Nonprofit reduces homelessness with tailored services, one person at a time

For 40 years, Portland’s Central City Concern (CCC) has been helping people experiencing homelessness find shelter, and provide people what they need to transition to permanent housing and be able to keep it. CCC provides detox services, follow-up substance abuse treatment, harm reduction programs, mental health counseling and even jobs for those in recovery. The nonprofit serves 14,000 people each year and recently broke ground on another affordable housing building that provides an array of services. We hear from Rachel Solotaroff, the CEO of the nonprofit, about CCC’s integrated services, their new Cedar Commons building, and the possibilities she sees for the future. And we meet Charlette Severns who overcame homelessness and 17 years of substance abuse. She is now housed, employed full time in Washington and has renewed her relationships with her three children and five grandchildren.

This transcript as been created by a computer and edited by a volunteer.

Dave Miller: From the Gert Boyle studio at OPB, this is Think Out Loud. I’m Dave Miller. Portland’s Central City Concern has been helping people experiencing homelessness for 40 years now. The nonprofit has developed a kind of ‘all of the above’ approach. It provides detox services, ongoing substance abuse treatment, harm reduction programs, mental health counseling and even jobs for those in recovery. That is in addition to permanent supportive housing. The organization recently finished work on a new affordable housing building called Cedar Commons. More are in the works. In a few minutes we’re going to hear from the CEO of Central City Concern. But first I’m joined by someone who was able to turn her life around because of help she received from the nonprofit. Charlotte Severns, welcome to Think Out Loud.

Charlotte Severns: Thank you.

Miller: Can you give us a sense for what your life was like a little more than two years ago when you were living in the streets in Seattle?

Severns: Yes, I was homeless. I was completely utterly addicted to drugs and it was horrific. It was horrible. I was living from couch to couch in trap houses, doing everything that I could possibly find to do to not deal with reality.

Miller: How much of a connection was there between your substance abuse and your homelessness?

Severns: A really big connection because having a stable place to live on a daily basis, being able to eat and shower. Yeah, it was a very big deal. You’re homeless, you’re having to find some place to shower, someplace to use the restroom. Being on substances, you really don’t care.

Miller: My understanding is that you had tried to get clean before. Why do you think those earlier efforts didn’t take?

Severns: I had went to a couple of detox places in Seattle, Washington, which is where I’m from. Basically they do the five-day detox and then they just push you out the door. There’s no follow up care. There’s no extending out to... I got nothing. I got no phone numbers, no sponsors, no meetings, no list or anything. Just basically they do a detox cocktail and then you’re pushed out the door.

Miller: So five-day detox and then out the door. So on day six, what would you do?

Severns: Well, I just went back to my brother’s house and eventually, I was so freshly detoxed that in my mind of thinking and not knowing and having the tools to stay away from it all. I was out there for 17 years. I’m from Seattle so I knew everybody. So I just went right back to doing what I was doing before.

Miller: So what was different two years ago? First of all, what led you to Portland to seek treatment?

Severns: Like I said I was out there for 17 years and at the end of my rope. I was doing it all. Within a seven day period I had five of my friends pass away from overdoses. Not intentionally, just from the street drugs that were out there. It was a do or die situation for me. It’s either I’m going to continue doing this and die, or I need to stop and do something about it.

Miller: What brought you to Portland?

Severns: I have family in Portland. Three years prior to me getting clean I called and asked if I could come there because I knew too many people in Seattle. I could not stay clean in Seattle. I could get clean, but I couldn’t stay clean. There was not really too much in Seattle to provide me with the tools that I needed to stay clean. So I asked my family members there if I could come to Portland because I don’t know anybody in Portland. I’ve been there once or twice to visit and so I asked if I could come and get the help that I needed there. Actually, the person who helped me, my sister Melissa, she looked up a bunch of places and got the numbers, referrals, everything that I needed. She actually drove to Seattle to get me from Portland.

Miller: What did you find at Central City Concern?

Severns: When I got into Portland, I did a five-day detox at my sister’s house on my own. But there was a detox place for me to go to there. Once I got there, I was five days really sick. I found she had Central City Concern’s number and that was the first one that I called. She had three other ones, but that’s the one that I called. I walked in there on my fifth day and I was provided with medical care, housing options. I was on medical care in Washington. They, all in one day, within a few hours... and I was their third patient at the Blackburn Center.They provided me with health care and all the tools that I needed, housing and the follow up care for meetings, going to meetings.

Miller: So it was housing, follow up care, medical support. It was sort of everything at once, it seems.

