Care Coordination


Targeted Case Management

Targeted Case Management is a voluntary, community-based service helping individuals identify, access, develop and coordinate available services and resources.

How it Works

A case manager meets with an individual approved to receive this service to conduct a needs assessment. Together, they develop an individual service plan.

After a plan is developed, case managers meet with participants at least once a month to help them reach their goals by connecting them with needed resources, providing care coordination and advocacy.


  • Available to adults 18 years of age or older
  • Must meet medical necessity criteria, as determined by the Maryland Behavioral Health Administration
  • Must have a mental health diagnosis, Medical Assistance, and be referred by a treating mental health professional

Referral Form


Care Connections: Bridging the Gap

The objective of Care Connections is to reduce repeated use of the Shore Regional Health Emergency Department and Inpatient resources.

The Care Connections program aims to increase access to community resources such as primary care and preventative health.

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Project for Assistance in Transition from Homelessness (PATH) Case Management provides outreach services to identify and connect with homeless individuals seeking to recover from mental illness.

We network with shelters, state agencies, behavioral health providers and other grass roots organizations to assure the connection of homeless individuals with behavioral health treatment.


Individuals has a mental health diagnosis and meets one of these definitions of homelessness:

  • Being evicted within a week from a private dwelling with no subsequent residence identified, AND is in arrears in rent/utility payments
  • Being discharged within a week from an institution in which the person has been a resident for more than 30 consecutive days, no subsequent residence has been identified, and the person lacks the resources and support networks needed to obtain housing
  • Lacks a permanent, fixed nighttime residence and needs support to obtain independent housing
  • Fleeing a domestic violence situation
  • Residing in a long- or short-term shelter and/or transitional housing

Referrals may be initiated by the individual, a treating behavioral health professional or other professional provider.

Referral Form