Tag Archives: Outside In

Portland Children’s Levy first budget reductions cut deep

By Amanda Waldroupe, Staff Writer

For the first time in its history, the Portland Children’s Levy has cut funding to children’s programs — the byproduct of  declining property tax revenues. The drastic measures taken by the Levy’s allocation committee have sent ripples of shock and worry throughout the provider community.

“I cried,” says County Commissioner Deborah Kafoury, a member of the Levy’s allocation committee. “These are among the most painful cuts I’ve made in my entire public career. We were making incredibly deep cuts to incredibly successful programs.”

Julie Young, a children’s advocate and community member of the Levy’s allocation committee, says children will be directly effected.

“We know that quality programs generally cost more money. It will be a hard challenge,” Young says. “There will be more waiting lists. It will mean that some programs that serve children will have to do more with less. Some children will not be served as well.” Continue reading

Another political casualty: Needle exchange programs rely on local support after the feds bail on funding

By Amanda Waldroupe, Staff Writer

For the second time in two years, Congress is reversing its policy on federal funding for syringe exchange programs, leaving many in health care business wondering how far local money can continue to carry the harm reduction programs.

While Portland and Multnomah County’s needle exchange clinics don’t expect a direct hit from the federal funding ban, shrinking state and local dollars are another issue altogether.

Kathy Oliver, the executive director of Outside In, a Portland-area homeless youth agency operating a needle exchange that is frequently used by young injection drug users, worries in particular about $63,000 in one-time money from the City of Portland that may be cut this year. Continue reading

Part IV: The good, the bad and the ugly: tracking brain injuries, health care for the homeless

Street Roots is running an in-depth investigative series on Brain injuries and homelessness. ReadPart I: All in their heads, Part II: Why Diagnosing traumatic brain injuries on the streets matters,” and “Part III: Brain injuries push victims into homelessness

By Stacy Brownhill, Staff writer

Complaining about health care and health insurance is a national pastime in the US, but when you’re homeless and mobile, without insurance or a regular doctor, health care is truly an uphill battle. Tracking and sharing the health history of a homeless person across multiple systems is fundamental in providing better care, reducing costs, and creating a more efficient and successful system of safety nets. But it’s rare.

The good

Every night when the clock strikes 12 in San Francisco, records from over a dozen incompatible safety-net databases – including data from shelters, ambulances, mental health services, hospitals and sobering centers – are dumped into one central digital warehouse called the Coordinated Case Management System (CCMS). Once there, the data is collated and duplicates are deleted for an end result of around 270,000 individual profiles of vulnerable people, about 50,000 identified as being homeless, or formerly homeless.

The noble success of CCMS is that it provides a benefit to overburdened agencies without requiring them to change their systems or do any extra work. The next time a homeless person walks into any safety-net agency in San Francisco, a social worker or physician can simply click a link to CCMS and see a client’s complete health and social service history.

And it’s inexpensive. Three committed employees of the San Francisco Department of Public Health created CCMS, without extra funding, using the software Oracle.

Boston is another innovative hub for health care for the homeless systems. From 1993-1995, Boston merged records of 75 different clinics and soup kitchens into one database using Centricity software. “It has helped us begin to understand homeless people’s patterns of behaviors,” says O’Connell with Boston’s Health Care for the Homeless Program. “If I’m seeing someone at the Pine Street Inn shelter on a Friday night and they had been seen at a soup kitchen the day before, I see that on their record.”

The Homeless Youth Service Continuum in Portland is another example of shared systems, albeit a micro-approach that only targets homeless youth ages 13-21. Outside In, New Avenues for Youth and Janus Youth Programs double-enter records into a common database that is available to several youth homeless providers.

Double-entering gets challenging when organizations are interested in tracking different things, often motivated by grant reporting, or when agencies have different definitions of data points, says John Duke, health clinic director at Outside In.

MiVIA is an online health database launched in California in 2003 to provide electronic health records for migrant workers, whose transient lifestyle means discontinuity in health care. The mission of MiVIA revolves around saving time and money by avoiding duplicate tests. Web-based records like MiVIA have enormous potential among the homeless population.

The bad

“We’re trying to make sure all clinics are connected but it depends on which clinic you go to,” says Chase.

“Right now, (healthcare for the homeless) isn’t really tracked that easily,” says Duke, who must request records from other clinics once patients tell him they’ve been to those clinics.

Portland’s closest thing to a homeless tracking system is the Homeless National Information Systems (HMIS), a U.S. Department of Housing and Urban Development (HUD) sponsored program. HMIS is limited, however, because only data from HUD-funded agencies is collected. And clinical information is excluded.

