Navigating Uncertain Seas

Before COVID-19 hit, Ana Morelos' job was all about direct contact with her clients.

On an average day, she would meet with at least four different expectant mothers to support them through their pregnancies. On one visit, for example, she might pick up a pregnant mother with a toddler and drive them to a specialist's office for an appointment.

In the doctor's office, Morelos might act as an interpreter for the woman, watch her other child during the appointment, and help her navigate payment options and scheduling for other appointments if necessary. Back at her office, Morelos takes on the role of case manager for each of her patients, helping them connect to other services such as The Life Link for housing or La Familia Medical Center for other health care needs.

Now, she does as much of this work as she can over the phone, but still meets with mothers when it's necessary.

Morelos is a "navigator" for the Las Cumbres Community Services Que Cute Healthy Babies program, which helps pregnant mothers in rough situations get the pre-natal care they need. The women she works with face incredible odds. Most are living in poverty, many are homeless, some struggle with addiction or with unsafe domestic relationships. The goal of the program is to help lower the percentage of babies born with low birth weights in New Mexico—which is significantly higher than the national average—by giving the moms who are most at risk extra support.

Morelos' position at Las Cumbres is paid for by the Santa Fe County CONNECT program, which funded the Que Cute initiative as one of its first pilot projects in 2015.

CONNECT is a network of community organizations and agencies aimed at helping Santa Feans meet basic needs such as housing, food security and mental health care. "Navigators" like Morelos run projects targeted towards specific community needs and act as case managers for people seeking services at those organizations, or refer them to more appropriate partners in the network.

CONNECT was started by the county with only a handful of programs. More have joined the network each year, and the city joined as a funder in July 2019 and brought on an additional 20 navigators from 13 community organizations. Now the network has over 100 navigators, according to the city, who work for organizations that include the New Mexico Immigrant Law Center, the City of Santa Fe Veteran Alliance, Kitchen Angels and the Recovery Center.

In response to COVID-19, CONNECT has ramped up. This month, CONNECT launched a public portal on the city and county websites that makes it easy for residents to find help for everything from paying for groceries to making rent (santafenm.gov/connect).

A simple online form asks a person for their name, contact info and the kind of help they are looking for. The city and county community services departments have hired new program care coordinators who use that information to link the individual with the appropriate service.

This is the first time the program has a public interface that allows people to essentially "refer themselves into the program," says Kyra Ochoa, director of the city Community Services Department.

Ochoa says the program is already seeing "a huge spike" in people needing help. Since the public portal launched on April 15, the program has received 43 applications through the new platform alone. In all of 2019, the program served 963 people.

In March, the city allocated $255,000 to COVID-19 emergency projects including CONNECT. Officials report $80,000 has been spent, some of which went to setting up the new emergency shelter at Midtown campus.

The Life Link tells SFR it received $50,000 from the Affordable Housing Trust Fund to help people pay rent. Half its referrals have come through CONNECT.

The funds available through CONNECT are "flexible," which means that organizations can use them at their discretion to meet the most pressing needs. That kind of funding structure is particularly important now, says Ochoa, because it means an organization can help people pay for immediate needs directly, such as paying for a trip to the mechanic or a phone bill.

But this funding structure is what has distinguished CONNECT from the beginning, says Morelos, because it has allowed her to craft a program that meets the needs she sees in the community rather than trying to build a program to fit into the requirements of a grant.

"It's about supporting the community from the bottom up," she says.

It's also an example of how technology can be used to streamline care.

All CONNECT service providers are linked into a database that makes it simple for navigators to share basic personal information—with permission from the client—each time they make a referral to another organization in the system.