ACCESS Harris County Initiative

Information Privacy and Security Policy and Procedure

One of Harris County's strategic priorities set by the Harris County Commissioners Court is to provide integrated service delivery through a no-wrong door approach for individuals in need of services across county departments, affiliated governmental entities, and community-based programs. To address this priority, Harris County developed an initiative called Accessing Coordinated Care to Empower Self Sufficiency (ACCESS) Harris County. This initiative provides an integrated care-coordination model to improve outcomes for vulnerable individuals through a care coordination team. The team will focus on supporting clients holistically, addressing multiple needs that ensure better outcomes and greater stability.

The following Information Privacy and Security Policy and Procedure applies to the ACCESS Harris County Interdepartmental Multi-disciplinary Team (IMDT) and Coordinated Care Teams (CCTs) when accessing, disclosing, or using personally identifiable information. All ACCESS Harris County Participating Agencies and Workforce Members must comply with these policies and procedures.

1. Purpose
   The purpose of this policy and procedure is to provide mandatory guidance for the creation, storage, use, disclosure and exchange of information that is protected by state and federal law when acting as part of or on behalf of ACCESS Harris County.
2. Scope
   This policy and procedure applies to all entities and individuals participating in or acting on behalf of the ACCESS Harris County
3. Relevant Law
   A variety of state and federal laws protect the confidentiality of health, behavioral health, and social services information, including, but not limited to: the Health Insurance Portability and Accountability Act (HIPAA) and its implementing regulations (45 C.F.R. Parts 160 and 164); federal Substance Abuse Confidentiality Regulations (42 C.F.R. Part 2); Texas law on electronic disclosure of protected health information (Tex. Health & Safety Code § 181.154); Texas law on mental health records (Tex. Health & Safety Code § 611.002); Texas law on information in the juvenile justice information system (Tex. Family Code § 58.106); and Texas law making law enforcement records concerning a child confidential (Tex. Family Code § 58.008).
   To ensure compliance with these laws, ACCESS Harris County operates pursuant to a consent-based model that limits enrollment in ACCESS Harris County to clients who give Participating Agencies permission to share their information. This model supports the IMDT approach, which is premised on unrestricted information sharing between Participant Agencies to help clients get the services and resources they need. Clients who do not consent to share their information may separately seek any of the services offered by the Participating Agencies and will not be denied assistance based on their decision not to enroll in ACCESS Harris County.
4. Definitions:
   1. ACCESS Harris County IMDT
      The Interdepartmental Multi-Disciplinary Team (IMDT) operationalizes the programmatic goals and objectives set by the Safety Net Collaborative. The IMDT is a care coordination, advisory team of subject matter experts from various disciplines and frontline staff across Harris County Safety Net Departments. It is led by the IMDT Manager, who reports to the ACCESS Harris County Associate Director.
      Reporting to the IMDT Manager are the Cohort Managers, who are responsible for the day-to-day operations of the Coordinated Care Teams (“CCTs”). The CCTs are multidisciplinary teams across the Participating Agencies that coordinate care for a group of ACCESS participants that meet participation criteria and requirements for a specific cohort. The team is comprised of frontline staff who coordinate the care plans and service goals for Cohort participants.
   2. Watson Care Manager
      1. The Care Manager Interface within Watson Care Manager is a platform that allows Workforce Members to input and view client demographics, case notes, care plans, client goals and other information relevant to client case management. The Care Manager Interface does not directly receive information from outside electronic databases (information must be added by Workforce Members).
      2. Access to Watson Care Manager shall be granted on a business-need basis to members of a CCT. Watson Care Manager system access for CCT Workforce Members shall be approved by the ACCESS Director or their designee, which may be the ACCESS Associate Director, IMDT Manager, the Cohort Manager, and the HCPH Compliance and Privacy Officer.
   3. Cohort
      Cohort refers to a group of clients designated to receive intensive case management and related services through the Access Harris County IMDT. Cohorts are identified, defined, and approved by the Safety Net Collaborative. Clients must be assigned to a Cohort before they may receive services through the ACCESS Harris County Initiative.