“HMIS could potentially work like CCMS if it collected information from non-HUD safety-net agencies and included clinical records,” says Maria X. Martinez, who headed the creation of CCMS and works in the Director’s Office of the Department of Public Health in San Francisco.

And the ugly

“There are not always incentives to create a common database for homeless health care,” says Duke. “Hospitals are competitive.”

“Even though it is completely legal to share records through electronic databases, physicians from different hospitals get nervous about increased liability,” says Martinez, a former specialist in health information privacy laws. “Picking up the phone to discuss a case is one thing, but codifying information is unnerving for institutions.”

With the exception of substance abuse records, however, records from social workers, primary care physicians, psychiatrists, case managers and shelters are all fair game to share among providers of care, says Martinez.

Martinez will be the first to admit that even CCMS has major flaws. Despite being an enormous wealth of information about a homeless client, CCMS usually comes in second to an agency’s own database. Social workers might make time to look at both sets of records, but physicians who are pressed for time may not, says Martinez.

Then, there’s the question of what to do after data is shared. “So-what-now-what?” asks Martinez. “What’s the next step? We’ve seen that sharing information alone doesn’t change practice. (Sharing information) is a whole new way of delivering care because you don’t just have your toolkit; you have many agencies’ toolkits. So we’ve got to change our protocols and our whole way of thinking.”

City pumps $1 million into housing bottleneck

By Amanda Waldroupe, Staff Writer

The Portland Housing Bureau announced this month how it plans to spend a $1 million special allocation to address the rise in homelessness in Portland.

The money is being used to alleviate the housing bottleneck by placing homeless people currently in shelters or transitional facilities, into permanent housing, and to then use those empty shelter and transitional beds for people now living on the streets.

The Housing Bureau expects that 200 individuals or family members will be permanently housed, the incomes of 47 people will increase through job and employment training, and 105 beds in shelters and transitional housing will open for people currently living outside.

“It’s a crisis time in our system,” says Portland Housing Bureau Director Margaret Van Vliet, speaking about the economic pressures put on the homeless network of services.

“If we can help people who are a little bit stuck and ready to transition to the next level of housing…then we free up more space along the continuum,” Vliet said.

“There will be people who will be permanently self sufficient because of this money,” Traci Manning, Central City Concern’ s chief operating officer, said.

The $1 million is funding two collaborations of service agencies, one serving homeless adults and the second serving homeless youth.

The adult collaboration is composed of seven social service agencies, led by the outreach agency JOIN. The other agencies are Central City Concern, Cascade AIDS Project, the Black Parent Initiative, the Salvation Army’s female shelter, and Catholic Charities’ El Programa Hispano and Housing Transitions Programs.

The collaboration received $820,000. JOIN’ s executive director, Marc Jolin, said JOIN will focus on placing people into permanent housing and provide rental assistance, move-in and moving costs, and other support services so people can stay in their housing.

Manning said Central City Concern will use its portion of the money to provide eviction prevention and rent assistance, move 40 people into permanent housing, and help 30 people find employment or apply for Social Security benefits.

The other agencies will provide housing placement for people living with HIV/AIDS, ethnic minorities, and homeless women.

The youth collaboration is made up of New Avenues for Youth, Janus Youth Programs, the Native American Youth and Family Center, and Outside In. The collaboration received $180,000. $51,000 of that money will infuse Janus Youth’ s outreach programs, which suddenly and unexpectedly did not receive a $100,000 grant from the federal government earlier this month.

Dennis Lundberg, a Janus associate director, said the money will be used to rehire two full-time outreach staff he was forced to lay off after the federal grant fell through. Ken Cowdery, the executive director of New Avenues, said the remaining money will be used to house 20 youths and provide employment and job training services.

Mayor Sam Adams gave this one-time allocation to the Housing Bureau in April to address homelessness in the Portland’ s downtown core. The money was originally meant to increase the amount of shelter beds, but City Commissioner Nick Fish, who oversees the Housing Bureau, convened meetings of stakeholders, including social service providers, activists, law enforcement and business leaders. The group decided to use the money on permanently housing homeless people.

The stakeholders involved have perspectives about homelessness that are often extremely disparate from each other. For instance, the Portland Business Alliance has long advocated for the increase of shelter capacity, which is at loggerheads with Portland’s emphasis on spending resources placing homeless people directly into housing.

Sources say the process of applying for the funding was no different than other proposal applications. What was slightly unusual, sources said, was the inclusion of very specific language regarding how many people were to placed in permanent housing.

