A small agency takes on a big problem | Behavioral Healthcare Executive Skip to content Skip to navigation

A small agency takes on a big problem

April 1, 2008
by Howard Spanbock, LCSW, CADC III
| Reprints
Building solutions to care for homeless mentally ill adults

Washington County is part of the tri-county metro area surrounding Portland, Oregon, and has experienced explosive population growth during the past 20 years. Before the 1990s, the county, which extends westward from the Portland urban center toward the Pacific Coast, consisted mainly of sleepy farming communities, with a population just over 300,000. During the past two decades, as downtown Portland pushed growth into the county's rural spaces, the population rapidly increased to more than 500,000, with a recent growth rate of more than 15%—nearly twice the state average.

Along with the benefits of a booming population (such as a larger tax base, rapid economic growth, and upscale housing developments) came the challenges of a diverse urban population, including a larger and more visible homeless population. What used to be limited to a few homeless individuals known to local residents on a first-name basis, and who were “taken care of” for the most part by the faith-based community and local law enforcement, now became a population of more than 1,200 homeless adults (according to the county's 2007 one-night count).

By 2003, Washington County human services agencies had responded to the shifting demographics by establishing programs that offered services to homeless families. No providers, however, offered services to the growing number of single homeless adults.

Stepping up to the Challenge

Nationally, almost half of homeless adults struggle with mental health challenges, a statistic Washington County's one-night street and shelter count has confirmed year after year. In 2004, the board members of Luke-Dorf, Inc., a small licensed adult mental healthcare provider, decided to establish programming for single homeless adults with severe and persistent mental illness (SPMI).

Luke-Dorf's hillsboro campus includes the garrett lee smith safe haven (structure on left) and a 15-bed facility (right) for residents needing dual-diagnosis services

Luke-Dorf's Hillsboro campus includes the Garrett Lee Smith Safe Haven (structure on left) and a 15-bed facility (right) for residents needing dual-diagnosis services.

We identified two priority needs for this population. First, a facility was needed to offer services that did not demand that clients initially engage in treatment and welcomed all homeless mentally ill adults, regardless of their treatment readiness. Second, a facility that specialized in providing treatment to chronically mentally ill persons challenged by both substance use and homelessness also was needed.

We determined that the Safe Haven model, developed by the U.S. Department of Housing and Urban Development in the 1990s in response to the first flood of homeless former state hospital patients, was a perfect solution to the county's need for a front-door low-demand facility. The model targets are the hard to find and even harder to engage homeless mentally ill population commonly found camping in doorways, alleys, and isolated urban settings who are often reluctant to participate in the mental healthcare system. Safe Havens nationwide have proven the effectiveness of offering housing first, and then a gradual entry into services at a person's own pace.

Our vision also included creating a freestanding 15-bed building dedicated to dually diagnosed clients, where we could practice evidence-based integrated dual-diagnosis treatment for individuals referred for the most part by corrections programs, emergency departments, and jails.

Making the Vision Reality

As we prepared to meet these goals, our agency was also transitioning from an annualized reimbursement rate to a fee-for-service model and simultaneously moving to a paperless chart and automated billing. In addition to these challenges, we realized that in order to fulfill our vision we had to commit to raising an estimated $1.7 million to renovate an existing structure and construct a building.

Luke-Dorf's safe haven is named after garrett lee smith, son of u.s. sen. gordon smith and sharon smith (pictured).

Luke-Dorf's Safe Haven is named after Garrett Lee Smith, son of U.S. Sen. Gordon Smith and Sharon Smith (pictured).

As anyone involved in development surely knows, a project of this size and complexity happens only when a coalition of stakeholders is formed, all of whom have an interest, each for its own reasons, in a shared outcome. Using that premise, we began identifying both public and private entities committed to ending homelessness and invested in the cause of mental healthcare. We also engaged community and business leaders searching for a positive solution to homelessness.

We were careful to explain not only the moral and humanitarian imperatives around the issues, but also spoke to the financial benefits for the community: the reduced use of emergency rooms, EMTs, correctional facilities, police, detox facilities, and other emergency services that experience the burden of a large unserved homeless community.