Celebrating Transgender Awareness Week

Nov 18, 2016

Nov. 14 – Nov. 20 is Transgender Awareness Week! GLAAD describes this week as a time to “help raise the visibility of transgender and gender non-conforming people, and address the issues the community faces.”

The transgender patients and clients we serve at Central City Concern are a valued part of our vibrant community, but they also face a number of unique barriers. According to CCC Associate Medical Director of Primary Care, Dr. Eowyn Rieke, people who identify as transgender are more likely to have difficulty finding employment and accessing housing. This, of course, increases the chances they become homeless and live in poverty, which is often how they end up as CCC patients.

Roran Everheart, an urgent care medical assistant at our Old Town Clinic, adds, “There is an overriding fear of being outed and ending up on the street. There’s a fear of violence.”

Our mental health providers also see a relationship between people who struggle with questions about their gender identity in isolation, and mental illness and substance use disorders. “Oftentimes we see that someone’s gender identity struggles play such a role in their mental illness that we actually see a relief of symptoms when people can make steps toward living the life that they believe is rightfully theirs,” says Erika Armsbury, Director of Clinical Services at our Old Town Recovery Center. “And the same goes with substance use—we see people who use substances as a means to manage whatever it is they are struggling with around who they are with respect to gender.”

Roran, who identifies as trans, understands some of this firsthand. “I wasn’t able to transition until I got into recovery,” he shares. “Gender identity is so complex. When you’re trying to figure out what your gender identity is, it’s a strain on your mental state. From my own experience, it’s hard for me to imagine how hard it must be for someone who is also homeless, addicted, and also trying to transition.”

These are the very real issues that affect the transgender community we serve; they matter profoundly to us. We also know CCC must continue working to extend the values of equity and inclusion to more and more people. In fact, increasing equity is an explicit part of our organization’s strategic plan.

In that spirit, CCC—particularly our health services—has taken steps over the last year to make our agency is more trans affirming, trans inclusive, and responsive to the experiences of transgender individuals. Staff members formed working groups. They held meetings, brainstormed, and prioritized. They consulted with our own health care consumers and colleagues.

Since that call to action, CCC’s health services have made significant advances to address the unique issues our trans patients and clients experience.

Trainings
Within the past few months, every single CCC staff member across our primary care, mental health care, and substance use disorder programs has gone through a “Trans 101” training to provide an understanding of the basics. The information covered in these trainings was intended to demystify trans issues, as well as to learn how to be an ally and interact with transgender patients in appropriate, sensitive ways.

However, Eowyn emphasizes that this is not about cultural competence; instead, it’s about humility. “Competence implies that we who don’t identify as trans ‘get it.’ Instead, we’re working toward a culture of humility as it relates to gender identity—recognizing that there are great differences at play here and that we need to be humble about our assumptions.”

Old Town Clinic primary care providers received additional training on the basic medical care of transgender patients. In a separate two-session training, mental health providers at Old Town Recovery Center learned about working with transgender patients during the transition process, as well as their responsibilities related to writing assessment and approval letters for patients hoping to transition.

“We want to be sure out providers are on the same page,” Erika says. “[Providing letters] is something we want to offer our patients consistently, but it’s important for us to improve our larger understanding of trans issues because, for us and our patients, the letter isn’t the ultimate goal, nor is it the end of their journey.”

Providing CCC health staff with information doesn’t just benefit them. It’s also a way to take a common burden off our trans patients. As Roran says, “Having to train your doctor to be trans aware can be so exhausting.” Staff members who are aware of trans patients’ experiences drastically reduces the chances of retraumatizing patients with insensitivity and judgment. Instead, calling back to CCC’s goal of cultural humility, Erika says, “Even if we aren’t experts, we know enough to be open and accepting. We honor their experiences and all the things they come to us with. We can show that we want to work with them to tease out the severe mental health hardships while also supporting them around their gender identity.”

Transgender Support Group
Patients of Old Town Clinic and the Old Town Recovery Center can now find a community of support, thanks to a new group co-facilitated by Roran and Shanako DeVoll. Though in its early stages, Roran sees great potential for the group, named “Chrysalis.”

