The Sooke Navigator Project

1
The Sooke Navigator Project

• Dr. Ellen Anderson Susan Larke
• 8th National Conference on
• Collaborative Mental Health Care
• June 4th 2007

2
Acknowledgements

• Navigators Lynn Simonson Jim MacSporran
• Sponsoring Agency Sooke Family Resource Society
• District of Sooke, British Columbia
• Dr. Ken Moselle, VIHA
• Dr. Donna Jeffery, UVic
• Dr. Elliot Goldner, SFU

3
Overview

• The Place
• The Problem
• The People
• The Plan
• The Project
• Critical success factors
• Service activities and objectives
• Research activities and objectives
• Project Outcomes

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The Place Sooke, Vancouver Island, BC
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Pacheedaht
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The Problem Burden of Mental Health
Addictions (MHA)
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Sooke Mental Health and Addiction Service (MHAS)
Situation in 2005

• Rural Remote communities
• Very few local services
• No local youth MHAS
• Limited adult service
• 6 family doctors, no MH nurses, or MH center
• Many adults have no family doctors
• Population 15,000, growing 2.3 yearly
• 20 of population under 19
• 3 First Nations SciaNeu, TSouke, Pacheedaht
• NO local data on MHAS need

8
Generic issues in MH Service Delivery

• Clients with least resources most barriers
  negotiate most complex service system
• Clients bounce off bounce around the system
• Hard to get accurate data on local need
• Need to improve communication between service
  providers
• Need to connect with, and support primary care

9
Youth Service Issues

• Many institutional players school district,
  primary care, MCFD, health authority, NGOs
• Institutions dont talk to each other -- or they
  speak different languages
• Parents and kids get lost in the maze
• No voice for youth in service planning
• Need integration of youth services
  family/parent services
• Youth much less likely to seek out care for
  themselves

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Family Physician Survey(August 2005)
Survey courtesy of Dr. Nick Kates, McMaster
University
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What would MH services look like if

• Communities owned local problems?
• Communities collected their own data?
• Communities determined their own research agenda?
• Communities provided valid data and informed
  direction to health authorities and government
  service planners?

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What if..

• Service planning was based on need rather than
  utilization?
• Service planning was based on recent relevant
  local data?
• Services were designed to meet client need?
• Services were designed to help the hard to help
  clients?

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The Sooke Navigator Project
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The Plan The Navigator Project

• Community Initiated
• Participatory Action Research
• Mixed Method data collection Quantitative and
  Qualitative
• Stories and relationships are as important as
  statistics
• Transparent, open, ethically sound process

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The PeopleResearch Partners

• Members of the community of Sooke BC
• Vancouver Island Health Authority
• University of Victoria
• BC Ministry of Children Family Development
• Sooke Family Resource Society
• Simon Fraser University
• Centre for Applied Research in Mental Health and
  Addictions (CARMHA)

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The PeopleFunders

• BC Provincial government
• Vancouver Island Health Authority
• BC Ministry of Children Family Development
• Foundations
• Vancouver Foundation
• Sutherland Foundation
• Victoria Foundation
• Michael Smith Health Research Foundation
• Local
• Sooke District Council
• Sooke Lions Lionesses
• The Rotary Club Sooke Branch

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Community InvolvementNavigator Steering Committee

• TSouke First Nation
• Shoppers Drug Mart Sooke
• Edward Milne Community School
• Sookeworks Employment
• Port Renfrew Health and Social Service Society
• Community members

• Sooke Crisis Centre
• Sooke Family Resource Society
• RCMP/Victim Services
• BC Ambulance Service
• Sooke Seniors Centre
• Sooke Transition House
• Sooke Family Physicians
• Pacific Centre for the Family

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Steering Committee Activities

• Monthly Meetings
• Ongoing data and service reviews
• Navigator Policy Practice reviews
• Anonymized Case Review meetings
• Community training opportunities
• Celebrations of key successes

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The Project Goals

• Improve MHAS access using pilot Navigator service
• Document and characterize MHAS needs
• Optimize Navigator role in local context
• Identify/manage barriers to MHAS
• Gather, analyze, evaluate, and share knowledge to
  support most effective appropriate use of
  Navigator service in Sooke
• Share what we learn to support accessible
  appropriate service delivery models elsewhere

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Research Questions

• What are the current behavioral health needs of
  the Sooke catchment area?
• Are currently available programs and resources
  able to meet that need when organizational/informa
  tional/access barriers are reduced?
• Will an optimized Navigator model enhance
  community capacity by improving access to
  appropriate mental health and social services?

