Harbor:Whole person care

For ANY Medi-Cal patients (including OOP) (not just DHS)

  • Substance Abuse Referrals With drug or ETOH use
    • WPC discharge instructions are now available! Any patient with MediCal with SUD qualifies. 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 CHW will come to talk with them in the ER OR will follow up with them (likely via phone) after discharge. CHWs can be busy and may not always be able to contact them until after discharge. Please make sure the right contact information is in the EMR!
      • 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) (swing and weekend hours forthcoming)
      • 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)
    • ORCHID Message/Call/Text Lelalee Vicedo - Social Work Supervisor. Please include MRN, pt phone number, and reason for referral. (213) 572-9895. She will respond M-F 9:00-4:30 pm but you can ORCHID message/call/text/email anytime.
      • AND place order in ORCHID:
        • Consult to Social Work: reason for referral = other, free text WPC TOC
  • 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, free text WPC
  • Disabled and needs disability benefits (SSI)
    • Refer to Social Work
      • Place Order in ORCHID
        • Consult to Social Work: reason for referral: disability benefits, free text WPC
  • 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

References