Student Resource Navigator Program

A New Week, A New Pivot

Feeling a bit optimistic this week, as things are starting to move forward in a new direction. The program pivot to support no-shows was approved by the OBGYN office, and I worked on developing materials this week to implement this shift.

Many of the current stalls we have been facing are due to capacity reasons–the OB-GYN office has been chronically understaffed, and especially so in recent years. Although we have the drive to bring in programming that will be helpful in the future, the actual capacity of administration to add additional changes has made this difficult. As such, I am thankful that we are able to help address one part of the workload, which is accounting for no-show patients and their needs. Laura let us know that there are around 10-20/week, with referrals coming in immediately, which meant that we had to quickly adjust our scripts and workflows to account for the influx.

Essentially, the basic processes are the same: the contact information of no-show patients (those who do not make it to their appointment) will be sent to us–the student navigators–through the PtRefs system. While the call structure will differ slightly, the resources and support that we were planning to offer will be the same.

We have also discussed bringing this program to Day Reporting Probation Program in Tompkins County, of which Jen at CCE helps run programming for. This is very exciting to me as a potential prospect, especially since I’ve learned about the program and what it does through my CCE course last semester. If this shift were to take place, the social needs screening form would be readily applicable, although some resources may be less relevant, such as the doula services.

Documentation: Edits and Finalization

The longer I work on various projects, the more I realize just how detailed every piece of the project is. I find this to be especially true for pilot programs, since we’re constantly creating and troubleshooting as we go. One example of this is considering the pros and cons of various web storage platforms, as well as the ways in which we can store our information in conjunction with what local health partners already use. We have been considering a few different platforms to store medical information–Sharepoint, a Microsoft folder, etc.–and have finally decided on Box, which is also getting implemented this week.

To account for this web platform shift, some materials I’ve been working on this past week include new documentation forms we will store in Box. I’ve been finalizing a large excel sheet, including working through the deceivingly simple task of creating a multi-check dropdown list. For example, I had to include code into the excel sheet to make this work, meaning that I had to turn the file into a macro: a file that has its own unique embedded programming. I actually found this to be very fun, and it reminded me of working through coding errors through Stata: something about troubleshooting, and finally resolving the issue, is so satisfying. Plus, it’s always interesting to see how many different things you can make using only Excel.

Research Interests and Visualization

After some more research on my end, I’ve decided that I want to focus in on the Health Policy and Public Health Communication aspects of this work. I have been reading about articles discussing the delayed returns associated with public health, in the sense that they are not always immediate. As such, ways to convincingly communicate the necessity of a program to stakeholders is key to long-term program implementation.

After discussing these ideas with my team, I’m planning to look more into Expectations Management and Logic Models. Additionally, I discussed with Grace and Jen the variations in impacts and outcomes: short-term, mid-term, and long-term, and the effectiveness of communicating real-wins in the short-term to promote continued investment in programs.

We also discussed how even the groundwork of developing partnerships with organizations is foundational, and I want to highlight this aspect of collaborating with local health organizations as part of that “leading time” as still being critically valuable. This discussion made me think about ways to connect these ideas visually, and I will be developing and refining graphic drafts in the next week or so.

Student Interviews

On the promotional side of things, I have been developing some social media materials. These may not be immediately used since we are currently pausing recruitment for the fall semester, but will be helpful for future marketing purposes and/or Cornell’s OADI and Health Advising offices.

I am also planning to interview all student navigators working on this program on their experience this summer during August on their experience, so I will be creating a questionnaire and scheduling meetings during the next week or so.

We are also looking into creating Federal Work-Study positions for students interested in the program, of which these materials can be used for reference.

While this pilot has not been as streamline as I had anticipated, I’ve also been learning that this type of troubleshooting is all part of the process of implementing new programming, especially when working with health organizations that already have their own administrative structures in place. I’m looking forward to seeing how this new direction of the pilot takes us and learning/analyzing more about patient needs in Tompkins County in the next few weeks!

Hello! I’ve been working on a few different things recently, including finishing up poster designs and dropping them off at the OB-GYN & Midwifery Associates of Ithaca office with Grace, troubleshooting ways to increase referrals, and working on my own research regarding the health policy report.

Visiting OB-GYN & Midwifery Associates of Ithaca

This was my first time going to the office in-person, and it was nice getting a better feel for the type of healthcare space they offer. Me and Grace drove over to the office to drop off the program posters and quarter cards and met the front-desk workers. We’re hoping that these materials help increase the visibility and presence of the program, increasing referrals and boost the permanence of the program within the office.

Our first referral!

