Leaning on Experience, Care Navigators Help Those on the Rough Path to Stability

Unhoused and substance dependent, Jan Allen "lived," as he put it, in a hospital waiting room.

"I called it my base of operations," Allen said, slowly. "I used it for food, housing, income. I would fake an injury so I could get to the back and get a sandwich, get an apple juice, get some pills so I could sell them and get the drug of my choice. This is what I had resigned to be my life, and I was OK with it.

"But the universe," he said, "had something different for me."

Today, following years of recovery, the 51-year-old is on the front line of the County of San Mateo's efforts to address the overlapping traumas of homelessness, mental illness and drug and alcohol addiction. Allen is among a handful of specialists in County Health'sBridges to Wellness program who use their own experience living on the fractured edges of society to help others claw their way to stability.

These specialists consist of care navigators and supervisors like Allen who work with clients (never cases: the focus is on people, not process) facing the greatest challenges, the chronically homeless with multiple visits to emergency rooms or psychiatric emergency services with an addiction to alcohol or drugs or both. The term "complex," as in "clients with complex needs," appears six times in the job description.

Allen and his colleagues keep clients connected to medical and behavioral health care, along with social service agencies for benefits and additional support.

They are, in short, an unlikely band of rescue swimmers who help people who have fallen out of the safety net.

"There's a persistent myth that people choose to be homeless, addiction is an option and mental illness is a weakness," said Lucinda Dei Rossi, who runs the program for County Health. "We know that none of this is true. What we do know is that with the proper interventions - and with the support of our care navigators - people can recover."

"It's not a homeless person, a crazy person, a junkie, a druggie. We're all people," said Joseph Morales, a care navigator. "The question turns from, 'How could you be doing that?' To once you hear somebody out and understand them, to, 'How could you not?'"

Allen's road to redemption began around age 40 when a complete stranger took an interest in him. "It felt like they were willing to go the extra mile because they knew what my struggle was," he said. "That was the turning point for me."

'People just like us'
Bridges to Wellness employs 14 care navigators who each work with about two dozen clients have fallen hard out of the safety net.

"We're helping our mirrors, people just like us," said Traci Bradford, a 58-year-old care navigator who spent two decades using "anything from crack to heroin to alcohol" before getting sober in 2000. "Many of us have criminal backgrounds. We have a history with substances. We have a history with mental health and the work we've done on ourselves. We understand what it takes to get to where we are."

Clients' complex needs require complex solutions. Care navigators connect clients to a wide array of services offered by local, state and federal programs and, importantly, work to maintain those connections.

They help find housing, book medical appointments, fill out paperwork and replace long-lost IDs. They remind clients to take their Naltrexoneto reduce symptoms of withdrawal and cravings for opioids. They bring them food and water ("We get a lot of people who haven't had a hot meal or a bottle of water in awhile," Bradford said. "That's my icebreaker.") and sign them up for a service that brings them healthy meals.

Sometimes they simply fill the void of crushing loneliness.

Not all care navigators have gone through the struggles of addiction and the chaotic life of erratic mental health and homelessness. Four who have - Allen, Bradford, Morales and Nancy Wilson-Locke - agreed to talk about their lives and let a writer shadow them.

'I don't want to do this anymore'
Recent figures show more than 1,100 peopleare living on the streets or in vehicles in San Mateo County, a rise of 5 percent since 2022. In a major survey of individuals experiencing homelessness in California, 82 percent reported a serious mental health condition at some point in their life. More than one in four - 27 percent - had been hospitalized for a mental health condition.

"Human kindness is everything," said Wilson-Locke, 61, a Bridges to Wellness supervisor who credits "just that one person who believed in me" for helping her turn her life around. "You don't have to have a million dollars in the bank. You don't have to be all put together. If you have a kind word for somebody, you might just save their life."

Wilson-Locke grew up in San Francisco under the care of her grandparents after her parents divorced when she was very young.

"I started using when I was 13 years old. My first recovery program, I was 18 and I had 16 subsequent interactions with treatment facilities. I deemed myself, at that point, I was beyond help. I was not going to live to 30. That's what I used to tell myself," she said.

Wilson-Locke cut out and moved to Oklahoma for 15 years. She didn't know anyone, and Oklahoma had no appeal other than it was far away. "I thought it was the area" - that San Francisco and the Bay Area were the source of her troubles - "and it was me."

