Trial Summary
What is the purpose of this trial?
The purpose is to study a model of mental health navigation for African American and Latinx children (0-14 years) in high poverty urban communities focused on reducing key parental attitudinal barriers to care. Reducing persistent racial and ethnic disparities in children's mental health is a national priority and patient navigation is a highly promising approach that is rarely used in children's mental health services. The study will examine the effectiveness of paraprofessional (PP) navigators who have strong community knowledge and waitlist as usual condition (active wailt list \[AWL\]. The study will examine specific mechanisms of navigator effectiveness in children's mental health and compare an AWL to provide a rigorous test of the proposed mechanisms. The knowledge gained from this application may be important to reducing disparities and employing the workforce best suited to navigation in the community mental health system. Two community boards, one focused on identifying factors important to supporting navigators at the agencies (Implementation and Sustainability Community Board) will meet quarterly, and the other focused on implications for state and federal policy (Public Policy Board), will meet annually.
Will I have to stop taking my current medications?
The trial information does not specify whether participants need to stop taking their current medications.
What data supports the effectiveness of the treatment Patient Navigators for Community Mental Health Services?
Research shows that patient navigators can improve engagement and health outcomes in various settings, such as cancer care and mental health services, by helping people access necessary services and support. This suggests that using patient navigators in community mental health services could similarly enhance access and outcomes for patients.12345
Is the use of patient navigators for mental health services safe?
How is the Patient Navigator treatment different from other mental health treatments?
Patient Navigators are unique because they help connect individuals with mental health services by providing guidance, support, and facilitating access to care. Unlike traditional treatments that focus solely on medical interventions, navigators work to improve service access and communication between patients and various healthcare providers, making the mental health care process more integrated and patient-centered.23101112
Research Team
TM
Tara Mehta, PhD
Principal Investigator
University of Illinois at Chicago
Eligibility Criteria
This trial is for African American and Latinx children aged 5-12 in high poverty urban areas, along with their caregivers. They must be new referrals on the waitlist for outpatient mental health services and screened as appropriate for services at participating community agencies.Inclusion Criteria
Have been screened and deemed appropriate for services at one of two social service participating community mental health agencies
New referrals on the waitlist for outpatient mental health services
I am a caregiver of an African American or Latinx child aged 5-12.
Exclusion Criteria
N/A
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Paraprofessional Navigation
Paraprofessional Navigators implement a model of navigation with caregivers focused on reducing logistical and attitudinal barriers to care.
18 months
Periodic check-ins and training sessions
Active Waitlist
Participants are placed on an active waitlist with periodic check-ins by community agency intake staff.
18 months
Periodic check-ins
Follow-up
Participants are monitored for child and caregiver outcomes at baseline, 6, 12, and 18 months post intake.
18 months
Assessments at 6-month intervals
Treatment Details
Interventions
- Patient Navigators (Behavioural Intervention)
Trial OverviewThe study tests a mental health navigation model to reduce parental barriers to care. It compares paraprofessional navigators familiar with the community against formally trained case manager navigators, plus a control group on a waitlist.
Participant Groups
2Treatment groups
Experimental Treatment
Active Control
Group I: Paraprofessional Navigation ConditionExperimental Treatment1 Intervention
Paraprofessional Navigators will implement a model of navigation with caregivers focused on reducing logistical and attitudinal barriers to care.
Group II: Wait-List as UsualActive Control1 Intervention
Participants will be assigned as wait-list as usual (active wait list) at each agency.
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
University of Illinois at ChicagoChicago, IL
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Who Is Running the Clinical Trial?
University of Illinois at Chicago
Lead Sponsor
Trials
653
Patients Recruited
1,574,000+
References
Patient navigators: Mapping the route toward accessibility in health care. [2020]Children and youth with developmental and mental health conditions require a wide range of clinical supports and social services to improve their quality of life. However, few children and youth are currently able to adequately access these clinical, community and social services, and newcomers or those living in poverty are even further disadvantaged. Patient navigator programs can bridge this gap by facilitating connections to social services, supporting family coping strategies and advocating for patient clinical services. Although there are few paediatric-focused patient navigator programs in the literature, they offer the potential to improve short and long-term health outcomes. As social and clinical services, particularly for developmental and mental health conditions, become increasingly complex and restricted, it is important that physicians and policymakers consider implementing patient navigator programs with a rigorous evaluation framework to improve accessibility and health outcomes. This can ultimately facilitate policymakers in creating more equitable resources in challenging fiscal climates.
