Our Concept of Service Navigation
One of the things we learned from listening to families whose loved ones have an intellectual disability and/or autism is the amount of time they spend navigating the complex and ever changing systems of services for their family members.
- They have to learn about services provided by physical health, behavioral health, and Medicaid waivers, all of which have different eligibility requirements, required paperwork, regulations and processes.
- These systems have different names for the same services (community living vs residential habilitation) and different names for the same service providers (service coordinators vs support coordinators). And, these systems are not connected to each other so a physician does not have access to information about a person’s Medicaid waiver services. Individuals and families go to each appointment with information they have already shared countless times before.
- For single caregivers, elderly caregivers, and caregivers who are not fluent in English, their experiences are generally more confusing and demand more of their time to understand the complexities of these systems.
When we asked families what they need assistance with, the majority gave the same responses. They wished for:
- one knowledgeable person who can provide information and help coordinate all of their family member’s services.
- someone who will advocate for their family member, especially when a person is denied or not able to access a community service or healthcare provider.
- someone who will help with scheduling appointments, especially when a family member is being discharged from a hospital or is initially diagnosed with an illness.
- someone who can help the individual and family plan for the future.
So, William Penn Human Services is creating Service Navigation:
Service navigation is an individual and family centered, team-based approach that facilitates access to needed services, resolves barriers and helps people with intellectual disabilities/autism and families navigate effectively and efficiently through multiple and complicated systems such as Medicaid home and community waiver services and health care services, including in-patient and out-patient hospital care, primary and specialized care, dental and behavioral health care, and social services.
How Can Service Navigation Help Individuals and Families
Service navigation offers guidance and support with greater clarity and care, outperforming traditional support coordination at every step.
Support Coordination
From the PA Office of Developmental Programs
BASIC FUNCTIONS
- Locating needed services and providers
- Coordinating, development and on-going
- Monitoring and assessing a person’s health, safety, and well-being
RESPONSIBILITIES
- Facilitate meetings to ensure the ISP is working and person’s desired outcomes occur
- Discuss needs and update ISPs as needs change
- Explain waiver services and budget caps
- Conduct face to face and/or virtual monitoring determined by waiver enrollment
- Assist with identifying services provided by waiver and base funding
- Informing/education families on activities to participate in, such as IM4Q
Service Navigation
From William Penn Human Services
CORE FUNCTIONS
- Be the link between Medicaid home and community-based waiver, health care and social service providers
- Locate, coordinate and monitor services and remove barriers that prevent access to services
- Support individuals to ensure their desires are discovered and reflected in their Person-Centered Plan and integrated into their supports
- Advocate with individuals and families for needed services
- Promote self-determination of individuals with ID/A
DUTIES
- Is knowledgeable about and supportive of each individual on their caseload
- Provides information and educates individuals and families about services
- Works with individuals to create person centered support teams
- Assists individuals to lead person centered planning meetings and ensures the person/family is at the center of decision making
- Arranges/schedules assessments as needed
- Ensures that authorizations for services are completed
- Continuously meets with the individual/family/providers (in person and/or virtual) and monitors waiver, physical health, behavioral health and social services provided to a person to ensure they are meeting the person’s needs and the person//family are satisfied with the outcome of the services
- Advocates with the person/family when services are not provided/denied/terminated to remove barriers to accessing the services