Providence Health Care (PHC)—located in Vancouver, British Columbia, Canada—is a non-profit organization providing services in partnership with the Vancouver Coastal Health and Provincial Health Services Authority. PHC has almost 9,000 people working at 16 sites, providing patient- and family-centered health care to all British Columbians. Driven by compassion and social justice, Providence is "at the forefront of exceptional care and innovation" and is committed to treating those it serves "and each other—with compassion and respect."
The HIV Peer Navigation Program at PHC's St. Paul's Hospital John Ruedy Immunodeficiency Clinic (IDC) is the first and only program of its kind in Canada. This Peer Navigation Program evolved from a strong commitment to include patients in all aspects of program planning, development, and delivery. Positive Living BC, a community-based program serving individuals with HIV partnered with PHC to design a program in which paid peer navigators would be located within the clinic. In 2010,the Ministry of Health provided initial funding under "treatment as prevention" Positive Living BC. The Peer Navigation program is located in the HIV Primary Care Clinic (IDC) with peer navigators involved with the acute care of inpatients as needed. This program is now well established and funded.
Organizational goals include providing patient- and family-centered care based in social justice values. Strategies include a strong commitment to including patients in all aspects of program planning, development, and delivery. The Peer Navigation Program evolved from the long-standing involvement of HIV positive people in the delivery of HIV care and support services.
PHC-IDC collaborated with its long-standing community partners, Positive Living BC (formerly BC PWA Coalition). Through this collaboration, working together to provide programming the Peer Navigation program, developed. A clinic professional and a BC PWA member co-facilitated a support group. The PWA facilitator provided facilitation, education, and support alongside a professional. As a result, talks began about having a clinic-based Peer Navigation program in which paid peer navigators would be located within the clinic. The regional health authority, Vancouver Coastal Health, via the Ministry of Health, funded several programs involving health care organizations and community based agencies-under the "treatment as prevention" initiative introduced in 2009 by the BC Provincial STOP HIV pilot. This funding enabled PHC to contract with Positive Living BC to develop the Peer Navigation program housed in the clinic. This is one part of a larger Peer Navigation and Outreach Program managed through Positive Living BC and Vancouver Coastal Health. The planning team for the Peer Navigation Program included the co-facilitator of the support group who became the Peer Navigation coordinator, other members of the team at PHC, and staff from Positive Living BC.
The Peer Navigation Program is located in the John Ruedy Immunodeficiency Clinic (IDC) specialist HIV Primary Care Clinic. Peer navigators are also involved with inpatients as needed. There are four peer mentors in the clinic, and there are a total of 6-8 mentors in the larger umbrella program.
The peer navigators in the IDC clinic are employed by Positive Living BC and report to a manager based in the Positive Living BC office. The manager has social services training as well as many years of experience in community agencies. His experience includes participating in numerous training sessions, on HIV program development and counseling techniques. Salaries vary.
Peer navigators provide full time coverage in the clinic, working a variety of shifts and days. This ensures that different peer navigators will be available throughout the week to provide a good skill mix. One important factor is for the clinic to have Aboriginal peers, to provide culturally safe navigation and support to Aboriginal clients. This is part of the commitment that PHC has to cultural humility and cultural safety.
Positive Living BC provides training and support for peer navigators with support from PHC/IDC. The supervisor is one of the key developers of the program, and provides ongoing supervision and support to the navigators. The peer navigators work closely with professional team members (social workers, physicians, and nurses) in the IDC. Professional staff members collaborate with peer navigators, and can also provide education and support. At least one peer navigator is in the IDC, in a dedicated office, during daytime clinic hours. Additional peer navigators also provide outreach and co-facilitate groups in the clinic.
Peers are recruited and hired by Positive Living BC, which is contracted by PHC. The amount of training for peers varies, but includes individualized initial training and ongoing continuing education. After training, peers are available in the clinic but not necessarily matched with patients. However, in some cases supportive relationships may be planned with some consideration for gender, ethnicity, etc. Peer mentors have supervision and access to psychosocial support through their employer as well as their health care providers. These peers are widely recognized throughout the organization. The peer program is a model for other departments in the hospital, and the manager of the program is called upon to consult and educate about peer mentoring.
The program is evaluated through the funder and contract holder (Vancouver Coastal Health Authority). Within the clinic, peer navigation is included in ongoing quality improvement assessments such as patient satisfaction surveys, etc. The initial funding for the peer mentor program was under a special funding allocation through "treatment as prevention." However, the program is now well established through contract and on-going funding.
Scott Harrison RN BScN MA CCHNC
Director Urban Health, HIV & Addiction
Providence Health Care