Understanding the Implications of a Referral to a Higher Level of Care for You or a Loved One

Receiving a referral for a higher level of care from your clinician can feel overwhelming and confusing. Let's break down what this really means—and what it doesn't.

What Does It Mean?

At its core, a referral to a higher level of care means your clinician (therapist, dietitian, doctor, etc.) wants you to receive a level of care that matches your needs based on your symptoms and their clinical judgment. Clinicians have boundaries around what they will and won't treat based on their training and experience—this is called their scope of practice. Practicing beyond one's scope is unethical and could result in serious consequences for your provider's professional license and for your health and safety.

Receiving a referral for a higher level of care means your provider is willing to risk their livelihood, and potentially hurt your feelings, to prioritize your safety and wellness.

The Level of Care Ladder

Think of levels of care like a ladder, with each rung representing increased intensity and support:

Outpatient Care (Bottom Rung) 

This involves hour-long weekly (sometimes bi-weekly or monthly) appointments with your provider. At this level, clients are expected to have decent motivation to recover, be fairly self-sufficient in caring for themselves, and have a good support system they feel comfortable reaching out to when needed. This is the most basic level of care and what most people think of when considering therapy.

Intensive Outpatient Treatment (IOP) 

IOP can occur virtually, at a treatment center, or in a hospital setting. Treatment typically lasts about 3 hours per day for several days a week, though scheduling varies by program. IOP provides group support, individual support, and often includes family support, medication management, meal support, case management, and peer support. Clients are expected to have fair to good motivation to recover and adequate emotional and practical support. They live at home and can often engage in treatment outside of work or school hours.

Partial Hospitalization Program (PHP) 

PHP requires full-day treatment for most of the week and offers similar support as IOP but in a more structured setting. Clients may have partial motivation to recover, be preoccupied with frequent intrusive thoughts, and need more structural support. While they live at home, they often need to take a leave of absence from work or school to meet program requirements.

Residential Treatment 

Clients live at a treatment facility and receive comprehensive support, which may include additional services like mindfulness training, yoga, tai chi, or massage therapy. This level is appropriate for clients who struggle with motivation to recover, are preoccupied with intrusive thoughts, need supervision, and have limited support systems. Residential treatment provides an opportunity to step away from current circumstances and receive intensive help.

Inpatient Treatment (Top Rung) 

Clients reside at a hospital and receive around-the-clock medical supervision. This level is needed when someone requires stabilization and medical assistance that only a hospital can provide, which may include psychiatric stabilization, detoxification, or medical interventions.

Just as someone can travel up a ladder, they can also travel back down when ready. A referral for higher-level care means your clinician sees that you have needs that can be met with different treatment approaches using tools and expertise they may not have access to.

What a Higher Level of Care Referral Does NOT Mean

It doesn't feel good to receive a referral for a higher level of care. It can be disappointing and scary, but it's not a personal failing.

Five Messages Your Provider Is NOT Saying:

• This is all your fault

• I don't like you

• You are too much

• You are broken beyond repair

• You are not enough

Five Messages Your Provider IS Saying:

• I see you—I see your struggle and pain

• I care about you as my client and as a person

• I want the best for you

• Your safety is my top priority

• I believe in your ability to feel better

It's tempting to believe those negative messages when you're already in pain, but they're not true and will keep you stuck. Clinicians recommend higher levels of care when they feel it's appropriate and medically necessary.

Could you continue with your current level of care and see how it goes? Perhaps, but it could take significantly longer to achieve the results you want. With some conditions—like addictions, suicidal ideation, and eating disorders—time is critical. It's important to act swiftly when your provider makes a higher-level care referral because they're doing so in good faith that you need this change in treatment to not just improve, but to thrive and stay safe. 

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The information provided on this blog is for educational and informational purposes only and is not intended as medical advice. The content should not be used to diagnose, treat, cure, or prevent any disease or medical condition.