Care Navigation: A Competency Framework

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Care Navigation: ACompetency Framework

I must go down to the seasagain, to the lonely sea andthe sky,And all I ask is a tall shipand a star to steer her byJohn Masefield(from Sea Fever,Salt-Water Ballads, 1902) Health Education England 2016

Contents1.Introduction 42.Care navigation and why it is important 63.Who provides care navigation? 84.What is the evidence for care navigation? 105.What is the purpose of a competencyframework? 126.How the framework was developed 137.Framework overview 188.Navigating the competency framework 199.Education and training 3210.Building education and career pathways 3411.Case studies 36Appendices Appendix 1: Key principles which underpinperson-centered care and support 43Appendix 2: Principles of patient navigation. 44Appendix 3: Example job descriptions for eachframework level 45References 53Further reading 55Acknowledgements 57 Health Education England 2016342 word ‘navigator’ derives from Latinnavis - ‘ship’ - and agere - ‘drive’ - meaning‘a person who steers a ship’. Chartingstormy uncertain seas requires goodnavigation – with purpose and direction.Similarly, most people at some point in theirlife may benefit from ‘navigation’ throughencounters with different health services,agencies and professionals, across an oftenconfusing seascape of health, social andcommunity care. And it’s not just an issue forservice users, there is broad consensus fromhealthcare professionals that such systemscan be complex and difficult to navigate.Effective navigation is a key element ofdelivering coordinated, person-centeredcare and support (see Appendix 1: Keyprinciples which underpin person-centeredcare and support). ‘Care navigators’ canplay a crucial role in helping people to getthe right support, at the right time to helpmanage a wide range of needs. This mayinclude support with long term conditions,help with finances and signposting to a rangeof statutory and voluntary sector services.The purpose of this document isto describe a core, common set ofcompetencies for care navigation. Thesecore competencies are brought together in atiered competency framework, recognisingthree successive levels; essential, enhancedand expert. This will help provide a coherentbenchmark or set of standards for carenavigation, to help ensure relevant staffreceive the necessary education, training andsupport to work effectively. This frameworkmay be used by employers, educationproviders and individuals to inform educationand training needs. It will also help lay thefoundations for a career pathway frameworkfor non-clinical staff, within primary andsecondary care sectors. This is importantto secure a sustainable current and futureworkforce, offering opportunities fordevelopment.1.4Navigator roles, job titles and day-to-day tasksvary depending on local context, includingorganisation function, peoples’ existing skillsand local population need. For example ‘carecoordinators’ and ‘care navigators’ may workin hospitals, focusing on discharging peoplesafely from hospital to home, or as partof a general practice in a multidisciplinaryteam. There is no ‘one size fits all’ navigationservice, with variations throughout the UKand internationally. Whilst flexibility andvariation to meet local need is appropriateand expected in job roles, this frameworkseeks to articulate some common generic‘threads’, to promote a consistentapproach to training and education.1.5A key concept in this work is an attempt tomove away from the labels of job ‘roles’ orfixed ‘titles’. Roles developed in isolationare difficult to sustain, and lack of nationalrecognised competency framework canlimit people to use skills elsewhere or buildtheir careers. By instead, keeping focuson the core tasks, purpose and corecompetencies of ‘care navigation’, this canhelp promote standardisation and recognitionof people providing care navigation, andopen up opportunities for people from manybackgrounds and in a plethora of roles.1.6The competencies are not intended tobe all encompassing and comprehensive;depending on some areas of work andpopulation served, there may need to beadditional ‘extra’ or ‘bolt on’ modules/curricula and training for example working

with a condition-specific group of people e.g.stroke, learning disabilities. The Frameworkas a whole is intended to be a guide and willundoubtedly evolve over time.1.75It has been recognised that throughdeveloping this framework, there is avariety of different approaches to solvinglocal problems around coordinating andsignposting patients. There are examples ofdifferent care navigation services and relatednavigator /signposting /coordinator rolesaround the UK. Roles developed in isolationare difficult to sustain. This work seeks not toreplace but rather complement and supportthese efforts. There will be ongoing need forcommitment to share, coordinate and worktogether across sectors and organisations tohelp support, provide education and trainingfor people delivering care navigation.