We had our first referral come in last week. It was an interesting learning experience, as it was our first time working through the PtRefs system outside of practice. I had to quickly communicate with one of the student navigators to address some platform questions, including when to move the patient into the “Scheduling” category and MAHA administrative issues.

On the contents of the call itself–we were put into a situation where follow-up calls and texts may actually be more important than the initial one, as the patient was already in the process of applying to programs and waiting to hear back. This was definitely a learning experience, and I’m sure one of many as we hear from different patients on their paths to receiving resources they need.

We also ran into a scanning issue initially with the form only coming up in black and white–which blocked out valuable contact information and times to call–but eventually got this fixed with the office so that the form comes in through color.

My Own Research: Narrowing Scope

Something that I always find to be true about research is that it feels endless. I often find myself clicking on one article, and then looking at the citations, which again pulls me in various directions of interest. This is especially true, as I have a lot of flexibility with what I want to research for this project.

I’m working on narrowing down my research interests in accordance to this project. I’m interested especially in the cost sides of preventative health and have been looking into return-on-investment models, as applied to community health programming. I’m planning to deepen and specify these interests in the coming weeks, potentially producing some graphics to accompany what I find.

Troubleshooting Methods to Increase Referrals

Something new I learned is that the Cortland office has recently closed, leaving the Ithaca one as the truly standalone office in Upstate New York. This creates major issues for the office’s policies around no-shows (which previously was 2 no-shows = patient no longer allowed to return).

Understanding that patients don’t show up to appointments for various different reasons, many outside of their control, Me, Grace, Jen, and Isabel have discussed pivoting our program to help address this no-show issue by sending check-in texts early to gain a better grasp on a patient’s situation: for example, if a patient struggles with transportation or taking care of a child (which is especially applicable to OB-GYN patients), we can help them address this need early on so they are more likely to make it to their appointment. Additionally, if we have the patient’s contact information, we can talk to them afterwards to gain a better understanding for their situation and any help they may need.

It’s definitely been a learning experience over the past month, and I’ve gotten a much better understanding of how much troubleshooting goes into public health program implementation, health policy, and health communication. I’ve been able to get a deeper understanding for the many different layers that come together to implement a program, including an understanding of patient psychology, actual administrative/capacity barriers with local health leaders, and integrating what we want out of the program itself. I’m excited to move forward with this potential pivot and see where the rest of the pilot goes this summer.

Things have been picking up a bit over the past two weeks! I’m happy to be in a more involved place with the internship, and I was especially happy to realize that a lot of the skills I exercised this week related back to my research experience last summer and the academic year. This included developing materials to support the pilot, making recruitment posters via Canva, and discussing cost-savings research.

While some of the work has been familiar, a lot of it has been new as well. This included being trained on and testing a new platform: PtRefs. I was trained on this platform, Cayuga Health guidelines, and HIPAA over zoom with the other student navigators and my mentors. We learned about the context behind the work of Cayuga Health Partners, various HIPAA violations that may take place, and what to avoid sharing when interacting with patients.

The PtRefs training was a bit more confusing, as it’s a web platform I’ve never navigated before, but we were given testing sites to practice and familiarize ourselves with. This is essentially the main platform for all incoming patient referrals, student referral  assignments, and patient document attachments.

Student navigators will be able to see what patients check as social needs on the screening form (ex. childcare, food, transportation) before calls are made via this platform and, after calling, send direct patient referrals to medical providers (pictured below). I will be responsible for consistently checking this platform for any incoming calls and assigning them to navigators when necessary. Calls will be made via another platform, MAHA, where all students can access and call patients from a shared phone number for patient familiarity.

I also met with Grace and Jen for a check-in on Tuesday. It was a really productive and good meeting, where we made more clear immediate and long-term goals for this internship. We discussed a few immediate documents that were necessary, including a sample call schedule based off navigator abilities. This was a bit more difficult to create than I thought, since we had to consider limited student availabilities, limited Friday/weekend evening hours, and a somewhat even distribution of hours throughout the week per student. After some feedback, I ended up simplifying it to 3 hour morning and evening chunks on weekdays.

We also discussed potential deliverables for this summer, including a literature review of medical cost savings based on meeting social needs (to justify investment), needed policy recommendations, and a toolkit for how other communities/college towns can implement a similar program. As someone with interest in health administration, I’m really excited to work on this research and learn more about different community health programs that have taken place. I find the medical savings side of preventative health especially fascinating (I’ve developed an ROI model on medical technologies and loved it), so I’m looking forward to doing this deep-dive. Another “deliverable” was the development of social media or other outreach materials to recruit future students. I’m also very excited about this, and I’m already thinking about potentially interviewing student navigators on their program experiences.

