Service Navigation As Primary Prevention: Navigation Workforce Perceptions of Barriers and Facilitators to Health and Social Care

Background and purpose: Access to health and social care is associated with improved physical, social, emotional, and behavioral health, and enhanced quality of life. In response to recent calls to reshape human service systems to address root causes of health and social inequality, and to support at-risk individuals and families, service navigation has emerged as a primary prevention approach to prevent child maltreatment and child welfare involvement. Despite the proliferation of service navigation approaches, little is currently known about service navigation practice, including the barriers and facilitators that influence navigators' efforts to connect individuals and families to health and social care. To address this need, we examined workforce perceptions of barriers and facilitators to health and social care access using qualitative research methods.

Methods: We conducted 20 semi-structured in-depth interviews and one focus group with service navigators who were working in a large midwestern state. Participants were recruited from list-servs that were curated by the state's Departments of Health and Human Services. Participants included community health workers (n=8), family navigators (n=9), supervisors (n=3), and program administrators (n=2). Respondents worked in diverse settings, including: healthcare (n=7), social services (n=6), schools (n=2) and community-based organizations (n=7). The interviews and focus groups were conducted through Zoom, and were transcribed, independently coded, and analyzed independently by two researchers using Braun & Clarke’s (2006) approach to thematic analysis.

Results: Findings revealed a range of client, navigator, organizational, and structural factors that hinder or support effective service navigation practice. Client level barriers included lack of transportation, limited system literacy, and stigma. Navigator level barriers encompassed lack of cultural competence, time constraints, emotional burnout, communication barriers, and lack of a centralized database of community resources. Organizational level barriers involved workforce shortages, compensation issues, non-cooperation from referred organizations, unavailability of culturally appropriate services, funding and sustainability challenges, and resistance to change. Structural barriers included service eligibility constraints, systemic discrimination and bias, and lack of affordable care. Facilitators to care at the navigator level included building meaningful rapport, consistent presence and communication, personalized support, resource sharing, leveraging technology, coordinated referrals, facilitating direct assistance, and advocating for systemic change. Organizational facilitators included inter-agency collaboration, innovating leadership, and culturally informed and holistic service provisions. Facilitators at the structural level included policies and practices to reduce discrimination and bias, and funding to strengthen service infrastructure to improve service delivery.

Conclusions and implications: Service navigators adopt innovative strategies to support service access and bridge service gaps, relying on inter-organizational collaborations and person-centered care to promote service access. Despite service navigators’ work in bridging gaps in care, organizational and systemic barriers, including stigmatization of service recipients, impede equitable care access. Culturally appropriate services show promise, however a lack of culturally informed services remains a barrier. While navigators are critical to overcoming service barriers, the multitude of challenges they face need further attention. Policy reforms, including strategic workforce development, integrated technology, inter-organizational collaborations, and sustainable funding to support service delivery are needed.