Targeted Care Coordination · Tiered LIFE Specialist Support
Tiered care coordination, built around your case manager.
The Virtual LIFE Center deploys tiered LIFE Specialists to provide targeted care coordination alongside the case manager already assigned — giving housing coalitions, human service agencies, schools, and public safety partners an added layer of support across every system a client touches, without replacing the case manager on file.
"The challenge isn't the absence of services. It's the absence of coordination."— The LIFE Center, Village LIFE Support Network Program Design
Virtual Care Coordination
Care that meets clients virtually — and keeps your agency in the loop.
LIFE Specialists connect with clients by phone, video, and text — then log every step in one shared system, so your agency always knows where a referral stands without picking up the phone.
Virtual Engagement
LIFE Specialists reach clients where they are — reducing missed appointments and closing coverage gaps in rural counties without a physical office nearby.
One Access Point for Providers
Partner agencies get a single point of contact for every client in care coordination — status, service linkages, and progress notes, feeding directly back to the case manager already assigned to the case.
"We don't just serve people. We build connections. We cultivate villages. We change legacies." — The LIFE Center
Who We Partner With
Built to extend the capacity you already have.
You don't need to hand off your case manager's role. You need a partner who coordinates around them — reporting back across behavioral health, housing, education, workforce, child welfare, juvenile justice, and transportation on your client's behalf.
Housing Coalitions & Authorities
A warm handoff for residents who need behavioral health, employment, or family support beyond a housing placement.
YMCAs & Community Centers
Connect members flagged for deeper needs to tiered care coordination — without adding case management staff to your payroll.
Human Service & Provider Agencies
Extend your capacity with tiered LIFE Specialists who coordinate alongside your case managers and report outcomes back to your team.
Community-Based Care Organizations
Formal MOUs, shared referral protocols, and joint outcome tracking through the Village Provider Network.
Schools & Districts
School-based referral pathways for students and families facing housing instability, trauma, or justice-system barriers.
Police & Fire / Public Safety
Pre-arrest and post-crisis diversion pathways for individuals who need a navigator, not a justice-system encounter.
The Referral Model
What happens after you refer.
Every referral moves through the same structured process — so your agency always knows where a client stands, and never has to chase the next step.
Referral
Intake from your agency, school, or Village Provider Network partner.
Screening
Initial behavioral health and social-needs screening.
Assessment
Full intake across behavioral health and social determinants.
Capital Deficiency Scale
A standardized measure of where support is most needed.
Individualized LIFE Plan
One plan, built with the client, that every partner can see.
Service Matching
Matched to housing, behavioral health, workforce, or education resources.
Navigation & Care Coordination
The LIFE Specialist manages the handoffs directly with your case manager.
Reassessment
Ongoing check-ins to confirm the plan is still working.
Transition Planning
A clear exit plan once stability and goals are reached.
Workforce Pipeline
A tiered LIFE Specialist model, staffed for volume.
Every tier can be filled by a traditionally credentialed professional or a Certified Peer Specialist with lived experience — so your referrals get a navigator fast, not a waitlist.
LIFE Specialist I
Workforce Development Fellow
Undergraduate fellows recruited through university partnerships, providing direct community-engagement support under supervision.
LIFE Specialist II
Care Coordination Specialist
Graduate-level training in social work, counseling, or public health — or a Certified Peer Specialist credential paired with relevant care coordination experience.
LIFE Specialist III
Senior Care Coordinator
Licensed social workers and behavioral health professionals — or Certified Peer Specialists with extensive lived experience and advanced coordination capability.
Eight Years of the Village System of Care
What tiered care coordination produces.
Outcomes from The LIFE Center's Village System of Care implementation, 2022–2025.
The Village LIFE Network
Care coordination needs somewhere to refer into.
Beyond direct navigation, The LIFE Center builds the trusted network LIFE Specialists refer clients into — Safe Space partnerships in churches, businesses, barbershops, and community centers that increase access to mentoring, recreation, and behavioral health support before a crisis occurs.
Partner With Us
Bring tiered care coordination into your referral pipeline.
Tell us about your agency and the population you serve. We'll walk you through the LIFE Specialist model, how it works alongside your case manager, and what a partnership looks like in your first 90 days.
Or reach us directly — [email protected] · 850-755-9413