   4. Cohort Manager
      The Cohort Manager will oversee services and case management of Cohorts. Workforce Members who have been assigned to CCTs will work with the Cohort Manager. These Workforce Members are defined as the CCT.
   5. Consent Form
      The Consent Form reflects a client's consent to participate in ACCESS Harris County. The Consent Form also conveys a client's consent to release a range of information, including social service records, to enable care coordination through ACCESS Harris County. If a client does not sign the Consent Form, they cannot participate in ACCESS Harris County. The Consent Form is attached hereto as Attachment C.
   6. Coordinated Care Teams (CCTs)
      Reporting to the IMDT Manager are the Cohort Managers, who are responsible for the day-to-day operations of the CCTs. The CCTs are specific subject matter experts that support the overall goals of the ACCESS Harris County Initiative. Each CCT is comprised of frontline staff from Participating Agencies who coordinate the care plans and service goals for Cohort participants. The members of the CCT and the Participating Agencies they represent are identified in Attachment A, which may be updated by the IMDT Manager with the approval of the Privacy Committee.
   7. IMDT Authorization
      IMDT Authorization, included as Attachment B, refers to a client's permission to release otherwise confidential health information to facilitate intensive case management and service delivery by Workforce Members of the ACCESS Harris County IMDT and CCTs.
   8. Participating Agencies
      Participating Agencies in the ACCESS Harris County IMDT include County Departments and agencies who are affiliated or have contracted with the County to support ACCESS Harris County. Participating Agencies may include governmental agencies and non-governmental agencies. All Participating Agencies have, as one of their purposes, the care, care management, or rehabilitation of high-need, vulnerable populations. All Participating Agencies must sign an agreement containing an obligation to abide by this Information Privacy and Security Policy and Procedure before receiving and being permitted to share information for the purposes of the ACCESS Harris County Initiative, and any sharing of information obtained pursuant to consents and authorizations given for the ACCESS Harris County Initiative may only be used for that purpose. New Participating Agencies may be designated by the IMDT Manager with the approval of the Privacy Committee. Participating Agencies are identified in Attachment A.
   9. Privacy Commitee
      The Privacy Committee is a workgroup of the Safety Net Collaborative that meets as needed to consider privacy issues related to ACCESS Harris County. The Privacy Committee reports to the Safety Net Collaborative. The Privacy Committee shall consist of the Harris County Public Health Compliance and Privacy Officer or their designee, County Privacy Officer or their designee, a liaison with the Universal Services Department, the ACCESS Harris County Director or their designee, one or more liaisons with the Coordinated Care Teams, a liaison with the Harris County Attorney's Office, and a liaison with each Safety Net Department. The Privacy Committee shall establish written guidelines, to be approved by the Safety Net Collaborative, under which the Safety Net Collaborative may delegate certain privacy responsibilities to the Privacy Committee.
   10. Safety Net Collaborative
       The Safety Net Collaborative is a group consisting of one designee from each of the following Participating Agencies and Harris County Safety Net Departments: the Harris County Public Health Department, Community Supervision & Corrections Department, Department of Economics, Equity, and Opportunity, Harris County Community Services Department, Harris County Department of Education,, Harris County Juvenile Probation Department, Harris County Resources for Children and Adults, Harris County Sheriff's Office, Harris Health System, The Harris Center for Mental Health & IDD, and Texas Department of Criminal Justice Parole Division Region III/Area Agency on Parole. The Safety Net Collaborative, with the approval of the ARPA Steering Committee, selects the Cohorts that will be eligible to receive case management and related services.
   11. Virtual Client Record
       The Virtual Client Record is a component of Watson Care Manager that offers a view of selected client information uploaded from Participating Agencies.
   12. Connect360 Integrated Hub
       The Connect360 Integrated Hub is the tool that the ACCESS Harris County IMDT uses to support case management and information sharing. Connect360 Integrated Hub allows the ACCESS Harris County IMDT to perform key functions such as look up and review of client demographic data and other shared data from source systems, streamlined intake, closed loop referral processing, alerts and notifications, analytics, and reporting.
