Ellen Anderson, MD, MHSc. Susan Larke, MSc. Submitted by: Sooke Family Resource Society. Navigator Project Steering Committee. Vancouver. Foundation.
The Sooke Navigator Project Final Report July 2007 Authors: Ellen Anderson, MD, MHSc Susan Larke, MSc
Submitted by: Sooke Family Resource Society Navigator Project Steering Committee
Vancouver Foundation
UBC Department of Family Practice Research Office
BC College of Family Physicians
Ministry of Children and Family Development
The Sooke Navigator Project Final Report
June 2007
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The Sooke Navigator Project Final Report
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Table of Contents ACKNOWLEDGEMENTS
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EXECUTIVE SUMMARY
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INTRODUCTION
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BACKGROUND
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RESEARCH METHODS
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Client Data Collection Iterative Research Activities PHASE ONE: PRE-NAVIGATOR COMMUNITY VOICES Parents/Family members Community Service Providers: Family Physician Survey PHASE TWO: PROJECT GOALS SERVICE OBJECTIVES RESEARCH OBJECTIVES PHASE TWO: PROJECT ACTIVITIES STEERING COMMITTEE NAVIGATOR CLIENT SERVICES Navigator Activities – Time Spent Seasonal and Longitudinal Referral Patterns PHASE TWO: PROJECT OUTCOMES
15 15 16 16 16 16 17 19 19 20 20 20 21 22 24 26
PROJECT OUTCOMES I. WHAT WERE THE CHARACTERISTICS OF CLIENTS SEEKING NAVIGATOR SERVICE? 27 Who were the clients who saw the Navigators? 27 What were Navigator clients’ presenting complaints? 36 What were identified client needs once navigation was underway (research dataset)? 38 PROJECT OUTCOMES II. IMPACT OF NAVIGATOR SERVICE ON CLIENTS 42 Client Feedback 43 Reasons for successful Navigation 44 PROJECT OUTCOMES III: IMPACT OF THE NAVIGATOR SERVICE IN THE COMMUNITY? 46 PROJECT OUTCOMES IV: BARRIERS, LINKAGE AND CLIENT NEED 48 Connections to MHAS services 48 Client service needs compared to services in place at follow up 51 Barriers to service access prior to referral. 54 Barriers to service access, following referral 56 PHASE THREE: POST-NAVIGATOR WHAT WERE THE LIMITATIONS, CONSTRAINTS, AND POTENTIAL RISKS OF RESEARCH PROJECT? EVALUATION CRITICAL SUCCESS FACTORS Funding: Community Awareness and Engagement:
58 58 62 62 62 62
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Treatment/Service Availability: 62 Service and Research: 63 Bi-directional Knowledge Transfer: 63 Navigator Project Goals 64 What value has the Navigator service added to the network of MHAS care in Sooke? 65 RECOMMENDATIONS BUILT ON RESPECT JUST SO YOU KNOW… FORM OF INTENT
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APPENDIX B: SOOKE NAVIGATOR SERVICE MODEL
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APPENDIX C: STEERING COMMITTEE MEMBERS
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APPENDIX D: STEERING COMMITTEE CHARTER
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APPENDIX E: CLIENT FEEDBACK FORM
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APPENDIX F: ADMINISTRATIVE DATASET DATA DICTIONARY
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SERVICES REFERRED TO BY NAVIGATORS: JULY 2005 – MARCH 2007 APPENDIX G: LOGIC MODEL & EVALUATION PLAN
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List of Tables Table 1: Physician survey August 2005. Physician ratings of overall MHAS in 2005 N=11 ........................................................................Error! Bookmark not defined. Table 2. Physician survey August 2005. Physician ratings of specific MHAS (provided by VIHA &MCFD) N=11). ...................................................................................17 Table 3. Navigator time spent on specific activities (35 hour work week, 49 weeks per year) ..........................................................................................................23 Table 4. Navigator consultation services provided in addition to direct client services (discrete categories).....................................................................................23 Table 5. Age and Gender of Navigator Clients (Administrative dataset N=258)..............28 Table 6. Research consent: gender and adult/youth (N=258) ......................................30 Table 7. Number of issues reported by Navigator clients in each dataset (Research and Administrative). ...........................................................................................30 Table 8. Reasons for families seeking Navigator service (Administrative dataset N=36) .31 Table 9. Adult client consent to participate in research, by referral source (N=184) .......31 Table 10. Youth client consent to participate in research, by referral source (N=74) ......32 Table 11. Highest level of Education reported by Navigator clients (N=145, research dataset) ......................................................................................................32 Table 12. Financial status/sources of income reported by Navigator clients (N=145, research dataset) .........................................................................................33 Table 