Table 3 Thematic categories with themes, subthemes, and exemplar quotes

Inconsistency in referral process

Varying referral types

“[There are] three or four … practitioners in [city] that I trust and then [I made] sure it was okay to refer to myself … It was really [figuring out how I will refer] on-site and just going ahead and coming up with resources that I already knew of. Or resources that other people at [the MCHC] knew of and … just asking and checking, ‘hey, are these appropriate?’”

Lack of infrastructure

“I got there an hour earlier so that I could be prepped and set up. But there wasn't a formal orientation ahead of time or anything like that.”

Provider referral resource knowledge

Professional network

“[The mental health screener] recommended a [local therapist]. I reached out to [them], and we set our initial consultation which was probably two or four weeks after I went to the [MCHC] … It's been a little over year, [they’re] still my therapist.”

Sponsoring organization

“The soft referral and the handoff is basically within our own organization. And with all of our forms and everything, and even with referrals, we get individuals to sign an authorization so that we can make that referral to another provider.‬‬‬”

Individual client barriers in the referral process

Resource limitations

“For some individuals, especially those that work, having to get off work to go to appointments [is an obstacle] because not everybody has the type of job where they have sick leave or [paid time off].”

Anxiety around healthcare systems

“A major issue … [is] if it's not an obviously affirming [provider], …because like if I send a referral to [a clinic,] they're not necessarily affirming or non-affirming. They're just the place to go if you need to see a psychiatrist and a counselor…so, depending on how sensitive [a client is] to people not being super affirming and understanding, that could be a deterrent.”

Opportunities for improving the client referral process

Follow-up with clients

“It’s the gaps that people can fall through. In [South Carolina] being a queer person seeking medical services [means] there are a lot of challenges. And so, anything to close those gaps and reach out and make sure that people are taken care of shows a great deal of respect and care for the community.”

Resource availability

“[Getting] local doctors when [the MCHC] does stuff would probably help because then [I am] able to [assess if], I really like [the] person. Let me see if I can schedule something with them or … they're able to link you up with somebody near because they're in that community.”