NHCW 2017: Starting primary care engagement outside clinic walls

Aug 16, 2017

There are few professions in the world that call on you to do your job in an RV, but that’s where Catherine Hull found herself a few weeks ago, helping the person who lived inside fill out intake paperwork. If she minds the odd working environment, she certainly doesn’t show it. After all, her role as Central City Concern’s Community Health Outreach Worker (CHOW) has also taken her under bridges and overpasses, into day centers and shelters, and onto most of the streets that form downtown Portland.

“My days are almost always pretty uncertain. A lot of the time, I get a phone call or an email and I’m off to respond at the drop of a hat,” she says. “Once I get to where I’m needed, I can help people figure out the different needs they have.”

CCC’s CHOW program was originally created partly in response to the difficulty of phone outreach to individuals who, though insured, weren’t engaging with our Old Town Clinic or any other primary care clinic, often leaving chronic health conditions unmanaged. Rather, these folks were utilizing the emergency room or acute care services at high rates for needs that could have been taken care of, and even avoided, with a primary care provider.

These potential patients—most unhoused or low-income—didn’t need reminders; they needed relationships to enter into and navigate a health care world that was as confusing as it was untrustworthy.

Calling people wasn’t enough. These potential patients—most unhoused or low-income—didn’t need reminders; they needed relationships to enter into and navigate a health care world that was as confusing as it was untrustworthy. So Catherine started hitting the pavement.

Hospitals contact Catherine when an emergency room patient who they had previously referred to the Old Town Clinic for primary care shows up again and again. Community members phone get in touch when they feel compelled to help someone on the street they see every day. CCC programs like Hooper Detox call her when a patient needs to establish a primary care provider in order to be referred to other programs. As long as there’s someone to meet, she goes.

Through it all, Catherine practices profound empathy. While following through on a primary care appointment may seem like a small task to many, she understands—and hears firsthand—what stands in the way.

“Patients typically have to wait a few weeks after their initial intake to see a provider, and that can clearly be frustrating when we’re asking them to take charge of their health,” Catherine says. “A lot of the time their primary concern isn’t primary care at all; it’s their substance use disorder or mental health or the simple fact that they don’t have a home.”

Lack of transportation, sleep deprivation, fear of being judged by a doctor, and a feeling of stuck in their situation place additional barriers to engaging with primary care. Catherine listens and then does what she can to help each person inch closer to primary care. She performs intakes on the spot, ensuring that the individual can see a provider even sooner. She hands out bus tickets, offers assurances that our care providers truly have heard it all before and are not in the business of judging, and true to her self-given title of “the queen of resources,” offers information that can be of any further help.

“It’s understandable that if someone doesn’t know where they’re sleeping each night, a clinic appointment two weeks from now won’t be at the top of their mind. So we’ll make a plan to look for each other on 4th Ave. every day to check in until the day of the appointment,” she says. “I’m hoping to bring what little bit of the clinic I can take with me to where they are.”

In addition to responding to calls and emails, Catherine holds hours twice a week at CCC’s Bud Clark Acute Care Clinic, which treats acute issues as a bridge until patients feel ready to engage with a primary care home. When a patient feels ready, Catherine is there to seize the moment.

“The ability of our patients to access care has improved markedly by having Catherine do her outreach,” says Pat Buckley, a provider who splits her time between Bud Clark Clinic and Old Town Clinic. “She facilitates people who desperately need to get into a primary care environment very quickly. CHOW’s been an amazing adjunct to CCC’s practice.”

“I’m hoping to bring what little bit of the clinic I can take with me to where they are.”

Catherine is aware that the CHOW program won’t result in every person she sees engaging with primary care, but she remains hopeful for each person she meets.

“Of course my goal is to get them excited about primary care, but if I can at least get them to start thinking about it, I’ll take it. I’ll keep trying as hard as I can to help them understand that primary care is a good thing to do, but I’ll always be understanding that there are so many things in the way.”

Until then, Catherine will continue going to where the people who don’t think they’re quite ready for primary care are. An RV one day, an underpass the next, and maybe an ER bed later. All of it is worthwhile as long as the people she meets get closer to setting foot inside Old Town Clinic.



NHCW 2017: Breaking down the walls between housing & health

Aug 15, 2017

While he waited for his name to rise to the top of the Central City Concern housing wait list, Glenn O. lived out of his van in northwest Portland. As he walked back to where he had last parked, he found his van stolen. Gone. And with it, all his possessions, including his dentures.

Not long after, he moved into CCC housing. But even with a roof over his head, his troubles weren’t over. The doctor he had begun seeing wanted him to eat healthier, but without dentures, the list of foods he could eat was short. What he could eat, and how he ate them, led to intestinal problems and months of feeling sick and uncomfortable.

He called his insurance to see if they would cover new dentures. After all, they were stolen, not carelessly lost. They said that they could only cover new dentures once every 10 years. He’d only had his dentures for three.

Glenn went back to gumming his food, feeling unhealthy, and going against his doctor’s orders.

