Mental Health Association of Portland

Chief Mike Reese (center)

By Maxine Bernstein, The Oregonian, April 9, 2013

Portland police have selected about 50 officers who volunteered to be part of a new specialized unit to respond to mental health crisis calls.

The new unit is one of the initiatives that federal justice investigators last year urged the bureau to adopt to improve police encounters with people suffering from mental illness.

The U.S. Department of Justice found last year that Portland police engaged in a pattern of excessive force against people with mental illness.

The Portland officers assigned to the bureau’s Enhanced Crisis Intervention Team will remain on patrol but become the go-to responders on mental health crisis calls.

While all Portland patrol officers have received 40 hours of crisis intervention training, this group will receive an additional 40 hours over four days next month that’s based on input from mental health agencies and consumers.

The training will include classroom instruction, role-playing, tours of mental health facilities and a panel discussion with people living with mental illness and their family members.

Central Precinct Officer Amy Bruner-Denhart, who joined the bureau 8-1/2 yrs ago, will serve as the team coordinator.

“We have high hopes that when someone is a volunteer, they’ll be perhaps more familiar and more able to react in a highly supportive manner,” said Terri Walker, board president of the Multnomah County chapter of the National Alliance on Mental Illness.

Police have also created the Behavioral Health Coordination Team, with  police meeting twice a month with representatives of mental health care agencies. Together, they identify the city’s most vulnerable citizens who have been the subject of repeated police calls or are considered a heightened danger to refer them to appropriate treatment.

“Our hope is we can plug the right person with the right agency,” Central Precinct Cmdr. Bob Day said Tuesday.

Lt. Cliff Bacigalupi said the Behavioral Health Coordination Team is modeled after the bureau’s existing Service Coordination Team, which works to connect repeat low-level offenders with alcohol treatment and housing.

The Behavioral Health Coordination Team meets every other Friday, drawing representatives from agencies such as Cascadia Behavioral Healthcare, the U.S. Department of Veterans Affairs, Transition Projects and Multnomah County’s Mental Health and Addiction Services, along with a new county prosecutor assigned to mental health cases and county jail medical staff.

Laura Maurer, the county’s deputy district attorney assigned since September to work on mental health matters, said she attends the meetings to help police or mental health care providers navigate legal matters that might arise. She also works to educate officers and others on what’s needed for civil commitment hearings.

Last month, the U.S. Department of Justice urged the bureau to return to a specialized group of officers who have the desire, crisis intervention training and skills to work with people suffering from mental illness. The federal review found Portland’s crisis training sorely lacked key components: “live exposure” to mental health consumers and family members, role-playing scenarios and community collaboration.

Portland police had adopted the Memphis model in 1995, creating a specialized team of volunteer officers to respond to crisis calls after the 1992 Portland police shooting of Nathan Thomas, a 12-year-old held hostage by a mentally ill man with a knife. Portland police started it with 60 officers who volunteered for the 40-hour training and, within 18 months, grew to 185 officers.

But the bureau veered away from the voluntary training and required that all officers be trained in 2007. The switch came after the controversial 2006 death in police custody of James P. Chasse Jr., who suffered from paranoid schizophrenia.

Shannon Pullen, interim executive director of the National Alliance on Mental Illness’ Multnomah chapter, is co-chairing a new advisory committee for the police bureau’s Behavioral Health Unit.  It has met twice this year and includes members of Central City Concern, Volunteers of America, Cascadia, Disability Rights Oregon and mental health consumers.

Pullen said she’s excited that police are engaging a diverse group of people who work in the mental health field. The advisory panel will sit in on next month’s enhanced crisis intervention training and is coordinating a panel to address the officers.

“It’s what the community has wanted,” Pullen said. “My mantra is engagement. We can only work better together and try to see the issue from each other’s point of view. And, hopefully, it’ll result in better outcomes.”

By Peter Korn, Portland Tribune, March 28, 2013

Ten months ago Multnomah County opened the nation’s first court set in a homeless facility. Nobody showed up.

In what court authorities around the country labeled a potential breakthrough experiment, Multnomah County’s Community Court last year moved its Friday afternoon operation to Bud Clark Commons.

