10.1 Referrals, Case Management, and Resources
Key Takeaways
- ADC tasks III.E and III.K are one loop: know when to refer, facilitate the link (including case management), follow up, and identify a resource that actually meets the need.
- Refer when the need is outside scope, requires a different level of care, or needs a specialized or reachable setting — not to punish a difficult client.
- A warm handoff introduces the person in real time to the receiving provider and stays until a next step is scheduled; a phone-book slip is a cold referral.
- Follow-up asks whether the person connected, names the barrier if they did not, and rematches the resource; faxing a form does not close the loop.
- SAMHSA TIP 27 frames broker, strengths-based, assertive, and clinical case-management intensities; match resources on need, population, medication, access, safety, and client choice.
10.1 Referrals, Case Management, and Resources
Quick Answer: Tasks III.E and III.K travel together. III.E is when to use a referral and how to facilitate it, including case management and follow-up. III.K is identify available resources to meet client needs. A faxed phone number is not a referral. Match the resource, obtain consent, make a warm handoff when you can, and check whether the person actually got in.
The IC&RC Alcohol and Drug Counselor (ADC) Candidate Guide (effective November 2022; the PDF IC&RC posted in July 2025) places referral inside Domain III because counseling that never connects the person to medication, housing, medical care, or a different level of care is incomplete. Independent ADC prep by OpenExamPrep treats III.E and III.K as one clinical loop: see the need, name a real resource, walk the person toward it, and close the loop. Domain II already asked you to determine immediate needs and ASAM placement. This section asks whether you can broker those needs without abandoning the counseling relationship.
When a referral is the intervention
Referral is a planned share or transfer of a task the person needs that you or your program cannot meet well enough, fast enough, or within scope. Case management is the ongoing work of assessing those needs, planning, linking, advocating, and monitoring. SAMHSA's TAP 21: Addiction Counseling Competencies (SMA15-4171) treats both as practice-dimension skills, not clerical extras.
Refer when:
- The need is outside ADC scope (starting methadone in an OTP, managing acute psychosis, giving legal advice, obstetric management).
- The person needs a different or higher level of care than you can deliver today (medically managed withdrawal, residential perinatal care, an adolescent specialty program).
- A specialized door fits better: youth, pregnancy, LGBTQ+-affirming care, a language-matched group, a domestic-violence shelter, vocational rehabilitation, or an infectious-disease clinic.
- Access barriers (no evening hours, no bus, no childcare, no wheelchair access) make your otherwise correct program unusable.
- Safety requires a parallel system (a required child-abuse report, an emergency department, a mobile crisis team). That is still a facilitated referral, not a dump.
Do not refer to get rid of a difficult client, to punish a positive toxicology, or to outsource empathy. If you remain the treating counselor, referral is additive. If you are stepping a person up, you still owe a handoff, not a closed door.
| Situation | Keep and treat | Refer or co-manage | Exam trap |
|---|---|---|---|
| Weekly alcohol pattern, stable housing, you have an opening | Continue counseling | Add a mutual-help meeting only if they want it | Sending everyone to the same meeting as a reflex |
| Fentanyl use, withdrawal, outpatient-only program | Stabilizing counseling while you link | OTP or office-based buprenorphine, medical care | Teaching willpower instead of medication access |
| 16-year-old parked in an adult process group | Individual engagement | Adolescent specialty or family-based program | Treating the teen as a short adult |
| You want trauma consultation | Stay in the counseling role | Trauma therapist or psychiatrist with consent | Dumping the whole SUD story without a release |
How to facilitate: consent, specificity, barriers
Facilitation is the how. A usable referral is specific enough that a tired person could follow it tomorrow morning.
- Name the reason in ordinary language. "You need a program that can start buprenorphine this week, and we cannot prescribe it here" beats "I am referring you for wraparound optimization."
- Obtain consent for what will be shared. Domain IV tests the form. Here, the counseling move is that the person knows who will hear what, and they can refuse a non-emergency referral.
- Give a real resource: program name, address, hours, eligibility, cost or insurance, what to bring (photo ID, medication list), and a named contact when one exists.
- Remove one barrier on purpose. A bus pass, an interpreter, a morning slot after the night shift, a same-day OTP intake number. III.K fails when the resource is theoretically perfect and practically unreachable.
- Document the need, the offer, the client's decision, and the next check-in.
