Factors | Elements describing each factor |
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1. Patient Characteristics: | • Complexity of clients/patients • Need to address clients/patients basic needs (e.g., shelter) first • Caregivers of clients/patients are patients themselves • Geographic restrictions (e.g., access to services in rural communities) • Language barriers • Respect for cultural values |
2. Effective Recruitment and Training of Navigators | • Recruitment of lay navigators supported by word of mouth • Maintenance of ongoing training to support: o Growth and development of navigators, o Role transitions o Problem solving for complex cases o Collaboration and mutual support among navigators o Orientation to the needs of the population being served by navigators |
3. Role Clarity | • Clear boundaries set for navigators (particularly lay navigators) in their role o Clarifying role boundaries with patients/clients as well as physicians • Valuing role clarification • Management of anxiety when taking on new navigation role to build confidence |
4. Effective and Clear Operational Processes | • Careful development of planning processes • Development of policies and procedures to support program activities • Establishment of documentation mechanisms such as clinical intake forms • Use of consensus decision-making approaches • Provision of clinical supervision and steering committee oversight • Regular communication between agencies for planning purposes • Mechanisms to address scheduling and referral challenges |
5. Adequate Human, Financial, and Tangible Resources including Technological Resources | Provision for: • Human resources o Dedicated, committed, engaged and adequately trained clinical staff o External availability of experts such as attorneys • Financial resources o Secured external funding • Tangible resources o Appropriate space for navigator and navigation work • Technological Resources o Internet resources to locate resources and support complex cases o Electronic health records (EHR) to support documentation of evidence based care plans, patient assessments o EHR to support access to community resources, coordinate transitions, and promote self-management o Email or phones to support communication with physicians • Adequate time to support transitional care and provide comprehensive care to a large caseload. |
6. Strong Inter and Intra Organizational Relationships/Partnerships: | • Encouraging commitment from all professionals involved • Establishment of self-governing team environment in the practice (supports role development) • Development of strong relationships with community agencies by: o Development of a community charter o Establishment of a community-based steering committee o Development of communication strategies with partner agencies o Mechanisms to address inter-organizational issues with power differentials and other tensions between agencies |
7. Lack of Available Services in a Community | • Addressing the problem of “navigation to nowhere” (Inadequate or non-existent local services) |
8. Effective Communication between Providers | • Encouragement of consistent attendance at regular meetings by staff (monthly) • Sharing of updates related to patient/client progress (through EHR) regularly • Involvement of physicians in meetings regularly • Communication between all care providers |
9. Program Uptake and Buy In by End Users of the Program | • Selling/getting buy in to the navigation program with consumers • Use of diverse strategies for recruitment to programs o Recruitment strategies are not successful with all population groups (i.e., outreach,) need to be tailored • Addressing potential stigma in getting participation in mental health navigation programs |
10. Valuing of navigators | • Valuing navigators by providing them with opportunities to be recognized and heard |
11. Evaluation of navigation programs | • Evaluation of navigation programs: o Developing evaluation plan with team for ongoing evaluation o Considering community-based participatory research approaches o Focusing on program related processes (degree to which mission/goals are met) o Considering using pre-identified indicators o Addressing potential problems with lack of access to data, monitoring health status changes over time attribution of outcomes to navigation interventions |