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Care Coordination

What is Care Coordination?

Care Coordination is the organization of care activities between two or more participants, including the person served and family (with consent) involved in an individual’s care to facilitate the effective delivery of health care services. Care Coordination Services has relationships with Okaloosa County community organizations and is cultivating new relationships with community organizations in Escambia, Santa Rosa, and Walton counties.

Purpose:

  • Collaboration
  • Connection
  • Assessment
  • Partnership

    Priority Population:

    • Adult acute care high utilizer
    • Individuals discharged from a State Mental Health Treatment Facility (SMHTF)
    • Adults with multiple arrests and/or incarceration
    • Individuals awaiting placement in an SMHTF
    • Other as approved by the Department.
    • Families with infants experiencing, or AT RISK for, NAS or SEN
    • Caretakers and parents considered AT RISK for Involvement with child welfare with behavioral health needs.
    • Children/adolescents with multiple arrests/incarceration (does not meet the criteria as a high utilizer)
    • Families INVOLVED with the child welfare system with behavioral health needs.
    • Children and adolescent acute care high utilizers (including children not currently receiving services by a CAT Team)
    • Adolescents, as defined in s. 394.492, who require assistance in transitioning to services provided in the adult system of care.
    If you are interested in utilizing Care Coordination Services, please reach out to Bridgeway Center at bridgeway@bridgeway.org

    Early Childhood Care Coordination

    The Early Childhood Care Coordination (ECCC) program is designed to strengthen the bond of connection between caregiver and child, to promote healthy early childhood neurodevelopment in a safe and stable environment, both in the home and early childcare settings.

    Adult Care Coordination

    Adult Care Coordination (ACC) works with eligible adults to ensure they receive the care they need to improve their physical, behavioral, social, and health. The ACC facilitates connections between healthcare and service providers to support individuals and bridge gaps in the care system. The ACC will connect the adult to a treatment home as well as community support.

    Youth Care Coordination

    Youth Care Coordination (YCC) works with eligible, at-risk youth to ensure they receive the care they need to improve their physical, behavioral, social, and health. The YCC facilitates connections between healthcare and service providers to support individuals and bridge gaps in the care system. The YCC will connect these young people and their parents/guardians to a treatment home and as community support.

    Residential Stability Coordination

    Available for persons aged 18 or older, experiencing a behavioral health condition, who are experiencing immediate and long-term barriers to stable housing or at risk of or currently experiencing homelessness.