Worksheet Under constructionCriterion 44 concerns selecting a resource that can address the identified need and that the client can realistically use. The facilitator checks qualifications, scope, availability, cost, accessibility, and the client's preferences. Research on the working alliance supports attention to the relationship a client may form with a provider, although it cannot predict the success of a particular referral (Horvath et al., 2011). When a specialist is unavailable, explain the gap and consider safe interim care within its stated limits. Criterion 46 develops the assistance needed to reach the service and confirm what happened.
Learning Objectives
By the end of this module, the trainee will be able to:
- Verify a referral resource for the identified need and explain the basis of the recommendation.
- Describe the association between working alliance and psychotherapy outcomes and the limits of applying it to referral decisions.
- Conduct the needs assessment across medical, psychiatric, social, and spiritual dimensions that matching depends on.
- Build and maintain a vetted referral network in advance of needing it, and state the vetting criteria used.
- Consider clinical suitability, client preferences, urgency, and availability together when selecting a resource.
- Take cultural and identity factors seriously without stereotyping the client.
- Treat accessibility, cost, travel, and coverage, as part of the match rather than an afterthought.
- Recognize when no adequate resource exists, and say so honestly rather than supplying a harmful match.
- Verify the level, urgency, acceptance status, and responsibilities of the receiving service.
- Record the reasons for a match and reassess it when new information arrives.
Key Terms
Matching. The facilitator's judgment that aligns a specific identified need with a specific resource capable of meeting it, considering competence, fit, identity, and accessibility. Distinct from identifying the need (Criterion 42), explaining the referral (Criterion 43), and assisting the client to use it (Criterion 46).
Facilitator vetting. The facilitator's own evaluation of a resource's training, ethics, accountability, and competence, performed before a client is sent there. Distinguished from the client side vetting skill taught in Criterion 40, which equips the client to evaluate services the facilitator has not seen.
Fit. How well a service addresses the client's needs, preferences, circumstances, and access requirements. It must be checked with the client and reviewed after contact.
Working alliance. The collaborative bond and agreement on goals and tasks between a client and a provider, which meta analysis across more than fourteen thousand treatments finds to be a modest but robust correlate of outcome (r = .275; Horvath et al., 2011). Its causal direction is debated.
Referral network. A directory of services with current information about qualifications, scope, access, and availability, including a responsible person for updates.
Referral related harm. A problem arising from the choice or conduct of a receiving service, including inappropriate care, delayed treatment, boundary violations, or avoidable exposure of private information. A disappointing fit does not automatically constitute an adverse event.
Accessibility. The practical reachability of a resource, including cost, insurance coverage, travel, waiting times, and scheduling. A resource the client cannot afford or reach is not a match, however well suited it is in principle.
An unmet referral need. A need for which no adequate available resource has been identified. The plan should document the gap, safe interim options, continuing search responsibilities, and the response if risk increases.
Core Teaching
Choosing an appropriate resource
Clarify the question the receiving provider is being asked to address. A medical assessment, trauma treatment, peer connection, and housing assistance require different capabilities. Check that the proposed service actually provides the relevant work and can accept the client in the needed timeframe. A referral can delay care or expose a client to harm when the provider lacks the necessary competence, so explain the basis of the recommendation and its limits. Include the client's preferences and prior experience in the decision. Their response after the first contact may reveal a mismatch that was not apparent beforehand.
Working alliance and referral fit
Horvath et al. (2011) synthesized psychotherapy research on the working alliance and found an association with treatment outcome of r = .275. The alliance includes the collaborative relationship and agreement on goals and tasks. This is an association from psychotherapy studies; it does not establish causation or validate a method for matching psychedelic clients to providers. It does support asking whether the person feels able to work with the provider and whether the proposed goals make sense to them. Clinical competence, access, and the appropriate level of care remain necessary considerations alongside the relationship.
Clarifying the full set of needs
Review the concern that prompted referral and any related medical, psychiatric, social, or spiritual needs. Confirm what is established, what the client reports, and what requires assessment. A facilitator should not supply an unqualified diagnosis in order to make the referral sound precise. Ask how the concern affects daily life and what the client wants help with. Consider their existing clinicians and support network so the recommendation fits into ongoing care. Multiple needs may require more than one resource, with clear responsibilities and consent for any coordination.
Maintaining a referral network
Build a directory of clinicians, community services, peer supports, and practical resources before a crisis makes access urgent. Verify active credentials where applicable, service scope, populations served, location, availability, fees, accessibility, and complaint routes. Record the date and method of checking. A professional association, directory listing, or colleague's recommendation can identify a candidate but does not establish all of these facts. Recheck after a concern or a material change. Emergency services should be contacted when needed even if the program has not previously vetted a particular responding clinician.
