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One Team – Valerie Simmons, Senior Health Home Care Coordinator


Welcome to One Team, a series of Q&As shining a light on outstanding members of Citizen Advocates’ 800-strong workforce that stretches from Lake Champlain to Lake Ontario.

Citizen Advocates’ Health Home Care Coordination program bridges the gap between people and services with the goal of becoming self-sufficient and building confidence. “Many people struggle with asking for help, or don’t know that help is out there,” said Valerie Simmons, Senior Care Coordinator. Below is her story in her own words.

How do Health Home Care Coordinators connect clients to services?

Simmons: You name it, we connect them – therapy, medication management, food pantries, volunteer opportunities, friendship programs where someone comes in once a month to have coffee. We connect clients to HUD [Housing and Urban Development] and supported housing programs, coordinate Social Security benefits, set them up with home health aides. We work on parenting skills, help individuals find jobs, write resumes and join support groups for whatever they’re going through.

Someone might have a hard time making a phone call to a doctor’s office or doesn’t want to go into a store because they have a criminal history and think that everyone is judging them. They might have a mental health issue that makes it difficult to be in public. We help people get support and tap into every resource we can to get them on track.

Anything that a person experiences on a daily basis – work, home life, healthcare, entertainment – we strive for self-sufficiency. The goal of the program is to get clients to the point where they can manage their care on their own. We want to work ourselves out of a job.

How are clients referred to you?

Simmons: Often, referrals come from a county community services office, doctor’s office or therapist. Our coverage area is roughly a circle centered around Malone that includes Potsdam, Saranac Lake and parts of Clinton and Essex counties. Typically, a referral comes in and I call the referral source to glean any information about the situation before contacting the individual. I handle the enrollment and assessment then I assign the client to one of our care coordinators.

But clients also refer themselves. Sometimes I’ll get a call, and someone just says “I need help. Can you help me?” We do our best.

What specific needs do you commonly see in clients?

Simmons: A client has to have two chronic conditions to qualify for Health Home. Many of the people we work with are homeless or below the poverty line. They suffer from food insecurity or struggle to find employment. Many have significant mental health needs that prevent them from living the life of their choosing and need help with medication management. Some are just out of incarceration and psychiatric centers.

We work with youth and adults.

How did you become a care coordinator?

Simmons: I’ve always been in roles where I helped people. That’s pretty much all I’ve ever wanted to do. Before I was at Citizen Advocates, I worked at Head Start where I was a mental health special services coordinator.

I started working at Citizen Advocates around 2016 as an intensive case manager. At that point I was working with school-age kids.

One of the kids who I worked with I was told from day one was the most difficult client you could imagine. She had a background that would devastate most people, so she understandably had her guard up.

When I was assigned to her case, she reached out to my school-aged son and asked for intel about me. So, I talked to her about boundaries and how to build a working relationship without crossing them. I could see that she had so much potential, but she thought that no one cared about her.

Little by little, we worked together, and things got better. Now, she’s graduated from high school and has a home and child of her own. It’s amazing. She’s worked so hard to do better for herself. Everything she has is because she worked to get it. I just gave her a little push.

Working in community services can be challenging. How do you manage when situations get stressful?

Simmons: Self-care is important. I try to be a good listener for members of the team and reach out when I need to chat. In this line of work, there are a lot of things that are beyond our control – staff turnover, changes with individuals that we work with. You face them one at a time.

What do you do for fun outside of work?

Simmons: I enjoy time with my kids. They’re older, but I still do. I love being outside and playing with my grand pups. I love a vanilla chai. [laughs].

If you’re interested in learning more about a career at Citizen Advocates, visit