Scope of Practice & Referral Protocol for Non-Licensed Practitioners

1. Purpose and Application

1.1 This guideline states the scope of practice expected of non-licensed practitioners trained and certified by AccrediPro University, and the protocol by which presentations outside that scope are referred to licensed care. It is prepared by the Office of Academic Publications and reviewed by the Clinical Faculty Board.

1.2 The guideline applies to every practitioner who holds a University credential and works with clients in a coaching, educational, or lifestyle-support capacity, whatever the specialism of the credential. Where a practitioner also holds a professional licence — in nursing, dietetics, psychology, or another regulated field — the standards of that licence govern the licensed portion of her work, and this guideline governs the remainder.

1.3 Nothing in this document creates, enlarges, or replaces any legal authority to practise. The statutes and regulations of the jurisdiction in which the practitioner works prevail over this guideline wherever the two differ, and the practitioner is responsible for knowing the law that applies to her own practice.

1.4 The guideline rests on one principle, stated here once and assumed throughout: non-clinical practice works alongside licensed care, never in place of it. A practitioner who keeps that principle needs very little else in this document; a practitioner who loses it cannot be saved by the rest of it.

2. Definitions

2.1 Non-licensed practitioner. A person who provides coaching, education, or lifestyle support in matters of health and wellbeing and who does not, in that work, act under a governmental licence to diagnose or treat disease.

2.2 Licensed care. Assessment, diagnosis, treatment, or prescription provided by a professional acting under a governmental licence — among others, a physician, nurse practitioner, registered dietitian, psychologist, or licensed counsellor.

2.3 Non-clinical support. Education drawn from published and generally accepted health information; support for habits, routines, and behaviour change; goal-setting and accountability; and help preparing for, understanding, and following through on licensed care.

2.4 Diagnosis. The identification of a disease or disorder as the explanation of a person's signs and symptoms. For the purposes of this guideline, naming a suspected condition to a client as though it were established is diagnosis, however the sentence is phrased.

2.5 Treatment. Any intervention represented as curing, correcting, or managing a diagnosed or suspected disease, including the direction of medication, supplementation at therapeutic doses, or diets designed for a disease state.

2.6 Referral. The act of directing a client, explicitly and in documented form, to licensed care at the level the presentation requires.

2.7 Red-flag presentation. A sign, symptom, or disclosure listed in Section 5, or reasonably comparable to those listed, which requires referral whether or not the client raises it as a concern.

3. The Boundary of Non-Clinical Practice

3.1 A practitioner in non-clinical practice educates, supports, and accompanies. She may explain published health information in plain language; support the formation of habits in sleep, movement, nutrition, and stress within generally accepted guidance; structure goals and accountability; and help a client prepare for, understand, and follow through on the care of licensed professionals.

3.2 A practitioner shall not diagnose. She shall not tell a client what condition she believes the client has, shall not rule conditions in or out, and shall not present screening impressions as findings.

3.3 A practitioner shall not treat. She shall not represent any programme, protocol, product, or regimen as curing, reversing, or managing a disease.

3.4 A practitioner shall not direct medication. She shall not recommend that a client begin, stop, increase, decrease, or substitute any prescribed medicine, and shall refer every medication question to the prescriber or a pharmacist.

3.5 A practitioner shall not order laboratory testing for diagnostic purposes, and shall not interpret laboratory results as the basis of a diagnosis or a treatment decision. Where a client brings results to a session, the practitioner's role is to encourage and support a proper clinical review of them.

3.6 A practitioner shall not contradict licensed advice. Where she believes licensed advice deserves a second look, the correct instrument is a second licensed opinion, encouraged and supported — never a private countermand.

3.7 A practitioner shall not discourage a client from seeking or continuing licensed care, and shall not position her services as a substitute for it. This clause is breached as easily by implication as by statement, and the practitioner is responsible for both.

3.8 In an emergency, a practitioner's duty is the response any layperson owes: summon emergency services, stay with the person where possible, and hand over. She shall not attempt clinical management of an emergency.

3.9 A practitioner shall describe herself accurately. Titles, biographies, and materials shall state what she is — a certified practitioner in her field of study — and shall not borrow the dress of licensure. 'Diagnose', 'prescribe', 'patients', 'clinic', and their cognates are not the vocabulary of non-clinical practice.

4. The Referral Obligation

4.1 A practitioner shall refer whenever a presentation falls outside the boundary stated in Section 3 — whenever the question actually on the table is a question of diagnosis, treatment, medication, or unexplained symptoms. Referral is not a courtesy and not a last resort; it is the mechanism by which non-clinical practice remains safe.

4.2 Doubt resolves in favour of referral. The test is not whether the practitioner feels confident, but whether a careful colleague could reasonably want licensed eyes on the matter. If that question can be asked seriously, the answer is yes.

