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Commissioner Sharon Meieran Newsletter - 2023

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Commissioner Sharon Meieran Newsletter - November 2023

Dear friends and neighbors, 
 
Happy (belated) Halloween! Halloween is my favorite holiday and I wish I had the luxury of focusing on the tricks and treats. But given what’s happening in our region and the world, unfortunately I feel compelled to focus on the scary. Times are difficult right now, and we are facing challenges on numerous fronts. As I near the end of my penultimate year as a Commissioner, I am focused on the “Big Picture” at the County. 
 
This Newsletter will focus on both the enormous challenges we face, along with my ideas for solutions (some you’ve heard about for years, others are new). This will be an expanded Newsletter as it’s been a while since my last formal outreach, and there’s a lot to say. The good news: There are pictures! Think of it as “Sharon’s Newsletter - the Graphic Novel.” 

Homelessness
 
I’ve said it before and I’ll say it again - the County has no strategic plan to holistically address homelessness. This results from a combination of structural challenges and lack of leadership, is exacerbated because there is no meaningful advisory structure to inform policy, is compounded by misunderstanding of some basic concepts relating to homelessness, and is characterized by poor data and lack of systems coordination. 
 
Structural Challenges: The following is the graphic I created to try to understand how the pieces of governance of homeless services fit together. The bottom line is - they don’t. Take a look and you’ll see why it’s no wonder there is massive confusion.

first



Lack of an Advisory Body: Right now we have no centralized advisory structure to inform decision-making around homelessness. Many well-intentioned groups are striving to do pieces of this work, but they are not unified or coordinated in their efforts. They include Metro’s Oversight and Tri County Advisory Committees; the Governor’s Central City Task Force; the County’s Continuum of Care Committee; the HereTogether advocacy table; faith groups United In Spirit and the Interfaith Alliance on Poverty; community groups like Shelter Now; and community committees both formal - such as Revitalize Portland - and informal - such as the self-described “Kitchen Cabinet”. 

There are many cooks in the kitchen but no head chef. I’ve proposed the following advisory structure as a basis for designing a body that can be effective in informing and developing policy:

second




Misunderstanding of key concepts: There are many examples where lack of shared understanding of concepts leads to confusion and even acrimony. With different understandings of the foundations of the County’s key work, expectations about impacts vary wildly. I could spend an entire newsletter on this topic but I will focus on two compelling examples. 

  • Housing First: Few phrases have generated as much misunderstanding or distrust among people who are actually aligned in their desire to end homelessness as “Housing First”. To paraphrase a quote from The Princess Bride: “I do not think this phrase means what you think it means.”

Housing First is unfortunately a misnomer - Housing First as an approach includes both housing and wraparound services. And the approach has been shown to work - if it is done right, and if it is sustained. The problem is that the model is rarely “done right” in Multnomah County. It requires matching of individuals to the services they need, and it is very resource intensive. Housing First absolutely has a role to play in the continuum of homelessness to housing for a small sector of the homeless population. However, it is still only a piece of the puzzle. I’ve personally done the research and outlined some key misconceptions and clarifications, which I will share on my County website. 
 

  • By Name List: Built For Zero is a proven approach to ending homelessness. It relies on a By Name List that identifies all people living outside, along with their needs, so that investments can be made intentionally and effectively. The goal is to get the known number of people living outside down to zero in a specified period of time. After years of delay I am pleased that the County finally adopted the model. However, their claims that they have a robust “By Name List” are not accurate.

 
The County uses its Homeless Management Information System (HMIS) as its list, and the Point In Time Count (PITC) to roughly estimate how many people are homeless. But HMIS only identifies people already using County services, so it leaves out the thousands of people living unsheltered who are not already in the system. And the PITC only reaches a limited number of people in known geographic locations. These are fundamental and fatal flaws. The people missing from our current counts are those who are often the most vulnerable and in need of deep services, and there are hundreds to thousands of them.
 
I have proposed establishing assertive outreach teams to create a true By Name List that includes all of the people living unsheltered in our community. Because if we do not understand the scale and scope of the problem we are trying to solve, we will never reach a solution.

We need a PLAN: As the City and County focus on one-offs, fail to coordinate, and spend unfathomable amounts of money without an overarching plan, our homeless services system is crumbling around us. People continue to live in squalor and die on our streets. We need a shared vision and a comprehensive plan to move us forward. Here is my proposal:
 
A way forward: As the City and County focus on one-offs, fail to coordinate, and spend unfathomable amounts of money without an overarching plan, our homeless services system is crumbling around us. People continue to live in squalor and die on our streets. We need a shared vision and a comprehensive plan to move us forward.
 
