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AmericaServes 101: Provider Guidebook

To read the complete AmericaServes 101: Provider Guidebook, please download the PDF or read the plain text version below.

The Institute for Veterans and Military Families at Syracuse University (IVMF) is the first interdisciplinary national institute in higher education focused on the social, economic, education and policy issues impacting veterans and their families post-service. Through our focus on delivering world-class programs and services
to service members, veterans, and their families, the Institute provides the nation with impactful analysis of the challenges facing the community, captures and applies best practices, and serves as a national forum to facilitate new partnerships and strong relationships between these individuals and the organizations committed to serving their needs. AmericaServes is driven by the IVMF.
For more information, visit

Unite US

Unite Us is an outcome-focused technology company that builds coordinated care networks connecting health and social service providers together. The company helps systems and communities efficiently deliver care and services by inter-connecting providers around every patient, seamlessly integrating the social determinants of health into patient care. Providers across the service continuum can receive and send external referrals and track every patient’s total health journey while reporting on all tangible outcomes across a full range of services in a centralized, cohesive, and collaborative ecosystem. This social infrastructure helps communities move beyond legacy resource directories and transform their ability to measure impact, improve health, and track outcomes at scale. Unite Us is headquartered in New York City, with offices in Raleigh and Portland. Follow Unite Us on Twitter, LinkedIn, and their Blog.
For more information, visit


Accenture is a leading global professional services company, providing a broad range of services and solutions in strategy, consulting, digital, technology and operations. Combining unmatched experience and specialized skills across more than 40 industries and all business functions – underpinned by the world’s largest delivery network – Accenture works at the intersection of business and technology, to help clients improve their performance and create sustainable value for their stakeholders. With approximately 384,000 people serving clients in more than 120 countries, Accenture drives innovation to improve the way the world works and lives.
For more information, visit

Introducing AmericaServes


AmericaServes is a first-of-its kind, coordinated network of service providers who are self-organizing as a collective body – beyond their own unique organizational designs – to ensure unequaled access to the very best and most comprehensive network of services, resources, and care designed exclusively for service members, veterans, and their families. Central to the AmericaServes solution is the concept of “Collective Impact”, and the idea that true change comes from community-wide buy-in.

An initiative founded by the Institute for Veterans and Military Families at Syracuse University (IVMF) and operating in partnership with software company, Unite Us, and global technology consulting firm, Accenture, AmericaServes is a national-facing movement dedicated to building and sustaining community-based practices to best serving those that have served in the Armed Forces.


Our mission is to catalyze and instill a sustainable, community-based commitment to care coordination excellence for America’s military-connected members and
their families. We do so by providing innovative practice, actionable strategies, technology, resources, and expertise to communities, organizations, and individuals who are willing to improve upon their efforts to serve the needs of the nation’s all-volunteer armed forces, veterans, and their families.


First, is that every service member, veteran, and their family can easily access the full range of comprehensive services required to achieve their unique goals, and to provide a first-class service experience to match service members’ and veterans’ first-class service to our nation. Second, is that all public, private, and nonprofit organizations serving veterans and their families are accountable to one another and embrace formalized communication, coordination, and transparency.

Our Partners

The Institute for Veterans and Military Families (IVMF) at Syracuse University: IVMF leads the strategic development and implementation of the community network – providing oversight, direction and strategy, as well as working with community partners to build a sustainable model of the network.

Unite Us: Underpinning the operations of all AmericaServes networks is a secure, robust technology platform called Unite Us, which records the interactions between the coordination center, service provider organizations and participants (transitioning service members, veterans and family members). The technology platform also saves referral records and eligibility documents of the client, allowing for easy retrieval and a speedy referral process in the future. The ability to track and report on data in real time allows for an unprecedented level of transparency.

Accenture: By providing both cash grants and pro bono consulting support, Accenture has helped IVMF move AmericaServes from conception to implementation and expansion.

