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Decision Support:
Incorporate Community-Based Staff (Social Workers and Case Managers) into Decision Support
  1. Include case managers and other community-based staff in the assessment and treatment decision-making process (e.g., assessment of timing and choice of medications, ongoing medication adherence, identification of related co-morbidities such as substance abuse).
  2. Identify areas of interest overlap and ensure that standard assessments include information of mutual interest (e.g., medication adherence, harm reduction).
  3. Ensure sharing or common use of treatment guidelines.
  4. Assign shared responsibility for follow-up.

Tips
  • Build social relationships between clinical and community-based staff.
  • Include feedback from peer educators and volunteers when making care decisions.
  • Hold case presentations involving providers and community-based staff.
  • Combine charts when possible.
  • Survey or assess provider satisfaction.
  • Assess unity and coordination of care.



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