She returned about 20 years ago.

"Lot of prison. Lot of jail time. Lot of PES (psychiatric emergency services) …. I attempted to take my own life. I was on 5150, then 5250(a 14-day hold for intensive treatment related to mental health or chronic alcoholism and danger to self or others) and then they put me in Cordilleras(a locked facility, for long-term recovery). I finally got out and said, 'What am I going to do? I don't want to do this anymore.'''

Her turning point was meeting a therapist for the County who "believed in me. She didn't leave. On Saturday she came to see me. She'd meet me after hours so we could talk. She introduced me to some really wonderful women…. That really helped me. Just that one person who believed in me."

How is she today?

"I found myself. That little hurt person who was going through all those traumatic events wasn't who I was," she said. "I just got lost somewhere along the way and I found myself."

After 12 years of service, Wilson-Locke retired from San Mateo County Health this month.

"How much courage did it take just to get up today"
On a sunny July day, Allen, a former care navigator and now a social work supervisor, and colleague climbed into a small white County car and drove to see a client, a man named Michael living in an apartment next to Highway 101 in East Palo Alto.

Allen and all care navigators visit clients "where they are" - under a freeway overpass, in court, at a medical clinic, wherever. Michael had been living in a shelter for two years before landing a scarce subsidized apartment he shares with his cat, Cry Baby, and a friend he met at the shelter.

It had been a tough summer: Michael's motorized wheelchair had been plagued by battery and other problems. Far more concerning, he was waiting to learn if the spot of cancer found on his lung was benign or malignant.

Allen and his colleague asked Michael about his goals, taking a cooking class (he once aspired to be a chef) and trying to connect with old friends. They took notes. They listed what they will arrange for him: a referral for new glasses, food delivery to help him eat well, rides to medical appointments.

They will see if they can find a program that will lower his utility bills and another that would help him get free cat litter and cat food delivered.

Michael tells them he has $16 to see him and Cry Baby through the end of the month. Like most Bridges' clients, Michael has few visitors after years of a turbulent life.

"We really don't know where an individual is at or what an individual is going through," Allen said later when asked about his philosophy. "I don't know what it takes for an individual to get to where they need to go or what it took an individual to get here today.

"How much courage did it take just to get up today and put one put in front of the other? I just don't know, and I try to have that empathy with people.

"If you don't remember, you're doomed to repeat," Allen said. "I don't ever want to get to a place where I can't remember what it was like for me, so that I know how to treat people."

'If they see I care, maybe they'll care a little more'
On an overcast July morning, Morales met a client at the County's Navigation Center, which offers temporary housing and an array of services for people experiencing homelessness. The client had been sober and living at the center for two weeks.

"The only things I have," he told Morales, "is my dog and my donation clothes."

Later, in a car on the way to see another client, Morales talked about the pain of being homeless and alone, of being around people who ignore you or treat you with scorn.

"We have clients who have no one else. They don't have any family, friends around," Morales said. "We have clients who put us as their emergency contact. On holidays I'll get voice mails or messages: 'Happy Easter.' 'Happy New Year.' Clients don't have many personal connections."

At 33, Morales is younger than most care navigators as well as his clients. But their stories share a common frayed thread.

His parents separated when he was young; he barely knew his dad who, he was told, died after slipping and hitting his head. "On his death certificate it said, 'chronic alcoholism,'" Morales said.

His mother, struggling with substance use, was in and out of jail. "I was what we call straight edge until 14, 15, then began to experiment with alcohol and other drugs," Morales said.

"I knew in my heart of hearts this wasn't me. I didn't want to do this. I knew I was going down a path that wasn't good," he said.

"At one point, my mom and sister were using my pick-up truck for shelter along with our pet dogs until there was room for them to get into shelter. It was heartbreaking - I was devastated and hurt," he said.

"I would use drugs and alcohol, and party, to have fun, but later on, I learned that I was also escaping and masking those unwanted and negative feelings that would surface after seeing my mom and sister in their situation and knowing that, that's what was in my future if I did not make something happen for myself."

An intervention by friends was key. Morales graduated from college in 2013 and began a career in drug and alcohol counseling.

"These little things the community - users and addicts - know of, they don't really speak about it to other people," Morales said. "When I'm able to open up and share my experience, they know, 'Oh wow. This guy's been there. He knows the real deal.'