   13. Workforce Member
       Workforce Members are those individuals fulfilling operational needs of ACCESS Harris County, including individuals on the ACCESS Harris County IMDT and CCTs. Workforce Members, for the purpose of these policies and procedures, includes individuals whose conduct, as part of the ACCESS Harris County IMDT and CCTs, is on behalf of, or under the direct control of, the County or a Participating Agency. Workforce Members may include, but are not limited to, County employees (full-time, part-time), contracted individuals, unpaid interns, temporary agency workers, and volunteers. All Workforce Members must sign a Confidentiality Statement.
5. Establishment of the IMDT and CCTs
   1. ACCESS Harris County IMDT
      1. The ACCESS Harris County IMDT has been established by and operates under the direction of the Safety Net Collaborative.
      2. An IMDT Manager shall be appointed by the HCPH ACCESS Administration. The IMDT Manager oversees the Cohort Managers.
   2. ACCESS Harris County CCTs
      1. A Cohort Manager shall be selected for each CCT. The Cohort Manager oversees and supervises the activities of the CCT.
      2. Additional individuals and Participating Agencies that are included in the CCT shall be determined by the IMDT Manager, subject to the approval of the Privacy Committee.
      3. As necessary, the Cohort Manager shall solicit the advice and recommendation of Participating Agencies with expertise pertaining to the Cohort. A CCT may include the case managers, support staff, service providers, and supervisors who provide or support services to Cohorts.
      4. A new CCT shall be authorized to view categories of information in Watson Care Manager that are consistent with the purpose and needs of the CCT, as determined by the Cohort Manager and the Privacy Committee. CCTs may be authorized to view additional categories of information upon the recommendation of the Cohort Manager and the approval of the Privacy Committee.
      5. Consistent with the Consent Form, IMDT Authorization, and law, all members of a CCT may verbally discuss client issues between each other as necessary to support the well-being of the client and the goals of the case management team.
      6. Workforce Members shall access client records in Watson Care Manager only when there is a business need to do so. All activity in Watson Care Manager is logged, monitored, and subject to audit.
6. IMDT and Care Coordination Workforce Members
   A range of Workforce Members who are trained in the case management of high-needs, vulnerable populations and/or the identification and treatment of homeless adults and families may participate in the ACCESS Harris County IMDT and CCTs. Teams may include, but are not limited to, the following:
   • Housing or homeless services provider agencies and designated personnel.
   • Mental health and substance abuse services personnel and practitioners or other trained counseling personnel.
   • Peace officers, probation officers, or other law enforcement agents.
   • Medical personnel, with sufficient training to provide health services and/or training in the treatment of individuals experiencing homelessness or other socio-economic problems.
   • Social services workers with experience or training in the provision of social services to vulnerable populations or in the funding of and eligibility for public assistance programs.
   • Child support services agencies and designated personnel.
   • Veterans services providers and counselors.
   • Domestic violence victim service organizations.
   • Legal counsel for the adult or family representing them in a civil or criminal matter.
   • Tribal or faith-based representatives.
7. IMDT Authorization
   1. Description of the IMDT Authorization
      The IMDT Authorization, included as Attachment B, authorizes the disclosure of information to ACCESS Harris County and the exchange of information between entities and individuals participating in ACCESS Harris County. The IMDT Authorization requires the client to agree that all Participating Agencies may share all information with each other, including substance-use-disorder (SUD) and mental health information. Clients who do not agree that their information may be disclosed to Participating Agencies will not be enrolled into the program because the fundamental nature of the services offered involves unrestricted information sharing.
   2. Purpose of the IMDT Authorization
      In some cases, health care providers or other entities may share information about a client without the client's authorization. For example, a physician can share information about a patient's diabetes with a hospital that has admitted that patient for the purpose of treating the patient. Similarly, a community clinic could share information about a patient's visit in order to obtain payment for the visit. For these reasons, many ACCESS Harris County information sharing activities would be permissible under the applicable laws whether or not the client has signed the IMDT Authorization.
