CERTIFICATE COURSE
ESSENTIALS OF
CARE NAVIGATION
INSTRUCTOR WORKBOOK
Workbook created by Hospital Employee Education and Training Grant 2015
Table of Contents
Essentials of Care Navigation
About this course................................................................................................................................ 3
Module 1: Introduction to Care Navigation and the Healthcare System ....................................... 5
Unit 1: Introduction to Client Navigation ............................................................................................. 6
Unit 2: Introduction to Healthcare Systems / Insurance ................................................................. 7
Unit 3: Client Navigation and Advocacy ............................................................................................... 8
Unit 4: Client Navigation and the Healthcare Team ......................................................................... 9
Unit 5: Overview of Community Systems and Resources ..........................................................10
Module 2: The Client ......................................................................................................................... 12
Unit 1: Cultural Awareness.......................................................................................................................13
Unit 2: The Social Determinants of Health .........................................................................................14
Unit 3: Barriers / Disparities .....................................................................................................................15
Unit 4: Health Literacy Theory / Assessment.....................................................................................16
Unit 5: Behavioral Health Overview .....................................................................................................17
Unit 6: End of Life / Palliative Care ........................................................................................................18
Module 3: Introduction to Chronic Illness and Conditions ........................................................... 20
Unit 1: Concepts of Chronic Illness/Comorbidities .........................................................................21
Unit 2: Mental Illness, Crisis Management, ACES.............................................................................22
Unit 3: Self-management of Chronic Illness/Conditions ..............................................................23
Unit 4: Cognitive Impairment .................................................................................................................24
Unit 5: Pain Management ........................................................................................................................25
Module 4: Communication Essentials ............................................................................................. 27
Unit 1: Basic Communication Skills, Active Listening, Empathy ................................................28
Unit 2: Personal/Professional Boundaries ..........................................................................................29
Unit 3: Professionalism and Basics of Professional Communication ........................................30
Unit 4: Change Theory...............................................................................................................................31
Unit 5: Documentation .............................................................................................................................32
Module 5: Health Coaching and Navigation .................................................................................. 34
Unit 1: Wellness/Health Promotion and Prevention.......................................................................35
Unit 2: Intro to Motivational Interviewing .........................................................................................36
Unit 3: Health Coaching and Navigation ............................................................................................37
Unit 4: Activation, Engagement, Self-Management.......................................................................38
Unit 5: Care Transitions .............................................................................................................................39
Introduction
to Care Navigation and the Healthcare
Table
Basic Skills
of Contents<<
System
Part 1 << 2
Care Navigation
and Coordination
ABOUT THIS COURSE
To succeed in today’s emerging healthcare models such as health homes, patient-centered
medical homes and accountable care organizations, front line healthcare staff members
increasingly are being asked to serve as a bridge between patients and providers. To
accomplish this, front-line staff members require more advanced skills and training than they
traditionally have received. Specifically, they need patient navigation and care coordination
skills.
Module 4:
Chronic Disease and Behavioral Health
Our “Essentials of Care Navigation” curriculum consists of twenty-four, two-hour classes
that are
structured
to build1on one another sequentially. Medical assistants, patient care
1
Chronic
Health
technicians, certified nurse aides, community health workers, case managers, educators,
and health coaches working in team-based healthcare environments can all benefit from
2
Chronic
Health 2introduces staff to the concepts of patient navigation and care
this course.
The curriculum
coordination, and helps them develop the practical skills needed to provide these services.
3
Adverse Childhood Experiences Study
Students will experience a highly interactive class environment tailored to adult learners. Our
approach strengthens the students’ critical thinking skills by engaging them in discussion,
4
Behavioral
Overview
and Crisis
Management
individual
exercises, Health
and group
activities. Students
complete
the course prepared to assist
their patients in navigating the healthcare system, and to be strong, productive members of
healthcare
providing
coordinated
5 Endteams
of Life
Palliative
Care and patient-centered care.
Module 1
Introduction
to the Patient Navigation and theAbout
Healthcare
System<<
Basic
Skills
this Course
Part 1 << 3
Care Navigation
and Coordination
ABOUT THIS COURSE continued
Course Description:
This course is an introduction to the knowledge, skills, and attitudes necessary to apply
care navigation for the benefit of the client, the first of three courses for a certificate in care
navigation. Focus is on the human and healthcare services systems, client profiles and
needs, communication basics, an introduction to chronic illness, and health coaching. This
course serves as foundational to advanced courses.
Module 4:
Chronic Disease and Behavioral Health
Course Outcomes:
•1 Apply
basic care
navigation
Chronic
Health
1 strategies with activation and engagement strategies when
working with clients and interdisciplinary teams.
• Recognize the impact of demographic, age, physical, emotional, and social aspects of
2 chronic
Chronic
Health
2
disease
and behavioral
health incorporating basic population management
strategies.
•3 Employ
basic health
literacy,Experiences
change, and communication
strategies.
Adverse
Childhood
Study
• Identify end of life issues for the client and family.
• Apply basic knowledge of community human services, medical systems, emerging care
4 coordination
Behavioral
Health
Overview
Crisis Management
models,
law/policy,
ethics,and
and insurance
to individual cases.
• Employ professional boundaries and use effective and culturally sensitive communication
techniques at a fundamental level.
5
End of Life Palliative Care
Module 1
Introduction
to the Patient Navigation and theAbout
Healthcare
System<<
Basic
Skills
this Course
Part 1 << 4
Care Navigation
and Coordination
Module 1:
Introduction to Care Navigation and the Healthcare System
1
Introduction to Client Navigation
2
Introduction to Healthcare Systems/Insurance
3
Client Navigation and Advocacy
4
Client Navigation and the Healthcare Team
5
Overview of Community Systems and Resources
Module Description
This module introduces the complexities of the healthcare system, and the process of care navigation in
assisting the client to maneuver effectively within this system. Care navigation as a service in relationship to
the other members of the medical team will be explored.
Competencies - Upon completion of this module the student will be able to:
•
Navigate the healthcare and human services systems to connect client to resources
•
Apply knowledge of care coordination to facilitate individual plan of care outcomes
•
Use knowledge of one’s own roles and other care team roles to maintain professional boundaries and
responsibilities
•
Apply knowledge of care coordination to facilitate individual plan of care outcomes
Unit 1
Introduction
to Care Navigation
Introduction
and theto
Healthcare
Basic
ClientSkills
Navigation<<
System
Part 1 << 5
Care Navigation
and Coordination
Module 1:
Introduction to Care Navigation
and the Healthcare System
MODULE 1: Intro to Care Navigation and the Healthcare System: This
unit introduces the complexities of the health care system, and the process of care navigation in assisting the client to maneuver effectively
within this system. Care navigation as a service in relationship to the
other members of the medical team will be explored.
