Evaluation of a Health Navigator Pilot Program for Youth in Foster Care

Authors

DOI:

https://doi.org/10.5195/jyd.2022.1103

Keywords:

youth aging out of foster care, health navigator, program evaluation, marginalized youth, child welfare organizations/systems

Abstract

The Health Navigator Program (HNP) was a pilot health mentor intervention program for youth in British Columbia, Canada, with connections to the provincial child welfare system. In this article, youth participants are referred to as “independent youth” as they are independent of traditional familial care. Children and youth in the foster care system face increased prevalence and risk of physical and mental health challenges with lasting implications throughout adulthood. The cumulative effect of childhood trauma, lack of connections to supportive adults, and structural obstacles such as poverty, racism, and sexism all contribute to creating significant barriers for independent youth navigating the health care system. The HNP was created to address these obstacles and facilitate improved health outcomes for independent youth. Youth from 2 program sites were paired with medical student volunteers who provided advocacy and mentorship. A qualitative process evaluation was undertaken to assess the effectiveness of the HNP in achieving the intended program outcomes. Findings revealed that the independent youth participants increased awareness of their own health needs, gained confidence in navigating the health care system, and had improved short-term health outcomes. Relationship building with a caring adult, outside of a paid professional role, was shown to be the most significant factor in achieving these positive outcomes. 

Author Biographies

Stephanie Skourtes, University of British Columbia

Research Scientist, Division of Adolescent Medicine, Department of Pediatrics, University of British Columbia

 

Kyla Brophy, McGill University

Department of Educational and Counseling Psychology, McGill University

Eva Moore, University of British Columbia

Division of Adolescent Medicine, Department of Pediatrics, University of British Columbia

References

Ahrens, K. R., Garrison, M. M., & Courtney, M. E. (2014). Health outcomes in young adults from foster care and economically diverse backgrounds. Pediatrics, 134(6), 1067-1074. https://doi.org/10.1542/peds.2014-1150

Al-HadiHasan, A., Callaghan, P., & Lymn, J. S. (2017). Qualitative process evaluation of a psycho-educational intervention targeted at people diagnosed with schizophrenia and their primary caregivers in Jordan. BMC Psychiatry, 17(1), 68. https://doi.org/10.1186/s12888-017-1225-2

Arnett, J. J. (1998). Learning to stand alone: The contemporary American transition to adulthood in cultural and historical context. Human Development, 41(5-6), 295-315. https://doi.org/10.1159/000022591

Bieling, P. J., Madsen, V., & Zipursky, R. B. (2013). A ‘navigator’ model in emerging mental illness? Early Intervention in Psychiatry, 7(4), 451-457. https://doi.org/10.1111/eip.12078

British Columbia Medical Association. (2012). Closing the gap: Youth transitioning to adult care in BC. https://www.doctorsofbc.ca/sites/default/files/1984-bcma_youth_transitions.web_.pdf

British Columbia Representative for Children and Youth. (2013). Still waiting: First-hand experiences with youth mental health services in BC. https://www.rcybc.ca/reports-and-publications/reports/monitoring-reports/still-waiting-first-hand-experiences-youth

Broughton, W. (1991). Qualitative methods in program evaluation. American Journal of Health Promotion, 5(6), 461-465. https://doi.org/10.4278/0890-1171-5.6.461

Burawoy, M. (1998). The extended case method. Sociological Theory, 16(1), 4-33. https://doi.org/10.1111/0735-2751.00040

Burt, K. B., & Paysnick, A. A. (2012). Resilience in the transition to adulthood. Development and Psychopathology, 24(2), 493-505. https://doi.org/10.1017/S0954579412000119

The Change Foundation. (2013). Health system navigators: Band-aid or cure? A Primer with reflections from the change foundation’s panorama panel. http://deslibris.ca.ezproxy.library.ubc.ca/ID/241021

Christian, C. W., & Schwarz, D. F. (2011). Child maltreatment and the transition to adult-based medical and mental health care. Pediatrics, 127(1), 139-145. https://doi.org/10.1542/peds.2010-2297

Courtney, M. E., Dworsky, A., Hook, J., Brown, A., Cary, C., Love, K., Vorhies, V., Lee, J. S., Raap, M., Cusick, G. R., Keller, T., Havlicek, J., Perez, A., Terao, S., & Bost, N. (2005). Midwest evaluation of the adult functioning of former foster youth. Chapin Hall Center for Children at the University of Chicago. http://www.chapinhall.org/research/report/midwest-evaluation-adult-functioning-former-foster-youth

Deutsch, S. A., & Fortin, K. (2015). Physical health problems and barriers to optimal health care among children in foster care. Current Problems in Pediatric and Adolescent Health Care, 45(10), 286-291. https://doi.org/10.1016/j.cppeds.2015.08.002

Dewar, L., & Goodman, D. (2014). Literature review: Best practices in transitioning youth out of care—Successful transitions, success as adults. http://www.untilthelastchild.com/wp-content/uploads/2014/06/CWI-Best-Practices-Transition-Youth-Lit-Review-Mar-30-2014-FINAL.pdf

Doolan-Noble, F., Waters, D. L., Gauld, R., & Reriti, H. (2013). Evolution of a health navigator model of care within a primary care setting: A case study. Australian Health Review, 37(4), 523.

