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PART V. DESIGNING AN OUTREACH AND RECRUITMENT PLAN

The Telewellness Program will connect underserved populations through telehealth and empower them with connected technology to increase digital social engagement with family, friends, community and necessary healthcare services through a train-the-trainer program.  Ultimately, collaborations among key stakeholders will leverage previously uncoordinated efforts to bring about significant impact and sustainability.  A Telewellness program should address one or more of these barriers in a comprehensive multi-modal approach that may consist of:

  • installation of some sort of internet infrastructure in a community,
  • provision of affordable internet service plan for all residents,
  • provision of user-friendly hardware and software for each resident
  • use of resident-specific training through a peer centered Train-the-Trainer program,
  • conducting an evidence-based evaluation to assess reach, efficacy, adoption, engagement, and implementation, including health and mental health outcomes, and
  • design for sustainability and rapid replicability. 

This program will address the two largest barriers to telehealth implementation and operations in affordable housing: 1) having the right broadband tools (installation of Wi-Fi and proper technology) and 2) the proper training and education of end users that has a meaningful purpose, which is the organizing principle for a Telewellness Program. This includes implementing a culturally sensitive wellness program in the community. Although there are endless technology applications for low-income older adults (telehealth, voice devices, tablets, smart home, wearables), they’re only valuable when they provide the user with meaningful purpose.  The Telewellness Program as well as curriculum thus includes the following elements: 

  • Multi-cultural requirements or services with cultural sensitivity for recruitment/outreach, training, and support
  • Engagement and activation through education
  • Digital inclusivity for all persons, with a focus on older adults and persons living with disabilities
  • Older adult champions who promote the wellness program as a peer to fellow residents
  • Training staff for behavioral health and technology basics
  • Multi-lingual capabilities and a culturally aware adoption and support approach

A focus on trust and communication with an understanding that time and patience is essential to build adoption.

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  1. Self-activation through education and awareness

    The Telewellness Program at any community is a unique collaboration of senior-serving organizations to use technology-based tools to support the mental health and wellbeing needs of residents of affordable housing communities. The project’s objectives should include:

    • providing mental wellness education and outreach to low-income residents at affordable housing communities;
    • providing staff with the training and awareness to identify mental health needs; and
    • providing mental health support to residents by enrolling them in telemental health services

     

    An important objective of this program is mental health education and awareness. Allowing residents to learn about different topics of mental health, you create a baseline foundation of education and awareness that also support efforts to de-stigmatize and normalize mental health. FPCIW created resources to allow for residents to learn about mental health topics while allowing program champions to promote and signup residents for personal therapy sessions. This playbook’s resources are currently available in the following languages:

    • English
    • Spanish
    • Korean
    • Chinese (Mandarin and Cantonese)
    • Vietnamese
    • Tagalog

     

    The variety and range of wellness presentation/webinar topics include:

    • Health, Wellness, and Wholeness
    • Preserving Your Memory
    • Grief and Loss
    • Depression and Anxiety
    • Hoarding
    • Bullying; Inclusive Community
    • Emotional wellbeing and Emotional Intelligence
    • Holiday Blues
    • The Importance of Sleep
    • Late Life Transition
    • Resiliency
    • Managing Your Stress
    • Elder Financial Exploitation: Impact on Emotional Wellbeing

     

    Click here to view our Telewellness Workshops via YouTube.

    Depending on social distancing guidelines and COVID circumstances, these topical education webinars can be hosted on video conference tools such as Zoom. Topics can be announced about 2-3 weeks prior to the webinar via flyers (see next section for details). Physical copies of webinar content should also be part of the marketing campaign to allow for those that do not feel comfortable joining in to still receive the education materials.

  2. Outreach materials: asset and collateral development

    Marketing your Telewellness Program in your community can be an opportunity to create excitement and interest around your program activities. Oftentimes, your mental health education and services provider will have such content available, but with a little bit of time and thought, you can create your own.

    Outreach materials should be posted around high traffic areas of the community in-language and if possible, be directed toward specific residents who may need the service. Free online flyer-creating services like Canva are helpful to developing fun and engaging marketing materials.

    Translation of outreach materials can be a challenge. If language resources to create marketing content is difficult, consider using freely available tools such as Google Translate to convert the content, and ask a volunteer native speaker to confirm the information. If you do have a budget for translation, online services can provide efficient and quality products (we have had great success with using InWhatLanguage).

  3. Developing resident and staff trainings

    The success of your Telewellness Program will depend in part on adequately preparing staff and volunteers through training for mental health awareness and basic technical support. Depending on the services you provide to your community, you should be prepared to refer residents to a service provider you’re directly partnering with, or connect them with other mental health resources freely available to the community (such as a county or municipal mental health service program).

    Staff training should include outreach strategies such as using non-stigmatized terms/words, acknowledging the need of wellness services for certain residents, and having basic knowledge of early signs of mental health issues as they relate to older adults.