Module Competencies: Upon completion of this unit the student
will be able to:
Navigate the healthcare and human services systems to connect client to resources
Apply knowledge of care coordination to facilitate individual plan of
care outcomes
Use knowledge of one’s own roles and other care team roles to maintain professional boundaries and responsibilities
Apply knowledge of care coordination to facilitate individual plan of
care outcomes
Care Navigation and Coordination
Unit 1
Introduction to Basic
ClientSkills
Navigation<<
Part 1 << 6
Unit 1:
Introduction to Client Navigation:
General Understanding of CNav and how it came to be
Unit 1: Learning Objectives
• Define the role and function of care navigation and how it fits
into the care team
• Describe the need for client advocacy and care coordination
in today’s complex health care system
• Identify skills needed for effective client navigation
• Define the role and purpose of care navigation
• Discuss current healthcare legislation, policy and ethics
as it applies to healthcare, including the evolution and
advancement of the care navigation role
Care Navigation and Coordination
Unit 1
Introduction to Basic
ClientSkills
Navigation<<
Part 1 << 7
Group Work
Unit 1 Introduction to Client Navigation
Learner outcomes: During the class, the student will:
Define the role and function of care navigation and how it fits into the care team
Describe the need for client advocacy and care coordination in today’s complex health
care system
Identify skills needed for effective client navigation
Define the role and purpose of care navigation
Define the role and purpose of care navigation
ONLINE MATERIALS
KEY TERMS
Textbook Reading: Module 1 Unit 1 in Essentials of Care
Navigation Online Textbook
Video: “What if Air Travel Worked like Healthcare”
This video discusses the challenges of navigating the
current healthcare system and highlights the need for the
role of a Care Navigator.
Care Navigation
Care Coordination
Advocacy
Affordable Care Act
Triple Aim
Video: “Navigating Mesothelioma Treatment:The Role
of the Patient Navigator”
This video is of a Patient Navigator describing their role
and function when working with clients in the healthcare
system.
Care Navigation and Coordination
Unit 1
Introduction to Client
Basic
Course
Skills
Navigation
Outline<<
Part 1 << 8
Group Work
Unit 1 Introduction to Client Navigation
TALKING POINTS
• Define care navigation
• Brainstorm with class, offer
definition
• Review history of care navigation
• Patient Navigation
• Howard P. Freeman
• Define role of Care Navigator
• Goals
• Skills Needed
• Relation of Care Navigator within
healthcare team
• Scope of Role
• Other roles that Navigators
interface with
• Define client advocacy
• Describe challenges and barriers in
current healthcare system
• Outline need for advocacy and care
coordination
• Describe the Affordable Care Act
• Define Triple Aime Triple
IN CLASS ACTIVITIES
• Powerpoint
• Building a Community Health System Map
• Handout: Self-Management Support through Productive Interactions
• Role of a Care Navigator Activity
DISCUSSION QUESTIONS
• How does Client Navigation differ from other professional roles such as Social Worker,
Counselor, Caregiver, or Nurse?
• What are challenges have you or your family experienced in today’s complex health
care system?
• How could a navigator could have helped you or your family?
• What are skills and qualities needed for an effective Care Navigator?
Care Navigation and Coordination
Unit 1
Introduction to Client
Basic
Course
Skills
Navigation
Outline<<
Part 1 << 9
Group Work
Building a Community Health System Map
Note: Students are cutting up Self-Management Support Through Productive Interaction and Care
Coordination graphics so that the students can think through arranging a new picture of the system and
patient relationship.
Materials for Game:
1. 2 sheets of 11x17 paper for each table group.
2. Large baggie (gallon size) with pieces of Self-Management Support
Through Productive Interactions and Care Coordination graphics printed on card stock and cut up in the
following pieces:
3. Large circle (blank)
4. Medium circle (blank)
5. 9 labeled system circles
6. Productive interaction arrows (2)
7. Measurable improved outcome arrow
8. Labels including:
· The Patient
· Whole person,
· Patient Experience
· Effective Self
· Prevention
· Maintenance
· Informed Activated Patient
· Self-Management Support through Productive Interactions and Care Coordination title
· Factors Affecting Patient Profiling and Learning content rectangle
· Patient Experience content rectangle
Directions: This is a 3-part exercise.
Part One:
•
Provide each team with a large sheet of paper (legal size or 11x17)
•
Ask individuals to take 5 minutes in their group to brainstorm/ list what they believe the
parts of the healthcare system are in the community health services system.
•
Have each group use their ideas to create a picture of the system on the sheet of paper
provided.
•
Have a representative from each group explain the group picture. Collect the pictures
and post on a wall or flip chart.
•
Identify group findings by component of system (system, patient, PN and Team). Discuss
how easy it is to overlook pieces in such a complex system. Link components to course
design.
Care Navigation and Coordination
Unit 1
Introduction to Client
Basic Skills
Navigation
Part 1 << 10
Group Work
Building a Community Health System Map
Part Two:
•
Distribute another legal or larger piece of paper to each group and a baggie with SelfManagement Support through Productive Interactions graphic pieces noted previously in
materials for game above
•
Allow 15 minutes for teams to create a picture using the pieces provided. When satisfied,
they should attach the pieces to the paper using tape or glue stick.
•
Have groups volunteer to share their new pictures. Note the similarities and differences in
personal, group pictures posted on wall.
Part Three:
•
Distribute a Self-Management Support through Productive Interactions and
Care Coordination graphic handout. Have groups compare their graphics to the
completed one. Then ask “What one or two things came up for you as a team as you
compared the two pictures?”
Result: Students will have created a personal and team picture of the system interactions with the
patient without you having to offer a hand out and lecture on what it means. This will give them
a perspective to guide discussions through the rest of the course. The graphic will be used several
times during the course to connect content relevance to the graphic.
Have students summarize what they know about the system. Look at graphic and show that there
are other critical parts. State that the patient and the patient experience is the next topic keeping
in mind that patient profiles affect the interactions with the system and that linking the two are the
first step in putting the healthcare system puzzle together.
Discussion
Open a question and answer period for clarification. Discuss the overall picture of the health and
community services system with emphasis on the components (system, client, Care Navigator and
Team, and Care Navigator Skills). Relate components to course design and how the components
will be integrated throughout the course.
Care Navigation and Coordination
Unit 1
Introduction to Client
Basic Skills
Navigation
Part 1 << 11
Group Work
Role of a Care Navigator Activity
Print out these tables on small cards. Break students up into small groups and have them sort out
whether the activity is within the role of a Care Navigator or should not be done as a Care Navigator.
The role of a Care Navigator:
Work with your client to develop goals
Address any questions or concerns of
clients.
Use plain-language when offering
information and resources to clients.
Work with client to understand
insurance coverage for needed
services.
