Individual and Family Supports. The AMH+ practice or CMA must incorporate individual and family supports by performing the following activities at a minimum:
i. Educate the member in self-management;
ii. Educate and provide guidance on self-advocacy to the member, family members, and support members;
iii. Connect the member and caregivers to education and training to help the member improve function, develop socialization and adaptive skills, and navigate the service system;
iv. Provide information and connections to needed services and supports including but not limited to self-help services, peer support services, and respite services;
v. Provide information to the member, family members, and support members about the member’s rights, protections, and responsibilities, including the right to change providers, the grievance and complaint resolution process, and fair hearing processes;
vi. Promote wellness and prevention programs; SAMPLE
vii. Provide information on establishing advance directives, including psychiatric advance directives as appropriate, and guardianship options/alternatives, as appropriate;
viii. Connect members and family members to resources that support maintaining employment, community integration, and success in school, as appropriate; and
1. For high-risk pregnant women, inquiring about broader family needs, offering guidance on family planning, and beginning discussions about the potential for an Infant Plan of Safe Care.
Individual and Family Supports. The Contractor must ensure the Health Home Care Coordinator involves individual and family supports in care coordination, care management, and transitional care activities, including:
12.13.1. Identification of the role that families, informal supports and caregivers provide to achieve the Beneficiary’s self-management and optimal levels of physical and cognitive function;
00.00.0. Xxxxxxxxx and support of self-management, self-help, recovery, and other resources necessary to achieve the Beneficiary’s health action goals;
12.13.3. Documentation and discussion of advance directives; and
12.13.4. Communication and information sharing with the Beneficiary’s family and other caregivers with appropriate consideration of language, activation level, literacy, and cultural preferences.
Individual and Family Supports. The Contractor shall ensure the Health Home Care Coordinator with Beneficiary’s consent involves individual and family supports in care coordination, care management, and transitional care activities, including:
12.13.1. Identification of the role that families, informal supports and paid caregivers provide to achieve the Beneficiary’s self-management and optimal levels of physical and cognitive function;
12.13.2. Education and support of self-management, self-help, recovery, and other resources necessary to achieve the Beneficiary’s health action goals;
12.13.3. Documentation and discussion of advance directives within the first or second HAP reporting period; and
12.13.4. Communication and information sharing with the Beneficiary’s family and other caregivers with appropriate consideration of language, activation level, literacy, and cultural preferences.