Service Providers: You, service providers are the most important component of the AmericaServes model. Whether you provide job training, behavioral health counseling or anything else in between, the services your organization provides is the cornerstone of our collective impact initiative. Ultimately, your work is what makes our network possible.

Coordinating Care: How does the Network Work?

Every day, AmericaServes communities coordinate care; resources and services for veterans and their families of all service eras. In each case, AmericaServes works towards our root guiding principle: to match the right veteran to the right provider at the right time they need assistance.

Each community hosts a Care Coordination Center, which serves as the “air traffic controller” by directing referrals for service members, veterans, and their families to and from providers with in the community network, based on needs of the client. Clients can enter the network by visiting a network provider or self-refer by completing a web-based form on the networks website or by calling the Coordination Center.

Working behind the scenes, the Coordination Center reviews the referral to ensure that it matches each providers’ eligibility requirements, service region limitations, and workload capacity. The goal is to match the veteran with the right provider that can best serve his or her needs in the shortest amount of time.

Throughout the process, providers can track the status of the referral and the delivery of care hrough the technology platform.

What does this all mean for you? As a service provider, referrals you receive from an AmericaServes Coordination Center will be crosschecked against your programmatic eligibility criteria, ensuring that (in most cases), you will be able to serve the individuals that are sent to you. What’s more, if your organization encounters a client you are unable to assist you can send the referral back to the Coordination Center with a note and they’ll work to get the client to an alternate provider.

AmericaServes Coordinated Care

Access — Veteran, service member, or family can request assistance in three ways:

  • Fill out the “Request Assistance Form” on the Coordination Center website
  • Calling the Coordination Center directly
  • By visiting an in-network provider’s location

Intake — An in-network provider or Coordination Center performs an intake to understand the client’s needs, then creates a referral and distributes it through the Network’s technology platform.

Referral — The Coordination Center receives and then sends referrals to the appropriate provider based on the client’s needs, eligibility restrictions, and location. The provider either accepts or rejects the referral, and the process is repeated until a positve match is made and all needs are addressed.

Service — Once a positive match is made, the provider connects with the client directly to set up an appointment. Service updates and notes are recorded on the network’s platform for easier tracking and data collection. Once the client’s needs are addressed, the referral is closed.

The Value Proposition

AmericaServes continuously works towards our root value proposition: to match the right veteran to the right provider at the
right time that they need it.

In upholding our value proposition, AmericaServes continues to support three groups of stakeholders:

  1. People—Service Members, Veterans, and their Families
  2. Providers—Health and Human Service Providers
  3. Communities—Whole Communities

We have learned that by better empowering providers: their veteran clients and the communities where they live are better served.

With a referral through AmericaServes, all of the client’s information and service request details are provided in referral sent through the software. As a provider in the network, you are able to stay in contact with the client to ensure continuity of care through out the entire referral process. The coordination center is also tracking all referrals during the course of service and will remain a constant, available point of contact as the client’s case proceeds. Anytime a client possesses a need outside
of a provider’s primary scope, they can send a referral back to the coordination center and they will work to identify an additional provider based on that co-occurring need.

AmericaServes is underpinned by an insights team that analyzes the data collected about clients seeking assistance across 20+ service categories in each network. In addition to the value this data has at a community level, it also enables individual organizations to better understand their own clients and operations. In turn, this information empowers quality improvements as well as facilitates effective communication and accountability with stakeholders.

For communities, the AmericaServes model creates an infrastructure that promotes trust and confidence knowing that the network is comprised of providers, who adhere to quality standards and practices. The IVMF offers access to their evidencebased research and methodologies via the AmericaServes Community of Practice, which allows communities to better understand and address the needs of their military-connected population and improve upon their service performance in real time.

Additional AmericaServes Components

As a Network Provider in a local AmericaServes community, you now have access to tools and partnerships that are designed to help you, your organization, and your community excel at serving those in need.