• • •

Moving into Central City Concern permanent housing is often reason enough for our new residents to feel good about their trajectory. The assurance of having a roof over one’s head feels like a giant step forward toward something better. Indeed, we know that having housing is one of the most significant determinants of health, so becoming a resident of CCC housing is definitely an occasion to cheer.

However, being housed isn’t a guarantee that better health is on the horizon. Even for residents of CCC housing, especially those with more complex health care needs, successfully engaging with CCC’s health care services—or any health care services, for that matter—can feel like a world away. The connection between housing and health care is crucial: how well a resident's health needs are met is tied closely to a resident’s likelihood of successfully staying in housing, says Dana Schultz, Central City Concern’s Permanent Supportive Housing Manager.

Though CCC provides both housing and health care, the nature of the programs, as well as privacy considerations, have traditionally made it difficult to share information between the two areas of service. But where Dana saw walls, she also saw an opportunity. The situation called for a way to put teeth behind a core belief that housing is health. That way? A program called Housed and Healthy (H+H).

"Our supportive housing program realized that we can’t distance ourselves from our residents’ health—it’s everything to them and it’s everything to us."

“We started Housed and Healthy as an initiative to better support our residents’ health by engaging with them where they are: in our housing,” Dana says. “Our supportive housing program realized that we can’t distance ourselves from our residents’ health—it’s everything to them and it’s everything to us.”

The Housed and Healthy program serves to improve the connection between health clinics—be it CCC’s own Old Town Clinic and Old Town Recovery Center or other community providers—and CCC’s supportive housing program, and vice versa. Since H+H started, all new residents of CCC’s permanent housing are given a health assessment so that staff can gain a fuller picture of the new tenant. They are asked about their health insurance status, any chronic health conditions they may be dealing with, and who, if anyone, their primary care provider is.

Perhaps most importantly, new residents are asked to sign a release of information, which unlocks the line of communication between CCC’s housing and health service programs.

“Once the two program areas can start talking, we can immediately map out a web of support,” says Dana. “Our clinic can flag the resident’s electronic health record to show that they live in our housing and note who their resident service coordinator is in case they need their help reaching out to a patient. In turn, our resident service coordinators can know which providers and clinics their tenants are connected to in case health issues arise.”

Housed and Healthy represents a big shift in the way supportive housing sees its role in the well-being of its residents. Housing staff are integral to extending health care out from the clinic setting into where their patients live.

The health assessment can also help H+H coordinators identify potential issues—related to their physical or mental health, or to substance use disorder—that, if unaddressed, could result in a resident losing their housing because of violations that put the safety and peace of the rest of the housing community at risk.

“In the past, we’ve seen people not succeed in our housing for reasons that, in retrospect, were preventable,” she says. “If we know what to look out for and the team of support people we can coordinate with, we can put out fires before they really burn down a person’s entire life.”

Housed and Healthy represents a big shift in the way supportive housing sees its role in the well-being of its residents. Housing staff are integral to extending health care out from the clinic setting into where their patients live. H+H even brings opportunities for health education, such as chronic pain workshops and classes like Cooking Matters, straight to residents. In doing so, the chances that patients continue to have a place to live increase.

Glenn, who had seen Dana in his building frequently as part of her work as the H+H Coordinator, approached her about his denture problem. His issues didn’t put him at high risk of losing his housing yet, but he wanted to follow his doctor’s eating advice. He was, after all, nearly three years sober, and he wanted to continue feeling healthier.

She promised him that she’d look into it. She consulted with Glenn’s Old Town Clinic care team. She researched resources and made countless phone calls. Several weeks later, she gave Glenn the best news he’d received since learning that he had his own CCC apartment: she found a city program that would cover nearly the entire cost of new dentures.

“Dana did all the work I didn’t know how to do. The questions she asked me sounded like she knew a lot about what I needed,” Glenn says. “Now that I have dentures again, oh yeah, I feel healthier now. I’m so grateful to her.”

While Housed and Healthy is ostensibly a housing program, it functions as a way to not only expose residents to the many ways to better health, but as a de facto arm of health services that can reach into where their patients live. Gaps in care get caught and filled; residents are supported in better utilizing health care services; and people like Glenn find trustworthy faces to bring health-related concerns.

“Our housing staff want to see our residents healthier; health care providers want to see their patients housed,” Dana says. “It just makes sense.”



NHCW 2017: A clean safe resting place with a dedicated staff

Aug 14, 2017

Central City Concern’s Sobering Station for people incapacitated by alcohol or drugs might not sound like an uplifting place, but there is plenty to love about it. “My favorite part is getting to know people and hearing their stories,” says Amanda Guevara, program director. She has worked for CCC for 11 years and is dedicated to helping people in the community.

“We have return visitors,” she says, “and when they decide to make a change, we can be a part of it.”

Sobering visitors range from repeat visitors to weekend warriors.... Last year, the CHIERS van conducted 1,128 street assessments, and 3,757 people were admitted into sobering.

