The Rhode Island Medical Navigator Partnership (RIMNP) was formed in 2014 through the partnership of medical students at Warren Alpert Medical School of Brown University and case managers from the House of Hope, a community development corporation. RIMNP uses an interdisciplinary approach to achieve their overarching goal – “to improve health outcomes of those impacted by homelessness.” This team-based approach includes case managers, peer navigators (those who have experienced homelessness), and students across disciplines (i.e.., social work, medicine, law and nursing, and undergraduate programs). These organizations offer support by helping those impacted by homelessness schedule and attend medical appointments, improve communication with providers, assist in navigating the healthcare system, facilitating SSI benefits, securing housing opportunities, providing social support, and combating healthcare inequalities for those experiencing homelessness. Much of the work has been funded by a Cooperative Agreements to Benefit Homeless Individuals (CABHI) Grant through the Substance Abuse and Mental Health Services Administration (SAMSHA).
Catherine May, is a nurse practitioner and clinical instructor at the University Of Rhode Island, College Of Nursing. She is also a teaching associate at Brown University. May currently precepts RN to BsN nursing students who are involved in community initiatives through the RIMNP and House of Hope. Nursing students use this unique opportunity to fulfill their community health and nursing leadership rotations.
Students experience a variety of interdisciplinary learning experiences including outreach at a men’s homeless shelter where they provide basic nursing care and assist case managers and social workers in care coordination. Students also participate in street outreach with the House of Hope outreach workers and social workers and provide basic nursing care and medical navigation with the team of peer support workers at the Shower to Empower Mobile unit.
“Shower to Empower” is House of Hope’s unique mobile unit initiative. A trailer, equipped with hot showers and air-conditioned or heated interior space provides homeless and housing insecure individuals a space to shower, get free haircuts nursing exams and medical navigation three mornings per week. Through this opportunity May’s RN to BSN students not only “see how medical navigation occurs in an outreach setting,” but also “takes a comprehensive history of the patient and screens for vulnerability to help prioritize interventions for those who seek care.”
This outreach work encompasses the IPE core competencies of ethics/values, roles and responsibilities, teamwork and communication. May states, “we can consider the ethical aspects of care every time we review an emergency department or hospital discharge report for an individual experiencing homelessness.” This includes evaluating the care provided and the recommendations for follow-up, as they intersect with social determinants of health that may impact a homeless individual. Part of the work done through the House of Hope and RIMNP is “translating” discharge plans for patients, helping them overcome barriers that may prevent them from following discharge recommendations.
May also feels this community experience helps students develop their interpersonal communication skills. This includes follow up with physicians regarding care coordination and connecting homeless individuals with community resources. Nursing students acquire practice in interprofessional communication through their volunteer work at the House of Hope. Students contact community health centers to work with social workers, community outreach workers and clinicians regarding a patient. When coordinating care for a patient they acquire intersystem navigation skills and gain the clinical confidence to present the patient to another professional. Outreach also helps students share aspects of their professional learning experiences, a rare opportunity between medical and nursing students.
Students learn interprofessional roles and responsibilities and teamwork through working in teams that include clients, case managers, social workers, medical students, nurses and peer navigators. The nursing student better understands his or her unique training and how that can contribute to providing optimal, patient centered care, but also learns to act as part of a team. For instance, undergraduate students may perform a Screening, Brief Intervention and Referral to Treatment (SBIRT) on a patient to identify, reduce and prevent substance abuse on a patient, but then may refer this person to a community-based recovery specialist for on-going support. May describes SBIRT training as “a learning experience in using a tool or instrument to improve knowledge and comfort level discussing substance use, and subsequently learning the community resources for referral to treatment.”
When asked to describe a situation where May’s students learn to work in teams, May paints a very vivid picture of how a social worker, medical student, peer navigator (person with lived experience of homelessness), and RN to BsN student, all doing street outreach or on a mobile unit might work together.
The peer navigator plays a crucial role in outreach and initial connection, earning trust and facilitating introduction. From there, the rest of the team all has an opportunity to get to know and prioritize needs and goals. May stresses that it is the patient who is the most important member of this team. The social worker helps address barriers to care for the patient, such as figuring out if the patient’s insurance is still active. The nursing student will do a nursing assessment which will includes a physical assessment, including foot care, and asking the patient about day to day activities and ability for self-care. These questions may revolve around what they eat and where they sleep. The nurse utilizes active listening and models “safe touch” when interacting with the patient. The medical student may help the person navigate the hospital or clinic system and will often have the opportunity to ask questions related to past medical and family history. For all students involved, the experience helps them develop communication and empathic skills. It is wonderful opportunity to work in an interdisciplinary team, caring and learning about each other.