Trauma-Informed Program Assessment: NAVIGATE Program
Introduction
Established in 1912, Erie County Medical Center (ECMC) has grown to become one of the area’s leading healthcare providers, one of the country’s most modern and operational healthcare delivery systems, and one of the best regional center’s for trauma and behavioral health. ECMC strives to provide each patient with the highest quality of care which includes access to services, dignity, privacy, collaboration, and excellence. Amongst all of the services provided by ECMC, the award winning hospital also is responsible for over 30 outpatient specialty services, one of which includes the Adult, Child and Family Outpatient Behavioral Health Clinic. The ECMC Adult, Child and Family Outpatient Behavioral Health Clinic strives to assist patients across the spectrum of mental health concerns with comprehensive treatment such as daily mental health intake assessments, individual and group sessions, medication monitoring and evaluation, dually diagnosed treatment, psychiatric disorders, and much more.
One particular program that can be found within ECMC’s Adult, Child and Family Outpatient Behavioral Health Clinic is the NAVIGATE Program. NAVIGATE is a comprehensive program proposed to provide early and effective treatment for individuals who have experienced a first episode of psychosis (FEP). Developed with the support of the National Institute of Mental Health (NIMH), NAVIGATE has been implemented and shown success within 20 sites throughout the United States. Early psychosis or first episode psychosis (FEP) effects about 100, 000 young people within the United States, and at least three in 100 people will have experienced a psychotic episode throughout their lifetime. Psychosis is used to describe conditions that affect the mind, and creates a loss of contact with reality. Typically, psychosis begins when a person is in their late teens to early/mid-twenties. Psychosis can affect everyone, and can include hallucinations, paranoia, delusions, and disordered thoughts and speech.
Found within ECMC’s NAVIGATE Program, the different types of psychosis are documented. Those include psychosis occurring within other disorders such as bipolar, major depression, schizophrenia, and schizoaffective disorder (Mental Health America, 2014). Although the individuals involved are continuously learning how and why psychosis develops, it is found that numerous factors are involved. An increase in episodes of psychosis are found within teenagers and young adults due to hormonal changes in their brain during puberty. Several factors that contribute to psychosis include genetics, trauma, substance use/abuse, and like stated above, mental health conditions.
Through the NAVIGATE Program found at ECMC, patients, ages 14-30 in need are connected to the right sources for treatment such as a primary therapist, family educator, psychiatrist, support education/employment specialist (SEE), and case management services. Social work practices within this setting is assisted through the various roles considered above. The primary therapist is typically a psychiatric social worker, who carries their license within the state. Therapist’s within the NAVIGATE program primarily base their therapy session with cognitive behavioral therapy (CBT). CBT is often found to assist individuals who suffer from psychosis due to its primary focus on reducing the distress caused by the hallucinations and intrusive thoughts. The family educator works with the family members who are involved with the client, typically their guardian(s), to educate them regarding psychosis. This support system is crucial for the family members to learn coping skills, communication, and assisting their loved one during this time. Family members are also provided individual therapy sessions if desired. The psychiatrist works to assist the psychosis symptoms within the client, and manage the medications.
Developed by the RAISE Early Treatment Program (RAISE-ETP) and ONTrackNY, NAVIGATE is a Coordinated Specialty Care (CSC) treatment model. Because psychosis is classified as a symptom, and not an illness, fast intervention and connection can assist a client towards receiving treatment and prevention. Within the mental health population, treatment and intervention is often overlooked. When considering psychosis with trauma and human rights, there are numerous conflicts that are formed within the current human rights legislation and practice. Due to the human rights restraint, the legislation operates close-minded rather than universally. Those considered to struggle with a mental illness are often looked at as a “limited figure” to the human rights perspective.