Here is my proposal:

third



This graphic generated some attention when the County Chair shockingly refused to allow me to display it during a recent Board meeting. Since then, many people have requested access, voiced support, and asked for a detailed presentation. I will be hosting a dedicated Town Hall on this topic before the end of the year, so please stay tuned for details!
 
“Behavioral Health” (aka “Mental Health and Addictions”):
 
I’ve written to you many times about the failure of our behavioral health system. Numerous audits and media reports have confirmed that we do not actually have a system of behavioral health care in our County or our state. The Mental Health Systems Analysis I sponsored a few years back revealed profound gaps at the local level and made over 60 recommendations for filling them.
 
I worked with Ebony Clarke (now Director of Behavioral Health at the Oregon Health Authority), along with a small team of local and state behavioral health leaders, to prioritize and operationalize the recommendations. Through a process called Analyze, Align and Act, we identified multiple areas of need that we consolidated into eight broad goals:

 

Need

Goal

  1. A Shared Vision for what a functional BH system should be

Create a shared vision for our BH system anchored in equity and serving as the foundation for consistent, reciprocal, dynamic communication among system leaders and the communities they serve. 

  1. BH-specific housing and shelter

Create a coordinated and holistic continuum of permanent and temporary housing that is tailored to meet individual needs and promote treatment, recovery and wellbeing.

  1. Effective and coordinated data sharing and analytics

Create a system for sharing data within and across systems and sectors that supports the shared vision for BH. This must include integration of information-sharing platforms, meaningful outcomes measures, and effective analytic strategies.

  1. Trauma-informed, culturally appropriate workforce at all levels with effective pipeline to build and sustain that workforce

Create pathways and incentives for addressing workforce shortages, with a focus on peer-related services.

  1. A holistic and accessible continuum of services meeting people’s actual needs

Ensure a full and effective continuum of services from prevention through treatment and recovery that are trauma-informed and  culturally and linguistically relevant.

  1. Coordination across systems and sectors

Create mechanisms to effectively coordinate across systems and sectors that impact or are impacted by BH, including but not limited to public safety, public health, community justice, education, housing, and  physician health.

  1. Address complex and co-occurring needs

Create an evidence-based continuum of services and supports for people with complex needs, including but not limited to co-occurring mental health and addictions issues, intellectual and/or development disabilities, dementia, brain injuries, and other chronic health conditions.

  1. Parity

Enforce equity between behavioral and physical health,and between Medicaid, Medicare and commercial insurance.


The groundwork has been laid; now we need to put the goals together to create a plan with a meaningful continuum of care. I’m working on this.
 
Meanwhile, we are in a full-fledged behavioral health crisis and should be acting like it.
Focusing on the addiction and overdose crisis, there are urgent actions we can and should be taking, with investments that will move the dial, decompress our systems, and make a visible difference in our communities. Here are my top three recommendations that I’ve shared publicly and with the Chair and my fellow Commissioners:
 

  • Declare the fentanyl crisis a public health emergency. People are dying from fentanyl on our streets – and in our schools and in our homes. Multnomah County has had no plan, no convening of partners outside the County, and no dedicated approach. We use the words “fentanyl crisis” and “fentanyl emergency”, but as an ER doctor I’ve never seen an emergency treated with less urgency or action. It’s time we did something meaningful about the crisis.

 

  • Develop a plan for a sobering facility. I have background and expertise in this work both from a policy standpoint and working on the front line as an emergency physician. A few weeks ago I attended the National Sobering Collaborative’s Sobering Summit in Washington, DC, which brought together people from around the country who had created or were in the process of creating sobering centers. I am excited to bring what I learned to Multnomah County. You will be hearing a lot more about this in the coming weeks and months, and I’m excited to partner with Commissioner Brim-Edwards on this crucial work.

 

  • Develop a robust array of recovery-based housing to meet the need for thousands of individuals currently cycling through the revolving door of ERs, jails and streets. I have proposed investing in the Crowne Plaza Hotel as a recovery-based housing campus with on site job training. This should be a no-brainer if we are serious about getting a handle on our addiction crisis. (Note: I recently received an in-depth report by an engineering and architectural firm that worked with city planners, showing that NO significant seismic upgrades would be required to convert the Crowne Plaza to recovery-based housing).

 
There are also great projects that are ready to go in East and Northwest Portland. With the hundreds of millions of dollars the County has sprinkled over multiple ill-defined programs and proposals over the past year, we could have been well on our way to achieving a true Recovery-based continuum of care throughout our County. But there’s still hope. I will continue to work with partners to hone these ideas, especially as we anticipate another $50 million in “unanticipated” SHS revenue to be available to the County this month.
 
