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Table 4 Factors and their elements influencing implementation and maintenance of navigation programs

From: Implementation and maintenance of patient navigation programs linking primary care with community-based health and social services: a scoping literature review

Factors

Elements describing each factor

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