Uphold HIPAA and confidentiality.
Assist with scheduling and confirming
healthcare appointments.
Ensure transportation and accessibility
barriers are addressed.
Document meetings and client
communications daily.
Assists clients with understanding
their diagnoses.
Refer clients and family to community
resources.
Supports clients with developing
questions for provider and advocating
for services.
Ensuring language translators are
available for clients, as needed.
A Care Navigator should not:
Develop goals for the client
Provide counseling to clients
Help assess to determine a client's
diagnosis
Provide direct healthcare such as
bathing or replacing bandages
Provide opinions on the quality of
medi
Assist with scheduling and confirming
healthcare appointments.
Care Navigation and Coordination
Unit 1
Introduction to Client
Basic Skills
Navigation
Part 1 << 12
Group
Handout
Work
Care Navigation
The Role of a Care Navigator:
•
•
•
•
•
•
Works directly with a client on their health plan
Provides culturally sensitive and client centered services
Works to develop goals with the client
Follows the plan of care with the health care team
Connects with the healthcare team to coordinate services
Refers clients and their family or caregivers to community
resources
• Works to promote accessibility and address barriers to healthcare
The Skills of a Care Navigator:
• Strong interpersonal skills
• Understanding of healthcare systems, health insurance and
medical terminology
• Communication skills both written and verbal
• Documentation skills
• Strong ethics and boundaries
• Knowledge of community resources
• Client activation and engagement skills such as motivational
interviewing
The care navigator works directly with vulnerable clients or clients with new diagnosis to gain access to healthcare services. The role assists clients with creating goals,
scheduling appointments, navigating insurance coverage, and accessing services to
promote positive health outcomes. The care navigator is a lay professional working
within and interdisciplinary team and coordinating services with the client.
Care Navigation and Coordination
Unit 1
Introduction to Client
Basic Skills
Navigation
Part 1 << 13
Group Work
Self Management Support through Productive Interactions and Care Coordination
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nc
e
c
an
e
Behavioral Health
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Larger Medical
Community
Pharmacies
Home Health
Hospice
Medical Equipment
Social Services
ain
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Ma
Medical Management
Clinics
Labs
Radiology
PT/OT
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te e
nc
M
Hospitals
Public Health
Environment, Air,
Water
Other
Insurance
Payment /
Reimbursement
Whole Person, &
Housing
Spiritual Support
EMR
Ethics
Policy
HIPAA
Legal
Advocacy
Insurance
Meals
Home Care
Finances
Interpreters
System Support
Recall
Scheduling
Reinforcement
Follow-up
Healthcare Team
& Navigator
Measurable Improved Outcomes
Clues from environment to
Sensory lters scan clues
preference developed
results
Care Navigation and Coordination
Developed by North-
-7 grant 2015
Unit 1
Introduction to Client
Basic Skills
Navigation
Part 1 << 14
Group Work
Self Management Support through Productive Interactions and Care Coordination
Disease
No disease
One chronic disease
Two or more chronic diseases
Knowledge/Competency Level
Literacy level
Familiarity with disease
Ability to navigate the healthcare system
Computer literacy
Culture/Ethnic Background
Language rst or primary)
Value/belief system
Whole Person, &
Gender
Past Experiences
Family status
Religion
Personality style
Learning style
Readiness to learn
countability
Life Stage
Impairments—physical, mental, social, sensory,
Socio-economic, nancial status
ACE’s—Adverse Childhood Experiences
outcomes.
Developed by North-
Care Navigation and Coordination
-7 grant 2015
Unit 1
Introduction to Client
Basic Skills
Navigation
Part 1 << 15
Unit 2:
Introduction to Healthcare Systems / Insurance:
The big picture of HC
Unit 2: Learning Objectives
• Describe the relevance of insurance in care coordination
• Describe the basics of health insurance and paying for
healthcare services including the differences in Medicare and
Medicaid
• Differentiate between types of insurance, entitlement
programs, and funding sources that pay for healthcare and
how to advocate on the client’s behalf
• Differentiate between the various funding sources that pay
for health care
Unit 2
Introduction to the Healthcare System/Insurance
Basic Skills Part 1 << 16
Care Navigation and Coordination
Group Work
Unit 2 Introduction to Healthcare Systems/Insurance
Learner outcomes: During the class, the student will:
Describe the relevance of insurance in care coordination
Describe the basics of health insurance and paying for healthcare services including
the differences in Medicare and Medicaid
Differentiate between types of insurance, entitlement programs, and funding sources
that pay for healthcare and how to advocate on the client’s behalf
Differentiate between the various funding sources that pay for health care
ONLINE MATERIALS
Textbook Reading: Module 1 Unit 2 in Essentials of Care
Navigation Online Textbook
Video: “What if Your Hotel Bill Was Like a Hospital Bill?”
This video emphasizes the struggle that clients face when
trying to work within the health care system, specifically
with healthcare expenses and billing.
Video: “If Restaurants Were Run Like Hospitals"
This video highlights the unique and at times challenging
experience that clients experience when accessing healthcare.
Video: “Health Insurance Explained- The YouToons Have
it Covered Kaiser Family Foundation"
This video outlines the basics of health insurance, including
accessing, paying for, and using health insurance coverage.
Care Navigation and Coordination
KEY TERMS
Insurance
Care Coordination
Private Insurance
Medicare
Coinsurance
Premium
Deductible
Copayment
Insurance Policy
Unit 1
Introduction to Client
Basic
Course
Skills
Navigation
Outline<<
Part 1 << 17
Group Work
Unit 2 Introduction to Healthcare Systems/Insurance
TALKING POINTS
• Describe Care Coordination and
need for knowledge of insurance
• Patient Access
• Health Outcomes
• Relate to Triple Aim
• Review Health Insurance Options
• Medicaid
• Medicare
• Private
• Employer Based
• Tricare
• Other
• Clarify funding sources for health
insurance
• Review Patient Bill of Rights
• Health Insurance Terms
• Outline options and tips for health
insurance advocacy
• Advocating directly with
providers
• Insurance Appeal Process
• External Reviewple Aim
IN CLASS ACTIVITIES
• Powerpoint
• Insurance Glossary Game
• Patient Bill of Rights Handout
• Glossary of Health Coverage and Medical Terms
DISCUSSION QUESTIONS
• Explain how the hidden costs, confusing insurance coverage, etc. can become a barrier
to patient care.
• From the videos, how could having a navigator provide access to health care?
• What components of the Patient Bill of Rights were you not familiar with? How does
this relate to the role of a Care Navigator?