      However, because of the complexities of federal and state privacy laws applicable to services for vulnerable populations, Workforce Members may not be certain of their ability to share client information or may conclude that sharing is not permissible without the client's authorization. These concerns are particularly relevant with respect to SUD and mental health information, which is frequently at issue when providing services to the vulnerable populations served by the ACCESS Harris County Initiative. The IMDT Authorization ensures that Workforce Members may permissibly share all relevant information with each other as they work to get clients the services they need.
   3. Requests to Limit IMDT Authorization
      Clients may request limitations on the sharing of their data. Consistent with applicable laws, the Harris County Public Health Compliance and Privacy Officer or their designee will review those requests to determine if they are feasible. However, due to the nature of the ACCESS Harris County Initiative, and the need to accommodate the Watson Care Manager platform, many such requests may not be able to be accommodated.
      The Harris County Public Health Compliance and Privacy Officer or their designee shall review requests for limitations on data sharing in accordance with the standards set forth by the Privacy Committee and shall comply with state and federal law and regulations and all contractual obligations. The County is not obligated to agree to patient requests for restrictions. All such requests for limitations on data sharing will be responded to in writing.
   4. Documentation of IMDT Authorization
      If the client consents to information sharing, he or she will need to sign and date the IMDT Authorization. The IMDT Authorization may be signed electronically. The IMDT Authorization may be signed by the client's personal representative (such as a parent or legal guardian), as long as the personal representative indicates his or her relationship to the client. The signed IMDT Authorization will be available electronically in Provider Portal. If a paper authorization is signed instead of an electronic one, a scanned copy will be available within Watson Care Manager.
8. ACCESS Harris County Consent Form
   1. Purpose of the ACCESS Harris County Consent
      Clients participating in ACCESS Harris County also sign the Consent Form before being accepted into the program. The primary purpose of the Consent Form is to explain the ACCESS Harris County program in plain terms and solicit the agreement of the client that they will cooperate with assigned members of their CCT.
   2. Additional authority to share information pursuant to Client Consent
      The Consent Form also requires the client to agree that entities participating in ACCESS Harris County may share and discuss the clients information with each other to help coordinate the clients services. This statement expressly refers to social services information, health information, demographic information, and other records that relate to services the client has received from the County or the community. Because this language is broader in some respects than the IMDT Authorization, which is focuses on the use and disclosure of personal health information, it provides another legal authority to share information.
9. Information Uses
   1. Information uses by the ACCESS Harris County IMDT and CCT
      1. All members of the ACCESS Harris County IMDT and CCT shall be permitted to use or share client information under the following conditions:
         1. Consistent with a valid Consent Form and IMDT Authorization.
         2. In any other manner permitted by state and federal law.
      2. Access to Watson Care Manager
         1. Until a signed Consent Form and IMDT Authorization are obtained, Workforce Members shall be permitted to view only basic demographic information used to confirm an individual's identity (i.e., name, date of birth, and gender). This information is available from the provider portal before entering Watson Care Manager and is used during the intake or enrollment process to assess whether a new client account needs to be created. This information is not attributed to any source system and does not indicate whether the individual has or had a past or present physical or mental health condition, including a substance use disorder or diagnosis, either directly, by reference to publicly available information, or through verification of such identification by another person.
         2. All information contained in Watson Care Manager, including the Virtual Client Record, may be made available to Workforce Members only after a signed Consent Form and IMDT Authorization are obtained from the client or the client's authorized representative.
      3. Information Included and Viewable in Watson Care Manager
         1. Virtual Client Record:
