Care Coordination

Services Offered
 
Maternity Care Coordination (MCC) - Baby Love Program

The Maternity Care Coordination Program provides specially trained Social Workers called Maternity Care Coordinators to assist pregnant women in obtaining medical care and an array of social support services such as transportation, housing, job training and child care. Services are provided at prenatal clinic sites, client’s homes and in the community. Participants are encouraged to attend childbirth and parenting classes. In addition, participants are encouraged to continue their education and career counseling is provided. A home visit is provided by a public health nurse for postnatal assessment and follow-up care for mom and her newborn baby.
 
Maternal Outreach Worker (MOW) Program

The Maternal Outreach Worker Program offers the support of a trained home visitor to work one-on-one with at-risk families in their homes or the community, to provide social support; encourage healthy behaviors, and ensure that families are linked with available community resources. The Maternal Outreach Worker is a critical part of the Care Coordination Team, and enhances and extends the services provided by the Maternity Care Coordination and Child Service Coordination programs.
 
Services are provided to eligible pregnant women through 60 days postpartum and babies enrolled in the program by 2 months of age through their first birthday.
 
Child Service Coordination (CSC) Program

The Child Service Coordination program provides services to families of children birth-5 who are at-risk for or have been diagnosed with developmental delay/disability, serious illness or social/emotional problems. Services are provided by qualified Public Health Social Workers called Child Service Coordinators through monthly home visits, telephone calls and community visits. The CSC’s work with families to make sure their child receives the best care during the first years of life. Assistance is provided to help facilitate medical appointments, transportation, developmental evaluations, counseling and education. The program staff collaborates with a variety of agencies to ensure the overall needs of a child are identified and met.
 
Healthy Start Baby Love Plus

The Baby Love Plus program promotes strong and healthy communities designed to give babies the best possible start by improving families access to essential health and social services. The program is staffed by two Community Health Advocates who actively reach into the community to recruit pregnant women into early prenatal care and promote the importance and availability of health and social services to women of childbearing age and their families. An Enhanced Care Coordinator (Social Worker) provides counseling and support services to women identified as high-risk during the interconceptional period which is 60 days postpartum through two years.
 
The goals of this program are to empower the clients to effectively manage their health and psychosocial needs; better navigate the health and social service system; and increase use of contraception. Transportation is available to families for emergency medical appointments, department of social services visits and appointments to receive counseling for women experiencing postpartum depression.

For more information call 252-641-7511