Community-Based Social Care

Personalized social care, close to home

At the HEaL Trauma Program, social care services are an integral part of our whole-person care approach. Social care services focus on addressing the non-medical challenges that significantly impact a patient’s health and well-being.

How community health workers support healing

Our community health workers (CHWs) support patients in the community setting following hospital discharge. They collaborate closely with inpatient trauma social workers to identify social needs, offer personalized assistance, and ensure continuity of care. Using a patient-centered approach, CHWs actively listen to individuals, educate them about available services, and empower them to achieve sustainable, independent outcomes.

Services provided by community health workers

: CHWs identify the challenges that may interfere with a patient’s recovery, such as housing insecurity, food access, transportation and financial instability.
: Patients receive assistance in understanding and accessing community resources to meet their needs effectively.
: CHWs guide patients through applications for public benefits, insurance coverage, and job opportunities.
: Patients are referred to appropriate programs to address mental health challenges and substance use concerns.
: To ensure a smooth recovery, CHWs maintain regular contact with patients, providing continued guidance and support.