Start Healthy Program 

This care coordination program provides services to pregnant women and families. Prenatal Care Coordination assists pregnant women in accessing a Primary Medical Provider, provides education about pregnancy and childbirth, (especially in pre-term labor and smoking cessation) and provides advocacy on behalf of women.  Family Care Coordination assists families who may not be accessing health care appropriately.  The family may have a child who is chronically ill and cannot afford regular medical care or the family may have recently moved to the area and does not have a family physician.  Some families “doctor shop”, seeking a new physician when they can no longer pay their bill and some families use the emergency room as the primary medical provider.  Family Care coordination insures all children are current on their immunizations, dispenses education about second hand smoke and injury prevention and advocates on behalf of the family.  

The Role of the Family Care Coordinator Is: 

 

·        To comprehensively evaluate the family using assessment skills and interviewing techniques to gather information concerning current and anticipated needs and problems.

·        To serve as an advocate for the family in facilitating services for at least the pregnant women, children, adolescents, children with special health care needs, children who are at risk for developmental delays, and other family members whose presence impacts the health and safety of the enrolled family..

·        To ensure families have a primary care provider for preventive and acute health care with 24-hour coverage.

·        To establish a working relationship with the primary care provider and promote and ongoing exchange of pertinent information that could impact the health or care of the client.

·        To ensure compliance with appointments to those medical and other services such as dental health, mental health, and vision and hearing services as necessary.

·        To increase compliance of families with medical care recommendations such as immunizations, therapies, and office procedures of the primary care provider.

·        To provide health education interventions to members of the family to reduce risk-taking behaviors and improve parenting skills.

·        To teach the family signs of illness, pregnancy complications, treatment of simple injuries, care of minor injuries, and illness to prevent overuse of emergency rooms for non-emergency care.

·        To identify barriers or factors those impinge upon the client’s ability to utilize and benefit from primary health care services.

·        To develop and maintain a viable network of community resources for families to meet all their needs.

·        To make appropriate referrals to community agencies and provide follow-up to assure continuity of care.

·        To work collaboratively with other community service providers and care coordinators to prevent fragmentation and gaps in services or duplication of services.

·        To work actively with families at risk of suspected child abuse or neglect in order to assist or reduce the involvement of child protective services.

·        To evaluate effectiveness of services provided through tracking and follow-up of clients.

·        To evaluate the family’s coping skills (e.g., with HIV)

·        To assist clients with pharmaceutical monitoring and compliance.

·        Advocacy in discrimination (E.g., HIV, disabled.)

       

Prenatal Care Coordination