Community Health & Well-Being
Non-medical healthcare problems need attention, too
Many community members are unable to follow their medical care plans because of non-medical barriers such as lack of access to transportation, childcare, or affordable medications. Our Social Care program was developed to promote healthy behaviors while helping patients, colleagues, and community members access essential needs.
Community Health Workers (CHWs) are a key component of Social Care and serve as liaisons between health/social services and the community to address patients' social needs and mitigate barriers. Trinity Health's Community Health Worker Hub drives the integration and deployment of CHWs throughout the health system. It includes a network of CHWs and community-based organizations that help communities work together to support individuals and families in need. Because of their lived experiences, CHWs work closely with a patient by assessing their social needs, home environment, and other risk factors and ultimately connect the individual to services within the community.
Additionally, we've created the Trinity Health Community Resource Directory, which is an online portal connecting those in need to free or reduced-cost health and social service resources within the community and across all Trinity Health locations. We invite everyone we serve, our colleagues and community members to access the Community Resource Directory by visiting https://communityresources.trinity-health.org/.
Examples of Social Care services we offer or can make available for referral (as available locally – not available everywhere) include:
- Behavioral Health (peer support, substance use treatment, mental health)
- Benefit Enrollment Support (unemployment, Medicaid, and/or SNAP)
- Diabetes Prevention Program
- Financial Assistance
- Food Assistance
- Primary Care for the uninsured/and or Medicaid Population
- Low/no cost medications or medication delivery for persons unable to leave their home
- Shelter (temporary placement or longer-term supported housing or permanent placement)
- Social Isolation programs
- Tobacco Cessation
- Transportation Assistance