A small agency takes on a big problem: 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).

[ILLUSTRATION OMITTED]

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.

[ILLUSTRATION OMITTED]

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 homeless-ness 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.

We also approached U.S. Sen. Gordon Smith, who has been a champion for mental health issues in part due to the suicide of his son, Garrett. Sen. Smith secured a federal earmark that allowed us to purchase property close to public transportation and services. In addition, McKinney-Vento funding, federal homeless services funds administered by the Washington County Department of Housing, as well as community development block grants from the county Office of Community Development, played a major role in financing both facilities. We also were supported by grants from the state Division of Addictions and Mental Health Services, City of Hillsboro, Community Housing Fund, Nike Corporation, Providence Hospital Foundation, and numerous private donors.

In December 2006, the Garrett Lee Smith Safe Haven opened in a renovated Victorian home to serve 10 formerly homeless persons at their individualized level of need. Almost immediately the construction of the neighboring dual-diagnosis facility began. In December 2007, Luke-Dorf hosted a party celebrating the simultaneous opening of the 15-bed dual-diagnosis facility and the completion of our Hillsboro campus. This major service center now provides assistance to 25 formerly homeless residents at any given time.

As the executive director of a small community-based not-for-profit mental healthcare provider, I believe that this project was a significant achievement not only for Luke-Dorf but also for the entire community. The campus's opening was the culmination of a four-year effort combining our original vision with a design based on client needs, networking with dozens of interested participants and consumers, and complex negotiations of logistical details.

We have seen the following accomplishments:

* the renovation of a dilapidated property that previously had a negative impact on the neighborhood;

* the establishment of 10 Safe Haven and 15 dual-diagnosis beds for SPMI homeless single adults;

* the creation of community connections among multiple providers such as Community Action Partnership (CAP), government agencies (Department of Community Development), corporate foundations (Nike), Oregon Food Bank, and many other nonprofits;

* the introduction of new McKinney-Vento funding into Washington County;

* the establishment of Washington County's first dedicated program for the adult SPMI homeless population; and

* the creation of new social service employment opportunities.

Suggestions

I hope some of our experiences will assist providers who are interested in developing property to serve homeless persons. Below are some tips for others considering such an endeavor.

Know your population. Close coordination with the Homeless Outreach team at CAP, as well as our own PATH-funded homeless outreach worker, gave us direct knowledge regarding the level and extent of need for the population we wanted to serve. The population's needs should drive your vision for development.

Identify and involve key staff early, ensuring that your vision for programming and services has energy and momentum.

Knowyour community. Identify its service gaps and the interests of everyone--from your U.S. senator to the homeless person on the street. Our project was successful because we brought together stakeholders with diverse interests (such as the neighborhood association, zoning department, historical society, wider nonprofit provider community, county housing department, mental health community, and elected officials) and showed them how we could achieve common goals.

Prepare for a multilevel, ongoing fund-raising campaign. We found that tireless fund raising was needed to keep up with the inflation of materials' costs plus labor as the project came together.

Involve as many participants as possible. The more stakeholders who have an interest in the project, the more likely it will be seen as an indispensable community resource.

Final Thoughts

With many communities in the middle of their ten-year plan to end homelessness (see www.endhomelessness.org), we hope that our project sets an example. A small mental healthcare agency can make a difference and be an important part of the continuum of care.

Over the past 30 years, the community mental healthcare system has developed creative and flexible programs in response to ever-changing social needs. It is this ability that will continue to make community mental healthcare an indispensable part of the American healthcare system.

For more information, e-mail hspanbock@luke-dorf.org.

BY HOWARD SPANBOCK, LCSW, CADC III

ABOUT THE AUTHOR

Howard Spanbock, LCSW, CADC III, is Executive Director of Luke-Dorf, Inc.

[ILLUSTRATION OMITTED]