Funder: Kaiser Permanente Community Health
December 2018 | Case Study
Ashley Turner, a substance use disorder community health worker for Los Angeles (LA) County’s Whole Person Care initiative, knows from experience that the first steps toward recovery are the hardest. The primarily homeless clients she works with come from all walks of life: “A lot of them are ashamed…They might have come from a prestigious background, their parents had everything, or they were high up on the corporate ladder, and just fell.” Meaning, there is no simple, one-size-fits-all approach to addressing their situation. Still, the soft-spoken 26-year-old woman is constantly asked by admiring clients: “How do I get to where you’re at?” Because, it is not only what Turner says that convinces her clients to seek help: it is also who she is.
Just a few years earlier, Turner herself was struggling to survive in a city with the second largest homeless population in the nation. At 24, she was pregnant, homeless, and fighting an addiction that led to her and her partner sleeping in the back of an abandoned house. One day, at a loss for what else to do, she walked into the Department of Public Social Services (DPSS) in Los Angeles and asked for a job. The DPSS connected her to an administrative position at the California Black Women’s Health Project, but it did not take her long to develop a desire for a more hands-on position serving the people she felt called to help.
That desire led her to a job as a peer community health worker with LA County’s Whole Person Care initiative, which is focused on improving health and social service delivery for LA’s most vulnerable Medi-Cal (California’s Medicaid program) beneficiaries.
Having struggled with many of the same challenges, Turner was well-suited to helping clients experiencing homelessness and substance abuse. She received approximately 120 hours of training in techniques such as motivational interviewing and patient engagement, as well as tailoring her approach to the needs of specific populations, such as transgender clients. She receives referrals through a hotline used by local health and social service agencies. The agencies refer tough cases: patients who regularly visit emergency departments, often after having overdosed or while seeking drugs or shelter. They also refer individuals who will benefit from the one-on-one peer support and connections to community housing, recovery, and support services.
“It’s not my job to manipulate patients…it’s helping them understand the outcome of the work that they’re doing for themselves.”
Turner maintains regular contact with approximately 20 clients, and meets them “where they are at,” whether the storefront they call “home base,” in a library, halfway house, or hospital. Although patients are typically enrolled in the program no more than two months, Turner and her supervisor can extend a patient’s time based on their specific mental, physical, or behavioral health needs. She acknowledges the work can be frustrating: “A lot of times the patients don’t want to go through the process, they want it immediately,” she says. “But I always tell them, think of this as a stepping stool to where you want to be.” These are likely words clients have heard before — but from someone like Turner, they have infinitely greater meaning.
Today, Turner lives in her own apartment with her two-year-old son. There is a smile in her voice as she reflects on her job: “I’m a part of this whole new movement…I never would’ve guessed I’d be here.”
Author: Mariel Gingrich, Center for Health Care Strategies.