Through this REOI we seek to engage with providers and professionals in the skilled fields listed below and gauge the level of interest providers and professionals who share our mission to build a Statewide AOT program that reduces hospitalization and incarceration rates, improves treatment engagement, and enhances quality of life for individuals and families. In this future state, the Care Coordination Team will serve as a trusted, multidisciplinary resource that bridges clinical expertise, intensive case management, and lived experience to deliver holistic, culturally competent care coordination; and to deliver evidence-based and recovery-oriented treatment. By investing in this collaborative model, we envision a system where timely intervention, continuity of care, and supportive relationships empower participants to live safely, independently, and with dignity in their communities. The Maryland Department of Health (“MDH”) envisions this team encompassing the following skilled areas: ⮚ Clinical expertise (Psychiatrist) - Psychiatric assessment and medication management - Diagnosis and treatment planning for severe and persistent mental illness (SPMI) - Crisis Intervention and de-escalation skills - Co-occurring substance use disorder management ⮚ Care Coordination & Case Management (Case Manager) - Comprehensive needs assessment - Individualized service planning(ISP) - Linkage to community supports and resources (housing, benefits, primary care) - Monitoring treatment adherence and progress - Advocacy and navigation of legal/justice systems if relevant
