Health Navigators Research Articles

Integrating health systems for children and young people in out of home care: Challenging the nature of siloed service delivery in rural Australia.

The purpose of this paper is to report on enablers and barriers during the first 2 years of the health systems integration project that included the implementation of a health navigator role. The project aims to improve health outcomes for children and young people residing in out of home care in rural Australia with a health navigator co-located between child protection practitioners and community health services clinicians. Rural Northwest Victoria. Sunraysia Community Health Services and the Department of Health and Human Services. The qualitative design of the project evaluation involved semi-structured interviews and documentary evidence analysis. Analyses of interviews and documentary data demonstrate the challenging nature of siloed service delivery in rural Australia, particularly during a time that comprised multiple interruptions due to COVID-19. A limited synergy between organisational priorities and reporting systems hindered project progress. The lack of a shared definition of 'health' challenged the effective collaboration between health clinicians and child protection practitioners and the role of the health navigator. The health navigator raising health awareness through project involvement, training and sector-wide stakeholder engagement resulted in a slow but steady process of increased prioritisation of health care, increased health literacy among the child protection workforce, and broadening participation of area-based stakeholders, but did not translate to increased access to health plans for children. Integrating health systems across multiple sites with support of a health navigator revealed difficulties, particularly during COVID-19. The first phase of the project demonstrated the value of shared governance and partnerships as an imperative foundation for fundamental change. Relationships strengthened throughout the project, leading to a better understanding of area-based strengths, which in turn supports improved pathways to health care for children and young people in OOHC within rural communities and driving the subsequent phases of the 10-year project.

Integrating Lawyers into the Perinatal Health Care Team: Initial Findings From an Innovative Medical–Legal Partnership [ID: 1377957

INTRODUCTION: Health-harming legal needs (HHLNs), social determinants of health that have a legal remedy, are drivers of poor health outcomes for Black women and children. HHLNs include inadequate access to safe housing, employment accommodations, and income supports. A medical–legal partnership (MLP) adds an attorney to the health care team to address patients’ HHLNs in a variety of health care settings. The Perinatal LAW Project (P-LAW), an MLP between the Georgetown University Health Justice Alliance and MedStar Washington Hospital Center Women’s & Infants’ Services, addresses perinatal patients’ HHLNs in an obstetrics and gynecology practice. METHODS: Perinatal LAW Project attorneys record client and case data in a legal case management system. The research team analyzed data for the first 18 months of the program (March 2021 to September 2022). RESULTS: One hundred thirty-one patients were referred for legal assistance, primarily by social workers and health navigators. Most patients were in their second and third trimesters. The majority of patients were Black or African American, aged 20–34, and lived under 200% FPL. The most common legal issues were in the areas of employment (parental leave, discrimination), housing (conditions, eviction), public benefits (food stamps, disability benefits), and family law (child support, domestic violence). The P-LAW addressed 150 legal issues and served 117 patients. CONCLUSION: Medical–legal partnership is a novel approach to addressing maternal health disparities. In our experience, legal services have a high utilization rate and patients often have more than one legal need. Future efforts to measure patient outcomes, including reduced maternal stress and medical appointment attendance, will build the evidence base for MLP in the perinatal context.

PATHA's vision for transgender healthcare under the current health reforms.

The Aotearoa New Zealand healthcare system does not adequately meet the needs of transgender people. Due to healthcare reforms and increases in funding and awareness of transgender health, the Ministry of Health has met with the Professional Association for Transgender Health Aotearoa (PATHA) to discuss ways to improve the healthcare system. We developed a vision for a transgender healthcare document to enable a process for our members to collaborate and to increase transparency about what advice PATHA has provided to the Ministry. Feedback from PATHA's committees was incorporated into a draft document, which was then sent to all PATHA members for further feedback and collaboration. PATHA proposes improvements to transgender healthcare that are centred around a new transgender health resourcing hub, which should operate according to a Te Tiriti o Waitangi framework, provide national coordination of a distributed model of care, provide resourcing (including education) for primary care and actively work to increase provision and equity of gender-affirming surgeries. In order to be effective, the new resourcing hub would utilise peer health navigators, provide education and professional development, promote healing-focussed care and incorporate transgender community leadership and accountability. These improvements would allow for the best practices from existing regional programmes to be implemented throughout the healthcare system. The proposed changes align with the goals of the healthcare reforms to make healthcare for transgender people more equitable, accessible and cohesive.