    It’s vitally important that all community staff members directly related to the outreach education, recruitment, and identification of mental health needs of residents undergo some basic training on mental wellness. There is a wealth of mental health resources available online, as well as formal training models that help to equip community members with the tools to support resident needs. Here are a few resource examples:

    The Substance Abuse and Mental health Services Administration (SAMHSA) is a federal agency that advances behavioral health. It is a comprehensive resource guide that includes treatment support, grants, and research with regional coordination.

    The Program to Encourage Active and Rewarding LiveS (PEARLS) is an evidence-based community treatment and intervention program designed by the University of Washington to reduce depression in physically impaired and socially isolated people that includes older adults. PEARLS is an ideal resource for resident service coordinators serving a population of residents in affordable housing.

    Mental Health America’s National Certified Peer Specialist (NCPS) credential

    Mental Health First Training (recommended for lay persons who work with those who need potential behavioral health support)

     

     

    How we did it...

    FPCIW worked closely with our mental health provider SSG to provide culturally-sensitive training to our resident service coordinator team. We discussed telltale signs that a resident may need mental health services, approaches to discussing the therapy and counseling solutions, and sharing other available programs. Our RSCs also used discussions as opportunities to talk about the use of iPads and other tablet devices to virtually connect residents to their therapists.

    While the community outreach, education, and awareness of mental health and wellness is essential to the adoption of your program, the onboarding of residents in your Telewellness Program in the use of devices will also need to consider trainings and other materials that meet the unique needs of your community members.

    If your budget only allows for a shared device (a laptop or a tablet/iPad) to the community for the purpose of providing virtual mental therapy, consider making it available for other uses. Design a check-out that would allow residents can borrow the device for things like watching YouTube clips, connecting with friends/family through video chat, playing games, or browsing webpages. Advertise the loan program to the community, and provide a basic training session with a very simple “how-to” handout on using the device.

    How we did it...

    To encourage the use of data-enabled iPads at our communities, FPCIW worked closely with resident service coordinators to implement a system that let residents keep the device over several days in the comfort of their homes. We also used this as an opportunity to keep particularly vulnerable residents engaged who had mobility challenges or were at risk of social isolation. We created a tutorial handout with basic operating instructions on using the iPad, and encouraged users to access specific content to support their overall wellness (such as education YouTube videos on falls prevention, or in-language news apps).

  4. Cultural and linguistic considerations

    The Telewellness Program is based on a culturally- and linguistically-sensitive approach to meeting the mental health needs of community members. According to research from Princeton University, individuals who are linguistically isolated have limited access to wellness services and other types of health resources. Ensuring adequate and quality language access to a services and activities such as your Telewellness Program can often be challenging and expensive, but any effort to meet the linguistic needs of underserved older adults will go a long way.

    Free resources like Google Translate can be extremely effective in creating content in language. If possible, using a paid service like InWhatLanguage allows for quick and affordable written translation services. Volunteers are also a potential resource. Consider reaching out to local university student groups, or place a volunteer job posting on free sites such as volunteermatch.org.

    How we did it...

    SSG SIVLER and FPCIW developed referral documents and flyers in languages to address cultural and linguistic needs. We’ve incorporated linguistically- and culturally-sensitive approaches to our instructions, introductions to staff representing each language, and the creation of video clips for wellness education presentations in multiple languages. SSG SILVER also provided community housing staff, volunteers, and interns with culturally appropriate outreach trainings and consultations on messaging, word choices, and general communications about telewellness services to reduce the stigma of mental health.

    For document and verbal translations, in circumstances when the language skills were not available among community staff, FPCIW turned to our wide network of current and past volunteer interns from local universities. Many of these students were able and willing to help for small translation work (flyers, video presentation recordings). At times, we used Google Translate to convert content from English to other languages, and asked volunteers to verify the translations.

    Regardless of what cultural or linguistic needs you may need to consider, addressing stigma in mental health services will be important in any context when discussing mental health: stigma can play a powerfully negative role in participation, the acceptance of therapy and counseling help, and the discouragement of others living with difficult mental health conditions. Discrimination based on stigma may be obvious and direct—it can be expressed in the form of someone making a negative remark about someone’s mental illness or one’s treatment; or it may be unintentional or subtle, such as someone avoiding the person with mental illness because the person assumes the person with mental illness could be unstable, violent or dangerous due to perceived mental illness. The person living with mental illness may refuse behavioral health services due to peer pressure, or be in denial because of his/her own cultural attitudes about mental health reinforced through cultural or religious biases against depression, anxiety, or stress.

    Some of the harmful effects of stigma can include:

    • Reluctance to seek help or treatment
    • Lack of understanding by family, friends, or others
    • Fewer opportunities for social activities or trouble finding housing
    • Bullying, physical violence or harassment
    • Health insurance that doesn’t adequately cover your mental illness treatment
    • The belief that the individual will never succeed at certain challenges or that the individual can’t improve your situation

     

    Stigma is one of the important reasons why community-based education and awareness are critical to creating a supportive environment that normalizes conversations about mental health. As you design and develop your Telewellness Program, be sure to work closely with your team and mental health partner to discuss approaches that actively reduce mental health stigma.