Strategies

Revise health care processes and provider roles to integrate mental health and substance abuse treatment into primary care; continue to refer patients with severe conditions to specialty care

Provide education, information, counseling, and support for breastfeeding to women throughout pre- and post-natal care

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.

Provide preschool education and comprehensive support to families with low incomes, including small classes, student meals, and home visits with referrals for social service support as needed

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

Provide child care, parent education, physical health and mental health services, and other family supports to pregnant women and parents with low incomes and children aged 0 to 3

Support self-contained, homelike dwellings for 10-12 elderly adults who require nursing care; universal caregivers, usually CNAs, provide care and other supports while clinical teams visit for specialized care

Train volunteers, professionals, or paraprofessionals to help residents assess and reduce environmental home health risks and recommend low cost changes (e.g., improved ventilation, integrated pest management, etc.)

Provided high quality preschool with home visiting to African-American children from families with low incomes with an emphasis on active learning in Ypsilanti, Michigan

Inform parents about lead exposure pathways and cleaning and hygiene techniques and undertake minor repairs or specialized cleaning