NavWell: Pathways to Wellbeing

Program Description

NavWell is a secure, web-based software solution for youth with behavioral health challenges, facilitating real time connection between Primary Care and Behavioral Health providers. It was designed by practitioners in the medical and behavioral fields as a platform for care coordination, communication and decision support. NavWell provides access to tools and resources endorsed by trusted medical and behavioral health associations such as the American Academy of Pediatrics, the National Institute of Mental Health, and the Substance Abuse and Mental Health Services Administration. Best practice assessments, such as the PHQ 9, the Vanderbilt Scales, the Modified Checklist for Autism in Toddlers (M-CHAT), and the GAD 7, are tracked over time, enabling health professionals to better identify and address anxiety, depression, trauma exposure, nutritional risks, ADHD/ADD, substance use, and autism spectrum disorders. NavWell is a mobile-compatible software which assists in assessments, referrals and communications between primary care and behavioral health care specialists. Patient information in NavWell is secure and protected. NavWell is designed to be flexible for any sized practice and is compatible with existing health information systems & technology, to handle input from practitioners, parents, teachers, and most importantly, the families of children and adolescents in need of coordinated care.

Creativity

By facilitating connections between EMR’s, NavWell integrates seamlessly into the existing system by serving as a bridge between primary care and behavioral health. In this way, NavWell saves time, improves access, reduces error, and facilitates ongoing communication and coordination between providers. When a patient arrives for their appointment, the front office staff greeting them can identify the purpose of their visit and choose an appropriate screening tool for initial assessment. For example, a 15-year old patient may complete a PHQ-9 for depression. Once completed, the assessment is automatically scored in NavWell and the primary care provider receives information on symptom severity, treatment options, and referral recommendations based on demographics and symptoms. NavWell is an inventive solution designed to support and connect primary care providers in screening, referring, and coordinating behavioral health care for youth by using application program interfaces to link existing EMR’s across current primary care behavioral health systems.

Leadership

Upon identifying children’s behavioral health as priority in grant making, LOHF launched a research project to understand our landscape and needs by analyzing National and State data. This needs assessment included conducting local focus groups, interviews, and phone surveys, which resulted in an entirely new grant making portfolio for LOHF. Out of this portfolio, LOHF created NavWell with intent for easy adoption in current health systems, based on needs of various end users. As the ongoing pilot effort begins to see patients, we anticipate sharing our findings, broadening the field of children’s behavioral health with publications, and presenting results widely. Our robust team includes an Advisory Council of behavioral health providers, health system representatives, attorneys, psychiatrists, county behavioral health leadership, and foundations. This team also works with a Research and Evaluation Subcommittee of statisticians, behavioral health care leadership, and primary care providers to collect baseline data and disseminate preliminary results.

Sustainability

Foundations often seek to identify needs and gaps in community resources, in order to best allocate funding to the highest and best use for maximum impact. In this way, LOHF has created NavWell as a solution that health systems, big and small, can easily adopt to fill a need. LOHF inherently and organically engaged the community at large at every turn over the last 4 years. As NavWell continues to grow, the multidisciplinary partnership grows between LOHF/sponsor, Advanced Metrics/software architects and experts in implementation science, and coLAB/program manager with a focus on community engagement. Given these organization’s investment and inclination for mission driven work as partners, capacity building and overall end user/stakeholder engagement remains at the epicenter of program continuity. There is a commercialization plan to meet greater market demand for care coordination, indicating NavWell will continue to see financial and community support over time and beyond the pilot.

Replicability

NavWell benefits from a proven, structured implementation science model for the pilot that includes five steps, which can be easily replicated to other organizations. Engage At pilot launch, we engage with the practice to identify key stakeholder(s) in the practice, the EMR involved, and obtain necessary information to implement NavWell. Assess Administer a readiness assessment to implement NavWell. This will help ascertain level of familiarity with the assessments, the technology in the office, and optimal workflow to incorporate NavWell into practice protocols. Onboard Bring the practice online in a Cloud infrastructure, and work with EMR vendor to make necessary connections between NavWell/EMR. Train Conduct training sessions for practice on system utilization, to answer questions and conduct follow-on webinars as new features are added to the system. Operate Regular contact via in person/phone meetings for feedback/support/ongoing training. NavWell enhances information flow for practitioners, not supplanting current system(s).

Results/Outcomes

The NavWell pilot will equip primary care providers with a utility belt of proven, scientifically-valid and professionally-vetted assessment tools to measure the severity and change-over-time of specific behavioral/emotional/psychosocial conditions such as anxiety, depression, trauma exposure, nutritional risk, ADHD/ADD, bipolar, domestic violence, and substance abuse. The diagnostic and screening tools are self-administered by the caregiver or youth and have been proven reliable for this population. Change over time, as reflected in NavWell, supports the relationship between the measure and the clinical outcomes. Once treatment has started, the same instrument can be used to determine progress and treatment efficacy for youth. The anticipated outcomes would demonstrate improvement or stability in condition, effectiveness in care coordination and communication, decreased time between visits, less wait time to see a behavioral health provider. This data will empower all partners, and specifically the Research/Evaluation Subcommittee, to use an iterative and robust approach to analyzing outcomes.