2. Care navigation and why it is important2.12.26There is widespread recognition that healthand social care needs are changing. Thisincludes an ageing population, with risingprevalence of people living with long term,complex conditions and needs. There is asignificant need to shift NHS service provisionand professional working towards a paradigmof more sustainable, proactive and integratedhealth and social care.1 People with long termconditions often need to access differenthealth services, with numerous assessmentsfrom multiple different professionals. This canbe confusing and individuals and their familiescan encounter problems. Moving betweendifferent care settings can be an especiallyvulnerable time with the risk of ‘slippingthrough the gaps’. Often family or informalcaregivers provide the only ‘common thread’to access and coordinate care from a long listof health and social care providers.These issues are not new. Care navigation isan emerging concept in the UK, intertwinedwith that of care coordination – whichrepresents the idea that simply havingservices and trained people in place are notenough. What then matters is how people(individuals, teams, services and systems)then work together – in a ‘joined up’ way– so that people know when and how theycan get access the right help, at the righttime, in the right place. Indeed these themesof coordinated, person-centered care echoperspectives from patients2 and nationaland global policy makers.3,4 In times ofgrowing economic pressure within complex,fragmented health and social care systems, itis important to use our resources wisely; theseinclude our workforce as well as the patients,families, carers and non-traditional servicesfor example community and voluntary sectors(See Figure 1).52.3There is no universal definition of carenavigation or a ‘care navigator’; navigation atits heart is a coordination process and keyingredient to achieve integrated care provisionto improve health and well-being. A personproviding in care navigation is usually based ina multidisciplinary team, helps identify andsignpost people to available services, acting aslink workers.6,7 The person who provides carenavigation is therefore an important (thoughalone not sufficient) lynch-pin or enabler toachieving integrated care provision. Macredieand colleagues (2014) offer one definition ofcare navigation to be:The assistance offeredto patients and carers innavigating through thecomplex health and socialcare systems to overcomebarriers in accessing qualitycare and treatment.”82.4Age UK defines care navigation to includethe key components of: Personalisation support (assessmentfor social care with follow up to enablesmooth running, advice and signpostpersonal finances e.g. personal budgets,direct to services can access free ofcharge) Coordination (re-refer to services ifneeded, alert health professionals needinginput, help, step up care) Integration across health, social care andvoluntary sectors.

From an individual perspective, people who provide care navigation buildrelationships, problem solve and help locate resources, serving as a link betweencommunity, health and social services. They advocate the needs of people,they are enabling and focused on recovery, to strengthen the work of themultidisciplinary team. A key purpose is to ensure patients experience seamless,joined up care and support.2.5The pressures and workload facingclinical staff are unsustainable; we needto change tack and work together towardrealistic solutions. This has to include steppingoutside of traditional ‘health’ and ‘social’service silos to develop the multi professionalworkforce, with people equipped withmind-set and skills to work with patientsand across traditional sector boundaries.Supporting patients to navigate health andsocial systems is an area where the workloadin clinical practice is increasing, includingsecondary care and general practice. Newroles and extended existing non-clinical roles(e.g. experienced GP receptionists) can offerfresh ways of sensibly sharing work andresponsibility, helping to relieve front-lineclinician pressures and improve overall qualityof care for patients.9,102.6A workforce skilled in providinghigh quality care navigation has thepotential to release clinicians fromsignificant workload, including unnecessaryadministrative burden. For example, trainednon-clinical front-line staff in a generalpractice or A&E can help advice and signpostpatients to a more appropriate service orperson to best help them. Such non-clinicalroles require attention to training, to developcareer pathways and professional regulationframeworks for delivering new workersfor general practice and the wider careworkforce. Building up trust and workingrelationships with emerging non-clinical staffwill take time; education and training areessential to enable alservicesInformalsupportnetworksFigure 1. Examples of the differentsectors and organisations through whichindividuals providing care navigation work7Generalpractice

