The PIRE team implemented an evaluation design that took into account the constraints and limitations associated with HCAM HealthLink program and the data available from HCAM and Saint Agnes Hospital. The evaluation was comprised of two interrelated parts: an implementation evaluation and an outcome evaluation, each described separately. The data for the evaluation were collected from three sources (1) HCAM HealthLink records, (2) self-report from HCAM HealthLink clients, and (3) St. Agnes Electronic Medical Record data (de-identified).