“A lot of our clients are pretty isolated in their lives,” Roran says. “When you start to navigate your gender identity without supportive family or friends, it can be lonely to not have that sounding board. This group gives them a chance to meet other people who identify as trans.”

The hour-long support groups make room for organic conversation to talk about struggles and victories, resources, and relevant topics. Roran and Shanako co-facilitate, but the group itself is largely client-led. It begins open for anyone for two meetings, then closed for the following three months to give the group time to develop a sense of community and trust. After, the group open up again. That sense of trust, Roran says, is imperative to our clients.

“Many of our clients face mental health and addiction challenges. There are already lots of groups out there for trans people, the feeling is that many of them feel cliquish. Clients with mental health challenges may not be able to navigate the social cues at larger, more established groups, so having someone like Shanako, a mental health professional, on board is great.”

Roran hopes to see the support group thrive. Early signs show interest is high, and people appreciate this opportunity to find an accepting community. “I hope that people want to come back all the time and that this first group will invite their friends to this awesome group they’ve discovered.”

Adapting Electronic Health Records
In a health care setting, it’s easy to forget infrastructure and technology can carry the same biases and blind spots that we seek to mitigate. Thankfully, CCC health services didn’t forget, and instead spearheaded substantive changes to our Electronic Health Records (EHR) system to, as Eowyn says, “reflect this culture change of becoming more trans affirming and inclusive that we’re working to embed within the organization.”

The most immediate and noticeable change is the banner when one pulls up a patient’s record. There, at the very top, is now an area that shows the patient’s pronoun and preferred name. Though small, this change will help staff interact much more appropriately in the way that the patient identifies.

The EHR system will also help health care staff ask appropriate questions related to gender identity and sexual orientation, in both content and word choice. Staff members performed hours of research to learn about best practices for asking these questions, then adapted it to CCC’s culture to be even more inclusive than what the current body of research suggests. The goal, according to Eowyn, is to structure these questions in a way so “as many people as possible have a place to feel like they belong.”

Better, more inclusive questions means gathering better, more inclusive responses. This, ultimately, will help CCC health services track how we are serving our transgender patients as a whole. In that vein, an OHSU Doctorate of Nursing student is planning a period of focus groups and one-on-one interviews during which trans patients and clients can provide direct feedback about how CCC is doing and how we can continue to improve.

Keeping the Trans Community Visible
Finally, CCC will continue to be intentional about talking about trans issues, whether internally within the CCC community, or externally with partners and constituents. (Even this blog post is part of that effort!)

According to Erika, “The more we talk about [trans issues], the more we see it, and the more we work with people who identify as trans in a safe, open, and aware way, it will have a ripple effect in the public.”

Knowing that, CCC will continue to bring stories of our trans patients, as well as the work we do to, as Erika says, “give people an opportunity for people to live as they see themselves.”

 



The Impact of Never Giving Up

Nov 14, 2016

The road has been long. It’s been bumpy. It’s been forked. And sometimes, it’s even been closed. But when Keva S. makes up her mind to start something… she finishes. A 2016 graduate of Oregon Health & Science University, Keva is now employed as a Physician Assistant at Central City Concern’s Old Town Clinic. She’s come a long way since getting clean and sober ten years ago.

As a child, bouncing between an alcoholic mother, a cocaine-addicted father, and foster care in Michigan, Keva couldn’t count on where she and her two younger brothers would be sleeping next. As a young adult, she moved to Portland, where an unstable and unhealthy lifestyle continued. After enduring years of addiction, illness, violence, and eventually homelessness, Keva checked into Central City Concern’s Hooper Detox. Soon after, she received a key to a tiny Central City Concern apartment and entered Central City Concern’s Recovery Mentor program. There, “the world just flipped,” Keva says.

With new confidence and hope for the future, Keva engaged in Central City Concern’s Employment Access Center. An employment specialist helped her put together a résumé and look for a job. Soon Keva found a program that allowed her to earn certification as a phlebotomist. For the next seven years, she worked at a hospital, drawing blood. But Keva wanted to go further.

Watching resident medical students do rounds in the hospital where she worked inspired Keva to enroll in a pre- med program at Portland State University. A presentation she saw on homelessness and the need for Physician Assistants piqued her interest. So she set her sights on OHSU.

