expanding their existing workforce skill sets to include behavioral health. The coordination of primary and behavioral health services is also called integrated care. In January 2014, the SAMHSA-HRSA Center for Integrated Health Solutions described the Core Competencies for Integrated Behavioral Health and Primary Care. The following lists specific strategies for serving older adults as they relate to each of the core competencies: I. Interpersonal Communication. Provide anticipatory guidance for patients and caregivers, especially related to advanced care planning. Actively engage family members who may not accompany patients to appointments but are part of the patient’s care. Accommodate for the impact of dementia, language and hearing barriers. Avoid confusing medical terminology. Clearly explain medication and treatment options, repeat when necessary and provide in writing using friendly, helpful, accessible language. Tap into the patient’s strengths to promote self-management and communicate positive views of aging. Recognize sensory changes that occur with age such as diminished peripheral vision and differential auditory strength. II. Collaboration and Teamwork. Recognize that one provider cannot address all medical and behavioral health needs in 15-20 minutes. Use an informed team approach to provide comprehensive services, with all team members aware of their responsibilities. Train non-medical staff to conduct environmental, social and medical histories and screenings. Establish working relationships with other internal and external members of the care team. Listen to patient and caregiver and recognize that the desired outcome for older adults may be a change in function, not a change in symptoms. Refer to specialty behavioral health care or aging services as needed or use telebehavioral health, especially in rural settings. III. Screening and Assessment. Screen for depression, anxiety, substance use, chronic pain, risk of falls — including any recent stressful events that can elevate risk of a fallxv— and abuse. Identify general health concerns that affect or manifest as behavioral health symptoms. Be cognizant of gender differences in prevalence of behavioral health conditions DESIGNATE A CARE MANAGER who can help connect patients with community resources and specialty care and can check in to ensure the patient followed the treatment recommendation. CONSIDER USING NONCLINICAL LANGUAGE to discuss behavioral health systems (e.g., “stressed” instead of “anxious,” “sad” instead of “depressed”). integration.samhsa.gov 9 — women are more likely to experience depression, dementia and trauma, while men are more likely to abuse alcohol and prescription drugs. It is especially important that providers differentiate between depression, delirium and dementia. Implement a protocol for suspected abuse and ensure that all members of the care team, including front desk staff, know the warning signs of elder abuse. Be aware of the risk of pain medication abuse/opioid dependency. Monitor for suicide risk. Have a consultation arrangement in place with geriatric mental health and substance use disorder specialists that includes conducting a medication review. IV. Care Planning and Care Coordination. Engage unpaid and paid caregivers in care planning. Identify and use aging system resources like peer support and advanced care planning supports (see “Resources” for additional ideas). Collaborate with the pharmacist to ensure proper prescribing and dosage to avoid medication risks. Older adults may need additional help accessing follow-up care. Employ warm hand-offs to ensure continuity of care. Recognize the appropriateness of short, time-limited interventions for addressing many mental health and substance use concerns (e.g., Florida BRITE). V. Intervention. Understand common ailments of older adults that should trigger a primary care evaluation. Physical symptoms are often caused by stress, trauma, loss and mental health conditions while physical health conditions may manifest as behavioral concerns. Implement evidence-based practices that are known to be effective for older adults and refer to specialist behavioral health providers who use best practices in your