From the Associated Press, October 30, 2002

Jeffrey Alan Wyden, brother of U.S. Sen. Ron Wyden, died Tuesday at a hospital in California, the senator’s office said. He was 51.

Jeffrey Wyden died at Valley Medical Center in San Jose, Calif., said Josh Kardon, chief of staff for Sen. Wyden. He said the cause of death was still being determined.

Jeffrey Wyden struggled with schizophrenia for three decades, passing through numerous hospitals, clinics and treatments. When he died, he had been living at a halfway house in San Jose, Kardon said.

Jeffrey Wyden’s illness was chronicled in a moving book written by the Wyden brothers’ father, Peter Wyden, titled “Conquering Schizophrenia: A Father, His Son and a Medical Breakthrough.”

The 1998 book brought renewed attention to schizophrenia, a disease suffered by an estimated 2 million Americans.

“Jeff was an inspiration to all who knew him. He was a courageous fighter against his disease. He never gave up fighting it,” Sen. Wyden said of his brother.

Jeffrey Wyden came from a widely respected family.

Oregonians elected his brother, Ron, to the U.S. House in 1980 and re-elected him to seven consecutive terms. He was elected to the U.S. Senate in 1996.

Their father, Peter, escaped from Nazi Germany with his Jewish parents in 1937 and moved to the United States. Peter Wyden became a prolific author, writing books about the 1961 “Bay of Pigs” invasion of Cuba and the Berlin Wall, among other topics.

Peter Wyden married Edith Rosenow in 1947. Ron was born in 1949, and Jeff two years later. After the parents divorced in 1959, Edith and the boys moved from Chicago to California and Peter Wyden moved to New York City.

While watching one son win elections, Peter watched the other battle with schizophrenia. But in conversations with friends, Peter Wyden expressed a great deal of pride in both of them.

After the book was published, People magazine published a piece about Jeffrey’s struggles with schizophrenia and his father’s crusade to find a cure.

As a child, Jeffrey Wyden was charming, artistic and energetic. But he began to show personality changes in early adolescence. He grew withdrawn and eventually become disconnected from reality.

While a 21-year-old student at Stanford University, Jeffrey Wyden was diagnosed with schizophrenia. During the next three decades, he went through an array of treatments that included psychoanalysis, electroshock, hypnosis and difficult drug therapies.

A new anti-psychotic drug called Olanzapine gave the Wyden family hope. The drug made Jeffrey more lucid, less irritable and more sociable.

“The ugly years have been whisked away like a dilapidated stage set,” Peter Wyden wrote optimistically in his book. “I’m in San Jose now for the first time in six months and the changes in Jeff are difficult to believe.”

But lasting changes apparently did not materialize.

Kardon, Ron Wyden’s chief of staff, said Tuesday the drug was helpful for awhile but ultimately it did not produce the hoped-for results.

In the acknowledgments section of Peter Wyden’s book, he saved the last one for Jeffrey: “He will always will be — I need to say it again — my hero.”

Kardon said Jeffrey Wyden had no children and never married.

Jeffrey Wyden is survived by his brother and mother, who lives in Palo Alto, Calif. Peter Wyden died four years ago in Connecticut.

By Robert Landauer – editorial columnist for The Oregonian, October 26, 2002. Not available elsewhere online.

Sometimes a negative is a positive, as in the steep drop in hospital days for mentally ill Portland-area residents.

In November 2001, the number of mentally ill Multnomah County residents in acute-care hospitals peaked at 3,485 patient bed days. At $700 a day, the bill totaled $2.44 million. That’s for one month. Since then, the mental -illness bed-day tally has plummeted to 2,150 (preliminary) in September. The 1,335 difference amounts to $935,000 less in monthly hospital bills.

Hospital stays aren’t down because local governments are sidestepping problems that are tough to solve.

Just the opposite. Reshaped agencies and new programs are stepping in earlier, before odd behavior caused by schizophrenia, depression, bipolar or other disorders unravels to the point that patients need hospital care to avoid danger to themselves or others.