In 2014, Keva was one of 1,300 applicants for 42 spots in OHSU’s Physician Assistant program. Not only did she get in, she was a unanimous choice and received a scholarship.

In August, Keva graduated from OHSU and applied to work at Central City Concern’s Old Town Clinic. Explaining her motivation for wanting to work at Old Town Clinic, Keva shares, “When you’re a homeless addict, not many people are nice to you. And I had had lots of health problems, so I got to see lots of doctors at lots of hospitals and clinics. The people at Old Town Clinic were the only ones that treated me with respect. They were nice to me. They were willing to see me when I didn’t have money, or insurance, or anything else—and just needed health care. That was huge to me.”

Keva’s first day was September 6, 2016. She started seeing patients in October. She believes her experience overcoming addiction and homelessness will give her unique insight into her new profession—working with people who may not have any money, or insurance, or anything else. “Despite all the resources that it takes, it pays off,” she says. “When you look at somebody like me, and the medical bills I would have had, and that eventually I would have ended up in jail … I would have needed public support forever, until my death. None of that happened. All of that money that would have been spent supporting me just to sustain my addiction didn’t happen because Central City Concern offered me help. And so instead, I’ve gotten to turn everything around. And make money, and donate money, and be productive, and give back.

“Central City Concern on an urgent level, stabilized me. They provided me with a home, so that I could go to treatment every day, and so that I could get that process started. They gave me a mentor. They gave me a whole team of people who told me I could do things when I didn’t think I could. They gave me back dignity. They gave me a life. They gave me the opportunity to hope for a life.

“Now I’m going to try and give that opportunity to other people.”



Positive response: Central City Concern’s Crisis Team

Oct 27, 2016

About five years ago, Central City Concern leadership wanted to provide the best assistance to clients in need, but was equally concerned about the emotional toll on staff members responding to crisis. Our mission is based on finding the positive in every person and situation. But because we are a large organization serving many people, things happen. Our staff—often alone and unprepared—had to deal with intense situations involving distressed, and sometimes traumatized, people.

In 2012, CCC’s Director of Equity and Inclusion Sonja Ervin looked for a better way to respond to incidents that protected clients and staff. “How do you support people and make them feel safe?” she wondered. She proposed a new Crisis Team model, which consists of “primary” contacts who carry the crisis phone for a week at a time, 24/7. There is also a “secondary” supervisor to support the primary contact and go on scene with them in cases of physical and emotional trauma. Crisis Team responders, usually six to eight people rotating through a year, come from across the agency’s housing, employment and health care programs. It is a paid on-call position that is above and beyond their regular jobs.

“It’s really meaningful work,” says Freda Ceaser, CCC’s Employment Access Center director, who has been on the Crisis Team close to three years. “It can be hard, but I feel completely supported by CCC.” Most of the crises, such as elevator problems, water issues and minor disturbances, can be handled over the phone. But sadly, physical and emotional traumas, including deaths, are among the crises that the team responds to in person. But the crisis responders always arrive together to support each other and everyone else who has been affected by the event.

Since it began, the Crisis Team responders, now led by Dana Brandon, CCC’s director of Supportive Housing, have answered the call to hundreds of incidents, large and small, at all hours of the day and night. Their only goal is to help people get through it. “The Crisis Team is peer support, peer driven, and they have no other agenda than to be there,” Sonja says. “They really do it from the heart.”



CCC Outreach Workers Fill Gaps in Health Care

Oct 21, 2016

On Monday, PBS Newhour aired a fascinating and insightful segment on the rise of utilizing community health workers—already popular in other parts of the world like Sub-Saharan Africa—to better serve vulnerable and hard-to-reach patients. (You can watch the video above or on the PBS website.) As the segment makes clear, community health workers play a vital role in helping patients improve their health.

At Central City Concern, a number of our specialized health care programs rely on Outreach Workers to engage those we serve in direct, meaningful ways that truly exemplify our commitment to meeting patients where they are.

The Community Health Outreach Workers (CHOW) team works to bring individuals who are newly enrolled in the Oregon Health Plan (Oregon’s state Medicaid program) into our Primary Care Home, where patients can find barrier-free access, team-based care, integrated mental health and addiction treatment, and additional wellness resources. They’ve also been working with the care teams at Old Town Recovery Center, CCC’s mental health clinic, to help their clients get connected with primary care.