Severns: Yes. Within a few hours they did give me Suboxone and they put me on an outpatient program. Four days a week, I had to go from my sister’s house to Blackburn, which was a good 10 mile radius between that. But they provided rides four days a week. I was there every day and it was a very wonderful program for me. It just worked so well because within a month after starting the Blackburn Center, CCC I was provided housing and a job.

Miller: Charlotte Severns, I want to hear more of your story, including what you’re doing today. But as I mentioned, the President and CEO of Central City Concern is with us as well. Rachel Solotaroff, welcome to Think Out Loud.

Rachel Solotaroff: Thanks so much, Dave. Good to be here.

Miller: Can you give us a sense for the overall mission of Central City Concern, the umbrella for all the different kinds of services that Charlotte has just described?

Solotaroff: Sure, and thanks so much, Charlotte. We’ve met before. It’s great to hear your voice.

Severns: Nice to hear you again.

Solotaroff: As you mentioned, Dave, the mission of Central City Concern is around providing comprehensive solutions to ending homelessness. As you can imagine, homelessness evolves when the drivers of it change. So Central City Concern, in it’s 40 years of existence, has evolved and changed to meet those needs. In broad strokes, what we do is to provide service across four key domains, all of which Charlotte mentioned. One is access. We both develop and manage and help to provide access to safe and affordable supportive housing. We provide health care services which are inclusive of mental health services, substance use, disorder services and primary care. We provide support with access to employment and sometimes that’s a fairly rapid process and sometimes it’s a process of working with someone for over a year. Then I would call it kind of the secret sauce of Central City Concern is the importance of peer support, of building community, of working often with people who’ve had the same experiences as yourself and can really help to be a partner with you through that journey.

Miller: On some level, what you’re describing here seems like common sense because we’ve heard enough over the last decades, not years but decades, to know how interrelated so many of these things are: health care and housing and mental health and substance abuse. How common is it for service providers to combine all of these in one place?

Solotaroff: I think it’s variable. I know that there are places within our community here in Portland that are doing this kind of integrated and holistic work. There are different organizations around the country who are doing it as well. I think that what really guides the work, though, is really thinking about a strategic theory of change. It may be and there may be different. What seems like common sense actually becomes a little more complex as you actually need to dig down a bit into thinking about the root causes of homelessness and again, those may be different in different places. But a lot of evidence has shown that root causes can be structural, like the absence of affordable housing, structural racism, absence of meaningful wage employment, an underdeveloped behavioral health system. Or those root causes can be ones of individual experience; somebody who’s experienced trauma or serious mental illness or substance use disorder. I think where the real change comes in is when you understand that you really have to attend to those structural issues as much if not more as you attend to those individual experience issues, because the more profound those structural issues are, the easier it is to push someone into homelessness and keep them there, even if they don’t have those individual experiences. I do think the uniqueness in Central City Concern is trying to... maybe it’s not unique, but what we really focus on is trying to make sure we are addressing the structural issues as root causes, as much as trying to attend to the needs of a person walking in the door.

Miller: One that as we’ve just been hearing, it takes both a systemic and an individual approach. Rachel Solotaroff is the President and CEO of the nonprofit. Charlotte Severns is a former client of Central City’s Blackburn Center. She now has her own job and a home and is clean from drugs. Charlotte, I’m curious looking back now, it hasn’t been that long, but your life has changed so much. I’m curious for you, how much you think this was because you were in a different place and you were ready to fully change your life around. And how much was because of the programs that were offered to you at Central City Concern?

Severns: Well, I definitely can say that I was at the end of my rope and I was mentally and physically ready to do this. I had no more options. The connection between the two is that when I walked into the Blackburn Center, like I said, I was provided health care immediately, medication immediately, counseling immediately. Then once I got into the Blackburn Center, the housing part of it was just fantastic, because I lived at the Blackburn Center and then my health care was right next door. So I would just leave my room, which is like a college dorm room living, which is perfect. I had a shared kitchen, shared showers, which was fine, but I had my own room and all my counseling was right there. My outpatient four meetings a day and then my four days a week, I had to just walk out the door and go right next door. So I didn’t have to venture out and travel anywhere. They also provided so much, not only the housing, but making you accountable by giving you a job. So you got a sense of stability. You’re making your own money. I have a cat and they went ahead and let me have her as a caregiving cat. I got a cell phone. They give out gift certificates. It’s just, it’s amazing how if you are ready for this, they go to no ends to keep you. If you’re ready to do it, they provide everything.

Miller: Rachel Solotaroff, what kinds of research do you do to see if successes like Charlotte’s are more likely for people who go through your programs? I mean, what is the data behind it?