Our insights and analytics are powered by the Research and Evaluation team at the IVMF. They have cultivated a multidisciplinary “action-tank” that translates these insights directly into practices for our communities. The Unite Us technology enables ongoing data tracking and reporting that make these insights possible. The data is analyzed and outcomes are periodically shared with stakeholders through In-Practice Reviews (IPRs), dashboards, reports, and other analytics that allow for higher levels of transparency into each network’s key performance indicators and community needs.


AmericaServes delivers supportive services with a high-touch model, methodically implemented and engineered by the skilled AmericaServes staff. Each community has a dedicated AmericaServes Market Lead, who is uniquely qualified to provide technical assistance to the coordination center by assisting with provider engagement, community asset mapping, and coordination of the Community of Practice. We work side-by-side with the best non-profit and health and human services agencies in cities, counties, and states across the country, with a singular vision of improving the lives of service members, veterans and their families.

AmericaServes Practice360

AmericaServes Practice360 is a collective learning network fueled by our Community of Practice. Organized at the local, regional and national level, each Community of Practice is comprised of Coordination Centers and provider partners who share a passion for serving military-connected families.

Practice360 provides a method to collect, curate, and disseminate knowledge through reoccurring collaborative learning activities, professional development, and quality improvement. This is done to stimulate our communities into higher, more sophisticated forms of service delivery.

Unite US

AmericaServes Network Providers have exclusive access to the secured, shared, web-based software platform developed by Unite Us. With all client information, case notes, and referrals stored centrally in one place, this allows for easy access and complete transparency of the services your clients are receiving. There is also accountability, as you can see in real time when your client gets connected to another community provider and what the outcome for that need is.

AmericaServes Fundamentals

Your Coordination Team

Your local AmericaServes Coordination Center Team will be your main point of contact for all things related to your network, so it is important that as a network provider, you meet the team and familiarize yourself with their roles and what those roles mean to you.

Typically, a Coordination Center Team is comprised of three individuals; one lead and two support staff, however every network and community are unique and yours may have additional staff dedicated to the effort. To help familiarize yourself, we have provided the common titles applied to the Coordination Center Team, their typical roles, and how these individuals interface with you as a provider:

Intake Specialist
This individual receives and reviews incoming self-requests for service, whether the client has completed the online assistance form or called the local 1-800 number. The intake specialist conducts the initial assessment(s), collects identifying information, documents, and eligibility qualifications from the client, then creates and sends out
the appropriate referrals to community partners. From there, the Intake Specialist tracks the progress of that referral through completion.

Care Coordinator
The Care Coordinator receives and reviews incoming referrals from innetwork providers. Like the Intake Specialist, the Care Coordinator will collect any necessary information, documents, and eligibility criteria that was not included in the original referral. From there, the Care Coordinator tracks the progress of that referral through completion.

* Often, the Intake Specialist and Care Coordinator role are merged to become one in the same, resulting in one individual working on service requests that are both self-referrals and provider referrals. Typically, a network will choose their title of choice to apply to the individual who is fulfilling both roles (i.e. two care coordinators or two intake specialists).

Operations Manager The Operations Manager
oversees the daily workload of the front-line staff. They will review incoming and outgoing referrals for completion of identifying information, accuracy, assessments, and follow through. When needed, the Operations Manager may also assign specific referrals to front-line staff to ensure the team’s workload is balanced. The Operations Manager will also assist the front line staff when an urgent or complex issue arises.

Network Director
This individual is responsible for the overall performance of the Coordination Center, developing and implementing a plan to engage Network Providers, as well as allow the Coordination Center to emerge as the community leader in serving veterans, service members, and their families. The Network Director also communicates directly with their AmericaServes Market Lead who serves as the local network liaison.

*Often, the Operations Manager and Network Director role are merged to become one in the same, resulting in one individual working to lead the front line staff directly and also serve as the network ambassador to providers, and the community at large. Typically, a network will choose their title of choice and apply it to the individual who is fulfilling both roles (i.e. a Network Director or an Operations Manager*)


As a provider, Intake Specialists and Care Coordinators work directly with the clients that you refer, and/or that are referred to you. They are the frontline staff of the Coordination Center. They will be your point of contact when you have a specific question about a particular case or client, you are working with.

