Jennifer Ross, a PCAP case manager, prepares for the day at her desk at Sound Pathways on Thursday, Jan. 25, 2024, in downtown Everett, Washington. (Ryan Berry / The Herald)

Jennifer Ross, a PCAP case manager, prepares for the day at her desk at Sound Pathways on Thursday, Jan. 25, 2024, in downtown Everett, Washington. (Ryan Berry / The Herald)

As homelessness rises, Everett programs aims to help struggling moms

UW’s Parent-Child Assistance Program is designed for mothers, like Aunalisa Dawn Evans, who struggle with addiction during and after pregnancy.

EVERETT — Aunalisa Dawn Evans needed glasses.

Last spring, she wore broken dollar store frames, held up by just one arm and missing a nose piece. The lenses didn’t fit the frames and were so cracked and scratched they impaired her vision. She hadn’t had an eye exam in about a decade.

When Evans, 32, enrolled in the University of Washington’s Parent-Child Assistance Program last March, she was living in a van, trying to regain custody of her toddler and struggling with addictions to opioids and meth. Within a few months, she found out she was pregnant again.

That’s where Jennifer Ross came in.

Ross is one of eight case managers at the Snohomish County Parent-Child Assistance Program site, a nonprofit Everett-based Sound Pathways runs with oversight from the university. The three-year program, known as PCAP, has 15 sites across the state. It’s designed for mothers who use substances during pregnancy. Women can be eligible for the program for two years after giving birth.

The University of Washington and the local agencies that run PCAP contract with the state Health Care Authority to fund the program. It costs about $15 million annually. Last year, 1,286 clients were enrolled statewide.

Emilio Gomez, 9 months, plays at the Parent-Child Assistance Program office at Sound Pathways in Everett, Washington, on Friday, Jan. 12, 2024. (Annie Barker / The Herald)

Emilio Gomez, 9 months, plays at the Parent-Child Assistance Program office at Sound Pathways in Everett, Washington, on Friday, Jan. 12, 2024. (Annie Barker / The Herald)

In recent years, opioid overdose deaths have been on the rise in Snohomish County, largely driven by the rise of cheap, potent fentanyl. Data from the county medical examiner shows overdoses increasing every year, from 263 in 2021, to 285 in 2022 and 326 last year.

Nationally, there was a 131% increase between 2010 and 2017 in women with “opioid related diagnoses” at the time they gave birth to a child, according to a 2021 paper. In that same time period, there was an 82% rise in babies born with neonatal abstinence syndrome, which is caused by substance exposure in the womb.

Data collected by the University of Washington points to the program’s effectiveness. Between 2015 and 2021, 88% of mothers who graduated from the program had either finished addiction treatment or were enrolled. In that same group, 52% took work training, college or GED classes while in the program.

Case managers help them surmount any obstacles they may be facing and access resources.

Like new glasses.

‘A very good squeaky wheel’

At first glance, Evans’ glasses seemed like a low priority to Ross, compared to the dire stakes of homelessness, child custody and addiction.

But Evans kept bringing them up.

They were a source of shame. Evans felt the frames made her look more homeless, more like a “user.” She hated going places where strangers could see her, even the store.

“I just felt dirty all the time,” she said.

Ross realized the glasses needed to be the first step.

Evans and Ross had a tight budget. Ross would have to hunt for a steep discount.

They went to Lynnwood Visionworks. Ross told the manager there the situation: Evans was expecting, living in a van and preparing to go away for medical treatment. Was there any way, “on God’s green earth,” she remembered asking, the clinic could help her?

Tali Kiboigo, the clinic’s general manager they spoke to that day, said the exam, frames and lenses Evans needed usually cost about $740.

She got it all for $50.

With the new frames, Evans could actually see.

Beyond that, “I didn’t feel like I had to hide anymore,” she said.

Some might not have bothered to approach an eye clinic with so little money to spare. But Ross was “100%” sure it was going to work, she said.

