Globally, the surge in number of older adults is unprecedented. With an aging population, the resultant effects include increased need for healthcare, social services and long term care to support the population. Older adults particularly those above 65 years present a plethora of healthcare needs relative to younger adults due to manifestation of a multiplicity of chronic health problems such as hypertension, diabetes, depression, heart disease and arthritis. Statistics indicate that 90% of the adults aged 65 and older report one or more chronic conditions which necessitate increased attention in respect to administration of specific treatments and delivery of medica care ( Prost et al., 2016) . Behavioral healthcare is an integral part of healthcare practice. Elderly population are vulnerable to behavioral based conditions such as substance abuse disorders, heart disease, diabetes, depression and obesity. Older adults require support from primary care physicians and other health professionals for long term care services. Social workers, family care givers, long term care assistants and nurses ought to work collaboratively to provide tailored and coordinated care to older adults ( Payne et al., 2015) . An aged population exhibits behavioral health needs characterized by addiction, mood disorders, relationship problems and other psychological concerns. Due to the fragile state of the population, this strategic plan pursues an area of expansion in older adult population. The strategic plan will be instrumental in capacitating the Harbour City Behavioral Health Center (HCBHC) towards optimally addressing the behavioral health needs of an aging adult population. The plan lays a road map which will be critical in improving services rendered by the canter’s key functional areas such as clinical and community services, human resource, information technology, fiscal and regulatory faculties. The recommendation made will play a pivotal role in execution of the formulated strategic plan.
Strategic Plan Propositions
To effectively address the aging population behavioral health needs, HCBHC will increase assessment services. The assessment services are critical in rendering cost effective, objective and comprehensive clinical evaluations. Detailed assessment will build an accurate picture of various individual’s needs. To increase range of assessment services, the center will gather a multidisciplinary team of health professionals comprising psychologists, nurses, psychiatrists, specialist’s pharmacists and social workers. To improve on the behavioral assessment health outcome, elderly individuals will be seen either by one of the health professionals or a combination of the specialists. Assessmnets by the health professionals will broaden its reach to include areas such the individuals’ physical health and wellbeing, culture and ethnic background, housing and financial circumstances, mental health symptoms and experiences, employment and training needs. Additionally, assessment will target the patient’s use of drugs and alcohol, past experiences, social and family relationships, housing and financial circumstances, hopes, skills, strengths and aspirations. The professionals will be required to determine if there is anyone who depends on the patient such as a relative and issues relevant to the individual and others safety. The broadened package of assessment services will provide a vivid picture of endogenous and exogenous factors influencing the patient’s behavior, leading to administration of right treatment modalities.
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Another area of growth targeting the behavioral health needs of the aging population will be expansion of home health services. HCBHC will recruit additional health professionals to significantly increase number of older adults being attended to at their homes. The health specialists will provide clinical services and medical suppliers to aged patients directly in the community. To effectively address the individual’s behavioral health needs at their homes, healthcare specialists will widen home health services to include social, medial or psychological assessment, medication education, speech and physical therapy and pain management. Additional home care services that will accorded include disease education and management, medication reminders, empowerment for health promotion and prevention. Health education for the elderly will focus on services such as nutrition, healthy lifestyles and prevention of falls. Personal care services will include exercising and checking vital signs which may indicate stress or depression for example blood pressure, heart rate and pulse. Psychological support and social services will encompass counselling both to the elderly and their family members. Previous cohort studies term social support as a critical determinant of the elderly behavioral health since it accords the patient’s mental stability to deal with different circumstances ( Ramsey, 2015 and Thorpe et al., 2017) . HCBHC will provide a rigorous training to specialists including community health workers, social workers, nutritionists, psychiatrists, physiotherapists and general practitioners who will offer home health services. Training will encompass general areas such as counselling, healthcare supervision, monitoring and case evaluation, nursing services, communication skills, emergency and first aid management and healthcare supervision. Wellness home care services will also cover suicide prevention, depression care management and SBIRT for elderly individuals grappling with substance abuse. To effectively address behavioral health needs of the aging population through home healthcare, HCBHC will make an assessment and map existing capacities based on epidemiological and demographic data. The center will also develop a list of specific services needed, assess the knowledge and skills of health workforce, evaluate financial requirements and undertake pilot study to find the most efficient and effective model for integration of care to the elderly. Crowley and Kirschner (2015) regarded home care as an integral component necessary for a patient’s recovery process. The home health care services will be individually coordinated and planned packages tailored to the specific needs of each elderly patient. The center plans to expand home health services to the elderly as home care approach is less expensive, more convenient and effective. HCBHC projects that increment in home healthcare will reduce pressure on elderly patient’s family members and improve access to primary healthcare to the vulnerable group.
