What is Care Coordination?

Care Coordination is a “wrap around” approach to providing community based services and supports that assist youth with serious emotional and behavioral health challenges and their families develop a comprehensive plan to achieve their goals.  The planning process that Care Coordination utilizes is called Child and Family Team process (CFT).

The CFT process begins with a strengths and cultural discovery to encourage youth and families to share their story, experiences, values and beliefs which will shape their individualized plan.  The Care Coordinator, who faciliates the CFT process, will help youth and families to identify formal (professional) and informal (natural) supports, develop a team, determine strengths and needs, and highlight the outcomes the youth and family are seeking.

If you have questions about Care Coordination, you may contact Heather Starks, Children's Clinical Services Coordinator at the Monroe County Office of Mental Health at 585-753-2697 or email at hstarks@monroecounty.gov.

Tell me more about the Child and Family Team process.

The Child and Family Team process is child focused (or youth guided) and family driven, with a belief that children’s behaviors are a demonstration of unmet needs and that if the team can begin to address these needs, behaviors will begin to improve.  A team approach is used to support youth and their families so they can become empowered to continue working on meeting their child's needs even after intensive, in-home services are no longer required.

How can I access Care Coordination?

In Monroe County, all Care Coordination services are accessed through FACT (Family Access and Connection Team).  Referrals to FACT are initiated by the family by calling (585) 753-2639.  A FACT worker will review the referral, meet with the family, and begin to identify strengths and needs. If it is determined to be appropriate, the FACT worker will refer the family to a care coordination service.  Go to Contact Us.