The Navigator, Coach, and caregiver or parent review the summary notes from the Support Plan to confirm the Family’s network of support, strengths, and needs identified when the service episode first opened. The Navigator asks if any events have occurred that have changed the make-up of the household. If yes, the navigator will update documentation accordingly.
The Navigator, with the Coach’s additional support, will ask about each need and its referral(s) listed in the Support Plan to understand the following:
- How each referral addressed the identified need
- If there were any challenges or barriers to accessing each referred service
- If the family cannot access a service, this should be documented as a service gap in the data system
- If a family does not intend to use a referral the service should be end dated in the data system
- Example: if the family received multiple referrals to meet the same need such as three different childcare providers, and selects one of these services, the other two should be end dated
- How the Navigator provided navigation and advocacy support to ensure the Family accessed the service
- Whether additional referrals or advocacy support were needed to address the identified need.
- If yes, Navigator, with Coach’s support, suggest additional referrals and action steps for advocacy support. Revise the Support Plan to include changes accepted by the caregiver or parent.
After reviewing each need and its referrals in the Support Plan, the Navigator asks if the Family had any needs that were not identified in the Support Plan.
- If yes, the Navigator revises the Support Plan to document these needs. The Navigator, with Coach’s support, suggests referrals to address these needs and revises the Support Plan to include those accepted by the caregiver or parent.
- If no, the Navigator asks if the caregiver or parent feels all their needs have been met at this time and if they are ready to close the service episode.
- If yes, close the service episode
- If no, Navigator confirms that the Support Plan is accurate and includes all the Family’s needs (identified prior to and during the Quarterly Support Plan Review meeting)