The following success story describes experiences across multiple Providing Access and Transforming Health (PATH) initiatives.
PATH funding and collaborative networks are helping rural providers offer safe environments where Californians can receive the resources they need to improve their lives, and access safe shelter. Del Norte Mission Possible is one of these providers leveraging multiple PATH opportunities to scale their programs and better address their clients’ needs.
Del Norte Mission Possible began as a small initiative in 2019, supported by a dedicated team of three people serving up to 900 unhoused individuals in rural Del Norte County. Through strategic use of PATH capacity-building grants and community collaboration, Del Norte Mission Possible has grown to 10 members and significantly expanded its impact on the local community.
PATH Capacity and Infrastructure Transition, Expansion, and Development (CITED) Round 1 funding allowed Del Norte County to make needed investments to its workforce, including hiring six new case managers and a California Advancing and Innovating Medi-Cal (CalAIM) Manager. Funding also allowed the organization to scale their Community Supports offerings, bridging gaps for vulnerable populations throughout the county that they could not previously reach.
In addition to PATH CITED funding, Del Norte County is involved in the PATH Collaborative Planning and Implementation (CPI) Initiative, working with local organizations to build sustainable networks of care.
Daphne Cortese-Lambert, Director of Homeless Services for Del Norte Mission Possible, recalls the significant challenges faced by the unhoused senior population. Before CalAIM and PATH, senior clients frequently ended up in the emergency room. Now, through innovation and collaboration with the Open Door program, Del Norte County’s unhoused senior population can find housing and receive case management support, either within a skilled nursing facility setting or at their current location.
“These programs are not only changing people’s lives, but saving lives,” said Daphne.
In a county with no emergency shelters, unhoused individuals were being released from the hospital only to return to the emergency room or face worse outcomes. CITED funding allowed Del Norte County to develop a recuperative care program, which has already helped dozens of people. Case managers work to place members in recuperative care into permanent housing, with considerable success. Stable housing allows individuals to address barriers and receive whole-person care comfortably.
“Life is hard on the streets, but when you are sick, vulnerable, and older with no family, this is a lifeline,” Daphne emphasizes.
Similarly, rural populations now have equitable access to services through a navigation center near a rural encampment where 500 individuals currently lack access to needed services. CITED funding has made management of the center possible. The center is a safe haven, assisting people who have no access to phone or transportation services, and serves about 200 unhoused individuals.
Through its integrated CalAIM ecosystem and strategic leveraging of community and state grants, Del Norte Mission Possible has made significant strides in improving the lives of Del Norte County’s unhoused population. Its commitment offers tangible pathways to a better future, serving as an inspiration for rural communities to collaborate to achieve collective goals.
“We, and those we serve, are forever grateful for the PATH CITED funding that has supported our much-needed improvements to serve our most vulnerable neighbors while relieving the pressures on our medical community. Thank you for entrusting this essential work to our organization. Together we are making a difference in the lives of Del Norte County residents.” – Daphne Cortese-Lambert, Director of Homeless Services.
Have you joined your local network of CalAIM stakeholders working together to implement quality Enhanced Care Management (ECM) and Community Supports services for members?
Have you applied for funding to support your organization’s workforce, vendor contracting, IT, community assessment and other Medi-Cal needs necessary to deliver ECM and Community Supports?
Would free coding and billing, client outreach and enrollment, program development, CalAIM implementation and monitoring, and other technical assistance services help your organization meet its Medi-Cal needs?