Behavioral health and substance use navigators are filling a longstanding gap in the continuum for health systems: connecting patients to aftercare. When behavioral health patients are discharged from the emergency department, ensuring they remain engaged with services can be a challenge, often leading to fragmented care across their recovery journey.
“Sometimes a patient will come to the emergency department with a diagnosis of a psych problem,” Becky Dvorak, MSN, RN, regional vice president of behavioral health, told Becker’s when discussing emergency department boarding challenges. “But a lot of times what they need is not necessarily any type of psychiatrist help. They need a lot of psychosocial services.”
At Los Angeles-based Cedars-Sinai Medical Center, which has nearly 1,000 beds and handles more than 90,000 patient visits, investing in substance use disorder navigators made sense. It helps patients identify the resources they need to remain connected to substance use disorder services and their community. The approach is designed to reduce care fragmentation across the system, Itai Danovitch, MD, chair of the department of psychiatry and behavioral neurosciences, told Becker’s.
Navigators at the center do not provide psychotherapy services. Instead, they serve as nonclinical, peer-based supporters who focus on engagement and trust-building, he said.
“It takes time to engage a patient who’s been traumatized, or feels stigmatized or embarrassed and ashamed of some of their behaviors,” Dr. Danovitch said. “These are roles that can help with some of the soft skills that are so important to engaging individuals who have had negative experiences with hospitals in the past.”
The navigator role is especially impactful for health systems that see the same patients repeatedly returning to the emergency department, Tracey Izzard, vice president of behavioral health services at Norfolk, Va.-based Sentara Health, told Becker’s.
At Sentara, navigators focus primarily on bedside consultation, identifying resources and providing bedside therapeutic interventions. The system currently employs one manager and 10 full-time navigators deployed across its hospitals.
Before the navigator role was implemented, the average emergency department length of stay was 2,740 minutes. In the first few months after implementation, it dropped to 2,090 minutes, Ms. Izzard said. Thirty-day readmission rates also fell from 14.1% to 7.3% when navigators were engaged before discharge. Without navigators, 26.2% of patients returned; with navigators, the rate dropped to 14%.
From aftercare coordination to connections with community services, navigators provide the support that is often missing from traditional care models, whether related to clinical follow-up or social determinants of health.
“We helped a member linking them to community resources for utility assistance and furniture assistance, because these are all the things that are incredibly impactful and can be very destabilizing,” Ms. Izzard said.