The County as Local Mental Health Authority: Finally, I feel compelled to share that I have major concerns about the County’s ability to serve as the Local Mental Health Authority (LMHA) right now. My concerns stem from leadership challenges compounded by misunderstanding of some basic concepts relating to behavioral health and poor data strategy and lack of systems coordination. There is more to come on this subject, so don’t be surprised if you hear me elevating these issues over the coming months.
 
Health in general:
 
Overseeing the health of our community is one of the County’s primary responsibilities but right now we have a shell of a Health Department. The implications on the Behavioral Health Division have been profound, but the dysfunction runs broader and deeper than just a single division. Here are a few examples:
 

  • Corrections Health: Mass resignations, including nurses and a psychiatrist, due to reported lack of a safe practice environment, with deaths in jail at unprecedented levels.

 

  • Public Health: Despite references to the fentanyl crisis, there has been no acknowledgement of fentanyl overdose and death as a public health emergency. I am sad to say that I am not sure what is actually happening in the Public Health Division right now. 

 

  • Emergency Medical Systems: We could and should have increased the number of ambulances on our streets for months, but instead have perpetuated an outdated system that only serves to delay critical care.

 
There has been shocking turnover at the highest levels (seven Health Department directors, five Behavioral Health directors, five Public Health Directors, five Integrated Clinical Services directors). It has taken almost a year to fill the permanent Health Department Director position, and the permanent Behavioral Health Director position remains unfilled - even as Behavioral Health is one of the most critical needs in our community.
 
These are red flags that should be raising alarm bells for anyone who is paying attention. Yet the turnover and vacancies are barely acknowledged, and when they are, they are reported as one-offs rather than a collective pattern of dysfunction. I am pushing for a root cause evaluation and drastic change management. Because this is not normal, even in the unprecedented times we have recently experienced.
 
In closing…
 
As you can see, there’s been a lot going on. One final important piece of news: There have been some changes to my team. Cynthia Castro, my wonderful former Chief of Staff, has gone back to the City of Portland, which is her passion. She is now working in Commissioner Mapps’ office. My new Chief of Staff, Adam Lyons, ironically has transitioned from Portland City Commissioner Mapps’ office. I am very excited to have Adam on my team, as he brings a wealth of experience in the areas of homelessness and behavioral health, as well as deep understanding of the City. 

Please continue to reach out to me with your thoughts, ideas, comments, and concerns. I love hearing from you.
 

In Good Health, 

Sharon Meieran
Multnomah County District 1 Commissioner

Commissioner Sharon Meieran Newsletter - Budget Passage Reflections 2023

Dear Friends,

Earlier today the Multnomah County Board voted on the County’s FY 2024 Budget, and I was the lone “no” vote. A commissioner has not voted against budget adoption in recent memory - at least since I started on the Board seven years ago. And I did not make the decision lightly.  I wanted to share my Talking Points with you because they express how and why I voted as I did. You can also watch all of the Commissioners’ comments here. As always, I welcome your thoughts, questions and feedback. I hope you are well, and I look forward to resuming regular Newsletters in the coming weeks. 

In good health,

Sharon

 

Sharon Meieran Talking Points - FY 2024 Budget Adoption

I am proud of all the budget amendments that I brought forward, even those that did not make it into the final budget such as: (1) creating an effective strategy to count and understand how many people actually live unsheltered in our County so we can begin to invest hundreds of millions of dollars in homeless services in a way that is strategic and effective; (2) supporting facilities such as Bybee Lakes that fill gaps in our community by providing a sober living environment and services for people needing shelter or transitional housing; and (3) my continued effort to not only report on the number of people dying outside, but actually intervene to prevent those deaths. It continues to disturb me that even as death counts soar, we do not take meaningful action to do something about it.

I am incredibly proud of my budget amendment that will support my plan for building out a coordinated network of microvillages across the County. These community-led tiny community sites are cheaper to build, cheaper to operate, faster to erect, and are places where people living outside want to live. They reduce harm to people living outside and the surrounding neighborhoods, provide much needed shelter and hygiene facilities for people experiencing homelessness, will better connect them to services and get them on a pathway to housing, and foster community. 

This has been years in the making - I only wish it was adopted when I first introduced it several years ago - but some stalwart community leaders have made things happen despite tremendous obstacles. I want to thank the team of visionaries and doers who met with me for months to help me put forward this plan. Special thank you to Andy Olshin, Jan McManus, Sermin Yesilada, Darlene Garrett, Caleb Coder, Zora Hess, Becky Wilkinson, Tim McCormick, and Cara Rothe. You are all on the frontlines supporting our most vulnerable community members and are so appreciated.