CHOW team members may meet people on the street, at shelters or hospitals, or in their own homes, and often check in with patients to ensure that they are engaged comfortably into the care available to them.

Members of the CCC Health Improvement Projects (CHIPs) team, also known as our Health Resilience Specialists, are embedded in the four main care teams at CCC’s Old Town Clinic (OTC). CHIPs team member work closely with OTC patients (what we call “high touch” support) who have shown a high rate of hospital emergency utilization, helping them decrease unnecessary hospital use by providing intensive case management and addressing social determinants of health. CHIPs team members meet patients at home, on the street, in the hospital, or wherever else the patient needs engagement to happen most.

For those already living in our housing, CCC’s Housed + Healthy team provides a direct pipeline from housing to CCC health care. By performing a needs assessment with new residents as they move into their CCC home, the Housed + Healthy team can identify high needs residents who have gaps in their health care support. The Housed + Healthy team can streamline the referral processes to connect residents to care and even increase coordination between service providers. Further, our Housed + Healthy team provides on-site wellness education programming to encourage healthy living.

The work and impact of Outreach Workers are so important that they can be found beyond the three teams we highlighted here; programs like CCC's Bud Clark Clinic, among others, also lean on Outreach Workers to build relationships with those who are vulnerable in order to connect them with basic health care and services.

The flexibility of CCC’s Outreach Workers allows them to bring care and compassion to our patients. Maintaining and improving health outcomes takes work outside clinic walls, and our Outreach Workers are there to walk that journey with those we serve!



CCC Celebrates National Health Center Week 2016!

Aug 08, 2016

“We choose to go to the moon … not because it is easy, but because it is hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win.”

President John F. Kennedy’s famous speech at Rice University in September 1962 captured the tone of the United States. It was a time of extraordinary innovation, responding to deep and complex societal problems. Lyndon B. Johnson’s Great Society initiative brought us education reform and the earliest roots of community health centers, which we celebrate this week during National Health Center Week. Civil rights leaders like Malcolm X, Reverend Martin Luther King, Jr., and Medgar Evers, among many others, led the movement against Jim Crow and socially and legally institutionalized racism. Stonewall birthed a new age of LGBTQ activism, while second-wave feminism brought us Titles IX and X and a sea change in societal attitudes toward women.

Today, we face a different but no less daunting set of social ills. Homelessness and poverty, along with the deeply entrenched social and economic disparities that drive them, are problems of such breadth and depth that they can seem immovable. Social planners and others talk about the concept of wicked problems, not merely hard problems that can be solved with enough resources and time, but deeply complex and interdependent problems with no clear causes or easy solutions. Wicked problems challenge us to think with creativity and clarity, to work collaboratively, and to be willing to try harder every day. They are problems of such scale and urgency that we can do no less than bring our very best.

At Central City Concern, our 800 employees, together with the 10,000 people we are privileged to serve every year and our many community partners, are deeply motivated by the wicked problems of homelessness and poverty: challenges that cannot be postponed and must be won. Working with limited resources to solve problems that may seem unsolvable, rather than being Sisyphean, inspires (and requires) us to innovate every day.

In celebration of National Health Center Week, we are profiling Central City Concern staff, patients, and programs within our Federally Qualified Health Center sites who are working to develop innovative and thoughtful solutions to the complex problems we face in community health work. These profiles represent some of the best of what our organization has to offer. I challenge you all to address your problems, no matter how great or small, with the strength of innovation.

Leslie Tallyn
Chief Clinical Operations Officer

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NHCW 2016: Using Data to Ensure Patients Receive the Right Care

Aug 08, 2016

Not long ago, Central City Concern recognized a gap in our health services. CCC’s substance use disorder services and specialty mental health services had multiple tiers of programs designed to meet a variety of needs—including acute teams for more complex clients. Our primary care health services didn’t. To fill that need, CCC created the Summit team, a new care team based on the concept of an ambulatory intensive care unit.

Like our substance use disorder and mental health acute care services, the Summit team was designed to serve patients who usually have compound health issues that place them at greater risk for an extra, higher level of care. The team limited its size by design so patients receive streamlined, in-house care from the fewest people possible. “The idea with Summit is to improve care for those who really struggle,” says Matt Mitchell. “So much of the design philosophy around it is: let’s keep it small.”

