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7.5.10.2 Community Health Services (CHS)
The goal of the PCCM CHS program is to facilitate the coordination of health related services required by PCCM clients. This means collaborating with providers, clients, and their families in identifying problems and resources, and removing barriers in accessing treatment and services. PCCM community health coordinators are located in all PCCM SAs. Examples of services offered by staff include:
• Provide counseling for clients who miss appointments.
•Provide counseling for clients who inappropriately use the ER.
•Educate clients about obtaining PCCM services.
•Management of high-risk pregnancies in conjunction with the client's physician.
•Pediatric care coordination and education services for acute and chronically ill children.
•Case management for all chronic and/or complex cases identified and eligible for CHS.
•Assistance in accessing state and community resources.
•Assistance in improving healthy behaviors and treatment compliance.
•Provide health education on a variety of health-related topics.
By offering the above services, PCCM assists both providers and clients with early, expedited access and intervention, increasing the likelihood of improved health outcomes.
Clients can be referred for health-care management and/or education on the following subjects:
•A newly diagnosed condition.
•Asthma management.
•Coronary artery disease.
•Chronic obstructive pulmonary disease.
•Dental health.
•Diabetes management.
•Effective use of benefits.
•Hypertension.
•Nutrition.
•Otitis media.
•Prenatal education.
•Parenting and child development.
•Puberty education.
•Safety.
•Smoking cessation.
Community health coordinators assist clients in obtaining food, clothing, and other resources by linking them with public and/or private community organizations.
Providers interested in scheduling a community health education program in their office or referring a PCCM client for CHS can do so by:
•Completing the "Primary Care Case Management (PCCM) Community Health Services Referral Request Form" and faxing to 1-512-302-0318; or
•Calling the CHS Intake staff at 1-888-276-0702, Monday through Friday, 8 a.m. to 5 p.m., Central Time. A message can be left between 5 p.m. and 8 a.m. TMHP staff will return calls on the next business day.
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