Systems Navigation (Frederick County FY 18 and beyond-Annual)

Program Summary

FY21

Systems and Family Navigators provide intensive supports to targeted linkages to overburdened families, guiding them through the myriad of human services to ensure access to services that meet each family’s unique needs.

FY20

Systems and Family Navigators provide intensive supports to targeted linkages to overburdened families, guiding them through the myriad of human services to ensure access to services that meet each family’s unique needs.

 

FY19

Systems and Family Navigators provide intensive supports to targeted linkages to overburdened families, guiding them through the myriad human services to ensure access to services that meet each family’s unique needs. Provider: Mental Health Association of Frederick County.

Target Population

FY21

Disconnected Youth (or Youth in Jeopardy of Disconnection), Families Impacted by Incarceration in Frederick County, and Families not meeting other definitions including families served by the Local Care Team.

FY20

Disconnected Youth (or Youth in Jeopardy of Disconnection), Families Impacted by Incarceration in Frederick County, and Families seen by the Local Care Team.

 

FY19

The target population for Systems Navigation is disconnected youth and families impacted by incarceration.

Measures
Time
Period
Current Actual Value
Current Target Value
Current
Trend
Baseline
% Change
Story Behind the Curve

FY21

  • Operating services during the pandemic and subsequent state of emergency presented many challenges and opportunities. While the Systems Navigation Program met some goals, it fell short on others, program staff persevered through an incredibly challenging year and they are extremely proud of the services provided to the community this past year.
  • The decrease in referrals contributed to downward trends for the numbers served compared to last year. Some of the referrals received from school personnel were inappropriate, since the focus of the referrals were on poor student attendance and or no attendance.
  • Many families were reluctant to engage in services provided through virtual platforms, this reluctance also contributed to the lower number served. Families experienced the pandemic for five months during FY20, compared to the full year for FY21.  

FY20

Although the numbers for two target populations served (Disconnected Youth and Families Impacted by Incarceration) have declined; more families and youth gained access to services through the new target population of LCT families and families not meeting other definitions compared to the past two years. Engaging families in services before children become disconnected is proactive and beneficial to the family, the youth and to society.

FY19

Lower overall enrollments for FY19 resulted from:

  • A portion of the initial connections between navigator and potential participant conducted over the phone resulted in a referral that did not necessitate a face-to-face meeting
  • Some of the families experiencing a crisis who were referred for navigation saw a resolution of said crisis before following through with their navigation appointment, which resulted in no enrollment. 

Fewer disconnected youth were enrolled in FY19, in part to the situations above, and in addition:

  • There are many challenges with getting youth in particular to follow-through with initial in-person meetings after referral
  • A number of the youth who sought services did not meet the definition and age criteria; said youth were not attending school but were too young to legally drop out of school.

With regard to disconnected youth completing a plan, the number appears down compared to FY18 because enrollments were down, but every youth served in FY19 (100%) did complete a plan.

FY18

First year of GOC funded program focusing exclusively on disconnected youth and families impacted by incarceration.  Has required an adjustment in how connections and services provided based on needs and attributes of these populations.

  • Identifying youth is easier than keeping them engaged in services.
  • Began tracking number of connection attempts and number of successful connections
  • Families impacted by incarceration better at reaching out and reconnecting with navigators than youth
  • Most successful interactions occur with participants who are linked and connected to outside services providers for long term service
Partners

FY21

  • FCPS is a referral source and assisted with some resources
  • Frederick County Local Care Team (LCT) provided referrals and resources to for families that included paying for therapy not covered by insurance and providing supplies, etc. Paid for by Frederick County.
  • DJS is a referral source and resource
  • DSS is a referral source and resource
  • Pediatric Center is a referral source
  • The “Student Homelessness Initiative  Partnership” (SHIP) is a referral source and youth resource
  • Victim Services with Sheriff’s Department is a referral source

FY20

  • Frederick County Public Schools
  • Excel Youth
  • Family Preservation (DSS)
  • Counseling Services
  • Children of Incarcerated Parents Partnership (COIPP)
  • Student Homelessness Initiative Partnership (SHIP)
  • The Crossover Committee
  • State’s Attorney Office
  • DJS
  • CASA

FY19

  • Villa Maria
  • Potomac Case Management System
  • Family Preservation Way Station
  • Workforce Services,
  • Frederick County Public Schools (FCPS)
  • Student Homelessness Initiative Partnership (SHIP)
  • Family Partnership  
What Works

FY21

  • Collaboration with community partners was a key element in engaging and sustaining several youth in the program throughout the year. The “Student Homelessness Initiative Partnership” (SHIP) filled service gaps such as providing temporary house and other resources for homeless youth.
  • Frederick County Public Schools (FCPS) and other community partners continued to refer youth and families to the Systems Navigation Program.
  • The Local Care Team (LCT) provided referrals. In addition, the LCT provided resources to families including funding therapy, YMCA memberships and other resources utilizing funds from Frederick County.

