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GUIDELINES FOR SOCIAL WORK REFERRAL
OBSTETRICS AND GYNECOLOGY SERVICE
These guidelines have been developed to help providers on the Obstetrics and Gynecology Service
to consider the situations where referral and/or consultation might be of help. These situations are
meant to serve as “red flags” and are not meant to serve as “automatic” referral criteria. In each of
these situations, the provider should use clinical judgment, taking into account whether these
situations impact on the patient and/or baby’s current safety and wellbeing.
I.
REFERRALS/CONSULTATIONS REGARDING:
A.
At-Risk Situations
1.
Current history of domestic violence, sexual assault. If pt has a past history of
DV or sexual assault, consider referral if this impacts the patient’s safety or
adaptation to current situation.
2.
Current history of substance abuse. If currently using, does the pt have an
interest in pursuing treatment. If patient has a past history of substance
use/abuse, consider referral if patient is at risk for relapse.
3.
Current or past history of DCF involvement. Children not in patient’s care or
custody
4.
Current history of psychiatric illness or hospitalization. Staff should determine
if patient has current therapist or treatment team and if so, refer pt back to that
team. If pt has a past history of psychiatric illness, consider referral if patient
is showing signs/symptoms of recurrence.
5.
Young mothers (under 21) with history of poor prenatal care and uncertain
family/social supports. Inconsistent or lack of prenatal care in the absence of
other barriers to care
B. Obstetric/Neonatal Problems
1.
Parents with premature, anomalous or otherwise compromised newborn
2.
Current or past history of prenatal demise (miscarriage, IUFD, stillborn,
neonatal death )
3.
History of depression and/ or postpartum depression. Referral should be
considered if patient does not have a therapist and/or patient is demonstrating
acute symptoms
4.
Complicated delivery of newborn ( difficult labor, emergency c-section, DIC,
hysterectomy)
5.
Undelivered patient with uncertain pregnancy outcome. Pt with more than
usual anxiety around parenting, coping with newborn.
6.
Adoption or possible foster care; ambivalence about parenting
7.
Lack of resources (food, clothing, shelter, baby supplies)
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C. Gynecologic Problems
1. Patient distress related to current or past history of sexually transmitted diseases
2. Emotional distress related to diagnosis or surgery (new cancer diagnosis,
hysterectomy)
3. Conflict around decision making (ex: keeping or terminating pregnancy, tubal
ligation).
4. Threatened or completed miscarriage
5. Emotional distress related to infertility
II.
TO INITIATE A REFERRAL:
A.
Establish if patient is known to social work. To obtain this information, call the social
work department (617-667-3421) or look in registration field of clinical computing
under Demographics. If known, contact the social worker involved. If not known,
email referral to SWD-OGN or look at coverage schedule and call the covering social
worker.
B.
For resident outpatient cases, not currently known to a social worker, call Nina
Douglass (7-5725). For attending/private patients, call Barbara Sarnoff Lee (7-4628).
Non-urgent ambulatory patients will be offered an appointment within one week.
Non-urgent inpatients will be seen within 48 hours of referral. Urgent/emergent
patients will be seen within 24 hours or directed to ED as needed. Emergent inpatient
cases will be seen on the day of referral.
If there are any questions, contact: Barbara Sarnoff Lee, LICSW
Director, Social Work
(617) 667-4628 (Beeper 33010)
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