Balancing suitability and access
Consider the level of care required, the provider's relevant competence, the client's preferences, and how soon the service can be reached. A highly specialized provider with a long wait may need to be paired with timely interim assessment or support. Discuss treatment approaches and the client's previous experience without assuming that a particular modality will work because another did not. Ask about preferences concerning language, gender, cultural background, military experience, recovery goals, or spiritual practice. Avoid guaranteeing benefit from a perceived match, and arrange a way to review the referral after contact.
Checking practical access
Discuss the total cost, insurance or payment arrangements, waiting time, transport, childcare, work schedule, language access, and disability accommodations. Confirm details directly where possible, with appropriate consent before sharing identifying information. For remote care, check the client's location, the provider's authority to serve it, privacy, and technology requirements. A low cost service may still be unusable if the person cannot reach the appointment or receive it privately. Ask what assistance would change that. Document the barrier and the agreed next step so the referral does not rest on an assumption the client is reluctant to correct.
Fit includes the client's account
Ask what the client wants from the next relationship and what has made previous care difficult. They may want a clinician who can discuss a psychedelic experience without ridicule, while preferring treatment that does not involve further psychedelic use. They may need a practitioner familiar with their faith, disability, language, gender, or recovery goals. Ask which features are essential and which are preferences.
Tervalon and Murray-García (1998) describe cultural humility as continuing self evaluation and attention to power in professional relationships. Applied here, that means checking your assumptions with the person. Shared identity can be meaningful to a client; it should not be imposed as the definition of a good match. Respect a preference for a clinician outside the client's community when privacy or another concern makes that preferable.
Horvath and colleagues (2011) found an association between the working alliance and psychotherapy outcomes. This supports attending to the relationship, while leaving uncertainty about causation and about the value of a particular matching method. A warm first impression does not establish clinical adequacy. Ask both whether the client feels able to work with the provider and whether the provider can meet the identified need.
The service is suitable but inaccessible
Check the full cost of using the resource. A fee may be manageable while travel, childcare, missed wages, or a required subscription makes attendance impossible. Insurance participation should be confirmed for the relevant service and plan; a practice's general statement that it accepts insurance may not settle the client's cost. Offer help checking without promising a benefit determination on the insurer's behalf.
For telehealth, ask about a private place, an adequate device, reliable connection, communication needs, and the provider's authority to see a client in that location. A video option may solve travel and create a privacy problem at home. Consider whether an in person appointment, telephone service where appropriate, or access through a local clinic would work better.
When the ideal service is unavailable
Identify the care that is needed now and the specialist input that can follow. A qualified general clinician may be able to assess symptoms, address immediate needs, and arrange further care while a specialist appointment is pending. Make the limitations explicit and confirm who is responsible during the wait. An imperfect but clinically appropriate option can be useful; an unqualified person should not be presented as a substitute for required care.
If no safe match is available, document the unmet need and obtain consultation about the next route. Tell the client what has been tried and what remains unresolved. Provide emergency instructions appropriate to their circumstances and arrange a defined follow up when that is within the program's responsibility. Do not leave an urgent need on an unmonitored waiting list.
After contact, ask whether the service addressed the referral question and whether another arrangement is needed. A completed first appointment does not establish that the match will remain suitable. A provider may discover a different need, or the client may find the relationship unworkable. Update the referral plan and the directory information without turning one person's experience into an unsupported general verdict.
Preparing the first appointment
Help the client identify what they want the receiving provider to understand first. A short account can include the present concern, when it began, relevant treatment, and the question they want help answering. If the psychedelic experience is relevant, they can describe it plainly without feeling obliged to defend a worldview. Encourage an accurate medication and substance history for clinical assessment.
Ask what would make the first meeting easier. The person may want to write down their questions, bring a chosen support person where appropriate, request an interpreter, or explain a sensory need in advance. After the appointment, they can consider whether the provider understood the concern, explained the proposed work, and offered a feasible next step. That review helps refine the match using actual experience.
Matching the level and urgency of care
Describe the care needed before choosing a name from the directory. A one time medical opinion, ongoing psychiatric treatment, urgent evaluation, structured substance use treatment, and peer support involve different responsibilities. Ask a qualified clinician to determine the level and urgency of clinical care when that judgment exceeds the facilitator's role. Share the resulting referral question accurately.
Confirm that the proposed service can meet the need within that timeframe. A practitioner may have the right specialty and no capacity to accept a new client. An outpatient appointment may be inappropriate for an immediate emergency. Record the actual opening offered and the interim plan. If the service cannot provide timely care, continue the search or escalate according to the person's condition.
