Care
Coordination
People who are struggling and suffering have needs that overlap in complex ways.
This often means that those most in need end up having to navigate a system that is fragmented into many silos and sectors (e.g., health care, housing, transportation, food, and nutrition).
Because no single agency or program can meet all the intertwined social and health needs of individuals and families, organizations must coordinate to provide effective care.
Community-Based Care Coordination
Since 2018, Thriving Together NCW has invested in programs and coordinated initiatives that enhance community-based care coordination across the region.
Community-based care coordination is a relational and person-centered approach that organizes and facilitates access to comprehensive social and health care services to increase the wellbeing of individuals and those who care for them.
Our long-term goal is to build a Social Care Network that effectively responds to the intertwined needs of North Central residents who are struggling or suffering.
Community Care Hub
Thriving Together NCW is working with Action Health Partners and Advance to build our North Central Community Care Hub infrastructure, thanks to funding from various state entities. We are working closely together to build a Social Care Network and create a system that works for people, rather than a system that makes people work.
How do Community Care Hubs work?
Community Care Hubs of Washington connect and coordinate a regional network of social and health service providers, so people can get the care they need when they need it. Hubs connect anyone in the region to the support and social services they need through a trusted and trained community-based workforce.
Community-based workers (trusted messengers and professionals rooted in the community) provide one-on-one, culturally responsive support to help people achieve wellbeing and thrive. The community-based workers in our contracted network have been trained to provide community-based care coordination.
By contracting with and building the capacity of diverse community-based organizations, our North Central Community Care Hub helps strengthen a culturally and linguistically diverse workforce rooted in the communities they serve – communities often experiencing the highest rates of health disparities.
How do I make a referral?
To get the referral process started, you can:
Use our streamlined and HIPAA compliant referral form to share some basic information.
Call 1-833-453-0336 to talk to dedicated and trained intake staff from our centralized call center team.
With this information, our hub partners will make sure referrals are routed to the most appropriate care coordinator in our North Central region.
Social Care Network Updates
Our efforts are a delicate balancing act between navigating the needs of our people and region alongside the expectations of state and federal funders. Through brief and regular updates, we aim to connect the dots and bring clarity to this complex, ever-evolving work.
Read past updates here:
Sign up for future email updates to stay informed about the latest initiatives, resources, and opportunities to make a difference.
We are always open to questions from those wanting to understand more – and feedback from those committed to helping us make things better. Questions, input, advice? Connect with Caroline.
Caroline Tillier
Director of Strategy & Community Integration