Building Community Through Care Coordination


July is Social Wellness Month, and central to health and wellness is a sense of community. How can health and human service organizations better foster this belongingness? It starts with care coordination that is focused on bringing services together.

A Sense of Community

Community is all around us. For many it is a physical place, like a neighborhood or geographical area, where people can gather and share experiences. Community can also be a virtual space, like a social media group or online forum, allowing individuals to connect over shared values and interests. No matter the medium, communities operate through specific guidelines to serve those individuals within. Communities function as a way to support, influence, and guide groups of people.  

Experts have found that a “sense of community,” or feeling of belonging to a group or area, is directly correlated with quality of life. Simply put, those with strong communities often live healthier, happier, and more fulfilled lives. 

Unfortunately, for those experiencing adverse social determinants of health, community is hard to establish. Roadblocks like neighborhood safety, access to transportation, and affordable healthcare make it difficult for communities to find and build support.  

Community Health and Wellness 

Communities also play a critical role in health and wellness. When communities are organized and connected, people can get the help and services they need. 

More often than not, however, healthcare providers are siloed away from each other. Specialists are separated from primary physicians, leaving the individual to navigate the difficult world of healthcare alone. Those without the resources or networks to understand the complex world of health and social care are often sidelined and left without proper care. 

The good news is that community healthcare does not need to function this way. It is entirely possible to develop a sense of community in healthcare and other social services through care coordination.  


What is Care Coordination?   

Care coordination is the synchronized effort of health and social care providers to help a single patient receive comprehensive, integrated care. The term is used interchangeably with coordinated care. The philosophy is simple: ensure that all the doctors and social services share relevant information, like test results and medications, so that they can effectively serve the same patients. 

“Care coordination is the synchronized effort of health and social care providers to help a single patient receive comprehensive, integrated care.” 

However, it is a lot more complicated in practice. Each organization may have their own process of record keeping, information sharing, and result delivery. Additionally, some may be more organized than others. When you consider all the possible services an individual or family may need—from healthcare to homeless shelters to food banks to domestic violence support centers—the complexity grows. 

Case management is designed to bridge this gap. Through technology solutions like ClientTrack™, health and human service organizations can seamlessly integrate care coordination into their own practices. This, in turn, builds and strengthens communities. Together, services can communicate and support one another, which fosters the sense of belongingness for those they serve. 

Tools for Community Building 

The most important step in building community through care coordination is getting to know the community itself. What resources are available? What other organizations serve the area? What roadblocks or social determinants impact those who you help? 

Once you have gained a better understanding of where your community stands, the next tool for community building is to identify community leaders. Who is leading the innovation and collaboration in your area? What are they doing successfully, and why is it working? Having these people on your side is a powerful step in strengthening community. Together, they can help your organization reach more people as well as cooperate with other related programs. 

Additionally, your organization can strengthen your community by valuing and listening to the frontline staff. The social workers, nurses, care teams, and volunteers on the ground know your community better than almost anyone else. Start with those within your own program. What are their insights into the community? What are its greatest strengths, and where are its biggest needs? 

What all these tools have in common is information and communication. This is perhaps the most critical part of care coordination—learning to function not as an individual organization, but as a community.  

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