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Field-Based Approach

As one of the largest field-based outreach teams in Sacramento County, our Community Health Workers provide individualized support and case management to help individuals experiencing homelessness and/or living with complex health issues get comprehensive health and social care.

Case Management

We are proud to have played a critical role in Sacramento's Whole Person Care and Health Homes Programs. To date, we continue to coordinate care across organizations and systems, and collaborate with numerous health care, housing, and social service providers to build and grow a patient-centered continuum of care.

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provided by our team for Sacramento's Whole Person Care program since its launch in 2017.

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by our team for Health Homes program since its beginning in 2019.

Between 2018 and 2020, our Community Health Workers facilitated 1,055 housing placements for individuals experiencing homelessness.

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Transitional Housing

We own and operate a behavioral health recuperative care home in Sacramento, where we provide housing and supportive case management services to six residents at a time. This transitional house serves people who are experiencing homeless, have behavioral health needs, and have a frequent pattern of using the hospital emergency department.

We offer our clients:

  • A safe place to stay while they recover from their health crisis.
  • A treatment plan that is customized for their unique needs.
  • Services in English, Spanish and other languages.

Community Transition for Formerly Incarcerated

Our adult re-entry services program offers a variety of services to help individuals who were formerly incarcerated re-enter the community. We coordinate case management and care coordination services with local health and justice system providers, including with the Sacramento County Adult Correctional Health and Sacramento County Probation departments, to support health coverage enrollment, and access to health care, behavioral health care, and social services.

The program is supported by the California Mental Health Services Act (CalMHSA) and the state Department of Health Care Services (DHCS) Health Navigators project.

A Trusted Team

The best care is achieved through relationships. Our Community Health Workers, Health Navigators, and Patient Navigators are more than just staff—they're part of the community.

From the hospital to the homeless shelter, from the health center to the housing authority, they meet clients where they are and represent the communities they serve with lived experience. They also receive ongoing training to build and maintain trusted relationships that lead to better patient outcomes.