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Data Sources

• Client data
• Quantitative and qualitative
• Admin dataset (N258)
• Research dataset (N145)
• Client feedback forms
• Familes (N36no research consent process)

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Data Sources

• Surveys and Interviews
• Service Provider Interviews
• Focus groups
• Youth
• Seniors
• Physician survey Year One
• Physician interviews Year Two
• Steering Committee written feedback

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Service Objectives

• Integration of MHAS with primary care and NGOs
• Improve Access for all clients to assessment
  service
• Efficient, effective, appropriate
• Support/Navigate
• Client today
• Appropriate client referrals
• Community service providers
• Address barriers
• Avoid unnecessary repetition of assessment,
  inappropriate referrals, duplication of service
• Document individual client barriers to service
  access

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Navigator Service ModelNavigators have a
can-do approach
Therapeutic but not psychotherapeutic
Client-centered Client owns the plan
NAVIGATOR SERVICES
Flexible
Timely communication
Ethical Transparent Process
Support self management
Timely, Low-threshold Access Every door is the
right door
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Strengths-based Assessment

• Collaborative
• Empowering for clients
• Uses client strengths/capacity and desire to
  improve their life
• Creates momentum for change
• Can un-stick clients, and service providers
• Can remove stigma from help seeking

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Strength based assessment

• Standardized measures (e.g., YRADS)
• Longitudinal approach
• Clients need coaching
• Sample questions
• Tell me about the last time things were going
  well for you.
• What would people who know you say about your
  strengths or the things you are good at?
• Do you have any family traditions, and/or are you
  part of a culture that has traditions that you
  follow? Can you tell me about them?
• Tell me about something you have changed
  successfully in your life. How did you do that?
• Courtesy of Wayne Hammond, Resiliency Canada

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Project Outcomes

• What was the impact of the Navigator service on
  the community?
• What were the characteristics of clients seeking
  Navigator service?
• How did clients experience the Navigator service?
• When barriers to client assessment and linkage
  were reduced, were existing services adequate?
• What were the limitations constraints and risks
  of the Navigator Project?
• Project Evaluation

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Client Characteristics Age and Gender
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Data Summary

• Number of Clients
• Adult 184
• Youth 74
• Families 36
• Research consent
• Adult 145
• Youth 37
• Clients with follow-up data 145

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New Client Referrals per Month
2005
2007
2006
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Adult Clients Source of Income
32
All Clients Housing
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36 Families Reasons for Referral
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All Clients Research consent or not any
differences?

• No significant differences across age, gender
• Total Clients258
• Research Consent145
• Possible trend individuals with more presenting
  concerns more likely to give consent

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Youth Referral Sources (n74)
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Adult Referral Sources (n184)
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Substance Use Reported All ages (N145)
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Number of Clients Reporting Specific Issues at
Intake (N258)
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Substance use Navigator-rated Client needs
(N145)

• 53 of the clients with problematic use were
  interested in receiving treatment
• 8 of clients had emerging or significant
  withdrawal symptoms

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Duration to Follow-up (n145)
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Client Needs Post Navigation Adults

• MH Diagnosis Clarification or Re-evaluation
• 74 of clients needed
• This need not met for 50 of these clients
• Support with Managing Psychiatric Symptoms
• 45 of clients needed
• This need not met for 50 of clients
• No local access to psychiatric consultation

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Client Needs Post Navigation Adults

• Addiction Dependency
• 93 of clients with Addictions needs had these
  partially or fully addressed through Navigation.
• Many needs were met with informal, family and/or
  community supports
• Risk Management
• Only 50 of clients needing support had it in
  place at follow up
• Basic Self Care/ADLs
• 37 of clients needed ADL support
• Need met in 50 of those clients
• Service seldom available for high prevalence
  disorders

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Client Needs Post Navigation Youth Clients

• Bridging school, youth and family
• Half of clients needed bridging
• One third had it in place.
• Family counseling
• For two thirds of youth who needed it, service in
  place. (does not include family referrals)

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Navigator Client Feedback

• People were very understanding and didnt judge
  me for what happened mentally. This program is
  the best thing that happened to the community.
  Thanks so much if it wasnt for the program, I
  proberly (sic) wouldnt be here today.
• I am feeling cautious/optimistic about my
  future. I am aware that I will continue to need
  assistance for mental health issues and medical
  issues. The Navigator helped to connect me to
  those resources so I feel like I am leaving
  transitional housing with help in place.

