Teresa Gilbert

• Provide comprehensive case management services to individuals living with HIV, including intake, reassessment, service planning, and care coordination
• Conduct psychosocial assessments addressing mental health, substance use, housing stability, and barriers to medical adherence
• Coordinate medical, behavioral health, housing, transportation, and financial assistance services to support continuity of care
• Provide HIV and Hepatitis C education, prevention counseling, and treatment adherence support
• Collaborate with physicians, behavioral health providers, pharmacists, and community agencies to ensure integrated care
• Maintain compliance with Ryan White documentation, grant reporting, and quality assurance standards
• Participate in community outreach events, health fairs, and testing initiatives across the White Mountains region

Assessment and Evaluation: Conduct thorough assessments to identify clients' mental health needs, substance use patterns, and

social circumstances. Evaluate clients' strengths, weaknesses, and goals to develop individualized treatment plans. Case

Management: Coordinate care with healthcare providers, therapists, social workers, and other support services. Monitor clients'

progress and make necessary adjustments to treatment plans. Advocate for clients' needs and ensure they receive appropriate

resources. Treatment and Intervention: Provide evidence-based interventions, such as individual and group therapy, crisis

management, and medication management. Educate clients about mental health conditions, treatment options, and coping

mechanisms. Assist clients in developing healthy lifestyle habits and improving their overall well-being. Resource Navigation:

Connect clients with community resources, such as housing, employment, and financial assistance programs. Help clients access

support groups, peer recovery programs, and other community-based services. Documentation and Reporting: Maintain accurate

and detailed client records, including progress notes, treatment plans, and discharge summaries. Prepare reports and

documentation for insurance companies, healthcare providers, and other stakeholders. Collaboration and Communication: Work

closely with multidisciplinary teams, including doctors, nurses, social workers, and case managers. Collaborate with community

organizations and agencies to provide holistic support to clients. Communicate effectively with clients, their families, and other

professionals involved in their care. Additional Responsibilities: May provide crisis intervention and emergency support. May

conduct outreach and engagement activities to raise awareness of mental health services. May participate in research and

evaluation projects to improve case management practices.

AS a Parent Practitioner, I provide individualized parenting education and support to families, often those

referred by child protective services. They work with parents to develop stronger parenting skills, foster healthy parent-child

relationships, and improve family dynamics. Practitioners often conduct home visits, observe interactions, and provide

evidence-based interventions based on programs like the Nurturing Parenting Program.

Key Responsibilities:

Direct Service: Meet with parents and children in their homes or community settings to provide parenting education and

support, often using a structured curriculum.

Observation and Assessment: Observe parent-child interactions during supervised visits or in-home observations to assess

family dynamics and identify areas for improvement.

Parent Education: Educate parents on topics like non-violent discipline, empathy, and creating a safe and nurturing

environment for children.

Collaboration: Work with child protective services and other agencies to develop and implement care plans, attend meetings,

and provide required reports.

Documentation and Reporting: Maintain accurate and confidential case records, document progress, and prepare reports as

needed.