Health navigation a lifeline for southwestern Colorado

 In rural southwestern Colorado, many low-income residents struggle with navigating the health care system and the long distances to health care providers. Health care services can be far away from the small towns that make up the San Juan Basin and transportation is limited. Health navigators in this part of Colorado have to get creative in coordinating transportation, even using local rafting companies to bus patients to their health care appointments.

The patients referred to San Juan Basin Public Health (SJBPH) face many other barriers in this remote part of Colorado as well, including income, age, disability, insurance coverage, mental health and health literacy. Health navigators refer patients to doctors, dentists, mental health professionals, senior centers, and social services that provide food and housing assistance. SJBPH care coordinators provide home visits, help people sign up for Medicaid, coordinate with families and empower their clients to learn how to take care of their own health.

In 2016, the six SJBPH programs that make up its Care Coordination services - the Regional Care Collaborative(RCCO), Temporary Assistance for Needy Families (TANF), Healthy Communities, B4 Babies, Maternal Child Health (MCH) and dental navigation - served around 2,000 clients.

“Health care is hard to navigate and critical to our community,” said Kalisha Crossland, Care Coordination Services Program Manager, “You can see the ripples we make in our small communities.”

Crossland oversees navigation needs for SJBPH’s five health navigators, who respond each day to a variety of challenges. Access to health care providers, especially those who take Medicaid, is limited. Pediatric and dental providers are few and not always conveniently located. And specialty services at major hospitals are a day’s drive away, into Denver or Albuquerque.

Transportation from the small towns in these rural and frontier counties to health care providers is perhaps the area’s biggest obstacle. SJBPH navigators often have to get creative in arranging rides to necessary medical appointments. The agency uses two transit companies and enlists the help of a local raft company whose drivers bus patients to health care facilities off-season.

“That’s why we love our jobs,” says Care Coordinator Karen Evans. “Every day is different.”

Evans tells of a woman from Archuleta County that the care coordination team had worked with who had complex medical problems. She had little income, no insurance, and mental health challenges that kept her from understanding the care she needed or how to get it. Care Coordinators arranged for her transportation to surgery in Denver, helped her make follow-up medical appointments and access numerous community resources and services, eventually showing her how to manage her ongoing health needs. This isolated woman had a breakthrough, Evans said, from being dependent on others for her care to taking care of her own health care needs.

“It changed her quality of life,” said Evans. “We’re empowering people to take care of themselves.”

But it’s not easy. Health navigators, Crossland says, have to have the skills to succeed, including critical thinking, problem solving, public health and services knowledge, cultural sensitivity and communication - sometimes in more than one language. Education is important as well, she says, especially a background in nursing, social work or health navigator training. But the most important attribute for a successful health navigator, she says, is a caring attitude.

 “If you don’t care,” says Crossland, “This is probably not a good job for you.”