As a provider, the Operations Manager or Network Director will likely be your main point of contact for all operational questions related to being a participating network provider (i.e. onboarding process, provider expectations, referrals for new community organizations looking to join the network, etc). This individual will often be the first person that you meet as part of the Coordination Center Team, during the onboarding process, and the person who you can always go to when you have questions.

Your Role (What We Ask of Providers)

Once onboarded into the AmericaServes network, you become a trusted provider, which allows an opportunity for transparent and consistent quality of service delivery. During the onboarding process, you will work closely with the Coordination Center Team, AmericaServes, and other community stakeholders to determine the right fit in the network. As a Network Provider within your community’s AmericaServes network, there are several standards that are looked for:

Programs you offer are free — Despite the circumstances that brings a service member, veteran, or their family to AmericaServes, they deserve the best in class service – with out the additional burden of financial stress. AmericaServes providers are expected to offer services that don’t place additional financial stress on the client.

You, as the Provider, have the capacity to serve clients, on-going — AmericaServes expects that our providers will have the capacity to continually assist our veteran and military-connected populations. Before becoming a Network Provider, give thought to your organization’s client load capacity, your ability to consistently provide services (ie – what is your program’s longevity), and your hours of operations. By identifying your constraints and limitations, you will be in the best place to receive accurate referrals.

As a Provider, be responsive and proactive with communication — Open and clear communication is fundamental to ensuring the network runs efficiently. Our providers can expect regular communication with the Coordination Center Team with any questions, concerns, or ideas on improving the network. AmericaServes understands that programs change, funding priorities are shifted, and there is natural staff attrition; we ask that you be proactive in communicating any changes both short term (i.e. – holiday operating hours) and long term (i.e. – program has reached capacity for the remainder of the fiscal year) with your point of contact at the Coordination Center. Having consistent communication will ensure the smoothest operation in assisting a client.

Providers sending and receiving referrals through the system — Joining your local AmericaServes network is a commitment to exercising defined best practices and utilizing Unite Us as the new “norm” for assisting service members, veterans, and their families. As you complete onboarding and begin to “go live” in the network, there will be a learning curve within your organization around process change.

Active participation in Community of Practice — Being an AmericaServes Network Provider not only gives you the opportunity to accept and receive referrals more efficiently, but also offers membership in the Community of Practice (CoP). This allows for you and your organization’s attendance in regular webinars, calls, and meetings. You will be engaged in conversations and activities with your fellow network providers around the needs of your community and how you can better utilize the network to serve those needs.

Becoming an AmericaServes Provider


Prior to registering your organization, it is important to discuss the what, where, who, and how with your Coordination Center team as it relates to your organization’s participation in the network.

WHAT: What programs within your organization will be participating in your local AmericaServes Network?
WHERE: Are particular programs confined to specific areas of coverage – where are these services offered?
WHO: Who within each program is going to have access (user license) to the software – who will be making and
receiving referrals within the platform?
HOW: How does each of these programs operate on a daily basis and how will participation within the network

Step 1: Build Your Organizational Profile

Once you have an idea of how you would like to participate, you will complete an online registration form. This is an integral step in the onboarding process as the information collected in this form will be the basis of your organization’s profile the Unite Us software, and therefore will dictate the types of referrals you receive.

You can add as many programs as you like. However, you do not need to include every program your organization has – only the ones you would like to have access to receive and send referrals into the network. You can add, delete, or modify your organizational profile at any time right from the Unite Us software. Ask your Network Director to walk you through making updates in your profile. effect those processes?

Key Points

It is important to consider those staff members who will be using Unite Us to receive referrals and manage clients. Only the
individuals that need access to the software to receive and send referrals should be listed on the registration form and attend software training.

If you have a large organization that spans across counties or service types, it will be helpful to first strategize with your staff:

  • Who will review and accept or reject each referral sent to your organization?
  • Who will work on each case?
  • If your organization provides more than one service, like employment, housing, and education, should staff members have access to all programs, or only some?