 

The team's low patient-to-staff ratio affords patients longer visits, home or in-hospital visits, medication management, enhanced and around-the-clock access, and more. But CCC quickly found that having the Summit team providing care was only half the battle.

“It turns out identifying who Summit patients should be… is really difficult,” Matt says. By virtue of the type of care the Summit team provides, the criteria for pinpointing patients—advanced illness that’s expected to deteriorate without more intensive care, isolation, a need for extensive medication management, medical complexity driven by untreated or severe behavioral health condition, among others—is only partially helpful.

“There are over a thousand patients who can check all the right boxes on that [criteria] form,” says Matt. “But Summit isn’t meant to serve all of those patients.”

Identifying patients who would be best served by Summit is a balancing act.

“On one hand, the Summit team is trying to organically figure out who they can best serve and who’s right for Summit. The clinical judgment of the providers is so important.”

Matt, a data and quality specialist assigned to work exclusively with the Summit team, supplements their judgment with data. “On my end, I’m trying to do the same thing in parallel, but with data analysis to identify who are the highest risk patients we serve at Old Town Clinic [CCC’s primary care health center].”


When it comes to the care of patients as vulnerable as those Summit seeks to serve, it would be easy to choose sides or put more faith in one approach over another. Providers versus p-values. Informed hunches versus analysis. Matt doesn’t see it that way. In fact, he believes utilizing a balance of both approaches ultimately serves patients better.

“The clinical judgment piece is so important because there are things we just don’t have data on. Data isn’t truth, it gives us some ideas of where to go,” he says. “But I think it’s really important to put data in front of clinical staff and decision makers to help remind them of things they wouldn’t have thought about otherwise.”

Matt’s role as the Summit team’s dedicated data analyst has proven to be incredibly beneficial to the way he is able to support the aims of the team. He sits in on each morning’s team huddle, participates in their discussions about patients and priorities, and is part of the team’s thought processes—activities reminiscent of the time he spent as a Boston-area outreach worker.

“Understanding what’s happening on the ground and having an idea of what the patients’ stories are helps me understand the limitations of the data so that ultimately I can use that data more appropriately and effectively,” Matt says. “Otherwise I’m looking at numbers and statistics all day. Our patients are more than that.”

In addition to analyzing and incorporating data to identify Summit patients, Matt is working on an exciting project that visually maps out the characteristics of all Old Town Clinic patients, onto which he’ll overlay Summit patients data points to identify areas they tend to cluster. “Hopefully this will give us a new perspective on identifying the patients who are really right for Summit,” he says.


The benefits of this innovative solution won’t be confined to Summit. Matt plans to use this project to explore patients of other specialized teams at CCC, like Community Outreach Recovery & Engagement (CORE) and Integrated Health & Recovery Treatment (IHART).

Matt relishes the freedom he has as Summit’s data analyst to sit with and think through problems. Ultimately, his approach, process, and solutions end up being richer and deeper, which means his work can be valuable beyond Summit.

“Our hope is that Summit can operate like a learning lab for the rest of Old Town Clinic, and ideas and things we pilot can be expanded elsewhere.”

And even when he finds himself deep in numbers, formulas, and maps, Matt is intentional about not losing sight of the people Summit serves.

“I love these patients; this is a population I care about. It’s important to me to use data to ensure that people get the things they need.”

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NHCW 2016: Creating Safety from Race-Based Traumatic Stress

Aug 08, 2016

Since opening a year ago, Central City Concern’s Imani Center program has been providing outpatient mental health and drug and alcohol addiction treatment services specifically tailored to address barriers uniquely experienced by African Americans in mainstream treatment programs.

JoAnna Smith, the Imani Center’s Lead Mental Health Counselor, quickly recognized a trend in the center’s clients that she had begun to see in African-American clients she saw in prior years: addiction and mental health struggles triggered, maintained, and exacerbated by the trauma of racial oppressions.

“We see so many clients with post-traumatic stress disorder, a lot of people struggling with unresolved trauma histories,” JoAnna says. “Many of our clients have felt unsafe, unwelcome, targeted and discriminated against by the community for much of their lives.”

