Service Navigation

Research and Practice in Health and Human Services

Jennifer Davidson, Ralph Hampson, Marie Connolly, Jennifer Davidson, Ralph Hampson, Marie Connolly

• Publisher: Bloomsbury Academic
• Year: 2020
• Print ISBN:
  9781352009552
• Edition: 1
• eBook ISBN:
  9781350313453
• Topic: Social Sciences
• Subtopic: Social Work
• Index: Social Sciences

This exciting new book is the first of its kind to offer an analysis of Service Navigation and provide a framework for understanding the role and its application across a range of fields of practice. With an emphasis on the participation of individuals in their own care, it directly addresses the recent changes in policy and service development in health and human services, including the introduction of the National Disability Insurance Scheme.

Developed by a team of experts at one of Australia's leading universities, this unique text helps social workers, nurses, and allied health workers navigate the various systems that the service user has to use to become responsible for managing their own care arrangements and to help them to achieve their desired goals.

1	INTRODUCTION
	Jennifer Davidson, Ralph Hampson & Marie Connolly

In recent years, something of a revolution has been taking place in the complex area of disability service delivery. People are becoming more and more involved and indeed responsible for mobilising the services that best suit their own needs. As outlined by Professor Bruce Bonyhady in the foreword, the Australian National Disability Insurance Scheme (NDIS) has been at the forefront of a change in social and economic policy that will fundamentally alter the ways in which decisions are made about services, including who will provide them and how they will be funded. These changes in policy and service development have spearheaded similar changes, to a greater or lesser extent, in other areas in health and human services that have seen a continued emphasis on the participation of individuals in their own care. The changes represent a movement of ideas, where people have a greater say in what services they need and want and an increased responsibility for the funding that will support them.

Nevertheless, navigating and negotiating such systems can be complex tasks, and the stakes are high for individuals who become responsible for managing their own care arrangements. The development of individualised service systems has had drivers from the consumer movement and neoliberal concepts of service marketisation and individualisation, both evident in the roll out of the Australian NDIS and in other such schemes. Under the NDIS, disability support funding will move from program based block funding to direct payments made to individuals; those individuals then are charged to make their own service choices and purchases (Bigby, 2013). We are seeing similar advances in social and economic policy internationally (Department of Health, 2017; Sunnybrook, 2017; Integrating Professionals for Appalachian Children, 2017; CATIE, 2017; Action on Violence, 2017), illustrating a movement that supports self-determination and positions the person at the centre of decision-making.

Embedded in such policy environments are the liberal notions of an independent individual, who can make rational autonomous decisions based on informed choice (Christman, 2004: 143). In theory, the consumer, as the expert in their own lives, at the centre of these service systems is empowered to choose care arrangements that are tailored to their individual needs. They are charged with the capacity to negotiate and renegotiate these arrangements as their needs change or if the services provided no longer meet their care and support requirements. At a system and policy level, this empowerment is centred on the individual. It removes the supposed domination of service providers making best-interest decisions on their behalf and places the individual at the centre of the decision-making process. Positioned in this way, people have both the power and responsibility to make their own decisions, reinforcing the fundamental value of self-determination.

Nevertheless, this view is challenged by practical realities. People may find it difficult to negotiate complex systems, feeling unable to facilitate communication between the tiers of service (Warr et al., 2017). Critiques of neoliberalism suggest that these approaches are no more than nods to self-determination and empowerment (Dowse, 2009). Indeed, it is argued that, in practice, they represent a shift in responsibility away from the state and to the individual, resulting in cost reduction measures for the state rather than resource maximisation for users and creating a market that is driven by what suppliers want to provide and not by what consumers require, thus limiting the degree of choice and empowerment that they are supposedly offered (Dowse, 2009; Leadbeater, 2004; Spicker, 2013).

The complexity of service provision is clearly an issue that has the potential to overwhelm people seeking support. When funding is provided to support services, there is also a danger that unscrupulous marketing efforts may be applied in vulnerable clinical situations that potentially result in ‘funding grab’ resource manipulation. We see a role in this space for service navigators, who can foster client self-determination and who can enable people to engage the services they need with the expectation of good value for money. As these roles expand across various human service practice areas and across both the public and private sectors, it is essential that service users engaging ‘service navigators’ have a clear sense of what they can expect of these roles. The services provided by service navigators will come at a cost, be it privately or publicly funded, and as such, there is an obligation to ensure that with that cost there is commensurate value and quality.

