Continuing to listen to trans voices

Nov 16, 2017


Happy Transgender Awareness Week 2017! According to GLAAD, this special week, Nov. 13 to Nov. 17, is set aside to “help raise the visibility of transgender and gender non-conforming people, and address the issues the community faces.”

In this space last year, we shared about the numerous steps Central City Concern was taking to ensure that our programs and services, as well as the staff members providing them, were as affirming and inclusive of our transgender patients and clients as possible. This year, we want to provide an update on our efforts to do so!

Trainings: CCC continues to offer trainings year-round to our staff members about working with trans and gender non-binary patients and clients. Several lead staff members have also made it a point to attend trainings hosted by community organizations so they can share what they learn with our program staff.

We continue to encourage our training attendees to approach the sessions from a place of humility. What Eowyn Rieke, CCC’s Associate Medical Director of Primary Care, said last year continues to apply to our approach: “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.”

"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.”
- Eowyn Rieke, Associate Medical Director of Primary Care

CCC Director of Equity and Inclusion Freda Ceaser says that this posture has provided the organization with a blueprint to fully operationalize trans affirming program services across the agency. She says that in the coming year, her goal is to work with every CCC program to begin an initial assessment of procedures and policies to become more trans affirming and inclusive.

“It’s so rewarding to see how the work of health services intentionally recognizes and affirms the identity of each of our patients. I want every person we serve, no matter their gender identity, to feel accepted, valued, and respected.” 

Trans Support Group: Chrysalis, the trans and gender non-binary support group that formed last year in response to what we heard from our patients, has been thriving. Open to patients of Old Town Clinic (OTC) and Old Town Recovery Center (OTRC), Chrysalis is a safe place where, according to facilitator Shanako Devoll, “people can talk about the difficulties of navigating everyday life and strategies used to address safety, mental health, and substance use.”

Group members say that Chrysalis helps them counteract the isolation they can feel by being part of a group that understands each other’s struggles and triumphs. At each session, attendees share their experiences, bring information about resources they’ve come across, and slowly build a community of shared experiences together.

The group meets bi-weekly. While the make-up of each meeting can differ, Chrysalis averages about five attendees each time the group comes together. Chrysalis is currently open to new members; in mid-December, the group will close for six weeks to allow the group members build trust and create the safe space they need.

"I want every person we serve, no matter their gender identity, to feel accepted, valued, and respected.”
- Freda Ceaser, Director of Equity and Inclusion

Electronic Health Records: Thanks to CCC’s amazing EHR implementation team, our health services can now make changes to patients’ gender identification information faster and easier than ever.  

Responding to the Needs of the Trans Community: As we continue to listen to our trans patients, we’re making changes that we believe are positive for them and the larger community.

All our multi-stall bathrooms inside OTC and OTRC now have signs that emphasize our support for individuals using the bathroom that best fits with their gender identity.

To better support trans patients and clients in substance use disorder treatment programs, our services are working toward making our urinalysis collection process more trans affirming.  

And finally, Margot Presley, an OHSU Doctorate of Nursing Practice candidate, used her doctorate project as a way to seek out and listen to trans voices at our Old Town Clinic. Margot’s project, “Patient Engagement in Quality Improvement: Raising the Voice of Transgender Patients Experiencing Homelessness” used patient engagement and qualitative inquiry techniques to interview people about their experiences as trans patients of OTC. Their feedback was used to recommend changes to our clinic operations with the goal of better meeting their needs.

Her manuscript is in process of being published in Transgender Health, “the first peer-reviewed, open access journal dedicated to addressing the healthcare needs of transgender individual;” Margot also presented a poster showing her work at several conferences. 

