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To learn more about the CORE program and team, please contact us at 212-666-2091 or by email.

For information on eligibility, please contact us at 212-663-3000 x1240 or by email.

Community Outreach for Recovery and Engagement (CORE)

Community Outreach for Recovery and Engagement (CORE) provides targeted, person-centered interventions to help individuals become more engaged in their healthcare and to prevent unnecessary future hospitalizations. The program is designed to engage individuals who have a behavioral health diagnosis and a high rate of emergency room and/or inpatient services usage, and who are attributed to the Mount Sinai PPS (Performing Provider System). 

Staff on the interdisciplinary CORE team work together to provide six-month interventions to program participants, with the goal of successfully connecting individuals to longer-term services. These interventions include outreach, engagement, community care, and transition of care. 

Services Offered

CORE provides 24/7 call coverage, so participants have access to care at all times. In addition to a comprehensive assessment of client needs, services include:

  • Home visits and hospital engagement
  • Active involvement in discharge and aftercare planning
  • Medication management and reconciliation support
  • Benefits and entitlements support
  • Collaboration with other members of the individual's care team and support network
  • Linkages with community providers
  • Appointment reminders and escort to appointments
  • Transitional care support and effective handoff to longer-term services

This program is provided in partnership with the Mount Sinai PPS and the Coordinated Behavioral Care IPA.

Eligibility

To learn more about the CORE program and team, please contact us at 212-666-2091 or by email.

For information on eligibility, please contact us at 212-663-3000 x1240 or by email