Case/Care Management

Programs that develop plans for the evaluation, treatment and/or care of individuals who, because of age, illness, disability or other difficulties, need assistance in planning and arranging for services; which assess the individual's needs; coordinate the delivery of needed services; ensure that services are obtained in accordance with the case plan; and follow up and monitor progress to ensure that services are having a beneficial impact on the individual. Case management is a collaborative process characterized by communication, advocacy and resource management to promote high quality, cost-effective interventions and outcomes.

 

Services
Seniors at Risk in Hamilton Collaborative

A centralized referral and intake process to facilitate timely interventions and supports for seniors impacted by issues such as dementia, abuse/exploitation, mental and physical health challenges, precarious housing, food insecurity, and social isolation.

Services offered include: 

Seniors at Risk in Hamilton Collaborative

A centralized referral and intake process to facilitate timely interventions and supports for seniors impacted by issues such as dementia, abuse/exploitation, mental and physical health challenges, precarious housing, food insecurity, and social isolation.

Services offered include: 

YMCA Hamilton Youth in Transition Housing Support Worker Program

Providing support to 16 and 17-year-old youth seeking housing and/or housing maintenance; assistance to search for, view, apply, and retain housing.

Willowbridge Community Services Developmental Services

Offers a range of programs to individuals living with developmental disabilities that help make new friends, improve old relationships, connect to services, or build new skills.

Services include:

Ontario Autism Program

Single point of access for children and youth to be placed on the Ontario Autism Program (OAP) waitlist for autism services. Facilitates an integrated and coordinated intake process to identify needs of children and youth with autism spectrum disorder (ASD) and their families. Provides access to

Developmental Services Ontario Hamilton-Niagara Region

This program helps people aged 16 and older with a developmental disability who are looking for adult developmental services in the following ways:

Centre de Santé Communautaire Support Services for Seniors and Vulnerable Persons

Providing support services for older adults and vulnerable persons, including:

Banyan Developmental Services

The program assists adults with developmental disabilities living with their families or in the community with little or no support by:

YMCA Hamilton Youth in Transition Worker Program

Program providing support for youth who have been involved with Family and Children Services. Helps youth to transition to a more independent lifestyle by developing and implementing a personal plan, and providing help navigating adult service systems and connecting with community supports and re

Notre Dame House Youth Shelter

A 24-hour emergency shelter providing beds for youth between 16 and 21 years of age. It provides programming and support to youth in the following manner:

Breaking Free From Violence Family Support Worker

Supports Indigenous women in a culturally rooted, holistic way to navigate through complex systems encountered when experiencing violence and involvement in child welfare matters.

Hamilton Assertive Community Treatment Team 1, St. Joseph's Healthcare Hamilton

Delivers specialized community based services to adults with complex physical, psychological, and social needs due to severe mental illness accompanied by significant functional impairment, disruption of normal life tasks, periods of hospitalization, and a need for psychotropic medications.

Veteran Affairs Canada Veteran Services

Offers a wide variety of services for Canadian Veterans and their families. This includes: 

Contact Hamilton Children and Youth Services

This program helps children, youth, and their caregivers in the following ways:

St. Matthew's House Housing Focused Street Outreach Team

Outreach workers connect clients experiencing chronic or episodic homelessness to immediate support, including shelter, food, and income support, and engage with those experiencing longer-term homelessness, providing assistance to rapid re-housing and housing first support. 

Residential Mental Health Treatment, Brennan House

A co-ed residential treatment program for youth with complex mental health concerns. Helps residents develop skill to manage and understand their own mental health concerns and provides after care to youth for up to two years after they leave the residence. 
Services offered include

Good Shepherd Centres, Family Centre Emergency Shelter Services

Provides temporary emergency accommodation for families experiencing homelessness in the form of private, accessible self-contained units.

Services include:

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