Prospero Health has teamed up with Landmark Health.

Jean-Marie Cotton

“Tell Me Your Story”: A Conversation with a Prospero Social Worker

Portrait of Jean-Marie Cotton
Jean-Marie over FaceTime

Jean-Marie Cotton, a social worker, had only been making home visits for a few months when she received an unusual request from one of her patients: Helen would soon be turning 100 and wanted help organizing a celebration. Jean-Marie’s responsibilities do not usually include party planning, but she was delighted to lend a hand. Together, they came up with a guest list, picked out Helen’s outfit for the big day, and wrote the speech she would give to her family and friends before blowing out the candles.

“It was so important to Helen to have somebody help her prepare for her 100th birthday,” Jean-Marie said in an interview. “I had no greater joy than doing that with her. It was so meaningful to me.”

With decades of experience in the field, Jean-Marie is an expert at — to use the old social work adage — meeting people where they are. In the case of her role with Prospero Health, a company that provides care and support to those with complex conditions, the “people” are older adults with serious illness. The “where” signifies her patients’ physical location, at home, as well as the kind of support they’re looking for. When Jean-Marie sits down with a patient for the first time, she begins the conversation with a gentle request: “Tell me your story.” To understand how she honed this approach, which breaks down the defenses people put up when talking to healthcare providers, it’s important to know a little bit about her story.

Jean-Marie always knew that she wanted to work in a helping profession. Like most young adults, though, she fretted over choosing the best path to achieving her ambitions. Starting out in college, she initially thought she would major in social work. When that didn’t feel quite right, she switched her major to biology. In the end, she settled on psychology as a springboard to a graduate degree in social work. During the year between finishing college and enrolling in grad school, she worked at Pilgrim State, a psychiatric facility on Long Island that was at one time the largest hospital in the world. There, she solidified her passion for the mental health field.

“I absolutely loved working with adults with severe and persistent mental illness,” Jean-Marie said. “They’re one of the most underserved and vulnerable populations.

One of my goals was to help them find the voice that would allow them to get their needs met. I would encourage them by saying, ‘Listen. Your disease does not define you. You may have bipolar, you may have schizophrenia, but guess what — you are an individual and that is just a diagnosis.”

After earning a master’s in social work from Columbia University, Jean-Marie spent several years as a pediatric social worker in hospitals. She then moved to the U.K. and began working with older adults with chronic conditions. In England, where the healthcare model incorporates more home visits than in the U.S., she came to appreciate the value of spending time with patients in the place where they feel most at ease.

“Patients are never going to be their true selves in the hospital,” she said. “At home, they are. As social workers, we get a very different picture in the home.

When we go in, we’re not just assessing the individual — we’re assessing the physical space and the relationships.”

Following this period overseas, Jean-Marie took some time off to be a stay-at-home mom. When she returned to the workforce, she quickly rose to an executive role at a residential facility for seniors. While she appreciated the challenges that came with being an administrator, she missed the face-to-face interactions with patients that defined her early career.

“I wanted to get back to the true nature of social work, where my heart is, and that’s in supporting patients,” she said.

At Prospero, where Jean-Marie has been working for about a year, she applies the lessons she learned from previous roles serving people with severe mental illness and older adults with debilitating physical conditions. From her perspective, both populations are overlooked by a society that fails to see the fullness of their humanity.

“When I visit my patients, it’s not always, ‘Let’s talk about your serious illness,’” she said. “It’s, ‘Let me get to know you as a person.’ A lot of what Prospero is doing is about storytelling. Once you build that bond and they tell you their story, then you are able to bridge the gap and help them deal with their health concerns.”

A key aspect of meeting a patient’s needs is understanding the experience of their caregiver, especially if that person is a spouse or child. Even the most loving familial relationships contain hidden resentments that can fester and interfere with caretaking, which is a draining responsibility to begin with. Jean-Marie recalled working with a married couple where one partner struggled to perform certain tasks for her husband because she was carrying unresolved anger towards him. “Am I a couples counselor?” Jean-Marie wondered as she tried to mediate the situation. When such family dynamics are at play, she makes a point of spending half of the visit with the patient and the other half with the caregiver. The goal is to make all parties feel heard and create space for open and honest communication.

As Jean-Marie’s patients look back on their lives, they sometimes unearth long-buried traumas, such as abuse by a parent or partner. When this happens, she springs into action and draws from her training in mental health.

“When somebody is facing the end of their life, a lot of stuff comes up,” she said. “The nurse practitioner [on our team] is not going to address that, so that’s where I come in. I’ve done trauma work in the past and one thing I say to patients is, ‘We’re not going to change what happened to you, but if we can talk about it, we can develop some scar tissue over it.’”

Jean-Marie tries to meet more frequently with people who are processing difficult memories. If their emotions become overwhelming, however, she refers them to a mental health practitioner who can treat them on a more consistent basis.

With the ongoing pandemic, Jean-Marie has put her home visits on hold for the time being. While the Prospero team develops a system for virtual visits, she is making a point to check in more often with her patients over the phone. When she speaks with them, she can hear the fear and worry in their voices. It makes her sad to think about how isolated they must feel, especially the ones who live alone.

“You don’t realize how significant your visits are until a crisis happens,” she said.

In these uncertain times, Jean-Marie recognizes that both she and those in her care feel more emotional. The advice she gives them echoes the steadying words she tells herself.

“We never know what tomorrow holds,” she said. “I tell my patients, ‘Focus on what’s happening today and incorporate something that you enjoy, that brings you fulfillment.’ That’s really where I go with them — to try to refocus, redirect, and let them know I’m here for them, especially if they’re struggling.”