Worked facilitation: A 41-year-old with alcohol use disorder is sleeping in a car and missing group because the site is across town. The wrong referral is "call 211 sometime." The right one is: confirm they want housing help, identify the Continuum of Care coordinated-entry number and a same-week medical withdrawal bed if withdrawal risk is high, explain what each office will ask, and decide together which door they walk through first. Two resources, one sequenced plan.
Warm handoff versus cold paper
A cold referral is a slip of paper, a website, or "they already know about us." A warm handoff introduces the person in real time to the receiving provider — a walk-over, a three-way call, or a joint telehealth minute — and you stay until the next step is on the calendar. SAMHSA's case-management advisory, built on TIP 27: Comprehensive Case Management for Substance Abuse Treatment, treats accompanying the person and making a warm handoff as a real intensity choice, not a courtesy.
| Method | What the client experiences | When it can be enough | When it fails |
|---|---|---|---|
| Cold | A number and a hope | A highly resourced, high-agency person with a simple ask | Almost everyone in early withdrawal, homelessness, or cognitive fog |
| Warm handoff | They hear two professionals agree they are wanted | Most specialty and medical links | You "introduce" them and leave before an appointment exists |
| Accompanied / assertive | You go with them or meet them at the door | Low trust, first OTP visit, first shelter intake | You take over and speak as if they are not in the room |
Warm does not mean you become their parent. It means the receiving system sees a person, not a fax.
Follow-up closes the loop
The candidate guide names follow-up in III.E for a reason. Referral is not complete when your note says "referred to OTP." It is complete when you know whether they got in, and you act if they did not.
Follow-up questions that produce data:
- Did you get there? Who did you meet?
- What blocked it — waitlist, bus, shame, a urine requirement they could not meet on day one, a hostile remark at the front desk?
- Do we try the same door with a new time, or a different matched resource?
Broker-style case management (TIP 27) may only check. Strengths-based, clinical, and assertive models stay in the relationship with the resource. On the ADC, the best answer is rarely "I already gave them the number."
Resource matching (III.K)
Identify available resources is not "I know a guy." It is a living map of what exists for this need, updated when programs close, waitlists move, or medication capacity changes. Match on:
| Match dimension | Question | Mismatch example |
|---|---|---|
| Need / level of care | Withdrawal management, OTP, housing, childcare, legal aid, perinatal care | A weekend yoga class for untreated opioid withdrawal |
| Population | Youth, pregnancy, LGBTQ+, justice involvement, language, culture | An adult mixed group for a 15-year-old |
| Medication | Methadone OTP versus office-based buprenorphine versus naltrexone | Twelve-step only for a person who needs agonist treatment |
| Access | Hours, transit, insurance, documents, physical access | A perfect clinic 90 minutes away with no bus |
| Safety | Active domestic violence, unsheltered winter, a warrant the client named | Sending someone home to an abuser "for family support" |
| Choice | What the person will actually use | Forcing an abstinence-only recovery house when they asked for Housing First |
Keep a current list: SAMHSA's FindTreatment.gov locator, the local OTP roster, perinatal MOUD clinics, youth programs, LGBTQ+ centers, legal aid, domestic-violence hotlines, 211, and your jurisdiction's public SUD system. Stale resources are wrong answers with last year's phone number.
TIP 27's four models help you scale your own intensity; you do not need a brand-name diagnosis of the model to pick the right amount of help:
| Model | Core move | Follow-up intensity |
|---|---|---|
| Broker / generalist | Identify and link | Light check |
| Strengths-based | Client-driven goals, advocacy, outreach | Close, ongoing |
| Assertive / ACT-style | The team takes services to the person | High, integrated |
| Clinical / rehabilitation | The counselor also case-manages | Close, clinical |
Exam traps
- A correct resource that the person cannot reach is not a completed III.K task.
- Follow-up is part of III.E, not extra credit.
- A warm handoff is not dumping the caseload.
- Mutual-help is a resource, not the only resource.
- Referring out of annoyance is not case management.
A client with opioid use disorder needs an opioid treatment program this week. Which counselor action BEST facilitates the referral?
A counselor faxes an OTP referral form and writes "referred" in the note. Two weeks later the client is still using fentanyl and never got an intake. What did the counselor MOST clearly omit from Domain III.E?
Which action BEST shows Domain III.K resource matching rather than naming any available support?