Page 1 of 2 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) Page 2 of 2 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) s:\social work\word\obgyn\guidelines referral (3).doc 2/15/16