Esterberg, K. (2002). Qualitative methods in social research. McGraw Hill.

Feinstein, J. S. (1993). The relationship between socioeconomic status and health: A review of the literature. The Milbank Quarterly, 71(2), 279-322.

Fraser Health. (n.d.). Aboriginal health: Acute and community care. http://www.fraserhealth.ca/health-info/health-topics/aboriginal-health/

Garcia, A., & Courtney, M. (2011). Prevalence and predictors of service utilization among racially and ethnically diverse adolescents in foster care diagnosed with mental health and substance abuse disorders. Journal of Public Child Welfare, 5(5), 521-545. https://doi.org/10.1080/15548732.2011.617277

Gibson, F. (2007). Conducting focus groups with children and young people: Strategies for success. Journal of Research in Nursing, 12(5), 473-483. WorldCat.org. https://doi.org/10.1177/1744987107079791

Government of Canada, S. C. (2017, February 8). Focus on geography series, 2016 census—Province of British Columbia. https://www12.statcan.gc.ca/census-recensement/2016/as-sa/fogs-spg/Facts-PR-Eng.cfm?TOPIC=9&LANG=Eng&GK=PR&GC=59

Greeson, J. K. P., Usher, L., & Grinstein-Weiss, M. (2010). One adult who is crazy about you: Can natural mentoring relationships increase assets among young adults with and without foster care experience? Children and Youth Services Review, 32(4), 565-577. https://doi.org/10.1016/j.childyouth.2009.12.003

Havlicek, J. R., Garcia, A. R., & Smith, D. C. (2013). Mental health and substance use disorders among foster youth transitioning to adulthood: Past research and future directions. Children and Youth Services Review, 35(1), 194-203. https://doi.org/10.1016/j.childyouth.2012.10.003

Horwitz, S. M., Owens, P., & Simms, M. D. (2000). Specialized assessments for children in foster care. Pediatrics, 106(1 Pt 1), 59-66.

Iglehart, A. P., & Becerra, R. M. (2002). Hispanic and African American Youth: Life after foster care emancipation. Journal of Ethnic & Cultural Diversity in Social Work, 11(1-2), 79-107. https://doi.org/10.1300/J051v11n01_04

Lee, C., & Duerr Berrick, J. (2014). Experiences of youth who transition to adulthood out of care: Developing a theoretical framework. Children and Youth Services Review, 46, 78-84. https://doi.org/10.1016/j.childyouth.2014.08.005

Lee, J. S., Courtney, M. E., & Tajima, E. (2014). Extended foster care support during the transition to adulthood: Effect on the risk of arrest. Children and Youth Services Review, 42, 34-42. https://doi.org/10.1016/j.childyouth.2014.03.018

Lerner, R. M., Almerigi, J. B., Theokas, C., & Lerner, J. V. (2005). Positive youth development: A view of the issues. The Journal of Early Adolescence, 25(1), 10-16. https://doi.org/10.1177/0272431604273211

Lopez, P., & Allen, P. J. (2007). Addressing the health needs of adolescents transitioning out of foster care. Pediatric Nursing, 33(4), 345-355.

Maxwell, J. A. (2013). Qualitative research design: An interactive approach (3rd edition). SAGE.

Mendes, P., & Moslehuddin, B. (2006). From dependence to interdependence: Towards better outcomes for young people leaving state care. Child Abuse Review, 15(2), 110-126. https://doi.org/10.1002/car.932

Ministry of Child and Family Development. (2019, March 31). Children and youth in care. https://mcfd.gov.bc.ca/reporting/services/child-protection/permanency-for-children-and-youth/performance-indicators/children-in-care

Ministry of Child and Family Development. (2020). Post transition supports: Case data and trends. https://mcfd.gov.bc.ca/reporting/services/child-protection/post-transition-supports/case-data-and-trends

Mukherjee, K. (2015). Poverty as a cause and consequence of ill health. International Journal of Epidemiologic Research, 2(4), 209-220.