I was happy to co-sponsor the budget amendment to restore funding for the New Day Collaborative with Commissioner Jayapal. New Day provides trauma-informed and culturally responsive services for youth survivors of sex trafficking. This money actually goes to serving truly the most vulnerable members of our community, and puts them on a different path. This work represents all elements of the County’s mission, vision and values, and makes a difference in real lives, addressing intergenerational cycles of poverty and abuse.

I also secured funding to expand benefits acquisition services to help people who are homeless and have severe disabling conditions access the benefits they are entitled to but often don’t even know they exist, let alone are able to pursue them. These benefits translate into housing, income, and healthcare. This small investment will have an outsized impact as it frees up County resources that can be spent on other essential services. 

I am very excited about the Center for Tribal Nations which will be located in my district near OMSI. Thank you Commissioner Jayapal for introducing this budget amendment and co-sponsoring it with me. The center will restore the Native community’s presence along the Willamette River and be a Native-owned and Native-led gathering place for Indigenous peoples in the Pacific Northwest. Thank you to Anna Allen, our new Tribal Affairs Advisor, and James Parker from the Oregon Native American Chamber.

The Sheriff’s Office River Patrol Unit plays an important role in ensuring our waterways along the Columbia River, Willamette River, Sandy River and Multnomah Channel are safe for commerce and recreation. Thank you Commissioner Stegmann for introducing this budget amendment and co-sponsoring it with me. We heard concerns from many residents, non-profit organizations, and jurisdictional partners about the potential loss of River Patrol deputies at a time when our waterways have faced increasingly complex challenges.

At the same time, I’ve had frustrations that I’ve expressed throughout the process this year and in previous years. I’ve grappled with whether I am going to support this budget, until last night, because there are some great individual programs in it. In this and all things, there is always pressure to go along to get along. 

But I simply can’t do that in good conscience when year after year we succeed in spending record amounts of money, but fail to make a plan or measure meaningful progress toward solving the problems we face. I wish I had done this in earlier budgets, but that is not an excuse for not doing the right thing now.

Many people are just starting to understand what the County does and what a central role we play in addressing our most pressing issues - skyrocketing fentanyl and meth use and overdoses, homelessness, mental health, public safety. We have a $3.5 billion budget, with more than $250 million spent on homeless services alone. And things get worse. We need to be more transparent about our spending and be held accountable, but this budget process makes that very challenging for the public, and for us as stewards of public money and trust.

For those who are not aware, the budget is prepared by the Chair in consultation with department heads. It’s basically a bunch of individual programs - hundreds of them -  bound together in a huge booklike document.  Each program has a vague description, often recycled from the previous year, an amount of money assigned to it, often seemingly arbitrary, and a listing of a couple of “outcomes” - that aren’t. Nothing tells us what we’re buying for the money, or how the individual programs fit together or build toward a larger vision.

A couple of weeks before adoption, commissioners receive this giant pile of programs, are informed of how much money is available to us that is essentially “left over”, and then we divide those crumbs equally to try to get our programs funded. If we want to advocate for more programs, we have to find that money somewhere else in the budget and take it away from something that already exists. This is not conducive to collaboration or furtherance of a vision, but perpetuates the status quo.

In terms of public engagement, our public budget hearings generally occur after the budget is essentially baked. And no member of the general public could actually understand the budget as it exists.  

I have expressed my deep concerns about BHECN, or Behavioral Health Emergency Coordination Network, budget request and I know these concerns are shared by others who are on the front line doing the work, and experts and leaders in behavioral health. They are also shared by public safety partners, who are no longer effectively at the table. I am sorry my concerns weren’t heeded, and that I was prevented from participating in the process. We have been left with a whole bunch of words that sound good and check a bunch of boxes, and yet there is literally no there there. I’d love to be wrong, but I anticipate that BHECN will be the SHS underspend of behavioral health.

We need an actual plan that defines our objectives, makes priorities, and measures outcomes over time. The community depends on us to use taxpayer dollars wisely to help the most people. That’s literally our job. Yet we can’t manage to get $44 million SHS dollars out the door when people are suffering. We underspend other SHS funds by $25 million more yet say we don’t have enough money. We can’t follow the money and know whether what we’re doing works. 

Rather than trying to get things funded that sound good, we need to fund plans, strategies and systems that will actually do good.

Will this budget accomplish some good for some people? 

Absolutely.

Will it make any difference whatsoever in our crises?

I hope so, but I doubt it.

We have the money. We have tons of money. We literally couldn’t spend it all. What we lack is a plan and a system that actually accounts for where our money is going, along with outcomes. 

When those things are in place - which I hope is next year both because the need is so desperate AND it’s my last year on the Board - I will gladly vote yes. I know that addressing the shortcomings of the budget process are a priority for this Board. 

