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

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

Offer debt advice from trained providers to tenants with unpaid, overdue rent to help repay debt and increase financial literacy

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

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

Provide eligible families with low and very low incomes with vouchers to help cover the costs of rental housing; also called Section 8

Provide rapid access to permanent housing and support (e.g., crisis intervention, needs assessment, case management), usually for chronically homeless individuals with persistent mental illness or substance abuse issues