Overdose Measures Matter

Indicator Profile

Number of peer navigators embedded into community settings working to connect people to care and services

Category: Peer Workforce Support

Audience: Program ImplementerConvenerFunder

Data Type: Quantitative

Indicator Overview

Description:

Total number of navigators embedded into community settings working to connect people to the care and services that they need.

Note: In some cases, one navigator may be embedded in multiple community settings. In these cases, you may want to establish a standardized method to count navigators. One approach is to count the unique number of navigators and the unique number of settings in which they are embedded. For example, if one navigator is embedded in a jail and a housing program, you would count them as one navigator embedded in two settings. As another example, if three navigators are embedded in a local clinic, this would count as three navigators in one setting. Combining these two scenarios would give you a count of four navigators embedded in three settings.

Rationale:

Using navigators to support people who use drugs (PWUD) has been shown to decrease substance use, increase treatment retention and increase satisfaction with the overall treatment experience.1,2,3,4 Navigators should represent the people they serve, where possible.

Tracking where navigators most frequently provide services can help to determine where services may be most accessible and most needed. Further, this indicator may provide insight into where navigators can be best utilized within the community, to people seeking overdose prevention and recovery and support.

Related Indicators:

Consider pairing this indicator with the number or percent of referrals to care and services. Knowing how many referrals originate from each setting can help to identify the types and characteristics of settings and which programs are associated with the highest number of referrals. (From where are PWUD being referred and could the addition of a peer in the system improve outcomes?)

Using these two indicators together can help to identify opportunities to collaborate with community partners to expand and refine how navigators are embedded within the community.

Indicator Details

Definitions:

Navigators are individuals familiar with the local public health landscape and who work directly with PWUD to ensure they have the tools to address barriers to seeking care. Navigators support people accessing substance use disorder (SUD) treatment and care, as well as to other services and resources. Navigators could include peer navigators, certified peer recovery specialists, peer support specialists, case managers, patient navigators, community health workers, other people with lived and living substance use experience (PWLLE) and other individuals who link PWUD to care. Common tasks of navigators may include but are not limited to providing outreach and education, completing needs assessments, making phone calls to identify care options, driving someone to care, competing paperwork and data entry to track referrals.

Embedded means that navigators are integrated into existing organizations and settings throughout the community. Navigators may be working in healthcare clinics, emergency departments, harm reduction programs, jails and other community settings where there may be greater opportunities to interact with PWLLE. Navigators working in community settings may be uniquely positioned to build trust with clients, assess individual needs and refer people to care and services from settings that are most accessible to clients.

Care and services may be defined as a broad range of health, wellness and social services such as harm reduction, mental health, medical care (e.g., Hepatitis C and HIV services or other medical services such as primary medical or OBGYN care), treatment for substance use disorder and housing services.

Ways to Examine the Data:

  1. Type of setting in which navigators are embedded (e.g., medical, public safety, harm reduction program.) Within each setting, consider listing all sites and locations separately. For example:
    1. Medical setting:
      1. Setting 1: emergency department in hospital A
      2. Setting 2: clinic B
    2. Harm reduction program:
      1. Setting 1: syringe service program A
      2. Setting 2: harm reduction program B
  2. Zip code of setting where navigators are embedded
  3. Demographics of navigators (e.g., race, ethnicity, sex, gender, lived experience)
  4. Change in the number of navigators over time

Learn more about collecting demographic data. This type of data collection may require specialized training, skill and financial resources.

Data Sources:

  • Data tracked and reported by programs that hire and place navigators for referral and linkage to care services
  • Program staff

Data Collection Methods:

  • Review and analysis of program level data on navigator placement
  • Key informant interviews with program staff
  • Surveys with program staff

Application and Considerations

Suggested Use:

Program Implementer

  • To evaluate the extent to which navigators from your organization are embedded throughout the community
  • To identify gaps and settings where additional navigators may be embedded

Community Convener

  • To identify the total number of navigators embedded in the community
  • To evaluate the extent to which navigators are embedded throughout the community (e.g., saturation)

  • To identify gaps and settings where additional navigators may be embedded

  • To help coordinate efforts to streamline placements of navigators across organizations to address community needs

Funder

  • To identify the number of navigators embedded in the community
  • To identify which settings may need more staff to serve underserved populations
  • To help inform where additional funding and/or resources may be needed (e.g., sectors/locations without embedded staff)

Health Access Considerations:

You may want to consider:

  • Are there community settings that frequently serve PWUD that do not currently have embedded navigators?
  • Are navigators embedded in zip codes or areas in the community that experience higher rates of overdose or have been historically underserved?
  • Is there equitable access to navigation services?
  • How many hours are navigators embedded in each setting? This may help to further inform questions around accessibility.
  • Although more research is needed to establish a recommended ratio of navigators to clients served, you may consider how the current ratio impacts both navigators and clients. Consider: Are clients’ needs adequately met? Are navigators able to meet clients’ needs without being overburdened?

Evaluation Considerations:

Limitations:

  • Does not track what services are provided
  • Does not track quality of navigation services
  • Does not track number of individuals served

Policy Considerations and Resources:

Additional Resources

Examples:

  • Giraldo, A., Shah, P., Zerbo, E., & Nyaku, A. N. (2024). The role of recovery peer navigators in retention in outpatient buprenorphine treatment: a retrospective cohort study. Annals of medicine, 56(1), 2355566.
    https://doi.org/10.1080/07853890.2024.2355566
  • Lardier, D. T., Gilmore-Powell, K., Morton, C. M., Peterson, N. A., & Borys, S. (2024). Peer Recovery Specialists and Referrals to Treatment: Clinical Correlates Among Patients of an Opioid Overdose Recovery Program in New Jersey. Substance use & addiction journal, 45(3), 493–505.
    https://doi.org/10.1177/29767342241235765

Below are two programs supporting peer navigators:

References:

  1. Armitage, E. V., Lyons, H., & Moore, T. L. (2010). Recovery Association Project (RAP), Portland, Oregon. Alcoholism Treatment Quarterly, 28(3), 339–357.
    https://doi.org/10.1080/07347324.2010.488539
  2. Bassuk, E. L., Hanson, J., Greene, R. N., Richard, M., & Laudet, A. (2016). Peer-Delivered Recovery Support Services for Addictions in the United States: A Systematic Review. Journal of Substance Abuse Treatment, 63, 1-9.
    https://doi.org/10.1016/j.jsat.2016.01.003
  3. Kamon, J., W. Turner. (2013). Recovery coaching in recovery centers: What the initial data suggest: A brief report from the Vermont Recovery Network. Evidence-Based Solutions, Montpelier, Vermont
    https://legislature.vermont.gov/Documents/2014/WorkGroups/House%20Human%20Services/Bills/S.295/Witness%20Testimony/S.295~Mark%20Ames~Recovery%20Coaching%20Report~4-15-2014.pdf
  4. Reif, S., Braude, L., Lyman, D. R., Dougherty, R. H., Daniels, A. S., Ghose, S. S., Salim, O., & Delphin-Rittmon, M. E. (2014). Peer recovery support for individuals with substance use disorders: Assessing the evidence [Review]. Psychiatric Services, 65(7), 853-861.
    https://doi.org/10.1176/appi.ps.201400047