Strategies

Offer group educational, social, creative, musical, or physical activities that promote social interactions, regular attendance, and community involvement among older adults

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.

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

Engage professional or lay health workers to provide education, referral and follow-up, case management, home visiting, etc. for those who experience barriers in accessing health care; also called promotoras(es) de salud or community health representatives

Establish an ongoing relationship between an older youth or young adult and a younger child or adolescent, usually an elementary or middle school student

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

Support organized social, art, or physical activities for school-aged youth outside of the school time

Position registered nurses within a parish or similar faith community, or in a health care system to serve as a liaison to congregations; also called parish nursing or congregational nursing

Increase support for non-profit health care organizations and deliver comprehensive care to uninsured, underinsured, and vulnerable patients regardless of ability to pay; often called community health centers (CHCs)