The biggest changes are occurring as the county gains traction in its drive to make mental health service delivery more cost-effective. The notable advance was the formation last January of Cascadia Behavioral Healthcare. The community-governed nonprofit melded three mental health delivery providers into one unit. It treated more than 17,500 Multnomah County patients in the past year, about 80 percent of low-income Oregon Health Plan clients seeking mental health outpatient services in the county.

Three changes have been especially effective in reducing the area’s higher-than-average hospitalization rate: creation of Urgent Walk-in Clinics in four neighborhoods; expansion of a downtown-only mobile response team to two expanded outreach teams, eastside and westside, reaching patients countywide before they require inpatient care; and assigning county acute care coordinators to monitor people using crisis services and to arrange suitable follow-up treatments that are less expensive than hospital care.

Another indicator of progress came Tuesday when the Oregon Disabilities Commission recognized Employment Solutions Plus, in Portland, as its rehabilitation provider of the year. The program formerly was known as IPS+, shorthand for Individual Placement and Support Plus Enhancements.

Its idea is that specially crafted, coordinated, intensive services could help many severely mentally ill patients to get jobs that interest them.

This is a giant step in taking control of their lives because only 15 percent to 20 percent of adults with serious mental illnesses are believed to hold jobs compared with 81 percent of those without disabilities. People with disabilities are more than three times as likely as others to live in poverty.

Without jobs, mentally ill people often lose housing and can’t pay for prescription drugs. Street life leads to more time in jails and hospitals.

First-year program results showed that enrollees spent 65 percent fewer days hospitalized than in the prior year. Fewer individuals were hospitalized, and they got out faster (6.9-day stays before entry into the program and 2.4 days post-enrollment).

The project was able to help 38.6 percent of its 176 clients get work, placing them in a wide variety of competitive jobs in the community.

The results impress me for several reasons. Much of the job-placement advance occurred while the project fought headwinds of a slumping economy. Also, Employment Solutions Plus distinctly takes on clients that many other programs avoid or treat with little success, notably the high portion of alcohol and drug abusers among people with severe mental illnesses.

Cascadia’s and Employment Solutions’ actions testify that it is sound policy to invest in prevention efforts that cut down on mental health crises. Front-end staffing costs are repaid in big savings in hospital bills and in less wasteful use of police, court and jail resources. County commissioners should keep pushing to complete the mental -health reorganization.

Editorial by by Robert Landauer, October 26, 2002

Sometimes a negative is a positive, as in the steep drop in hospital days for mentally ill Portland-area residents.

In November 2001, the number of mentally ill Multnomah County residents in acute-care hospitals peaked at 3,485 patient bed days. At $700 a day, the bill totaled $2.44 million. That’s for one month. Since then, the mental-illness bed-day tally has plummeted to 2,150 (preliminary) in September. The 1,335 difference amounts to $935,000 less in monthly hospital bills.

Hospital stays aren’t down because local governments are sidestepping problems that are tough to solve.

Just the opposite. Reshaped agencies and new programs are stepping in earlier, before odd behavior caused by schizophrenia, depression, bipolar or other disorders unravels to the point that patients need hospital care to avoid danger to themselves or others.

The biggest changes are occurring as the county gains traction in its drive to make mental health service delivery more cost-effective. The notable advance was the formation last January of Cascadia Behavioral Healthcare. The community-governed nonprofit melded three mental health delivery providers into one unit. It treated more than 17,500 Multnomah County patients in the past year, about 80 percent of low-income Oregon Health Plan clients seeking mental health outpatient services in the county.

Three changes have been especially effective in reducing the area’s higher-than-average hospitalization rate: creation of Urgent Walk-in Clinics in four neighborhoods; expansion of a downtown-only mobile response team to two expanded outreach teams, eastside and westside, reaching patients countywide before they require inpatient care; and assigning county acute care coordinators to monitor people using crisis services and to arrange suitable follow-up treatments that are less expensive than hospital care.

Another indicator of progress came Tuesday when the Oregon Disabilities Commission recognized Employment Solutions Plus, in Portland, as its rehabilitation provider of the year. The program formerly was known as IPS+, shorthand for Individual Placement and Support Plus Enhancements.