Care Navigation and Coordination
Unit 1
Introduction to Client
Basic
Course
Skills
Navigation
Outline<<
Part 1 << 18
Group Work
Insurance Glossary Matching Game
Note: This is an easy way to introduce vocabulary without lecture. Groups discuss while figuring out
answers. Most times, no group gets 100% correct. This enables good discussion on why they chose the
answers they did and helps them commit the definitions to memory.
Directions: Give one game board and baggie with word pieces to each group. Allow 5-7 minutes
for groups to match word pieces with definitions on game board.
Discussion: Debrief game by reading definitions and asking what words they chose. Ask why they
picked answers they did. Offer brief and additional information while debriefing game to deliver
rest of content.
Game Pieces: Print on heavy card stock. Cut out rectangles and place in sandwich baggies. Students match word to definition on game board.
Benefit
Long-Term Care
Claim
COBRA
Medicaid
Medicare
Gatekeeper
Health Insurance Exchange
HMO
Point of Service
PPO
Explanation of Benefits
Fee for Service
Risk Sharing
Unit 2
Introduction to the Healthcare Sytems/Insurance
Basic Skills Part 1 << 19
Care Navigation and Coordination
Insurance Glossary Matching Game Board
Gives employees the right to pay premiums for and keep the
group health insurance that they would otherwise lose after
reducing their work hours, quitting their jobs, or losing their jobs.
A form or document that may be sent to individuals by their
insurance company several months after they have had a
healthcare service that was paid by the insurance company
A federal system of health insurance for people over 65 years of
age and for certain younger people with disabilities.
An organization that provides or arranges managed care
for health insurance, self-funded health care benefit plans,
individuals and other entities in US and acts as a liaison with
healthcare providers on a prepaid basis.
A payment model where services are unbundled and paid for
separately. In health care, it gives an incentive for physicians to
provide more treatments because payment is dependent on the
quantity of care, rather than the quality of care.
A health plan that has contracts with medical doctors, hospitals,
and other health care providers that doesn’t require referrals or a
primary care physician.
A physician who is responsible for determining a patient’s
primary services and coordinating the health care services that
are given.
A set of government-regulated and standardized health care
plans in the US from which individuals may purchase health
insurance eligible for federal subsidies.
A principal in which all the people who have contracts with the
health insurance company are sharing the risk that they will
become sick or injured, giving everyone a measure of security at a
relatively low price
Health program for families and individuals with low income and
resources
A healthcare plan that permits covered persons to choose
providers outside the plan’s network yet is designed to encourage
the use of providers in the network.
The amount payable by the insurance company
A variety of services that help meet both the medical and nonmedical needs of people with a chronic illness or disability who
cannot care for themselves for long periods of time.
A demand made by the insured or the insured’s beneficiary for
payment of the benefits provided by the policy.
Insurance Glossary Matching Answers
Claim
A demand made by the insured or the insured’s beneficiary for
payment of the benefits provided by the policy.
Point of Service
A healthcare plan that permits covered persons to choose
providers outside the plan’s network yet is designed to encourage
the use of providers in the network.
Medicare
A federal system of health insurance for people over 65 years of
age and for certain younger people with disabilities.
HMO An organization that provides or arranges managed
care for health insurance, self-funded health care benefit plans,
individuals and other entities in US and acts as a liaison with
healthcare providers on a prepaid basis.
Fee for Service A payment model where services are unbundled
and paid for separately. In health care, it gives an incentive for
physicians to provide more treatments because payment is
dependent on the quantity of care, rather than the quality of care.
Long-Term Care
A variety of services that help meet both the medical and nonmedical needs of people with a chronic illness or disability who
cannot care for themselves for long periods of time.
COBRA
Gives employees the right to pay premiums for and keep the
group health insurance that they would otherwise lose after
reducing their work hours, quitting their jobs, or losing their jobs.
Benefit
The amount payable by the insurance company
PPO
A health plan that has contracts with medical doctors, hospitals,
and other health care providers that doesn’t require referrals or a
primary care physician.
Gatekeeper
A physician who is responsible for determining a patient’s
primary services and coordinating the health care services that
are given.
Health Insurance Exchange
A set of government-regulated and standardized health care
plans in the US from which individuals may purchase health
insurance eligible for federal subsidies.
Risk-Sharing A principal in which all the people who have
contracts with the health insurance company are sharing the risk
that they will become sick or injured, giving everyone a measure
of security at a relatively low price
Medicaid
Health program for families and individuals with low income and
resources
Explanation of Benefits
A form or document that may be sent to individuals by their
insurance company several months after they have had a
healthcare service that was paid by the insurance company
Group
Handout
Work
The Patients Bill of Rights Handout
The Affordable Care Act puts consumers back in charge of their health care. Under the law, a new
"Patient's Bill of Rights" gives the American people the stability and flexibility they need to make
informed choices about their health.
• Provides Coverage to Americans with Pre-existing Conditions: You may be eligible for health coverage under the Pre-Existing Condition Insurance Plan.
• Protects Your Choice of Doctors: Choose the primary care doctor you want from your plan's network.
• Keeps Young Adults Covered: If you are under 26, you may be eligible to be covered under your
parent's health plan.
• Ends Lifetime Limits on Coverage: Lifetime limits on most benefits are banned for all new health
insurance plans.
• Ends Pre-Existing Condition Exclusions for Children: Health plans can no longer limit or deny benefits to children under 19 due to a pre-existing condition.
• Ends Arbitrary Withdrawals of Insurance Coverage: Insurers can no longer cancel your coverage
just because you made an honest mistake.
• Reviews Premium Increases: Insurance companies must now publicly justify any unreasonable rate
hikes.
• Helps You Get the Most from Your Premium Dollars: Your premium dollars must be spent primarily
on health care - not administrative costs.
• Restricts Annual Dollar Limits on Coverage: Annual limits on your health benefits will be phased
out by 2014.
• Removes Insurance Company Barriers to Emergency Services: You can seek emergency care at a
hospital outside of your health plan's network.
Since the Patient's Bill of Rights was enacted, the Affordable Care Act has provided additional rights
and protections.
The health care law:
• Covers Preventive Care at No Cost to You: You may be eligible for recommended preventive health
services. No copayment.
• Guarantees Your Right to Appeal: You now have the right to ask that your plan reconsider its denial
of payment.
https://www.whitehouse.gov/fi les/documents/healthcare-fact-sheets/patients-bill-rights.pdf
Unit 2
Introduction to the Healthcare Sytems/Insurance
Basic Skills Part 1 << 22
Care Navigation and Coordination
Glossary of Health Coverage and Medical Terms
∞ This glossary has many commonly used terms, but isn’t a full list. These glossary terms and definitions are intended
to be educational and may be different from the terms and definitions in your plan. Some of these terms also
might not have exactly the same meaning when used in your policy or plan, and in any such case, the policy or plan
governs. (See your Summary of Benefits and Coverage for information on how to get a copy of your policy or plan
document.)
