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Community Care Team


The purpose of the Flint Hills Community Care Team (FHCCT) is to provide person-centered care to improve health outcomes for the most vulnerable members of our community by developing wrap around services through multi-agency partnerships and care coordination.

FHCCT views “health” as defined by the social determinants of health – so it is not just an individual’s physical and mental health that are addressed – we are concerned about whether an individual has safe and affordable housing; reliable transportation; food; clothing; health insurance; a medical home; employment, etc. – all the things needed to live and thrive.



Flint Hills Community Care Team was started in October 2018 by the Flint Hills Wellness Coalition in response to the 2015 Community Needs Assessment for Riley County where respondents expressed concern about the lack of access and coordination of services for the most vulnerable people in our community.  FHCCT was modeled after a program in Middlesex County, Connecticut (Liberty Bank Foundation, "Middlesex Hospital Community Care Teams, K. Irwin & B. Branch, December 2015).

At inception, FHCCT started with about a dozen community member organizations: health department, hospital, community mental health center, emergency medical services, local school district, emergency shelter, and several local non-profit organizations that serve vulnerable populations.  Our membership has since grown to more than two dozen organizations as listed on the Authorization for the Release of Information (ROI) signed by clients.  They include:


Ascension Via Christi Hospital Manhattan 

Be Able Community

City of Manhattan – Manhattan Fire Department Risk Reduction

Flint Hills Wellness Coalition

Good Shepherd Homecare & Hospice

Habitat for Humanity of the Flint Hills
Infinite Counseling Connections LLC
Kansas Department of Children & Families Adult Protective Services

Kansas Department of Children & Families Child Protective Services

Kansas Department of Transportation/Flint Hills Area Transportation Agency

Kansas Guardianship Program

Manhattan Office of Kansas Legal Services

Kansas State University

Konza Prairie Community Health Center

Manhattan Emergency Shelter Inc.

Manhattan Free Clinic

Manhattan Housing Authority

Morningstar Inc.
North Central Flint Hills Area Agency on Aging

Pawnee Mental Health

Riley County Emergency Medical Services

Riley County Health Department

Riley County Police Department

Shepherd’s Crossing

Stonecreek Family Physicians
Stormont Vail Health Manhattan Campus
Three Rivers Inc.

Thrive! Flint Hills

USD 383

FHCCT meets on the first and third Wednesdays of the month from 12-1pm in the Leadership Board Room at Ascension Via Christi Manhattan Hospital.



Specific outcomes that have been realized as the result of the FHCCT include but are not limited to:

  • Fewer repeat visits to the hospital emergency room which is a cost savings to the hospital and community

  • Fewer repeat calls to Riley County Emergency Medical Services thus reducing the cost to the taxpayer

  • Social service agencies and affiliated organizations all work from the same “playbook,” so to speak, to meet the needs of individuals which reduces the likelihood that agencies will be taken advantage of

  • FHCCT clients’ needs are meet sooner than if they were trying to navigate the social service and health care systems on their own


Primary presenting problems

  • Housing insecurity / homelessness

  • Mental health / substance use

  • Financial insecurity / unemployment

  • Lack of insurance / underinsured

  • Lack of transportation

  • Food insecurity


Barriers to providing adequate support


  • Lack of community financial resources to meet the increasing need in the community

  • Criminal backgrounds limit housing options

  • Inadequate number of local mental health providers to address substance use; need local inpatient treatment options

  • Lack of beds in state hospitals

  • Lack of responsiveness on the part of some state agencies

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