Frequently Asked Questions

• What is the purpose of the Hospital to Home program?
  Hospital to Home (H2H) aims to be a bridge and support for families and youth in critical need. H2H will engage families, facilitate connections to community resources, and provide support to keep youth with their families and out of unnecessary hospital stays and residential placements.
• Why is a child referred to H2H?
  Children are referred by a hospital because they have multiple needs that require extra support—such as school difficulties, mental health concerns, or involvement with multiple systems (e.g., healthcare, education, social services) to transition back to home.
• What does a case manager do?
  The case manager helps develop a care plan, coordinates with other providers (such as schools or therapists), helps you access resources, and works closely with your family to support your child’s goals.
• Is participation voluntary?
  Yes, participation in the H2H program is voluntary.
• Do H2H services replace other services a child is receiving?
  No. H2H adds support—it doesn’t replace a child’s existing therapist, doctor, or school services, but we will help fill in any gaps in service parents and children may need and help create new community service linkages. The goal is to make sure the family and youth have all the community resources they need and ensure that everything works together effectively.
• How often do families meet with case managers?
  The frequency of meetings is based on the needs in each individual case. Some families meet weekly, others more or less often.
• What if I don't want people in my home?
  We have offices and meeting rooms available at our location in Schenectady, or we can schedule to meet in your community at a location you are more comfortable with. Meetings can happen in your home, at school, in the community, or virtually.
• What support can clients expect?
  H2H can assist with: • School advocacy and meetings • Mental health referrals • Parenting support • Behavioral support plans to use at home • Crisis planning • Access to community services • Residential respite when needed (Fall of 2025)
• How long do services last?
  This program is intended to last between 9 – 15 months. The case manager will regularly assess progress through the phases, keeping the family in the loop for each transition, and help plan for discharge when ready.
• Is client and family information kept confidential?
  Yes. Client and family information is private and only shared with client and family permission—except when required by law (e.g., safety concerns).
• How is H2H different from other programs?
  H2H is more intensive, with frequent contact and personalized support. It’s designed for youth and families with higher needs and offers stronger coordination between systems.
• Are case managers reachable between meetings?
  Yes. Case managers will provide contact info and explain how and when they can be reached—especially in urgent situations.
• What is expected of caregivers?
  We ask that caregivers: • Be actively involved • Attend meetings when possible • Communicate openly • Share goals and feedback Caregiver voice is essential in planning a child’s care.
• What happens if a child is not approved for H2H enrollment?
  There are two reasons why a child might not be accepted to the H2H program: They might not meet the eligibility criteria They might meet one of the exclusion criteria. Regardless of the reason we won’t leave anyone without resources. As part of our review process, should we determine that the child would best be served by other programs we will provide those referrals as well as any others a caregiver might ask for.
• How is this program paid for?
  Currently this program is 100% funded by New York State’s Office of Mental Health.
• Is this program covered by insurance?
  We expect that it will be in the future, but for now there is no cost for participation.