Central City Concern History
In the early 1970s, Portland’s public inebriate problem was one of the worst in the nation. Chronic alcoholics were on the streets of the Old Town area and sleeping in the alcoves of neighborhood businesses. Most of Old Town’s low income residents lived in the neighborhood’s single room occupancy (SRO) hotels. Unfortunately, they were often little better than living on the sidewalks. Some weren’t heated in winter. There were dangerous predators living side-by-side with late-stage alcoholics, and management was often enforced with a baseball bat. One infamous hotel housed its residents in small cubicles partitioned with chicken wire, charging 25 cents a night rent.The original plan for CCC was to provide minor repairs to the housing units to make them safe. Quickly, it became apparent that if the buildings weren’t managed in a humane and caring way, the quality of life would never be good.
In response to these and other pressing issues across the city, Portland began a massive planning and consensus-building effort, and developed a blueprint for change and revitalization that included downtown housing, light rail transportation, and a vigorous retail community. A key portion of that planning effort was the Downtown Plan, which included a vision of what Old Town should look like 20 years after its adoption. The Downtown Plan urged support for social services and mandated preservation of Old Town’s SRO housing stock, protecting many historic buildings. At this time, an idea began to take shape to develop a nonprofit that both the City and County could do business with, that would funnel social service funding into the area and begin efforts to save and make safe the SRO housing stock still in the neighborhood.
In 1979, the Regional Alcoholism Board wrote a proposal to the National Institute on Alcoholism and Alcohol Abuse (NIAAA) which created the Burnside Consortium, with a mandate to fund treatment services and to help preserve the housing stock. The Burnside Consortium was renamed Central City Concern in 1984. Separately, the Ecumenical Ministries of Oregon started the Old Town Clinic in 1978. Old Town was recognized and funded as a Federally Qualified Health Center in May, 1979 serving primarily the homeless population. Central City Concern (CCC) would later assume operations of Old Town, to provide an array of comprehensive services.
The original plan for CCC was to provide minor repairs to the housing units to make them safe. Quickly, it became apparent that if the buildings weren’t managed in a humane and caring way, the quality of life would never be good.
In 1980, CCC got into housing management at one SRO, and within two years added three more buildings with almost 250 units. The success of these projects was noticed by then-Congressman Les AuCoin, who became a major supporter, and pushed through legislation that gave federal Housing and Urban Development Section 8 Moderate Rehabilitation funds for SRO housing projects. Homeless people throughout the country are now living in safe, affordable housing because of this landmark work.
Housing was only half of the agency’s responsibilities. CCC administered the Public Inebriate Project, which passed federal funds to a wide array of Burnside area social service agencies. The agency never envisioned providing direct services to homeless people. Everything changed in 1981 when County employees operating the Hooper Memorial Detoxification Center went on strike. CCC organized a response with other social service providers and maintained operation of these services for about two months.
In the early 1980’s, Multnomah County was spinning off many of its programs to nonprofits, and CCC’s role in keeping services alive during the strike, combined with its role with the Public Inebriate Project made it a logical candidate to operate the Hooper programs. In 1982, CCC began operating the Hooper Center which included subacute detoxification services and a Sobering Station which primarily served the chronic street alcoholic population. Soon after, CCC designated 54 units (an entire floor) in one of its managed buildings to be its first alcohol and drug-free community housing (ADFC). This housing configuration allowed newly detoxed individuals to move into an environment designed to support their sobriety. This set the future path of combining housing and supportive services. In fact, as a result of this success with ADFC housing, CCC was part of a successful effort to change state landlord-tenant law to allow this kind of housing.
With the rise in the use of crack cocaine, methamphetamines, and heroin across the country through the 1980’s, the Hooper programs began detoxing clients from all drugs but found poor success rates with drug addicts.With funding through a Court Diversion program, it was able to provide chemical dependency treatment that reached beyond the moment of crisis, and provide a service that could take clients forward to long-term recovery.
Troubled with these outcomes, CCC management began looking for solutions and connected with Lincoln Hospital in New York City who had begun using acupuncture in their detox program. An initial demonstration of this approach yielded a fifty percent increase in detox completion rates, resulting in the awarding of county money in 1987 to begin providing acupuncture services as part of the detox process.
It was frustrating to see the same people coming back to the Hooper Center over and over again. In 1990, CCC had an opportunity to combine the power of acupuncture and longer-term treatment for better results.
