Our Process

1. Free Phone Consultation: 

Call us to hear more information, give a brief synapsis of your situation, discuss pricing and determine how we can best assist your needs. 

2. Contract for Services:

After your phone consultation, if both parties feel services will be a good fit and/or family has determined they would like to move forward with services, an appointment will be set to meet client(s) in their environment to further discuss care needs and initiate contracting. Upon completion of contract and cost for initial contracting/intake evaluation are paid, client will be scheduled for Comprehensive Assessment.

3. Comprehensive Assessment & Evaluation:

A Licensed Clinical Social Worker (LCSW) or Care Manager- team leader will come to your home to provide a comprehensive evaluation of: physical, mental, emotional, social, environmental, financial, functional, safety, and community support service needs. The assessment will identify key problems, strengths, needs and resources. Recommendations will be made and LCSW or CM will propose goals based on assessment needs and desired outcomes. 

4. Goal Planning:

LCSW and Care Manager will work with client and/or family to develop a goal plan that addresses the needs identified in the initial assessment.  The goals will help address needs and alleviate current emotional stressors as well as improve health, safety, and environmental concerns. Improved overall wellbeing is always our primary goal.

5. Care Coordination:

Our Care Management team provides linkages and arranges community supports and services, provides guidance and support to individuals & families, provides education, collaborates with physicians, hospitals, rehabs, assisted livings, advocates for client and maximizes continuity of care. Collaboration with all providers to ensure optimal delivery of services and care.

6. Care Management:

Care Manager provides ongoing monitoring and evaluation of client's overall wellbeing. Overseeing plan of care with the objective to monitor health, medical care, service delivery and satisfaction, environmental safety, social, emotional, and cognitive wellbeing. Client advocacy is a large component of Care Management to ensure all providers are working optimally for client. Ongoing frequent collaboration among physicians, service providers, and families. Frequent reassessment of goal plans and revising/adding to goals as new needs arise. 

7. Discharge:

Discharge from The Health Coach, LLC may take place upon achieving goals set forth in goal plan.  If and when a family or client feels that all needs have been met and there is no longer a need for ongoing care management and coordination a discharge plan will be provided. 

*At times families may feel a situation has stabilized and they no longer require frequent care management, but they do not want to discharge completely. They may request to go on WILL CALL status which means they are on hold until they need services again. During WILL CALL status a quarterly reassessment is required.