Geneva L. Fleming, PhD, D. Min, LCSW
Human Services Faculty
Trident Technical College
7000 Rivers Ave., CF-M
Charleston, South Carolina 29406
The term navigation has become the new “buzz” word for assisting individuals in their shift from one situation in life, to another. The process and service delivery of navigation is useful for helping individuals, families and communities achieve their goals. Navigation service is especially beneficial in helping persons manage their health and biopsychosocial needs, including mental health. Whether it is helping a person transition from mental illness to mental health, or assisting a student in their career development, having someone with the proper knowledge and skills to help navigate that process can be advantageous. This article will identify and describe the five essential components of effective case management and its application to the navigation process. It will also state some important interviewing skills that can enhance the practitioner-client relationship during the navigation case management process.
Key Words: Navigation- Case Management, Skills, Transformation-Outcome
Although “navigation” appear to be a somewhat new term in the education and human services industry, its processes mirrors that of traditional case management. The concept of case management is not new. Case management dates back more than 150 years and is deeply entrenched with the professional Social Work discipline (Flynn, Katherine, 2017). The processes of case management can also be found in other helping disciplines, such as public health, community-based nursing and behavioral health. Effective case management requires the practitioner to provide a strategic sequence of services to their respective clients. Too often individuals are released from hospitals, rehabilitation centers, prisons and other institutions, with unstable plans and undefined support systems, resulting in high recidivism rates (Fleming, 2015; Vigilante, et al, 2009). The lack of a thorough baseline assessment, combined with inadequate development of an organized strategic plan, often contribute to less than desired outcomes. Whether one is practicing at an entry, non-degree level or at a higher education degree level, the skills of navigation will greatly enhance the practitioner’s competence and will contribute to effective service delivery and customer satisfaction.
Navigation toward Transformation: Every Piece Matters
Navigation is a process that can precisely uncover one’s situation to identify challenges or needs, design a plan for improvement, then follow a specified route to the deliberate destination. The process is intended to provide guidance and direction that will lead to a desired outcome. It has proven to be effective in a variety of transdisciplinary settings. Counseling, along with a structured clinical patient navigation algorithm, has proven to be effective strategies to improve diagnostic resolution follow-up among low-income, ethnic minority women with certain health conditions (Ell, K, Vourlekis, B, Lee, PJ Xie, B. 2007). Like case management, effective navigation is a circular process that comprises the identification, planning, and the evaluation of human needs. It requires the practitioner to coordinate and complete a cycle of services to optimize client outcomes. There are five essential components to facilitate the case management process, and every piece matters. The absence of any one component can cause the whole process to be flawed. The same must be applied to the process of navigation. Those components are assessment, planning, resource management, monitoring and evaluation (Fleming, 2015, Summers, 2014 and Orme & Orme 2012). An understanding and application of these five components aims to produce effective outcome-informed counseling and case management practice, as well as contribute to effective service delivery and customer satisfaction.
The first component in the navigation case management process is assessment. Assessment involves a comprehensive exploration of the person seeking help (client) and includes an examination of multiple aspects of the client’s life; e.g. the background and impact of the current problem, support systems, other strengths and desired outcome. There are several broad categories to be explored during the assessment process; each aimed to establish an accurate profile of the person needing help (Summers, 2014). It is important for the practitioner to fully understand the complexities of the person’s situation, identify points of intervention and strategically design a plan that will bring satisfaction to the client as well as the service agency. This framework of understanding is known as the person-in-situation, or “person-in-environment” or PIE (Appleby, Colon & Hamilton, 2011). Some professionals refer to this beginning stage in the navigation case management process as the baseline assessment.
Vital to the assessment process is the practitioner’s ability to utilize deliberate, intentional interviewing techniques (Ivey & Ivey, Zalaquett & Carlos, 2010). There are definite skill sets to be used during the interview process that could contribute to the development of a thorough assessment. These skill sets include the ability to allow clients to tell their complete story through encouragement and support. The skill of establishing rapport, being genuine and transparent can help ease the burdens some people may have when seeking help. Knowing how to ask appropriate and timely open and closed-ended questions, exercise active listening and attending behaviors and being self-aware of the practitioner’s own values and biases are essential intentional skills for making the process of collecting information more efficient. A thorough assessment is the key to the design of a comprehensive plan and is foundational to a successful transformation experience. There must be a direct correlation between the assessment data, the plan for intervention (Orme, 2012), and the ultimate outcome of the therapeutic journey.
The second strategy in the navigation process is planning. This component is vital because it plots a structure of interventions and activities to accomplish the client’s goals. An effective practitioner will support the client’s goals by encouraging them to verbalize their desired outcome and expectations. Practitioners should never attempt to coerce or manipulate the client to accept the practitioner’s goals for the client (Summers, 2014). Goals for healing and other improvements must be client-driven. Once a client articulates what they would like to receive from that encounter, or their desired outcome, the practitioner and client together must design a plan to accomplish those goals. The plan may include collaboration with other agencies and services, with which the client might be involved. Practitioners must be knowledgeable of available resources in the community which can assist in meeting customers needs. These could include formal and informal institutions such as churches, CBOs (community-based organizations), NGO (non-governmental organizations) and others. This unified effort of all the stakeholders concerned with the client, contributes to customer satisfaction (Summers, 2014) and a sustained transformation experience.
Every consumer situation is unique; therefore, every remediation plan must be uniquely individualized. The term “treatment plan” may be familiar in many clinical settings; however,
some agencies may use a term other than “treatment” when designing their plan; especially if the
services they provide are not of a clinical nature. In such instances, agencies might refer to this process as intervention planning (Orme & Orme, 2012). A thorough and effective plan should include the targeted goals and objectives, along with a navigational outline that specifically maps the interventive strategies for achieving each objective. The outline must clearly delineate the services ordered, the purpose and frequency of each service, the tasks involved in completing each service, the person who is responsible for completing the task and the timeframe for completion.