The court deals mostly with low-level citation crimes such as drinking in public and small thefts. Many of the accused are homeless. The hope was that defendants might be more willing to show up for their court dates if court were held in a facility where many of the defendants spend their daytime hours.

The second week the court was in session, one defendant showed up, out of 16 who had been issued citations and ordered to appear.

Last Friday, 65 people were ordered to appear at the Bud Clark Commons Community Court and 21 did so.

Doreen Binder, executive director of Bud Clark Commons and the driving force behind the new court, says that’s progress. And, Binder says, the progress is best measured not by how many accused offenders actually make their court date, but by what happens to those who do.

Of the 15 who appeared in court two weeks ago, five agreed to perform community service and one chose to take his case to a full trial. Three opted to work with social workers to get treatment for addictions or attend groups to help them deal with the problems that have played a role in their homelessness. Six had returned to the court after completing work with social service agencies.

Those last nine, according to Binder, are the reason it makes sense to hold court in a facility that serves the homeless.

“We’re trying to turn the court into an entryway into services rather than something people view as a punitive institution,” Binder says.

Still, the fact that only about one in three defendants makes their court appearance shows there is still work to be done. Failure-to-appear rates for Community Court have long been a problem, though nobody can say exactly how large a problem since Multnomah County court officials don’t keep records on appearance rates.

The penalty for failing to appear can be a fine which many never pay, knowing they won’t be sent to jail anyway. At Bud Clark Commons, many of those who fail to appear are simply placed on the next week’s docket. Some are scheduled week after week and never appear. But Larry Turner, engagement director for Transition Projects, which runs the day facility, thinks holding the court at Bud Clark Commons gives him an opportunity to increase the appearance rate. In fact, he knows it does.

At Bud Clark Commons homeless men and women can use computers, do their laundry, take showers and connect with social service agencies. On a typical afternoon, dozens will be seated in the main lobby, waiting their turn or just hanging out. Every Wednesday Turner gets the docket for the Friday Community Court, which gives him two days to spot the familiar faces of those he knows are supposed to appear, or who failed to appear the week before.

When Turner finds them, he tries to persuade them to show up on Friday. He’s armed with a couple of convincing arguments. One section of Bud Clark Commons has overnight beds for the homeless. Four of those beds are reserved for people who have made their court appearances. On a Friday afternoon, a homeless man can go straight from his court appearance to one of those beds.

Turner’s bigger pitch has to do with longer term housing. All of the social services offered at Bud Clark Commons are aimed at getting homeless people off the street and into permanent subsidized apartments throughout the city. For some, the first step is an addiction recovery program, for others it might be mental health treatment.

But people with outstanding warrants and fines cannot legally be placed in those apartments. Which is why Community Court judges are willing to waive fines if an offender agrees to perform substitute community service or begin drug treatment.

Still, getting those defendants to court is an uphill battle. Turner says he can predict fairly well who will appear and who won’t. The most chronic offenders with multiple prior arrests for nuisance crimes rarely show up, he says.

“They know it’s just going to be a fine,” he says. “They’ll get picked up again. They’re always drinking, always loitering, because they know the most that can happen is a fine.”

A fine that likely will never be paid, according to Turner.

But, Turner says, those among the homeless who have been issued their first citations for drinking in public or small thefts are more likely to show up for court dates. Which, he says, makes a strong case for doing everything possible to get them into court before they become chronic offenders who never show up.

What Turner would like to do is begin an outreach program that would allow him to send social workers, possibly Bud Clark mentors, to search the streets for the people on each week’s docket and persuade them to come to court on Friday.

“Everybody knows where they are,” Turner says.

Training those mentors would take a little money that Transitions Projects can’t spare. But Turner remains optimistic about the community court program’s future.

“The court is still in its infancy,” Turner says. “It’s only been nine months. For people to expect this court to make drastic changes in people’s lives in nine months is expecting a miracle. But I believe with continuity, and the more familiar people get, the longer it happens, the more success we’re going to have.”

Multnomah County prosecutor Laurie Abraham says the still-high failure-to-appear rate doesn’t mean the community court isn’t working.

“Maybe it’s not getting a lot of people into housing and drug and alcohol treatment, but it is getting a few,” Abraham says. “Even when you get a few you save the criminal justice system a lot of money.”

Criminal justice officials around the country will be watching, says Julius Lang, director of technical assistance for the nonprofit Center for Court Innovation in New York City.

