Sherina L.

Referrals from the Transition Coordinator and ensure the transition process is followed through for each consumer. * Provide counseling and information for individuals and families who are considering, or are in the process of, transitioning. * Coordinate visits to institutions, provide potential participants with unbiased information regarding available home and community based services, participate in discharge planning, and coordinate with other relevant social service agencies involved in the discharge and transition care of the consumer. * Explain peer mentor program to potential participants and if appropriate provide referral to peer mentor program. * Develop and facilitate person centered plans effective for the 90-day transition period, secure qualified housing, coordinate home and community services during the transition period, and subsequently ensure continuation of services after the 90-days is completed. * Collaborate with the Transition Coordinator to determine barriers to transition; * Consult with Transition Coordinator to assist in addressing transition barriers related to medical condition or counseling need; * Ensures all significant client data and service provision details are current and accurate, and that they are documented in a timely manner into CIDNY's and the contracted provider's databases. * Attends Agency's in-service training and unit meetings as well as any other agency related activities.