Checking the provider and the organization
Verify the individual practitioner as well as the service. Confirm current credentials, any restrictions relevant to the work, and who is responsible for clinical decisions. Ask how the practice handles urgent concerns, coverage during absence, transfer to a higher level of care, and complaints. Check whether the person named in the directory will actually provide the service or whether clients are assigned to another practitioner after intake.
For nonclinical services, describe the role without upgrading a certificate into a clinical credential. Ask about training, supervision, boundaries, and the limits of support. When a provider claims authority within a cultural or spiritual tradition, establish the basis of that claim respectfully and describe what has been verified. Record unanswered questions so personal familiarity does not fill the gaps by default.
Documenting the match and the alternatives
Keep a short referral comparison in the care record. Identify the need, options considered, the basis for the chosen option, the client's preferences, practical barriers, and what remains to be confirmed. If only one appropriate service is available, explain that limitation. If an alternative was declined, record the client's reason in their own terms where useful.
Record financial relationships in the appropriate administrative register and disclose relevant interests to the client. Review whether an interest could influence the selection or the presentation of alternatives. A referral arrangement should never require the client to buy a related package that is unnecessary for the identified care. Ask the responsible administrative or legal professional to review applicable restrictions on referral compensation (American Psychological Association, 2017).
Confirming acceptance and shared responsibilities
Ask the receiving practice what it needs to decide whether it can accept the referral. Record whether it is reviewing the request, has offered an assessment, or has accepted ongoing care. An appointment for evaluation does not establish that treatment will continue there. Explain the distinction to the client and maintain the interim responsibilities already agreed.
When several services are involved, identify which one manages each need. A therapist may address distress while a prescriber manages medication and a community organization helps with housing. With appropriate authority, communicate the relevant parts of the plan so advice and appointments do not conflict. Ask who will coordinate when a need falls between services and record that responsibility.
Rechecking a referral after new information
A receiving provider may identify a different need, or the client may report that the service was inaccessible or harmful. Ask what occurred and reassess the match. Record new information without rewriting the original basis for the decision. If the concern suggests immediate danger, respond to that need before completing the directory review.
The referral network needs maintenance beyond an annual contact list. Track significant changes in scope, staffing, eligibility, cost, and availability. Review credible complaints through a defined process and record any temporary pause in recommendations. Notify staff managing affected referrals so a correction to the directory also reaches the clients already relying on it.
Clinical and Decision Tools
Tool 1 Resource selection and related tasks
The facilitator checks a proposed referral and also helps the client learn how to evaluate future services.
Criterion | The work | Who acts |
|---|---|---|
34 | Coordinate and liaise with services | Facilitator |
40 | Teach the client to navigate and evaluate the service landscape | Client learns to vet |
42 | Identify the need this facilitator or program cannot meet | Facilitator |
43 | Explain the rationale for the referral | Facilitator |
44 | Vet resources and match the need to the right one | Facilitator vets |
46 | Assist the client in actually using the resource | Facilitator supports |
Tool 2 Needs assessment across four dimensions
Ask about the person’s symptoms, goals, prior care, and preferences before selecting a resource.
Area | Question | Possible resource |
|---|---|---|
Medical | What assessment or treatment is needed? | Qualified clinician or the client's treating team |
Psychiatric | What symptoms and level of care need assessment? | Relevant mental health service |
Social | What practical or community support is needed? | Social services, accessible community resources, or peers |
Spiritual or meaning | What framework and kind of support does the client want? | An appropriate practitioner or community chosen with the client |
Tool 3 Checking a referral resource
Record what was verified, when it was checked, and which questions remain unanswered.
Vetting question | Warning sign |
|---|---|
Trained, and transparent about qualifications? | Vague, grandiose, or hidden credentials |
Clear ethical boundaries and confidentiality? | Blurry boundaries; loose with privacy |
Genuine informed consent; client can decline or leave? | Pressure; no real consent |
Accountable to a professional body or peer community? | Operating in isolation, answerable to no one |
Realistic claims? | Promises of cures or miracles |
Tool 4 Factors affecting suitability
Consider the client's clinical needs, preferences, and ability to use the service. Review the fit after contact.
Dimension | What to establish |
|---|---|
Specialty | The service can address the identified need or provide appropriate interim assessment |
Approach | The client understands the proposed work and wants to consider it |
Identity and experience | Ask which characteristics the client wants considered |
Recovery goals | The service respects the client's goals and appropriate ongoing treatment |
Culture and faith | Ask about preferences, privacy, and community connections |
Ask about identity and cultural preferences directly; the answer may differ from what staff expect.