Jolin described the goal numbers the proposal process identified as “aggressive,” but says they will not be impossible to meet because of the collaborating agencies’ ability to leverage their existing services.

“What’ s exciting is that it is going to allow us to serve some people who are difficult to house,” Jolin said. “Otherwise), we wouldn’t have the ability to house them.”

Given that the money is one-time funding, none of the agencies will be hiring additional staff. With the city expecting to lose revenue this year, it is unlikely that the money will be renewed.

“I am going to assume that the chances are not very high,” said Van Vliet, although she said it was possible that the Housing Bureau would seek the money from community sources, such as local businesses, especially if outcomes are successful.

The city has also announced its winter shelter initiative, to begin in mid-November. Transition Projects will receive $190,000 to operate an overnight warming center for single women living on the streets. The Salvation Army will receive $180,000 to help operate winter emergency shelter and day services at its Harbor Light facility at Second Avenue and Burnside.

Plugged in with Artist Mentorship Program (AMP)

Youth play in a jam session at the Artist Mentorship Program (AMP). Photo by Ken Hawkins

By Devan Schwartz, Contributing Writer

The electrical buzz of amplifiers predominates in the small studio space. A drummer strikes a three-count and starts laying down a beat. The second drummer hesitates only for a moment and joins him, throwing in a little extra high-hat and the deeper sound of the toms. Before long, rhythm and lead guitars have joined the jam, as has a bassist. The musicians communicate with eye contact or Spartan verbal cues when it’s an agreeable time for someone to solo or shift the tone to better match the group.

These musicians look ready for any of Portland’s music venues. Torn jeans. Tattoos.  Long foppish hair or assymetrical buzzcuts. Painted fingernails. Dangly jewelry. Baggy faux business attire and skate shoes. But they’re not here tonight to cut an album or polish a performance to get a percentage of some club’s cover fees.

Instead, they’re a group of homeless youth. They’re jamming for a couple of hours before Portland’s shelters open up for the evening. It’s just your average night at AMP — the Artist Mentorship Program — if such an average night exists. Continue reading

Living for two: Pregnancy among homeless teens is rising

By Amanda Waldroupe, Staff Writer

Sometimes, a person’s life will be forever changed because of an accident or unexpected event — for better or for worse, and regardless of whether the person welcomes their life’s new trajectory.

Last December, 19-year old Sylvia Titus was homeless and sleeping under bridges east of the Willamette River. She had been traveling the west coast for the last three years, hitch hiking or train hopping from one major city to the next, staying for only a few weeks at a time. She was planning to leave Portland again after staying for two months.

But one day, she noticed that she was late on her period, and her nipples were sensitive.

Chris Willis, her 26-year-old boyfriend of two months, told her doctors diagnosed him as sterile, and that he could not have children. Taking a pregnancy test at Outside In, a homeless agency, proved otherwise.

She was pregnant.

“I cried,” Titus says. “I was like, fuck. What are we going to do?”

To the alarm of the social services in Portland serving homeless youth, the number of homeless youth becoming pregnant is high and increasing.

Birth data from Multnomah County shows the number of first-time teen births has been steadily growing from 683 in 2004 to 736 births in 2007.

And they’re having their second child still in their teens. In 2007, one out of five teen mothers in Multnomah County had a second baby before the age of 19, most within a year of the birth of their first child.

The three primary agencies serving homeless youths — Outside In, Janus Youth, and New Avenues for Youth — had each noticed an increasingly visible population of homeless, pregnant youths.

The issue was brought to the attention of the Multnomah County Board of Commissioners last fall during an annual progress report of the youth continuum (the county funds the majority of homeless youth services).

In response, the county gave $300,000 to Janus Youth, and that doubled the capacity of Janus’s transitional housing program called Insights Teen Parent Program, from 20 to 40 beds.

Dennis Morrow, Janus’ executive director, also secured a matching $300,000 grant from the Portland Children’s Levy.

It was during that application process that for the first time, the agencies looked at the number of pregnant and parenting homeless teens as a whole. “That’s when the roof blew off the issue,” says Mary Li, Multnomah County’s community services manager.

The data, when combined, showed that 42 percent of the female youth accessing services are pregnant or parenting an infant, and more than 50 percent of female youth in transitional housing are pregnant or parenting.

“That’s a huge number,” says Kathy Oliver, Outside In’s executive director. “We were pretty astounded.”

The homeless youth agencies now consider their main priority to be addressing the problem of teen pregnancy.

After Titus’ initial shock, she resolved to give birth to and raise her child, at the same time making the determination that her and Willis’ life would radically change.

“We decided to get our shit together,” she says.

Continue reading