Community College Mental Health Navigators: A Pilot Program to Improve Access to Care

Assessment of Need

The California Community College (CCC), the nation’s largest system of higher education and provider of workforce training, serves approximately 2.1 million students across its 116 campuses. CCCs strive to reduce barriers to academic success by providing mental health services (MHS). The Jed Foundation reported an increase in MHS needs across college campuses over the past decade, with more students arriving to college with histories of mental health (MH) challenges and many more unable to cope with distress while in college (The Steve Fund & JED Foundation, 2017). CCCs provide MHS on a short-term model because of limited staffing and high demand; most CCC campuses place a limit of six to eight sessions per student per academic term.

A referral list of local agencies is typically provided for students who need continued care, although students often do not know how to explore options or navigate their health insurance benefits. Evidence is emerging on the promising use of a navigator model to meet the growing needs of individuals due to the fragmented and difficult-to-navigate MHS (Knesek & Hemphill, 2020). Other studies have demonstrated the effective use of peer-to-peer interventions to improve care delivery (Kirsch et al., 2014). In addition, peer support services are considered one of the 10 core components and guiding principles of recovery (Substance Abuse and Mental Health Services Administration, 2017).

Description of the Strategy

During the 2020–2021 academic year, an MH navigator program was piloted at four community colleges in a San Francisco Bay Area county. Participants included 10 students with academic/career interests in social work, nursing, and the social sciences. The focus during fall semester 2020 was on increasing student knowledge of mental health topics (see Table 1), while during spring semester 2021 we focused on experiential learning through case management of student clients. The curriculum covered modules ranging from health insurance literacy to the community MH landscape (Table 1). The program outlined effective navigator–client communication protocols, case studies, and highlighted the services of local agencies. We held biweekly spring semester meetings designed for navigators to share their case management efforts. We implemented a referral tracking system to ensure care coordination throughout the care continuum and developed a smartphone app which provided a user-friendly collaborative workspace to support the navigation process. We conducted an evaluation to measure changes in knowledge, skills, and self-efficacy levels. The project was not a research study, but rather, a workforce development pilot program which did not need institutional review board approval.

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Table 1

List of Program Topics and Navigator Referral Process

List of program topics and training curriculum

1. Adverse Childhood Experiences a

2. Agency practices and eligibility of CBOs b

3. Campus-based mental health services b

4. Confidentiality and mandatory reporting a

5. Continuum of Care a

6. Documentation of progress b

7. Emerging trends & data on college mental health b

8. Healthcare coverage options a

9. Navigation support practice sessions b

10. Primer on the U.S. Healthcare System a

11. Support and follow-up of clients b

12. The Community Mental Health System a

13. Warm-hand protocol & checklist b

14. Whole Person Care a

Navigator Referral Process

1. Warm hand-off and initial contact: clients will be assigned to a navigator by therapist near end of their 6 or 8 counseling session. Contact will be over email within 5 business days.

2. Navigator primary role: Clients without health insurance should be referred to community health organizations with Certified Enrollment Counselors to be enrolled in Covered California or Medi-Cal. Clients with health insurance will be helped by navigators to find community-based mental health organizations or therapists appropriate to their insurance coverage network.

3. Navigator transitional support: It could take 3–5 weeks for student clients to acquire insurance or begin receiving counseling services. Navigators will check in with clients weekly on their progress transitioning into long-term care.

4. Navigator services completion: The student client beginning long-term treatment will end regular communication with navigator and will received two scheduled check-ins: (a) 1 week, post client’s first appointment with their new provider, (b) 1 month thereafter to follow-up on their progress, including a quality-of-care survey.

a

An 8-week module training program was designed to build students’ knowledge, skills, and level of self-efficacy to facilitate continuity of care for their peers. ^b Various topics included in the didactic component were used to reinforce information covered and for case-management purposes.

Intended Impact/Outcomes

The navigator pilot program showed promising results. The retention rate of our 19 student-client referrals was 98%, and 58% were successfully connected to community agencies. One navigator received appreciation for helping to alleviate a great burden for the student-client by connecting them to a bicycle shop, a primary source of transportation. Post-survey results showed increases in navigator confidence levels with case management in areas such as collecting relevant information and successfully connecting students to community-based services.

Navigators gained practical experiences and exposure to mental health careers. A third-year student navigator highlighted their role as “the bridge between services and students.” Another remarked that she further developed her “career interests . . . that comes with mental health.” Navigators are students who have shared similar circumstances as MHS clients, but provide a pool of knowledge, experience, and skillset as advocates that allow them to help determine the MH resource(s) that is most appropriate for student clients. Navigator efforts may help reduce inequities by increasing access to MHS among college students.

Successes and Challenges

The coronavirus pandemic brought about unprecedented changes to education delivery, including opportunities to redesign student learning and engagement. Virtual learning facilitated participation from multiple campuses that would have been harder to support if we remained in-person given the geographic spread of campuses. The virtual-based program also facilitated easier access to community-based agency representatives as it reduced travel and the amount of time a campus visit would require. The curriculum was enhanced with additional content based on student interests, shepherding innovation and a sense of ownership among all. The cohort diversity in race/ethnicity, age, progress in their degree attainment, and the lived experience produced a committed group of students who reported a high degree of program satisfaction.

One challenge was the short planning timeline from the conceptualization of the program to implementation efforts. Recruitment of students during the summer reached a smaller audience because summer enrollment is limited on most campuses. The program also experienced a moderate attrition level with two of the 10 students leaving the program before the year’s end. Student navigators also did not receive the anticipated number of referrals from their respective MH therapists. Reasons for this include the reluctance of some student clients to be assigned to a navigator and the “warm hand-off” referral protocol process not being fully implemented. Another challenge was the need for more training and navigation practice sessions so that students feel prepared delivering services. These lessons learned will provide opportunities to build a more coordinated system for students to assist their peers—and for students in need of navigation support to feel that the system is a safe space for them to seek help.

Lessons Learned and Next Steps

Future efforts will focus on cultivating stronger relationships between navigators and MH liaisons. Doing so will help staff develop greater familiarity of the navigator role, thus, ensuring an increase in service usage, and allowing the student-client a smoother transitioning experience from campus-based to community-based care (Brekke et al., 2013). We will strengthen the MH navigator program by building a more robust infrastructure for increased collaboration. This program supports the transition of care while exposing students to the MH career field and providing opportunities to gain relevant work experience. Navigators’ work hours will increase to expand didactic content and interpersonal and communication skills training. The enhanced curriculum will integrate pandemic-related experience and the transition back to in-person learning. We will share the program model with other CCCs and beyond, to test the intervention in other settings and with other student populations.