Peer navigators and integrated care to address ethnic health disparities of people with serious mental illness. [2022]People of color with serious mental illnesses experience high rates of morbidity and mortality. Patient navigators, developed for cancer care, may help this group benefit from integrated care. This review examined patient navigators' key ingredients for cancer care for relevance to patients of color for application of peer services to psychiatric goals. Among cancer patients, navigators lead to greater treatment engagement and improved health outcomes for ethnic minority groups. Research also suggests peers can improve integrated care by providing effective psychiatric services to individuals with mental illness. Ongoing research examines peer navigators' impact on integrated care for patients of color.
Increasing Mental Health Engagement From Primary Care: The Potential Role of Family Navigation. [2020]Early engagement in mental health intervention is critical, yet the vast majority of children who are experiencing mental health concerns are not receiving needed services. Pediatric primary care clinics have been recognized as an ideal setting in which to identify and address mental health problems early, although engagement in mental health services within primary care and in community-based settings remains low. Navigators, or individuals with experience in navigating the mental health system, have been highlighted as promising partners in efforts to improve engagement in mental health services. Navigation has a growing body of research support among adults and in targeting medical concerns, but there has been limited research on integrating family navigators into pediatric primary care settings to address mental health concerns. Despite this gap in the evidence base, we believe there is significant promise for the use of this model in addressing children's mental health needs. In this report, we discuss factors contributing to high levels of unmet mental health needs and low levels of engagement in mental health services, the role that navigators can play in increasing engagement in mental health care, and implications and recommendations related to integrating mental health-focused family navigators into pediatric primary care settings.
Patient Navigation in Breast Cancer Treatment and Survivorship: A Systematic Review. [2019]Patient navigation is an intervention approach that improves cancer outcomes by reducing barriers and facilitating timely access to cancer care. Little is known about the benefits of patient navigation during breast cancer treatment and survivorship. This systematic review evaluates the efficacy of patient navigation in improving treatment and survivorship outcomes in women with breast cancer.
A Stepped Care Model of Patient Navigation to Enhance Engagement with Perinatal Mental Health Care. [2020]During the perinatal period, women are at increased risk for developing perinatal mood and anxiety disorders (PMADs). As perinatal mental health screening efforts increase, significantly more women will be identified who require mental health services. Evidence-based treatments exist, yet many women do not receive adequate care. Patient navigation (PN) offers a promising patient-centered approach to improve treatment attendance and engagement. The purpose of this study is to describe the development of a stepped care PN service at an intensive outpatient program for women with PMADs. Our experience incorporating this model of PN revealed significant features that may guide other treatment care facilities to adopt this service to increase identification and connection to care.
The Family Value of Information, Community Support, and Experience Study: Rationale, Design, and Methods of a "Family-Centered" Research Study. [2019]The Patient Protection and Affordable Care Act focuses on improving consumer engagement and patient-centered care. This article describes the design and rationale of a study targeting family engagement in pediatric mental health services. The study is a 90-day randomized trial of a telephone-delivered Family Navigator services versus usual care for parents of Medicaid-insured youth younger than 13 years with serious mental illness. Youth are identified through a pediatric antipsychotic medication preauthorization program. Family Navigators offer peer support to empower and engage parents in their child's recovery. Outcomes include parent report of empowerment, social support, satisfaction with child mental health services, and child functioning as well as claims-based measures of psychotherapy service utilization and antipsychotic medication dosage. The focus on "family-centered" care in this study is strongly supported by the active role of consumers in study design and implementation.
Supporting Individuals with Mental Health and/or Addictions Issues Through Patient Navigation: A Scoping Review. [2023]Pathways through the mental health care system can be complex and laden with barriers that prevent individuals from finding the most appropriate care. Navigation has been proposed as a solution for improving access to and transition through complex health care systems. While several MHA navigation programs have emerged in the past decade, no study has explored the core themes of MHA navigation, which was the goal of the current review. A scoping review was conducted; the search yielded 11,525 unique results, of which 26 were entered into extraction and subsequent descriptive and thematic analysis. Barrier reduction, client-centered support, and integrated care emerged as the distinct themes underlying MHA services, and overall, navigation significantly improved outcomes for individuals experiencing MHA issues. These findings may support evidence-based implementation of navigation services and point to a need for increased exploration and reporting of MHA navigation outcomes in the literature.