JoAnna recognizes the power of past experiences, particularly how they can profoundly shape people, for better or worse. She’s quick to point out that her own past—growing up in Portland, accessing great education, honing her counseling and social work skills at internships in South Central Los Angeles—has culminated in the fortunate position she finds herself in now. JoAnna extends that understanding to Imani Center clients, whose presenting mental health and addiction symptoms are rooted in their trauma.

Looking for ways to improve how she served Imani Center clients, JoAnna started learning about trauma-informed care, which is a framework used in CCC programs. She dove headfirst into learning more about the approach, completing a trauma-informed service certification program.


“Trauma-informed care is not a therapy, it’s not an intervention; it’s a way of understanding those we serve,” explains JoAnna. “It’s a framework that acknowledges how trauma affects people. And it’s an important part of supporting our clients who come to Imani with co-occurring disorders.”

Learning about trauma-informed care excited JoAnna so much that she brought it to the rest of the Imani Center staff, asking them which area of the program they thought could benefit most from utilizing the approach. Unanimously, they decided that they wanted to bring the framework into group work. Doing so, JoAnna says, begins and ends with creating safety.

“According to trauma-informed care, safety is the treatment. Each Imani Center group facilitator is responsible for creating an environment that is safe. Maybe more than anything else that we do, more than any other intervention, if we’ve created a safe environment for our clients, we’ve done our job.”

Each Imani Center staff member has now been trained to be mindful of three areas in their groups to create the safety so essential to bringing trauma-informed care to clients: presentation, tone, and structure. And though this approach was initially geared to integrate into group work, JoAnna is thrilled that trauma-informed care has spread to all parts of the program.

“Starting from when a client enters our building and meets our office manager, to when they do their first intake appointment and screening, to the groups, we ask ourselves, ‘Are we treating clients with worth, dignity, and respect?’” says JoAnna. “That happens when we understand people are coming to us with a lot of trauma history and we remain mindful of that.”


Though a relatively new program, the Imani Center has courageously embraced an effective trauma-informed approach that asks more of each staff member—as JoAnna summarizes, “even more awareness, more hospitality, more compassion”—to better serve their clients. And it’s paying off.

“A safe environment enables clients to integrate their traumatic experiences into their life stories instead of having them at odds,” JoAnna says.

A core goal of the Imani Center is to be a place where clients can be who they are, where they can bring their past and current experiences—with addiction and mental health struggles, homelessness, unemployment, and criminality, as well as race-based discrimination and prejudice—in the hopes of finding healing. JoAnna believes that the training and awareness she and her colleagues have integrated into the program is helping clients do just that.

“We the staff are the agents of the structure. When we approach our clients from that trauma lens, we understand that we get to create the environment of safety for them, which makes a world of a difference.”

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NHCW 2016: Meeting Patients Where They Are

Aug 08, 2016

Spend enough time in a community health center, and you’re bound to pick up on a common refrain used in conversation, in literature, in staff memos: “meeting people where they are.”

Many community clinic patients, according to Gene Biggs, “haven’t been treated with respect or decency, haven’t had the best experience with medical care." Trauma, fear, and mistrust, says Gene, also mean that this patient population is less willing or able to commit to ongoing primary care. Meeting patients where they are becomes an essential approach to not only getting them the care they need now, but getting them ready to continue receiving the care they'll need moving forward.


Gene is the Clinic Care Coordinator at Central City Concern's Bud Clark Clinic, which, like many other community health centers, provides acute care—care for episodic or urgent health needs—for those who are homeless and marginally housed. Bud Clark Clinic, however, is unique in two distinct ways: how they meet vulnerable people where they are, and their end goal.

The Bud Clark Clinic is located within Home Forward’s Bud Clark Commons, which consists of a daytime resource center run by Transition Projects, Inc. (TPI) and permanent supportive housing (the Apartments at Bud Clark Commons) provided by Home Forward. In this sense, the clinic meets patients where they are, literally.

"For marginally housed patients, the idea of getting on a bus or walking the city blocks to a big clinic with lots of providers and a lot of people to get care can be too much," Gene says. "It's much easier for them to come to a place where they're already going to spend time." That place, of course, is the TPI daytime center, just adjacent to them exam room.

