Extending Compassionate Care to Fullerton’s Homeless

April 24, 2018

Carrie DeLaurie works for a hospital, but her work – and her passion – takes her to parks, bus stations and local shelters.

Carrie is a community care navigator devoted to helping the homeless men and women who come to the emergency department at St. Jude Medical Center, a Providence St. Joseph Health hospital in Southern California. While some arrive for medical needs – a head injury, an infected wound, a chronic illness – others show up needing help with shelter, clothing and mental and substance abuse issues.

"The homeless come in, get triaged here and leave," says Carrie, who has a master’s degree in marriage and family therapy. "They live in the moment. Their whole life is an emergency room."
Carrie is trying to change that, meeting homeless people where they are in their life journeys. She builds trust, connects patients to resources, including outpatient medical care, transportation, social security, sobriety programs, mental health services or housing, food and other needs.

A community comes together

The impetus for this outreach was the 2011 death of Kelly Thomas, a mentally ill homeless man whose death made national headlines and shed light on the plight of the homeless who congregate in numerous parts of the city.

City and community leaders reached out to St. Jude Medical Center for help.

"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 look at why they were coming in. They weren't coming in for medical reasons but for mental health or substance abuse issues."

After looking at best practices from around the country, St. Jude launched an innovative program – the Community Care Navigator Program – to meet the medical, social, emotional and day-to-day needs of homeless patients.

After St. Jude physicians and nurses help with medical treatment, Carrie steps in. The goal is to not only extend comprehensive care but to reduce the number of visits to the emergency department.
"We want to make sure they are connected to some sort of resources," says Carrie, who works closely with St. Jude staff and with local agencies, including Orange County Department of Behavioral Health, churches and the Fullerton Police Department.

It's a busy job and not an easy one. Many patients are wary of people and of getting help.

"There's a lot of distrust. It sometimes takes years to build relationships with people," Carrie says. It's important to be there when they are ready for help, she says. "I try to focus on the ones that want help and build relationships with the others."

Carrie finds out how long the patients have been homeless, what the barriers are to getting help and asks questions. She finds out if someone is a veteran, has suffered mental illness or has a family. That information can help her get people to the appropriate resources.

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

Making a difference in people’s lives

Providence St. Joseph Health in Southern California began the Community Care Navigator program as a direct response to Providence’s community health needs assessment, which identified patients with mental/behavioral health issues as one of the greatest unmet needs in the region.

Through a total community benefit investment of $124,452 in 2017, Providence St. Joseph Health was able to assist more than 500 people in 2017 who were living on the streets or in their cars and came to St. Jude Medical Center’s emergency department. Forty-four percent were identified as having mental health disorders and 62 percent of them were able to be connected to services. Fifty-six percent of the people with substance abuse disorders were connected to services. Overall, St. Jude Medical Center saw a 33 percent reduction in ED visits by the homeless population in 2017.

The program's success is measured not only in the reduced number of visits to the ED but by the difference Carrie is making in the lives of homeless patients.

"What we've seen is that some of our patients who are frequently coming into the ED have fewer visits," Barry says. "These people are getting older and sicker and it's really hard to be on the streets when you are sick."

"We all need to have a more holistic view when it comes to helping the homeless," Carrie says.

A few years ago, Carrie helped a man secure housing. The man, who is his 70s, has no family and for years lived on a boat without electricity or water. He'd been living in a Fullerton park for about a year and showered at the gym, where he fell and hit his head. Paramedics took him to St. Jude. Given his age, medical history and history of alcoholism, the man may have been at particular risk out on the streets. He's now safe.

"He just needed that consistency, a little bit of guidance. You have to have good follow-up with the homeless," she says.

In fiscal year 2017, 118 people were connected to substance abuse services and 116 to mental health services.

Carrie says she loves her job.

"I just like being a steward of God. God wants us to help others, to help each other. I'm lucky I can do this," she says. "If everybody in the world helped one person, the world would be such a great place."