            The Virtual Client Record within Watson Care Manager imports information held by a variety of Participating Agencies. Privacy Committee approval shall be required before new Participating Agencies are linked to the Virtual Client Record and contribute information to the Virtual Client Record. Privacy Committee approval shall also be required before new data fields are added or made viewable in the Virtual Client Record.
         2. Care Manager Interface:
            The Care Manager Interface offers Workforce Members a technology platform to organize and share information. Workforce Members may add and receive information to and from the Care Manager Interface because they have client consent or pursuant to exceptions to privacy laws. Access to the Care Manager Interface shall be limited to CCT members, and CCT members may only view the records of those clients assigned to their Cohort.
      4. Information Uses by Harris County IMDT Workforce Members With Consent Form and IMDT Authorization
         With a signed Consent Form and IMDT Authorization, client information may be used by IMDT Workforce Members for purposes consistent with the authorization, including the following:
         • In coordinated care meetings to consult with other IMDT members regarding client care and case management.
         • In the field or office with the client to provide care, case management, or other services. • For referral/connection to other entities.
         • To coordinate services with other entities.
         • For other purposes allowed by state and federal law.
      5. Information Uses by Harris County IMDT Workforce Members Without IMDT Authorization
         Without a signed IMDT Authorization and Consent Form, client information may be used by IMDT Workforce Members only for the following purposes:
         Limited demographic information may be used when consistent with privacy laws to help identify and locate referred clients prior to signing an authorization. The limited demographic information may not include information that would identify the client as having or having had a past or present physical or mental health condition, including a substance use disorder or diagnosis, either directly, by reference to publicly available information, or through verification of such identification by another person.
   2. Restricted Information
      1. HIV Test Results. No HIV test result information shall be used or disclosed by Workforce Members of the ACCESS Harris County IMDT. The Virtual Client Record shall not include any HIV test result information.
      2. Records protected by 42 C.F.R. Part 2. Disclosures of substance-use disorder records protected by 42 C.F.R. Part 2 made with the individual's written consent will include the written statement required by 42 C.F.R. Part 2.
10. Confidentiality
    1. No confidential information shall be disclosed to persons who are not members of the Access Harris County IMDT or a CCT except to the extent required or permitted under applicable law.
    2. All Participating Agency Workforce Members must sign a Confidentiality Statement prior to participating in the ACCESS Harris County IMDT.
    3. Participating Agencies must keep all Workforce Members' signed Confidentiality Statements on file for a minimum of seven years.
    4. If a Workforce Member changes employers, and the new employer is also a Participating Agency, the Workforce Member must sign a new Confidentiality Statement.
11. Participating Agency Supplemental Policies and Procedures
    In addition to these Information Privacy and Security Policies and Procedures, Participating Agencies may establish their own Supplemental Policies and Procedures for use and disclosure of information obtained through participation in ACCESS Harris County. The Participating Agency policies and procedures shall not conflict with these Information Privacy and Security Policies and Procedures. Participating Agencies electing to establish their own Supplemental Policies and Procedures must share them with the Harris County Public Health Compliance and Privacy Officer or their designee when established and when material changes are implemented to the Supplemental Policies and Procedures.
12. Breach of Protected Information
    1. The follow definitions apply to this section:
       1. Breach: A breach is defined in 45 C.F.R. § 164.402 as the unauthorized acquisition, access, use, or disclosure of PHI which compromises the security, privacy or integrity of such information.
       2. Personally Identifiable Information (PII): PII is any information that identifies or describes an individual, including, but not limited to, names, Social Security number, date of birth, physical description, home address, telephone number, education, financial matters, medical, or employment history.
       3. Protected Health Information (PHI): PHI is defined in 45 C.F.R. § 160.103 as individually identifiable health information that is transmitted by electronic media, maintained in electronic media, or transmitted in any other form or medium.