Solotaroff: Great question. We can certainly look at our outcomes in a kind of linear level. How many people who are in housing retain that housing or exit to permanent housing or how many people get employed, or engage in treatment? The real magic, as Charlotte really elegantly describes, is when we can look at how these different interventions are woven together to meet the needs of a of a particular person or a particular population, and how those interventions can really synergize and leverage one another and then you can drive improvements across a number of domains. So, for instance, we did an observational study a few years ago looking at people who had come out of our detox here, and were engaged in outpatient treatment, had employment services, had access to primary care. But then what difference did that housing intervention make, as Charlotte mentioned? And we found that those people who had recovery housing in addition to those other services were three times as likely to complete their substance use disorders treatment. They were 10 times as likely to engage in primary care and over the year in care, their total health care costs came down by 60%.  Specifically, their behavioral health costs in the health care system came down by 60%. The next step of that is now starting to do more rigorous research, which involves a randomized control trial, which is a higher quality of evidence. And we’ve been doing that design over the last couple of years and plan to launch that this fall.

Miller: You know, hearing you over the last 10 minutes has given a sense of hope to me in terms of what seems like a successful approach for a very complicated, multi-variable problem. But on the other hand, people in the Portland area and around the West Coast can walk around and see so much increasing visible evidence of people who have no place of their own to live. Homelessness seems like it’s getting worse and worse and worse. What are we doing wrong as a city or as a society right now?

Solotaroff: Oh, gosh, can I invert that question and say, what are we doing right that maybe perhaps we need to scale? I think that we know in this it’s at the top of the list, our crisis around affordable housing, both in terms of the bricks and mortar, and also in terms of the services such as those that Charlotte described. We’re in a crisis around that, so we have some really terrific interventions in this community in the last several years around housing bonds and the supporting housing services measure, which really just went into effect a few weeks ago, that we need to ensure that those measures are again really thought about on a systems level, that we’re thinking about different interventions and how they’re weaving together. They’re really aimed at populations, and we’re looking at those outcomes broadly and in so doing, and then we can do that at scale. I think it’s really been in the last few years that our community has really made these kinds of non-incremental investments. I think the important thing will be to study them well and to scale them appropriately. Certainly, it’s been a rough year and a half as well, with a lot of other things that have driven difficulties around homelessness. So I have a lot of hope about what’s happening and what the potential is and to really be functioning at a systems level.

Miller: Charlotte Severns, can you give us a sense for what your life is like right now?

Severns: Well, as of today, I have moved from Portland. I’m back in Seattle living on Orcas Island. I was here about a month before I got a job at a grocery store. Within three months of working as a cashier at the grocery store, my boss came to me and wanted me to become a PIC, which is a Person in Charge, Assistant Manager at the front end. I felt, at that time, my life changing from Portland to here, just the moving and stuff, I wasn’t quite ready. I let her know about my past and she was so gracious and kind and said she doesn’t want me to go back down that rabbit hole. So a few months later I went back to her and I felt as though I was ready to become a PIC and I am now an Assistant Manager at the only grocery store on Orcas Island and have super high hopes. My story just keeps getting better. To be conceited about it, yes, a lot of my backbone is thanks to CCC and the Blackburn and everything that they’ve provided for me. Hopefully within the next three years I will own my own home and be the Manager of the front end at the market where I work.

Miller: I’m curious, looking back, what do you think could have helped you earlier? Because as you said, you spent 17 years of your life either living on the street or couch surfing or in the thrall of drugs. It seems like it’s so fantastic that you found Central City Concern when you did. But I’m curious, what do you think may have made a difference earlier?

Severns: I don’t know. I think it is just my mind state and where I was. Pretty much when you’re done, you’re done. I knew there was no other option for me except for death or to come out of this because if I didn’t, I was going to die. So to me, I think it’s just the mindset. When you’re either going to continue on and not be there, or you’re just going to get your life straightened out. That’s where my story is. That’s what I did. I knew that there was no... When watching the world, the epidemic with drugs and heroin and fentanyl and, just like I said, people dying off, that I had one or two ways to go. And I think you just really have to be mentally ready to do it.

Miller: Charlotte Severns and Rachel Solotaroff, thanks very much for joining us. Best of luck to both of you.

Severns: Thank you.

Solotaroff: Thanks for having us.

Miller: Charlotte Severns is now the Assistant Manager for a grocery store on Orcas Island in Washington, a former client at Central City Concern’s Blackburn Center. Rachel Solotaroff is the President and CEO of the nonprofit Central City Concern.

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