Monday, August 25, 2014

When To Refer, When Not To Refer

My inspiration to write today came from an email from a friend, and fellow Occupational Therapist from a nearby state. She wrote:
"Our Assistive Tech team keeps getting overwhelmed with referrals for an AT Eval or Consultation....How do you divide up the roles in your county? Any process tips you'd recommend to cut back on needless referrals or to put back some effort into the teams making the referrals? I've heard staff say, "Let's make an AT referral" as soon as a parent asks the team if the student might do better with keyboarding. I feel like the OT or teacher could answer that question without involving an AT referral. Any thoughts?"
We occasionally get referrals that don't require our expertise. When this happens, we follow up with a phone call to the referrer and try to get a bead on the situation. Are there questions that the team genuinely needs help with or are they simply looking for confirmation of their thinking. With newer staff, it is often an issue of sharing with them what our respective roles are. Occasionally, we may be faced with a potentially litigious situation, and so we are called in to be thorough.

In order to head off unnecessary referrals, we make a point to offer in-services to various staff groups (OT, SLP, PT, teachers) to really delineate what our respective roles are from our perspective.

For example, Occupational Therapists already have significant "Assistive Technology" as part of their domain. Consider adaptive eating utensils or cups, weighted vests, or pencil grips. An OT would never make a referral for such low-tech equipment, because they consider it a part of their domain. I posit that keyboarding software is a part of such equipment for most OT's. Similarly, many simple switches are part of a SLP's bailiwick as well.

Our Assistive Technology team considers our role as assessing need and prescribing technology interventions when the team "requires" such assistance. 

If the team already has a handle on the tools required to create an effective intervention, they probably don't need an evaluation, or possibly even consultation.

Assistive Technology teams are not here to replace your clinical reasoning. 

That being stated, I do have staff who will utilize their considerable knowledge, plan interventions, and then call or email to to see what we think regarding what they are doing, and whether or not we think they "missed" something. In my estimation, this is a great way to use available resources.

Other teams may handle such situations differently, and I'd be curious to hear from folks.

Thanks for reading, and happy therapy!

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