Riverwood Health Homes

Health Homes

Rhode Island's Community Mental Health Organizations ("CMHOs"), Riverwood Mental Health Services
("Riverwood"), and Fellowship Health Resources, Inc. ("Fellowship") have received approval from the federal Centers for Medicaid and Medicare Services ("CMS") to serve as Medicaid "CMHO Health Homes". Such Health Homes will be the fixed point of responsibility to provide person centered care for persons identified as meeting eligibility requirements for CMHO Health Home services.

Riverwood works with adults who may be experiencing physical or substance use issues in addition to their mental health issues. Our Health Home Team is a multidisciplinary team that includes psychiatrists, registered nurses, therapists, chemical dependency therapists (LCDPs), vocational specialists, case managers (CM), and a clinical pharmacist. The team is knowledgeable and aware of psychiatric/ emotional and co-occurring issues and their interrelatedness to medical issues.

Health Homes and Riverwood promote a healthy lifestyle through education, coordination of care, monitoring of target health conditions, and supporting the individual in increased self-management of chronic conditions while focusing on the needs of the whole person. Some of the services available through Riverwood include:

• Home Visits: Staff are available to meet with members/clients in their homes or the community as needed
• Registered Nurses: Are readily available to members/clients to discuss health concerns and provide education on medical topics
• Transportation: Staff can provide transportation when needed to medical ap pts. (labs, PT, etc.)
• Advocacy, Support, Follow-up: CMs/RNs are available to attend medical appts./mtgs with members/clients PRN for advocacy, support, and follow-through of provider' s recommendations
• Communication: Psychiatrists and nurses are available for professional communication to coordinate and enhance care
• Labs and Procedures: Monitoring of labs and assistance with prep for labs and/or procedures PRN
• Benefits & Medicaid: Assistance with benefits and insurances
• Nutrition: Assistance with food stamps, shopping, and reinforcement of nutritional principles, i.e. reading food labels
• Hospitalizations: Monitoring psych, substance abuse, and medical hospitalizations and participating in discharge planning and aftercare follow-up
• Medications: Registered nurses work with both psychiatric and medical meds, providing education, assisting with med minders and coordination of med drops up to twice a day when needed