Care Management Configurations Overview

Overview

For helping professionals, identifying social needs is an important first step. Aunt Bertha provides tools to identify an individual’s needs, and leverages the Social Care Network to seamlessly recommend programs that can help! Below are features that can be configured for your site to support Care Management workflows.

 

Identify Needs

Assessments

Tier: Enterprise, Professional (HRSN and PRAPARE Assessments)

Assessments allow Customers to collect information about the people they’re helping and the social needs they may have.  Based on the information captured in the Assessment, search tools like Program Recommendation Summaries and Highlighted Search, can suggest helpful resources to meet needs that have been identified. 

Learn more with this overview, or view configuration options.

 

Guided Search

Tier: Professional, Enterprise

Guided Search assists staff in identifying resources by social domain area, based on the goals of the person being helped. Developed in partnership with the Camden Coalition, we’ve digitized principles of motivational interviewing to help guide staff through domains of care, drivers of behavior, and interventions to find the right resource for the person they’re helping.

 

This is a great tool for new helping professionals, or helping professionals who want support navigating for services outside of their area of expertise. Learn more, and talk to your Customer Success Manager (CSM) to enable this feature.

 

Connect to Programs

Tier:  Basic, Professional, Enterprise

Connect

Connect allows people in need to connect directly to programs, or allow staff to make referrals to Community Based Organizations (CBOs) listed in the Social Care Network. Simply click the button (“Refer” or “Contact Here”) and fill out the form. 

When sent...

The person being helped:

  • Receives a notification with next steps to reach out to the program
  • Has the referral saved so they may log in and review or update it later

The Community Based Organization (CBO):

  • Receives a notification with next steps to reach out to the person in need
  • Has the referral saved so they may log in and review or update it later

The Helper:

  • Has the referral saved so they may log in and review or update it later

Who from my organization can see submitted referrals?

By default, the person who made the referral has access to it. Customers may set up teams and enable “Team Navigation” so that all team members can see referrals made by other members of their team.

Configuration Options

Additional optional fields can be added to referral forms for Customer sites. If you have additional questions about Connect, please talk to your Customer Success Manager (CSM).

 

Care Management Tools

Goals

Tier:  Basic, Professional, Enterprise (custom goals)

Goals allow staff to organize information like notes and referrals around different social needs as they are helping someone. Goals can be auto-generated based on an Assessment. Learn more about how goals work.

Enterprise Customers, contact your Customer Success Manager (CSM) to set up Custom Goals.

 

Navigation Notes

Tier:  Basic, Professional, Enterprise (custom notes)

Navigation Notes allows Helpers to track activity that they have done on behalf of the person they are helping, or add notes about their referrals and goals. Notes can be made in the Navigation History section, on goals, or on individual referrals. Learn more with this overview, or view configuration options. Learn more with this overview, or view configuration options.

 

Forms

Tier:  Professional, Enterprise

Access submitted Assessments and their corresponding search results under the “Forms” section. This allows staff to review submitted assessments, and make referrals based on those results. Learn more.

 

Custom Seeker Profile Fields 

Tier:  Professional, Enterprise

Seeker Profile Fields store important personal information about the person your teams are helping such as name, email address and phone number so that the Helper can easily view that information. Additional fields, such as Patient ID, address, or zip code can be added for Professional and Enterprise customers to track even more information.

Drop down fields, ID numbers and date fields are automatically added to the People I’m Helping Dashboard to allow staff to easily search and filter for people based on the information in these fields. Learn more with this overview, or view configuration options.

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