The Sobering Station in inner-southeast Portland takes people who need a safe place to come down from drinking too much alcohol or taking too many drugs. The Portland Police Bureau or community members refer people in need. The Central City Concern Hooper Inebriate Emergency Response Service (CHIERS) van picks people up and transports them to the Sobering Station where they receive an assessment from a medical professional. Anyone can call for the CHIERS van (503-238-8132, 1:45-11:45 pm) to pick up someone on the street who is incapacitated, and the van also roams the streets looking for people who may need help.

Sobering visitors range from repeat visitors to weekend warriors. PDX airport often calls for travelers who have had too much to drink, and Portland police refer people who have not done anything illegal, but need a safe place to sober up. Last year, the CHIERS van conducted 1,128 street assessments, and 3,757 people were admitted into sobering. 

Once someone is admitted into sobering, they get a medical assessment, a clean place to rest and referral to additional resources. But mostly, they receive a level of caring that only a dedicated staff can provide.

“I like knowing there is a population we help and know best,” says Kevin Smith, Sobering Station supervisor. “They know us—these are our people.” Kevin says he likes being able to offer resources and problem solve for people. The Sobering Station staff sometimes washes visitors’ clothes, provide hygiene kits and shoes, and even cut hair and apply lice treatments. “We see some people regularly,” says Kevin, who has worked for CCC for seven years. “We know what they need.”

“We’re here for people who may have burned bridges. We’re here for people who have nowhere else to go.”

The Sobering Station also does anything it can to serve the community at the street level. In the summer, the CHIERS van staff passes out water and sunscreen; in winter, hats, gloves and hot soup. On extremely bitter nights, volunteer crews make the rounds after hours and give people rides to shelters. The Sobering Station building sometimes opens as a warming shelter. In Sept. 2017, CCC will unveil a new CHIERS van with updated features that will ensure safe and comfortable transport for people going to the Sobering Station.

“We’re here for people who may have burned bridges,” says Amanda. “We’re here for people who have nowhere else to go.”

• • •

Download a card as a handy reminder of how to contact the CHIERS van in case you see someone in need.



CCC Celebrates National Health Center Week 2017!

Aug 14, 2017

Happy National Health Center Week from Central City Concern!

The health center movement was born during a time of extraordinary challenge, opportunity, and innovation in the United States. Today, as we face threats to the Affordable Care Act, a HUD budget proposal that would reduce housing subsidies by more than $900 million nationwide, and crises like the opioid epidemic and Portland’s housing affordability crisis, I find myself reflecting on our predecessors in the good fight for health care, housing, and equal opportunity and against poverty, homelessness, and oppression. We have a long way to go, but I take heart in recognizing how far we’ve come in the past fifty years.

Today, one in fifteen members of our community receive their care at a federally qualified health center. Here in Oregon, almost all of our FQHCs are designated by the state health authority as patient-centered primary care homes, meaning that they meet six core performance standards (access to care, accountability, comprehensiveness, continuity, coordination and integration, and patient and family-centered) that support positive patient outcomes, good experience of and access to care, and cost control and sustainability. Just a few weeks ago, we at CCC were thrilled to have our Old Town Clinic recognized as a Tier 5 patient-centered primary care home, achieving the highest level of recognition possible in the state. Being homeless or low-income in Portland doesn’t mean receiving substandard care: we should feel deep pride as a community that our most vulnerable friends and neighbors have access to excellent care through our health centers.

Along with providing high-quality, sustainable, accessible care, health centers like Central City Concern also partner closely with other social services providers and health care organizations. At CCC, we bring together health, housing, and jobs under one organizational roof, and we also rely on and treasure our relationships with community partners, who enable us to reach far more people than we would on our own. At the Bud Clark Commons, we partner with Home Forward, Transition Projects, Inc., and others to provide urgent care, mental health, and case management services to homeless and formerly homeless Portlanders. At our Puentes program, which provides culturally and linguistically specific behavioral health care to Portland’s Latino community, our close partnership with El Programa Hispano Católico enables us to bring care into places where the community already gathers. And across our continuum of substance use disorder services, we’re partnering closely with our friends at CODA, Inc., and Health Share of Oregon to develop and implement Wheelhouse, a hub-and-spoke model of care that will enhance access to medication-assisted treatment for people with opioid use disorders. When homeless and low-income Portlanders access services through Central City Concern, they’re tapping into a much larger network of support both within CCC and with our partners.

This year, in keeping with National Health Center Week 2017’s theme of Celebrating America’s Health Centers: The Key to Healthier Communities, we wanted to share some of the ways in which CCC, together with many partners, works to bring high-quality care into our surrounding community by extending our work past clinic walls and directly to where people are. You’ll learn about how our programs work to improve access, outcomes, and sustainability to support the people we serve and our larger community. We may still have a way to go, but we’re going together.

Leslie Tallyn
Chief Clinical Operations Officer



"My battle with addiction and ADHD"

Jul 25, 2017

Babs, a patient of Central City Concern's Old Town Recovery Center (OTRC), approached us earlier this year with a story to tell. Her story to tell.  And with the help of Dr. Brent Beenders, a former OHSU psychiatry resident at OTRC, she wrote it out. We're grateful that Babs is a part of our CCC community and honored that she asked us to help share her journey.

