Orients all caseload participants on external support programs and services that can improve maternal and child health outcomes (e.g., doulas, Home Visiting, dental care, Emotional Wellness, WIC, lactation education and consultations, car seats, cribettes, parenting groups, Family Success Center, sexual health care coordinators, etc) and support them in reaching their identified goals. Collaborates with each participant on caseload to develop an individualized care plan containing short- and long-term goals with particular emphasis on addressing risk factors (including but not limited to social needs, barriers to care, pregnancy planning, and food insecurity) and supporting positive child development.