Its idea is that specially crafted, coordinated, intensive services could help many severely mentally ill patients to get jobs that interest them.

This is a giant step in taking control of their lives because only 15 percent to 20 percent of adults with serious mental illnesses are believed to hold jobs compared with 81 percent of those without disabilities. People with disabilities are more than three times as likely as others to live in poverty.

Without jobs, mentally ill people often lose housing and can’t pay for prescription drugs. Street life leads to more time in jails and hospitals.

First-year program results showed that enrollees spent 65 percent fewer days hospitalized than in the prior year. Fewer individuals were hospitalized, and they got out faster (6.9-day stays before entry into the program and 2.4 days post-enrollment).

The project was able to help 38.6 percent of its 176 clients get work, placing them in a wide variety of competitive jobs in the community.

The results impress me for several reasons. Much of the job-placement advance occurred while the project fought headwinds of a slumping economy. Also, Employment Solutions Plus distinctly takes on clients that many other programs avoid or treat with little success, notably the high portion of alcohol and drug abusers among people with severe mental illnesses.

Cascadia’s and Employment Solutions’ actions testify that it is sound policy to invest in prevention efforts that cut down on mental health crises. Front-end staffing costs are repaid in big savings in hospital bills and in less wasteful use of police, court and jail resources. County commissioners should keep pushing to complete the mental-health reorganization.

Cascadia announces reductions, bracing for more state budget cuts, while reorganizing mental health services to further cut high hospitalization rates; Cascadia press release 10/24/02

Contact: Mark Schorr, Communications Director (503) 238-0780 xt 245 Schorr@cascadiabhc.org

Multnomah County’s largest nonprofit provider of mental health services, Cascadia Behavioral Healthcare, Inc, announced plans today to sharply reduce expenses and reduce the size of its workforce.

Cascadia serves about 80 percent of adults receiving mental health and addiction treatment in Multnomah County under the Oregon Health Plan.

“Our highest priority is to continue providing quality behavioral health services to this region,” said Leslie Ford, Cascadia CEO. “The cost-savings plan is driven by three primary forces:

• Continued streamlining of administrative and program management structures following the creation of Cascadia, formed this year by the consolidation of several major local nonprofits.
• Lower than expected revenue under a new Multnomah County contract put in place earlier this year for out patient mental health care.
• Anticipation of more than $100 million cuts in Oregon mental health spending this year after next January’s special election on a legislative-sponsored tax increase proposal.”

Today Cascadia completed internal announcements of staff cuts. About ten percent, or 108 fulltime positions will be eliminated effective November 7th. The layoffs and cost-cutting moves Cascadia to its goal of a ten percent budget reduction, Ford said. “We will continue to provide services to those who need it most. Consumers will get a chance to discuss their treatment plans face to face with a case manager or counselor.”

Ford noted that every effort was made to analyze resources, reduce overhead costs, and minimize the number of people being laid off. “This has been a difficult and painful decision process, as so many of our staff have worked so long and hard. But the mandate from our stakeholders is clear.”

Cascadia currently operates from 80 locations in Multnomah, Washington and Marion counties. As part of Cascadia’s cost-cutting, a downtown site at the Board of Trade building, a small Gresham site on Roberts Avenue, a Southeast Portland site at 67th and Foster and an administrative office near Lloyd Center are being closed.

Cascadia also operates more than 800 units of specialty housing in the County. While a few units will be closed in the short term, more than 150 new units will be opened in the next two years, Ford adds, explaining that having viable housing options for the mentally ill can often prevent them needing more crisis-oriented services, as well as providing a better quality of life.

At the same time, Cascadia has implemented a new service delivery plan designed to increase attention to clients most likely to end up in the hospital. Please see the attached Philosophy of Care for more information.

“Our initial efforts are showing success. Expanded mobile response teams and opening three walk-in clinics has cut Multnomah County’s higher-than-average rate of hospitalization,” Ford said. “Our new approach will cut the rate even further, meaning more funds for out-patient care that will keep patients out of the hospital in the first place.”