Each organization will need to identify a Point of Contact (P.O.C.) to receive correspondence from the network. The P.O.C. is not based on title and should be selected based on who will be responsible for communicating with the network.

Staff member permissions can be modified at any time. Contact the Coordination Center to inform them of any staff changes to your organization’s profile.

NOTE: Even though not every staff members needs software training, it is a best practice to make your organization situationally aware of the network. Create a process within your organization for sending and receiving referrals to and from the Network.

It is possible for your organization to participate in several (or all) AmericaServes networks. You will be asked on the registration form if you would like to be considered for inclusion into additional networks. Access to multiple/all networks is not automatic.

Step 2: Attend Unite US Technology Training

Once the registration process is complete, it is time to get hands on and complete software training. In the next section, Unite Us provides you with a comprehensive, reference guide on how to use the software; here we will outline ways to access training sessions. When it comes to learning the software, training can be tailored to fit the needs of your organization, with several options available:

Webinar training (Individual): Unite Us hosts regular, reoccurring software trainings which you can join (ideal when 1-3 people need training). First, visit

Unite Us will send a confirmation email that allows you to add the event to your calendar and also provides the URL link to the webinar.

There are several key takeaways to consider with the individual webinar training:

  • If more than one user is signing up for webinar training, you will need to register & participate individually, as this is how Unite Us tracks who has completed training and thus who receives email activation for their account. (if there is a group of users who need training, consider a group webinar – see next section)
  • Don’t wait! Although multiple days/times are offered for flexibility – this should not keep you from signing up for one of the first available training dates. Remember – putting off training just delays your opportunity to begin utilizing the network.
  • Webinars are not participatory or self-guided. These webinar trainings are live and led by a Unite Us expert, who is sharing their screen with attendees as they guide them through the software. (for those who prefer a more hands on approach to training, consider an in-person training –see following section)

Webinar training (group): Upon request, Unite Us can provide a personalized webinar training to a group (ideal for 4 or more people). The first step would be reaching out to your Coordination Center lead and Unite Us, requesting to hold a group training for your organization. From there a day, time, and venue will be decided. You will also want to discuss how participatory you want this training to be – do you want attendees to observe Unite Us navigating through the software on a large screen, or would you prefer to have each trainee at their own computer following along, practicing the steps in a mock software environment?

There are several key takeaways to consider with a group webinar training:

  • This training can allow for a more “hands on” approach. With this training option being tailored to your organization, you can opt to allow your group to utilize individual computers and follow along with Unite Us.
  • Since this training option is conducted between just your organization and Unite Us, this can allow your trainee group to ask questions directly to Unite Us – live. Your organization will receive answers in the moment, as they arise.
  • Opting for a group training when you have several organizational users is the best way to ensure that everyone completes training and are aligned for coordinated network activation, and utilization.

In-person training: Unite Us unfortunately cannot supply in-person trainings for every user, each time that it is needed. However, this is where the Coordination Center can be of assistance. If you feel that you, or a network user would benefit from individualized attention and direct instruction, contact your Network Director and request an in-person software training with them.

Ensuring that you and your team are properly trained on the network software is essential to an efficient experience for you, an effective experience for fellow providers and a safeguard for veterans and their families as they move through the network. This is why it is important that all users be trained via one of the methods outlined here and do not receive second hand training (i.e. organization user trains another user) – think of the telephone game, where information can be lost along the way.

There are several key takeaways to consider with an in-person training:

  • In-person training with your Coordination Center Lead is another great opportunity to get some face time and engage further. The Coordination Center Lead can answer any and all questions directly with you, and can also supply additional context that may not be covered during the group webinar trainings.
  • In-person training does not need to just be 1:1. Your Coordination Center Lead can provide this option for training to 1 person, or a group.
  • You can always supplement a webinar training (individual or group) with your Coordination Center by requesting your Coordination Center Lead to join you in person and assist in walking you through the software, as Unite Us presents via webinar – highly recommended.