“I’m a very good squeaky wheel,” she said. “We don’t have a lot of in-house resources here. But what I bring to the table is being very annoying and very persistent.”

Ross was a stay-at-home mom when she first heard of PCAP. After she became a foster parent to two siblings, Ross got close to their birth mom, who had a case manager in the program.

For Ross, family reunification is an important goal. The two kids that joined her family through the foster system are now in her care through guardianship, which in this case means their birth mom can petition for custody at any time. Her kids’ birth parents are in their lives “on a daily basis,” Ross said.

Helping her kids’ mom navigate resources inspired her to pursue working at PCAP. There, her belief in the value of bringing families together and healing generational trauma continues to motivate her. She has now been a case manager for 1½ years.

Kids aren’t born into the “wrong” families, she said: “I don’t think God makes mistakes.”

‘The first person that they could trust’

The University of Washington program has its roots in a 1980s study on prenatal cocaine exposure. Therese Grant, one of the researchers, founded PCAP after working with the mothers in that study. In 1991, the program launched in Seattle.

Originally, it was part of a research program. Studies examined its effectiveness, how losing custody of a child impacted future reproductive decisions and cannabis use among participating clients, among other topics.

In recent years, the program’s focus has shifted away from research. Though the university continues to analyze data collected before that shift, it is now primarily a social service program.

It’s unique because of its three-year duration and emphasis on the relationship between the client and case manager, said Susan Stoner, who took over as PCAP’s director in 2020.

A lot of clients have said “they found their case manager to be the first person that they could trust,” she said.

One of the program’s main missions is protecting future children from prenatal drug or alcohol exposure. That can mean helping women get into treatment or talking to them about birth control options.

“We’re not saying you shouldn’t have children,” Stoner said.

But clients don’t want their future kids disabled by drug or alcohol exposure in the womb.

Of the 1,783 program graduates from 2015 to 2021, roughly 78% did not give birth again during their three-year enrollment. Of those who did, more than half had a child born without exposure to substances, according to University of Washington data.

In that same group of graduates, just 28% started in stable housing. By the program’s end, the number was 70%.

When case managers talk to clients about barriers, they’re sometimes speaking from personal experience. Many have lived through the same issues clients are dealing with.

Personal experience allows case managers to relate to clients without judgment, said Sound Pathways Executive Director Shannon Smith, who started at the nonprofit as a PCAP case manager.

Smith spent 30 years struggling with alcohol addiction. She recently celebrated 10 years sober.

Sound Pathways Executive Director Shannon Smith poses for a photo at the Parent-Child Assistance Program office at Sound Pathways in Everett, Washington on Friday, Jan. 12, 2024. (Annie Barker / The Herald)

Sound Pathways Executive Director Shannon Smith poses for a photo at the Parent-Child Assistance Program office at Sound Pathways in Everett, Washington on Friday, Jan. 12, 2024. (Annie Barker / The Herald)

“If I could give 24 hours of my life clean and sober to somebody else, I would,” she said. “Because there’s days that my life is just crazy, but then I’m like, ‘OK, but I’m clean and sober.’ And I know tomorrow’s gonna be a better day.”

’You don’t feel like you deserve anything’

On a Thursday in late January, Ross pulled her minivan out of the Sound Pathways parking lot in downtown Everett. She was heading to a home visit with a client, with a pit stop at the nonprofit’s Harm Reduction Center to pick up naloxone kits.

The main problem with the way social services are set up, she explained in the car, is many agencies only provide one service.

“If you need food, you go to a food bank,” she said.

She wondered: Who is there to help people coordinate all of it?

Often people make calls asking for help and get told “that’s not what we do.”

“A lot of times, they’ll just be like, ‘OK,’ and then hang up and that’s the end of it,” Ross said. It “took all of their courage to make that call in the first place.”

Part of Ross’ role is to help people advocate for themselves.

At the Harm Reduction Center in north Everett, people can come in to get a host of necessities: food, hygiene kits, needles for safe injection, fentanyl and xylazine test strips, wound care and more. Staff also do outreach to people on the street.

