NURS FPX 4065 Assessment 5 Final Care Coordination Strategy

Name

Capella university

NURS-FPX4065 Patient-Centered Care Coordination

Prof. Name

Date

Final Care Coordination Strategy

Care coordination is a crucial element of healthcare that promotes continuity and integration of services for patients, especially those with chronic or complex conditions. It helps reduce care fragmentation, improves health outcomes, and enhances patient satisfaction (Garfin et al., 2022). For adults with mental health conditions in Florida, care coordination is particularly important because they face multiple barriers, including coexisting physical illnesses, stigma, and psychosocial challenges. This strategy emphasizes patient-centered interventions, ethical considerations, supportive policies, and alignment with Healthy People 2030 goals.

Patient-Centered Health Interventions and Timelines

Nearly 2.9 million adults in Florida are living with mental health disorders, with many experiencing comorbid conditions and stigma-related barriers to care (Garfin et al., 2022). Patient-centered, evidence-based interventions supported by community partnerships can address these challenges effectively. The three main interventions focus on physical comorbidities, cultural stigma, and emotional regulation, each with clear timelines and measurable outcomes.

Summary of Interventions, Partners, and Timelines

Barrier	Intervention	Community Partners	Timeline	Expected Outcome
Comorbid Physical Illnesses	Routine screenings for BMI, blood pressure, glucose, and cholesterol as part of mental health visits	Care Resource, Caron Florida, MHACF	Initial intake; follow-ups every 3 months; lifestyle counseling from first month	Improved detection of comorbidities, better physical health outcomes
Cultural Stigma & Mental Health Literacy	Biweekly culturally adapted educational sessions with booklets and workshops	NAMI Florida, MHACF, Care Resource	Start 2 weeks after diagnosis; continue for 6 months	Reduced stigma, improved literacy, greater service utilization
Emotional Dysregulation	Weekly Mindfulness-Based Cognitive Therapy (MBCT)	Caron Florida, MHACF Outlook Clinic, NAMI Florida	Initiate within 1 month; continue weekly for 6 months	40% reduction in PHQ-9 scores, enhanced coping skills

Ethical Decisions in Designing Patient-Centered Health Interventions

Question: How do we ensure truly informed consent in individuals who may struggle with comprehension due to their mental state?

Patients with cognitive or emotional impairments may not fully grasp treatment details. To uphold autonomy, consent should be obtained through simplified explanations, visual decision aids, repeated discussions, and involvement of family or advocates. This ensures patients remain central in decision-making while safeguarding their rights (Nagaoka et al., 2023).

Question: How do we make interventions culturally competent and respectful in a way that does not make patients feel labeled or marginalized?

Interventions must be designed collaboratively with patients to avoid feelings of stigmatization. Peer educators, culturally relevant examples, and patient-driven planning are essential to promote trust and engagement (Ahad et al., 2023).

Equity must also be considered. Many individuals with serious mental illness lack adequate insurance, limiting access to essential screenings and therapy. Programs like Care Resource and MHACF provide low-cost or free services to address these gaps, ensuring interventions remain accessible (Care Resource, 2025; MHACF, 2025).

Relevant Health Policy Implications

Policy frameworks provide the foundation for sustainable care coordination:

• The Mental Health Parity and Addiction Equity Act (MHPAEA): This legislation requires parity between mental and physical health coverage, reducing financial barriers for long-term treatments like MBCT and counseling (CMS, 2024).
• The Affordable Care Act (ACA): Expands access by mandating coverage of mental health and substance use disorder services, supporting preventive screenings and integration of behavioral and physical healthcare (Nielsen et al., 2021).
• Healthy People 2030: Offers national goals targeting stigma reduction, improved health equity, and increased access to care (Healthy People 2030, 2020).

Together, these policies support long-term, equitable, and coordinated care for individuals with mental illness.

Priorities for Care Coordinators in Patient and Family Discussions on Mental Illness

Care coordinators should focus on:

1. Routine Physical Integration: Highlighting the importance of physical health monitoring to reduce risks of comorbidities.
2. Culturally Competent Communication: Engaging families in sensitive discussions to overcome stigma using translated material and culturally adapted education.
3. Encouraging Active Participation: Establishing measurable goals such as attending MBCT sessions or education programs, while tracking progress using tools like PHQ-9 (Liu et al., 2024).