Step 3: Receive Unite US Access

No matter which method you choose, once your training session is complete Unite Us will be notified and you will receive your activation email. This email will provide you with a link to activate your log in credentials:
• Username = your email
• Password = created by you at activation

Upon logging in for the first time, you will be prompted to read and sign the user agreement from Unite Us. Essentially, you are agreeing to abide by the terms of having access to this shared network system and to uphold best practices when it comes to safeguarding client information. Once you have signed off on the agreement, you will be directed to the Network home page. This is your opportunity to look around the software’s “live environment” and familiarize yourself with the pages that were
covered during training.

PLEASE NOTE: Do NOT create any “false data” (i.e. fake clients, fake referrals, etc.) within the live environment. This information skews the overall network data and cannot be deleted. If you feel you need more practice – please reach out to your Coordination Center Lead and Unite Us to request the training software link and log in information.

You are now ready to be an active provider in the software; sending and receiving referrals within your local AmericaServes Network! Be sure to reach out to Unite Us and your Coordination Center Lead with any questions as they arise.

Step 4: Keep Your Profile Up to Date

Change happens. As such, it is imperative that when changes occur within your organization, you inform your Coordination Center Lead and Unite Us promptly. This is critical to ensuring your organization is up-to-date and is thus an accurate reflection of your ability to provide services. This could be adding/changing staff within the software, changing POC’s, changing/updating programs, or adding/removing programs. It is important to communicate changes promptly, to be sure the right people are getting the right information. Key information that you will want to communicate includes:


  • Name of individual leaving
  • Date when they will no longer need access
  • Name and email for the staff member being added
  • Role of this new addition within your organization & within the software
  • Date this new staff member will need access by


  • New program
  • Changes to program eligibility requirements
  • Service category changes within an existing program
  • When a program ends – end date

By letting BOTH the Coordination Center and Unite Us know this information ahead of time, they can guarantee a smooth transition of access from one user to another and also determine the best method for training directly with that individual. It also allows Unite Us to deactivate the user license in the software to make certain that access is granted only as long as it needs to be.

Unite US

The Unite Us software manages and tracks all referrals flowing through the network, providing an unparalleled level of accountability and transparency in the referral-making process. From tracking an individual client’s journey to analyzing community-wide trends, Unite Us powers our collaborative work.

Below we provide a brief overview of the major tasks associated with using the technology.

Unite Us has published a user guide, which you will receive at your training and should reference regularly.

Unite Us is rich in features, but you will primarily use the software to:

Create a referral: This feature allows you to refer a client with needs outside of your organization’s capacity to your local
coordination center where they will connect that client to a provider in the network who can assist.

Act on a referral: When your organization receives a referral, you will have the opportunity to review it and make a decision on to accept, reject or hold it for further review.

Manage a case: Each case file within Unite Us is tied to specific service request. Here, you will be able to take notes, track client interactions, and record any efforts made related to that case.

Close a case: Once a case has been completed, it will be closed as either resolved (client’s needs were met) or unresolved (client still needs assistance). When closing a case, you will be asked to record the applicable outcome from a drop-down menu specific to its service type.

Pull reports: The software’s reporting feature allows you to view data at two levels: network and organizational. Reporting at the network level includes visualizations of the community’s client demographics and performance. Reporting at the organizational level includes data specific to your organization such as cases, referrals and clients.

Promptness and appropriate action: When the Coordination Center sends a referral into your agency, it is essential that those on the receiving end are prompt with their ability to act and choose the appropriate action to take with a referral. It is best practice to take some type of action within 1 business day (excluding weekends and holidays), even if the need cannot be met right away. For example, if you need more time, you can place the case in Hold for Review.

An employee who receives a referral and does not act on it, is essentially keeping a client from receiving assistance, whether at your organization or another community provider.