"Or grimy situations. Addicts, they have - we have - weird mentalities. Like you'll steal from your friend and help them look for it all day. I think that's what's always been able to help me connect with clients, that experience that I survived through and been through."

Bridges to Wellness is County Health's implementation of Enhanced Care Management, a benefit available to Medi-Cal recipients through the Health Plan of San Mateo.

Clients enter the program voluntarily. They are identified as potential candidates after flagging various safety-net systems through repeated visits to emergency rooms and psychiatric emergency services or through referrals from a number of partner agencies.

There are 340 clients in the program who are also supported by public health nurses, mental health and substance use recovery specialists, benefits coordinators, housing program staff and others among County departments, Core Service Agenciesand local partner organizations.

Morales arrived at a client's apartment off East Third Avenue in San Mateo, the late-morning sun shining. The door swung open to reveal a spartan existence: shades down; empty cardboard boxes for a table; bare walls.

His client had been in and out of jail, emergency rooms, shelters. Methamphetamine was his nemesis, and his family had cut off contact. He now takes several medications to control cravings and smooth emotions. Morales is one of the man's few contacts in the world, along with occasional food deliveries and a visit from a public health nurse.

"You may not be proud of you, but I'm proud of you," Morales told him. "We all need support sometime. Really, that's a sign of strength."

Later, Morales said, "If they see I care, maybe they'll care a little more."

'I try to bring calmness'
On a warm August morning, Bradford emerged from her car into dazzling blue sunshine that matched her mood. "Hello!"

It was the kind of greeting you shout to a dear friend you haven't seen in ages. "How are you?!?"

Bradford was visiting a 52-year-old man she met three years ago when he was living outdoors and severely ill. Now he has his own apartment decorated with colorful "Welcome" signs and kitschy Fourth of July knick-knacks.

But not all is well. Bradford asked if he's taking his medication (sometimes) and went to his doctor in July for an infusion (he can't remember). Her tone goes from cheerful to serious: "What's going to end up happening if you don't get your infusion?"

In little more than a whisper, he replied: "Deceased."

Bradford pulled out her cell phone. "My name is Traci Bradford," she told his doctor's office. "I'm the case manager. It's on file."

She made a fresh appointment and scheduled a Lyft to get him there.

"If nobody every listened to me or helped me, I wouldn't be here," Bradford said later. "So I want to be that same vessel for someone else. I try to bring patience with people, I try to bring calmness."

What does success look like?

"Baby steps. Even the slightest movement in wellness, even the slightest interest in being better, just showing and expressing some interest is success.

"We get so many clients not willing to deal with their medical issues. I have one now who is really, really struggling, and success is building trust. It's motivating clients' interest."

How do you build trust?

"Listen. You got to be able to listen to understand. Not listen to have an answer. It's very important to just let them talk. A lot of people think, 'Nobody listens to me. Nobody cares.' That's the number one thing I hear.

"We're housed today, but we could be homeless tomorrow. I've had clients who were functional, had great jobs, and then everything just went bad. That could be me again. That could be you tomorrow. Be kind to people.''

Later, she met a 59-year-old client at a picnic table outside San Mateo Medical Center.

He spent 18 years living on the streets, mostly hustling for drug money: "I always had a gift for gab. I once talked a guy out of $500."

At his best he wore clean clothes and sharp shoes - that was part of his hustle. "People always look at your shoes. They tell where you've been and where you're going," he said.

At his worst he lived in alleys, sick, cold and alone.

With Bradford's help, he's now living in a "wonderful" apartment with his wife of four years, sober and undergoing cancer treatment.

"Traci is awesome. She cares. She really cares. She came to sit at my infusion appointment, almost two hours with me. She cares for people, and when you care for people, that's awesome because people need that.

"They need to have that extra voice that says, 'Hey, there's somebody here for you. I'm here for you. And I'm going to hold your hand through this. I'm going to help you make the right decisions to get you healthy. I'm going to help you with your housing. If you need food, give me a call.' Those are things I needed to hear from a person."

His success comes with a cost. Today, he's parting ways with Bradford as he no longer needed such intense care and motivation.

So the former homeless street hustler with the gift of gab reflected on the past few years, where he's been and where he's going. His voice, strong and confident earlier, quavered.

"Just do me a favor," he said to Bradford, pausing, "and check in sometime."