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Other Client Needs Met through Navigation

• Service or resource provided
• Supports
• Assistance with Transportation
• Support around appointments (e.g., reminders)
• Assistance with paperwork (e.g., disability
  application)
• Wait-list support
• Crisis support
• Advocacy (either Navigator, or connected to a
  community advocate)

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Other Client Needs Met through Navigation

• Care Coordination
• Primary care link
• Family meeting
• Navigator coordinated case conference
• Ad hoc monitoring
• Navigator helping client to re-connect with
  pre-existing services
• Resources
• Self-care depression guide (Bilsker et.al.,
  CARMHA at SFU)
• Other written resources

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Identified Barriers at time of Navigation

• Service related barriers
• Service unavailable in region (South Vancouver
  Island)
• Service unavailable in Sooke (East Sooke to Port
  Renfrew)
• Service available but client does not fit service
  mandate
• Barrier(s) for client
• Transportation/geographical
• Time constraints
• Communication issues
• Relationship issues
• Waitlist
• Financial
• Housing needs/Homelessness

of client with that barrier who were Navigated
through it
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Referral status at Followup (4-12 weeks post
referral) (n145, all ages)
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Barriers revealed at Nav Follow-up

• Client capacity
• No childcare
• Client too busy
• Didn't connect with counselor
• Life circumstances change
• Waitlist
• Other, (includes lost contact, no phone, physical
  illness, travel or distance, and unknown)

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Community ResponsesService Provider Interview
Themes Client-related

• The Navigator Model can
• Lead to appropriate and efficient service access
• Influence a clients referral readiness for MHA
  services
• Reconnect marginalized clients to primary care
• Empower clients (through strength-based
  assessment and collaborative service plan)
• De-stigmatize need for MH services for some
  clients

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Community Responses Service Provider Interview
Themes SP Impact

• The Navigator Model can
• Reduce MHA burden on non-MHA service providers
• Effectively link service providers together
• Help service providers find direction with their
  MHA clients
• Increase local capacity to meet MHA need
• Give all service providers a sense of being part
  of a supportive team

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Feedback from Referring Agencies

• We are seen by the clients as being part of a
  team working to serve their needs this
  service is a great information resource for my
  program
• Our client was very distraught and barely able
  to function. She received fast, effective,
  empathic service from the Navigator. It helped
  to change her outlook almost immediately, and
  helped put her at ease enough to get the job
  done.

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Feedback from Referring Agencies

• Navigators offer Support, Answers, Options,
  Connection to services. They make services
  viable. Navigator was at my door to see my
  client within 15 minutes! Without direction from
  the Navigator, we would have lost valuable time,
  and we may have lost the client as well.
  Tremendous support and follow-up as well.
• Navigators offer hope help and a bridge for
  those who cant access the mental health maze on
  their own

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Project Evaluation

• Increased connection and capacity across the
  network of care
• Navigator service model optimized and documented
• Timely access to strength based assessment and
  appropriate referrals
• Navigation of clients towards referral
  readiness
• Increased local understanding of MHA need and
  services
• Detailed local data available
• Partnerships and working relationships developed
  and maintained

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Critical Success Factors

• Community awareness and engagement
• MHAS treatment/service availability
• Service Research
• Bi-Directional Knowledge Available and Used

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Preliminary Conclusions...

• What do clients need for successful MHAS access?
• Low threshold access every door is the right
  door and open at the right time
• Strength-based comprehensive assessment early in
  the help-seeking process
• Collaborative service planning client owns the
  plan
• Timely communication with important providers
• Pre-emptive barrier identification
• Linkage facilitation
• On-going Service evaluation informed by good data

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Preliminary conclusions..

• Navigator service model may help other
  communities reconnect primary care, community
  services MHAS services into an effective
  network of care
• Engaging primary care and community service
  providers in MHAS planning can increase effective
  links in health care system

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Preliminary Conclusions.

• Community Steering committee
• increases likelihood of successful service
  delivery and local knowledge transfer and use
• process builds local understanding and capacity
• Collect good data it supports community
  understanding, and advocacy for service!
• Service capacity and data collection strategy
  needs to match front line service provider
  workload and flow

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Thank You!

• Ellen Anderson
• Principal investigator
• 250-642-4233
• jeanderson_at_telus.net
• Susan Larke
• Project manager/research coordinator
• 250-642-1852
• slarke_at_telus.net