• • •

My name is Babs. This is my story about battling addiction.

I've been an addict of methamphetamines and heroin for many years. I’ve experienced numerous periods of sobriety and relapse. NA meetings, SMART Recovery meetings, and various types of therapy provided me some, but not sustained, relief.

To fully appreciate my story we need to begin with my birth. I was born in 1960. I had various injuries during my birth. The umbilical cord was wrapped around my neck and my hand was pressed into my skull causing a compressed skull fracture. I am convinced that I was trying to get the cord from around my neck, thus causing my brain injury.

Not that this was enough, but my mother was addicted to alcohol, heroin, and barbiturates before and during her pregnancy with me. My mother’s attempted suicide while I was in the womb also may have been significant in my early development. I had seizures starting from birth. This combination of traumatic brain injury, seizures, and being born addicted to heroin and barbiturates set me up for a lifetime of frustration, fits of anger, anxiety, depression, cognitive difficulties, and severe attention deficit and hyperactivity disorder. Eventually I developed addictions to substances.

I had severe ADHD from a very young age which caused me difficulty in school; I was unable to sit still and could not concentrate on my work or comprehend what was taught. My symptoms were severe enough that I had to repeat the second grade; this was disruptive in that I lost my first group of friends. Finally, I was treated for my ADHD. This improved my hyperactivity, attention, and ability to focus. Despite learning disabilities, finally I was able to progress through several grades. Unfortunately, my doctors at the time thought that ADHD would resolve with puberty, so my medication was discontinued at age 12. I was able to struggle only through the first half of my sophomore year of high school after which I dropped out.

Three months after discontinuing my ADHD medicine was my first experience with street drugs. With the exception of a few brief periods of sobriety, I used illegal drugs daily for many years. I primarily used methamphetamine, but I also used heroin. My brain and body did not seem to know the difference between these different drugs. Without my ADHD medications, I found it near-impossible to use basic survival or coping tools. What the drugs did for me was provide brief relief from the chaos I was experiencing inside.

From the beginning of these years of drug use, I experienced numerous, deep physical and emotional traumas. The resulting PTSD further deepened my addictions and resulted in further personal turmoil. While there were many reasons for my turn to drugs, one important reason that I’ve come to realize is my untreated ADHD. With untreated ADHD, impulsivity ran rampant. ADHD, coupled with a naïve young adolescent brain, contributed to my drug use and other choices that resulted in years of intense victimization and abuse.

The key to breaking free from this cycle of drug abuse and trauma was getting adequate treatment for my ADHD. Given years of amphetamine abuse and sporadic use, finding a provider that would treat this disorder adequately was difficult—almost impossible—despite such an extensive record of my historical diagnosis and past treatment. I tried various treatment strategies recommended by various doctors over the years to address mood and anxiety, which were decidedly dysregulated. These included various antidepressants and antipsychotic medications; this treatment left me with even more severe depression and prone to fits of anger.

Though I had been a patient of Central City Concern’s Old Town Recovery Center years ago, I was getting increasingly desperate for help with my ADHD and how chaotic it made my life, so I decided to reestablish myself as a patient. Working with a psychiatric doctor, we found a medication that could be of immense help and would balance the chemicals in my brain, helping me focus, stay calm, regulate my emotions, and regain control of my life. But there was a big catch: I needed to show that I could be alcohol and drug free in order be given a prescription.

The doctor at Old Town Recovery Center—who, thankfully, understood how brain injuries, trauma, and addiction all affect each other—told me that if I could get alcohol and drug free, we could get started on medication. Ironically, without the right medication, sobriety sounded impossible. And given my current condition and my history of substance use, I was terrified that this was just turning out to be another dead end.

But something special happened: my doctor told me that she believed in me and my ability to get and stay in recovery. She saw that I needed it and that I wanted to regain control of my life. She not only saw the strength inside me, but the supports I could get outside myself.

During the time that I had to show I could get into and stay in recovery, I leaned heavily on the Old Town Recovery Center Living Room program, where a group of peers—each managing their own addiction and mental illness each day—helped me stay on the path of recovery. I learned how to sit in my discomfort and doubts, to embrace them.

Finally, in June 2015, we started the medication. It immediately calmed my thoughts and motor behavior. This allowed me to relearn how to focus on tasks, it provided me with motivation to accomplish tasks, and it allowed for me to sleep more regularly and soundly.

Most importantly it has allowed for me to remain in recovery. For so many years I was utilizing amphetamines and other drugs to try to help regulate my emotions, soothe my anxiety, and even allow me to sleep. With adequate treatment and continued recovery, I feel like I have now been able to finally “grow up.”

Even my interests have shifted. I’ve been on the board of a community health center and was able to help initiate a needle depository program for the City of Portland; among the many benefits of this, important to me is maintaining a clean public environment. I was also able to get some health issues addressed. I needed surgery on my neck and no surgeon was willing to operate on me because of my addictions. After my surgery, the sensations, strength, and dexterity in my hands all improved. I have been able to complete classes to become a certified peer support specialist. Now I can help others who are struggling with similar issues.