With funding through a Court Diversion program, it was able to provide chemical dependency treatment that reached beyond the moment of crisis, and provide a service that could take clients forward to long-term recovery.
State-licensed acupuncturists and alcohol and drug counselors were hired to provide outpatient treatment through a new program called the Portland Alternative Health Center (PAHC). Throughout the 1990’s the sources of funding shifted, but the service philosophy continued to focus on meeting the needs of the homeless and vulnerable individuals living in Portland’s west side. PAHC expanded into a multi-disciplinary integrated health center with medical doctors, naturopathic physicians, nurse practitioners, acupuncturists, and nurses along with recovering alcoholics and addicts with Certified Alcohol and Drug Counselor credentials and other mental health professionals. It was designated as one of the top six exemplary substance abuse treatment programs for people experiencing homelessness in the US in 2002 by the Bureau of Primary Health Care. Expanded Medicaid reimbursements helped to promote this growth, although a high proportion of individuals remain uninsured.
The idea for the Recovery Mentor program came from the Recovery Association Project (RAP), a group of people in recovery who advocated for services, housing and treatment. First funded by Multnomah County in 1999, the program hired recovering addicts to provide intensive supports to people leaving Hooper detox. Providing practical, hands-on support attached to the 54 beds of ADFC housing at the Estate, the Recovery Mentor program dramatically improved the rates of post-detox outpatient treatment participation and completion. The Recovery Mentor Program provides encouragement and a strong social network. It is a program in which individuals are held accountable for their successes, as well as for their digressions. With a mentor’s help, clients develop new relationships with others in recovery, gradually learning a new way of life. Since 1999, more than 1,600 people have chosen to work with a recovery mentor and live in alcohol & drug-free housing as effective approaches to success.
The next period of major change and growth occurred in 2001, when CCC assumed operation of two programs formerly operated by Ecumenical Ministries of Oregon, the Letty Owings Center, a 54- bed alcohol and drug residential treatment center for pregnant and parenting women, and the Old Town Clinic. The addition of the Old Town Clinic solidified CCC’s commitment to providing primary care services, and offered opportunities to enhance the holistic care approach that was begun with PAHC and bring much-needed medical services to its other programs. CCC was awarded its first Healthcare for the Homeless grant through the US Dept of Health and Human Services, Health Resources Services Administration in 2003 and has successfully renewed this funding in each subsequent grant cycle.
In 2002, CCC began looking at effective service models designed for chronically homeless individuals with mental health and addictive disorders. Within two years, funding had been secured through local and federal sources to begin the Community Engagement Program (CEP), which contributed significantly to the success of Portland’s Ten Year Plan to End Homelessness, and established CCC as a licensed mental health provider. Permanent supported housing was made available through HUD Shelter Plus Care vouchers, allowing individuals to find housing in scattered sites throughout the Portland metro area. The program philosophy included meeting people at whatever stage of recovery they were in and providing intensive supports based on the Assertive Community Treatment model. Within this program area, spinoff teams were subsequently developed to focus on specialized needs of Latino individuals and families (the Puentes program in 2004), and repeat offenders (Housing Rapid Response in 2005).
By 2004, CCC was operating multiple programs offering primary care, addictions, and mental health services, in addition to managing existing housing resources and continuing to develop more supportive housing sites (over 1,200 units by 2004). In an era of budget cuts and managed care, CCC began looking for ways to integrate and solidify its comprehensive service system. Healthcare, addictions treatment and mental health services began working more closely together under the umbrella of CCC Health Services with a shared vision to provide opportunities to homeless individuals and families who were experiencing multiple life challenges. PAHC had moved into the first two floors of a newly constructed 10-story supportive housing building, and OTC was operating out of cramped quarters in its original location in Old Town. Consolidating sites, OTC moved in with PAHC, effectively merging the complementary medicine and primary care services under the FQHC clinic.In a cost benefit review of a single typical patient, CareOregon documented that RCP reduced annual hospitalization and medical costs by more than $80,000.
Outpatient addictions treatment continued to operate and expand under the new title of CCC Recovery Center, working in collaboration with Old Town Clinic to address medical issues. In 2005, a six-month pilot was begun in collaboration with Oregon Health and Sciences University (OHSU) to provide transitional housing and community services to homeless individuals who were ready for discharge from inpatient treatment but medically fragile. This pilot was so successful that other hospital systems quickly became partners. The Recuperative Care Program (RCP) provides immediate housing, meals and appointments with healthcare providers at the Old Town Clinic allowing individuals additional time to fully recuperate. Once patients are stable, they can focus on rebuilding their lives. Central City Concern specialists help them get supportive housing, training, employment and the resources they need to recover and to become self sufficient.