Tool 5 Checking access
Ask the client directly what they can manage before offering a match, so the referral is not built on assumptions they are embarrassed to correct.
Barrier | Check |
|---|---|
Cost | Can they actually afford it? Sliding scale? Lower cost and peer led options held as genuine, not consolation |
Coverage | Does the practitioner take their insurance? Do they have any? |
Travel | Reachable without a car? Telehealth or online where distance is real |
Waiting list | A six month wait is not a plan for someone who needs help now |
Scheduling | Shift work, childcare |
Tool 6 Matching checklist
Confirm the match was vetted, well fitted, reachable, and honest.
Check | Done? |
|---|---|
Needs identified across relevant areas | Yes / No |
Credentials, services, accountability, and current availability checked | Yes / No |
Clinical adequacy and the client's preferences both considered | Yes / No |
Limits and potential mismatch discussed | Yes / No |
Identity and cultural preferences elicited without assumptions | Yes / No |
Cost, coverage, transport, privacy, communication, and timing checked | Yes / No |
Suitable options offered where available | Yes / No |
Unmet needs recorded; safe interim care or further consultation arranged where appropriate | Yes / No |
Referral match review
Question | Finding to document | If unresolved |
|---|---|---|
Can the service meet the need? | Scope, level of care, qualified practitioner | Seek clarification or another service |
Can it do so in time? | Actual availability and clinical urgency | Arrange appropriate interim or urgent care |
Can the client use it? | Cost, transport, privacy, eligibility, accommodations | Assign assistance or choose another option |
Has responsibility been accepted? | Assessment offered or ongoing care accepted | Keep the interim responsibilities explicit |
Does the match remain suitable? | Client feedback and receiving provider findings | Review and update the plan |
Worked Example A Match That Fits and One That Does Not Exist
This fictional example applies the practices discussed in this module.
Context: A combat veteran in a rural area has surfaced significant combat trauma during integration. He is skeptical of therapists, has limited money, no reliable transport, and told the facilitator that civilians do not understand.
Assessing across dimensions: The need is psychiatric and social. He needs trauma specific clinical care, and he needs connection with people whose credibility he will accept. The plan needs to address both needs.
Considering options: The facilitator checks clinicians with relevant trauma experience and asks about suitable interim care if specialist access is delayed. They also look for the veteran peer support the client has requested.
Client preferences: The facilitator does not assume that being a veteran means he wants a veteran therapist. He asks. The client says he does not care about the therapist's background as long as they know trauma, and that the peer group matters enormously. The match is built on his answer.
Verification: The facilitator checks the clinician's credentials, relevant service, availability, and accountability process, then explains to the client what was verified and what remains uncertain.
Accessibility as part of the match: Cost and distance are real. The facilitator finds a clinician offering telehealth on a sliding scale, and an online veteran peer community, rather than an excellent in person option two hours away that he would attend once.
An additional need: The client asks about ibogaine for opioid dependence. The facilitator explains that this requires specialist medical assessment and verification of the proposed service's legal authority. They also offer referral to established treatment for opioid dependence without making access to care depend on a future psychedelic option.
Case Vignettes
For each vignette, identify the concern, describe the response, and explain your reasoning. Record your responses on a separate page.
Vignette A
A facilitator refers a survivor of sexual violence to the only integration group in town, knowing it is a mixed, unstructured circle with no trauma informed practice. She is retraumatized by an exercise in her second session and does not return to any support at all.
Guided questions: Identify the harm described and the service mismatch. What verification and interim care were needed? Write a revised referral plan.
Vignette B
A facilitator refers clients to a charismatic local practitioner she has never vetted, because he is nearby, inexpensive, and friendly. He turns out to have no training, no accountability, and a habit of making sweeping promises to vulnerable people.
Guided questions: What did the facilitator implicitly vouch for? Which vetting questions were skipped? Why does the timing of network building matter here?
Vignette C
A facilitator, wanting to be culturally sensitive, refers an Indigenous client to an Indigenous healer without asking. The client, who is not connected to that tradition and had specifically wanted a clinical psychologist, feels reduced to a category.
Guided questions: What error is this, and how does it differ from ignoring culture? Who is the authority on what a client's identity requires? What is the corrective stance (Criterion 30)?
Vignette D
A facilitator gives a rural client on a low income the name of an excellent trauma specialist who charges two hundred dollars an hour, takes no insurance, and is a two hour drive away. The client thanks him warmly and never calls.
Guided questions: Identify the barriers preventing attendance. Confirm what assistance is available and revise the referral so the client has a feasible next step.
