4. Sustain: Case Coordination

Long-Term Support • Service Follow-Up Provides ongoing, individualized assistance for adults who need support across multiple systems or over an extended period. Individualized service and stability planning Coordination among courts, supervision officers, employers, treatment providers, and community agencies Connections to mental health care, substance-use treatment, housing, food, healthcare, transportation, and other resources Follow-up on referrals, appointments, and service access Progress monitoring and adjustment of support plans Continued mentoring, advocacy, and transition planning