Community Navigation: Iterative Development and Implementation of a Prenatal Psychosocial System of Care

We describe the iterative process of developing a universal psychosocial system of primary care across early life, called Community Navigation, and evaluate whether it can be implemented during the prenatal period with high engagement, identification of family needs, connections to community services, and family satisfaction. Community Navigation is a manualized program to improve child and family outcomes by engaging families during pregnancy, co-identifying their family-specific needs, and connecting them with community resources to address their needs. Continuous quality improvement efforts enhanced and refined the program leading to three iterative versions (Navigation 1.0, 2.0, and 2.1). Here, we report implementation metrics across all three versions. In each version, families were recruited during pregnancy and offered 1-3 visits with a trained Navigator. Findings from Versions 1.0 and 2.0 were used to improve the Navigation protocol, resulting in Navigation 2.1. Of the 194 Navigation 2.1 families who were eligible and offered the program, 81% completed the initial Navigation visit and 82% of those families completed at least one follow-up visit prior to birth (net total completion = 65% of the eligible population). Adherence to the protocol was 93%. Nearly all families (98%) reported at least one unmet need, with 75% reporting a major need requiring a community resource connection. Connection rates were high: 66% of families who received referrals were successfully connected to at least one community agency. Families reported high satisfaction with the program. Community Navigation holds promise as a novel system of universal primary psychosocial care for birthing families.