Health Navigation Service
The Conard House Health Navigation Project is proving to be the single most important strategic step for our residents who have avoided, resisted or refused available health care, a step forward that will make a real difference in their longevity and quality of life.
Those of us who pioneered Permanent Supportive Housing for adults with serious mental illnesses have witnessed over the past 25 years the inevitable but still disheartening increase in complex health needs among many of our residents. In fact, chronic medical conditions these days often overshadow behavioral health symptoms that were once our sole concern. Today more than one-third of the 712 residents within our 10 supportive housing communities reflect two stark underlying realities: a pervasive disengagement in self-care and a tragic failure to access health care that is available. From any perspective – human, public health, societal – both realities are too costly to ignore.
We believe both are best addressed through our Health Navigation Service in which Conard House Peer Health Navigators work with our least-engaged, highest-risk residents to connect face-to-face with primary care doctors, pharmacists, dentists and opthalmologists. Peer Health Navigators – our most-engaged, lowest-risk residents and other people with lived experience – know how to navigate the local health care system and to communicate with and advocate for those who don’t or won’t out of fear, denial or stigma.
Our organization’s initial response to disengagement and barriers to seeking health care was to train our entire staff in Motivational Interviewing engagement techniques. We introduced a second response in 2007: six Conard House staff became certified Master Trainers through Stanford University’s Chronic Disease Self-Management Program. Then, over several years we trained 120 staff and residents in Healthy Living Action Plans. In hindsight, this accomplished little more than reinforcing the skills of residents already adept at self-managing. The harder lesson learned was that self-management goals, while noble, were unrealistic for too many residents – the least able 25-33%.
To test a third more practical, hands-on approach, in 2013 we reassigned a traditional Case Manager to work as a Health Navigator in a year-long, small-scale pilot project to help a cohort of more disengaged residents navigate the intricacies of San Francisco’s public health system.
A year later, with grant support from Kaiser Permanente San Francisco Community Benefits and California Pacific Medical Center, we developed an evidence-based Peer Health Navigation Project to serve disengaged residents in our Tenderloin and South of Market supportive housing sites. We partnered with Pacific Clinics Training Institute in Pasadena and University of Southern California’s School of Social Work in Los Angeles for training and certification of four Peer Health Navigators and 18 supervising Program Directors and front-line Case Managers.
At each residential site, a team of Case Managers and certified Peer Health Navigators began working with high-need residents to connect them face-to-face – literally and purposefully – with their chosen primary care physician in their chosen medical clinics. Almost immediately the Health Navigators also had requests to navigate crucial connections with pharmacists, dentists and optometrists.
For adults with both serious mental illness and chronic medical conditions, health navigation is a critical factor in effective collaborative care. Public health efforts to integrate physical and behavioral health care will be wasted unless peer health navigators can activate engagement among residents and help sustain positive health-seeking behavior.