The term “care transition” refers to the movement patients make between healthcare practitioners and settings as their condition and care needs change. This program is designed to advance the skills and knowledge of existing care coordination professionals from hospitals, the health home, behavioral health facilities and/or other community-based settings to enhance the continuity of care across care settings, thus helping to deliver services to improve outcomes for patients, providers and payers.
This curriculum will better prepare professionals to work together in interdisciplinary teams with the patient. By sharing important clinical information and expectations about their role in the care plan, these efforts will assist regional and statewide initiatives to reduce potentially preventable hospital admissions.

This training program is intended for existing care coordination professionals from hospitals, the health home, behavioral health facilities and/or other community-based settings.

• 36 total hours of classroom training (12 three hour modules).
• Modules included:
1. Introduction to Care Coordination
2. Knowledge of Behavioral Health
3. Medical Terminology
4. Cultural Competency, Awareness of Individual Bias, Ethics and Customer Service
5. Documentation, Privacy and Security, and Electronic Health Records
6. Engagement and Assessment
7. Motivational Interviewing, Communication and Health Literacy
8. Crisis Intervention, Safe Environment and Conflict Management
9. Self-Care
10. Networking and Knowledge of Community Resources
11. Quality, Accountability, Performance and Process Improvement, and Evidence-based Practice
12. Payment Systems

Students must attend all 12 modules and pass (at least 70%) on each module exam to earn a certificate of completion. Only one excused absence will be acceptable and it must be approved by the instructor; however, the student will be required to make up the session by attending the course at the alternative location (JCC or Canton as necessary) OR will attend the one day make-up class at the end of the program. Student will be expected to complete a three page essay and present content of missed module at make-up class. Accepted Students must obtain approval/signature of employer, thus demonstrating attendance at all 12 modules.

Instructors include community thought leaders who are subject matter experts in the identified areas of instruction.

Tuition for the program will be covered by regional grant funds in partnership with the Fort Drum Regional Health Planning Organization and North Country Initiative.