Overview
The primary aim of the Family Navigator program is to provide short-term, individualized support to children, youth, and young adults (CYYA) and family caregivers seeking mental health services and resources to meet the needs of their CYYA. This support could be given in a single phone call or could be offered up to six months, helping navigate the complex systems that serve CYYA with Serious Emotional Disturbance (SED) or Serious Mental Illness (SMI).
The Family Navigator program seeks to:
- Promote Early Access: Supporting CYYA and family caregivers in reducing barriers to access with mental health services and resources.
- Enhance Engagement: Encouraging active participation from both the CYYA and family caregivers in developing Family Driven Action Plans.
- Improve Coordination: Streamlining communication and collaboration between service providers and systems through integrated planning.
- Optimize Treatment: Tailoring connections to mental health interventions to meet the unique needs of each CYYA and family.
The Process
The Family Navigator model guides collaboration between CYYA, family caregivers, and support teams. The goal is to prioritize needs, integrate planning, and connect families to resources to build self-efficacy through three key phases:
During the Engagement phase, Family Navigators:
- Collaborate with the CYYA and family caregivers to develop a deeper understanding of crisis needs, developing an individualized Family Driven Crisis Plan to stabilize safety concerns.
- Develop strong engagement by learning about the family’s needs, strengths and culture that guide the Family Driven Action Plan.
- Explore community resources that will help the family move towards their vision.
During the Planning and Implementation phases, Family Navigators:
- Facilitate monthly Family Driven Action Plans that provide clear direction to the family accessing the services and resources that fit their needs.
- Orient, educate, and support CYYA and family caregivers in accessing services they are seeking in their communities.
- Empowering CYYA and their family caregivers to learn the skills needed to access services and resources in the future.
During the Transition phase, Family Navigators:
- Develop a Transition Plan with the CYYA and family caregivers that will solidify skills developed and finalize next steps needed to navigate the child-serving system more independently.
- Partner with the service or resources that the CYYA enrolls in, providing a “warm handoff” to assist in a successful transition out of the Family Navigator program.
The Role of the Family Navigator
- Providing Information and Education: Family Navigators inform CYYA and family caregivers about mental health, treatment options, and services. They provide education on rights, empower voice and choice, and share lived experiences for support and guidance.
- Assisting with System Navigation: Family Navigators assist CYYA and family caregivers in accessing services, understanding provider roles, and connecting to resources like therapy and crisis intervention.
- Supporting Emotional and Practical Needs: Family Navigators provide emotional support and practical help to CYYA and family caregivers, assist with stress management, daily challenges, understanding care plans, and accessing community resources.
- Supporting Family Empowerment: Family Navigators give CYYA and family caregivers tools, knowledge, and the confidence to manage care coordination.
- Facilitating Access to Resources: Family Navigators link CYYA and family caregivers to local resources and services with a warm handoff, provide follow-up support, and help create Family Driven Action Plans to meet their CYYA’s needs.
- Promoting Collaboration: Family Navigators work with teams to facilitate effective communication, promoting coordinated care.
- Crisis Support: Family Navigators help CYYA and family caregivers identify immediate needs and access crisis services during emergencies; however, they are not on call 24/7.
- Culturally Competent Care: Action plans align with the cultural values, beliefs, and practices of the individual and family, enhancing engagement and buy-in.
Impact
- Improved Mental Health Outcomes and Satisfaction with Care
- Reduced Family Caregiver Stress
- Increased Engagement in the Care Process
- Improved System Navigation and Integrated Planning
- Increased Access to Insurance
Family Navigator Pilot Sites Overview
Allegheny Family Network
Proposal Overview: Allegheny Family Network (AFN) is a “Family Run” non-profit organization serving Allegheny County for over 15 years. AFN will develop a Family Navigator division under its complement of peer to peer, education and advocacy programming.
AMI, Inc. of Washington-Greene Counties
Proposal Overview: Advocate, Mentor, Inspire (AMI) is a peer-run non-profit mental health organization focused on strengths-based, recovery-focused services that intends to develop a Family Navigator program that will promote early access, engagement, coordination, and optimization of mental health treatment and services for youth and young adults experiencing symptoms of mental health problems, while supporting their family caregivers.
Community Behavioral Health/Philadelphia Family Voices
Proposal Overview: Community Behavioral Health (CBH) is a not-for-profit 501c (3) corporation that is the Behavioral Health Managed Care Organization (BH-MCO) for Philadelphia’s Medicaid population and Philadelphia Family Voices (PFV) is Philadelphia’s formalized family support agency. They have partnered to address existing gaps to establish Family Navigators connected to children’s psychiatric Crisis Response Centers (CRC) and Behavioral Health Urgent Care Centers (UCC) located throughout Philadelphia County.
Crawford County Mental Health Awareness Program (CHAPS)
Program Overview: The Crawford County Mental Health Awareness Program (CHAPS), is a non-profit, consumer-driven organization that was founded in 1988 and Family Children & Community Association (FCCA) is a non-profit 501(c)(3) community organization originally established in 1951 that will partner to develop a Family Navigator program to serve family caregivers and youth in a site-based as well as community-based rural setting.
Whole Child Wellness Clinic – UPMC Children’s Hospital of Pittsburgh
Program Overview: The UPMC Children’s Hospital of Pittsburgh is a non-profit hospital founded in 1883 and consistently ranked as one of the top pediatric hospitals in the nation. The Whole Child Wellness Clinic (WCWC) provides combined physical and behavioral health care in a medical and behavioral health care home model for families. There are pediatricians, psychiatrists, therapists, nursing, care coordination and family
peers working together to support the family. The WCWC, the first of its kind in the country, offers a holistic approach to behavioral health and a “one-stop-shop” of coordinated care that treats a child’s physical and mental health all in one location and helps with navigating the system overall.
Youth MOVE PA
Program Overview: Youth MOVE PA is a non-profit statewide youth & young adult advocacy organization that is a program of the Pennsylvania Mental Health Consumers’ Association (PMHCA). They will build a “Youth Empowered” Family Navigator program that provides youth and their families with the tools, resources, and support necessary to ensure a smooth transition from the RTF setting to their home environment.
Contact Information
Daniel Fisher
Director of Training and Implementation
Youth and Family Training Institute
Email: fisherdj@upmc.edu