4.3 Referral is not the failure of an engagement; in most cases it is the engagement working. The chronic-care literature has argued for more than two decades that good outcomes come from coordinated teams in which self-management support surrounds — and never replaces — clinical care (Wagner, 1998; Institute of Medicine, 2001; Bodenheimer et al., 2002). The referring practitioner is doing the part of that team's work that belongs to her.

4.4 A referral suspends the practitioner's work on the referred matter until licensed care has seen it. Work on unrelated goals may continue where the practitioner judges it safe and useful, and shall be recorded as such.

5. Red-Flag Presentations Requiring Referral

5.1 The presentations below require referral whenever they appear — volunteered, observed, or discovered. Items in clause 5.2 require the practitioner to direct the client to emergency services the same day and, where the risk is immediate and the contact is live, to summon them herself.

5.2 Emergency response. (a) Chest pain or pressure, or pain radiating to the arm, neck, or jaw. (b) Sudden difficulty breathing. (c) Signs of stroke — sudden one-sided weakness, facial droop, slurred speech, or sudden severe headache. (d) Expressed intent or plan of suicide or self-harm, or disclosure of intended harm to another person. (e) Loss of consciousness, or confusion of sudden onset. (f) Signs of a severe allergic reaction following food, medication, or a sting.

5.3 Prompt referral to licensed care. (a) Unexplained or unintended weight loss. (b) Blood in stool, urine, or sputum, or unexplained bruising. (c) A new, growing, or changing lump. (d) Persistent pain without a diagnosed explanation. (e) Fainting, palpitations, or dizziness on exertion. (f) Symptoms of infection that are worsening or failing to resolve. (g) Signs of disordered eating — sustained restriction, purging, compulsive exercise, or a preoccupation with weight that distresses the client. (h) Any complication of pregnancy, and any significant new symptom in a client who is pregnant. (i) A chronic condition that appears unmanaged or destabilised, such as escalating blood glucose readings or uncontrolled blood pressure. (j) Suspected adverse effects of, or interactions between, medications or supplements. (k) Mood, anxiety, or trauma symptoms that are escalating or interfering with daily functioning.

5.4 The schedule is illustrative, not exhaustive. Chronic disease is common enough — by the Centers for Disease Control and Prevention's account, roughly six in ten American adults live with at least one chronic condition — that a practitioner should expect red-flag presentations as an ordinary feature of practice, and be unsurprised when they arrive.

6. The Referral Procedure

6.1 State the concern plainly and without diagnosis. The correct form names the observation and the boundary, not a condition: 'What you are describing is something a physician should look at, and it is outside what I do.' The incorrect form names a disease.

6.2 Direct the client to the level of care the presentation requires: emergency services for the matters in clause 5.2; the client's own physician or primary care for undiagnosed physical symptoms; a licensed mental health professional for psychological presentations; a registered dietitian for medical nutrition questions; the prescriber or a pharmacist for medication questions.

6.3 Put the referral in writing to the client — a short note restating the concern and the recommendation is sufficient — and enter it in the engagement record as required by the University's guideline on documentation and professional boundaries.

6.4 Follow up at the next contact. Ask whether the client has been seen, and record the answer. A referral without follow-up is half a referral.

6.5 If the client declines the referral, restate it once, plainly, and record the decline in the client's own words where possible. The practitioner shall then consider whether continuing the engagement serves the client, and shall not in any case continue work that assumes the referred matter is resolved. Where a declined referral concerns risk to life, the crisis provisions of the University's intake and screening standards apply.

7. Working Alongside Licensed Care

7.1 With the client's written consent, a practitioner may correspond with the client's licensed providers, and should welcome the arrangement: support of this kind works best in the open.

7.2 In any shared arrangement, the licensed professional's plan governs. The practitioner's contribution is structure, adherence, and encouragement — the self-management support that clinical teams have long been shown to need and to lack the hours to give (Bodenheimer et al., 2002; Wolever et al., 2013).

7.3 Information about a client passes to a provider only with the client's consent, and is limited to what the collaboration requires. The confidentiality provisions of the University's documentation guideline apply in full.

8. Documentation of Referral

8.1 Every referral is recorded: the date, the presentation in the client's words, the referral made and its level, the client's response, and the follow-up. The form of the record is governed by the University's practice guideline on documentation and professional boundaries; the obligation to make it is stated here.

8.2 A practitioner who cannot show a record of a referral should expect to be treated as though the referral was not made. The record is the referral's public form.

9. Review and Amendment

9.1 This guideline was prepared by the Office of Academic Publications and reviewed by the Clinical Faculty Board. It stands on an annual review cycle, and is reviewed earlier whenever the Board so directs. Amendments are published in the University's research library and supersede prior text on publication.