In April 2017, the Sonoma County Board of Supervisors prioritized strengthening the County’s Safety Net system as a key priority establishing a goal to identify the most vulnerable residents and develop coordinated strategies to improve their well-being, self-sufficiency, and recovery. The Board recognized that we needed a better way to address the needs of our most needy individuals and families. But to do that, we needed the organization, tools and technology to transform how we deliver services to these citizens.
What Is ACCESS Sonoma?
Accessing Coordinated Care and Empowering Self Sufficiency (ACCESS) Sonoma is a county initiative that focuses on the critical needs of residents who are experiencing physical and mental health challenges, economic uncertainty, housing instability, substance use disorders, criminal justice engagement and social inequity.
ACCESS Sonoma has a four-pronged approach; an Interdepartmental Multidisciplinary Team staffed by representatives from all of the Safety Net Departments, an Integrated Data Hub/Watson Care Manager developed in partnership with IBM, a system of governance led by the County’s Safety Net Collaborative, and partnerships with community based organizations and academic institutions. The result is coordinated care from across our Safety Net Departments for our most vulnerable residents. Care that is informed and supported by an innovative information and care management system, with strategic direction from the Safety Net Collaborative.
The objectives of ACCESS Sonoma are:
- To improve the health, well-being, sustained recovery, and self-sufficiency of the County’s most vulnerable residents
- To develop and implement a plan to coordinate cross-departmental services and reduce duplication of services
- To improve referrals, access and sustained engagement of clients
- To analyze the County’s highest service utilizers and develop strategies/policies for improved efficiencies, better utilization, and better outcomes
- To develop an integrated data sharing system to support care coordination across departments