Recovery is a unique process for each individual, and I could not hope to elaborate on every step along the way. Here, I hope to have provided a sufficient overview to understand my recovery and the importance of treatment for ADHD.

Acknowledgments: In order to accomplish writing this article I utilized the help of Brent Beenders, MD, a psychiatry resident to help focus my thoughts and polish my prose. I would like to thank everyone who has helped me in my recovery.

I dedicate this to all the addicts out there who are still struggling.



CCC Celebrates Addition to the Healing Through Art Collection

May 25, 2017

Laura Ross-Paul | Power of the Pacific, 1989 | Oil on canvas, 60”x72” | Donated by Laura Ross-PaulKatherine Ace | Conversation, 2007 | Oil/alkyd, paper, gold leaf and insect wings, 36”x36” | Donated by Katherine AceMike Newman | untitled (Pentecost) | Butterfly on metal with paint/acid, 15.5”x19” | Donated by Bennett & Sylvia EngelmanRick Bartow | Story (12/50), 2000 | Lithograph, 17”x14” | Donated by Bennett & Sylvia EngelmanBill Brewer | A Blind Knowing, 1993 | Acrylic on panel, 30”x16” | Donated by Bob Kochs & Phyllis OsborneFrank Boyden | LITH, 1993 | Etching (10/30), 18”x18” | Donated by Bennett & Sylvia Engelman
Erinn Kennedy | Blue Gem, 2001 | Acrylic, 10”x10” | Donated by Bennett & Sylvia EngelmanGregory Grenon | Dahlias, 1999 | Lithograph (5/75), 18”x15” | Donated by Bennett & Sylvia EngelmanWhitney Nye | Riff, 2002 | Acrylic, alkyd, paper, glass on wood panel, 24”x24” | Donated by Bennett & Sylvia EngelmanSusan McKinnon | Interiors #4, 1992 | Watercolor, 26”x26” | Donated by Bennett & Sylvia EngelmanJules Olitski | Elegy, 2002 | Color screenprint edition 108, 34”x42” | Donated by Bennett & Sylvia EngelmanDavid Slader | Eulogy for a Pastrami Sandwich, 2014 | Oil/oil crayon on panel on canvas, 36”x48” | Donated by David Slader
Next

Phase 2 of the Healing Through Art Collection consists of nearly 100 pieces of original fine art. Click on a photo to begin the slideshow of select pieces.

• • •

On Friday, May 19, Central City Concern celebrated the completion of Phase 2 of the Healing Through Art Collection, which placed nearly 100 beautiful and healing artworks in CCC housing and program sites across the Portland metro area.

Since 2012, patients, staff members, and guests of CCC’s Old Town Clinic and Old Town Recovery Center, collectively known as our downtown health campus, have enjoyed our Healing Though Art Collection. By late 2015, the collection had grown to nearly 60 pieces of fine art (from 35 artists based in the Pacific Northwest), each curated, procured, and approved for its aesthetic, healing, and calming properties.

But the collection inside the health campus—the product of several years of work done by the all-volunteer Art Task Force—turned out to be just the beginning.

Because the Healing Through Art collection consistently received such enthusiastic and appreciative response from clients and staff alike, the Art Task Force was asked to continue their work in order to bring original fine art into several CCC housing communities and program sites, including Miracles Central, Madrona Studios, the Sally McCracken Building, the Estate Hotel Building, and the Puentes program. The volunteer Art Task Force spent more than a year on this addition to the Healing Through Art collection, dubbed Phase 2, carefully selecting, procuring, and placing works across the five new sites.

The May 19 celebration brought together the Art Task Force, donors to Phase 2, several artists whose works are represented in the updated collection, and representatives from several local galleries who have both donated and provided guidance for the collection. Members of the Portland Art Museum Northwest Art Council joined the event.

CCC Executive Director Ed Blackburn kicked off the evening by thanking donors, artists, and volunteers for their support while providing an overview of CCC’s care model. He also shared how the artwork hung on the walls of our clinic spaces and housing communities impact the wellbeing of the people we serve.

Art Task Force Chair Pam Baker provided the history of the collection and called out each Phase 2 donor. She also announced that work on Phase 3 of the Healing Through Art Collection would begin shortly to extend the collection into the historic Golden West Hotel building where our Imani Center program is based, as well as the two housing communities and the combined housing and clinic building that slated to be completed in 2018 as part of Central City Concern’s Housing is Health initiative.

Special guest Grace Kook-Anderson, Portland Art Museum’s Curator of Northwest Art, concluded the program by speaking about how specific pieces in the collection stood out to her. She also shared that she was thrilled that the Healing Through Art collection brought such high-quality work to the population CCC serves.

Find the full list of the pieces that comprise Phase 2 of the Healing Through Art Collection and their donors by downloading the Healing Through Art Phase 2 addendum.