Residents of the Apartments at Bud Clark are served by a second clinic exam room upstairs. Even still, their trauma histories can make traveling down the hall for care too difficult or overwhelming. In those cases, care providers visit patients in their rooms.

Gene has found that setting up operations where patients already are provides, perhaps unsurprisingly, significant benefits to providing care.

"Being here every day, consistently, is a huge part of our care—a consistency that, in their situation, they don't have. Sometimes people just come and want to talk. Being immersed in the community has helped. "

Gene sees their everyday presence as a way to engender trust in and a feeling of safety with Bud Clark Clinic that helps patients believe that the clinic is there to help them, giving them an entryway to provide acute care. But the Bud Clark Clinic is concurrently oriented toward helping their patients become more comfortable with the idea of receiving ongoing care from a primary care provider.


"We can build on that relationship to get them to the next level of care [beyond acute care] that can offer more and ongoing medical services Bud Clark Clinic isn't set up to provide," Gene explains. "The big point of Bud Clark Clinic is to bridge the gap between getting people the care they need now and trying to get them care that's better suited for them in the long run."

At each visit, Gene and other care providers bring up the topic of primary care. Do you have a primary care provider? How do you feel about going to a primary care clinic? What are your reservations?

"We feed off the type of language use about it," Gene says. "We don't push, we don't force. We engage. Like a wading pool before the deep end of primary care."

Until a patient does feel ready to dive into a primary care medical home, Gene and the Bud Clark Clinic remain steadfast in meeting patients where they need to be met. Sometimes that might mean walking or riding in a cab with a patient to their next care site. Other times it might mean tracking down a patient who ended up in the hospital and visiting them.

That flexibility, Gene emphasizes, "is the Bud Clark Clinic. We let them know that we’re here to support them as much as we can. However and whatever it takes."


For Gene, his commitment to the people he sees at the clinic is just as much personal as it is professional.

"I’ve had some times of struggle personally, and family who have struggled with addiction who would be homeless if they had no one to rely on. If I didn’t have the family that I do, I could be here as well."

Meeting patients where they are can happen in a physical sense or a relational sense. Combine the two, like at the Bud Clark Clinic, and patients receive a depth of care that both honors where they are while seeking to propel them toward more sustained care.

"We want to get them to that next level of care. In the meantime, we're not done with their care once they leave the door."

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NHCW 2016: Offering Another Tool for the Recovery Toolkit

Aug 08, 2016

Central City Concern promotes high quality addiction treatment, which is founded on counseling, life skills and community support—with medication for those who need it.

Eastside Concern, CCC’s addiction and recovery outpatient facility in east Portland, offers Medication Assisted Treatment (MAT) that frees people from the highs and lows caused by drugs, as well as thinking about drugs all the time. MAT helps take away cravings and allows people to focus on positive change in other areas of life.

“MAT makes some people feel normal,” says Nickolas Reguero, a counselor in CCC’s Eastside Concern’s MAT program. “It gives people breathing room to look at their lives and relationships. They can really examine their identities: who they are, how they want to be remembered by others.”

Between July 1, 2015 and June 30, 2016, CCC clinics had 220 patients in MAT. About 60 clients are enrolled in Eastside Concern’s MAT program, which began as a CCC pilot in 2015 and became a program in 2016. To be eligible, enrollees must want to stop using all substances, including alcohol and marijuana, and have a safe place to keep their medications.

MAT includes:

- group and individual sessions for the duration of treatment
- random and regular urine drug screens and pill counts
- no alcohol, marijuana or non-prescribed drug use
- participation in community recover support activities
- and engagement with a primary care provider.

Nickolas has worked in the program for only a few months, but he’s already impressed by MAT successes. “To me, the biggest difference from traditional addiction treatment is the continuum of care. We are able to get people connected to community support and primary care,” he says. “I really like that we help people achieve a level of stability so they can make a change. That’s different from other office-based treatments that tend to be silo-ed.”

The program works because the staff keeps a positive, non-stigmatizing and pro-social attitude—and they utilize trauma-informed treatment. “Clients really struggle, but we use those struggles as opportunities to address deeper issues,” Nickolas says. For example, if someone has continually positive urine-analyses, staff can use them as a positive starting point to delve into the reasons why they’re so challenged.