I can hear the voices of so many saying “Be practical.  Be patient.” And then I go home to a roof over my head. I see my patients in the ER. I see the people I have provided care to directly on our streets. I see them and I can’t forget them. And I see this budget, and I cannot accept it. 

We think the problem is we can’t spend money fast enough, so we lower the standards by which we talk about outcomes.  We have dug a massive budget hole and now we are asked to dig faster with no sense of when to stop. 

As I mentioned, I wish I had voted no on a budget sooner. I kept believing that things would change if only I was patient. But I can’t do it any more. 

I know that my dissenting vote will not change the outcome for this budget. I appreciate the many hours of work County staff have put into crafting this budget, for the hundreds of community members who have given their input, and for the many community organizations that have been involved as well. But, approving this process is not something that I can do in good conscience. I am a no vote.

 

As always, I appreciate your feedback, thoughts and questions. Please do not hesitate to reach out! 

 

In good health,

Sharon  

Commissioner Sharon Meieran Newsletter - February 2023

Dear Friends and Neighbors,

As I write this newsletter - on the verge of spring - we are emerging from some record-breaking cold weather. During that time, Multnomah County officially reported that two people were suspected to have died from hypothermia and I anticipate that more deaths will be attributed to hypothermia over the coming days, weeks and months. I am deeply grateful to the numerous volunteers and first responders who showed up to help the most vulnerable in our community during the record snowfall and low temperatures. 

Given that my remaining time as a Commissioner is finite (less than 22 months) I am going to try a new approach to my newsletters, focusing on my highest priority issues - homelessness and behavioral health. Each month I will describe specific projects I am working on and let you know where there are opportunities for you to learn more, lean in, or advocate. I will start here with a general overview around homelessness, because too often the big picture is overlooked as tiny fragments of solutions suck all the air out of the larger and much more important conversation.

Homelessness

  1. Three Pillars

The big picture is actually not that difficult to conceptualize. There are essentially three pillars to any overarching approach to homelessness: Prevention, Shelter, and Housing. 

  1. Prevention

The most effective approach to addressing homelessness is to prevent it from happening in the first place. No matter what one considers the gold standard of “effectiveness,”- cost savings, prevention of suffering, mitigation of future intergenerational harm - an ounce of prevention is worth a pound of cure. 

  1. Shelter

If people are not prevented from becoming homeless, they will need some form of shelter and safety while they get connected to services and, ideally, transition into permanent housing. To be clear - The tragedy of unsheltered homelessness will never be solved by one type of shelter or forcing people to move without meaningful options. But it can be solved with a plan for a rapidly deployed effective, holistic and coordinated shelter ecosystem that fits into the larger picture. 

  1. Public health Intervention

Unsheltered homelessness is not just a housing problem, it is a public health crisis and we need to frame it in that way and act accordingly. People are dying in increasing numbers on our streets and, unconscionably, this has been tolerated for years. Fentanyl overdose deaths have increased 600% over two years. Almost half of gun-related murders are related to homelessness. The vast majority of pedestrians struck by motor vehicles in Portland have been homeless. People living outside suffer from conditions such as frostbite and endocarditis and die from hypothermia, which we have tragically witnessed just recently. 

  1. Pathway to long-term housing 

Currently, people living unsheltered are served by a largely uncoordinated group of service providers, ranging from outreach to crisis intervention to case management to camp cleanup to navigation. Individual outreach workers often do heroic work in the most difficult of circumstances. However, the way things currently stand, individual successes happen despite our systems, not facilitated by them. A coordinated ecosystem of shelters, coupled with a coordinated system of outreach, will improve people’s health and save lives, while streamlining unhoused people’s ability to move into available housing as efficiently as possible. 

  1. Permanent Housing

I often hear the phrase “the solution to homelessness is housing.” However, the real solution to homelessness requires more than housing. Solving homelessness requires a system of support that prevents people from becoming homeless whenever possible, keeps them healthy and safe if they do become homeless, transitions them effectively into housing, and gets them the housing they need with the supports that will sustain that housing. 

A number of strategies have been shown to effectively address each of the pillars of a holistic housing and homelessness solution. But we need a foundation of coordinated systems on which to build the pillars, information and strategies to fortify them, and a roof to hold them together. 

 

Graphic representing Homelessness to Housing Continuum

In addition to understanding the big picture, we need to know how people flow through our system. We need an accurate map of our current state, a vision of our future state, and identification of the information, processes and systems that will get us there. I’ve been working on a graphic to put this together because I needed a way to visualize our system but couldn’t find a decent schematic. I will walk you through my graphic, below, so that it hopefully makes sense: 

Key features:

  1. Orange rectangles represent the stepwise approach most people need to go from living unsheltered to becoming permanently housed.
  2. Large yellow ovals outline coordination needed - outreach and shelter. 

