**3. Approaches and frameworks**

Behavioral modification interventions have been proven to be effective. These approaches are client-centered and provide support for abstinence from substance use. Moreover, such flexible models of care offer a range of modifiable frameworks for addressing attitudes and behaviors related to addiction and recovery [28]. In the field of social work practice, in particular, problem-solving frameworks are often recommended because of the evidence-based, culturally informed, manualized strategic tools that give mental health care provider the options to tailor the intervention to diverse populations and can be implemented in a range of different settings, including clinics, hospital, community-based environments and even in-home services with older adults, specifically [22, 29].

Arguably, mental health intervention should take more of a community-based prevention approach versus a medical model, institutional treatment, when tailored to, and for persons living in homeliness [11]. The debate about the degree to which homeless persons will be able to access services to address their problems of substance use disorders, as well as, home and food insecurity, rest squarely on macro-level factors, including policies, legislation, research for evidence-based recommendations and solutions. The World Health Organization (WHO) recognizes mental disorders a public health concern, worldwide and its use of the term "disorder," implies the existence of observable behaviors or symptoms that interfere with normal functioning and that cause distress. Homelessness can exacerbate the symptoms of mental illness, causing an individual to become debilitated, depressed and anxious, all of which can be costly, socially and economically for individuals and families. Prevention of mental disorders and effective interventions, as well as, population-based policies that support and foster health accessibility among all person, are among the ongoing challenges that countries, worldwide must contend

**157**

*Exploring Mental Health Treatment and Prevention among Homeless Older Adults*

**4. Promising preventive strategies using a cultural competence** 

with [30]. In the U.S., culturally specific approaches to addressing mental health prevention and intervention among older adults is an important aspect of health

A cultural competence framework is one that guides healthcare providers' behaviors, attitudes, value and perspective on caring for individuals, families and communities. The culturally competent service provider takes into account an individual's multiple identities, preferences, norms, beliefs, as well as, their social determinants of health. The way in which healthcare providers' social and professional experiences impact their worldview, particularly as it relates to their delivery of care to diverse populations and it influences how and to what degree they are willing to ensure equity and parity in the mental healthcare services they provide. Furthermore, while homelessness is not considered to be a determinant of mental illness, interdisciplinary research and evidence-based theories suggest a strong correlation race culture, homelessness and access to healthcare [12, 13, 31]. Mental health providers have argued that it is extremely challenging to implement standard intervention strategies with this diverse population. The stigma associated with aging and mental health can make it rather difficult for providers to understand how to facilitate the same approaches with housing secure individuals, as one would implement with older adults living with homelessness. Changing the views and perspectives require a cultural competence lens through which to see and experience prevention and intervention this older adult populations. Based a comprehensive literature review, self-care and mindfulness are useful supporting cognitive behavioral modification interventions with person's managing mental health and substance use disorders [14]. These strategies may well have lasting, positive impacts on health outcomes. Promising preventive strategies for addressing mental health care among older persons that are homeless require a range of varied interventions. Some additional recommended approaches include self-help groups, integration of spiritual/religious beliefs, reminiscence therapy that incorporates the focus of balanced review and reflection of one's past life, and/or interdisciplinary clinical pharmacological treatments, as needed to maintain activities of daily living, physical exercise, and psychosocial health, while in recovery from substance use and homelessness [32]. The adaptation to cultural norms, attitudes and preference can increase

*DOI: http://dx.doi.org/10.5772/intechopen.89731*

accessibility and acceptability [13, 17, 22].

Cognitive behavioral literacy therapy using books, audiotapes, and video presentations also has been shown to alleviate mild depressive symptoms through promotion of self-help [33]. Such audio and video media for the elderly should take into consider educational level, readability, font size, and use of examples relevant different cultural groups. For example, appropriate content targeting older adults transitioning out of homelessness could involve retirement planning that includes development of positive expectations of a new life phase, a change of environment,

Preventive strategies aimed specifically at elders' spiritual/religious beliefs have been shown to be more effective than treatment-as-usual which neglects such beliefs and related practices [34]. These strategies may include religious participation involving prayer, spiritual music consumption, emotional and psychological preparation for an afterlife, a review of one's life journeys, and/or spiritual

developing new interests and stronger social support networks.

care access.

**framework**

*Exploring Mental Health Treatment and Prevention among Homeless Older Adults DOI: http://dx.doi.org/10.5772/intechopen.89731*

with [30]. In the U.S., culturally specific approaches to addressing mental health prevention and intervention among older adults is an important aspect of health care access.