HCBHC will expand on the community outreach events targeting the elderly population to effectively address their behavioral health needs. The center will increase the frequency of psychiatric outreach services purposed to provide mental health education, assessment and treatment to the elderly in their communities. The outreach program will be tailored to increase mental health awareness among the elderly population. Outreach events will be conducted in public spaces such as in schools, churches and government facilities. During the outreach programs, the elderly will be educated on signs and symptoms of poor mental health, triggers of mental problems and health living approaches. During the education campaign, education material such as pamphlets and flyers will be circulated to the audience. The outreach initiative will integrate mental health, social adaptability, physical health, functional status, and environmental conditions which quantify the elderly population’s overall health objectively. To increase the centre’s ability to meet needs of the elderly population, behavioral health screening will be embedded into the outreach program. During the awareness program, older patient will be asked to complete a wellness questionnaire which will include depression screening questions, prescription drug and alcohol misuse and tobacco dependency. Collaborative care coordinators will contact older adults with a positive screen via telephone to visit the center clinics to complete a detailed assessment to enable health professionals determine need for support. The primary goal of the outreach program will be to increase community awarenesses particularly among the elderly on signs and symptoms of depression and merits of mental health treatment. During the outreach community events, HCBHC will employ solution focussed brief therapy to provide depression care, alcohol and prescription misuse avoidance and education on suicide prevention.
The center will improve on rehabilitation and vocational training to the elderly population to effectively address their behavioral health needs. HCBHC will provide psychosocial rehabilitation to support recovery of elderly patients from mental illnesses. In the rehabilitation centers, the elderly individuals will be accorded opportunities for skill development, social interaction and self-determination. According to Choi et al., (2015), psychosocial rehabilitation is essential in training social and cognitive skills which assist individuals with mental and substance abuse disorders to recover, live and work in the communities independently. The rehabilitation will also admit elderly individuals grappling with drug and substance abuse. Treatment will be administered during rehabilitation which will be highly individualized, collaborative and person-centred. Vocational services will be provided to encourage an increase in the number of applicants who are above 65 years. The center will adopt an elderly care vocational training system in the rehabilitation centers to promote academic and social kills among the elderly.
I mpact of the Initiative in each of the key functional areas
Human Resource (HR)
The strategic plan will impact the human resource department both positively and negatively. The human resource department will be compelled to restructure service provision, a decision that will have implications on the type and number of staff at HCBHC. Increasing assessment services, home healthcare and improving community outreach will oblige the human resource function to recruit new health care specialists and retrain the existing care providers. Care specialists whose skills do not match the added services will considered redundant leading to their dismissal. The HR function will be compelled to design strategies by recalibrating rewards system to create a high performance culture among the healthcare professionals who will be added new responsibilities to address the increased patient scope. Another implication will be the need for the HR to undertake review and improvement in job analysis and recruitment, healthcare career promotion, motivation and support, legal and ethical management framework and distribution of employee benefits. For example, since the strategic plan recommends increased use of technology to address patient needs, there will be a need for training to equip healthcare professionals with knowhow to use technological devices.
IT
The information technology department will be positively and adversely impacted by the strategic plan propositions. New and upgraded softwares such as imaging e-prescribing software, Mobile MIM, ResolutionMD, Airstrip ONE and AliveCor will need to be acquired to address the elderly patients’ behavioral needs. To maintain costs of operation low for seamless healthcare provision, the IT department will be obliged to consider staff cuts which will be a negative implication.
Fiscal department
The finance department at HCBHC will have added responsibilities related to monthly funding allocations, audit work, financial statement and reconciliation preparation due to the broadened scope evidenced by expansion of services such as mental assessment and home healthcare. The fiscal department will have to consider soliciting increased funding through federal financing, private donation and grants to support the expanded service scope.