Additional features:

  1. Blue rectangles represent sources of inflow into homelessness.
  2. Beige circles and ovals represent aspects of the system that exist, though without good data.   
  3. Bright yellow represents pieces of the puzzle that are necessary but do not currently exist, including infrastructure such as shelter types, and data as described in the yellow boxes or in yellow font. 
  4. Orange arrows represent ways people can move from homelessness into housing, acknowledging that some people can go straight from unsheltered homelessness to housing and others can’t, but all need a clear, coordinated and streamlined path.

[Click here to view the Mailchimp version of the newsletter and view the graphic]

This is a work in progress, so please feel free to share your thoughts! And note that my inclusions are not exhaustive. This is a basic representation. 

Specific Projects

Areas I am actively working on and will provide updates about over the next months include:

  1. Data

The yellow boxes on my Graphic outline some of the data I believe we need to collect, manage, share and use effectively. For example, for Shelter, we need information about (1) the number of people living unsheltered, who they are, where they live, and what they need; (2) the outreach services system, including the services provided, how they’re coordinated, and the myriad organizations contracted to provide the services; and (3) the shelter ecosystem, including types of shelter, cost per bed, where they are located, and how they’re coordinated.

I continue to work with Chair Vega Pederson and others on her Data Systems Task Force. I am energized by the conversations we have had, though I am disheartened that some of the most basic systems that should have been in place aren’t. We are working on some “Key Performance Indicators” to highlight in a new public facing dashboard. I will be considering these with the rest of the group, and will be pushing for approaches such as Built For Zero and the needs outlined in my Graphic.

  1. Shelter Ecosystem, Public Health and Pathway to Housing

I am very excited to be working with a small group of people to create a viable and actionable plan to establish a network of microhamlets (groupings of 10-15 structures on tiny pieces of land) that can be replicated and dispersed throughout the County and meet a variety of needs. More on this in my next Newsletter!     

  1. Domicile Unknown

On February 15th, Multnomah County released its 2021 Domicile Unknown report. This report tells us the number of people who died living outside in Multnomah County, the causes of death, and something about the individuals’ lives. In 2021 193 fellow human beings were confirmed to have died in Multnomah County while living unsheltered and we know that’s just the tip of the iceberg. Every year memorials are held, there are press releases, elected officials lament the tragedy, and then we move on without any further action. It is an unconscionable cycle that I have called out since starting at the County in 2017 (when there were 79 deaths reported).  

The former Multnomah County Chair did not prioritize addressing this public health crisis, but with a new Chair and Board I am hopeful we will act to stop the increasing spiral of death and suffering. At our Board meeting on February 16th, I issued a challenge to my colleagues - that we implement policies so that next year the number of deaths has not increased. It sickens me that we are aiming so low - that our goal is for deaths not to increase, rather than actually lessening the number of people dying on our streets. But staying level would be a huge improvement.

  1. Command Center 

As part of her executive order declaring a homelessness state of emergency, Governor Kotek directed the establishment of Multi-Agency Coordinating groups (MAC groups), including one for Multnomah County. MAC groups should include representatives from local jurisdictions, public housing authorities, local homelessness agencies, landlord associations and behavioral health providers among others. They will be responsible for day-to-day operations focused on helping people experiencing unsheltered homelessness in a given geographic area connect to services and be placed into housing. The MAC groups will follow a similar approach as the Command Center model adopted in Seattle which I have been advocating for and am happy to see finally being pursued. Chair Vega Pederson and her team are currently working to assemble the MAC group and will direct them to implement her Housing Multnomah Now proposal that the Board will vote on resourcing on March 16th.

---

There is so much work to be done to better support people in our community who are experiencing homelessness and to improve our behavioral health services. But I believe that by understanding the big picture and advocating for projects that move our systems forward with transparency and accountability, we can move the dial. As always, please reach out to me with your ideas, questions or concerns. And in particular, I ‘d like to hear feedback on the updated Newsletter format and on the graphic I’ve shared!

In good health,

Sharon Meieran

Commissioner Sharon Meieran Newsletter - January 2023

Dear Friends,

 

I hope the new year has started out well for you! In this newsletter I will focus on transitions and provide a brief overview of what I will be working on over the coming months. All of this will be fleshed out in future newsletters and you can find more information on my website. 