European Cancer Summit 2022 Submission for Prevention, Early Detection and Screening NetworkCancer prevention and care for people experiencing homelessness: barriers and facilitators at system, provider, and individual level in four European countries

BackgroundPeople experiencing homelessness (PEH) have a higher prevalence of adverse health outcomes and premature mortality compared to the general population, including a higher burden of cancer and cancer-specific mortality (Thomas, 2012). These outcomes are associated with several etiological factors and may lead to significant barriers to accessing primary and secondary prevention and community health services. The CANCERLESS project (EU Horizon 2020) aims to enable PEH in Europe to access cancer prevention measures at an early stage by developing a novel care model, the Health Navigator Model (HNM). Implementing this co-designed person-centered and community-based intervention may be a way to address the growing health and social disparities in PEH and promote their timely access to cancer prevention services. MethodsTo qualitatively adapt the HNM to structural conditions in four European healthcare systems, we collected data through 69 semi-structured interviews between August and October 2021 with PEH, both with and without direct experiences of cancer, as well as with health and social care professionals. Interviews conducted by partners in Austria, Greece, Spain, and the United Kingdom were transcribed verbatim and thematically analyzed utilizing the approach set out by Saldaña (2021). ResultsWe derived the two overarching themes (1) Experiences and understanding of cancer prevention and treatment, and (2) Considerations for program intervention. While cancer was a major source of worry, participants’ responses indicated that PEH generally had very limited knowledge and understanding of cancer symptoms and cancer prevention. Across all settings, programs and activities for cancer prevention geared towards PEH were described as effectively non-existent, and very few participants experiencing homelessness recalled being invited to a screening appointment. As a result, health and social care professionals in some settings indicated that cancer in people experiencing homelessness was often missed in the early stages, and instead only picked up when the severity of symptoms intensified. ConclusionsAs cancer-specific knowledge among PEH is limited, engagement on educational and awareness-building levels in this population is needed. To achieve this, communication around cancer should be multilingual, accessible, and simple, while medical staff should be trained to provide more inclusive health services (Hauff & Secor-Turner, 2014).

Peer Health Navigation Experiences Before and After Prison Release Among People With Opioid Use Disorder.

Recently incarcerated people with opioid use disorder are at high risk of overdose and adverse outcomes as a result of biopsychosocial risk factors. Peer support models aiming to improve these outcomes have expanded in recent years. This qualitative study aimed to document participants' experiences with peer health navigation before and after prison release, examine participants' perspectives on the role of peer health navigators, and understand participants' views on service improvements. The authors conducted in-depth, semistructured interviews with 39 recipients of peer health navigation at release, 30 of whom also completed a follow-up interview 3 months later. Interviews were analyzed via cross-case analysis. Interviewees differently valued the various types of support they received. Participants appreciated working with someone with shared lived experience with whom they could establish a trusting relationship. Nevertheless, structural and policy barriers meant that certain key needs-such as housing and employment-could not always be met. Peer health navigators can connect participants to evidence-based treatment and help them address their psychosocial needs and develop skills to support long-term wellness. Further research is needed to assess the impact of peer health navigation on participant outcomes, such as overdose reduction, treatment engagement, and sustained recovery.

Digital healthcare equity in primary care: implementing an integrated digital health navigator.

