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.”



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



Catching—and Finding—Breath

Apr 28, 2017

Volunteer Manager Eric Reynolds visited a Living Yoga session at Central City Concern's Letty Owings Center, our residential addiction treatment program for pregnant or parenting young women. What he saw was an opportunity for the mothers to reflect and rest in the midst of their intensive work to build better futures for themselves and their blossoming families—an opportunity they wouldn't have if not for Living Yoga's volunteer instructors. Learn more in our latest National Volunteer Week blog below!

• • •

The class began with introductions that included each participant’s name, their reason for wanting to try yoga, and their sobriety date. In a true embodiment of the “inherent honesty in communication” that serves as a Guiding Value for Living Yoga’s practice, the instructor initiated this introduction with each subsequent participant. With the most formal portion of the class out of the way, the next hour was filled with smiles, laughter, and a few well-timed groans as seven new “yogis” planked, scorpioned, downward dogged, and child posed their way to reconnecting their mind and bodies.

The young women who begin substance use disorder treatment at Letty Owings Center have a lot on their plate. They are pregnant or parenting a young child, fairly new to a recovery-oriented lifestyle, and adjusting to unfamiliar guidelines, procedures, and regulations that will best aid in her treatment. They attend groups with their peers and meetings with counselors; they take classes to fill their life-skills toolbox with budgeting, meal planning, and parenting knowledge. The attention and effort that goes into this adjusted life, while worthwhile, can be exhausting.

Do these young women ever have a moment to simply catch their breath you might ask?

Thanks to Living Yoga’s volunteer instructors who visit Letty Owings Center twice a week, they can now stretch muscles that might have previously gone ignored, unwind themselves, and find respite. With some combination of heavy substance use, homelessness or poverty, and pregnancy and/or recent childbirth, LOC participants have experienced serious stressors over the years. The patient trauma-informed yoga Living Yoga volunteers bring to Letty Owings Center is an ideal avenue through which to aid the women’s mental, physical, and even spiritual recovery.

“I have bad anxiety so I feel like this will help a lot,” stated Danielle after completing her first-ever yoga session. “I don’t really pay attention to my breathing very often but it was relaxing with the breathing techniques. It helps.”

In conjunction with the mental gains of her foray into yoga, Danielle appreciated the physical benefits as well. “The stretching piece felt really good. I honestly don’t remember the last time I stretched like that.”

Through their volunteer instructors, Living Yoga’s goal is to “create a safe environment in which the practitioner can learn to befriend bodily sensations, to increase self-knowledge, to improve self-regulation, and to create a place of refuge within oneself.” Learning how to create a bank account, budget for a trip to the grocery store, or repair a torn pair of jeans with a sewing kit make life a little bit easier once a participant graduates from the Letty Owings Center. With a little help from Living Yoga we can now add destress through breathing, strengthen through stretching, and finding inner peace to that list as well.



"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.

• • •

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.



Monthly Volunteer Spotlight: December 2016 Edition

Dec 22, 2016

Old Town Clinic’s Wellness Program offers a variety of classes and activities to further patient care, healing, and connectedness within the Central City Concern community. This month we wanted to emphasize the outstanding work of Jeff Beers, an art therapy volunteer who Program Manager Moira Ryan refers to as “a co-conspirator toward the Wellness Program’s aim of encouraging self-acceptance while building community.”

In fact, when approached about Jeff’s wonderful service being the spotlight for December, Moira jumped at the opportunity to provide a glance into her work and experience with Jeff:

San Francisco-based artist Jeff Beers has years of experience working with diverse populations as an arts educator. Jeff joined us in July and has been a fantastic peer volunteer and co-facilitator of several Wellness groups. In our Art for Everybody and Art Journaling groups, he’s brought a more tactile experience of art-making as we practice trying out working with oils, inks, powder tempera, collage, collagraphy, and even found items! He draws upon his experience as a self-taught artist and encourages mistake-making, regularly reminding folks that we have permission to practice not being perfect here. Additionally, drawing from his experience as a certified instructor of Thai Massage, he’s developed curricula for a group we’re calling Eastern Techniques for Health and Longevity. In that group, we draw on trauma-informed somatic experiencing precepts as we explore tapping, brushing, acupressure, stretching, and other acts of gentle self-love.