In a cost benefit review of a single typical patient, CareOregon documented that RCP reduced annual hospitalization and medical costs by more than $80,000.
During this same period of time, CCC began its participation with the HRSA-sponsored Depression Collaborative, focusing on innovative ways to improve the treatment of depression in the primary care setting. Participation in the learning collaborative led to increased use of quality tools and wider involvement of staff in improving patient care. With the recruitment of a new Medical Director in 2006, CCC began an affiliation with the Oregon Health and Sciences University Dept. of Internal Medicine. Joint work groups were established to develop an orientation and training curriculum in Social Medicine for use with an on-going rotation of medical students working in CCC clinical programs. A part-time psychiatrist was also added to the staff to work in conjunction with psychiatric nurse practitioners and provide consultation to primary care providers.
Throughout this period of time, CCC received considerable support from CareOregon, the area’s largest HMO serving low income Oregonians. Through the Care Support and System Innovation (CSSI) program, CareOregon created partnerships to create fundamental change in the way health care was being delivered to its members, driven by the Institute of Medicine’s aims to make care safer, more effective, timely, efficient, patient-centered and equitable. In 2006, the CSSI began focusing on creating intentional systems integration, using the highly successful (Alaska) South Central Foundation as a model. Thus began another evolution of CCC’s Old Town Clinic
CCC’s 2007 CSSI proposal was to “establish a fully integrated demonstration team that would address the complex bio-psychosocial needs and co-occurring conditions of the homeless population.” This team started with the medical providers who had been working on the Depression Collaborative, added other disciplines and coached them to become a practice of integrated health care working with an assigned patient panel. This team also piloted the increased use of data to assist with care management and outcomes tracking with its panel as an interim step to moving into an electronic health record system. The third goal for this pilot was to implement improved scheduling through an open access system, utilizing electronic scheduling and improving quality.
The pilot team was named CATCH (Collaborative Access to Complete Health) and was designed around the following five core principles:
1. Care is based on the patient/customer’s needs, not the clinic’s
2. There is same-day access to care
3. Team delivery of care
4. Proactive management of the “panel” of patients the team cares for
5. Integrated mental health & addiction services within primary care
The pilot was successful and the model was spread to the entire clinic by 2008, necessitating space revisions in the clinic to accommodate team-based care and patient flow improvements. While housed in a building less than four years old, the space was nonetheless not designed with current needs in mind.
In 2008, CCC was approached by Multnomah County to consider assuming operation of a community mental health center located in downtown Portland which had experienced financial problems. As a clinic which focused on seriously mentally ill adults who frequently experienced homelessness and addictions, this population was one with whom we had developed a high degree of familiarity. CCC assumed operations and renamed it the 12th Avenue Recovery Center in December 2009, adding another 500 individuals to its enrollment. One of the first service improvements was to site a medical team in this clinic to improve access to primary care treatment and screening to adults with serious mental illness.
A newly constructed building which opened in late 2011. In order to truly support on-going recovery, CCC also brings housing and employment needs into the service mix.
Funded with Recovery Act money targeted to FQHC facility improvements, the Broadway Recovery Center is adjacent to the CCC property built in 2004 containing the Old Town Clinic and 180 units of alcohol and drug free housing. This new site will relocate the 12th Avenue Recovery Center and offer expanded space for Old Town Clinic, providing additional opportunities for effective integrated treatment approaches. The outpatient alcohol and drug treatment services (formerly PAHC and now renamed the CCC Recovery Center) are located just across busy west Burnside Street in another CCC building which also includes alcohol and drug free housing.
This constellation of recovery treatment and support services reflect over thirty years of program development and service expansion. We now envision Health Services at CCC to be an integrated array of service options to address an individual’s primary and behavioral healthcare needs. However,
In order to truly support on-going recovery, CCC also brings housing and employment needs into the service mix.
In 1990, Central City Concern began offering employment development services which have grown steadily and today serve more than 3,000 yearly. In 2010 the Old Town Clinic saw 2,421 distinct patients, the Primary Care at 12th Ave. Recovery Center saw 174 and the Recuperative Care Program saw 198 and CCC provides integrated primary and mental health care encounters. Today, CCC serevs more than 8,000 people. Under one organization, we offer access to everything one might need to transform their life.
