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Transition Support Program at Shepherd Center

Life After Rehabilitation

The Transition Support Program prevents rehospitalization, improves health and safety outcomes, and promotes patient and family autonomy once the patient is discharged from Shepherd Center. The program provides an average of eight weeks of follow-up support. Referred clients enroll in the Transition Support Program free of charge.

Transition Support Program Goals

The Transition Support Program assists both patients and their families with returning to life after rehabilitation. Team members help patients set goals to make this transition easy and manageable. These goals for patients and families often include:

  • Assess clients for early prevention of medical complications
  • Reinforce knowledge and skills learned in hospital-based rehabilitation programs
  • Facilitate effective medication management
  • Provide recommendations for home safety
  • Assist in the identification of local community support services

Clients entering the program will collaborate with a Transition Support case manager to achieve their goals. Clients and case managers work together to:

  • Move toward optimal health, safety, and wellness management
  • Follow discharge plan and home care instructions to prevent rehospitalization
  • Develop a client-centered treatment plan in the home.
  • Locate and utilize appropriate community resources (financial, healthcare, wellness, etc.)
  • Develop self-advocacy for medical, health, and wellness needs

Learn more about our Life Skills Training Program

Contacting the Transition Support Program

Get in touch with a Transition Support Program representative by using the following contact information: