DescriptionSummary:Working collaboratively as part of a team of Public Health AmeriCorps Community HEART Work (PHACHWs) Members, Community Health Workers, clinicians, and administrative professionals. The PHACHW I will provide screening, referral, and navigation services to connect individuals and their families to social and medical services to resolve their identified needs. The PHACHW I will provide culturally competent patient-centered care to develop a care plan, identifying individual barriers and goals, to improve areas of need. The PHACHW I act as an intermediary for individuals aiding communication between individuals and clinical and community service providers. The PHACHW I provide education and information about health, wellness, and