The Behavior Health Home Team is an integrated team of providers using a health home model. The team will include a multidisciplinary set of providers including a Clinical Team Leader, a Primary Care Physician/APRN, a Psychiatrist, a Nurse Care Manager, Team Nurse, Licensed Social workers, Skills Development Home Health Specialists, and Engagement Specialists. This team will increase consumer access to integrated mental health & primary care by using a health home model to support the recovery of this high risk population. This team will also be using innovative technology-based resources to manage health outcomes.
The Community Health Home Specialist position will work to coordinate integrated primary and behavioral healthcare services to promote continuity of care and improved health outcomes. To develop skills including self-care, daily life management, problem-solving, wellness and disease management using structured interventions for attaining goals identified in the recovery plan and the monitoring of progress in achieving those skills.