These priorities promote trust, patient empowerment, and shared decision-making.

Learning Session Content with Best Practices and Healthy People 2030

The interventions align with best practices and public health goals.

• Mindfulness-Based Cognitive Therapy (MBCT): Research confirms MBCT reduces relapse rates and improves emotional stability when supplemented with individual follow-ups (Gkintoni et al., 2025).
• Culturally Tailored Education: Education that uses peer-led strategies and culturally appropriate examples has been shown to reduce stigma and increase care-seeking behaviors (Ahad et al., 2023).

These approaches align with Healthy People 2030 objectives of reducing disparities, improving mental health awareness, and increasing equitable access.

Need for Change

The proposed strategy requires additional feedback systems and peer support integration. Without these, interventions risk being less responsive to cultural needs. Regular evaluations, peer facilitators, and open feedback channels can improve responsiveness and strengthen patient engagement (Healthy People 2030, 2020).

Conclusion

This care coordination strategy addresses the multifaceted needs of adults with mental illness in Florida through holistic, patient-centered approaches. By integrating physical health monitoring, stigma-reduction education, and psychosocial therapies such as MBCT, it promotes overall well-being. Policies like the ACA and MHPAEA support continuity of care, while community organizations ensure access. Incorporating feedback mechanisms and peer support can further strengthen cultural responsiveness and sustainability. Ultimately, this strategy supports Healthy People 2030 goals by reducing stigma, improving access, and promoting equity in mental health care delivery.

References

Ahad, A. A., Sanchez-Gonzalez, M., & Junquera, P. (2023). Understanding and addressing mental health stigma across cultures for improving psychiatric care: A narrative review. Cureus. https://doi.org/10.7759/cureus.39549

Care Resource. (2025). Behavioral health. Care Resource. https://careresource.org/services/behavioral-health/

Caron Florida. (2024). Mental health program. Caron Transformational Care. https://www.caron.org/treatment-programs/mental-health-program

NURS FPX 4065 Assessment 5 Final Care Coordination Strategy

Centers for Medicare & Medicaid Services. (2024, September 10). The mental health parity and addiction equity act (MHPAEA). CMS. https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity

Garfin, D. R., Thompson, R. R., Holman, E. A., Wong-Parodi, G., & Silver, R. C. (2022). Association between repeated exposure to hurricanes and mental health in a representative sample of Florida residents. JAMA Network Open, 5(6), e2217251. https://doi.org/10.1001/jamanetworkopen.2022.17251

Gkintoni, E., Vassilopoulos, S. P., & Nikolaou, G. (2025). Mindfulness-based cognitive therapy in clinical practice: A systematic review of neurocognitive outcomes and applications for mental health and well-being. Journal of Clinical Medicine, 14(5), 1703. https://doi.org/10.3390/jcm14051703

Healthy People 2030. (2020). Mental health and mental disorders. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. https://odphp.health.gov/healthypeople/objectives-and-data/browse-objectives/mental-health-and-mental-disorders

Liu, W., Yuan, J., Wu, Y., Xu, L., Wang, X., Meng, J., Wei, Y., Zhang, Y., Kang, C.-Y., & Yang, J.-Z. (2024). A randomized controlled trial of mindfulness-based cognitive therapy for major depressive disorder in undergraduate students: Dose–response effect, inflammatory markers and BDNF. Psychiatry Research, 331, 115671. https://doi.org/10.1016/j.psychres.2023.115671

Mental Health Association of Central Florida (MHACF). (2025). About us. MHACF. https://mhacf.org/learn-more/

NURS FPX 4065 Assessment 5 Final Care Coordination Strategy

Nagaoka, M., Koreki, A., Kosugi, T., Ninomiya, A., Mimura, M., & Sado, M. (2023). Economic evaluation alongside a randomized controlled trial of mindfulness-based cognitive therapy in healthy adults. Psychology Research and Behavior Management, 16, 2767–2785. https://doi.org/10.2147/prbm.s406347

National Alliance on Mental Illness Florida (NAMI Florida). (2025). Mission. NAMI Florida. https://namiflorida.org/about-nami-florida/mission/

Nielsen, R. E., Banner, J., & Jensen, S. E. (2021). Cardiovascular disease in patients with severe mental illness. Nature Reviews Cardiology, 18(2), 136–145. https://doi.org/10.1038/s41569-020-00463-7