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Trillium’s consumer and family advisory committees (CFAC) helped Trillium to develop a service that would create more Equity for people with IDD, TBI or Autism and their families called Family Navigator.   Trillium launched this community-based service in rural eastern North Carolina with three provider agencies and 2 large primary care practices in eastern NC.   Family Navigators work directly with the person and their caregivers often family members to navigate all the community-based systems and supports available to people with IDD, TBI or Autism.  Family Navigators are a whole person all systems approach providing guidance and support throughout the life span for a person with IDD, TBI or Autism.  This service is an integral part of the system that delivers Equity for this population.


Cindy Ehlers, MS, LCMHC  serves as the Chief Operations Officer for Trillium Health Resources a Medicaid Managed Care Organization that covers people with Behavioral Health or Intellectual/Developmental Disabilities and TBI.  Trillium is a health plan that takes a local approach to providing fully integrated, high quality, and cost effective services. Ms. Ehlers manages the plan operations for Medicaid programs and underinsured and uninsured individuals. Ms. Ehlers has spent her career focused on improving access to health and affordability through emerging analytics and innovative solutions.  She leads several major components of Trillium overseeing the strategy and innovation for Trillium along with the Member Team, Care Management and Population Health Team, Network Team, Enterprise Training as well as her own portfolio of member and provider-focused projects. Trillium Health Resources is a national leader in innovation for behavioral health and IDD and the life-long supports needed by these populations.

Ms. Ehlers has worked in both the public and private sectors and has been a public servant for the past 32 years.  She has developed many programs and services in behavioral health and intellectual and developmental disabilities in rural eastern North Carolina overcoming rural barriers and many health disparities in efforts to meet the service needs of the BH-IDD population.

Ms. Ehlers offers a unique perspective in her role as an Executive in the NC system, as she is both a parent and professional. Her career has been driven by her experiences she works tirelessly to improve healthcare for people of eastern North Carolina.  She has six children- several who have special needs; she was a therapeutic foster parent and is an adoptive parent.  Cindy understands the system from the perspective of the MCO, from inside out, and as a parent of children with special healthcare needs from the outside in.  Her lived experience is unique to find in healthcare at this level in an organization.  Trillium is the only health plan in the state with a parent who has been a foster parent, adoptive parent and is the parent of children with IDD on the Executive team of the organization.

Learning Objectives:

By end of the program, participants will be able to

1. Name at least 1 need for Family Navigation in our systems.
2. Apply at least 1 way where using the Working Together to Build a model of support increasing Equity for IDD, TBI, and Autism.
3. Name at least 2 ways Family Navigators are evolving in our system.


  • Levinson, J., Hickey, E., Fuchu, P., Chu, A., Barnett, M., Stadnick, N. A., Feinberg, E., & Broder-Fingert, S. (2023). Recommendations for post-implementation adaptations to optimize family navigation in pediatric primary care: a qualitative study with parents and navigators. BMC primary care, 24(1), 123.
  • Markoulakis, R., Chan, S., & Levitt, A. (2019). Identifying the key features and outcomes of family navigation services for mental health and/or addictions concerns: a Delphi study. BMC health services research, 19(1), 137.
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