The volunteer Art Task Force that worked on Phase 2 include:

  • Pam Baker
  • Alice McCartor
  • Carole Romm
  • Marcy Schwartz
  • Kathleen Stephenson-Kuhn
  • Dan Winter


A View from the Edge of the Mat

Apr 28, 2017

As you’ve seen by this week’s previous pieces, Living Yoga has truly ingrained themselves in Central City Concern programming. Luckily, it sounds like our class participants have endeared themselves to their teachers, as well.

“This was my first real experience of volunteering and I am so grateful for the opportunity that Living Yoga and CCC gave me to teach yoga to some of the most engaging and committed class participants,” shared a volunteer instructor, Diane, who teaches classes at Old Town Clinic. On several occasions, she’s shared that her “weekly yoga volunteer hour is the best hour of my whole week.”

With that warmth and positivity, and in the spirit of collaboration, volunteerism, and serving those who have so much to share, we wanted to finish our National Volunteer Week celebration with a piece from Laura Walsh. One of the very first Living Yoga volunteer instructors to give her time to Central City Concern—she started at Old Town Clinic some nine years ago!—Laura’s experience, wisdom, and beautiful writing seemed like the perfect way to conclude an amazing week.

Thank you, volunteers, for helping Central City Concern do more and do better with compassion, kindness, and an inspirational sense of service.

• • •

There’s a little story about some yogis sitting at the edge of a lake in meditation. All of a sudden, one of them jumps up and runs across the lake and comes back with a shawl, puts it on, and resumes a sitting posture. A little while later, another one of the group runs across the lake and whispers she needed to check on the soup for dinner. Well, after a bit more time goes by, a more recent member stands up and says, “Ahem… seems I forgot my mala beads.” He heads out to edge of the lake, takes a running start, and quickly becomes completely wet—splashing and struggling for footing before making his way to shore again. This scenario was repeated a couple of more times before the first yogi turns to the second and asks, “Do you suppose we might tell him where the rocks are in the lake?”

A chuckle, maybe? Some recognition of one time or another continuing to use the same unskillful ways to “reach” or gain solid ground—getting a proverbial “soaking” in the process? While there are several images or metaphors to illustrate “the way” or “path,” it essentially does come back to “the journey,” yes?

In this little vignette there is the sense that each person’s intention is to travel to the other side. The teaching rests in each person finding his or her own way. For one, it may mean paying attention to how others negotiate an obstacle and what skills are needed; another may ask questions and explore the conditions of the lake; someone might walk around while another could build a raft; one possibly could find a friend with a boat or even begin an active swimming regimen. Could a map, compass, or even a guide be of help?

The yoga of “IT” is in discovering how to honor one’s circumstances and nature with a practice to live in the “ground” of life’s circumstances—the union of all in and around “the lake.” A quote from Carl Rogers, “The curious paradox is that when I accept myself just as I am, then I can change,” brings us again to the image of the lake.

What I have experienced in my years sharing yoga at Old Town Clinic is that there is a readiness of participants to begin the sitting and the process of travel. There is a place for each person to symbolically look into the surface of the water for a reflection of how things are at that present time. There is a quality of movement within a contained landscape. Old Town Clinic continues to provide the opportunity for offering an environment where people are supported to engage in their proverbial lakeside experience—yoga is one of the elements that assist in safe and also challenging passage.

That there is a willingness to roll out the mat and take one’s seat is one of the most courageous and affirming acts in yoga. When we begin class, yogis are reminded of the principle, ahimsa, which translates as “non-harming.” One is reminded to offer kindness and respect and to bring a gentleness to the current state of body and mind. When we link breath awareness to movement or into stillness there is a space to notice what may be present and alive and asking for attention in that moment—to do or not do…. to sit at the edge of the “lake” or to enter into the “flow” of movement.

I am ever so grateful to be a part of this community and value the time spent with the ever-positive, present, and insightful Old Town Clinic staff ally, Moira. Over the years there have been people coming to yoga as part of a treatment program or a wellness regimen, to explore calming and regulating practices, or even for a place to rest. There has been a consistent member of our yoga collective who I offer deep gratitude for his brilliance, wisdom, discernment, and generosity of spirit. He gives expression to how yoga aligns one in well-being off the mat and into the world.

To those new to the practice, to those who are curious, and to some who find it not useful or of interest… thanks for showing up and for “getting the toes wet.” Maybe some will come back or may find interest in another discipline which offers healthful benefits… or maybe not, too. All who have come to my classes, however, have been such good sports!

For your trust and good-natured spirits to try, to modify, to be patient or curious, to stay with, to be with, and to allow for or to witness—I celebrate you. I thank you. I feel touched by the quality of intimate space created by sharing breath, time, and effort together.

So, at the edge of the lake… sharing a few lines from a noted author and activist, Wendell Berry, and then “jumping” in!

Expect the end of the world. Laugh.
Laughter is immeasurable. Be joyful though
you have considered all the facts.

Namaste



"Let all beings everywhere be happy and free"

Apr 26, 2017

Moira Ryan, Central City Concern Old Town Clinic’s Wellness Services Coordinator, works with a number of volunteers, and she witnesses firsthand what Living Yoga volunteer instructors bring to the patients of our community health clinic. In this latest National Volunteer Week blog post, Moira reflects on the many ways our Living Yoga volunteers meet our diverse patients where they are and embody the compassion, empathy, and kindness that we see across all CCC volunteers.

