Recovery Insights Lab · Research direction

Information and navigation

Where does the path from discharge to support break down?

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The research question

A referral may exist on paper—but can a survivor actually understand, reach, and use it?

People may leave rehabilitation with instructions, referrals, websites, and phone numbers, yet still struggle to know what to do when new questions arise.

This work compares the pathway the system intends with the pathway survivors and families actually experience, so recurring breakpoints can be identified and redesigned.

Research model

Mapping the journey from information to actual support

The visual shows the pieces that determine whether a referral becomes a usable pathway: information, handoffs, eligibility, transportation, community resources, follow-up, and the points where people get lost.

Information and navigation research model A visual model of the steps between discharge and support, including information, referrals, eligibility, transport, community resources and breakpoints. Discharge information what people are told Referrals handoffs · next steps Follow-up care appointments · continuity Eligibility insurance · criteria Transportation can I get there? Community resources what exists locally Questions what do I do next? Breakpoints where the path fails CAN PEOPLE REACH THE SUPPORT THEY NEED? A referral is only useful if the path works OUR APPROACH TRACE Map the intended journey LISTEN Capture survivor & family experience COMPARE Intended vs. experienced path CO-DESIGN Improve handoffs and information TEST Can people actually use the pathway? KEY DELIVERABLES Recovery journey map Breakpoint analysis Clearer handoff pathway Referral prototype & partner brief
A referral is not the same as reaching help. The pathway has to work from the survivor’s point of view.

Contribute to this work

Recovery Insights Lab brings together lived experience, clinical knowledge, and community expertise. We welcome people and organizations who can help make this work more useful and grounded.

Survivors & caregivers

Show us where the pathway worked—or failed

Share where you became confused, delayed, redirected, unable to qualify, or successfully connected.

Clinicians & rehabilitation programs

Help map the intended pathway

Share how discharge information, referrals, handoffs, and follow-up are designed to work in practice.

Community organizations

Help us understand what happens after referral

Share eligibility, capacity, access barriers, and what survivors need in order to actually use a service.

What this work will produce

A clearer path from discharge to support

An information and referral map that identifies recurring breakpoints and supports clearer handoffs, navigation, and referral approaches that partners can test in real settings.

Explore related research questions

Survivor-defined recovery outcomes Needs after discharge Community reintegration