 

Committee Assignments

Although County Commissioners do not oversee specific departments, there are a number of committee liaison positions that are assigned to us by the Chair. I have been appointed to the following committees, some of which are ongoing assignments, some of which are new:

  • Aging Services Advisory Council (ASAC): ASAC members advocate for system level changes, provide advice to ADVSD regarding policies and programs, and connect with the broader community to understand the issues and priorities of older adults. Aging services intersect with many issues that have been priorities for me, including homelessness and behavioral health and  I am very excited to continue serving as Board Liaison to ASAC. 
  • Disability Services Advisory Council (DSAC): DSAC advises our Disability Services Offices on basic policy guidelines that impact the people served by ADVSD, evaluate the effectiveness of our services, advocate for issues that are pertinent to the life and welfare of people with disabilities, and educate the general public of the issues and concerns facing all people with disabilities living in Multnomah County.  Many people experience disabilities, both visible and invisible, and are too often overlooked. I look forward to continuing working alongside the dedicated volunteers and staff of DSAC. 
  • Domestic Violence Fatality Review Team: The establishment of a regional Domestic Violence Fatality Review Team is established by statute. Its mission is to improve coordination among various agencies and organizations responsible for handling cases of domestic violence. Members of the team include professionals from local law enforcement, criminal justice, health, human services, and domestic violence agencies and organizations. Each year the team reviews one to three criminal cases in Multnomah County involving a death caused by domestic violence. These reviews are intended to improve our strategies to prevent these tragedies in the future. 
  • Gateway Center for Domestic Violence Services:  Survivors are often forced to live in unsafe environments, as they do not have access to housing and support services. The Gateway Center for Domestic Violence Services offers a safe place for survivors to access emergency shelter, food and rental assistance, legal, financial and/or spiritual counseling, and securing a restraining order. 
  • Metro Policy Advisory Committee (MPAC): MPAC is a new assignment for me, but the committee’s policy areas are especially relevant for District 1. These policy areas include: regional transportation; management of the urban growth boundary, protection of lands outside the urban growth boundary for natural resources, and future urban zoning; planning responsibilities required by state law; and other growth management and land use planning.
  • Regional Arts & Culture Council (RACC): RACC is an independent non-profit organization that supports the creative economy in Portland by providing opportunities and resources to artists and arts organizations.  I am meeting with RACC leadership soon and am eager to learn more about their organization and priorities. I’ve advocated for the incorporation of art therapy to support people with behavioral health challenges, including at the County’s Behavioral Health Resource Center, and this yet again points to intersectionality of all the work that we do. 
  • Our Creative Future Committee:  I join work already underway to engage the community in a cultural planning process to set the vision for the next generation of arts and culture in our region. Multnomah County is one of the governmental partners leading this effort along with the City of Portland Arts Program, Clackamas and Washington counties, the cities of Hillsboro and Beaverton, Metro, and RACC. I am very excited to be part of this visioning process that elevates the talent, creativity and culture of our region.
  • Veterans Task Force: The Veterans Task Force (VTF) was established in 2010 by Commissioner Diane McKeel to assess and identify the services provided to military veterans in the County. The VTF includes representatives from different County departments, community organizations, and other state and federal partners. I am thrilled to continue serving as the Board liaison to the VTF!  Earlier this year, my office collaborated with the task force and other Veteran-serving agencies and advocates to bring back Portland’s Veterans Day Parade. The event was a success and we are already planning for next year. My office also sponsored the Board’s 2022 Veterans Day Proclamation. We will continue to explore opportunities to support and advocate for Veterans. A huge “Thank You!” to Tabitha from my office for doing a phenomenal job leading this work. 
  • Westside Multimodal Committee (WMC): The Oregon Department of Transportation (ODOT) and Metro are conducting a study of how people travel in and through the westside corridor now and what is expected over the next 20 years. The two agencies have convened the WMC to discuss the current challenges people face with travel in this area and develop recommendations for solutions.    
 

Policy Priorities

No surprises here! My policy priorities continue to include homelessness, behavioral health, systems coordination and accountability. Below are specific projects in these areas that I am leading, tracking, and/or supporting: 

