County Spotlight: Placer Whole Person Care Program

Ellen was staying at a local homeless shelter.  She started to feel tired and dizzy all the time.  After an emergency room visit she got the news.  Stage 3 cancer.

Skip had been homeless on and off for years.  Whenever he got a placement, he wasn’t able to maintain it for long.  Health issues, smoking in his placements, and wandering around were some of the problems that led him back going back and forth from the streets to the shelter.

Karly suffered from agoraphobia and depression which led to excessive drinking.  After a DUI and couch surfing with different people she found herself staying at the Auburn shelter.  She never thought this is where her life would lead her.  “I had a job, I had friends.  I had my own home and money in the bank.”  But, here she was, homeless and seemingly without hope.

All three of these individuals enrolled into the Placer County Whole Person Care program and through their hard work and the guidance of dedicated case managers they are now all stably housed.  Ellen is cancer free.  Karly is working as an IHSS worker for Skip.  At the time of this writing, WPC has helped to house almost 100 individuals.

For those not familiar with the Whole Person Care program, in 2016, the Department of Healthcare Services (DHCS) approved 18 Whole Person Care (WPC) Pilots to test local initiatives coordinating services for particularly vulnerable Medi-Cal beneficiaries.  WPC programs work closely with various government agencies and local NGOs to collaborate on data and information sharing and on providing client-centered case management services to individuals that typically come from at least one of the following target populations: Repeated incidents of avoidable emergency room use, two or more chronic conditions, history of mental health and/or substance use disorders, and/or individuals who are homeless or at risk of homelessness (including individuals with law enforcement involvement).

Each WPC Pilot program is unique and Placer County has focused on serving homeless individuals that may have any of the high-need problems listed above.  Placer’s program has four distinct service bundles: Engagement, Comprehensive Complex Case Coordination (CCCC), Housing, and Medical Respite.  The Engagement bundle allows staff time to follow a “whatever it takes” model of client engagement so that people who may not be interested in services can warm up to the idea of participating.  Clients enrolled in the CCCC bundle receive a full “whole person” assessment and a client-centered treatment plan where they choose the life goals that they want to work on.  Clients enrolled in the Housing bundle receive assistance in obtaining and maintain housing.  The medical respite bundle allows homeless individuals to have a safe, nurturing environment to stay in while they are too ill to be on the streets or in the shelter.  Regular nurse case management helps get people on the road to a more speedy recovery.  Services from all four bundles work together seamlessly so that WPC members get the help they need to get back on their feet.

To learn more about Karly, Skip, Ellen, and the Placer WPC Program you can listen to the attached four-episode podcast series.

Placer is #HereForYou

Geoff Smith

Licensed Marriage and Family Therapist

Program Manager, Whole Person Care

Geoffrey SmithCBHDA