The 21st Century Cures Act and the rise of telemedicine led to renewed focus on patient portals. However, portal use disparities persist and are in part driven by limited digital literacy. To address digital disparities in primary care, we implemented an integrated digital health navigator program supporting portal use among patients with type II diabetes. During our pilot, we were able to enroll 121 (30.9%) patients onto the portal. Of newly enrolled or trained patients, 75 (62.0%) were Black, 13 (10.7%) were White, 23 (19.0%) were Hispanic/Latinx, 4 (3.3%) were Asian, 3 (2.5%) were of another race or ethnicity, and 3 (2.5%) had missing data. Our overall portal enrollment for clinic patients with type II diabetes increased for Hispanic/Latinx patients from 30% to 42% and Black patients from 49% to 61%. We used the Consolidated Framework for Implementation Research to understand key implementation components. Using our approach, other clinics can implement an integrated digital health navigator to support patient portal use.

Training community health navigators in the public health workforce to respond during the COVID-19 pandemic.

To describe the process of engaging underserved communities of color that designs, conducts, and evaluates community-engaged COVID-19 Community Health Navigator training on COVID-19: Vaccination, Prevention, and Contact Tracing. The project used a mixed-methods design; 18 community health navigators (CHNs) representing Asian American, Arab American, Black/African American, and Hispanic/Latinx communities completed the pretest, training, and post-test. Demographic characteristics, along with knowledge and confidence level questions regarding COVID-19 issues, were gathered in pre- and post-tests. Qualitative data were collected via open-ended questions in post-tests. Findings suggest that the community health navigator training successfully increased participants' knowledge of COVID-19-related topic areas and confidence in educating community members regarding COVID-19 vaccination and prevention. Qualitative evaluation contained information learned and found most helpful, and application and utilization plans for CHNs' follow-up work. The process of community health navigator training and evaluation results adds important insights to the current COVID-19 pandemic workforce literature and can inform future trainings.

Establishing an Academic-Community Partnership to Explore the Potential of Barbers and Barbershops in the Southern United States to Address Racial Disparities in HIV Care Outcomes for Black Men Living With HIV.

Black men comprise most new HIV infections in the Southern United States and have worse HIV outcomes than their non-Black counterparts. We developed an academic-community partnership in Nashville, Tennessee, to explore opportunities to improve HIV outcomes for Black men. We recruited barbers to an HIV training and focus group discussion about prevention and potential barber/barbershop-based strategies to address HIV-related needs for Black men. We assessed HIV knowledge and stigma with validated scales and conducted thematic analysis on discussion transcripts. HIV-related stigma was low (1.8 of 15 points [SD = 1.69]) among 13 participants of unknown HIV status (12 men and one woman). HIV knowledge increased among eight (67%) participants after receiving a brief HIV didactic. Participants described general health care barriers (e.g., the social norm that Black men do not go to the doctor until they are "damn near dead"), fears about unwanted HIV disclosure when seeking HIV testing or care, and community fears about negative stereotypes associated with HIV. Participants expressed enthusiasm about receiving more HIV-related training and utilizing communication skills and client/community relationships to serve as health educators and navigators. Barbers highlighted opportunities to disseminate HIV information in barbershops and combine HIV interventions with other health issues, such as COVID-19, and suggested that these interventions may help reduce HIV-related stigma. Our findings suggest that barbers and barbershops are an underutilized resource for disseminating HIV-related health information and engaging Black men in HIV and other important prevention and care activities such as COVID-19.

Population Health Navigators: An Innovative Approach for Supporting Underserved Patients

Population Health Navigators: An Innovative Approach for Supporting Underserved Patients

Demystifying Case Management in Aotearoa New Zealand: A Scoping and Mapping Review

Community-based case managers in health have been compared to glue which holds the dynamic needs of clients to a disjointed range of health and social services. However, case manager roles are difficult to understand due to poorly defined roles, confusing terminology, and low visibility in New Zealand. This review aims to map the landscape of case management work to advance workforce planning by clarifying the jobs, roles, and relationships of case managers in Aotearoa New Zealand (NZ). Our scoping and mapping review includes peer-reviewed articles, grey literature sources, and interview data from 15 case managers. Data was charted iteratively until convergent patterns emerged and distinctive roles identified. A rich and diverse body of literature describing and evaluating case management work in NZ (n = 148) is uncovered with at least 38 different job titles recorded. 18 distinctive roles are further analyzed with sufficient data to explore the research question. Social ecology maps highlight diverse interprofessional and intersectoral relationships. Significant innovation and adaptations are evident in this field, particularly in the last five years. Case managers also known as health navigators, play a pivotal but often undervalued role in NZ health care, through their interprofessional and intersectoral relationships. Their work is often unrecognised which impedes workforce development and the promotion of person-centered and integrated health care.

