A client may decline, disagree with, or be unable to access a recommended Higher Level of Care. A client's decision does not automatically mean that treatment must end.
If my client declines, what should I do?
If a client declines or disagrees with an HLOC recommendation:
- Explore the client's understanding and perception of the recommendation.
- Ask why they are declining or disagreeing.
- Identify barriers to accessing care.
- Consider alternative treatment options when clinically appropriate.
- Reassess current risk and safety factors.
- Develop an interim treatment plan, as appropriate.
- Consider seeking professional consultation.
- Continue ongoing assessment and monitoring.
- Document the discussion, clinical reasoning, alternatives considered, and plan.
Consider the client's barriers
A client may decline HLOC because of:
- Financial or insurance limitations
- Location or transportation challenges
- School, work, or caregiving responsibilities
- Program eligibility
- Waitlists
- Treatment preferences
- Previous treatment experiences
- Cultural or language needs
- Technology requirements
Work collaboratively with the client to understand these barriers and determine whether reasonable alternatives are available.
Does declining HLOC mean I need to terminate care?
Not automatically. A client who declines or disagrees with an HLOC recommendation does not automatically require termination of care. Consider whether the client can continue to be maintained safely at the current level of care while you explore alternatives and address barriers to accessing HLOC.
If continuing treatment is not clinically appropriate, providers should use their clinical judgment and seek consultation when needed.