    2. The following procedures apply in the event of a breach or potential breach.
       1. Any member of ACCESS Harris County who knows or suspects that there has been a breach of PHI or PII shall immediately notify one of the following individuals of the breach or suspected breach: the ACCESS Director, IMDT Manager, Associate ACCESS Director, Cohort Managers, or Harris County Public Health Compliance and Privacy Officer. Regulations require the County to report breaches to some state agencies within 24 hours. As such, immediate reporting is essential to meet this statutory timeline. The breach must be reported whether committed by the person reporting the violation, or another individual and it must be reported whether intentional or accidental. The person receiving the report of the breach shall contact the Harris County Public Health Compliance and Privacy Officer or their designee and follow these procedures for investigating the breach and determining appropriate response and mitigation measures if necessary.
       2. Retaliation against any person who in good faith reports a violation of these privacy and security policies and procedures or retaliation against any person who supports someone else who reports a violation of the policy is prohibited. In addition, retaliation against any person who cooperates in an investigation related to this policy is prohibited.
       3. A report of a breach or suspected breach may be made via any of the following:
          • PHONE: Contact the Harris County Public Health Compliance and Privacy Officer or their designee by leaving a message at 713-274-1999. The Privacy Committee will be notified by email that a message has been left. Please be sure to leave your name, position, department, and contact information.
          • EMAIL: Send an email to PHS-Privacy@phs.hctx.net. Please be sure to include your name, position, department, and contact information.
          • IN PERSON: See any ACCESS Director, IMDT Manager, Associate ACCESS Director, Cohort Managers, or Harris County Public Health Compliance and Privacy Officer, Care Coordinator Team Supervisor to report the breach or suspected breach.
    3. Following the initial notice of the discovery of a potential Breach, the Harris County Public Health Compliance and Privacy Officer or their designee will coordinate efforts with the one or more Participating Agencies to investigate and mitigate the Breach.
    4. The Harris County Public Health Compliance and Privacy Officer or their designee shall report all Breaches to the Privacy Committee. The Harris County Compliance and Privacy Officer or their designee may also consult with the Privacy Committee when evaluating whether a potential Breach is a Breach.
13. Training
    1. All Participating Agency Workforce Members must complete information privacy and security training prior to participating on the ACCESS Harris County CCT, and must renew training annually as long as remaining on the IMDT.
    2. Participating Agencies must keep verification of all Workforce Members' successful completion of information privacy and security training on file for seven (7) years.
    3. If a Workforce Member changes employers, and the new employer is also a Participating Agency, training does not need to be repeated if the Workforce Member completed information privacy and security training while in the position occupied immediately prior to taking a new position. However, the Workforce Member must obtain verification of successful training completion from the previous employer and the new employer must keep this verification on file.
    4. Information privacy and security training will be presented by the Harris County Public Health Department. The training will be provided via a virtual platform and/or different modalities (i.e. surveys, web presentations, etc.).
14. Information Security
    1. Information shared electronically under this policy is subject to the Harris County Information Security Policy.
15. Sanctions
    Federal laws require that Participating Agencies sanction (discipline) individuals who violate privacy and security policies. As a condition of participation, all Participating Agencies agree to sanction any Workforce Member under their control who violates these policies.
16. Inquiries About and Changes to Policies and Procedures
    1. Any inquiries about these Policies and Procedures should be directed to the Privacy Committee or their designee at 713-274-1999 or PHS-Privacy@phs.hctx.net.
    2. With the exception of the revisions to Attachment A contemplated by Sections 4.6 and 4.8, all substantive changes to these Policies and Procedures shall be approved by the Harris County Safety Net Collaborative. Prior to approval, the Privacy Committee shall provide its recommendation regarding the proposed changes. All Participating Agencies will receive a copy of revised Policies and Procedures upon such approval.

