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Coordinating Across the System of Care
Care Coordination Teams
The Need
Enhancing collaboration among service providers, as a means of increasing the quality and availability of care to families and individuals, is a high priority for the CCNTR Board of Directors and member agencies. Service delivery in rural areas, can be fragmented and difficult for people to access because of gaps in available services, or difficulty in getting people to services, or in coordinating care among agencies because of shortages in professional staff.
Actions
CCNTR developed care coordination teams centered in Franklin and Bristol to encourage service providers to meet regularly, solve problems together for households, and identify needs, in terms of the larger service delivery system. Four teams are currently operating and engage in resource sharing and opening access to care discussion.Today, the Care Coordination Teams in the CCNTR region consist of direct service providers. Four teams hold regularly scheduled monthly meetings. The Franklin Children’s Team meets at the Franklin
Middle School in the Franklin Family Resource Center. Members in Franklin who work with Adult & Elder clients meet for the Franklin Adult Care Coordination Team at the Franklin Visiting Nurse Association. The Southern Grafton County Elder Resource Team and the Newfound Children’s Care Coordination Team meet monthly at the Bristol Town Office and support all services in the Newfound area. For information on these meetings and when they occur, please contact Michael Loomis at 934-0177 ext 102.
Practices are in place that safeguard individual confidentiality while supporting individual agency policy. Additionally, CCNTR coordinates staff development and training opportunities for member agencies, making the best use of limited training budgets.
Involvement
All CCNTR member agencies, committees of the Board, staff and partners, work together to implement projects that improve care coordination. These long-term commitments to strengthen the way agencies work together, in order to best deliver care, are supported by the management and staff of not-for-profits, public agencies, municipal officers, as well as, community members. This work is funded by a Rural Health Network Development Grant and Healthy Communities Access Project.
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