3. Who provides care navigation? navigation, is, of course, an essentialtask for all clinical and non-clinical staff.Taking an even broader view, care navigationis in fact ‘everyone’s business’ including theinformal workforce (e.g. family, neighbours,voluntary sector workers) who already providea significant amount of care and support.Dohan and Schrag11 also support the ideathat care navigation is and needs to bepart of all staffs’ work ethos and duty,rather than restricted to a specific role.Navigation therefore may best considered asa process or intervention rather than aspecific role for one specific person in onesetting, and needs to be able to take placeacross the whole spectrum of the individual’sjourney, a ‘link worker’ to enable a ‘seamless’pathway. This therefore strengthens theneed to define some core competencies tohelp characterise people who provide carenavigation.Currently there are a range of care navigationservice models. Non-clinical staff who delivercare navigation in the UK tend to occupy aplethora of roles, work in many settings andhave varying job titles and backgrounds suchas trained volunteers, administrative staff,staff with health or social care backgrounds(see Table 1).The idea of a navigator has emerged fromdifferent areas over time. The ‘patientnavigator’ came from oncology care in theUSA, in an attempt to remove barriers tofacilitate timely diagnosis, treatment andaddress inequalities that existed in cancercare.12 Patient navigators were usually nurseswith oncology nursing backgrounds. Freemanand his colleagues articulated nine principlesA care navigator is a ‘goto’ person who glues it alltogetherCarer and volunteer memberof Healthwatch Haveringof patient navigation (see Appendices).3.4In the UK, the health and social navigator rolein London developed as a product of NHSLondon’s leading workforce transformationprogramme between 2009-2011, to helpequip staff with the skills to plan and developnew and existing roles for a modern NHS. Thiswas to ensure the workforce have flexible,generalist skills and capabilities to supportpeople to self-care.133.5The Patient Liaison Officer (PLO) role wasdeveloped in UK general practice to providea non-clinical facilitative ‘link’ and supportivefunction, for communication, administrationand reducing unnecessary GP workload.143.6Social prescribing is developing within theUK, where services have a ‘facilitator’ or‘navigator’ to help bridge between primarycare professionals and ‘social opportunities’.Within social prescribing, the facilitatorrole can be challenging and requires goodlistening skills and the ability to relate tohealth professionals, the wide variety ofpeople in the third sector and the patientwho has been referred. There must also bea regularly updated and accessible databaseof opportunities. The emerging socialprescribing UK network are also developing

a consensus understanding and groundingprinciples of social prescribing.15A link worker – link workers have avariety of names e.g. health advisor,health trainer and community navigator.In this report it refers to a non-clinicallytrained person who works in a socialprescribing service, and receives theperson who has been referred to them.Briefly, the link worker is responsible forassessing a person’s needs and suggestingthe appropriate resources for them toaccess. 3.73.893.9Despite such a rich variety of non-clinicalroles with a navigation function, with someexcellent examples of practice there is acurrent lack of clarity, clear consensusand coherence in such navigation roles,and the necessary skills, attributes andtraining requirements. Without a clearoutline of career structure, progression andcompetencies, these new or transformedexisting roles may fail to attract or evendiscourage people being recruited orremaining in these roles.3.10This competency framework has explicitlybeen construc

fragmented health and social care systems, it is important to use our resources wisely; these include our workforce as well as the patients, families, carers and non-traditional services for example community and voluntary sectors (See Figure 1).5 2.3 There is no universal definition of care navigation or a ‘care navigator’; navigation at its heart is a coordination process and key .

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