“It’s turning the paradigm on its head,” Lang says of the Bud Clark Commons approach of bringing the court to the defendants. “What we need is evidence of the impact that Bud Clark is having. Once we have a more complete story to tell I think it will be a very compelling example.”

At the Bud Clark Commons Community Court, about 1 in 3 defendants shows up. At Community Court in Hartford, Conn., better than 9 in 10 do.

The Bud Clark Commons Community Court experiment is intended to lower a historically high failure-to-appear rate. But in Hartford, Conn., tackling time, rather than place, is proving much more effective.

In Multnomah County, a police officer issues a citation for a court date that is usually two to four weeks away. In Hartford, no more than two days lapse between when police issue a citation and the court date.

“The quicker you get them here, the better it is,” says Hartford Community Court Judge Raymond Norko, who suggests Portland should at least attempt to have court dates the same week as citations are issued.

A shorter turnaround time makes sense, says Binder, the Bud Clark Commons executive director. “These are people who, some are sleeping on the streets. It’s almost impossible (for them) to remember dates,” she says.

The Hartford court, which is in session five days a week, does more than shorten the time between citation and court appearance. Every afternoon the court sends the next day’s docket to the homeless shelters in town. Shelter staff members check who in their facility is scheduled to appear in court, and then accompany clients to the courtroom.

Multnomah County prosecutor Abraham says “logistics” have made it impossible to shorten the time between citations and court dates here. Police officers have to get their reports to prosecutors who have to get them to the court, and in Multnomah County that paperwork process is often taking a month.

“We can’t seem to shorten that period up,” Abraham says. “We ought to be able to do that faster and I don’t really know why we can’t.”

The Hartford approach is vastly different from Portland’s, where nuisance offenders often tear up police citations as soon as they are issued, and know they likely will never be taken to jail if they fail to appear in court. Even if they are arrested after an abundance of failures to appear, they are released after a few hours, according to Abraham.

That wouldn’t fly in Hartford, according to Norko. Hartford defendants who don’t show up for their nuisance crime court dates face a $150 cash bond that can be worked off with community service, according to Norko. Social workers who offer addiction services and mental health treatment are part of the process as well.

But if offenders still don’t appear, Norko issues an arrest warrant, police bring them to jail, and their community service time increases. The failure-to-appear rate has dropped below 5 percent.

“You can make the argument you’re criminalizing the homeless, but the community in Hartford demands their quality of life be enforced by the police department and the court,” Norko says.

From the Transition Projects April e-newsletter

Shelley Dixon is a name that is known well around Transition Projects. Clients, staff and volunteers who have had the pleasure of meeting her will all sing her praises. Shelley has served every role imaginable at Transition Projects and has knowledge of both sides of the social service experience. She is not shy about sharing her story and you will agree that she shouldn’t be when you hear how far she has traveled in her journey.

Shelley Dixon

Shelley came to Transition Projects in 1988, then Burnside Projects, as a client. Referred from her parole officer, she had been previously been to detox and did not have success. Arriving at the shelter, she jokes, that she had no idea of what she was getting into.

“I had a t-shirt, pair of shorts, no shoes and a teddy bear,” Shelley explains. “I showed up and said: where’s my room?”

Shelley enrolled in the drug and alcohol treatment and corrections programs to get her life in order. Shortly after that she began her community service, serving as a volunteer aid helping other clients access showers and clothing at Transition Projects, as well as volunteering with the Blanchet House and Sisters of the Road Café.

In August of 1989, Dixon was hired on as a residential advocate. During that time she worked out of temporary administrative offices in Portland’s Union Station. She was tasked with entering in the handwritten records of clients into a computer database. This made it possible to track services that clients used and how many nights spent in the shelter, something that had not been possible to keep up with before.

During that time, Shelley also worked at our Street Light Youth Shelter. Working 13 hour shifts, she saw kids showing up at all hours looking for a place to stay. She would eventually serve as shelter supervisor working the swing, graveyard and weekend shifts. What stands out the most to her about that time was the struggle to care for as many youth as possible with limited resources.

“How are you going to tell a 12 year old, at three in the morning, in the snow, that they can’t stay here?” Shelley says. “We found ways to get them in.”

