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



CCC Celebrates National Health Center Week 2016!

Aug 08, 2016

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

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

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

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

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

Leslie Tallyn
Chief Clinical Operations Officer

• • •

Visit These Profiles of Innovation at Central City Concern!

       

       



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

Aug 08, 2016

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

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

 

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

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

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

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

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

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


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

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

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

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

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


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

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

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

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

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

• • •

Visit These Profiles of Innovation at Central City Concern!

       

       



NHCW 2016: Creating Safety from Race-Based Traumatic Stress

Aug 08, 2016

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

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

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

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

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


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

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

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

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

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


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

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

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

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

• • •

Visit These Profiles of Innovation at Central City Concern!

       

       



NHCW 2016: Meeting Patients Where They Are

Aug 08, 2016

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

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


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

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

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

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

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

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

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


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

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

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

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

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


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

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

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

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

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