The Role of the CHN

Community Health Navigators (CHNs) are a mobile group of community experts with extensive knowledge of the resources, support, and services available to patients. CHNs meet with patients in a comfortable environment, whether in the clinic, community or at home and support them in establishing and following through on co-created action plans to achieve their health and wellness goals.

Role of CHN

  • Be an extension of the health care system into the community of the patient

  • Walk alongside patients in their journey towards better health​, bridging gaps along the way

  • Support patients in three broad areas:

    • Support system navigation

    • Encourage self-management

    • Connect with resources

CHN Tasks

System Navigation: Help patients manage referrals, schedule and monitor appointments, coordinate transportation to health care appointments, and communicate information to health care providers.

  • Identify barriers to improving health that the patient is experiencing ​

  • Navigate the health care system with a patient

    • accompany patient to medical appointments

    • help patient coordinate/schedule lab work

    • explain role of different health care service providers

  • Coordinate interpretation and translation services ​

  • Facilitate active communication between patient and health care providers ​

  • Guide patients to credible, health-related materials that complement the information provided by health care professionals ​

  • Guide patient on how to use transit to navigate town/city 

  • Ensure support and information is culturally appropriate

  • Connect patients to suitable cultural support

Self-management: Provide education (written/verbal) and support patients in following their health plan.

  • Provide time-limited support to build skills

  • Connect patients to longer term support  / resources ​

  • Empower patients to become advocates for their health ​

  • Help facilitate self-referrals to health and wellness professionals ​

  • Support implementation of patient care plan

  • Assist patient with self-organization ​

  • Provide check-ins to encourage patients to remain engaged with co-created schedules for appointments and medication regimes

  • Support patients in increasing movement

    • attending fitness classes

    • walking with patients ​

    • providing movement reminders, encouraging patients to move independently

  • Help patient problem-solve challenges related to their care

  • Encourage patients to engage in self-guided research

    • familiarize patient with internet search options

    • introduce patient to library services​

  • Ensure patient feels confident in understanding their own health conditions and treatment plan

Resource Connections: use motivational interviewing and goal setting, connect patients with resources (social/financial), provide culturally safe support, and advocate for use of translation services.

  • Connect patient to community groups ​

  • Connect patients with community resources that align with their self-identified interests, including:

    • Financial insecurity

    • Addictions

    • Mental health and wellness

    • Nutrition

    • Fitness ​

  • Attend health and wellness education classes with patient within the PCN or in community ​

  • Link patients to affordable resources for mental health or financial support

  • Provide information on translation services and advocate for their use with providers

Core Competencies