Natale-Pereira, A., Enard, K. R., Nevarez, L., & Jones, L. A. (2011). The role of patient navigators in eliminating health disparities. Cancer, 117(S15), 3541-3550. https://doi.org/10.1002/cncr.26264

Nesmith, A., & Christophersen, K. (2014). Smoothing the transition to adulthood: Creating ongoing supportive relationships among foster youth. Children and Youth Services Review, 37, 1-8. https://doi.org/10.1016/j.childyouth.2013.11.028

Newman, S. D., Gillenwater, G., Toatley, S., Rodgers, M. D., Todd, N., Epperly, D., & Andrews, J. O. (2014). A community-based participatory research approach to the development of a Peer Navigator health promotion intervention for people with spinal cord injury. Disability and Health Journal, 7(4), 478-484. https://doi.org/10.1016/j.dhjo.2014.04.006

Nichols, N., Schwan, K., Gaetz, S., Redman, M., French, D., Kidd, S., & O’Grady, B. (2017). Child welfare and youth homelessness in Canada: A proposal for action (#YouthWithoutHome Policy Brief Series). Canadian Observatory on Homelessness.

Overton, W. F. (2010). Life-span development: Concepts and issues. In R. M. Lerner & W. F. Overton (Eds.), The handbook of life-span development: Vol. 1. Cognition, biology, and methods (pp. 1-29). Wiley.

Page-Reeves, J., Moffett, M. L., Steimel, L., & Smith, D. T. (2016). The evolution of an innovative community-engaged health navigator program to address social determinants of health. Progress in Community Health Partnership, 10(4), 603-610.

Pope, L. (2003). Report on health system navigator models prepared for: The Durham Haliburton Kawartha and Pine Ridge & the Simcoe York District health councils. Simcoe York District Health Council and Durham Haliburton Kawartha Pine Ridge District Health Council. http://booksnow1.scholarsportal.info/ebooks/ebooks2/ogdc/2014-02-25/5/299238/299238.pdf

Propp, J., Ortega, D. M., & NewHeart, F. (2003). Independence or interdependence: Rethinking the transition from ‘ward of the court’ to adulthood. Families in Society: The Journal of Contemporary Human Services, 84(2), 259-266. https://doi.org/10.1606/1044-3894.102

Rebbe, R., Nurius, P., Courtney, M., & Ahrens. (2018). Adverse childhood experiences and young adult health outcomes among youth aging out of foster care. Academic Pediatrics, 18(5), 502-509. https://doi.org/10.1016/j.acap.2018.04.011

Rhodes, J. E., Spencer, R., Keller, T. E., Liang, B., & Noam, G. (2006). A model for the influence of mentoring relationships on youth development. Journal of Community Psychology, 34(6), 691-707. https://doi.org/10.1002/jcop.20124

Rubin, H. J., & Rubin, I. (2012a). Designing main questions and probes. In Qualitative interviewing: The art of hearing data (3rd ed., pp. 152-172). SAGE; WorldCat.org. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=024397306&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA

Rubin, H. J., & Rubin, I. (2012b). Preparing follow-up questions. In Qualitative interviewing: The art of hearing data (3rd ed., pp. 173-200). SAGE; WorldCat.org. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=024397306&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA

Shaffer, M., Anderson, L., & Nelson, A. (2016). Opportunities in transition: An economic analysis of investing in youth aging out of foster care in their 20s. (Report 3 of 3: Opportunities for increased support). SFU School of Public Policy, Fostering change, Vancouver Foundation. https://youthrex.com/report/opportunities-in-transition-an-economic-analysis-of-investing-in-youth-aging-out-of-foster-care-report-3-of-3/

Svoboda, D. V., Shaw, T. V., Barth, R. P., & Bright, C. L. (2012). Pregnancy and parenting among youth in foster care: A review. Children and Youth Services Review, 34(5), 867-875. https://doi.org/10.1016/j.childyouth.2012.01.023

Swartz, T. T. (2008). Family capital and the invisible transfer of privilege: Intergenerational support and social class in early adulthood. New Directions for Child and Adolescent Development, 2008(119), 11-24. https://doi.org/10.1002/cd.206

Vancouver Foundation. (2016). Fostering change. Fostering Change. http://www.fosteringchange.ca/

Vargas, R. (2016). How health navigators legitimize the Affordable Care Act to the uninsured poor. Social Science & Medicine, 165, 263-270. https://doi.org/10.1016/j.socscimed.2016.01.012

Ziemann, M. J. (2019). ‘We don’t know what to do with you’: Changing the way we support the mental health of youth in and from care. Canadian Mental Health Association, BC Division. https://cmha.bc.ca/wp-content/uploads/2019/04/MentalHealthForYouthInCare_April2019.pdf

Zlotnick, C., Tam, T. W., & Soman, L. A. (2012). Life course outcomes on mental and physical health: The impact of foster care on adulthood. American Journal of Public Health, 102(3), 534-540. https://doi.org/10.2105/AJPH.2011.300285

Downloads

Published

2022-03-28

Issue

Section

Program & Practice Articles