Assessing the impact of a health navigator on improving access to care and addressing the social needs of palliative care patients experiencing homelessness: A service evaluation

Background: Health navigators are healthcare professionals who specialize in care coordination, case management, navigating transitions, and reducing barriers to care. There is limited literature on the impact of health navigators on community-based palliative care for people experiencing homelessness. Aim: We devised key performance indicators in nine categories with the aim to quantify the impact of a health navigator on the delivery of palliative care to patients experiencing homelessness. Design: Data were collected prospectively for all patient encounters involving a health navigator from July 2020 to 2021 and reviewed to determine the distribution of the health navigator’s role and the ways in which patient care was impacted. Setting and participants: This study was conducted in Toronto, Ontario with the Palliative Education and Care for the Homeless (PEACH) Program. At any one time, the PEACH health navigator served a total of 50 patients. Results: We identified five key areas of the health navigator role including (1) facilitating access (2) coordinating care (3) addressing social determinants of health (4) advocating for patients, and (5) counselling patients and loved ones. The health navigator role was split evenly between activities pertaining to palliative care for structurally vulnerable populations and community-based palliative care for the general population. To achieve high impact outcomes, a considerable investment of time and energy was required of the health navigator, speaking to the importance of adequate and sustainable funding. Conclusions: These findings underscore the potential for health navigators to add value to community-based palliative care teams, especially those caring for structurally vulnerable populations.

A Study of New Zealand’s Indigenous Healthcare Model and Its Impact on Curtailing Obesity

The Māori holistic model of healthcare was established by Sir Mason Durie in 1984 to stipulate a Māori perspective on health. This model deals with taking care of all elements of life to maintain sustainable welfare. The four elements and their significance are represented by the wharenui (meeting house). The wharenui's link to the whenua (land) serves as the foundation for other elements, thereby pioneering health and wellbeing of yourself and whanau (family). The Māori holistic model of healthcare draws on strong bonding between the foundation and other walls in case any issues crop up (Health Navigator NZ, 2022). #). The purpose of this research paper is to identify the significance of Māori holistic healthcare framework and analyze how obesity affects the healthcare systems of New Zealand by shedding light on its impact on confronting individuals, families, and primary health-care professionals. Keywords: Māori holistic model, Healthcare, Obesity

Māori Academic Challenges: Delivering Mātauranga Māori During COVID-19

In March 2020, the COVID-19 pandemic disrupted academic educational programmes in universities across the world, including Aotearoa New Zealand. For Māori academics who implement mātauranga Māori as a pedagogy, it became theoretically and practically challenging teaching virtually and online. The Te Taha Tinana, of Te Whare Tapa Wha model, created by aDurie in 1984 (Health Navigator, 2022) regarding the four dimensions of well-being, focuses on the physical presence, physical embodiment, and physical behaviour. This could not be easily taught virtuality through a computer screen during COVID-19 lockdown. For Māori academics transitioning from teaching Mātauranga Māori in person to an online environment brought forth these challenges. The challenges re-emerged in August 2021 when New Zealand went into Level 4 lockdown overnight because of the new COVID-19 Delta Virus variant. In 2022, the Omicron variant caused many universities in Aotearoa New Zealand to continue their first semester teaching online. Mātauranga Māori is a body of knowledge exercised by Māori people in New Zealand. Sadler (2007) argues Mātauranga Māori was first invented by Māori when Pākehā (English people) arrived in New Zealand. He suggests Mātauranga Māori is a paradigm where Māori define the parameters. Royal (2009; 2012) claims this knowledge was brought to New Zealand by Polynesian ancestors and is an evolutionary continuum of knowledge that relates to encountering the world as Māori with the focus on improving humankind. Le Grice, Braun, and Wetherell (2017) state Mātauranga Māori incorporates theories, practices, and protocols that are bound to relationships, people, and places in a world that supports Māori ambitions. This knowledge, for me an Indigenous Māori academic, incorporates the physical and spiritual worlds embracing the energies of the universe handed down by our forefathers. This position paper discusses the pedagogical challenges encountered during COVID-19 Lockdown for Indigenous academics to continue delivering programmes requiring indigenous expertise and human contact. It explores: 1) the Covid 19 Educational Barriers; 2) Online Academic Challenges; 3) Managing Cultural Shifts; 4) Sustaining Indigenous Pedagogy. It asserts that Mātauranga Māori contributes to the growth of Indigenous knowledge on a world stage and the challenges indigenous academics encounter brought by a global pandemic.

