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Home & Community-Based Care Coordination

Home and Community-Based Care Coordination

CATS works with families to reduce the need for out-of-home placements, including the number of children needing foster care, hospitalization, residential treatment or detention through our Children’s Health Home and High Fidelity Wrap Program. The following comprehensive services help families gain the skills to preserve the family unit.

Children’s Health Home

A Health Home is a care management  service model whereby all of an individual’s caregivers communicate with one another so that all of the child’s needs are addressed in a comprehensive manner.  All the services and partners are collectively considered as the “Health Home”.  CATS will provide a care manager to eligible children, youth and their families to provide access to services assuring they have everything necessary to stay healthy.

Who is Eligible to enroll?

Children from birth to age 21 who are presently enrolled in Medicaid and have two or more chronic health conditions or one single qualifying condition:

  • Severe Emotional Disturbance
  • Complex Trauma
  • HIV/AIDS
  • Can benefit from this level of care

What does a Children’s Health Home do?

  • Comprehensive Care Management
  • Care Coordination and Health Promotion
  • Comprehensive Transitional Care
  • Individual and Family Support
  • Referral to Community and Social Support Services

 

High Fidelity Wrap Program

CATS partners with the family to create and implement an individual plan of care that supports and strengthens the family in order to maintain the child in the community. The High Fidelity Wrap Program is a nationally recognized, evidence-based model that works with youth and their families.

The process attempts to maintain the youth in their community-based family setting, instead of entering into out-of-home placement, hospital, or a residential treatment program. By partnering with the entire family, a collective family vision is created to form the family’s Plan of Care (POC) or treatment plan. Monthly Child & Family Team (CFT) meetings are held with team members that the family identifies as a part of their team. This wraparound philosophy includes the entire family and attempts to locate natural supports to assist a family in meeting their needs.

Natural supports are individuals or organizations available to families in their own community. These can include spiritual or social networks, extended family members, ministers, and/or neighbors. In the event that natural resources are unavailable, service providers can be retained to assist a family meet their goals.   Ultimately, the goal is to empower and educate the youth and family about resources in their community rather than having to rely on paid professionals to meet the family’s needs.

Wraparound is a planning process that follows a series of steps to help families realize their hopes and dreams. Services are planned and delivered with a family driven strength-based focus using the a process which creates a collaboration between the youth, their families and a team they select. Each family receives individualized services that are family driven, youth guided, community-based, and culturally sensitive to their needs.

The Key Characteristics of the High Fidelity Wrap Process Include

  • Create a Plan of Care that specifically addresses the unique needs of the family & is approved by the parents & the youth
  • Identify the strengths & needs of the youth & family
  • Create a family support system where the family form a Child & Family Team (CFT) of support to help with the decisions of what is best for the youth & the family
  • Educate & empower families & youth to take an active role in planning what care they feel they need to move to the next level in life & reach independence
  • Identify natural supports that exist within the family structure & the community
  • Create an awareness, understanding & utilization of natural supports
  • Create an individualized plan of care that supports the whole family, thereby strengthening the family
  • Collaborate with parents to address the needs of the child, particularly when the child or family is receiving services or support from more than one system provider (e.g., Department of Social Services, Juvenile Justice, or Department of Mental Health)

“My husband and I wanted to let you know how well our daughter is doing since we have been involved with your program and received your help. She has averages in the 80s in high school, has been accepted to college and is currently looking for a summer job. Thank you so much for EVERYTHING! It is great to have our family back.”

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