Integrated Health Home Program
The Integrated Health Home continues our overall mission to deliver the highest quality of care in the best possible environment. It is a wellness program designed to provide behavioral health and physical health services and ensures that each client has an ongoing relationship with both a medical- and a psychiatric-licensed independent practitioner in a co-located facility. Clients benefit from having access to team-based clinical providers offering integrated care and coordination of services that help them get healthy and stay healthy.
Servicing both Monmouth and Ocean Counties, the Integrated Health Home offers:
-
Enhanced Discharge Planning
-
Case Management
- Care Coordination
- Client and Caregiver Education
- Staff and Provider Education
- Social Support Assessment
- Referral Interventions
- Client Self-Care Plan
- Screening Tools
- Medical Home
- Client Group Visit Plans
- Nutritional Support
- Home Visits
The Integrated Health Home Team Focus
- Ensure that each patient has an ongoing relationship with medical and psychiatric-licensed practitioner in a co-located facility
- Ensure coordination and access to chronic disease management, and screening and prevention services including self-management support and health navigation provided by community health workers to clients and their caregivers
- Ensure treatment compliance by providing outreach to clients
- Ensure the development of a single treatment plan that includes behavioral health issues, medical issues, substance abuse issues and social needs. This includes incorporating interventions such as nutrition monitoring, healthy lifestyle coaching and wellness activities
- Ensure all client information is maintained on a secure electronic health record (EHR)
For more information, please contact our Integrated Health Home program at 732.923.6500 ext. 7
.png)