Strategies

Use a case management model for frail elderly patients living independently, coordinating aspects of long-term care (LTC) such as status assessment, monitoring, advocacy, care planning, etc.

Implement multi-component efforts that include coordination of health services by multidisciplinary teams of health care professionals, patient self-management, and patient education

Combine academic, mental and physical health, and social service resources in schools for students and families via partnerships with community organizations; also called community learning centers

Increase health care providers’ skills and knowledge to understand and respond to cultural differences, value diversity, etc. via factual information, skills training, and other efforts

Support a collaborative approach by a multidisciplinary team of professionals working to meet the full range of long-term care (LTC) needs for frail elderly patients living in community settings

Delay school start times for middle and high schools to better align with adolescent sleep-wake cycles; often until 8:30 a.m. or later

Provide continuous, comprehensive, whole person primary care that uses a coordinated team of medical providers across the health care system

Integrate legal services into health care settings to address legal issues that affect health (e.g., housing, food, utilities); services provided by private practice lawyers, law students, etc.

Provide culturally sensitive assistance and care coordination, and guide patients through available medical, insurance, and social support; also called systems navigators

Teach positively stated behavior expectations to all students, often reinforced with prizes or privileges and supported with coaching and data