For each goal, there must be a set of strategic steps known as objectives. Objectives must be
SMART (Burgin, 2012); that is specific, measurable, attainable, realistic and timely. Each objective may have a series of action steps to accomplish those objectives. These action steps are sometimes referred to as strategies, methodologies, or implementation plans (Kettner, 2002). Thorough navigation planning is rooted in a strength-based approach; meaning, it considers the customer’s strengths and interest and strategically weaves those factors into actions that will build customer confidence, self-esteem and empowerment. Again, objectives must be SMART. Being mindful of this acronym and documenting accordingly is certain to enhance the effectiveness and efficiency of the plan as well as lead to a positive transformation experience.
Next in the navigation process is resource management, also known as linking and advocacy. The absence of this component could leave a client in an immobile state. Successful counseling and case management cannot be completed in a vacuum. Resource management is the provision of information and referrals in its purest form. It involves the careful connection of the client with the necessary resources that aims to help the client maximize their goals (NADA, 2009; Summers, 2014). These resources might be individual providers and/or provider agencies. Individual providers can include both professional and paraprofessional helpers. Provider agencies may include both formal and informal organizations with a mission to offer help in a variety of areas, such as food, housing, employment, health, literacy or other. Government agencies, such as social services, mental health, the justice system and public health, are examples of formal agency systems. These agencies can offer valuable assistance; however, the process of receiving help may be more time consuming than with informal agencies. Churches, community-based organizations and other non-profits are considered informal agencies. They are usually easier to access and more efficient in its service delivery. Careful linking often requires knowledge and utilization of both the formal and informal agency systems ((Peckham & Neysmith, 2014; Summers, 2014; Rogers & Sheaff, 2000).
The fourth component is monitoring. To assure that the navigation plan is being implemented according to design, it is necessary to monitor every activity documented in the plan. This component is not to be taken lightly. It is during this stage of case management that outcome-informed practice becomes evident (Orme & Orme 2012). Outcome-informed practice is a system in which the practitioner:
- Measures the client’s outcomes at regular, frequent and pre-designated intervals, in a way
that is sensitive and respectful to the client;
- Monitor those outcomes to determine if the client is making satisfactory progress; and
- Modify the intervention plan as needed (Orme & Orme 2012, p. xv).
Monitoring requires the practitioner to periodically follow up with the client and the providers to
determine if progress is being made. Close monitoring helps the practitioner identify whether or not modification needs to be made to the interventions, or to the entire plan (Orme, 2012). For example, if a client is unemployed and a goal is set for the client to be employed within ninety days of the assessment; instead of waiting until the end of the 90 days to review the status of the client’s employment situation, effective navigation case management requires the practitioner to make frequent, periodic checks to assure the client is on track with preparing for employment. It should also be noted that well-intended interventions may not produce the desired results, requiring the practitioner to adjust the plan in order to protect the client’s safety and health (Orme, 2012).
The primary focus of monitoring is successful outcome(s) of the plan. Outcomes are deemed statuses of the client’s situation before, during and after intervention (Orme & Orme, 2012). A comprehensive assessment will describe the status of the client’s condition before any intervention is applied. For example, in the case of hospitalization, how did the patient present on admission or during the initial assessment? The results of this assessment should point to the level of intervention and type of intervention needed to adequately meet the patient’s needs. The level and type of intervention determines the amount and the type of assistance the patient may need to improve their situation. The planning, linking, and monitoring phases will describe the status of the client’s situation during the process of intervention. The evaluation stage of the case management navigational process will document the status of the client’s problem after intervention has been applied. (Orme & Orme, 2012).
The final component in the navigation process is evaluation. At this stage, the practitioner
conducts a final review of the client’s condition and status to determine if goals were
accomplished according to the plan (Pennell, Joan, Anderson & Gary, 2005). If not, then the
practitioner must investigate the reasons why the goals were not attained. There should be no
sudden surprises at this stage in the navigation case management process. Purposeful and intentional monitoring of interventions at frequent, predetermined intervals during service delivery should have identified any issues or new challenges long before the final evaluation occurs (Orme, 2012). Moreover, if issues are identified during the process of monitoring, an updated plan for resolution should be made at that time of identification.
Some practitioners refer to this evaluation stage as termination, discharge planning or end assessment (Pennell, Joan & Anderson, Gary, 2005). Although this component is
the final step in the process, it could also point to new areas of concern to be addressed. In such
instances, the practitioner and client return to the circular process of planning, resource management and monitoring of the new situation. An important point to remember is that evaluation is not a single event that happens at the end of delivering services to clients (Orme & Orme, 2012). This stage in the navigation case management process, is the culmination and result of every intervention strategy implemented during the helping process. This process becomes the client’s transformation journey. The aim of each component, along with all of its actions, are geared toward the final destination for the client. Evaluation completes the cycle of all the pieces needed for a successful journey. To reiterate, a system of quality outcome-informed counseling and case management practice requires periodic progress checks; from the identification of the condition (baseline assessment) to the plan for specific interventions, monitoring those interventions and then making a final evaluation (end assessment) of the client’s progress after intervention.
In conclusion, the process of navigation case management is an effective means of responding to diverse human needs (Bigelow, Douglas & Young, Deborah, 1991). Because every piece matters, the successful completion of each component, in the appropriate order discussed, is necessary to yield valuable, outcome-informed service. It demonstrates the competent skill set of the practitioner and can result in a “win-win” situation for all the parties involved; adding to the satisfaction and healthy transformation of the client.
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