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Starting any movement or exercise practice can be so intimidating, especially for folks dealing with limited mobility, social anxiety, chronic pain, body shame, or an institutionalized mind-set. Walking into a practice like yoga can be even more stressful—“I don’t know the right words, I’ve seen yogis on TV and I know I can’t do yoga the right way,” etc.

One of the many things that I love about Living Yoga (LY) instructors is their gentle encouragement. The teachers don’t single folks out or shame modifications, but instead take the temperature of the room and offer safe options for every body. Just as important, LY teachers don’t assume that people in wheelchairs can’t test themselves, and don’t fragilize folks out of trying new postures. This mix of gentleness and encouragement the volunteers practice allows our clients to feel they have permission to try as well as permission to let themselves guide their practice. Having permission to practice being yourself in this way, and in a room full of people, is so important.

After Gentle Yoga groups, people report feeling stronger, clearer, and better about themselves. Some do leave frustrated with themselves, but many come back to try again. I’ve seen one client practice twice a week for the last year move gradually out of her wheelchair and onto the mat. She uses a chair when she needs one, and more and more, she doesn’t. Two months ago, she successfully worked her body into a beautiful Downward Dog and held that pose for over a minute. She was so happy, so pleased with herself. When new people come in and talk about “not doing it right,” she often interrupts the instructor to let the new person know that that’s ok: “We do what we can. And we’re doing it. You’re doing great.”

LY teachers typically let our classes know how yoga has worked for themselves. They talk about their own anxiety, injuries, or recovery stories, and I think this transparency makes our groups feel less didactic and more individualized and exploratory. Group members often tell me how much they enjoy the different kinds of yoga practice they learn from various teachers. One brings in harmoniums and teaches us chants ("Let all beings everywhere be happy and free" is a favorite). One offers a quieter, more internal practice. One laughs a lot, and makes us work our hamstrings like crazy. One focuses more on balance and talks about aging. One always helps us with some really yummy neck stretches. All are unique models of some different ways to practice, helping clients move away from “shoulds" and toward finding their own yoga.

Aside from the physical practice, I know that offering folks a safe, routine, short practice of meditation has been hugely helpful. It can be really tough to walk into a 30-90 minute meditation group, but not so hard to try meditation for a few minutes at the end of a yoga group. People talk about feeling more open and more peaceful because of the minutes we spend in our final relaxation pose.

Gentle Yoga has been for years one of our most successful offerings. We’ve tried other movement modalities—gentle dance, walking, etc.—but none have caught on like the classes Living Yoga offers.

I really want to thank the behinds-the-scenes team for supporting the instructors and managing the schedules and coordinating with all the programs you serve. This includes Eric Reynolds, CCC's fabulous volunteer manager, who's been instrumental in connecting Living Yoga with the Wellness Program and continues to offer ongoing support. I’d also like to thank those who donate to Living Yoga on behalf of OTC clients, for helping us provide yoga to folks who can’t afford or access studio classes.



Seva: The Act of Selfless Service

Apr 25, 2017

As Central City Concern celebrates National Volunteer Week by highlighting our volunteer partnership with Living Yoga, we thought it imperative to hear from them directly. Avery Lewis, Living Yoga’s Events and Communications Manager, was gracious enough to write a guest blog post on the organization’s behalf in which she shares how trauma-informed yoga aligns with the needs of those CCC serves, how Living Yoga’s own volunteers are transformed by their service, and much more.

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In honor of volunteer week, we want to recognize the 130+ volunteers who selflessly dedicate their time and energy to teach trauma-informed yoga at our partner sites every year, including Central City Concern’s Letty Owing Center, Hooper Detox, and Old Town Clinic. At these sites alone, 24 Living Yoga volunteers have practiced yoga with more than 900 students in the past twelve months.

In yoga, some refer to this act of selfless service as seva. Seva is the Sanskrit word used to describe an action in which we selflessly give of ourselves to promote the well-being of others. Perhaps the most beautiful thing about seva is that, more often than not, the one serving and the one served both benefit. This is something Living Yoga volunteers experience time and time again when working with students at our partner sites.

Greg, who teaches weekly at Hooper Detox, says, “My experience at Hooper has helped me grow and connect not only as a yoga teacher, but also as a human. I am always impressed by the attitudes of the students and staff—I love their authenticity and gratitude. I feel invited to causally express myself in my teaching, just as I invite the students to do so through their breath and movement. I have fun when I teach yoga at Hooper, and the students appear to enjoy themselves as well. Their occasional contributions of light-hearted banter, sighs of relief, and brief anecdotes help create a relaxed and comfortable atmosphere.”

Living Yoga’s partnership with Central City Concern over the past nine years has played an integral role in the healing process and resiliency of our students. By offering trauma-informed yoga classes, students learn to create positive change from the inside out. Trauma-informed yoga acknowledges that trauma can cause individuals to feel unsafe and disconnected from their bodies. Practicing trauma-informed yoga allows the individual to reconnect with their body, increase self-knowledge, and create a safe place within themselves. It’s a powerful tool for recovery and for life in general.