The diagnostic experience of women with fragile X-associated primary ovarian insufficiency (FXPOI).

The fragile X premutation occurs when there are 55-200 CGG repeats in the 5' UTR of the FMR1 gene. An estimated 1 in 148 women carry a premutation, with 20-30% of these individuals at risk for fragile X-associated primary ovarian insufficiency (FXPOI). Diagnostic experiences of FXPOI have not previously been included in the literature, limiting insight on experiences surrounding the diagnosis. This study identifies barriers and facilitators to receiving a FXPOI diagnosis and follow-up care, which can inform care and possibly improve quality of life. We conducted qualitative interviews with 24 women with FXPOI exploring how FMR1 screening, physician education, and supportive care impacted their experience. Three subgroups were compared: women diagnosed through family history who have biological children, women diagnosed through family history who do not have biological children, and women diagnosed through symptoms of POI. Themes from interviews included hopes for broader clinician awareness of FXPOI, clear guidelines for clinical treatment, and proper fertility workups to expand reproductive options prior to POI onset. Participants also spoke of difficulty finding centralized sources of care. Our results indicate a lack of optimal care of women with a premutation particularly with respect to FMR1 screening for molecular diagnosis, short- and long-term centralized treatment, and clinical and emotional support. The creation of a "FXPOI health navigator" could serve as a centralized resource for the premutation patient population, assisting in connection to optimal treatment and appropriate referrals, including genetic counseling, mental health resources, advocacy organizations, and better-informed physicians.

Beyond CANCERLESS: Building up strategies to guarantee the scalability and transferability of the Health Navigator Model to real-life settings across Europe.

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 2.913 (2021 JCR, received in June 2022)The IJIC 20th Anniversary Issue was published in 2021.

SMI Adviser to Launch Training Curriculum for Digital Health Navigators

SMI Adviser to Launch Training Curriculum for Digital Health Navigators

Acceptability and Preliminary Effectiveness of a Remote Dementia Educational Training Among Primary Care Providers and Health Navigators.

Optimal care can improve lives of families with dementia but remains under-implemented. Most healthcare professional training is in person, time-intensive, and does not focus on key aspects such as early detection, and cultural competency. We explored the acceptability and preliminary effectiveness of a training, The Dementia Update Course, which addressed these issues. We hypothesized that the training would lead to increased levels of perceived dementia care competency among key healthcare workers, namely primary care providers (PCPs) and health navigators (HNs). We conducted pre-post training assessments among 22 PCPs and 32 HNs. The 6.5-h training was remote, and included didactic lectures, case discussion techniques, and materials on dementia detection and care. Outcomes included two 5-point Likert scales on acceptability, eleven on perceived dementia care competency, and the three subscales of the General Practitioners Confidence and Attitude Scale for Dementia. We used paired samples t-tests to assess the mean differences in all preliminary effectiveness outcomes. The training included 28.6% of PCPs and 15.6% of HNs that self-identified as non-White or Latino and 45.5% of PCPs and 21.9% of HNs who served in rural areas. PCPs (84.2%) and HNs (91.7%) reported a high likelihood to recommend the training and high satisfaction. Most preliminary effectiveness outcomes analyzed among PCPs (11/14) and all among HNs (8/8) experienced an improvement from pre- to post-training (p < 0.05). A relatively brief, remote, and inclusive dementia training was associated with high levels of acceptability and improvements in perceived dementia care competency among PCPs and HNs.

