PolicyLab

Fewer than 50% of children referred to mental health services access them, in part because it can be complicated and confusing for families to navigate the mental health care system. Their caregivers can face similar barriers—about 50% of adults with mental health needs do not get care.

Care navigators, who may be social workers, community health workers, or other non-clinical professionals, can help connect patients and their families with mental health care providers, specialty care providers and family resources. Many have lived experiences with mental health conditions and come from disenfranchised communities, so they can better relate to families impacted by behavioral health challenges. While care navigator models vary, families who have worked with care navigators are more likely to complete assessments that can help identify mental health challenges and to stay engaged in care once connected.

As a strategist working with PolicyLab’s Behavioral Health Portfolio, I have a front-row seat to my colleagues’ research on various behavioral health care navigator models. Below, I’ll share just a few examples of this work, as well as how additional research and policy efforts can contribute to families getting the care they need.

Exploring Patient Navigation to Support Children & Caregivers’ Access Behavioral Health Care

• Dr. Rhonda Boyd and Dr. Jason Jones are conducting a randomized controlled trial of an adaptation of Suicidal Teens Accessing Treatment (STAT-ED) meant for Black youth and their caregivers. Within this study, they are examining whether a patient navigation intervention started after youth visited the emergency department can increase mental health treatment initiation and the number of visits attended. For this trial, the care navigator is a licensed clinical social worker.

• Dr. Jennifer Mautone, Dr. Tom Power and their colleagues are studying the effectiveness of an enhanced behavior therapy program for families of children with ADHD called Partnering to Achieve School Success (PASS). Community Health Partners, one element of the program, aim to promote family engagement in treatment and improve the cultural effectiveness of care. The Community Health Partners regularly communicate with families to encourage session attendance and the use of PASS strategies, assist in resolving barriers to treatment and connect families with needed community resources. In this program, the Community Health Partner role is filled by a professional with knowledge of the communities in which the participating families reside.

• Former PolicyLab researcher Dr. Ariel Williamson and her team integrated a sleep navigator into primary care to enhance patients’ ability to access specialized sleep care when referred, increase sleep health promotion education and improve patient outcomes. In this initiative, the sleep navigator was a community member with lived experience around managing sleep problems, and the project focused on patients with evidence of sleep disordered breathing, a common pediatric sleep concern linked to significant neurocognitive and behavioral impairments.

• Dr. Barbara Chaiyachati and her colleagues, as part of the NFP-Rise program, provide long-term support to infants born with prenatal opioid exposure and their caregivers. Caregiver-child pairs are supported from birth through early childhood with care and care navigation around the infant’s physical and behavioral health needs, including promoting parental recovery when applicable. This program includes collaborative access to care navigation—provided by a peer-recovery specialist—for the child and parent.

• Dr. Jim Guevara, Dr. Rhonda Boyd, and their teams are studying a virtual patient navigation intervention among postpartum mothers with persistent or severe depressive symptoms or suicidal ideation. The intervention aims to connect mothers to behavioral care and in this study, a non-clinical professional facilitates care navigation. This effort is part of a broader research project to support the strong connections between maternal mental health and children’s health and well-being.

As exemplified by this research at Children’s Hospital of Philadelphia, there is important nuance within these navigator roles. In addition to providing support to connect a patient to behavioral or other specialty health care, a navigator may provide brief interventions, advocate for the patient or help the patient problem-solve. Some navigators may also utilize motivational interviewing approaches to support behavior change and further engage patients and their families in care. As such, these roles may be best filled by someone with lived experience or specific credentials or training. These are important considerations for related research and policy.

Opportunities to Bolster the Behavioral Health Patient Navigator Role

As we explore how to integrate patient navigation into behavioral health services for families, there are additional actions that can be taken to further support this role.

• More research is needed to identify which families benefit the most from patient navigation models, and where these models can be feasibly implemented across the care continuum (e.g., at initial identification or once diagnosed). Research funding to study the impact of family navigation models is available to help address these questions.

• Through these studies of patient navigation models, PolicyLab researchers are also thinking ahead to sustainability and long-term success. Options exist to finance and support some of these different roles within clinical teams. However, financing for these positions is dependent on state and payer policies and often includes limitations based on patient age or diagnoses. To leverage these roles more fully, states may consider expanding the populations eligible for support by a behavioral health navigator.

• Recent trends in state policy related to care navigation have increased opportunities to reimburse community health workers and peer specialist roles via public insurance. However, the scope of these roles varies. As states consider these roles and financing them with Medicaid funding or other sources, opportunities exist to uniquely consider the pediatric population and the needs that families face in connecting to care. Allowing for flexibility in the scope of these roles, including the reimbursable activities and allowable modes of engagement (e.g., virtual or in-person), will make them more relevant within different models of care.

In order to improve behavioral health outcomes for children and their caregivers, families must be able to access behavioral health care services. Patient navigators can be an important link, but further research and research-informed policy is needed to more fully support and sustain patient navigator roles within the health care system.