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.

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

Provide educational and behavioral interventions that support patients’ ability to actively manage their condition(s) in everyday life

Tailor health care to patients’ norms, beliefs, and values, as well as their language and literacy skills

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

Regulate mental health insurance to increase access to mental health services, including treatment for substance use disorders

Support joint decision making between health care practitioners and patients through shared decision making (SDM); part of patient-centered care

Conduct individual assessments that gauge older adults’ risk of falling and develop personalized approaches to help prevent falls

Provide health care services on school premises to attending elementary, middle, and high school students; physical and mental health services provided by teams of nurses, nurse practitioners, and physicians