Through the practice of yoga, students gain valuable skills that support their ability to realize their full potential. Students find themselves using these skills outside the classroom, contributing to their own long term well-being and to the health and well-being of the communities in which they live. Jillian, a Living Yoga volunteer teacher at Letty Owings Center, reported, “Another great class! Again these women are so open and ready for yoga. We talked a little about the classes they’ve done so far—one woman said she couldn’t sleep the other night so she got out of bed and did yoga to relax! It’s like textbook Living Yoga—awesome! It is really landing with them, and it feels so great to be part of their yoga journey.” 

Yoga is such a deeply transformational practice to share with someone. It promotes self-love, self-respect, forgiveness, healing, confidence, and growth. It teaches us compassion and how to communicate with heart and intention. And it has a ripple effect! When we realize the inherent goodness inside of ourselves, we learn to act and interact from that place with others. We learn that we are more than our worst behaviors.

For the volunteer teachers at Living Yoga, it is clear that the sharing of this experience through yoga is as satisfying, if not more so, as the practice of yoga itself.



Monthly Volunteer Spotlight: January 2017 Edition

Jan 31, 2017

Our first Volunteer Spotlight of 2017 highlights the unique role of Dr. John Bishop, a clinician who has chosen to spend time in Old Town Clinic’s Wound Care Clinic. As the Wound Care Clinic program is in its relative infancy, our lead practitioner, Pat Buckley, had this to say about Dr. Bishop’s contributions:

“Having his expertise as we were developing the program was extremely beneficial because it really helped us ramp up the quality of care more quickly than we otherwise would have been able to… He’s the bomb.”

If you’d like to learn more about Old Town Clinic’s Wound Care program we recommend you check out the National Health Care for the Homeless’s Healing Hands newsletter, where they highlight this young, yet valuable, Old Town Clinic service. In the meantime, take a look below to find out both what distinctive challenges Dr. Bishop encounters while at Old Town Clinic, but also what makes the care process so rewarding to him.

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Name and Volunteer Position: John Bishop, provider in the Wound Care Clinic of Old Town Clinic.

How long have you been volunteering with us?
About year and a half now; it’s been very positive. It’s a different kind of wound care than I was used to, a different kind of situation, but it’s been very positive. Good, nice, qualified people to work with... pleasant, friendly. I like the patients, too. The patients, for the most part, are very nice.

What made you want to volunteer at Central City Concern?
I decided to be retired. And moving to Oregon from Florida there was no real employment for me, financially, in a semi-retired level. I spent many years learning how to do wound care and I didn’t want to just give up that knowledge overnight. It took a long time to develop what I know and I didn’t want to just throw it away so I figured I could use what I know positively for a few more years. And since I don’t get paid, I’d rather take care of people who can’t pay [Note: All Old Town Clinic patients are on a sliding scale fee.] They need the care and there’s no reason why they shouldn’t get it.

Have there been any surprises at Old Town Clinic so far?
Well, the biggest problem I have here is with continuity of care and follow-up. Part of it is me as I only volunteer but two times a week, but part of it is the patients that don’t come back. That’s probably the biggest disappointment.

Then again, that’s the challenge from which we have to work. That’s what’s different from my civilian or private practice before I got here. That’s just one of those things in the practice of medicine.

Have you tried strategies to combat that?
Well it does direct how we administer our care. We have to prescribe a type of care with the assumption that maybe the patient won’t come back. That way, if they don’t, they’re not going to get themselves into more trouble from the care. My philosophy is to be positive, develop a little relationship with them, and have them feel like I’m expecting them so that they might feel more of an obligation from that. I make sure to say “I will see you next week!” and I hope they think, “If he cares enough to be there to look for me I ought to show up.” I don’t know if that’s how it works but that’s my goal.

I like doing wound care, I like taking care of people, and I like seeing wounds get well. It’s a very satisfying thing to start off with a mess and then see the patient eventually walk out and to tell them, “Don’t come back, you’re all done!" And along the way, since many wounds are chronic, there’s a big effort to teach the patient how to take care of it themselves so that they won’t have to come back. I don’t know how successful I am with that but it’s always been my guiding light in wound care. It’s  "Okay, this is what I want to do; if it happens again, this is what you can do for yourself.”

Having practiced medicine at Old Town Clinic, if somebody were on the fence about volunteering here is there anything you would want them to know?
Well I think the volunteering business is pretty nice. The state of Oregon has their physician emeritus program that kind of gives you liability coverage and allows you to practice and keep your skills alive. It lets you use the skills you already have and I think more physicians ought to consider that.

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If you are a licensed practitioner interested in volunteering time with Portland’s vulnerable populations, we recommend checking out the Coalition for Community Health Clinics, a community and care-driven collaborative (of which Old Town Clinic is a partner).

For any other Central City Concern volunteer inquiries, please visit our volunteer webpage.