∞ Bold blue text indicates a term defined in this Glos sary.
∞ See page 4 for an example showing how deductibles, co-insurance and out-of-pocket limits work together in a real
life situation.
Allowed Amount
Co-payment
Maximum amount on which payment is based for
covered health care services. This may be called “eligible
expense,” “payment allowance" or "negotiated rate." If
your provider charges more than the allowed amount, you
may have to pay the difference. (See Balance Billing.)
A fixed amount (for example, $15) you pay for a covered
health care service, usually when you receive the service.
The amount can vary by the type of covered health care
service.
Appeal
The amount you owe for
health care services your
health insurance or plan
covers before your health
insurance or plan begins
Jane pays
Her plan pays
to pay. For example, if
100%
0%
your deductible is $1000,
(See page 4 for a detailed example.)
your plan won’t pay
anything until you’ve met
your $1000 deductible for covered health care services
subject to the deductible. The deductible may not apply
to all services.
A request for your health insurer or plan to review a
decision or a grievance again.
Balance Billing
When a provider bills you for the difference between the
provider’s charge and the allowed amount. For example,
if the provider’s charge is $100 and the allowed amount
is $70, the provider may bill you for the remaining $30.
A preferred provider may not balance bill you for covered
services.
Co-insurance
Your share of the costs
of a covered health care
service, calculated as a
percent (for example,
20%) of the allowed
amount for the service.
Jane pays
Her plan pays
You pay co-insurance
20%
80%
plus any deductibles (See page 4 for a detailed example.)
you owe. For example,
if the health insurance or plan’s allowed amount for an
office visit is $100 and you’ve met your deductible, your
co-insurance payment of 20% would be $20. The health
insurance or plan pays the rest of the allowed amount.
Complications of Pregnancy
Conditions due to pregnancy, labor and deliv ery that
require medical care to prevent serious harm to the health
of the mother or the fetus. Morning sickness and a nonemergency caesarean section aren’t complications of
pregnancy.
Glossary of Health Coverage and Medical Terms
Deductible
Durable Medical Equipment (DME)
Equipment and supplies ordered by a health care provider
for everyday or extended use. Coverage for DME may
include: oxygen equipment, wheelchairs, crutches or
blood testing strips for diabetics.
Emergency Medical Condition
An illness, injury, symptom or condition so serious that a
reasonable person would seek care right away to avoid
severe harm.
Emergency Medical Transportation
Ambulance services for an emergency medical condition.
Emergency Room Care
Emergency services you get in an emergency room.
Emergency Services
Evaluation of an emergency medical condition and
treatment to keep the condition from getting worse.
OMB Control Numbers 1545-2229, 1210-0147, and 0938-1146
Page 1 of 4
Excluded Services
Health care services that your health insurance or plan
doesn’t pay for or cover.
Grievance
A complaint that you communicate to your health insurer
or plan.
Habilitation Services
Health care services that help a person keep, learn or
improve skills and functioning for daily living. Examples
include therapy for a child who isn’t walking or talking at
the expected age. These services may include physical and
occupational therapy, speech-language pathology and
other services for people with disabilities in a variety of
inpatient and/or outpatient settings.
Health Insurance
A contract that requires your health insurer to pay some
or all of your health care costs in exchange for a
premium.
Home Health Care
Health care services a person receives at home.
Hospice Services
Services to provide comfort and support for persons in
the last stages of a terminal illness and their families.
Hospitalization
Care in a hospital that requires admission as an inpatient
and usually requires an overnight stay. An overnight stay
for observation could be outpatient care.
Hospital Outpatient Care
Care in a hospital that usually doesn’t require an
overnight stay.
In-network Co-insurance
The percent (for example, 20%) you pay of the allowed
amount for covered health care services to providers who
contract with your health insurance or plan. In-network
co-insurance usually costs you less than out-of-network
co-insurance.
In-network Co-payment
A fixed amount (for example, $15) you pay for covered
health care services to providers who contract with your
health insurance or plan. In-network co-payments usually
are less than out-of-network co-payments.
Glossary of Health Coverage and Medical Terms
Medically Necessary
Health care services or supplies needed to prevent,
diagnose or treat an illness, injury, condition, disease or
its symptoms and that meet accepted standards of
medicine.
Network
The facilities, providers and suppliers your health insurer
or plan has contracted with to provide health care
services.
Non-Preferred Provider
A provider who doesn’t have a contract with your health
insurer or plan to provide services to you. You’ll pay
more to see a non-preferred provider. Check your policy
to see if you can go to all providers who have contracted
with your health insurance or plan, or if your health
insurance or plan has a “tiered” network and you must
pay extra to see some providers.
Out-of-network Co-insurance
The percent (for example, 40%) you pay of the allowed
amount for covered health care services to providers who
do not contract with your health insurance or plan. Outof-network co-insurance usually costs you more than innetwork co-insurance.
Out-of-network Co-payment
A fixed amount (for example, $30) you pay for covered
health care services from providers who do not contract
with your health insurance or plan. Out-of-network copayments usually are more than in-network co-payments.
Out-of-Pocket Limit
The most you pay during a
policy period (usually a
year) before your health
insurance or plan begins to
pay 100% of the allowed
amount. This limit never
Jane pays
Her plan pays
includes your premium,
0%
100%
balance-billed charges or
(See page 4 for a detailed example.)
health care your health
insurance or plan doesn’t cover. Some health insurance
or plans don’t count all of your co-payments, deductibles,
co-insurance payments, out-of-network payments or
other expenses toward this limit.
Physician Services
Health care services a licensed medical physician (M.D. –
Medical Doctor or D.O. – Doctor of Osteopathic
Medicine) provides or coordinates.
Page 2 of 4
Plan
A benefit your employer, union or other group sponsor
provides to you to pay for your health care services.
Preauthorization
A decision by your health insurer or plan that a health
care service, treatment plan, prescription drug or durable
medical equipment is medically necessary. Sometimes
called prior authorization, prior approval or
precertification. Your health insurance or plan may
require preauthorization for certain services before you
receive them, except in an emergency. Preauthorization
isn’t a promise your health insurance or plan will cover
the cost.
Preferred Provider
A provider who has a contract with your health insurer or
plan to provide services to you at a discount. Check your
policy to see if you can see all preferred providers or if
your health insurance or plan has a “tiered” network and
you must pay extra to see some providers. Your health
insurance or plan may have preferred providers who are
also “participating” providers. Participating providers
also contract with your health insurer or plan, but the
discount may not be as great, and you may have to pay
more.
Provider
A physician (M.D. – Medical Doctor or D.O. – Doctor
of Osteopathic Medicine), health care professional or
health care facility licensed, certified or accredited as
required by state law.