FY20

  • Systems Navigation staff transitioned from in person services to virtual services at the onset of the pandemic. Staff utilized a variety of virtual platforms to support participants with accessing services.
  • Adding the target population of LCT families and families not meeting other definitions increased the access to services for families and youth, who do not meet the two other target populations served by the Systems Navigation program.
  • While the numbers for the two initial target populations (Disconnected Youth and Families Impacted by Incarceration) are lower compared to previous years, the overall number of individuals served have increased with the addition of the services to LCT families and families not meeting other definitions.
  • The Systems Navigator worked with five LCT families to provide support and resources to sustain five youth and their siblings safely in the home during the height of COVID19, since out of home placements were not an option. The resources included items identified by therapists, parents and the navigator to stop negative behaviors and engage the youth in positive activities. The items included punching bags, games and art supplies, etc.

FY19

  • Systems Navigation staff will incorporate the ACES questionnaire and resiliency education into assessments, using a strengths based approach.
  • Systems Navigation is part of “Teen Roundtable”, a collaborative which consists many teen serving agencies. The “Teen Roundtable” includes Family Partnership, Excel Youth, Family Preservation, Workforce Services, Frederick County Public Schools, Villa Maria, Counseling Services and COIPP.  

FY18

The number one predictor of success for each participants is the relationship between the family and the navigator.  If there is a connection and trust, the outcomes and satisfaction ratings are higher.  This is the number one indicator from the SN post service surveys.  However, it is difficult to measure in an outcome.  As mentioned above, collaboration with community partners that increases everyone's ability to look for solutions outside the box is another indicator of success for participants.  Developing a service plan with obtainable objectives to reach an overall goal is also important.  The more concrete the objective, the better the outcome.  Families seem to do best when they can see progress and feel there is someone invested in the goal with them.   

 

Action Plan

FY20

  • Outreach to Frederick County Public School (FCPS) counselors and Pupil Personal Worker’s (PPW) to schedule virtual information sessions to explain the Systems Navigation Program, the target populations served, and the referral process.
  • Distribute program information monthly at area food pantries to increase program enrollment
  • Create a mid-term satisfaction surveys which will help us know sooner whether customers are satisfied with current services and to better determine the degree of impact Systems Navigation is having without waiting until the end of services.

FY19

  • The Systems Navigation program will work to increase the numbers served by a navigator by expanding outreach efforts to include participation at community events and highlight services they provide at partnership meetings.
  • A Systems Navigator will be present at all LCT meetings and families will be referred to a navigator at the meeting.
  • Program staff will meet with youth at the location of the referring agency to ensure more face-to-face connection and reduce the lack of follow-through by youth.

FY18

  • The program will improve internal data collection
  • Program staff will strengthen relationships with other programs. Community collaborations are essential and the program continues to work on strengthening these relationships.  As there is a lot of turnover in the agencies that navigator's work with, the program is constantly in a position of building relationships with front line workers.
  • The other area that requires additional focus is the on how progress is measured for families.  The program will incorporate shorter term goals (such as completion of identified objectives toward overall goals), in FY19 measures.
Local Highlight

FY21

  • There were a larger number of youth served during FY21, who remained engaged throughout the year. Collaborations with community partners who filled service gaps (such as providing temporary housing and schools supplies, etc.) significantly influenced this positive trend.
  • Two youth in jeopardy of disconnection, graduated high school.  One entered the military and the other achieved full-time employment following graduation.  Both were homeless and unaccompanied during the pandemic. The support of the Navigator, community partners and the youth’s persistence made graduation possible.
  • Systems Navigation served 41 of 50 (82%) participants, who met the target populations.  

FY20:

  • Systems Navigation exceeded the target number of 50 individuals served.
  • Fifty-one participants were served for FY20; which is an increase of 57% compared to the same period last year.
  • Of the 51 participants served, 47 of 51 (92%) met the priority populations.
  • For FY20, 39 children were served among the 35 LCT families and families not meeting other definitions, this number includes several siblings.
  • There were 16 children served among the 14 families impacted by incarceration.
  • Although the reported number of families impacted by incarceration who completed objectives have declined, there were several families who met the criteria of this target group and who completed objectives among the target population of “LCT families.”
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