Toolkit provides best practices and practical tools for designing, implementing, and evaluating the impact of community health workers.

Peer support services for substance use care led to reduced acute care utilization among select managed care members in Pennsylvania.

State investments in enhanced primary care for older and chronically ill individuals recently released from incarceration yielded a $2.55 return on investment for Medicaid and criminal justice combined.

Case study of interdisciplinary primary care program for high-risk patients based at an academic health system offers lessons on program design and implementation.

Including spiritual care within care management programs in outpatient, managed care, and population health settings can enhance patient care and support the effectiveness of the interdisciplinary care team.

Identifies best practices for implementing peer support interventions and advancing recovery-oriented care within mental health organizations.

An interdisciplinary, hospital-based addiction medicine consultation team improved substance use disorder treatment engagement after hospitalization.

Describes how health care providers and their correctional agency partners can design medications for addiction treatment programs for people with opioid use disorder in jails and prisons.

Details the key considerations for providers considering integrating peer services for behavioral health into their health care organizations.

Details the main elements of a hospital-based addiction care consultation team.

A hospital-based program showed that peer recovery coaching can be seamlessly integrated into the workflow of busy emergency departments to address the longer-term needs of people with substance use disorders.

Initiative successfully implemented several evidence-based and promising addiction care models across multiple medical settings, including an inpatient addiction consult team, a low-threshold bridge clinic, peer recovery coaches, and office-based addiction treatment nurses.

Highlighted two community paramedicine programs in New England and rural North Carolina that serve people with complex needs.

Nurses and members of fully staffed interdisciplinary care teams are more likely to use patient identification and care management tools.

Patients with complex needs were more satisfied with in-home urgent care delivered by community paramedics than with emergency department urgent care.

Virtual collaborative care intervention demonstrates an approach to improve medication adherence and health outcomes.

Case managers noted establishing trust, fostering mindset changes, and increasing stability and independence can be measures of success when working with people with complex needs.

A short-term emergency department navigator program helped address acute care utilization for individuals with low baseline utilization through primary care follow up appointments and assistance with social needs.