Central City Concern

Providing comprehensive solutions to ending homelessness and achieving self-sufficiency.

After July’s Jesuit Volunteer Corps Anniversary edition of the Volunteer Spotlight, we’re now taking some time with one of CCC’s most flexible volunteers, Deborah, as she tells us about her behind-the-scenes tasks, many volunteer roles and impressions of CCC!

Name: My name is Deborah Dory, as in finding Dory…but I do know who I am, ha!

Position: I would be considered an On-Call Administrative Volunteer.

What kind of projects have you participated in as an On-Call Administrative Volunteer?

Let’s see, you might have to jog my memory on some things but I enjoyed them all. I can remember the childcare, the donor envelope filling and signing addresses, and doing some [phone-call] invites for one of the donor programs a couple of times and medical records filing and archiving quite a bit. Data entry with the grants documentation with both the Quality Management and the Supportive Housing programs. The recent one was with the Imani Program: some of their photocopying and re-orchestrating their filing. Just all the range is very enjoyable and it’s just a great program that you guys are doing. Great work. I like it all.

How did you first hear about Central City Concern?

Well I always knew about Central City Concern. It was a long time ago…when I was working at DePaul Treatment Center, and I knew about it then because a lot of the clients were going into housing and there were some other programs, the Letty Owings Center [and others], that we referred to through outpatient and things. And then of course you’d hear about different things you guys were doing and you’d see the buildings that you guys were doing.

Do you think you’ve learned a lot about the organization since you first started volunteering?

Well, I think one of the things I learned is that the staff is committed, both emotionally and professionally. You want to assume that when you’re doing nonprofit work but it just more solidifies that the people are devoted and happy that they’re there.

Of these various projects that you’ve done with CCC, do you have a favorite?

I like the donor program. Helping with that you realize that people are going about their daily lives and so it’s using your charisma to encourage them to continue supporting the work. You had to use some of your skillset more than just being in a room and filing or being at a computer doing data entry.

And of course, I think I’m just simple. I enjoyed filing the medical stuff because I take that in very high regard and I take pride in filing things right. I guess I could say something that I’ve learned, or something that I already know, is that I’m a person who really upholds confidentiality and I hold that sensitivity to a very high esteem.

What words of advice do you have for somebody on the fence about volunteering?

Just go to the site and see what they do. For me, I kind of got a feel before I started so for the most part a lot of people would have heard your name before too. It’s not many hours you have to commit, so it’s worth a try because it’s good and necessary work that you guys do, and from there you can be hooked. What’s a small commitment for at least an emotional reward?

Do you have any parting words about your time as a volunteer?

Well, I think I just enjoy the process. It wasn’t that I could just walk in and start volunteering so I appreciate that professionalism. I look forward to doing more things and learning more about the programs but so far they have been vast and all of them exciting. I don’t want to just say that I want this specific thing because I know there is so much more. And just connecting with the human condition and there are all these different issues as far as trying to empower people so I know that I don’t just want to commit to one specific area.

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

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

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

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

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

Leslie Tallyn Chief Clinical Operations Officer

Visit These Profiles of Innovation at Central City Concern!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Visit These Profiles of Innovation at Central City Concern!

Central City Concern (CCC) is a 501(c)(3) nonprofit agency serving single adults and families in the Portland metro area who are impacted by homelessness, poverty and addictions.

Primary Focus of the Provider

• Mix of Mental Health and Substance Abuse

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Type of Care

• Substance abuse treatment
• Do not treat opiod addiction

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Facility Type

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Treatment Approaches

• Cognitive/behavioral therapy
• Dialectical behavioral therapy
• Substance abuse counseling approach
• Trauma-related counseling

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Facility Smoking Policy

• Smoking permitted in designated area

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Service Setting (e.g., Outpatient, Residential, etc.)

• Outpatient
• Intensive outpatient treatment
• Regular outpatient treatment

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Facility Operation (e.g. Private, Public)

• Private organization
• State substance abuse agency
• State mental health department

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Payment/Insurance Accepted

• Cash or self-payment
• Medicaid
• Private health insurance
• Federal, or any government funding for substance abuse programs

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Emergency Mental Health Services

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Payment Assistance Available

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Language Services

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Special Programs/Groups Offered

• Persons with co-occurring mental and substance abuse disorders
• Clients referred from the court/judicial system
• Adolescents
• Adult women
• Adult men
• Transitional age young adults

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Ancillary Services

• Individual counseling offered
• Group counseling offered
• Family counseling offered
• Marital/couples counseling offered
• Brief intervention approach
• Contingency management/motivational incentive
• Motivational interviewing
• Anger management
• Martix Model
• Community reinforcement plus vouchers
• Relapse prevention

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Age Groups Accepted

• Children/adolescents
• Adults

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Gender Accepted

• Female
• Male

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Exclusive Services

• DUI/DWI clients

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