Safety: Due to the nature of psychosis, it is imperative to provide not only support, but physical and emotional safety to those in need of treatment. Educating clients on how to effectively handle psychosis symptoms and medication side effects is a very important part of the NAVIGATE Program. The NAVIGATE Program strives to engage clients through their psychosis, and provide a support network that ensures their safety, and symptom stabilization. Team members work in collaboration with the client’s family, inpatient staff and directly with the client to ensure all are on the same page regarding care, safety concerns, medications, and any persisting issues. The NAVIGATE Program aims towards managing the clients psychological, physical, and psychosocial safety and functioning. ECMC’s Adult, Child and Family Outpatient Behavioral Health Clinic and their NAVIGATE Program strive to guarantee physical and emotional safety for all clients. An example of this would be their 24/7 emergency hotline, and access to inpatient services. If clients find themselves in times of need or struggle, ECMC provides them with a list of numbers for all hours of the day to assist them during these times. In addition, ECMC offers urgent mental health care through their Comprehensive Psychiatric Emergency Program (CPEP). The hospitals CPEP services are known as one of the largest CPEP programs found within New York State, and is available 24 hours a day, seven days a week to assist adult, children, and adolescent patients in times of crisis. Along with the hospitals CPEP program, clients in need can also be referred to home-based crisis intervention, crisis residency, and extended observation unites to ensure safety concerns are regulated. When discussing safety in regards to the staff, there are numerous safety procedures taken into consideration at ECMC. All staff is required to go through annual trainings regarding building codes, and emergency procedures. This includes emergencies such as fires, gun threat/active shooter, medical emergencies, disasters, and evacuation. Heard throughout the hospital, these codes are announced over loudspeakers found in each room. Additionally, all doors in the hospital are locked and require a valid identification badge swipe to enter. This ensures everyone’s safety; the staff is safe from hospital consumers, and the consumers information are safe from other consumers obtaining it. Due to the severity and professionalism of the hospital safety precautions, they are constantly winning awards for their safety procedures for their medical service line safety.
Trustworthiness: In order to establish clarity, reliability, and interpersonal boundaries within the NAVIGATE Program, numerous efforts are put into place to ensure service delivery is established and executed. Weekly meetings involving the NAVIGATE team serve as an important connection for sharing and collaboration towards ensuring all NAVIGATE team members are aware of each client’s progress and setbacks. The shared information serves to assist the treatment planning for the client. Because all services that are provided by the NAVIGATE team are individualized towards each client’s needs and goals, service delivery is clearly outlined on the client’s treatment plan to ensure consistent services within practice, and maintaining boundaries within services. The NAVIGATE manual serves as a tool for clarity, consistency, and boundaries for the program and its activities. The manuals are standardized and split up into six separate handbooks to ensure all areas and disciplines are covered for the program. Each manual is devoted towards different sections or roles of the program. For example, the NAVIGATE Team Member’s Guide provides each team member with background and rationale for the program, an overview of the services provided, guidelines for treatment, planning, and teamwork, and information regarding maintaining healthy boundaries. A specific manual is dedicated for the director, who serves as a team leader, and the other manuals are set towards the several intervention techniques. By devoting a guide for each specific intervention used for the clients, this ensures that service delivery is adequate and consistent within one another. In addition, because each intervention covers the guided techniques and required practices, clients and the NAVIGATE team is given strict and distinct clarity.
Choice: When considering a program such as NAVIGATE to help treat mental illness, it is important to consider all aspects of the program, and the boundaries you are given as a consumer. Within this specific program, consumers are given the choice to choose their NAVIGATE interventions and when to start, stop and resume each one. This allows the consumer to feel in control of their illness, and allow them to choose their own treatment plan. NAVIGATE follows a strict pharmacological treatment that is guided by a shared decision-making model.
For the Individualized Medication Treatment, consumers apart of NAVIGATE who feel they are in a good place to discontinue their medications are encouraged to make these independent decisions when the time is right. Those who do so must remain in NAVIGATE, and participate in group activities weekly, and see their prescriber on a regular basis to maintain. Consumers are given the choice and control to focus on Family Education Programs (FEP) with relatives and significant others towards providing social support and treatment. FEP is found to show developments in the client psychological well-being, and the families caregiving. With the client’s permission, families are contacted and encouraged to engage within the consumer’s treatment through group sessions to identify the client’s strengths, concerns, and understanding of psychosis. FEP includes four main stages: engagement, orientation, assessment/stabilization, and recovery. The Individual Resiliency Training (IRT) is aimed towards improving the consumer’s illness self-management and psychosocial functioning. IRT is practiced weekly or biweekly, based on the client’s treatment plan, and is provided by a clinician. IRT serves as an educational handout for the client that displays several modules through a cognitive-behavioral approach, combined with a psychoeducational and motivational enhancement. Consumers are given the control and choice towards selecting their desired module for session. Some examples of these modules include substance abuse, weight management, and coping with distress and symptoms.
By allowing the consumer the power of choice, it is found that motivation is increased during treatment. Supported Employment and Education (SEE) is influential for consumers who are recovering from a first episode. This service assists the client towards regaining their life, and returning to work or school after experiencing psychosis. This whole process is guided by the consumer. The consumer meets with the SEE specialist to discuss their interests and how they can assist towards achieving their work or educational goals. Additionally, supports such as accessing student disability services or on-the-job trainings and study skills are communicated. SEE services are organized into three comprehensive stages: developing a career and/or education profile, searching for jobs/education programs, and follow-along supports. This whole process is completely controlled by the consumer.
