The Clinical Wellness Recovery Team (CWRT) is a program aimed to help improve the physical and behavioral health care that an individual receives. The team consists of a Registered Nurse and/or Behavioral Health Therapist who work collaboratively with individuals to coordinate care. Communication is established and maintained with the individual’s Primary Care Physician (PCP) and their Psychiatrist as well as any medical and behavioral health provider, treatment team member, and support system. The Navigators will demonstrate a focus on interventions designed to coordinate ongoing care for the individual. This could include helping the individual gain access to services, health and disease screening, and education regarding medications and diseases. The Navigator will act as a health advocate to help members receive ongoing and appropriate care. They are able to support clients in their homes, at medical appointments and evaluation, and facilitate and advocate for medical follow-up. In addition, some other services they are able to provide include: offering information and resources to members about help with tobacco cessation, exercise, dietary restrictions, and health maintenance. They will also notify the PCP and psychiatrist upon entry to/discharge from an inpatient hospitalization. The Navigators provide health monitoring for members on atypical antipsychotic medication. And, if an individual is having difficulty maintaining recommended treatment compliance, our Navigators can help them work through barriers to adherence with their medical and behavioral health care.
The Clinical Wellness Recovery Team was launched in 2008 by the Center for Health Care Strategies as part of a multi-state, national effort to improve quality care and reduce expenditures for Medicaid members with complex medical and behavioral health needs. The Department of Public Welfare in Pennsylvania has joined in this initiative as a way to reduce costs and provide better care.
Individuals must be 18 years or older, have a serious mental illness (SMI) diagnosis as well as a chronic physical health problem, and live within eastern and central Montgomery County. In addition, clients with medical assistance and insurance through Magellan will need to submit a recent psychiatric evaluation within the past year.