Another need mentioned was for supplementary OB-GYN office materials. Below are some Canva quarter card designs I’ve been working on–these are meant for midwives to have to inform about how the program works. I’m also working on developing a poster about social needs to be displayed in the OB-GYN waiting/exam rooms.

I’ve also been working on a student navigator shift checklist/workflow to detail tasks for students to take. This included more details on follow-up calls and tasks to keep in mind. Although it seems like a lot of information at first, I’ve made a few of these in my research lab during the academic year, and it’s always something that comes in handy just until students get more familiar with the tasks at hand.

I’m very excited for this upcoming launch week, as calls should be coming in! Other than tracking incoming referrals, my goals next week are to develop the program’s social media, finish designing office and student recruitment materials, and create a formal curriculum guide (detailing what parts of training have and haven’t went well) for this program.

What do chopsticks, air-fryers, espresso machines, and a grill have in common? Great question–they are the chosen kitchen utensil personalities of the people I am working with this summer!

To give some context, I am working on the pilot of a public health project connecting Tompkins County health providers with student resource navigators. A resource navigator is a Cornell student who is responsible for making calls to refer patients to resources they may need, navigating Ithaca resource lists, and following up with said patients.

This summer, I am working individually with my mentors to develop this project, including figuring out a new web platform for calls and analyzing referral data, as well as with a group of 5 pilot student navigators to discuss and refine the project for the school semester. The project is eventually meant to reach the wider Cornell student population by next year.

I have a few main goals for myself regarding this project, of which I’ve outlined below:

• 1) Gain a better understanding of the Ithaca community.
  • I plan to do this by learning more about local health resources, but also through direct engagement with those in need of such resources.
• 2) Seeing if the public health field is for me.
  • While I know I’d like to enter the public health/health administration field, this will be the most involved experience I will have thus far where I’m putting my academic knowledge into a real project. I’m excited for the project and for how it will impact the way I see the field’s work!
• 3) Gain a better understanding of health disparities.
  • This goes hand in hand with number 1 and number 2. Health disparities is a broad term, and I’ve taken many classes covering what they are and can be. While I know that nearly everything in one’s environment can impact one’s health, I think that the best way to learn is by listening and empathizing with people’s individual life stories. To this end, I’m very interested in gaining a wider and more nuanced perspective on the many different factors that come together to impact someone’s life, both mental and physical.

Now onto my week…

This week, I attended virtual training each morning, led by my CCE mentors Grace and Jennifer, to learn more about my project and its context. Having worked on the project during the school year, being able to have a more in-depth experience where I could engage and share my own ideas was exciting.

We discussed several things, including what we wanted to be our collaborative group goals, where we touched on topics like correcting each other for biases in wording, listening to understand, and “saying it messy”–i.e., caring less about how the thought comes out, and just letting your words be heard.

Additionally, we reflected on the goals and context of this project, including its critical importance/extra emphasis with the pandemic, as well as the fact that there is only one OB-GYN office in Ithaca. With this much pressure to supply resources and knowledge, this project is novel in its goals to use students as mediators in guiding those in need to public health resources. Community stakeholders also came in to talk to us about their experiences, conduct practice calls with us, give advice on how to make calls more conversational and open, and answer our questions about the ways in which the pandemic has changed their work.

We also discussed the critical academic layout of this work: the effects of trauma on the brain, social determinants of health, and social risk factors. This type of work can be taxing, if only to understand the depth of others’ trauma, but we discussed these topics with a positive, strength-based light: noting and recognizing that there are ways to heal this trauma, especially through strong friendships and family relationships. The importance of community, at its core, is crucial to this work. Most importantly, when we are compassionate to ourselves and the many ways in which we often feel like life has thrown us under the bus, we are more forgiving and empathetic to those who are also struggling. This is key. We can more easily forgive and be empathetic to others when we can extend that same kindness to ourselves.

On my own, I have been setting up messaging channels and gaining familiarity with the new web platform. I will be the person scheduling calls and matching them up with student schedules, tracking calls as they come in, troubleshooting any platform issues, and analyzing referrals/discussing new approaches as they come up. I will also be doing some of my own research on successful community health programs, creating a literature review, and potentially developing a community health policy report.

We plan to start the calls next week. For all the time that I’ve been at Cornell, I’ve often felt that my student groups help only and just that–the Cornell community. As such, I am incredibly excited to be able to head a lot of this collaborative, community work within the Greater Tompkins County and see where this project goes this summer.