by explaining the importance of a code of ethics using some of the material in the presentation. Next ask the participants what they would like to have in their code of ethics. As the participants share ideas, write them down on the blackboard. At the end of the brainstorming, you could ask for a couple of volunteers to write down the list and present it to the group for the next session. To save time, you could compile the list for presentation next session.

ACTIVITY 13.7: Brainstorming Referral Situations

TIME: 20 Minutes

DIRECTIONS: Divide the blackboard into two parts and label one part "Situations" and the other part "To Whom." Ask the participants to think of a helping situations which they feel would be something they could not handle and therefore would want to refer. List all the situations on the blackboard. Next, take each situation and ask the participants what they would do and to whom they would refer to. Be sure to summarize the findings at the end of the brainstorming.

ACTIVITY 13.8: Referral 'Round Robin'

TIME: 30 Minutes

DIRECTIONS: Ask the participants to get in a circle. Each participant is to turn to the person to the left and make a statement describing a problem which should be referred. For example, "Life just doesn't seem worth living anymore". The next person is to use the referral guidelines to refer the person. For example: "You seem so discouraged. I am wondering if you would like to talk to Rod McCormick, our counsellor, about that. He is a very good person." The person making the referral response then makes a statement that requires some referral. This continues until everyone has had a chance. Remember to give an example of what they are to do before you start and make suggestions or give feedback to the participants after they finish.

ACTIVITY 13.9: Invited Speaker

TIME: 30-60 Minutes

DIRECTIONS: Invite a professional, such as a nurse, mental health worker or a traditional healer to come and speak to the participants about their agency and how they receive referrals. You can allow 15-20 minutes for the presentation followed by an equal amount of time for any questions the participants might have for the professional.

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|Page Updated: May 2, 2000 |