By April of 1994, Shelley had become a case manager. She worked very closely with the corrections program and support groups, fostering relationships that would help her clients thrive. She was one of the first case managers at Jean’s Place, our women’s residential program when it opened.

In 2004, Shelley began meeting with every client that was put on our shelter waiting list. This allowed her to house 175 people in six months, a record that still stands.

Another program Shelley has influenced is the current mentor program. The initial class of graduating mentors were all at one time Shelley’s clients. Ask any of them and they will attribute some of their desire to change the lives of others to the compassion Shelley had shown them.

Some of Shelley’s proudest accomplishments involve the amount of people she was able to help and the longevity of their stay in housing after being placed. To her, the number one priority was always clients. There was something about her that allowed clients to open up to her and share information and stories that they never had before.

“I don’t know how or why,” Shelley admits. “But they would come into my office and begin to tell me all of the things that they would never tell anyone. Sometimes things that they wouldn’t even admit to themselves.”

For all she had accomplished, Shelley credits her coworkers at Transition Projects. She can rattle off a list of names of current and former staff members that have helped make her success possible. Shelley is amazed by the ability of each individual to look past appearances and personal barriers and treat everyone with respect, something she role-modeled on a daily basis.

Shelley retired shortly after Transition Projects offices moved into the Bud Clark Commons. She was able to see the organization and its clients benefit from the new setting.

“I loved the surroundings. I loved it for the clients, because the building was built for them. Basically it came down to more space for everyone.” Shelley says.

Shelley’s work throughout the years should not be measure by how many individuals she housed or connected to services, but rather in the number of relationships she has created. Staff or clients, everyone has a story involving Shelley’s kindness and compassion.

“We see people fail on a daily basis,” says Shelley. “At a certain moment in some individuals’ lives they cannot move past those failures. But then, there are so many people who do well and that is what keeps you going.”

By David Stabler, The Oregonian, Friday, February 24, 2012

Benjamin Brink / The Oregonian
Because it was full, the Right 2 Dream Too tent area in Old Town turned away the two men who were later shot under the Morrison Bridge. The organization turns away an average of 20 people a night.

Hours before they bedded down Tuesday night under the Morrison Bridge, Carter “Joe” Hickman and Albert “Allen” Dean, sought shelter at an Old Town homeless tent area, said Ibrahim Mubarak, who runs the shelter. They were turned away for lack of room — an increasingly common event for Portland-area shelters.

At 5:12 a.m. Wednesday, Portland police officers responded to reports of a shooting under the bridge’s east side. Hickman, 57, and Dean, 43, were shot while they slept. Both are expected to survive. The assailant remains unknown, but police have a description of the vehicle.

The two men had shown up Tuesday night with a third friend, Mubarak said. “All three were turned away because we were full,” he said. Each night, the shelter, Right 2 Dream Too, turns away an average of 20 people, he said.

Mubarak knows Hickman, who remains in fair condition at OHSU Hospital. Hickman frequently slept at the shelter, which occupies a vacant lot by Old Town’s Chinese Gates. Dean was treated for a grazing wound and released.

The circumstances of Wednesday’s shooting underscore the area’s severe shortage of homeless shelters. Demand has never been higher, advocates say.

Hickman and Dean are two of the roughly 2,700 homeless people who sleep outside, in vehicles, abandoned buildings or in Multnomah County’s emergency shelters. In Washington County, 1,356 people were homeless or in transitional housing on a one-night count in 2011. Clackamas County homeless numbered 2,747 last year, with only 48 beds in emergency shelters.

Homelessness increased 8 percent in Multnomah County in 2011, according to a survey by Portland Housing Bureau and Multnomah County. In January, 361 men and 173 women were waiting for a room at Transition Projects Inc., Portland’s largest homeless agency for single adults.

Portland Homeless Family Solutions, which shelters families, used to overfill three or four times a year. Today, the agency fills 75 percent of the time, said Brandi Tuck, Executive Director. “For years, we have not had less than capacity,” she said. Twenty families are waiting for shelter. The average wait is one month.

Portland isn’t alone. A woman waited six months to get into My Sister’s House, a woman’s shelter in Gresham, said director Becky Coleman. Another shelter, My Father’s House, is also full.