California EDs awarded $17 million for training navigators

Last week, the California Department of Health Care Services (DHCS) awarded more than $17 million to 142 hospitals to train behavioral health navigators to expand access to substance use disorder (SUD) services and mental health services. The awards are part of the second round of the CalBridge Behavioral Health Navigator Program, which so far has funded 232 hospitals.

Help Is Available: Supporting Mental Wellness Through Peer Health Navigation with Young Black Men Who Have Sex with Men with HIV.

Young black men who have sex with men (YBMSM) with HIV experience disproportionate rates of trauma, incarceration, poverty, racial discrimination, and homophobia. The synergistic effects of these adverse experiences, along with increased rates of mental health disorders, increase their risk for poor health. To address this need, the study authors adapted a current HIV service model to include a peer-health navigation intervention (WITH U) to attend to behavioral health, health literacy, linkage to services, and psychosocial support for YBMSM with HIV. This longitudinal, mixed-methods, nonexperimental study reports on the mental health burden among participants and the association between participation in WITH U and mental wellness outcomes. Participants (N = 65) were an average age of 25-26 years (mean = 25.48, standard deviation = 2.51). Over 25% of participants reported clinically significant depression and/or anxiety symptoms and nearly half the participants reported experiencing post-traumatic stress symptoms that were at least moderately difficult to handle. Quantitative analyses indicated no significant positive association between intervention engagement and mental health symptoms; however, reporting a greater number of depression symptoms was associated with attending fewer intervention sessions. Qualitative data analysis revealed that participants' mental wellness was positively impacted by participating in the intervention and that participants preferred to receive mental wellness support from peer health navigators (HNs) rather than licensed mental health professionals. Yet, peer HNs did not feel adequately prepared to address participants' mental wellness concerns. Increased training for peer HNs and development of a linkage process to more formalized mental health services with community input may strengthen mental wellness support.

ReUnidos: Farmworker Skin Cancer Health Navigation Program.

113 Background: Farmworkers are at increased risk for skin cancer because of occupational exposure to sun and pesticides. In 2017/2018, Farmworker Justice conducted the Unidos community mobilization project to raise skin-cancer awareness and promote skin-cancer care access in farmworker communities. Unmet needs were identified in follow-up care coordination for patients who screened positive for a suspicious skin lesion. We undertook this ReUnidos study to document the incidence of skin cancer in the farmworker community and to evaluate the benefits of a health-navigator program to facilitate follow-up care. Methods: Participants (primarily Latinx) are screened in the community setting by volunteer dermatologists. Those who screen positive for suspected skin cancer are invited to participate in the study. They are assigned a trained navigator who addresses the importance of evaluating the lesion, the details of the diagnostic process, and any questions the subjects have. The navigators also help arrange travel, scheduling of appointments, interpretation services, and any other supports needed during the care journey. Data are collected on the number of biopsies performed, diagnoses, time from screening to diagnosis, skin cancer staging, time to treatment, as well as satisfaction with and perceived effectiveness of the navigator program. Outcome measures are extracted from chart review and final semi-structured interviews of both subjects and navigators. The project seeks to screen 1,000 community members. Approximately 2% are expected to screen positive for a suspicious lesion and require follow-up care. Results: To date, 16 health navigators have been trained and 6 screening events have been conducted in Northern San Diego County by Vista Community Clinic. A total of 126 adult participants have been screened, with 47% identifying as farmworkers. One participant screened positive for a potential skin cancer and has consented to the study. Conclusions: Community-based screenings linked to health-navigation programs may be effective tools to increase access to skin-cancer care among farmworkers. A telemedicine screening model is also being investigated for a second site in upstate New York to expand rural skin screening access. This model may also be useful in care coordination for other malignancies in farmworker communities such as lung cancer and lymphoma, which have also been linked to occupational pesticide exposure.[Table: see text]