The day Ross stopped by to pick up naloxone, staff were gearing up to help a client furnish a new apartment.

Joe Dugan, HRC Community Outreach Specialist, packs a bag with Naloxone and other supplies on Thursday, Jan. 25, 2024, at the Sound Pathways Harm Reduction Center in Everett, Washington. (Ryan Berry / The Herald)

Joe Dugan, HRC Community Outreach Specialist, packs a bag with Naloxone and other supplies on Thursday, Jan. 25, 2024, at the Sound Pathways Harm Reduction Center in Everett, Washington. (Ryan Berry / The Herald)

Ross spends a lot of time in the car, either driving to clients or driving them to resources.

Transportation is a huge barrier, she explained. Not all service providers are on bus lines. Then there’s the added complication of traveling with young children. It’s rare for a client starting in the program to have a driver’s license, she said.

After the Harm Reduction Center, Ross was off to Smokey Point. There, Ross met Andrea Gomez at her new apartment.

Having a home is a big milestone. Gomez, 39, couldn’t pay rent at the sober housing she was living in. So she and her baby, now roughly 10 months old, bounced from shelter to shelter for months.

Ross “helped me move like 500 times,” Gomez said with a laugh. Now, she has a permanent home in a Housing Hope apartment complex.

The pair called a methadone clinic in Arlington to figure out paperwork to get Gomez transferred to the clinic.

Her clinic in Everett, which she visited twice weekly, was a three- to four-hour bus ride away.

Ross put the phone on speaker so Gomez could hear as she asked questions, like, “How long is the wait for an intake appointment?”

On the visit, Gomez and Ross chatted like friends. The pair have built up a lot of trust. Gomez had few people in her life who could help when she had her baby. Ross was there almost every day, Gomez said. Once, she came over just to hold the baby while Gomez showered.

“When you’re in early recovery, you don’t feel like you deserve anything,” Gomez explained. “She helped me with my confidence just by helping me get little things done at a time.”

Aunalisa Evans holds her daughter Julia while speaking with her PCAP case manager Jennifer Ross at the Providence NICU on Thursday, Jan. 25, 2024, in Everett, Washington. (Ryan Berry / The Herald)

Aunalisa Evans holds her daughter Julia while speaking with her PCAP case manager Jennifer Ross at the Providence NICU on Thursday, Jan. 25, 2024, in Everett, Washington. (Ryan Berry / The Herald)

Later that afternoon, Ross picked up Evans from the Evergreen Recovery Centers-run inpatient treatment facility in Everett. She first took her grocery shopping, then to Providence hospital to visit her daughter, who was born in December, in the Neonatal Intensive Care Unit. Evans visited her every day, as long as she could get transportation.

In the hospital, Evans sat in a private room with her daughter nestled in the crook of her arm.

Finding out she was pregnant was her “saving grace,” Evans said. Knowing she had to get things together for her children got her to stop delaying “getting my head together.”

Evans entered a detox program at Swedish Ballard last summer before moving to the Evergreen Recovery Centers facility.

Ross got her into treatment, Evans said. To get in, “you have to be pretty much on standby by your phone,” ready to leave at a moment’s notice — something that would have been difficult to do alone.

Evans has now been sober for seven months. She graduated from Evergreen on Monday and moved into transitional housing. Ross is working with her to find permanent housing. At some point, Evans would like to go back to school.

“There needs to be a lot more programs” like PCAP, Evans said.

“I consider myself somebody that’s very resourceful,” she said. “I can find resources for everything, but I could not find resources like (Ross) can. And she’s relentless.”

Need help?

Apply for the Snohomish County Parent-Child Assistance Program at soundpathways.org/application

For emergency resources relating to housing, mental health, substance abuse treatment and more, you can also dial 211.

Sophia Gates: 425-339-3035; sophia.gates@heraldnet.com; Twitter: @SophiaSGates.

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