“A lot of homeless just camp out on the Springwater Corridor or downtown in alleyways, underneath awnings,” Coleman said.

Washington County’s three homeless shelters are full, too. In January, 64 families were waiting for emergency shelter, said Annette M. Evans, Homeless Program Coordinator for Washington County’s Department of Housing Services.

Demand no longer spikes only in winter, advocates said.

“When I first came here 17 years ago, we would see a substantial difference between summer and winter,” said Doreen Binder, Transition Projects’ Executive Director. “We don’t see that anymore.”

When winter warming shelters close in spring, demand at other emergency shelters rises, said CityTeam’s Roger Burke.

With shelters chronically full, it’s hard to track changes in demand. But another yardstick, meals served to the homeless, shows increased demand. Zarephath Kitchen in Gresham served a record 142,000 meals last year. Portland Rescue Mission on West Burnside normally serves 250 to 350 meals a day. Last Tuesday, it dished up 420.

Age is another change in homelessness. Today’s homeless men and women are younger than in previous years. More mothers and children are homeless, as well, advocates said.

“We used to see a lot of two-parent families with kids who had been around for a while,” Tuck said. “Now, we’re seeing younger parents with toddlers.”

At 5 p.m. Thursday, a line of men stretched down a Portland block, each hoping to secure a mat to sleep on the floor at CityTeam International, a homeless shelter on Grand Avenue.

When the doors opened at 6 p.m., the line surged forward. Within 10 minutes, all but six of the 51 spots were taken.

“We can’t keep up,” said Rev. Chuck Currie, who has worked with homeless issues for 25 years. “Portland is the national model for how to address homelessness, but that only shows you how bad off the rest of the country is.”

Deborah Kafoury, a Multnomah County commissioner who works on housing issues, points to programs such as Rapid Rehousing for Homeless Families as one solution. The program seeks to get families into permanent housing quickly, often by working with landlords.

“When families lose their housing, we’ve found jumping through a bunch of hoops is not helpful to anyone and costs more money,” she said.

Also see:

Portland Mercury: Drive-By Shooting Injures Two Homeless Men Sleeping Under Morrison Bridge
Portland Mercury: Homeless Men Shot Under Morrison Bridge Had Been Turned Away from Packed Old Town Tent Refuge
KATU TV: Two homeless men shot in ‘drive-by’ under Morrison Bridge
KPTV TV: Homeless men shot while sleeping under Morrison Bridge
Rev. Chuck Currie: Statement On Ash Wednesday Shootings Of Homeless Portlanders
The Oregonian: Two Homeless Men Shot While Sleeping Under Morrison Bridge
The Oregonian: Police Release Suspect Information, Victim Names in Homeless Shooting
Right 2 Survive Pdx: Right 2 Dream Too Response to Shootings of Two Unhoused Men

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From the Portland Tribune, November 7, 2011

Portland housing officials are preparing for cold weather by asking the City Council to increase funding for emergency warming shelters.

On Wednesday the council will consider a request from the Portland Housing Bureau for $367,000 for a number of nonprofit organizations that already provide similar services. The bureau says the money is needed to guarantee shelter and beds for the homeless and those without adequate shelter when temperatures drop below dangerous levels, as they are predicted to do in coming weeks or months.

“There remains a critical annual need for expanded winter shelter and services from November through April to safeguard the lives of vulnerable, unsheltered individuals from inclement weather conditions that pose a threat of severe illness and/or death due to exposure,” reads the ordinance, which was introduced by Housing Commissioner Nick Fish.

The money is in addition to approximately $2.3 million to the organizations already received from the city to help house the homeless. The organizations are the American Red Cross, the Salvation Army and Transition Projects. According to the request, the funds are projected to provide emergency shelter for up to 300 people for a maximum of 15 nights. Shelters include the 70-bed shelter for women operated by Transition Projects.

Under city policies, new emergency warming shelters are to be opened under the following severe weather conditions:

• Dry conditions – single night temperatures of 22 degrees or below, three or more nights of 25 degrees or below, and temperatures of 32 degrees and below with sustained winds of 15 miles per hour or greater.

• Wet conditions – snow accumulations of one inch or more, temperatures of 32 degrees or below with driving rain of one inch or more, and temperatures of 32 degrees or below with winds forecast at 15 miles per hour or greater.