Cascadia, a community-governed nonprofit, provides a comprehensive menu of behavior healthcare services with programs for mental health counseling, housing, and addiction therapy for drug, alcohol, and gambling abuse. It was formed by the joining of five major, long-time behavioral healthcare providers.

In 1998, Delaunay Family of Services and Mental Health Services West merged into Unity, which also picked up programs in Northeast Portland after Garlington Center closed. Mt. Hood Community Mental Health and Network Behavioral HealthCare merged in January 2002, and acquired Unity in July 2002.

With more than 1,000 employees, Cascadia treats about 20,000 people throughout Multnomah, Washington and Marion counties.

Cascadia Bulletin – October 15, 2002 [The Cascadia Bulletin was a routine all-staff paper and email message]

Decisions about our reduction in force are being made as quickly as possible, while being balanced against the need to make careful choices. I thought it would be helpful to outline our process in making these cuts.

I wanted to first form the new leadership team so those individuals could put together effective management and line staff teams. To that end, we began with the selection of four Regional Directors who have the responsibility for leading us forward. They had to select six Site Program Directors who they were confident understood what was needed, and had the skills, knowledge, resources, and willingness to do what was necessary. That same thinking was used as managers were selected and together, the managers and directors are determining which line staff can best adapt to our new model.

Some positive factors which we anticipate from the reorganization are:

• Having a more consolidated budget for sites
• Leaner management and administrative structure
• Sharpened focus to our clinical work
• Each site will be under one Site Program Director, who can understand the complex systemic issues at that site, as well as the role of that site within the system
• Some of our current leaders have been shifted to focus on particular areas of expertise

Some sites will be closed as a consolidation and cost-cutting measure. This was done after evaluating factors including convenience for clients, type of service provided, geographic range, and lease cost. The timeline for the moves has not been firmly set—as you may imagine this is a major logistical problem—but we anticipate that most moves will be finalized by the end of November. More details will be forthcoming on this front.

Attached to this Bulletin is an organizational chart with names filled in to the Program Director level. Manager names are not included at this time since not every decision has been finalized. You will note that all service elements at each major site fall under the supervision of one Site Program Director.

It is always painful to have to eliminate positions, and no doubt in the upcoming weeks we will be thinking about friends and colleagues who are no longer working for the organization. For financial reasons as well as to minimize the period of uncertainty, I am committed to holding to October 21st as the notification date so that we can collect ourselves and move forward as quickly as possible to create the kind of system our community is requiring.

[signed] Leslie Ford, CEO

Memo
To: Cascadia Administration
From: Leslie Ford
Date: October 15, 2002

The last several weeks have been an intense, difficult experience for us all. We have had to absorb and react to a disappointing financial picture with very little lead time. The management team including Regional Directors, Program Directors, and many others have worked long hours to craft a plan to carry us through this cycle. Today, we are close to having a balanced budget for an organization that looks very different than it did at the start of this fiscal year (see attached clinical organizational chart).

In order to accomplish this we have developed plans to increase revenue by $1.8 million, reduced indirect, facility, and administrative costs by $1.6 million, and we will reduce staff costs (both administrative and clinical) by an additional $3.1 million. Overall, we have reduced our costs by 10.7%, and as a percentage of the overall budget, administrative costs have dropped by 9.25%. This means that this month 118 staff have been notified that their jobs with Cascadia have been eliminated. Some savings came from resignations and vacancies, but the majority were cuts.

It is important that those who are leaving and those who have been transferred know that this is about systemic shifts and shortfalls, and all they have contributed is valued. For those who are leaving, I hope that “one door closes and another opens” is proven true once again. Those who had their positions changed and those whose positions are essentially unchanged will struggle with new difficulties and rewards, as well as missing old friends and colleagues.

This is a time of many challenges. The hard part is focusing on the opportunities and the chances we have to grow. We can take pride in the lives we have improved, or even saved. I want to thank everyone who has worked so hard. Know that I appreciate all you have done and wish you well as we begin the process of moving forward.