Although the role of service navigator has developed over time, the term ‘navigator’ is not a new one. It was first used to describe a role supporting service users in complex health or human service systems in the early 1990s (Freeman, 2012; Shih et al., 2016) and growing out of an understanding of the fragmented systems surrounding cancer-related health care. Although cancer screening programs were successfully identifying thousands of patients who required treatment, the numbers actually accessing treatment were far smaller (Freeman, 2012). Identified barriers to accessing care services included people who were uninsured, socioeconomically disadvantaged and/or culturally and linguistically diverse (Freeman, 2012). It was clear that, without individualised assistance to overcome these barriers, patients could be disconnected from cancer treatment.

The concept of a role designed to navigate and lead service users through complex health systems has moved beyond cancer into other areas such as primary health care (Elliott and Stolee, 2015), geriatric chronic illness (Manderson et al., 2012), family decision-making in intensive care units (Torke et al., 2016), domestic and family violence interventions (Howarth, Stimpson, Barran & Robinson, 2009) and individualised systems. Today, service navigation is a term used to describe how individuals understand the service system they are participating in and how they can make informed decisions about the care and service offerings they wish to access. Service navigators are people who help individuals to navigate these systems and who work with broader families and communities to mobilise the supports that people need.

Health navigators, family navigators, cultural navigators, domestic violence navigators, mental health service navigators, peer navigators and patient navigators can be found in government services (such as child and family services, justice and community health), philanthropic foundations, hospitals, primary health networks and private practices across Canada, the US, the UK, New Zealand and Australia (Department of Health, 2017; Sunnybrook, 2017; Integrating Professionals for Appalachian Children, 2017; CATIE, 2017; Action on Violence, 2017; Whanau Ora, n.d.; Elder Care Navigator, n.d.). Navigator roles are developing in various forms and comprise professionals or lay persons or a mixture of the two (Meade et al., 2014) and are based around one individual or a range of individuals within a system (Freeman, 2012) and as external roles or roles within existing health or human service teams or both (Elliott & Stolee, 2015).

Although service navigation roles are expanding across the health and human services sectors (for all the reasons outlined earlier), we believe that an ethical framing of service provision is required to neutralise the negative aspects of the neoliberal critique and ultimately to enable the value and spirit of agency and self-determination. At a theoretical level, a number of writers insist that individuals are relational and socially driven beings and that this reality is lost in the notion of autonomous self-determination (Mackenzie & Stoljar, 2000). In this book, we depart from isolated individual decision-making and explore relational contexts across fields of practice – including children and families, domestic and family violence, older people, disability and people with health and mental health concerns – and across disciplinary boundaries in social care, health and allied health. We recognise that, in these situations, families, friends and institutions play central roles in the actual process of individual navigation and decision-making; for example, although a young person with a disability may be the pivotal player, navigation and decision-making will likely involve family members, friends or organisational support.

Relational autonomy acknowledges that all individual decision-making is conducted in a relational and social context from which the individual cannot be separated (Mackenzie & Stoljar, 2000). We use the notion of relational autonomy in this book to provide a way of understanding these challenges and critiques and as a means through which the values of self-determination and autonomy can be realised. Relational autonomy addresses the power and influence dynamics that exist within complex systems and, in doing so, identifies who is stepping into influencing and supporting roles. It also provides a distinct lens through which to consider the roles arising to meet this need and an ethical foundation for the development of these roles, regardless of where they sit across the service sector.

This book offers the first analysis of service navigation, positioning the role strongly within a relational context supporting service-user agency and self-determination. We explore the movement of ideas that position service users at the forefront of service decision-making. Importantly, given the contested nature of service navigation, we provide an ethically informed framework for understanding the role and its application across a range of fields of practice, developed within and across disciplines. We believe that service navigation and the approach we have taken to it present contemporary opportunities for professionals to strengthen their skills and capability in a new and developing area that inspires enabling and empowering practices in health and human services.