City standards for requesting existing shelters and warming centers to provide additional beds when severe weather alerts have not been issued include:

• Dry conditions – temperatures of 25 degrees or below, or three nights of 27 degrees or below.

• Wet Conditions – temperatures of 32 degrees or below with sticking snow or rain, temperatures of 33 to 35 degrees with heavy rain (about three-quarters of an inch overnight), or freezing rain.

A number of local meteorologists predicted the upcoming winter would be wetter and colder than usual at the 19th Annual Winter Weather Forecast sponsored by the Oregon chapter of the American Meteorological Society.

All five forecasters who made presentations agreed that La Nina weather conditions are still in force, which is likely to produce severe conditions across the Pacific Northwest. Last winter — when La Nina conditions were also in effect — featured two notable cold spells with low-level snow in late November and late February. It also featured lowland flooding along the Sandy River and record setting snowfall in the mountains.

Some forecasters went even further, however, suggesting that February may be the coldest month of the winter, with the best chances for low-level snow and an arctic outbreak.

From the Oregonian, June 21, 2011

Homelessness in Multnomah County jumped about 8 percent between 2009 and 2011, according to a new report that looked at how many people were living on the streets, at emergency shelters or in motels with vouchers earlier this year.

READ – ‘The Portland Housing Bureau, Multnomah County and their partners worked together to produce the “2011 Point-in-Time Count of Homelessness,” a comprehensive report examining a point-in-time snapshot of homelessness in our community.’

Precisely how much worse the picture has gotten amid the recession depends on how one defines homeless.

The report, compiled by the city of Portland and Multnomah County, studied four types of homelessness: people who sleep outside, in short-term shelters, transitional apartments or on the couches of friends and relatives. In those categories, homelessness increased between 7 and 9 percent between 2009 and 2011.

Generally speaking, the number of homeless Multnomah County residents grew from 2,542 to 2,727 in the two-year period. Using the broadest definition of the term, which includes all four categories, the increase went from an estimated 14,451 to 15,563.

“Even one person on the street is too many,” said Portland Commissioner Nick Fish, who oversees the Portland Housing Bureau.

Other statistics from the survey, released Tuesday but conducted in January, reveal additional trends. For example, 12 percent of the homeless population identified themselves as military veterans this year, although only 9 percent of Multnomah County’s overall population falls into that category. In 2011, 35 percent of homeless women said they had experienced domestic violence.

African-Americans comprised 18 percent of the county’s homeless population, but only 7 percent of the general population. Native Americans saw a similar over-representation. They accounted for 9 percent of the homeless population compared with 2 percent of the overall population.

The down economy explains most of the uptick, city and county officials said. But better, more exhaustive methods for counting the homeless also contributed to the increase, which they characterized as relatively slight given the historic proportions of the recession.

“The fact that there is anybody who is homeless in our community is something to be concerned about,” said Multnomah County Commissioner Deborah Kafoury.

The count took place on Jan. 26, because federal rules say the survey must occur when the number of people in emergency shelters is typically highest. If local governments want federal grants to address homelessness, they must provide updated figures for homelessness every two years. The state of Oregon also requires an annual tally of shelter occupants for budgetary reasons.

Doreen Binder, executive director of the Portland nonprofit Transition Projects, said Tuesday the latest snapshot of the county’s homeless population doesn’t account fully for the impact of the recession on low-income residents.

Her agency gives people free laundry detergent, toiletries and food so they can save their money for rent. “Just because they’re not living on the street, doesn’t mean their needs haven’t increased,” Binder said.

From the Portland Tribune, May 5, 2011

Portland’s most vulnerable have a shot at a free home

John hasn’t had a place to live in four years. Being in and out of jail is the closest he’s come to that.

A longtime methamphetamine addict, John (not his real name) says he mostly uses marijuana now. John also suffers from severe mental illness, including depression.

John, in his 40s, is articulate and resourceful. After years of on-and-off homelessness, he has learned where to go for a hot meal or a shower. That resourcefulness is about to cost him a place to live.

As the Housing Authority of Portland prepares to open its $47 million Bud Clark Commons near Union Station in Old Town, workers at four community health care clinics have administered Vulnerability Index tests to the city’s homeless. The 130 people with the highest scores — basically those most likely to die or get assaulted if left out on the street — will be offered apartments in the LEED-certified building.