Reconstructive Surgery
Surgery and follow-up treatment needed to correct or
improve a part of the body because of birth defects,
accidents, injuries or medical conditions.
Rehabilitation Services
Health care services that help a person keep, get back or
improve skills and functioning for daily living that have
been lost or impaired because a person was sick, hurt or
disabled. These services may include physical and
occupational therapy, speech-language pathology and
psychiatric rehabilitation services in a variety of inpatient
and/or outpatient settings.
Skilled Nursing Care
Services from licensed nurses in your own home or in a
nursing home. Skilled care services are from technicians
and therapists in your own home or in a nursing home.
Specialist
The amount that must be paid for your health insurance
or plan. You and/or your employer usually pay it
monthly, quarterly or yearly.
A physician specialist focuses on a specific area of
medicine or a group of patients to diagnose, manage,
prevent or treat certain types of symptoms and
conditions. A non-physician specialist is a provider who
has more training in a specific area of health care.
Prescription Drug Coverage
UCR (Usual, Customary and Reasonable)
Premium
Health insurance or plan that helps pay for prescription
drugs and medications.
Drugs and medications that by law require a prescription.
The amount paid for a medical service in a geographic
area based on what providers in the area usually charge
for the same or similar medical service. The UCR
amount sometimes is used to determine the allowed
amount.
Primary Care Physician
Urgent Care
Prescription Drugs
A physician (M.D. – Medical Doctor or D.O. – Doctor
of Osteopathic Medicine) who directly provides or
coordinates a range of health care services for a patient.
Care for an illness, injury or condition serious enough
that a reasonable person would seek care right away, but
not so severe as to require emergency room care.
Primary Care Provider
A physician (M.D. – Medical Doctor or D.O. – Doctor
of Osteopathic Medicine), nurse practitioner, clinical
nurse specialist or physician assistant, as allowed under
state law, who provides, coordinates or helps a patient
access a range of health care services.
Glossary of Health Coverage and Medical Terms
Page 3 of 4
more
costs
Jane pays
more
costs
Out-of-Pocket Limit: $5,000
Her plan pays
80%
Jane reaches her $1,500
deductible, co-insurance begins
Jane has seen a doctor several times and
paid $1,500 in total. Her plan pays some
of the costs for her next visit.
Office visit costs: $75
Jane pays: 20% of $75 = $15
Her plan pays: 80% of $75 = $60
20%
Co-insurance: 20%
How You and Your Insurer Share Costs - Example
Jane’s Plan Deductible: $1,500
0%
Her plan pays
January 1st
Beginning of Coverage
Period
Jane pays
100%
Jane hasn’t reached her
$1,500 deductible yet
Her plan doesn’t pay any of the costs.
Office visit costs: $125
Jane pays: $125
Her plan pays: $0
Glossary of Health Coverage and Medical Terms
Jane pays
0%
st
December 31
End of Coverage Period
Her plan pays
100%
Jane reaches her $5,000
out-of-pocket limit
Jane has seen the doctor often and paid
$5,000 in total. Her plan pays the full
cost of her covered health care services
for the rest of the year.
Office visit costs: $200
Jane pays: $0
Her plan pays: $200
Page 4 of 4
Unit 3:
Client Navigation and Advocacy:
What is CNav, How It Differs From Other Roles
Unit 3: Learning Objectives
• Define advocacy
• State the purpose of Client Navigation
• Identify the processes used to coordinate and make referrals
to community resources
• Identify strategies to advocate for a client during
appointments that impact the client's health and wellness
Care Navigation and Coordination
Unit 3
Client Navigation
Basic
and
Skills
Advocacy<<
Part 1 << 27
Unit 3 Client Navigation and Advocacy
Learner outcomes: During the class, the student will:
Define Advocacy
State the purpose of Client Navigation
Identify the processes used to coordinate and make referrals to community resources
Identify strategies to advocate for a client during appointments that impact the client’s
health and wellness
ONLINE MATERIALS
Textbook Reading: Module 1 Unit 3 in Essentials of Care
Navigation Online Textbook
Video: “The Important Role of Nurse Patient Advocates”
This video describes the role of a Nurse Patient Advocate
that highlights the advocacy role of a Care Navigator and
the important impact of advocacy for client’s health outcomes.
Video: “Health Advocate Patient Advocacy"
This video describes the components of Healthcare Advocacy and their role to improve patient involvement, improving healthcare safety and increasing patient centered
care.
Care Navigation and Coordination
KEY TERMS
Advocacy
Referrals
Resources
Wellness
Health Outcomes
Unit 3
Client Navigation
Basic
Course
and
Skills
Advocacy<<
Outline<<
Part 1 << 28
Unit 3 Client Navigation and Advocacy
TALKING POINTS
• Define Advocacy
• Health Advocacy
• Client Advocacy
• Policy Advocacy
• Client Centered Advocacy
• Discuss the purpose of Client
Navigation
• Brainstorm in small groups
• Present to class
• Movement of client through
healthcare continuum
• Refer to Triple Aim
• Resources and Referrals
• Healthcare referrals
• Social Service referrals
• How to make effective referral
• Accuracy of information
• Timely referral
• Coordinating with resource
• Empowering client
• Written and verbal information
• Strategies for Client Advocacy
IN CLASS ACTIVITIES
• Powerpoint
• Case Scenario Referral Activity
DISCUSSION QUESTIONS
• When considering your role as an advocate, at what level should you involve clients
when advocating for access to healthcare?
• What scenarios would you not want to involve the client?
• How can you ensure that your clients access referrals?
• How do you empower clients during the advocacy and referral process?
• How would you describe the importance of client centered advocacy as a Care
Navigator?
Care Navigation and Coordination
Unit 3
Client Navigation
Basic
Course
and
Skills
Advocacy<<
Outline<<
Part 1 << 29
Group Work
Unit 3 Activity
Break up the class into small groups. Assign each group a case scenario. Have them develop
answers to the following prompts.
•
•
•
What barriers might these clients face when accessing resources?
Brainstorm a list of resources to refer this client to.
What are strategies you would use to ensure that your referral is effective and utilized
by the client?
Have the groups come together and present their work to the class.
Patient: Melvin Garcia
Age: 18
Patient Background:
Melvin is an 18 year old, Hispanic male. He has become more and more involved in the drug and
gang scene in the urban area where he lives. He is a senior in High School and is on track to maybe
graduate this spring- this depends on him bringing his grades up. Currently, Melvin is failing math
and history. Melvin has an older brother who went to college and a younger sister who is a few
years behind him in school. His brother suffers from mental health issues, though he is not sure
really what that means. His sister has significant asthma issues.
Melvin’s mother works 2 jobs to support her children, Melvin does not know his father and does not
have a father figure in his life since his brother moved away. Melvin has been tested by his school
as being above average intelligence and they are encouraging him to get his act together to take
some college courses next year. Melvin loves literature and the classics and is always reading a book
when he is home or in school, however he is embarrassed to do this when he is around his friends.