*Remember that each referral is a veteran, service member, or military family member, who is waiting for help*

Regularly updating and maintaining client cases: Once a referral has been accepted by your organization, that client and their need(s) become your responsibility to meet. The Coordination Center has entrusted you with this client moving forward and will be checking on the case within the software platform to ensure it is being worked on. This is why it is important that employees working on the cases regularly update the case notes on the client’s timeline as it progresses.

*Best practice is to have the employee update the case with a progress note in a continuous fashion (we recommend at least once per week, if not more, depending on the severity and turnaround time)

AmericaServes Practice360

AmericaServes Practice360 is a collective learning network fueled by communities of practice. Our Communities of Practice are groups of people who share a passion for serving veterans and militaryconnected families and who strive to do it better as they interact regularly. AmericaServes sponsors communities of practice at three levels: local, regional, and national where the learnings from one continuously improve the others.

Practice360 encompasses recurring collaborative learning activities (gatherings, trainings conferences, etc.), professional development, and the sharing of meaningful content to stimulate our communities into higher, more sophisticated forms of service delivery.

Locally, AmericaServes sponsors 17+ communities of practice that consist of 50 (+) human service providers each participating in their locally coordinated community network. While most organizations network already, truly connecting the community with shared software (tools) and the resultant analytics (insights), and the structure and rigor of collective impact, we can accomplish more.

Regional Communities of Practice in the Northeast, Mid-Atlantic, Southeast, Southwest and West support a larger National effort that ensures hard-learned lessons don’t end at the edge of your service area. Launched in 2019, there are five Regional Practice Champions that identify professional development and quality improvement activities tailored to the needs of our network providers, co-creating programing and training specific to their needs.

The National Community of Practice is a an opportunity to bring together all 17+ communities in 12 states and the nation’s capital. The national focus surrounds a shared learning framework dedicated to educating, enabling, and supporting one provider at a time, in one community at a time until a new level of professional,
transparent and accountable service delivery becomes the national norm.

In-Practice Reviews (IPRs) give the Coordination Centers, supported by the AmericaServes team, an opportunity to share relevant data collected over the given time period, make insights into network health and success measures, and discuss important topics within the community. IPRs provide an opportunity for Network members to gather and take a deep look at the important information and insights revealed from the previous six months or year, look at possible correlations of service requests, supply versus demand disparities in services requests, and assemble as colleagues to announce any important community events.

How to Participate in Your Network

If you haven’t already, it’s time to schedule an in-person meeting with your local coordination center to begin building a first name basis relationship. This meeting is also a great opportunity for the Care Coordination Team to learn more about you, so ask yourself – what does the team need to know about me and my organization? It is good to provide an overview of your agency as a whole:

• History
• Mission & vision
• Populations served
• Services provided, eligibility criteria & restrictions
• Geographical coverage area, etc.

Address any questions that you have – the experts are at your disposal! Here are a few areas to consider asking about if you are still unclear:

• Coordination Center Team roles—who to ask for what
• Expectations on providers—what are your responsibilities as a provider
• Collateral—what materials will you need to start your partnership and properly promote the network (brochures, proud member badge, transparency reports, outreach cards, etc.)
• Any upcoming network events—ways you can participate, to familiarize yourself and your team
• Unite Us—Are you comfortable using the technology? Are all the necessary staff adequately trained?

Remember to exchange contact information with all of the Coordination Center Team members. That way when a question or need arises later on – you know how to contact the team and vice versa.

Equally important to meeting your local Care Coordination Center Team is also meeting your fellow Network Providers. You probably know several of these providers already, as they serve your local community right alongside you. There may be network providers that you do not know at all so this will be an opportunity for introductions and to learn more about the services being offered to veterans, service members, and their families and to create in-person synergies. There are a couple of ways to engage with your fellow Network Providers at the start:

• Attend a local CoP meeting—your local AmericaServes network will hold regular Community of Practice meetings. These can be done via webinar, conference call, in person, or all of the above. Most importantly, these meetings serve as a catalyst to bring together Network Providers to discuss the network, and our common goal of serving military connected individuals. When at your local CoP meeting, contribute your thoughts and opinions around the information presented. Help your fellow network providers ask critical questions of your network and the services that you all are providing.

