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Indian Health Service The Federal Health Program for American Indians and Alaska Natives


     Indian Health Manual
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Part 3, Chapter 8:  Manual Appendix 3-8-A

Examples of Referrals to Social Work Services


The following are examples of referrals for social work services according to categories of problems, clinical impressions or diagnoses.  The listing is not limited and may need to be modified according to local service needs Social work services provided may consist of any combination of the following functions; case finding/social risk screening, psychosocial evaluation, psychosocial intervention, pre-admission/discharge planning, case consultation to hospital staff and community agencies, education, information and referral, and case management.

Health Status Category

HEALTH HOMEMAKER NEEDS - Clients with health status requiring care and monitoring in the home.

MEDICAL VISITS, MULTIPLE - Clients with psychosocial problems associated with frequent hospitalizations or clinic visits.

PHYSICAL/PSYCHOLOGICAL COMPLAINT WITHOUT DIAGNOSIS - Individuals who may use complaints to seek unmet emotional and social problems.

DEVELOPMENTAL DISABILITY/REHABILITATION - Individuals with problems of physical restoration, social and emotional adjustment to physical disability.

PHYSICAL ILLNESS, ACUTE - Individuals with social and emotional adjustment problems associated with acute illness.

PHYSICAL ILLNESS, CHRONIC - Individuals with social and emotional problems associated with long-term or devastating illness and medical care.  Includes automatic referral of HIV/AIDS clients.

TERMINAL ILLNESS - Referrals for social and emotional problems of the terminally ill patient and the family, particularly in regard to death and dying issues.

NON-COMPLIANCE - Non-compliance problems with medical/psychosocial treatment

Abuse Category

CHILD ABUSE (physical/emotional/sexual) - All children suspected of being abused should be referred.

DEPENDENT ADULT ABUSE (elderly/retarded/disabled) - All dependent adults suspected of being abused should be referred.

RAPE - Referrals for victims of any act of sexual assault that is forced upon a person.

SPOUSE ABUSE/DOMESTIC VIOLENCE - Referrals of victims of emotional or physical abuse by spouses or significant others.

ABUSIVE BEHAVIOR - Referrals of perpetrators in abuse situations;

Neglect Category

CHILD ABANDONMENT - Referrals for children deserted at or brought to a health facility.

CHILD NEGLECT - Children suspected of suffering from emotional, social, economic, medical or educational deprivation should be referred.

DEPENDENT ADULT NEGLECT - Elderly, mentally retarded or disabled adults suspected of suffering from emotional, social or economic deprivation.

Family Life Category

ADULT/CHILD RELATIONSHIP - Individuals with problems associated with dysfunctional relationships between parent/guardian and child.

DEATH IN THE FAMILY - Psychosocial issues associated with grief reaction in addition to facilitating access for burial arrangements.

MARITAL PROBLEM - Individuals or couples with conflict related to marital problems on a continuum from premarital counseling to coping with the marriage relationship, (excluding broken family/separation/divorce).

SEPARATION/DIVORCE - Problems related to coping with separation or divorce of spouses or significant others.

FAMILY CONFLICT - Symptoms of family dysfunction or conflict.

OTHER INTERPERSONAL RELATIONSHIPS - Difficulties with any interpersonal relationship not covered elsewhere in the problem list, e.g. single adults, romantic partners.

Pregnancy/Childbirth Category

UNWANTED PREGNANCY - Individuals with problems associated with unwanted pregnancy, including referrals for financial assistance, counseling about options (adoption, termination), and feelings about options.

FAMILY PLANNING - Individuals with psychosocial problems related to contraceptive use or nonuse, family size/spacing of offspring, adoption, sterility, and sterilization.

PREGNANCY CONCERNS - Psychosocial problems related to an abnormal pregnancy or difficulties associated with inability to conceive.

TEENAGE PREGNANCY - Teenagers with problems related to childbearing and parenting in this high risk age group.

Out of Home Care Category

PARTIAL CARE - Clients with problems associated with planned day/night care of children of working parents, aged, Mentally retarded or emotionally ill persons.

SHELTER CARE - Clients with problems associated with arranging a place of residence for board, room and supervision, e.g. VA Domiciliary Care, Victims of domestic violence, dependent adults requiring care and supervision, etc.

FOSTER CARE - Children and adolescents with problems associated with providing alternative room, board and supervision away from the natural family.

HALFWAY HOUSE - Placement for convalescence and readjustment after institutional care for substance abuse, mental illness or mental retardation before returning to the home, family and community.

INPATIENT PSYCHIATRIC HOSPITAL CARE - Individuals with problems associated with voluntary or involuntary commitment to a psychiatric facility or treatment center.

HOSPICE CARE - Referrals to a hospice program for the terminally ill patient.

NURSING HOME CARE - Patients with medical problems requiring intermediate and skilled nursing home care.

RESPITE CARE - Clients-requiring short-term care for children, the elderly or disabled in order to prevent burn out of primary caretaker and provide caretakers the opportunity to take care of personal matters.

Socioeconomic Category

ALTERNATE HEALTH RESOURCES - Complex cases regarding access to Medicare/Medicaid, insurance coverage, Children’s Medical Services, Veterans Administration and other resources.  The regular referrals to these resources should be made through the Contact Representative in the Business Office system.

FINANCIAL NEEDS/ASSISTANCE - Problems related to lack of money, employment, payments from public assistance, or other economic resources.

HOUSING - Referrals for coordination of services for problems related to lack of housing or the improvement of living quarters in addressing the health requirements of patients.

NUTRITION - Referral to and coordination of services for problems related to adequate nourishment, food resources, food stamps, WIC, congregate feeding, etc.

Socio-legal Category

JUVENILE LEGAL NEEDS - Assessment and referrals of children with legal needs.

ADULT LEGAL NEEDS - Assessment and referrals of adults with legal needs.


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