One Family’s Road to Stability through Case Conferencing
In August 2024, a Patient Navigator at the UC Davis Child and Adolescent Abuse Resource and Evaluation (CAARE) Center joined Family case conferencing. She presented for discussion a family of six living outdoors in the backyard of a home they recently lost to a fire. One parent worked three part-time jobs, while the other took care of their four children (aged 2, 9, 10, and 14). Their lack of income, poor credit, and thousands of dollars of debt made it difficult to secure permanent housing without assistance.
The case conferencing team walked the navigator through the steps required to bring this family into the homelessness response system. She worked tirelessly to create profiles, perform assessments, complete housing documents, and build relationships with other programs in the community that could meet their many, complicated needs.
With the help of our case conferencing Coordinator, the navigator made two powerful connections that would set this family on the path to permanent housing. While they were still living outdoors, they could be referred to Sacramento County’s Department of Human Assistance (DHA) for enrollment in CalWORKS and the Housing Support Program. This provided additional guidance for securing full-time employment as well as an ongoing subsidy once they located a unit.
Then, the navigator was introduced to Lao Family Community Development, Inc. The organization had recently purchased several homes and wanted to fill them will families who had gone through case conferencing. Lao Family felt that our work to address a multitude of service needs would contribute to a smoother transition into stable housing. By mid-November, the family had moved into a three-bedroom home with rental assistance.
The System-Wide Impact of Case Conferencing
Originally published in the February 2025 SSF Monthly Newsletter.
Over the last year, I’ve had the privilege of collaborating directly with service providers to transition people experiencing homelessness into housing in Sacramento. One of the most valuable tools we use is a process called case conferencing. This approach focuses on a particular set of vulnerable clients who have long histories of homelessness and need the support of specialized resources and permanent housing. Facilitated by our team at Sacramento Steps Forward, case conferencing groups challenge both individual and systemic barriers, while also challenging providers to show up with creativity and accountability.
Each of our providers commits to working through some of their toughest client cases with us in twelve-week cycles. At the end of each cycle, many people will have moved into permanent housing or enrolled with a short-term program designed to move them to permanent housing within six months.
The success of this approach has been remarkable. From February to December 2024, we discussed 560 households and 253 (45%) of them achieved positive housing outcomes. Of these, 176 (31%) were housed or waiting to move in, and 77 (14%) enrolled with programs to quickly get them sheltered, such as Rapid Rehousing or the Landlord Engagement and Assistance Program.
These outcomes are due in large part to partners who bring diverse and complementary knowledge and experience. Service providers now join case conferencing from a myriad of programs across Sacramento—including Shelter and Navigation Centers, Street Outreach, County Behavioral Health, Primary Care Clinics, Substance Use Treatment Programs, CalAIM Community Supports and Enhanced Care Management, Supportive Services for Veteran Families, and Veterans Affairs.
The approach also recognizes that housing is only one piece of a complex puzzle for many clients. For example, it’s common for people experiencing homelessness to need support with other aspects of their lives, especially their health. Among those supported in 2024 by case conferencing, 107 households (19%) were connected to ongoing mental health programs and primary care providers.
In addition to directly assisting people experiencing homelessness in our community, case conferencing must benefit the service providers who participate. Despite working from loud, chaotic shelters or calling from cars during outreach, these frontline staff attended more than 200 meetings in 2024. Our 75% average attendance rate indicates that case conferencing is, among other things, a useful and important part of resolving homelessness.
This year offers opportunities to bridge the many systems in our community and to continue delivering coordinated, compassionate care. Included in our 2025 efforts are two new case conferencing groups. One focuses on people who frequently use the emergency departments at four major hospitals (Kaiser Permanente, UC Davis, Sutter Health, and Dignity Health) and the other supports justice-involved clients. We are eager to see the benefits of this approach to help many more of our neighbors become housed and supported in the year ahead. It’s going to be another busy year!