In the following chapters, we have brought together experts from across disciplines who have engaged with service navigation and the role it can play in their fields of practice. The book is divided in two parts. Part I introduces our three chapters where we lay the groundwork for understanding service navigation and the issues that the service navigation role presents. The increased development of these roles provides an imperative to develop a framework for supporting the role of the navigator providing practice guidance that is ethically informed and driven by consumer needs, self-determination and agency. In Chapter 2, Jennifer Davidson, Ralph Hampson and Marie Connolly present a new framework, created through practice and academic partnerships, that supports service navigation practice. The Service Navigation Relational Autonomy Framework (SNAF) incorporates four key domains: reinforcing ethical practices, fostering self-determination, supporting transitions and well-being, and mobilising service systems. The framework is embedded within and influenced by a broader understanding of relational autonomy as a foundation for navigator practice, recognising both the nature of relationships in the provision of care and the critical importance of self-determination in care provision. They argue that there is a pressing need for a service navigation framework that attends to critical practice issues and provides navigators with guidance that will assist them to meet the needs of service users and their families. Chapter 3 explores service navigation from a cultural perspective. Kerry Arabena (2019) recently argued, in the context of both First Nation Peoples and new migrants to Australia, that benevolent responses have framed service provision to service users, exposing subtle but powerful assumptions about the nature of relationships and the role of the state. She argues that, although benevolence may be important, particularly in the immediate context of need, it can also be effective in maintaining the status quo, resulting in situations where power structures remain unchallenged and inequities persist. In Chapter 3, Kristy Cooper considers this in the context of Aboriginal and Torres Strait Islander service needs and concerns, reinforcing the importance of building services that focus on Indigenous rights, partnership and self-determination. Kristy explores the holistic nature of health care and Indigenous practices and its implications for service navigation. She critically examines the service navigation framework presented in Chapter 2, noting that the principles and values underpinning the SNAF resonate with Indigenous concerns. In her insightful analysis, she argues that any service delivery model needs to be seen in the context of a broader commitment to Indigenous concerns and an authentic commitment to a paradigm shift from paternalism to consumer autonomy.

We move into fields of practice in Part II of the book. Kath Sellick, Aviva Beecher Kelk and Dariane McLean begin the discussion in Chapter 4, providing a comprehensive analysis of service navigation in the context of disability. Consistent with the principle of partnership, the writing team brings together academic and practice expertise in the area of disability. Drawing upon the field of disability studies, they tease out what is unique to the field and explore policies and practice that support disability practices. The concept of supporting self-determination for service users is not new in the disability field. Indeed, notions of co-design of services and research are common practice despite clear challenges relating to the barriers that many people with disability face. In their comprehensive analysis, the writing team provide important background information about the history of disability policy and the contemporary need for specialised service navigation.

This leads us to service navigation in the context of aged care. It is clear that the ageing of the population is a global phenomenon that brings many challenges for individuals, families and service systems. In Chapter 5, Ralph Hampson explores the changing context of service delivery in aged care, including the important shift to consumer-directed care. Ralph explores these changes in aged care and the role of service navigators in negotiating complex systems to better support individual trajec...

Table of contents

• Cover
• Half-Titlepage
• Titlepage
• Copyright
• Contents
• List of Figures
• List of Tables
• About the Authors
• Foreword
• 1 Introduction
• 2 Service Navigation Theory and Practice
• 3 Service Navigation and Indigenous Health-Care Practices
• 4 Service Navigation in the Disability Sector
• 5 Service Navigation with Older People
• 6 Mental Health and Service Navigation
• 7 Service Navigation in Health
• 8 Primary Care Service Navigation to Address Young People’s Health and Well-Being Needs
• 9 Health Service Navigation and Nursing
• 10 Service Navigation in Health Care: A Physiotherapy Perspective
• 11 Service Navigation in the Context of Domestic Violence
• 12 Emerging Fields of Practice in Service Navigation
• 13 A Service in the Making
• 14 Service Navigation – Concluding Thoughts
• Index