Melvin lives with his mother and younger sister in subsidized housing. Melvin does not work and
relies on his mother for any spending money he has. He is inactive, drinks large sodas and eats fast
food daily. Melvin’s family struggles to make ends meet financially.
Medical History:
Melvin has a primary physician he sees on occasion. He has been on an antidepressant for many
years. Melvin struggles with allergies which often exacerbate his asthma issues. He has had 4 ER
visits in the last 6 months due to this. Melvin smokes both marijuana and cigarettes.
Melvin has, in the past, seen counselors for an abuse history. In the past, he lived with an uncle who
was physically and mentally abusive towards him. Melvin has struggled to remain consistent in
addressing his mental health issues.
Medications:
Prozac 20mg/ day
Albuterol 2 puffs as needed for shortness of breath
Patient: Jessica Samford
Age: 54
Care Navigation and Coordination
Unit 3
Client Navigation
Basic
and
Skills
Advocacy<<
Part 1 << 30
Group Work
Unit 3 Activity Continued
Patient Background:
Jessica is a 54 year old woman who has struggled with crippling depression all her life. She has
had 2 suicide attempts, one at age 18 and one at 21. She has no husband and no children and still
lives at home with her mother. Jessica’s mother is aging and struggling with dementia. Jessica is
overwhelmed in trying to provide her care and has made a 3rd attempt on her own life. She has
shot herself in the stomach and is now unable to walk. While she was in the hospital, her mother
was placed in an assisted living facility. Jessica is no longer hospital level of care and was recently
discharged to a local homeless shelter. She is currently receiving intensive outpatient therapy at a
local clinic. Jessica has a 10th grade education and struggles with reading and writing. There has
been some speculation that she has some intellectual disabilities.
Medical History:
Jessica has had 2 previous suicide attempts, one by overdose, one by cutting her wrists. She has
distinct scars from not only this attempt, but a lifelong behavior of cutting. Jessica is severely overweight and has developed diabetes, COPD, CHF and sleep apnea. She needs a machine to sleep at
night and is on 2 units of continuous oxygen. Jessica does not have a good history of managing her
chronic conditions, she often misses appointments and medication doses. Jessica has severe shellfish allergies and an allergy to strawberries.
Medications:
Metformin 40mg twice a day for diabetes.
Paxil 20 mg per day for depression.
Coumadin 5 mg per day to thin her blood and prevent stroke.
Codeine 5mg up to four times a day for pain control.
Amoxicillin 500mg three times a day to control an infection in her wound.
Marinol 2.5 mg BID for pain.
Combivent 2 puffs 4 times per day.
Care Navigation and Coordination
Unit 3
Client Navigation
Basic
and
Skills
Advocacy<<
Part 1 << 31
Unit 4:
Client Navigation and the Health Care Team:
How CNav Works in the HC Team
Unit 4: Learning Objectives
• Explain the importance of ongoing communication with the
interdisciplinary team, client and family
• Describe the significance of working as part of an
interdisciplinary team and how client care navigation fits as a
function on the team
• Explain the relationship between care coordination, plan of
care, and continuum of care
• Compare and contrast the clinical and non-clinical roles of
staff providing care coordination
Unit 4
Client Navigation and the Basic
Healthcare
Skills Part
Team
1 << 32
Care Navigation and Coordination
Unit 4 Client Navigation and the Healthcare Team
Learner outcomes: During the class, the student will:
Explain the importance of ongoing communication with the interdisciplinary team,
client and family
Describe the significance of working as part of an interdisciplinary team and how
client care navigation fits as a function on the team
Explain the relationship between care coordination, plan of care, and continuum of
care
Compare and contrast the clinical and non-clinical roles of staff providing care
coordination
ONLINE MATERIALS
Textbook Reading: Module 1 Unit 4 in Essentials of Care
Navigation Online Textbook
Video: “Interdisciplinary Collaboration in Healthcare
Teams”
This video describes the barriers and benefits of
interdisciplinary teams in Canadian healthcare and helps
with identifying skills needed for collaboration.
Video: “Cultivating Collaboration"
This TED talk describes collaboration dynamics and
behaviors that create healthy and unhealthy collaboration
within groups.
Video: “Collaboration Across Professions Improves
Patient Outcomes"
This video shows the impact of interdisciplinary teams
on the patient experience. It highlights the how meeting
patients in their home can help bring their needs to the
healthcare team to ensure coordinated care and improved
health outcomes.
KEY TERMS
Interdisciplinary Team
Care Coordination
Plan of Care
Continuum of Care
Unit 4
Client Navigation and the Basic
Healthcare
Course
SkillsOutline<<
Part
Team
1 << 33
Care Navigation and Coordination
Unit 4 Client Navigation and the Healthcare Team
TALKING POINTS
• Defining interdisciplinary teams
• Roles on interdisciplinary teams
• Clinical vs. Non-clinical
• How roles may interact
• How Care Navigator fits within
team
• Communication within
Interdisciplinary Teams
• Essential skills
• Role of technology within
communication
• Challenges and strategies
• Care Navigation and function on
team
• Define Care Coordination Role
• Significance of role
• Plan of Care
• How it is created
• How each role on
interdisciplinary team interfaces
with plan of care
• Continuum of Care
• How this informs clients plan of
care
IN CLASS ACTIVITIES
• Box Top Memory Game
• Interdisciplinary Teams Activity
DISCUSSION QUESTIONS
• What are some potential barriers to communication within the healthcare team?
• What are essential skills as a Care Navigator when working within a healthcare team?
• How can technology aid or hinder work within a healthcare team?
Unit 4
Client Navigation and the Basic
Healthcare
Course
SkillsOutline<<
Part
Team
1 << 34
Care Navigation and Coordination
Group Work
Box Top Memory Game
This is a very easy game to play to drive home the importance of working with a team. It
takes no more than 20 minutes including discussion for a class size of 16.
•
Find a large flat box top. Paper box lids are the perfect size. The box top should be large
enough to spread out 15 items across the bottom of the box.
•
Arrange 15 items in the bottom of the box. Items from offices work fine, such as pencil,
colored pens, paper clips, Post-it notes, erasers, binder clips, index cards, rulers, letter
openers, coins or anything small enough for the box. Use your Imagination!
•
Provide for one Box Top Memory Game Worksheet for each student. See Appendix
•
Advise students that they will have 30 seconds to observe the contents of the box.
•
Hold the box in the center of each table for 30 seconds.
•
After all students have observed the contents, ask them to record from memory all of the
items in the box in the appropriate column of their worksheet. Allow 1-2 minutes only.