13. Client residence as reported to the Navigators at intake (N=145, research dataset) ......................................................................................................34 Table 14. Youth and Adult Referral Sources (adminstrative dataset, N=258) .................34 Table 15. Issues reported by ALL Navigator clients (Administrative dataset: Youth N=74, Adult N=184) ..............................................................................................36 Table 16. Frequency of clients reporting Self-harm issues at intake - by age.................37 Table 17. Substance use (moderate to heavy consumption levels within the last month) reported by Navigator clients (research dataset: N=145, all ages) .....................38 Table 18. Clients with problems with substance misuse, desire for treatment and withdrawal symptoms (N=145, research dataset, all ages) ................................39 Table 19. Overall estimated frequency/level of service need for support after Navigation for Youth and Adult Navigator clients (research dataset N=145) ........................40 Table 20. Specific level and area of MHAS functional difficulty in Navigator clients: Post assessment rated by Navigator (N=145, all ages, research dataset) ...................40 Table 21. Overall results of Navigation (research dataset, N=145, all ages)..................42 Table 22. Client Feedback (all ages, N=46) ..............................................................43 Table 23. Factors contributing to success in client navigation (research dataset n=145)..44
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Table 24. Navigator provided assistance that contributed to success (and/or improved client functioning), n=145, all ages ................................................................45 Table 25. Time elapsed before follow up contact (N=145, Research dataset) .................48 Table 26. Referrals and connections in Sooke, Western Communities and Victoria .........49 Table 27. Overall Results of Navigator referrals to service (N=145, research dataset, all ages) ..........................................................................................................49 Table 28. Follow up results of Navigator referrals. (N=145, research dataset, all ages) ..50 Table 29. Navigator client needs, as rated by the Navigators after completing the strengths-based assessment (research dataset, Adults n=108, Youth n=37) .......53 Table 30. Navigator-rated barriers at the time of Navigation (N=145, Research dataset, all ages) ..........................................................................................................54 Table 31. Barriers to referred service access at follow up (n=145, research dataset) ......56 Table 32. Risk Assessment/Analysis for the Navigator Project: May 2007 ....................59
List of Figures Figure 1. Adult New Referrals to the Navigator Project (administrative dataset, n=184) .24 Figure 2. Youth New Referrals to the Navigator Project (administrative dataset, n=74) ..25 Figure 3. Summary of Navigator clients and research consent.....................................27 Figure 4. Age and Gender of Navigator Clients (Administrative dataset, N=258) Age data are in 3 year cohorts for clients 19 ..................................................................................................................29 Figure 5. Frequency of clients reporting self-harm issues at intake - by age and gender.37
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Acknowledgements The authors wish to acknowledge the dedication and wisdom of the community members of the Sooke Navigator Steering Committee. They provided the impetus and direction for our collaborative adventure in responsible action research with our community. We also wish to acknowledge the Sooke Navigators. Lynn Simonson and Jim MacSporran worked hard to make the service a reality, skillfully and compassionately serving their clients. The Sooke Family Resource Society (SFRS) ably took on the role of sponsoring agency, and the Vancouver Island Health Authority (VIHA) provided support, guidance and funding. Dr. Ken Moselle of VIHA has always been resourceful, supportive and engaged. Dr. Elliot Goldner and his staff at the Center for Applied Research in Mental Health and Addictions have generously provided us their time, advice, research expertise and financial support. We are also grateful to the Vancouver Foundation, the Victoria Foundation, the Sutherland Foundation, the Michael Smith Foundation for Health Research, the BC College of Family Physicians, the UBC Department of Family Practice and the Ministry of Children and Family Development (MCFD) for their funding. This research was supported, in part, by the Vancouver Foundation through a BC Medical Services Foundation grant to the Community Based Clinical Investigator (CBCI) program at UBC’s Department of Family Practice. Most of all we wish to acknowledge the courage and trust of the many community members, clients, and service providers who joined up and sought help from our project. You gave us permission to record and try to understand and share your stories. We are inspired by your efforts to create better lives for yourselves, your families, and your community.
