AMH-TCM Core Components - Referral and Monitoring and Coordination highlightedMonitoring and Coordination.

Monitoring and Coordination means:

  • Following up and evaluating with the individual that services/resources/supports are meeting the individual’s needs;
  • Evaluating services/resources/supports to access if the individual is reaching the goals of the plan;
  • Coordinating with service providers and resource representatives to assess effectiveness and individual’s goal attainment; and to resolve/mediate any issues; and
  • Monitor the individual’s situation for new needs and goals.