CARE Network

CARE Network offers health care navigation and interventions to select populations of patients with an overall goal of providing individuals the tools needed to become active partners in their health management, especially during times of transition between health care settings. Connection to resources for housing, transportation and social services, medication self-management, disease process education, Behavioral Health Services, support for follow-up visits and respite housing are some of the interventions provided.

The CARE Network team coordinates planning of services with hospital inpatient discharge planning as well as the emergency department, then works with patients outside of the hospital setting. The care and services provided by the team are evidence-based, person-centered and focused on a community-based, multi-disciplinary approach, linking individuals to the various resources available to help meet ongoing health care needs.

The CARE Network team consists of registered nurses, social workers and community health workers.

All CARE Network Services are voluntary and provided free of charge to patients.

CARE Network Services

Substance use disorder (SUD) services and navigation

Population served: Emergency department patients with substance use issues who would benefit from and are interested in substance use treatment. Linkage to Medication assisted treatment (MAT) provided. Services are provided by the emergency department substance use navigator (SUN) and ED social worker.

Referrals: 707-445-8121 ext. 5840

Medical respite program

Population served: Unhoused individuals who are being discharged from the hospital, and who need the opportunity to recuperate in a safe, healing environment while accessing medical care and other supportive services post-hospitalization. The CARE Network Team provides care coordination, case management and transitional assistance to clients in medical respite throughout their stay, which is typically up to 21 days.

Referrals: 707-445-8121 ext. 5858

Enhanced Case Management (ECM)

Population served: Partnership Health Plan members who are at high risk for hospital admissions or multiple emergency department visits due to complex social and health issues. ECM clients receive intensive, personalized, goal-oriented case management from a team of community health workers and social workers. The length of service is determined by need and as authorized by Partnership Health Plan.

Referrals: 707-445-8121 ext. 5858

Transitional care

Population served: Recently hospitalized patients with chronic health conditions and at higher risk of complications. Phone calls and home visits are provided to offer support and guidance with questions related to hospital discharge instructions and necessary follow-up care.

Referrals: Received via EPIC or 707-445-8121 ext. 5828

Providence Mother Bernard House (MBH) supportive services

Population served: Previously unhoused people residing at the MBH permanent supportive housing unit in Eureka. Services are provided to help tenants adjust to and succeed in this housing environment.

Learn more about Providence Supportive Housing