• Schedule a community partner conference call/meeting—when it comes to learning about how your organization or program, fits within the Network it is a good idea to connect with a seasoned Network Provider who offers the same or similar services to you. By talking with another provider with a comparable infrastructure and process, it can allow you to internalize how your organization will participate and it can provide you guidance on how another provider has “set up” their team within the software (i.e. permission levels, process of referrals in and out, etc) so you do not have to go back to the drawing board on certain items. Speaking with another community partner also allows you to hear first-hand how providers feel about being part of the network – consider this call to consist of peer-supported context, answers, and advice.

• Attend the Network’s annual In Practice Review (IPR)—The IPR is the culminating activity held once per year, which brings together all the Network Providers and other community stakeholders to discuss the accomplishments of the Network over the last year. This is a wonderful occasion to meet fellow Network Providers and learn about the Network in its entirety.

Open and honest communication/feedback is key to ensuring a productive and successful relationship with your Coordination Center. If you haven’t already, make it a priority to schedule regular, in-person meetings with your local network’s Network Director. Invite your team to participate in these meetings as well. This will allow your team and the Coordination Center to be aligned on the expectations, outcomes, and an action plan moving forward.

One on one meetings are also a great opportunity to give your Care Coordination Team updates on any changes in your services and staffing model, which allows you to plan ahead for any necessary software updates and training needs.

Whether your organization provides financial counseling, legal services, employment readiness training, or something entirely different, we all regularly interact with clients who could benefit from additional services. As such, we ask all our participating members to refer your clients into the network whenever appropriate. These referrals help our communities keep track of the additional needs of our clients and will inform our future efforts to proactively connect those individuals to additional services.

Being a brand ambassador—As a Network Provider in your local AmericaServes community, part of your participation in the initiative will be as a brand ambassador. When you attend a local community impact or human services meeting, you will have the opportunity to talk to fellow providers, who have not heard about the network on your joining the local AmericaServes effort. This is your chance to discuss the value proposition for this type of care coordination, the enhanced outcomes and efficiencies it has had within your agency, and the greater impact it is having on your community.

Getting clients connected—Being part of your local AmericaServes network with access to the software, allows you the opportunity to easily connect your clients to additional resources. Consider those times when you are out in the community and away from your desk (and thus your ability to log into the software), how can you still connect clients to the network? Here are several ways:

1. Brochures/cards—be sure to request some network brochures and cards from your Care Coordination Team and carry them with you during outreaches and events.

Mobile intakes—if you are manning a table at a community event and have the ability to bring a laptop with Wi-Fi connectivity – log in to your Unite Us account and prep yourself to do mobile intake on the spot for a client in need. (Remember to bring a handful of paper consent forms in case another form of consent is not an option).

Outreach Cards—if you are representing your organization at a local outreach and do not have access to a laptop, outreach cards are another great way to capture a client’s information, request and consent all on one page. Simply have the client fill out the card and sign for consent. From there, you can bring the outreach card back to the office to input into the software. (Ask you Care Coordination Team about how to obtain these outreach cards).


Being new to your local network, you will meet several different network stakeholders and individuals along the way of your onboarding process and learn a lot of new information. Below is an outline of general topics and the coinciding AmericaServes entity who can provide you with an answer, should a question arise.

• Onboarding process
• Operational questions (day to day procedures, appropriate referral action, etc)
• Local CoP information
• Community outreach strategies
• Obtaining outreach materials
• Information on other providers in the network
• Network event information

• Software training schedule/availability
• How to complete a referral action step when in the software
• Updates/corrections to your organization’s profile
• Reporting a glitch or software recommendation
• Adding/deleting users
• Changing permission levels amongst users

Stay In Touch

phone: 315.443.0141
fax: 315.443.0312
email: [email protected]

Practice 360