IASC Reference Group on Mental Health and Psychosocial Support in Emergency Settings: Inter-Agency Referral Form and Guidance Note

The referral form is intended to be used by humanitarian organisations working with persons with MHPSS problems. The referral form and guidance note are tools to facilitate inter-agency referrals, referral pathways, trainings and workshops, and as a means to document referrals in accordance with minimum standards. The referral form and guide can be used by any service provider for example, by a Doctor working in a primary healthcare centre referring a child to a child friendly space or a nutrition feeding programme, or a Case Manager referring a client for physical rehabilitation. It can also be used by persons providing Psychological First Aid, depending on the person’s role/ responsibilities, after a distressing event.

The referral form is designed to facilitate referrals between and within all four levels of
the IASC MHPSS Intervention pyramid. Case Managers and Community Workers may find the tool of particular use in their work with individual clients and their families.