Regulatory function
The strategic plan recommends adoption of telehealth and other smartphone softwares to effectively address behavioral needs among elderly population. As an implication, the department will be obligated to stringently be compliant to the HIPAA regulation as a measure to protect the sensitive patient healthcare information from disclosure without knowledge and consent of clients. The department will subject itself to the Health Information Technology for Economic and Clinical Health (HITECH) Act as a commitment to adopt meaningful utilization of health information technologies such as ResolutionMD, Airstrip ONE and AliveCor to address behavioral patient needs.
Clinical and Community Services
One of the resultant implications will be increased scope of clinical and community services characterized by a broader reach to a high number of elderly patients. To promote improved health outcome over a wide area, clinical and community services will be provided to a higher number of patients in the entire South Florida. Additionally, increased adoption of technology to provide health will imply that a set of clinical and community services will shift from traditional face to face to attending patients via the telehealth platform. Clinical and community services will require restructuring to meet individual needs of the elderly target population.
Recommendations on how to execute the updated Strategic Plan
Harbour City Behavioral Health Center (HCBHC) ought to develop partnerships and collaborative relationships encompassing improved coordination and communication across different providers offering behavioral health problems in the United States. For seamless execution of the strategic plan, the center should establish relationships with community stakeholders who would play a critical role in identifying community resources such as clinical and financial support. The stakeholder relationships will be instrumental in increasing referrals and identifying strategies to counter challenges or barriers towards optimal service delivery ( Bao et al., 2013) . HCBHC should develop an active older adult advisory board to help in implementing the program. In the canter’s organization advisory board, HCBHC should incorporate older adults as members of the service delivery team.
The center ought to seek solicit technical assistance from program developers and experts to foster fidelity in the service delivery intervention model. Technical assistance will be essential in guiding the center on how to adapt a program while maintaining the initiative’s fidelity. The center should have clearly defined roles for healthcare professionals and program administrators. The initiative ought to include clearly articulated responsibilities of how healthcare specialists will support delivery of care services to address the elderly behavioral health needs. Clearly defined roles and responsibilities will ensure that the initiative’s vision is implemented across program components. HCBHC ought to build a strong planning and implementing team which should constitute an administrator, representatives from the centers functional departments and an elderly community member within Harbour City to aid in rolling out the program services.
HCBHC should pursue multiple funding streams to enable the center be capable of paying health specialists, facilitate their movement when delivering home health care and support acquisition of new health technology softwares. Funding ought to be solicited from multiple streams such as federal and state government, private donors and grants from governmental and non-governmental agencies. To track progression of the strategic plan during implementation process, HCBHC should partner with a local university in Florida or college for assistance with program evaluation milestones. The implementation team should evaluate the initiative by tracking the process and outcome measures to inform program improvement where deviations manifest.
References
Bao, Y., Casalino, L. P., & Pincus, H. A. (2013). Behavioral health and health care reform models: patient-centered medical home, health home, and accountable care organization. The journal of behavioral health services & research , 40 (1), 121-132.
Choi, H., Irwin, M. R., & Cho, H. J. (2015). Impact of social isolation on behavioral health in elderly: Systematic review. World journal of psychiatry , 5 (4), 432.
Crowley, R. A., & Kirschner, N. (2015). The integration of care for mental health, substance abuse, and other behavioral health conditions into primary care: executive summary of an American College of Physicians position paper. Annals of Internal Medicine , 163 (4), 298-299.
Ramsey, A. T. (2015). Integration of technology-based behavioral health interventions in substance abuse and addiction services. International journal of mental health and addiction , 13 (4), 470-480.
Thorpe, K., Jain, S., & Joski, P. (2017). Prevalence and spending associated with patients who have a behavioral health disorder and other conditions. Health Affairs , 36 (1), 124-132.
Payne, H. E., Lister, C., West, J. H., & Bernhardt, J. M. (2015). Behavioral functionality of mobile apps in health interventions: a systematic review of the literature. JMIR mHealth and uHealth , 3 (1), e20.
Prost, S. G., Ai, A. L., Ainsworth, S. E., & Ayers, J. (2016). Mental health professionals and behavioral interventions for obesity: a systematic literature review. Journal of evidence-informed social work , 13 (3), 305-330.