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Executive Summary The primary goal of the Sooke Navigator Project was to connect clients (with mental health and addictions needs) to timely accessible service, while at the same time gathering relevant data on local service needs. Project research team members1 developed a multi-method action research design. With our community-based Steering Committee, we developed a charter, framework and process to work together, and defined a Navigator role. This service was also intended to enhance capacity to provide appropriate service for clients whose Mental Health and Addictions Service (MHAS) needs were unmet. Our desire was to optimize the capacity of existing services to meet client need by creating a Navigator role that performs two key functions: 1) support engagement of disenfranchised clients with the network of services by ‘navigating’ clients to the point where they are prepared to engage effectively into the network of services; and 2) enhance the effectiveness of the existing service system by facilitating communication, linkage and coordination of care. The ongoing support and involvement of the Sooke Family Resource Society (SFRS) enabled the project to operate within an existing administrative infrastructure. The financial, administrative, and practical participation of the Vancouver Island Health Authority (VIHA), as well as our other funders2, was integral to the success of the project. The Navigator Project developed and adapted clinical assessment tools, and adapted an electronic database (provided by VIHA) to support systematic documentation and analysis of local mental health and addictions service needs, available resources and care pathways. We designed and implemented a variety of qualitative research activities to ensure we heard and understood the experiences of service providers and of community members who live and work with Mental Health and Addiction (MHA) concerns. We intend to use the information, knowledge and relationships we have developed to advocate for and support improved MHAS planning and delivery in the Sooke Region. In this report we describe and evaluate the key elements of the Navigator model of service facilitation, and its impact on local citizens and service providers. In future writing we hope to inform the health services research literature by providing additional detail on how a Navigator role might support access to effective and appropriate mental health and addictions services for other communities. It was beyond the scope and capacity of this pilot project to perform formal cost-benefit analysis, or to follow long term outcomes of clients linked to service by the Navigator. These activities are important next steps in evaluating a Navigator service model.
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Dr. Ellen Anderson, Principal Investigator and Susan Larke, Project Manager, supported by Dr. Ken Moselle, Vancouver Island Health Authority, Dr. Elliot Goldner, Center for Applied Research in Mental Health and Addictions – Simon Fraser University (and other CARMHA staff) and Dr. Donna Jeffery, University of Victoria. 2 The Vancouver Foundation, the Victoria Foundation, the Ministry of Children and Family Development, The Sutherland Foundation, the Michael Smith Foundation for Health Research, the Center for Applied Research in Mental Health and Addictions at SFU.
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The Sooke Navigator Project Final Report
June 2007
From July 2005 to February 2007, any community member with mental health and/or substance use concerns in the Sooke region could easily self refer or be referred to the Navigator by friends, family, their primary care physician, or any other service provider. All clients received timely client-focused, comprehensive assessments, including assessments of strengths/capacities, and deficits/risks, pre-emptive identification of barriers3 to service access, collaborative service planning, linkage facilitation, and (where possible) a follow-up call to confirm linkage and document barriers to service access. Over 21 months, 258 individual clients (184 adults, 74 youth (