The 130 apartments in the commons represent one of the more dramatic housing experiments that the city and the housing authority have attempted. Because of the way the tests measure vulnerability, tenants will include people who are trying out recovery living next to those still using drugs and alcohol, and those prone to violence next to longtime assault victims.

Two weeks ago John took the test. So did Cindy.

Cindy, by appearances, isn’t nearly as bad off as John. She’s much younger, just a year or two over 30, so she hasn’t been homeless nearly as long.

She lives on the street by herself, addicted to meth, a loner who was a victim of domestic violence much of her early life.

Cindy does have hepatitis C, bipolar disease, asthma and her addiction. Still, her mortality risk is rated at two on a scale of one to five. Unlike many older, longtime homeless people, she doesn’t yet have cirrhosis of the liver or chronic kidney disease, heart disease or diabetes.

But Cindy scores high for vulnerability, mostly because a lifetime of domestic abuse indicates that she allows herself to be victimized, and living on the street provides plenty of potential for that.

Cindy’s overall score of 29 is going to get her an apartment in the commons. John’s vulnerability score of 15 won’t even get him close.

In hour-long question-and-answer sessions, clinics workers have been trying to place objective measurements on the myriad conditions and hazards that create homelessness, and which distinguish lives that to many appear indistinguishable.

The lowest possible score on the vulnerability test is 10, the highest is 48. At this point, it appears a score in the high 20s will register in the top 130 and yield a lifetime rent-free apartment in Bud Clark Commons for those with no money (those receiving Social Security income will pay 30 percent of their benefits).

Drug users score higher

Kelly Moehling, who has administered the vulnerability tests at nonprofit Central City Concern’s Old Town Clinic, says there were a number of consistent themes among the high scorers she assessed. One was severe mental illness such as schizophrenia. Another was chronic alcoholism or drug abuse. Those who are in substance abuse recovery programs scored lower, mainly because they are better able to take care of their basic needs, such as finding their way to shelter and soup kitchens and reliably taking their medications.

In fact, one Central City Concern client was mistakenly assessed twice — once before he started a recovery program for chronic alcoholism and then a month later while in recovery. The second score, Moehling says, was markedly lower.

Jeanine Carr, community health nurse at the Multnomah County Westside Health Center downtown, says she and the staff have assessed about 50 homeless people so far. The highest score to come out of the county clinic as yet is a 32, and that man typifies a potential problem for the commons once all the tenants are in place.

The person with the highest score is 40, says he bathes every 10 days and gets new clothes from area shelters whenever his clothes get too dirty. That shows a fairly high degree of resourcefulness, Carr says, and lowers his score.

But the client scored high in the mortality risk category because he suffers from a number of chronic diseases, and because he visits local hospital emergency departments about once a month. He reports chronic unexplained seizures and that he sometimes passes out after taking his medications. A brain injury and learning disability increased his score.

Six years of homelessness didn’t keep the client from earning a four (out of five) for survivability skills after he told Carr his possessions are often stolen on the street. The fact that he says he’s a loner who fights a lot yields a four for organization and orientation. Memory impairment earned him a four, and the fact that he says he doesn’t need help for mental illness gave him a four in that category.

“If he had said, ‘I need mental health help,’ he would have scored lower,” Carr says.

But here’s the answer that has Carr thinking about this client’s fitness as a Bud Clark Commons tenant: When asked how he deals with conflict, the man said he has military training and would either “walk away or end it quick by attacking them.”

In contrast, a number of those doing the assessing say a theme among high scorers was meekness, which translates to an inability to take care of basic needs such as hygiene.

“ ‘Presents as helpless’ was a term I saw over and over,” says Central City Concern’s Moehling.

The Bud Clark Commons mix could be volatile.

“They’ll score high on the assessment but not be the best choices to be tenants,” Carr says. “But that’s kind of why they’re homeless. It’s not like (the housing authority) is trying to build a community that will work well together.”

Carr and others say the highest scorers are almost all what physicians call tri-morbid — suffering chronic physical diseases, mental illness and substance abuse.

