Health Navigators: Characteristics Through Internships

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In 2015, Kay Perrin, PhD, MPH, joined us as a guest blogger for a series of five blog posts on the topic of the exciting new career field of the Health Navigator. This is the second of five.

In the first blog, I introduced the concept of the role of Health Navigators. In this second blog, I expand this conversation to include some valuable characteristics of Health Navigators as well as the need for internships within their training. Before jumping into required internships, let’s step back and explore some personality traits desired in Health Navigators. When seeking a fulfilling career as a Health Navigator professional, students may assess if they have a desire to serve as a patient advocate, if they have an aptitude for attention to detail, and if their life experience allowed for the development of empathy.

First, whether they are called community health workers, patient navigators, health insurance navigators, or a growing number of other job titles, Health Navigators, serve as a liaison between patients, caregivers, and their health care providers. It is essential that they work as advocates within the complex health care system to improve patient care. Health Navigators are one additional piece of the health care puzzle that attempts to catch patients’ problems prior to falling through the cracks. Therefore, whenever a member of the health care team identifies an issue, every team member needs to listen so the details are not ignored. Although there will be an educational level gap between physicians, nurses, social workers, dieticians, health navigators, and other members of the health care team, the Health Navigators work to investigate problematic situations to find plausible solutions.

Health Navigators serve as effective and persuasive advocates for patients and their caregivers. For example, a Health Navigator works with the discharge physician, nurse, and social worker by conducting a home visit prior to discharge to evaluate wheelchair accessibility, height of bed, and bathing options. This evaluation is not a home health assessment (e.g., wound care or administration of intravenous medications), but rather a holistic approach for the patient and the caregiver with emphasis on a safe recovery at home with the tools and support needed or incurring a readmission due to lack of knowledge and support or an unintentional injury.

Second, Health Navigators do not merely follow written medical orders or prescriptions, but rather they approach each situation with a holistic approach. For instance, if a patient’s follow-up medical visit is scheduled for three days after discharge, the Health Navigator needs to ask the patient and caregiver a few questions to ensure that keeping the appointment is possible rather than merely assuming that the patient will arrive on the given date and time.

  1. Who will be driving you to the follow-up appointment?
  2. Will your driver be able to lift and fit your wheelchair into the car?
  3. Is your driver available when your appointment is scheduled?
  4. …and many more similar questions.

If the Health Navigator asks these or other appropriate questions, there is a higher probability of appointment compliance. On the other hand, without a Health Navigator, the time and date of the appointment is given to the patient during discharge with the expectation of agreement. However, without asking specific questions, the unresolved issues prevent compliance with a follow-up appointment. These types of simple questions ensure that the patients and caregivers have complete understanding of appointments, medications, wound care, treatment plans, etc. for utmost compliance through reduction of barriers and lack of understanding.

Third, Health Navigators need the quality of empathy rather than sympathy. A sympathetic Health Navigator shares the feeling of the person suffering from the bad news or sad feelings. An empathic Health Navigator focuses on trying to understand or vicariously experience the sad feelings from a past personal event rather than feeling sorry for the person. For example, the Health Navigator might remember the sad feeling when his or her grandparent died, but would not attempt to share in the experience. The attribute of empathy is acquired through personal experience across the lifespan. An empathic Health Navigator knows to ask simple questions to move the conversation forward towards purposeful action or resolution.

With these qualities in mind, let’s explore the proposed curriculum and training described in the Community Colleges and Public Health Report. With expert input and years of discussion, this report recommends that all health navigators as well other public health students at the associate degree level complete the following courses:

  • Population and Personal Health
  • Overview of Public Health
  • Health Communications

In addition, Health Navigator students should complete the following courses:

  • Prevention and Community Health
  • Healthcare Delivery
  • Health Insurance
  • Health Information

Along with the course requirements, there are nine semester hours of electives.

In this blog, I would like to put forth the notion of incorporating a required paid internship into the nine hours of electives. After years of working with undergraduate students, I have observed that most students fall into one of two categories. Either they are locked into a career path and have limited interest in exploring other options or they are seeking a diploma with limited exploration of career choices. Neither of these common scenarios works for the evolving field of Health Navigators. First, since the concept of Health Navigators is unfamiliar, students are not likely to know what the career entails. Second, if students do not have personal or employment experience with health care providers, patients, and caregivers, they are less likely to visualize a holistic approach of care. For these and many more reasons, it is essential that future Health Navigators obtain internship experience during their degree program; otherwise, it is improbable that they will obtain employment upon graduation. In addition, these internships must offer a modest stipend for several reasons.

For the students, the internship stipend focuses the responsibility on being a future health care team member rather than being a hospital volunteer. This mindset encourages professional workforce development skills, e.g. appropriate attire, time management, and communication skills. On the hospital side, the financial commitment of paid internships introduces the concept of Health Navigators into the hospital workforce; forms strong links between community college and local hospitals; and allows hospitals to make a financial commitment to the development and employment of Health Navigators as a way to reduce ACA penalties associated with Medicare readmission rates. Lastly, for the community colleges, the paid internships provide positive recruitment strategies into the new Health Navigator degree; allows faculty to network with hospitals through the development of responsibilities of the student interns; and connects the classroom with the internship experience.

Ideally, the internship would not be a culminating experience during the last semester, but rather one 8-hour shift per week in the hospital for two semesters. Therefore, as the students gain knowledge and understanding in the classroom, they would experience higher levels of critical thinking in their hospital internship. Yes, of course, this paid internship concept is expensive and time-intensive for hospitals, community colleges and students. However, without a serious commitment at all levels, Health Navigators will gain academic knowledge and receive diplomas, but may not secure employment. Their employment is based on creating and demonstrating the need for Health Navigators to become a profession, a valuable, cost-saving member of the health care team.

 —Kay Perrin

KayPerrinKay Perrin, PhD, MPH, is an Associate Professor and Assistant Dean for the Office of Undergraduate Studies at the University of South Florida, College of Public Health. Dr. Perrin’s research focuses on adolescent health with a special interest in teen pregnancy. Dr. Perrin also serves on several community boards in the Tampa Bay Area. Dr. Perrin is the author of three titles from Jones & Bartlett Learning: Principles of Evaluation and Research for Health Care Programs, Essentials of Planning and Evaluation for Public Health (both published in 2014), as well as a forthcoming introductory Health Navigator textbook, available in late 2016. Follow Kay Perrin on Twitter @KayPerrinPhD or watch a webcast of Dr. Perrin’s October 2014 Webinar on Teaching Health Research, Program Planning, and Evaluation.

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