Resource Library

Behavioral Health

Resources that pertain to mental health, mental illness, and substance abuse. Resources include providers and mobile crisis information. Tools include safety assessments.

Examples: PHQ9, county mobile crisis contact information, mental health, mental illness, addictions, New York state

Community Resources

Healthcare Tools

Chronic Conditions

Resources and information that pertain to chronic medical conditions. Sub folders include resources and tools. Tools subfolders are separated by specific conditions. Resources for chronic conditions will include patient teaching tools, support services, and health literacy appropriate literature. For information on depression, see behavioral health.

Examples: chronic disease red flag teaching tools, insulin administration education, self management literature for patients, clinician focused literature

Community Resources

Healthcare Tools

End of Life

Information and resources that pertain to end of life planning and care. Sub folders include resources and tools.

Examples: Hospice homes, MOLST forms

Community Resources

Miscellaneous- Support For Populations

Resources that benefit various patient populations and do not fit into any other categories listed. Sub folders include resources and tools. Resources for the general folder will include health ministries, support services for children, developmental disability services (non-waiver programs), and resources for blind/deaf populations.

Example: Interdenominational Health Ministry Coalition, Rochester-area Healthcare Service Agencies and Support Groups

Community Resources

  • Statewide
    • Eating healthy on a budget
    • United Way - A non-profit organization that partners with charities across the country to help local communities.
    • Pathstone - A non-profit community development and human service organization providing services to low-income families and economically depressed communities.

Healthcare Tools

Insurance and Government Assistance Programs

Resources that pertain to insurance programs, including private insurance, Medicare, and Medicaid, as well as managed care and managed long term care plans.  Resources are included for programs that offer government funded assistance to income eligible persons.  Subfolders will include Resources and Tools.

Examples: multiple pharmacy programs, EPIC, neighborworks information. 

Community Resources

Patient Activation and Engagement

Definition: Resources that pertain to assessing or building knowledge, skills and confidence among patients with the goal of managing their own health and health care. Resources for patient activation include low literacy tools to manage chronic conditions; training materials for motivational interviewing and teach back; and studies of effective self-management.

Examples: management tools for asthma, COPD, diabetes, heart failure, pneumonia, and patients who take Warfarin.

Healthcare Tools


Definition: Resources that pertain to payment models, billing codes, and government policy related to reimbursement.  Tools for reimbursement include presentations, examples of forms, and summary documents.

Examples: presentation on the Medicare Access and Chip Reauthorization Act of 2015; examples of forms used for Chronic Care Management billing codes. 

Healthcare Tools

Senior Services

Definition: Resources that pertain to adults 60 years of age and older.  Sub folders include resources and tools.  Resources help seniors with aging in place, move to higher living, and obtain services that pertain specifically to aging.

Examples: silver sneakers resources, literature on treating persistent pain in older adults, geriatric care management information 

Community Resources

  • Eldersource - Monroe County resources for older adults and disabled adults.
  • Grandma’s Helpers Brochure - Agency that helps older adults with transitioning from aging in place to moving to a higher level of care.  Assistance includes helping with moving estimates, movers, packing, and cleaning.
  • Silver Sneakers Programs 

Social Determinants of Health

Resources that pertain to psychosocial factors that impact an individual’s ability to access healthcare or maintain satisfactory health. Sub folder includes Resources. Resources for social determinants of health include cash assistance, benefits information, and food and housing issues.

Examples: HEAP/Project Share Heating Fund information, SNAP, and food cupboards.

Community Resources

Transitions in Care

Definitions: This will provide resources and information that pertain to transitions in care. Sub folders include resources and tools. Resources for transitions in care include transitions tools and processes for practices from AMA, ACP, and AHRQ.

Examples: AMA Transitions in Care – Putting the Pieces Together, AHRQ Transitions Implementation Handbook, and the National Transitions in Care Collaborative Issue Briefs.

Healthcare Tools


Resources that pertain to transportation for patients.  Transportation will include transporting for medical appointments, social activities, and personal needs.  Transportation for Medicaid recipients as well as private pay will be included.

Examples: Transportation vendors and rates

Community Resources