With Moira’s enlightening recap of Jeff’s involvement, read below to hear his own words about how he utilizes personal experience with a desire to help others through one of his greatest passions—art!

• • •

Name and Volunteer Position: My name is Jeff Beers and my volunteer positions are for Art for Everybody on Mondays, and then on Wednesdays we do table-top Games and then I lead a group in Eastern Techniques for Health. On Thursdays I do ceramics and the art journaling as well.

So a pretty wide array of activities. What’s your background?
My background is in art for the most part; that’s what I do. Every year I choose an organization I want to volunteer for. Money comes very low on my priorities so I feel like it’s a way I can give back since I can’t give back monetarily. So I just find places that I really believe in and then volunteer. I get to pay it back and do what I love.

How have you been able to use those skill sets to connect specifically with those that CCC serves?
Well, I really like the clients. I have a lot of admiration for them because I know that they’re struggling with one thing or another and I just admire their efforts to reach out for help and be there. A lot of the groups, they vary in sizes, but it’s just cool to see the people regularly and to be a part of their lives. And just to contribute whatever I can, which would be a positive attitude, and some skill sets, but mostly just showing these people my admiration for what they’re doing.

And I want to make it worth their time too. I always feel conscious that if people make the effort to be in the class or in the group it should be worth their while. I keep that in mind and try to get a lot of feedback from the people and just tune-in to what they’re interested in; that’s been a lot of fun.

Have you had any cool projects that have been more successful or well-received that stick out?
Yeah! In Art for Everybody on Mondays I’ve been having a lot of fun introducing different techniques to the clients and they’re usually always interested in at least trying it out which is great. They find their voice and the right materials they want to work with. Then all of a sudden they become artists. Before they were always saying, “I’m not an artist, I’m not an artist,” and that’s hard for me to hear, so I like to bring them forward and show them what they can find in themselves.

And then the Eastern Techniques Class, that’s been a blast. Although it takes more preparation for me to package and present all of these techniques I’ve learned through the years, it’s been a lot of fun. I ask the clients for a lot of feedback and they’re usually pretty forthright about just coming up with critiques so it’s been fun to constantly let that group grow in that way.

Do you feel like the activities are a good fit for CCC and the Wellness Program?
Oh, very much so. Your guys’ program is just fantastic. When I was a client I just was blown away by all of the services that were provided under one roof so people didn’t have to go to different parts of the city to receive different services. I thought that was great. Of all of the private insurances I’ve had in the past this was easily, no contest, the most fantastic clinic I’ve ever seen. And so, it was an easy choice to volunteer.

I mean you even have volunteers who work at Old Town Clinic cleaning up things, setting up different things, I think it’s great. I think your program should be like a model for most of the clinics in the United States. It’s a great example of what you can do.

And lastly Jeff: if somebody were on the fence about volunteering with Central City Concern or about getting involved, would you have any advice or words of wisdom for them?
For me, I’ve always had a respect for people no matter what their situation is and I want them to know that. I think it’s a good thing for volunteers to show their genuine respect or admiration and not feel that it’s something out of obligatory need. I’m blown away by some of the people CCC serves and what their stories are that they share. So I think for volunteers in general that would be the most important thing.

And I think that anybody that would find interest or have the time to volunteer at CCC should never have to have any doubt about the value of what they’re bringing.

• • •

If you are interested in learning more about volunteer positions in at Central City Concern’s health and recovery, housing, or employment programs contact Eric Reynolds, CCC’s Volunteer Manager, at eric.reynolds@ccconcern.org or visit our volunteer webpage.