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Table 1 Finalized list of statements for each of the three Navigation Components

From: Identifying the key features and outcomes of family navigation services for mental health and/or addictions concerns: a Delphi study

Navigation Component

Prompts

Retained Factors

Intraclass Correlation Coefficient

1: Expert consensus on the key features of a successful navigation process

• Prompt 1: What do you think are the features of a successful navigation process?

• Prompt 6: Are there specific principles and values of navigation that lead to good outcomes? What are they?

The navigator effectively determines the best fit by thoroughly understanding and considering the youth and families’ needs, collaborating with team members and service providers, and providing individualized suggestions

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There is a strong relationship/rapport between the family and the Navigator (i.e. Navigator validates and reassures, is non-judgmental, empathetic, reliable, kind and the family feels a sense of trust and safety, and is comfortable contacting the navigator with questions or concerns)

There is strong communication between the family and the Navigation Team, and with other service providers as necessary (i.e. clear, consistent, and transparent communication that ensures clients are kept informed) (removed Prompt 6 item “open communication”)

The family receives usable and practical resource options (i.e. options are clinically sound, comfortable for family, accessible to family)

The family and/or youth are actively involved in creating and implementing the navigation plan (i.e. motivated and willing to engage and follow through on navigation plan)

The family receives the information and tools required to make informed decisions about their options

The Navigation Team removes some burden and/or stress from family by performing some of the work associated with seeking and accessing the appropriate resources

The Navigation service provides family-centered support (i.e. meeting the youth and family where they are at, working with and supporting any or all family members, trusting parents’ observations and insights, empowering families)

Navigators have expertise, knowledge, and understanding of mental health and addictions system and existing services (i.e. expert navigators are well-informed and keep up to date through training and time spent understanding resources) (combined with Prompt 1 item 1 “navigator has expertise about youth mental health and the mental health and addictions system”)

The Navigation service matches youth and/or families to services/resources (i.e. through expert knowledge of system and resources, conduct effective profiling, present options, and connect families to service providers in a timely fashion)

The Navigators show compassionate persistence (i.e. staying connected with the family, following up, continuing to seek appropriate resources if needed, flexibility in timelines for length of involvement with FNP) (removed Prompt 1 item “continued and ongoing support”)

The Navigators show empathy and compassion

There is flexibility in Navigation service (i.e. recognizing individuality, anticipating and responding to changes in situation, creative solutions, flexibility in contact)

There is an intake process that is comprehensive and accessible

2: Expert consensus on the features of a good match between youth/families and services.

• Prompt 7: What are the factors to do with the youth that lead to a good match between the youth/family and referred service?

• Prompt 8: What are the features of a service that lead to a good match between the youth/family and referred service?

• Prompt 9: What are the factors to do with a family that lead to a good match between the youth/family and referred service?

The youth is willing to seek/participate in treatment (i.e. youth is willing to engage as an active participant, attends appointments, willing to learn about diagnosis and evidence-based options, open minded, etc.…)

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The youth likes the program offered (i.e. youth feels connected, accepted, heard, respected; has a positive attitude toward the service; compatibility with other clients at the service, etc.…)

The youth recognizes/accepts there is a problem

Service providers have excellent interpersonal skills (i.e., intake worker is friendly and engaging; all staff are friendly, patient, passionate, caring, dedicated, kind, empathetic, compassionate, honest, etc.…)

Service providers are knowledgeable and up-to-date on evidence-based practice, multidisciplinary perspectives in service

The service is able to connect/engage with youth

The service is responsive (i.e. answer calls/emails in a prompt manner)

The family is supportive of the youth in general (i.e. respect the youth’s rights, assist the youth in accessing service, assume the youth is doing their best, etc.…)

The family is willing to be actively involved in the process (i.e. involvement and collaboration with the treating team, engaged in treatment process, etc.…)

The family is supportive of the youth’s treatment journey (i.e. respect the relationship between the youth and service, respectful of service providers, open and vulnerable to the process, etc.…)

The family is willing to communicate with the youth, Navigator, and service provider (i.e. cooperative and responsive, available to speak to navigator and/or service provider, able to effectively share information with navigator and/or service provider, provide feedback when needed)

The family is committed to change (i.e. ready, engaged, motivated to change)

The family is willing to follow through with recommendations

Component 3: Expert consensus on the outcomes of importance in Navigation

• Prompt 2: What do good outcomes look like for the youth?

• Prompt 3: What do good outcomes look like for the whole family?

• Prompt 4: What do good outcomes look like for the navigator?

• Prompt 5: What do good outcomes look like for the service provider?

The youth is connected to/engaged with supports (i.e. accessing resources that are a good fit, satisfied with resources)

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The youth experiences improvement in symptoms (i.e. improvement in mental health, decreased substance use or risky behaviours, decreased stress, sense of well-being) (removed Prompt 3 item “youth is coping better and/or improving”)

The youth experiences improved daily functioning (i.e. able to leave the house, engage in activities of interest, sense of purpose) (removed Prompt 3 item “youth is coping better and/or improving”)

The youth is more motivated to take part in treatment (i.e. willing to seek treatment, contemplating change or acting to change, compliant with plan, motivated to improve)

The youth experiences emotional improvement (i.e. happier, self-awareness, increased maturity, better emotional regulation, etc.…)

The youth has more insight into their mental health and/or addictions difficulties (i.e. better understanding of their condition)

A less stressful home environment/family dynamic (i.e. decreased shame, isolation, guilt, blame, aggression, conflict; all members of family are safe; less stress-induced illness; members aware of their impact on the situation)

The family experiences improved daily functioning (i.e. all family members can manage their responsibilities, such as work, and be productive)

The caregivers develop improved parenting techniques (i.e. clear roles, boundaries, consequences; parents on the same page)

The family’s situation has improved (i.e. alleviation of stress, isolation, crisis; improvement in symptoms and behaviours; better coping; family has hope)

The navigator finds a suitable treatment/resource (i.e. providing a good match; providing a range of options; developing a clear plan; tracking options that did not work)

The family feels more supported, understood, and empowered by the Navigation Team

The Navigator has established a good therapeutic relationship with client (i.e. good communication, treated respectfully, family is open and transparent, youth engages/communicates with navigator)

The Navigation Team provides prompt and timely support (i.e. rapid intake, profiling, connection; adaptive and responsive to changing situations)

The service provider supports the family with a good therapeutic alliance (i.e. offer services respectfully and sensitively, listen to family, family/youth feel safe, understood, and supported, trust the service provider, are honest with the service provider, etc.…)

The family/youth show symptom improvement and/or make positive changes (i.e. independent, improved functioning, decreased number of hospital stays, growing confidence, desire for growth, setting long-term goals, etc.…)

The youth and/or family’s issues are a good match to services (i.e. good fit between youth/family’s needs and service, familiar with issues, able to provide appropriate treatment)

The youth and/or family commit to and engage with ongoing treatment (i.e. connect with referred provider, attend sessions, engaged in service and complete program, if applicable)

The client has improved tools/resources for coping/functioning (i.e. skills and strategies to be successful following completion of treatment, add: improved ability to manage stressful situations, recognizes strengths and learns from setbacks, has improved self-care skills, etc.…) (combined with Prompt 2 item “youth has more tools and skills to use when needed”)