Care Systems in Community-Based Contexts: The Role of Navigation and Technology in Promoting Access to Human Services in a Referral NetworkPublic
The provision of social services is becoming increasingly complex as human service agencies, nonprofits, and government agencies recognize the importance of wraparound care. A wraparound approach to social service provision acknowledges the importance of providing comprehensive services that meet various individual, family, and community needs. This approach is enacted through SoC. Systems of care are interorganizational referral networks that use technology and personnel to coordinate care and mobilize resources. This dissertation explores how community-based SoC use technology and navigation services to support care provision. It uses theoretical frameworks from community development, ecology, community psychology, and technology design to answer three research questions: 1) how do community-based network members perceive or characterize CMT use in collaboration?; 2) how does the use of CMT by community-based organizations mediate access and connection to care?; and 3) how do community navigators in community-based SoC influence access to care? Research question 1 uses a mixed-method approach. It examines how community-based members understand and conceptualize CMT tools concerning care system work and the potential for different use categories to appear. Using semi-structured interviews with 13 care system personnel and examining 467 service episode data from the IRIS case management system, this research finds that the community-based care system sees variation across metrics that point to the provision of care (time to accept, time to close distribution of referrals). Computing these metrics highlights different user categories. Specifically, care system backbone personnel and affiliates (senders) are responsible for routing most service requests. Combinatorially, this difference in use surfaces qualitatively as community-based partners (receivers) point to a reliance on backbone staff as the primary routers of service requests. Although there is uneven use of the CMT, both partners and backbone personnel show that CMTs afford the ability to build community relationships and capacity. These technologies support community connection and resilience that extends past the technologies themselves. These findings expand theoretical explanations surrounding the affordances that case management technologies provide. Research question 2 is descriptively driven and examines the outputs of using these technologies. Specifically, this research question emphasizes care system process metrics like time to accept, rejection rate, time to close by service type, and organization. An examination of 467 service episodes from IRIS finds significant variation in process metrics across service type categories and organizations. These findings suggest that service complexity and service ambiguity influence how community-based organizations provide care. Research question 3 examines how community navigators influence community members' access to services. Through a grounded qualitative approach of interview data from 13 care system personnel, this dissertation finds that community navigators also serve as community resource advocates and consensus builders. The community resource advocate role emphasizes local use of community resources. The consensus builder role underlines the ability of a community navigator to create buy-in and awareness across care system stakeholders to ensure a community member's care-seeking journey is comprehensively supported. Overall, this dissertation provides five key contributions. First, it offers a detailed empirical observation of ecological system theory by explaining how care systems embody the mesosystem and the exosystem. This dissertation expands our understanding of technologies' active role in our development. Specifically, technologies can comprise complex systems of relationships and interactions. Technologies mediate our experiences with others and are co-constitutive. Second, this work extends our theoretical understanding of technological affordance by surfacing a different use category that may be relevant as case management technologies move to community-based contexts. Third, this work provides a typology that expands our understanding of the roles community navigators play that are unique from their counterparts. Fourth, this work serves as a resource and guide to scholars and community-based organizations to fully embrace the potential of technology and community navigators as modes to create social impact and support equitable community development. Finally, this work provides propositions for further research to expand and test the presented results.
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