Quantifying the despair

Nonprofit Outside In has given vulnerability assessments to about 100 homeless people, many of them among Portland’s population of young street people. Lacey McCarley, the client access administrator, says it was sometimes hard to follow the assessment rules for the commons and still provide an accurate measure of vulnerability.

Administrators were told to grade people on their answers to the questions, not on what the administrators might know or learn on their own. McCarley says some of the people she tested had been Outside In clients for years. Because of that, she knew the extent of some of their health issues. If the client didn’t talk about those health issues, they were left off the assessment.

But sometimes, McCarley couldn’t help but plug her own observations into the assessments. For instance, one of the assessment’s questions is: “Do you know where to go for showers and laundry and how often do you go?”

McCarley says some clients told her they showered and washed their clothes regularly, but she’d be sitting there with them in a small room, and the smell of their bodies and the state of their clothes made it clear they probably hadn’t done either in a month. She would add notes to that effect on the assessment page.

“It’s people lives. It can’t just be a number,” McCarley says.

But that’s exactly what the vulnerability assessment is: quantifying the despair of Portland’s most down and out.

One of the assessment’s questions asks whether a client has friends or family with whom they are in contact. Another asks, “Have you ever been in a relationship that made you scared or fearful?”

Men, McCarley says, nearly always answered no to the second. “Some people just didn’t want to show any weakness because that’s how they survive on the street,” she says.

Similar, McCarley says, were answers to questions about drug abuse. A number of clients didn’t want to admit the extent of their addiction. One man insisted he hadn’t used drugs or alcohol in weeks, but kept nodding off during the assessment, clearly having used that morning.

McCarley says the commons will be full of intravenous drug users, who generally scored high. Designated as “wet housing,” the commons will allow tenants to drink in the building and, to some extent, use illegal drugs there as well. Not allowing that, housing officials say, would mean most would soon be back on the street.

Still, Rachael Duke, in charge of running the commons for the housing authority, says the extra staff assigned to the commons will make it clear to tenants that illegal drugs in the building’s shared spaces will not be tolerated, nor will selling drugs in the building. The building’s leases will allow monthly inspections.

“We’re going to be in their faces more here than we are in any other communities,” Duke says.
As for how this community of oddly matched residents are going to get along with each other, nobody really knows.

“The housing authority and the city are taking real leaps of faith,” says Stacy Borke, housing and support services director of Old Town homeless social services provider Transition Projects Inc.

Getting an apartment could be bad for health

Taking the 130 most vulnerable of Portland’s homeless people and placing them into one apartment building is experimental on any number of levels. Among concerns raised by skeptics is turnover.

Tenants of the new Bud Clark Commons are being given rent-free apartments in the new LEED-certified building for as long as they abide by the building’s rules. Some say that means most tenants will stay for life.

But Rachael Duke, who will be in charge of housing operations for the project, predicts there will be a higher rate of tenant turnover than many might expect. Duke and others say they have observed a phenomenon that takes place with some longtime homeless people who are placed into apartments: They die.

Most of the tenants at the commons suffer from chronic diseases such as hepatitis C and cirrhosis, so it’s natural that some will be close to death and might expire within a few months of moving into the apartments. But the phenomenon Duke describes is something different. She says it is as if some of the chronically homeless, who battled to stay alive on the street, let down their physical and mental guard once comfortable in their apartments and succumb to their diseases.

A number of local physicians consulted by the Tribune say they don’t know of any medical study substantiating what Duke and other housing officials say they have observed. But John Song, an internist and associate professor at the Center for Bioethics at the University of Minnesota who has studied end-of-life issues with the homeless, says what Duke is describing might be real.

Occasionally, he says, too much medical care too soon can have a negative effect.

For example, Song says, some AIDS patients who have not been taking their medications regularly develop suppressed immune systems that can’t handle the regular dosage of medications once they begin adhering to a doctor’s orders. They develop Immune Reconstitution Syndrome, in which their immune systems come back so strongly they begin attacking healthy tissue.

Homeless people with end-stage liver or kidney disease also can have escalating problems once they begin eating regular meals with richer foods such as red meat. They find they can’t digest properly and their kidneys and livers are unable to rid their bodies of toxins.

“I don’t think it’s a stretch to say probably the people they are observing, all of a sudden they’re getting fully nourished and all the care they need, and that might actually be deleterious to their health if it happens too quickly,” Song says.