“Our MAT program is about true relationships,” Nickolas explains. “We develop relationships in a thoughtful collaborative manner. We let clients know: somebody cares.”

Eastside Concern has been in operation for more than 30 years; it joined the CCC family in 2011. In addition to MAT, the facility offers a certified DUII program, domestic violence intervention, a specialized corrections program, patient groups to address substance use, specialized relapse prevention, and intensive outpatient services for those requiring maximum support in achieving and maintaining abstinence and recovery.

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NHCW 2016: Giving Consumers A Voice

Aug 08, 2016

While Samm McCrary wasn’t entirely sure what to expect at her very first Central City Concern Health Services Advisory Council (HSAC) meeting, the last thing she expected was to arrive at the same time as her former clinical supervisor, who was now working for CCC. For Samm, this chance meeting wasn’t just a reminder of her past—it was a preview of the opportunity and voice HSAC would afford her.

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Until 2008, Samm was living in a comfortable home and doing what she loved as an alcohol and drug counselor. But she began experiencing major mental health crises. Suddenly, she found herself without a job and without a home, living on the street. “I felt invisible to most of society,” Samm remembers.

With the help of local agencies, Samm was able to access permanent housing. Soon after, she became a patient at the Old Town Clinic, engaging in primary care, acupuncture, art therapy, and occupational therapy. There, she found community, which “nourished both my body and soul.”

Three years ago, her neighbor—also an Old Town Clinic patient—invited Samm to check out CCC’s Health Services Advisory Council.

“She basically said that the council was like a liaison for our peer patients to the CCC administration. We could share praises and concerns.”

What Samm found was a group of people engaged in CCC’s health and addiction recovery services—the majority of whom were homeless or recently homeless, diverse in ways that reflected the patient population—that had been meeting in various iterations since 2003. 

“Their purpose is to advise CCC Health and Recovery Services about client needs and ways to improve delivery of health care services,” says E.V. Armitage, who has provided invaluable administrative staff support since 2008. “HSAC is a great mechanism to give consumers a way to provide input into the agency's growing array of health services.”

Now with several years of HSAC service under her belt, Samm’s been able to identify the common thread found among all members of the council. “These people have integrity and they want to make positive change. Everyone on HSAC has a spark like that,” she says. “They’re all service-oriented and want to lend their voice to others.”

Samm recalls a time toward the beginning of her council membership when she was still hesitant to share anything that could be perceived as a complaint, but chose to go ahead and share a concern that a fellow patient had brought to her. What Samm shared on behalf of her peer was a problem CCC Health Services wasn’t even aware of that could have affected many other patients. But thanks to the opportunity to speak up, CCC took action, identified the source of the problem, and remedied it immediately.

“I learn something new every time I go to a meeting,” says Chief Clinical Operations Officer Leslie Tallyn, who attends all monthly meetings. “HSAC members hold us accountable—they illuminate areas where we can and should do better, and they also recognize where we’re doing well.”

And while HSAC’s benefit to CCC is built into the purpose of the council, Samm is clear that the benefit travels in both directions.

“It’s immense that they actually listen. I’m someone who dropped out of high school and went to college when I was 34. I waited tables for 15 years. And yet they hear me and take me seriously.”


Samm pauses and breathes deeply before she continues, as if she’s collecting and revisiting the experiences of the last several years. “A thing about being diagnosed with a mental health condition is that there becomes a sense of powerlessness; it’s like you no longer have any credibility. If anything goes wrong in your life, it’s perceived as being because of your mental health. Having a voice with your peers and with the administration who will listen is really meaningful.”

Which brings Samm back to her first HSAC meeting when she ran into her former clinical supervisor. Samm had worked hard to rebuild her life after losing her career as a counselor (ironically, “a profession where once I said something, it was accepted!”) and the roof over her head. She had felt powerless, invisible, unheard. But here she was, in a meeting where her word counted for just as much as those of her former supervisor.


“To have a voice that people will listen to and actually take you seriously is a healing thing,” Samm explains. “Peer patients who have a problem feel heard when they share them with us because they know we’ll bring it to the council. They see action from the administration. I think people get how powerful that is.”

Samm’s thankful to be a part of HSAC because it gives her a chance to share the voice she’s found with others.

“They might be discounted in other parts of their lives. Not here.”

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