Ollie Kelly

• Improved client outcomes by developing comprehensive case plans and coordinating services with community partners.
• Enhanced family stability by providing counseling, crisis intervention, and ongoing support for a diverse caseload.
• Reduced recidivism rates with effective case management, personalized interventions, and consistent followup.
• Managed high-risk cases to ensure safety and well-being of children through timely assessments and appropriate interventions.
• Increased access to resources by connecting clients to appropriate financial, housing, medical, and educational services.
• Empowered clients towards self-sufficiency through goal-setting, skill-building exercises, and motivational interviewing techniques.
• Collaborated with multidisciplinary teams to develop coordinated care plans that addressed clients'' complex needs holistically.
• Maintained accurate records, adhering to strict documentation guidelines and confidentiality requirements for compliance purposes.
• Developed strong relationships with community organizations in order to better serve clients'' needs within their local area.
• Organized workshops focused on life skills development like budgeting or parenting techniques in order to enhance overall wellbeing among caseloads.
• Reviewed agency policies regularly so as to stay updated regarding changes affecting eligibility criteria, service offerings, or client rights.
• Coordinated with mental health professionals or medical providers to address any concerns related to clients'' psychological or physical wellbeing.
• Maintained open lines of communication with supervisors and peers, contributing to a positive work environment that fostered collaboration and professional growth.
• Interviewed clients, families, or groups to assess situations, limitations and issues and implement services to address needs.
• Recommended long-term residential treatment, short-term residential treatment and individualized and group drug counseling for clients with substance abuse issues.
• Coordinated individual referrals to obtain community services, advocate for client needs and resolve roadblocks.
• Assessed community needs and identified resources for social and community service programs.
• Monitored program performance and outcomes for successful delivery of services.
• Facilitated successful reunifications by working collaboratively with families, foster parents, and legal representatives.

CM) Active participation in weekly IDR; waits for input from team members to direct action.

• Biopsychosocial Assessment and Motivational Interviewing
• Scheduled in a timely manner appointments, barriers addressed and patient's attendance known at each appointment. If appointments missed, CCC will outreach to patient in follow-up. Outreaches to external providers to see if appointments kept.
• Reaches out for assistance in finding solutions to overcome barriers for individuals, children and families (housing, substance use, transportation, food homelessness, etc.)
• Provides education materials to patients to assist in more fully understanding their disease process and disease trajectory
• Communicates with providers, Care Team, patients, families, as well as internal/external partners, paying particular attention to:
• Hospital utilization (ED & readmit)
• Critical information (labs, change in health status)
• Relationship with PCP/specialist
• Communication is active and frequent allowing NN/CM to anticipate potential complications and develop an action plan to avoid further deterioration of health.
• Ongoing communication with NN/CM partner to ensure full handoff/communication of plan and ensure smooth TOC Enhanced patient care by developing personalized care plans and coordinating with healthcare providers.
• Improved community health outcomes through outreach initiatives and health education programs.
• Streamlined care coordination processes, ensuring effective communication between patients, families, and healthcare providers.
• Reduced hospital readmissions by implementing effective follow-up procedures and monitoring patient progress.

• Provides non-clinical services intended to aid patients in establishing recovery from high risk of dependent alcohol and drug use problems and mental health problems.
• Function as an advocate for the person in recovery, both within and outside of the program.
• Enhanced client recovery by developing and implementing individualized peer support plans.
• Assisted clients in achieving their personal goals by providing continuous emotional support and resources.
• Increased client engagement with treatment programs by facilitating group sessions and workshops.
• Improved the overall recovery process for clients by advocating for their needs within the treatment team.
• Connected clients with community resources and services, fostering a strong support network for sustained recovery.
• Empowered clients by teaching effective communication skills, self-advocacy techniques, and coping strategies.
• Documented client interactions accurately and diligently, ensuring proper tracking of progress over time.
• Participated in ongoing training opportunities to stay current with industry trends and enhance professional expertise as a Peer Recovery Specialist.
• Assisted clients in identifying personal strengths and challenges, fostering self-awareness and growth towards a healthier lifestyle.

Responsible to advocate for residents regarding Cardiovascular Disease (CVD).

• Connect residents with preventive services.
• Identify residents that do not have a primary care physician.
• Identify/implement intervention for repeat high utilizers-ED
• Provide workshop for CVD.
• Conduct homes visits.
• Precept nurses from Coppin State University - advocacy work in community.
• Referrals for behavioral health services, substance abuse center, Community Works at Bon Secours Health System.
• Work with diverse populations, seniors/people with disabilities.
• Acute documentation and patient satisfaction by identifying and resolving healthcare concerns through comprehensive research and communication.
• Enhanced patient care quality by providing educational resources on disease prevention, treatment options, and wellness strategies.
• Streamlined the insurance claims process for clients by navigating complex healthcare policies and advocating for coverage of necessary treatments.
• Increased client trust through consistent support, advocacy, and proactive problem-solving during their healthcare journey.

Connected with the African American and Latino

Communities around Baltimore City to establish Cardiovascular Disease (CVD) program.

• Assisted in the development and implementation

of the CVD program.

• Canvassed door to door.
• Conducted workshops on CVD.
• Assisted in health fairs and and recruitment.
• Trained new community health workers. Improved community health by conducting assessments, identifying needs, and developing intervention plans.
• Enhanced patient outcomes by providing education on disease prevention and healthy lifestyle choices.
• Promoted access to healthcare services for underprivileged populations through community outreach efforts.
• Reduced hospital readmissions by collaborating with multidisciplinary teams to provide comprehensive care plans for patients.
• Increased awareness of available resources by organizing and participating in community health fairs and events.
• Facilitated group sessions on various health topics, empowering participants with knowledge and tools for healthier living.
• Connected families with necessary social services, alleviating barriers to healthcare access and improving quality of life.
• Built trust within diverse communities through cultural competency training, empathetic communication skills, and active listening techniques.
• Helped vulnerable individuals navigate complex healthcare system.
• Developed and maintained relationships with community partners to build program scope.