What is the Care Transitions Intervention Program?

Care Transitions Intervention Program pic
Care Transitions Intervention Program
Image: caretransitions.org

Sandra Schiff is a Certified Care Transitions Coach that trained with the Coleman Model. As a Care Transitions Coach, Sandra Schiff assists families in learning the self-management skills to address their needs and those of their members while in transition situations.

The Care Transitions Intervention, also known as the Coleman Transitions Intervention Model, is a 4-week program that empowers patients and their caregivers to learn self-management skills, thus guaranteeing their specific complex needs are met during the transition from hospital to home and into the future. This is an economical intervention that is composed of a home visit and a few phone calls.

As an alternative to traditional case management practices, CTI is a self-management program. The Care Transitions Coach works with the patient and the caregiver to enable the patient to self-manage their care and their treatment. A Care Transitions Intervention Coach works with the current needs of the patient and discusses future transitions before they occur.

Patients who utilize this program are much less likely to be readmitted to hospital or to have growing medical bills, and much more likely to achieve treatment goals and symptom management, to return to a full recovery, and to retain this progress six months after the Intervention.

The Transitions Coach also teaches the patient and the family successful communication techniques, enabling new behaviors and skills that allow all involved to address the needs of the patient as they arise.


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