Harnessing the Capacity of Head Start to Engage Mothers with Depression in Treatment. [2022]We assessed dimensions of feasibility of a patient navigation system in the Head Start preschool setting to help low-income mothers with depression engage with mental health care. Forty-seven mothers participated; none refused. Navigators demonstrated excellent model fidelity; we experienced no adverse events. We discuss implications for future evaluation design.
Proactive, Recovery-Oriented Treatment Navigation to Engage Racially Diverse Veterans in Mental Healthcare (PARTNER-MH), a Peer-Led Patient Navigation Intervention for Racially and Ethnically Minoritized Veterans in Veterans Health Administration Mental Health Services: Protocol for a Mixed Methods Randomized Controlled Feasibility Study. [2023]Mental health care disparities are persistent and have increased in recent years. Compared with their White counterparts, members of racially and ethnically minoritized groups have less access to mental health care. Minoritized groups also have lower engagement in mental health treatment and are more likely to experience ineffective patient-provider communication, which contribute to negative mental health care experiences and poor mental health outcomes. Interventions that embrace recovery-oriented practices to support patient engagement and empower patients to participate in their mental health care and treatment decisions may help reduce mental health care disparities. Designed to achieve this goal, the Proactive, Recovery-Oriented Treatment Navigation to Engage Racially Diverse Veterans in Mental Healthcare (PARTNER-MH) is a peer-led patient navigation intervention that aims to engage minoritized patients in mental health treatment, support them to play a greater role in their care, and facilitate their participation in shared treatment decision-making.
The Sooke Navigator project: using community resources and research to improve local service for mental health and addictions. [2021]Our rural BC community engaged in an innovative action research project to improve access to mental health and addiction (MHA) services for citizens and increase connections and communication between primary care, community-based providers, and the formal mental health service system. Developed by a community-based steering committee, our Navigator model is aimed at anyone with mental health and addictions issues seeking help in our region. The model includes the following services: timely needs assessment, collaborative assistance with need-based care planning, appropriate information, referral, and linkage facilitation. Key features of the Navigator model are discussed, including community engagement, guiding principles, and a description of the service is provided. In our rural and remote community, a community-supported Navigator model was effective in increasing access to comprehensive, strengths-based assessment, planning and referral facilitation.
Navigating the mental health and addictions maze: a community-based pilot project of a new role in primary mental health care. [2021]Problem being addressed In a medically under-served rural Canadian community where overburdened family physicians provide most of the cae for patients with mental illness and substance use problems, providing access to timely and effective help for all citizens is a challenge. The care burden of unmet mental health needs is experienced throughout the larger community by diverse community service providers.Supporting a shared understanding of the needs and challenges, and ensuring effective connection and clear communication between diverse disciplines in primary care, community services and the formal mental health system requires models of service organisation and delivery that go beyond traditional clinical roles.In cancer care a navigator model has previously been used to address information and service gaps and improve patient experience. We wished to evaluate whether a community-supported navigator model could help solve some of the challenges for clients and service providers in our community, while at the same time allowing data collection that offers a clearer understanding of actual service needs.Pre-programme activities Community members formed an interdisciplinary community steering committee which met monthly for two years to develop and adapt a service and collaborative research model, generate support, secure ethical approval and raise funds.Programme description The navigator service was embedded in a local family service organisation, the steering committee met monthly, and along with the researchers met regularly with programme staff and provided support, oversight and development of ethical data collection.Navigators provided low barrier access, comprehensive assessment, collaborative service planning, and linkage and referral facilitation for any individual or family who requested assistance with a mental health or substance use concern. Navigators also serve as an information resource for any community service provider or family physician needing to assist a client, and collected data on local service needs.Conclusions Analysis of quantitative administrative data, consented research data, and qualitative interview and survey data demonstrated that this community supported navigator service model was effective in improving service access, assessment and linkage for citizens with mental health and addictions concerns, and connecting a range of community services into a more effective network of care. Connecting unattached clients with a primary care provider and supporting needs assessment and service planning for patients of local family physicians were key navigator functions.
Patient navigators facilitating access to primary care: a scoping review. [2019]Patient navigators are a promising mechanism to link patients with primary care. While navigators have been used in population health promotion and prevention programmes, their impact on access to primary care is not clear. The aim of this scoping review was to examine the use of patient navigators to facilitate access to primary care and how they were defined and described, their components and the extent to which they were patient centred.