•
Next, have each student talk with others in the room (not their table team) to record items
they may have missed in the Peer Column. Allow 3 or 4 minutes for this.
•
Finally, have table teams coordinate their lists and add missing items to the Team Column.
Discussion:
•
Ask how many items people recorded as individuals. More than 5, more than 10, anyone
capture all 15?
•
Did you find all 15 items talking to others in the walk around?
•
After your team consulted, how many items did you find? Many will have all 15 items but
definitely more than they captured individually.
•
Ask: “What can you draw from this exercise that might relate to navigation and the team?
Students will begin speaking about the benefits of teamwork.
•
Ask: “What would be the advantages and disadvantages of working with the medical team
closely in advocating for the patient?”
Unit 4
Client Navigation and theBasic
Healthcare
Skills Part
Team<<
1 << 35
Care Navigation and Coordination
Group Work
Box Top Memory Game Worksheet
Box Top Memory Game Worksheet
My Memory
Peer Memory (Walk Around)
Team Memory
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Unit 4
Client Navigation and theBasic
Healthcare
Skills Part
Team<<
1 << 36
Care Navigation and Coordination
Group Work
Interdisciplinary Teams Activity
Review the following websites before completing this assignment:
•
Who’s Who on the Health Care Team: An Interdisciplinary Approach http://www.studentdoctor.net/2007/10/whos-who-on-the-health-care-team-an-interdisci
plinary-approach/
•
Interdisciplinary Team Issues
https://depts.washington.edu/bioethx/topics/team.html
Assignment:
•
Create a list of at least 5 different medical providers and care-givers you can think of who
could be involved in patient care. Compare and contrast their roles providing care.
•
Create a fictional patient who will need to access the services and any diagnosis they may
have.
•
Describe at least 3 barriers that could cause your patient difficulty in accessing care.
•
Describe how you, as the Care Navigator, would work with the patient to coordinate their
care.
•
Explain the importance of ongoing communication within the team and client.
•
Describe how the Care Navigator fits and their function on an interdisciplinary team.
Example:
Patient: Beverly Smith has bladder cancer and diabetes.
Providers/Care-Givers:
Primary Care Physician:
Endocrinologist
Radiation Therapist
Nutritionist
Behavioral Health Counselor
Barriers: Beverly Smith cannot drive, needs transportation to all appointments; Beverly is on public
assistance and has a very limited food budget; Beverly does not like her providers and is unkind to
them because she is stressed and overwhelmed by the variety of expectations she is responsible for.
Navigator: I would meet with Mrs. Smith to discuss her situation, her feelings, and help create goals
for her health care. I would work with her to coordinate appointments to ensure they are close to
each other to address transportation barriers. I would work with Mrs. Smith to prioritize the top
three goals to help limit the amount of expectation she is feeling.
Unit 4
Client Navigation and theBasic
Healthcare
Skills Part
Team<<
1 << 37
Care Navigation and Coordination
Unit 5:
Overview of Community Systems and Resources
Unit 5: Learning Objectives
• Define eligibility
• Explain the processes to establish eligibility for resources
• Identify the processes used to refer clients to the appropriate
• Level of care after determining eligibility to receive support
• Describe the role of care coordination in client navigation
throughout the continuum of care
Unit 5
Overview of System and Community
Basic Skills
Resources<<
Part 1 << 38
Care Navigation and Coordination
Unit 5 Overview of Community Systems and Resources
Learner outcomes: During the class, the student will:
Define eligibility
Explain the processes to establish eligibility for resources
Identify the processes used to refer clients to the appropriate level of care after determining eligibility to receive support
Describe the role of care coordination in client navigation throughout the continuum
of care
ONLINE MATERIALS
Textbook Reading: Module 1 Unit 5 in Essentials of Care
Navigation Online Textbook
Video: “Kahn Academy's Maslow's Hierarchy of Needs"
This video outlines Maslow’s Hierarchy of Needs to help
inform students on how to prioritize needs of clients, when
beginning to make referrals.
KEY TERMS
Eligibility
Resource
Referral
Continuum of Care
Barriers
Accessibility
Unit 5
Overview of System and Community
Basic
Course
Skills
Resources<<
Outline<<
Part 1 << 39
Care Navigation and Coordination
Unit 5 Overview of Community Systems and Resources
TALKING POINTS
• What is an Effective Referral?
• Identify Client Needs
• Prioritize Client Needs
• Client centered
• Review Resources
• Develop steps for effective
referral
• Collaborating with resources
• Considering accessibility
• Follow up
• Maslow’s Hierarchy of needs
• Look at whole person perspective
• Client centered services
• Common Eligibility considerations
• Income/Assets
• Age
• Insurance
• Disability
• Others/List
• When to make referrals
• Barriers to referrals
• How to address barriers
• Empowerment vs enabling
• Referrals through continuum of care
• Ensuring resource information is
accurate
• Networking
• Credible/less credible online
sources
IN CLASS ACTIVITIES
• Powerpoint
• Eligibility Assessment Activity
• Eligibility and Referral Road Map Activity
DISCUSSION QUESTIONS
• What are some unexpected barriers that may arise when connecting a client with
resources?
• What are some strategies that may help to ensure a client is able to access resources?
• How could technology assist in the eligibility and referral process?
Unit 5
Overview of System and Community
Basic
Course
Skills
Resources<<
Outline<<
Part 1 << 40
Care Navigation and Coordination
Group Work
Eligibilty and Referral Road Map Activity
Partner up students in groups of 2-3. On a large piece of paper, have them list important
pieces of information needed to determine eligibility for social and health services.
If a computer lab is available, have students develop a mock intake form for students to be able to
gather this information on 1-2 sheets of paper.
If possible, have students use laptops, a computer lab, or smart phones to begin to develop a
list of resources. Have students create individualized plans on how they will:
•
•
•
Keep up to date on new resources
Have resource information handy during client meetings
Ensure resource information is accurate
Have students journal in class for 2-5 minutes and then share with the group what strategies will be
used.
Unit 5
Overview of System and Community
Basic Skills
Resources<<
Part 1 << 41
Care Navigation and Coordination
Group Work
Eligibilty and Referral Road Map Activity
For this activity, students will be creating an eligibility and resource referral road map for a
client. On a large poster paper, have students outline the steps in a flow chart that a Care Navigator would
take to determine a client’s eligibility for community resources, what resources are available, and
how to refer clients to the appropriate level of care. Outline very practice steps you would take to
highlight the main phases, steps, and information needed throughout the referral process. You can
use a general client or if you want to make a case scenario and apply the process to that scenario to
help you, feel free.
Students can draw a visual road map, create a written outline, or draw images to help describe the
process.
Unit 5
Overview of System and Community
Basic Skills
Resources<<
Part 1 << 42
Care Navigation and Coordination