Community Care Network

The Community Care Network (CCN) is a collaborative learning program between Wooster Community Hospital and The College of Wooster. CCN benefits patients in the community and gives students the opportunity to experience, firsthand, many aspects of the health care profession. The goals of the program are to promote wellness, reduce the need for potentially unnecessary procedures and hospitalizations, and promote delivery of evidence-based health care.

An interdisciplinary team comprised of a social worker/discharge planner, mental health provider, dietitian, nurse, pharmacists, and other disciplines as needed meet and develop a plan of care that addresses a patient’s particular goals toward a healthier lifestyle.

Patients are selected based on their desire to embrace change for better health. Candidates for the program include those who have had multiple hospitalizations, and/or potentially avoidable emergency room visits, and have chronic diseases. Eligible participants may be identified during an acute care hospitalization, emergency department visit, or by physician referral.

It is anticipated that the patient will be enrolled in the program for a minimum of 15 weeks, but it may be longer depending on the needs of the patient. The program is free to enrolled patients.

How It Works

To enroll in CCN, patients are interviewed by a member of the interdisciplinary team. If a patient agrees to be in CCN, they sign a detailed consent form and a comprehensive assessment of their needs is completed. The assessment is used to develop a plan of care, based on the patient’s goals. A licensed health care professional on the team will make initial home visits with the patient and health coach. At a point agreed upon by the team and the health coach, the health coach will make visits on their own.

Selected College of Wooster students have been trained as health coaches and are assigned patients enrolled into the Community Care Network. The students have received a semester of health coach training incorporating didactic and experiential learning. These health coaches will visit patients weekly and assist them with their health goals, focusing on meaningful behavioral changes that become a part of a patient’s life. The students then report back to the team on the patient’s progress.

Read about how the health coach – patient relationship worked out for 70-year-old Richard Ceko: Community Care Network’s Efforts Change Lives.

To find out more about being a CCN member, contact RN Alex Davis at (330) 263-8483.

Community Care Network Class of 2017

Community Care Network Forms

• Building a Community Health Worker Program
• CCN Activity Log
• CCN Consent to Participate
• CCN Med List
• CCN Med Recon
• CCN Personal Emergency Plan- General
• CCN Referrals
• CCN Risk Screening Tool
• CCN Screening PT ID
• CCN Supervisory Visit
• Disease Specific Plan of Care
• E-House Call Alert Value
• Plan of Care
• Supplemental Health Profile

Read about the Community Partner in Experiential Learning Award that WCH received for the CCN program from The College of Wooster.

For more information about the Community Care Network at Wooster Community Hospital, call (330) 263-8483.