Harbor:Whole person care: Difference between revisions

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<big>WPC program is ending 11/30/21. No more referrals after that.</big>  
<big>WPC program ended 11/30/21. However, below are some other available programs addressing social determinates of health:</big>  
 
* '''Re-entry''' (released from prison <6 months with medical, mental health, substance abuse, or social needs)
** 844.804.5200 (24/7) and put patient on phone.
 


'''For ANY Medi-Cal patients (including OOP) (not just DHS)'''
*'''Substance Abuse Referrals''' With any drug or ETOH use
** Patients only need to be willing to engage about treatment or harm reduction strategies; they do not have to necessarily want to enter treatment immediately. If you have an eligible patient:
*** Make sure patient is aware you are making the referral to WPC.
*** Make sure the patient knows a Community Health Worker (CHW) will come to talk with them in the ED, or will follow up with them (likely via phone) after discharge. Please make sure the preferred phone number is documented by Registration!
*** Use the Consult to Whole Person Care auto-page in FirstNet to send a message to the WPC team (team will respond in real time M-F 9-4:30 pm, follow up asynchronously otherwise - so please always page)
***On discharge, include the WPC discharge instructions (“Whole Person Care Harbor-UCLA”, also available in Spanish) from ORCHID.  Please make sure correct phone number is documented in the chart.
* '''Re-entry''' (released from prison <6 months with medical, mental health, substance abuse, or social needs) 844.804.5200 (24/7) and put patient on phone.
* '''Medically Complex''' Transitions of care (includes 3 visits to  ED in past year)  
* '''Medically Complex''' Transitions of care (includes 3 visits to  ED in past year)  
** ORCHID Message/Call/Text Rosario Aliviado - Social Work Supervisor.  Please include MRN, pt phone number, and reason for referral. 213.294.8908.  She will respond M-F 9:00-4:30 pm but you can ORCHID message/call/text/email anytime.
** ORCHID Message/Call/Text Rosario Aliviado - Social Work Supervisor.  Please include MRN, pt phone number, and reason for referral.  
*** AND place order in ORCHID:
*** 21x.294.8908.  She will respond M-F 9:00-4:30 pm but you can ORCHID message/call/text/email anytime.
**** Consult to Whole Person Care: Reason for Consult Freetext, enter "Substance Use Disorder" and any relevant details
 
 
* '''Perinatal''' (high-risk pregnant mothers - homeless, mental health, substance abuse, domestic violence, no food)  844.376.2627
* '''Perinatal''' (high-risk pregnant mothers - homeless, mental health, substance abuse, domestic violence, no food)  844.376.2627
* '''Homeless'''  ... social work can help facilitate housing
* '''Homeless'''  ... social work can help facilitate housing
** Refer to Social Work
** Refer to Social Work
*** Place order in ORCHID
*** Place order in ORCHID
**** Consult to Social Work: reason for referral: homeless, free text WPC
**** Consult to Social Work: reason for referral: homeless
 
 
* Disabled and needs disability benefits (SSI)
* Disabled and needs disability benefits (SSI)
** Refer to Social Work
** Refer to Social Work
*** Place Order in ORCHID
*** Place Order in ORCHID
**** Consult to Social Work: reason for referral: disability benefits, free text WPC
**** Consult to Social Work: reason for referral: disability benefits
 
 
* '''Mental Health'''
* '''Mental Health'''
** Residential & Bridging Care (transition from mental health institution to community)  213.738.4775
** Residential & Bridging Care (transition from mental health institution to community)  213.738.4775

Revision as of 19:38, 1 December 2021

WPC program ended 11/30/21. However, below are some other available programs addressing social determinates of health:

  • Re-entry (released from prison <6 months with medical, mental health, substance abuse, or social needs)
    • 844.804.5200 (24/7) and put patient on phone.


  • Medically Complex Transitions of care (includes 3 visits to ED in past year)
    • ORCHID Message/Call/Text Rosario Aliviado - Social Work Supervisor. Please include MRN, pt phone number, and reason for referral.
      • 21x.294.8908. She will respond M-F 9:00-4:30 pm but you can ORCHID message/call/text/email anytime.


  • Perinatal (high-risk pregnant mothers - homeless, mental health, substance abuse, domestic violence, no food) 844.376.2627


  • Homeless ... social work can help facilitate housing
    • Refer to Social Work
      • Place order in ORCHID
        • Consult to Social Work: reason for referral: homeless


  • Disabled and needs disability benefits (SSI)
    • Refer to Social Work
      • Place Order in ORCHID
        • Consult to Social Work: reason for referral: disability benefits


  • Mental Health
    • Residential & Bridging Care (transition from mental health institution to community) 213.738.4775
    • Intensive Service Recipients (mental health with 2 or more admissions in year, recent DC from psych hospital) 844.804.5200


See Also

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