Handbook: Tools + Tips For Providing Transitional Care Coordination

In this handbook, New York City Correctional Health Services (NYCCHS) provides a blueprint for improving continuity of health care by transitioning clients from jail to community care. The network of organizations that may participate in a Transitional Care Coordination model include health and hospital centers, public health agencies, community-based organizations, Ryan White HIV/AIDS Program recipients and providers, substance use and mental health providers, jail health administrators, and others.

The handbook details NYCCHS’ Transitional Care Coordination intervention model, including program planning, implementation steps, and lessons learned, and is intended to:

  • Train staff
  • Inform implementation, expansion, and refinement of jail-related care coordination work, and
  • Help organizations strategize how they approach these activities.

The handbook also provides insight into negotiating and forming partnerships with other organizations in order to find common ground and advance organizational missions, while maximizing and improving patient health outcomes. Download the handbook.


About Kim Rodgers

Kim Rodgers serves as a Communications Specialist at NACCHO. Her work includes promoting local health departments' best practices, as well as partner tools and resources, in infectious disease and preparedness through NACCHO's communications channels, storytelling, and outreach to various audiences.

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