• IHPI assigned newly hired Community Health Worker for integration into ARE Early Intervention Services Program.
• RW Case Managers began referring consumers to Early Intervention Services Program for follow up.
• Case Managers identified 10 consumers who had fallen out of care. EIS Staff (Education/Outreach Coordinator and Community Health Worker) worked to confirm status of these individuals and verify if they were a) engaged in treatment elsewhere b) moved out of state c) not in treatment
• Four consumers who had fallen out of care were reengaged and currently being followed by Community Health Worker while working toward sustained adherence to treatment. Results measured by number of Medical Appts attended, medication adherence, frequent contact with CHW.
• Additional referrals were made to EIS Program for follow up for those identified by CM’s as at risk for falling out of care. Follow up included; frequent contact by CHW to support engagement, medication adherence counseling, support group referral, etc.
Identified Barriers to higher retention rates:
• Consumers not considering their treatment/healthcare as a priority and allowing other life issues such as running a business, work, family etc. take precedence over their health.
• Substance Abuse Issues, Mental Health Issues, Incarceration, Language
• Changes in state programs