Building bridges and connecting Fullerton’s homeless to essential resources

Community Care Navigator Program in Fullerton, California

Building trust through compassion is the foundation of Carrie Delaurie’s work as a community care navigator at St. Jude Medical Center in Fullerton, California.  

Delaurie is devoted to helping those experiencing homelessness who enter the Emergency Department in need of medical attention, shelter, clothing or substance use treatment.

Prior to our program, she says that "the homeless came in, got triaged here and left."   

She is working to change that, meeting people where they are – whether it be at a park, a bus stop or a local shelter. She slowly builds trust and connects patients to critical resources like housing, outpatient medical care, transportation, Social Security, treatment programs and mental health services.

In 2011, the City of Fullerton and community leaders reached out to St. Jude Medical Center, a Providence St. Joseph Health hospital, after the tragic death of a homeless person and a spike in emergency department repeat visits.

Carrie-Delaurie-community-panel-homelessness

Part of Carrie Delaurie’s role involves community education and outreach. Here she speaks at a Fullerton community panel on homelessness.

"We found that several dozen patients were coming into the ED very frequently," says Barry Ross, vice president, healthy communities at St. Jude Medical Center. “One man had 65 visits in a year,” he says. "We tried to understand why they were coming in."

After evaluating best practices from around the country, St. Jude launched an innovative program – the Community Care Navigator Program – as a direct response to the needs of the community’s most vulnerable.

When a patient enters the ED, St. Jude physicians and nurses first address medical needs and provide treatment as needed. Then a community care navigator, like Delaurie, steps in.

"We want to make sure they are connected to some sort of resources," says Delaurie, who closely coordinates with St. Jude staff and local agencies including the Illumination Foundation and CityNet, the Orange County Department of Behavioral Health and the Fullerton Police Department.

But it’s not always easy. Many patients are wary of new people.

"There's a lot of distrust. It sometimes takes years to build relationships with people,"Delaurie says. “It's important to be there when they are ready for help.”

Through conversation, Delaurie learns how long the patients have been homeless and what barriers they face when seeking help. She learns if someone is a veteran, has suffered mental illness or has family members nearby. This information can help Delaurie match patients with the appropriate resources.

"It's all about making connections and building relationships," Barry says. "These are the most vulnerable people in our community."

Through a total community benefit investment of $123,278 in 2018, Providence St. Joseph Health was able to assist more than 500 people in 2018 who came to St. Jude Medical Center’s emergency department. Often these individuals were living on the streets or in their cars. Forty-four percent were identified as having mental health disorders and of those, 62 percent were connected to appropriate services.

Overall, St. Jude Medical Center saw a 33 percent reduction in avoidable ED visits by those who were homeless. But the program's success is measured not only in guiding patients to the best care setting, but by the difference Delaurie and her colleagues are making in the lives of homeless patients. “When a person who was homeless can be connected to permanent housing, our caregivers (employees) feel a deep sense of satisfaction,” Barry explains.

I'm lucky I can do this," Delaurie says. "If everybody in the world helped one person, the world would be such a great place."

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