• • •

Each year, Trans Awareness Week leads up to the Trans Day of Remembrance on Nov. 20, an observance to honor and remember those whose lives were lost to acts of anti-trans violence. There are a number of events in the Portland metro area to participate in that day. All descriptions are from the event hosts: 

Thursday, Nov. 16
Keynote featuring Jennicet Gutiérrez: How to Get Involved, Hosted by Portland State Temprr Month and PSU Queer Resource Center
: Join us for our TEMPRR keynote panel event with activist Jennicet Gutiérrez! As a founding member of La Familia: Trans Queer Liberation Movement, Gutiérrez's activist experience with transgender rights and immigrant rights has given her great knowledge on how to get involved with various types of activism. This panel will also have local activists who will answer questions and share more about their activism. (Link) 

Friday, Nov. 17
5th Ave. Presents: ReAgitator, hosted at Fifth Avenue Cinema
: Join us in honoring Trans Day of Remembrance a few days early with an incredibly inventive film from independent trans-filmmaker Dylan Greenberg. Her film Re-Agitator: Revenge of The Parody, tells the bizarre story of a mad scientist using a cynical serum to revive a beautiful woman back from the dead leading to complete and total chaos. Using an arsenal of homages and spins off of classic and modern horror, Re-Agitator is bound to satisfy a weird and experimental itch. The film will feature an introduction from Dylan herself, including discussion of her experience with being an indie filmmaker and multi-media artist in NYC. This event will be donation-based instead of our regular ticketing prices, all proceeds will go to the artists. (Link) 

Sunday, Nov. 19
Trans Day of Remembrance March & Interfaith Vigil
: Please all Transgender folk and Cisgender allies join us in reverence and solidarity to honor the fallen and make a stand against Transphobia. We will gather at Terry Schrunk plaza for a staging and a brief program whereupon we will process to the First United Methodist Church for a candle lighting ceremony for the fallen and a message of hope and renewal from local area spiritual leaders followed by a reception where light refreshments will be served. (Link)

Monday, Nov. 20
Transgender Day of Remembrance 2017, hosted at Portland Community College
: This event is being planned by the Portland Transgender community, with the support of Portland Transgender organizations, Portland LGBTQIA2+ organizations, and allies, and is being led by Portland Transgender People of Color. (Link)

Transgender Day of Remembrance Memorial Meeting, hosted at Multnomah Friends Meeting House: We welcome you to join us on this day to mourn and honor the lives of those who have been murdered in the previous year because of anti-transgender hatred.

We gather to remember. We also gather to pray for, and to dedicate ourselves to work for, a world where transgender people are safe from hatred and violence. (Link)



Making Suicide Prevention a Routine Part of Care

Sep 11, 2017

national suicide prevention week ribbon and logoSuicide Prevention Week is Sept. 10-16, but preventing suicide is something Central City Concern (CCC) thinks about every day of the year. “Zero Suicide” is the national model of treatment that CCC’s Old Town Clinic (OTC) has adopted and integrated into all aspects of the primary care it provides to more than 5,000 individuals it serves annually. It’s a commitment to the idea that every suicide can be prevented with the right kind of care.

“No matter what your position, we’re all responsible for suicide prevention,” says Brian Barnes, Associate Director for Behavioral Health in Primary Care at OTC. Barnes explains that making suicide prevention a system-wide priority and a routine part of care is the key to ensuring that no one falls through the cracks. Having clear, established procedures is better for patients and better for staff because it normalizes prevention and helps everyone know how to get the right kind of help.

“Suicide prevention starts way back so that when we see a patient we are looking at the whole picture."

At Old Town Clinic, this has meant incorporating questions about suicide into regular patient visits, establishing new protocols to ensure that clinicians are aware of patients who have a plan to harm themselves and designating a suicide "clinician of the day" who can respond to help, usually within five minutes. An intervention by the clinician of the day can last several hours—enough time to really engage someone in a moment of crisis, gain new perspective on a situation that may seem hopeless and come up with a concrete safety plan for the day, which clinic staff follow up on. Implementing these changes entailed a team-effort at the clinic, with leadership for designing and operationalizing the new procedures from Susan Marie, Senior Medical Consultant for Behavioral Health in Primary Care, and Lydia Bartholow, Associate Medical Director for Outpatient Substance Abuse Disorder Services.

“This type of work is more typical in a specialty mental health setting,” says Barbara Martin, Senior Director of Primary Care at CCC. But in serving some of Portland’s most vulnerable residents, OTC aims for a comprehensive approach. Many of the clinic’s patients face struggles that make primary care especially challenging: finding housing, getting and keeping regular access to health care, or dealing with addiction and other severe mental illness. At the same time, health care providers can lean on CCC’s extended network of wraparound services in housing, addiction treatment, employment services and social support.