Vignette E
A client needs a service that does not exist within reach. Unable to bear giving her nothing, the facilitator sends her to a wellness coach who is available and pleasant but entirely unqualified for what she is carrying, telling himself that something is better than nothing.
Guided questions: Which need is outside the coach's qualifications? What could an appropriately qualified general clinician provide while specialist care is sought? How would you describe the limits of an interim option?
Role Play and Practice Scripts
Practice with a partner or team, then exchange roles. Use fictional details and discuss the choices made in each response.
Asking about preferences
Practice asking which aspects of a provider's background, language, approach, and experience the client wants considered. Check which are essential and avoid inferring preferences from identity alone.
Asking about accessibility before offering a match
Practice asking about cost, coverage, travel, privacy, scheduling, and communication needs before offering a resource. Let the client identify which barriers are most relevant and discuss a feasible option.
Discussing available options
Describe two or three verified options, including their different services, costs, availability, and limits. Ask which the client would like to explore and explain how to make contact.
Explaining an unavailable resource
Practice: “I have not found the specialist service we discussed. This clinic can assess your current symptoms and help arrange further care, but it does not provide that specialty. Would you like help contacting it while we continue the search?” Adapt the plan if the need is urgent.
Additional Practice
A clinically useful interim option
The preferred specialist has a long wait. A qualified general clinician can assess the client this week but has limited psychedelic experience. The client worries that they will be dismissed.
Practice questions: Check what the clinician can provide, how the psychedelic history can be discussed, and who will arrange further care. Explain the limits without withholding a useful assessment.
Applied Record Exercise
An assessment appointment mistaken for accepted care
A provider offers an initial evaluation next month. Staff tell the client that ongoing treatment is arranged. The client needs support sooner and cannot afford the later service without coverage.
Task: Clarify the acceptance status, urgency, costs, and interim responsibilities. Record the proposed match and alternatives with the client.
Review: The trainee confirms what the practice accepted, obtains qualified urgency review, and leaves the client with a feasible interim plan.
Self Assessment and Reflection
Knowledge check
Distinguish this criterion from Criterion 40 by asking who is doing the vetting.
Describe the alliance findings and how attention to the working relationship informs a referral.
Name the four dimensions of the needs assessment that matching depends on.
State the vetting questions a facilitator asks of a resource before sending a client there.
Name the dimensions of fit, and explain the difference between honoring identity and stereotyping.
Explain why accessibility is part of the match rather than an afterthought.
Explain how to respond when the preferred service is unavailable, including clinically appropriate interim care.
Reflection
How vetted is your actual referral network? Whom on it have you never checked, and what are you vouching for?
When did you last refer someone because a resource was available rather than because it fit? What happened?
How comfortable are you saying 'I do not have a good answer for you'? What do you tend to do instead?
Observed Practice Assessment
Give the trainee two candidate services with different capabilities, waiting times, costs, and acceptance conditions. Ask them to make and document a recommendation with the client.
The trainee checks the required level and urgency of care, individual credentials, actual service capacity, client preferences, and access. They identify the selected option, alternatives, interim needs, and exactly what the receiving service has accepted. Financial interests are disclosed and do not determine the match.
Choosing a resource solely because of familiarity, treating an assessment appointment as accepted ongoing care, or leaving an urgent need on a routine waiting list requires a revised plan.
The assessor records the scenario, date, work reviewed, observed performance, feedback, and any required practice. Use the ratings demonstrated, needs further practice, or not observed for each task. A verbal answer alone cannot establish performance on a task requiring demonstration. Confirm readiness only for the work assessed and within the trainee’s authorized role.
Summary
Match the identified need with a resource that can provide appropriate care and that the client can realistically use. Verify credentials, the actual service, availability, costs, access, and accountability. Ask about language, identity, culture, approach, recovery goals, and earlier experiences without assuming what those preferences should be. Explain what has been checked and what remains uncertain. When specialist care is unavailable, consider clinically appropriate interim assessment and support with clear responsibility. Do not substitute an unqualified service for required care. Review the match after contact and update the plan when circumstances change.
References
American Psychological Association. (2017). Ethical principles of psychologists and code of conduct (2002, amended effective June 1, 2010, and January 1, 2017). https://www.apa.org/ethics/code
Horvath, A. O., Del Re, A. C., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48(1), 9-16. https://doi.org/10.1037/a0022186
Tervalon, M., & Murray-García, J. (1998). Cultural Humility Versus Cultural Competence: A Critical Distinction in Defining Physician Training Outcomes in Multicultural Education. Journal of Health Care for the Poor and Underserved, 9(2), 117-125. https://doi.org/10.1353/hpu.2010.0233