Attachment A

1. ACCESS Harris County IMDT Core Group
   The Core Group includes specific subject matter experts who support the overall goals of the ACCESS Harris County Initiative. Core Group Workforce Members are authorized to access all records in Watson Care Manager. All Core Group Workforce Members are designated by the Safety Net Collaborative.
   Core Group Workforce Member

   Department Represented
2. ACCESS Harris County IMDT Participating Agencies
   Participating Agencies are entities involved in care, care management, or rehabilitation of high-needs, vulnerable populations that have agreed to participate in the ACCESS Harris County IMDT and be bound by the IMDT’s policies and procedures. One or more employee of each Participating Agency may be added to specific Coordinated Care Teams.
   Harris County Departments County Public Health
   Resources for Child and Adults
   Community Services Department
   Juvenile Probation Department
   County Department of Education
   Texas Department of Criminal Justice (TDCJ) Parole Division
   Texas Department of Juvenile Justice (TJJD) Parole Division
   County Sheriff’s Office
   Community Supervision and Corrections
   Department of Economic Equity and Opportunity
   

   Other Agencies (Community Partners)
   BASIC NEEDS
   Hope Center Houston
   The Coalition for the Homeless
   Waller Assistance and Restoration Ministries, Inc. (WARM)
   Memorial Assistance Ministries (MAM)
   Gateway Baptist Food Pantry
   Buckner Family Hope Center
   SEARCH Homeless Services
   Star of Hope Mission
   Braes Interfaith Ministries
   Core Services by Parnell Intermediary Services
   

   EDUCATIONAL
   Momentum High School in Spring Independent District (Spring ISD)
   Houston Advance
   Lone Star College
   Houston Community College
   

   MENTAL HEALTH
   LDS Family Services
   Vibrant Comprehensive Services
   Achor Counseling & Associates LLC
   IntraCare North Behavioral Health
   Moore Mental Health & Behavioral Services
   Shield-Bearer Counseling Centers
   

   SUBSTANCE ABUSE
   Cypress Creek Chemical Dependency Intensive Outpatient Program
   Hispanic Intergroup Office
   

   HEALTH
   Harris Health System
   The Harris Center for Mental Health & IDD
   Avenue 360 Health and Wellness
   Suburban Women’s Clinic/ Suburban Woman’s Medical Center
   Baylor Teen Health Clinic
   CareNet Pregnancy Center
   Legacy Community Health Clinics
   St. Hope Foundation, Inc.
   Baylor Teen Health Clinic
   Houston City Health Services
   Fifth Ward Pregnancy Help Center
   University Eye Institute (through the University of Houston)
   

   EMPLOYMENT ASSISTANCE
   Workforce Solutions
   

   SOCIAL SERVICES
   Refuge Center Online
   The Montrose Center
   Brothers Get It, and Community Promise
   The Salvation Army Greater Houston Area
   Command Boys & Girls Clubs
   Texas Department of Public Safety
   Social Security Administration
   

Right to Receive a Copy: I have a right to receive a copy of this authorization and have been offered a copy.

I understand that I do not have to sign this authorization and that my treatment, enrollment, or eligibility for benefits will not be denied if I do not sign this authorization; however, ACCESS Harris County won’t be able to coordinate support if I don’t allow my information to be shared.

TO BE COMPLETED BY ACCESS HARRIS COUNTY OR PARTICIPATING AGENCY:

Identity of Requestor Verified via: ☐ Photo ID ☐ Matching Signature ☐ Other, specify

Consent to Participate in ACCESS Harris County

You are eligible to participate in ACCESS Harris County. ACCESS stands for Accessing Coordinated Care and Empowering Self Sufficiency. ACCESS Harris County is a program that brings together Harris County departments, local government entities, and community organizations to team up to improve your health, well-being, and self-sufficiency. The program could help you get services and could help service providers coordinate with each other.

Residents are eligible to participate in ACCESS Harris County if they meet qualifying criteria. For example, ACCESS Harris County serves homeless individuals with physical and behavioral health conditions, minors in the juvenile justice system, adults in the Harris County Violence Prevention Program, individuals re-entering the community after release from jail, and minors who are aging out of the foster care system. ACCESS Harris County may also serve other populations that would benefit from its approach.

If you participate in ACCESS Harris County, you will be assigned a Care Coordination Team to help you access services that could improve your health, well-being, and self-sufficiency. Your team may include a primary case manager, a health eligibility navigator, or a behavioral health case manager. You can ask the person helping to enroll you in ACCESS Harris County for more information about who might be included in your Care Coordination Team.

Your Care Coordination Team will help you identify other Harris County departments, local government entities, and community organizations that offer services you may benefit from and will coordinate with these partners, as necessary, to provide you with care management. The agencies and services that may be available include the following:

By signing this form and agreeing to participate in the ACCESS Harris County program, you agree to the following:

• To cooperate and communicate with your Care Coordination Team and other professionals involved in the program.
• To allow someone from Harris County to visit and connect you with available County resources to improve your health, well-being, and self-sufficiency.
• To allow Harris County departments, other local government entities, and organizations that are participating in ACCESS Harris County to share and discuss information about you with each other to help coordinate your services. This may include social services information, health information, demographic information, and other records that relate to services you have received from the County or the community.