“Suicide prevention starts way back,” Barnes says, “so that when we see a patient we are looking at the whole picture.” It requires going beyond crisis-intervention and stabilization to address long-term needs that support overall health and well being. Recalling how the clinic staff helped one person who recently attempted suicide, Barnes notes: “We were able to get her treatment here, at Old Town Clinic, change some things with her mental health medications, and get her housed in CCC housing with programming specifically designed for people recovering from addiction. We consider all of that primary care, because it’s primary to the person, to their overall care.”

Having clear, established procedures is better for patients and better for staff because it normalizes prevention and helps everyone know how to get the right kind of help.

Barnes and Martin both emphasize that everyone can help make zero suicide a reality. Go with your gut, they say, and reach out to a hotline or many of the other resources available if it seems that someone is at risk of harming themselves. “The most important thing is to listen,” Martin says, “because the evidence shows that if someone is getting close to a point of despair, thinking about hurting themselves, they often talk to people.” And Barnes adds: “Every person’s behavior can be explained if you understand the context, but if you don’t have time to understand the context, then get someone who can.”

• • •

The Multnomah County Crisis Line is available 24/7: 503-988-4888. 
The National Suicide Prevention Lifeline is also available 24/7: 1-800-273-8255
The David Romprey Oregon Warmline offers confidential peer support from 9:00 a.m. to 11:00 p.m. every day: 1-800-698-2392



NHCW 2017: Serving a population where they live

Aug 18, 2017

On September 23, 2016, leaders from six Portland health organization gathered at Central City Concern’s Old Town Recovery Center to announce an unprecedented $21.5 million dollar investment in the Housing is Health initiative that will fund three new CCC buildings in Portland. The crown jewel of this shining trio is the Eastside Campus, which will serve medically fragile people and people recovering from substance use disorders and mental illness with a health care clinic and 172 housing units.

“This significant contribution is an excellent example of health organizations coming together for the common good of our community,” said Ed Blackburn, CCC president and CEO. “It also represents a transformational recognition that housing for lower income working people, including those who have experienced homelessness, is critical to the improvement of health outcomes."

Each floor is designed to foster healthy peer relationships, with vibrant common spaces where residents, supported by CCC staff, can build community.

CCC will break ground on the Eastside Campus in late October 2017. The center will build on CCC’s existing Eastside Concern program, and will offer integrated housing and clinical services, including substance use disorder treatment, primary care and urgent care. More than 3,000 CCC patients each year will access care in a unique and welcoming health home environment.

The housing portion of the Eastside Campus will have about 172 units of housing, including short-term medical stabilization and palliative beds as well as transitional housing for people in recovery from behavioral health disorders. Each floor is designed to foster healthy peer relationships, with vibrant common spaces where residents, supported by CCC staff, can build community.

“It’s important to serve people where they live."

“It’s important to serve people where they live,” said Blackburn. “This project will replicate the integrated care we give at our Old Town campus to help people get back on their feet and achieve health and self-sufficiency.”

The Housing is Health initiative is supported by Adventist Heath Portland, CareOregon, Kaiser Permanente Northwest, Legacy Health, OHSU and Providence Health & Services. The new construction includes the Eastside Campus, Stark Street Apartments and Charlotte B. Rutherford Place apartments on N Interstate.

The CCC Eastside Campus is scheduled to open in Winter 2019.



NHCW 2017: Adapting the system to work for our most complex patients

Aug 17, 2017

Central City Concern's Summit team takes care of our Old Town Clinic's most complex and medically fragile patients. Instead of expecting patients to fit into a health care system, the Summit team adapts the system to work for them by offering flexible scheduling, around-the-clock availability, and even home visits. Like many of the programs we've featured during National Health Center Week so far, the Summit team goes above and beyond to break barriers and narrow the gaps that keep vulnerable individuals from becoming as well and healthy as they can be.

We're so excited to share this video about Summit with you, which features Summit team staff and several Summit patients talking about what sets this program apart and how it impacts the lives of those it serves. A version of this video was originally shown at the National Health Care for the Homeless Conference in June.




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
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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.

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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