Homelessness

  • Data and information sharing: Accurate data collection and management is essential for any organization to understand what it is accomplishing and how it can improve. Currently, the County does not have an effective system of data collection, monitoring or management, nor a system that can be engaged by other users - the public, provider organizations, or other government agencies. For years I have advocated for a mapping of what information systems are currently in play, how they intersect, and recommendations for a functioning system that puts all the disparate pieces together. Unfortunately, this was not prioritized by the former County Chair, but I was able to sponsor a Budget Note last year requiring a briefing on our data systems. That briefing finally occurred today (you can check out the recording here) and during the briefing, Chair Vega Pederson announced a new Data Systems Task Force that will work on a 45 day timeline to develop some key recommendations for the Joint Office of Homeless Services (JOHS). I am grateful that the Chair invited me to partner with her in this work, and that she has elevated how foundational meaningful data is to our transparency, accountability and functioning as an organization. I look forward to sharing more in a future Newsletter! 
  • Mayor’s Proposal to Address Homelessness: I recently met with staff from Mayor Wheeler’s office to learn more about the housing resolutions proposed by the Mayor and Commissioner Ryan. From what I had initially understood about the Proposal it had seemed that there was a lot of misinformation circulating, and I wanted to hear the specifics directly from the source. From what I learned, it seems that the resolutions propose a number of actions that make sense and that I have been calling for, including expansion of the continuum of shelter and housing options and better coordination with partners in general, particularly the County and behavioral health services. Strengthening the County’s relationship with the City, especially related to housing and homelessness, continues to be a priority for me.
  • Built for Zero: I will continue to advocate for Built for Zero, part of a continuous systems improvement framework that is based on combining quality data and case management to house people experiencing chronic homelessness. A major component of Built For Zero is understanding a baseline of who people are, where they are living, how many people are living outside, what they need, and what their barriers to housing have been. Using this information, we can use our finite resources to build what is needed to meet actual needs. The JOHS has indicated that it has started on this process, and I will continue to push for transparency and accountability as they seek to refine the specifics of data collection and outreach strategies.
  • Microvillage Collaborative: I have long championed the development of a coordinated network of microvillages in our community to provide shelter that is safer and healthier than where people are living outside now. I view this as a core component of an ecosystem of shelter options that meets a variety of needs. As I have pushed for the County Board to allocate resources to this model in past budgets, I have also met with a range of neighbors, houseless individuals, homeless advocates, private landowners and faith institutions who are interested in bringing this vision to reality. Now that we have proven successes through projects I supported for years, like Beacon Village and the Parkrose Village established by WeShinePDX, I see a clear path forward. I am working with a group of dedicated individuals who have successfully done this work in our community to prepare a plan of action that will enable us to develop multiple sites in a finite period of time, and I look forward to sharing this with you very soon. 
 

Behavioral Health

  • Behavioral Health Emergency Coordination Network (BHECN): BHECN is a collaborative partnership of City, County, and community stakeholders focused on increasing the number of sobering beds throughout the County, coordinating crisis continuum response by working with public safety and emergency service partners. I was an early champion of BHECN at the County and served on the BHECN Executive Committee. I am committed to the success of BHECN and will stay engaged in the project.  
  • Behavioral Health Resource Center (BHRC): The BHRC, which opened in December 2022, is a facility that is designed to meet the needs of people with  mental health and substance use challenges who live outside. It is intended to offer space for respite and connection with resources through its Day Center, which is currently operational, and short term shelter and transitional housing that are expected to come online in Spring 2023. While I celebrate this new resource, I am also very concerned by reports I am hearing from community members and staff about health, safety, and operational issues. Many of these issues were raised in advance with the former County Chair but were not acted on. Chair Vega Pederson is working on addressing the needs of those using the facility and individuals and businesses located around the BHRC. There is a lot of work to be done and I will continue to engage with these constituents and advocate for a facility that is secure and healthy for the entire community. 
  • Mental Health Systems Transformation: I convened state and local mental health leaders, advocates and peers to create a Blueprint for Better Behavioral Health to move our dysfunctional and often destructive “system” of mental health care toward a holistic, preventive and proactive model that ensures people have access to the right services in the right place at the right time. The work was based on the findings of the Deep Systems Analysis I sponsored in 2018. Some of the recommendations from the Blueprint have been implemented at the County, but a lot of the work was put on hold as it was not prioritized by prior leadership at the County, and there was unprecedented turnover in leadership at the County Health Department, particularly in Behavioral Health. 
 

Systems Improvement

  • FUSE: Frequent User Systems Engagement (FUSE) is a methodology focused on creating supportive housing solutions for individuals who frequently cycle through multiple crisis systems - homelessness, healthcare, and criminal justice. If these individuals can be identified and connected with, then there can be an intensive focus on their specific needs to get them into housing that can then be sustained. I sponsored an initial FUSE analysis at the County, which revealed some shocking findings, and there is finally a pilot project being developed to apply the findings to a small cohort of individuals who meet FUSE criteria and make dedicated and concerted efforts to get them the housing and supports they need. 
  • County Contracting and Accountability: Last year I sponsored the hiring of an outside contractor to evaluate how the County contracts with partner organizations. It has been my experience that there is little visibility into how the County contracts with the organizations it works with to provide services in the community. In particular, it is not clear how the County globally determines whether contract goals are being met - i.e., are we getting what we pay for? The evaluation is well underway, and I look forward to the findings and recommendations made to the Board. Of note, the County Auditor recently released her audit schedule for the year, and I was glad to see County Contracts being called out as one of the subjects she will be addressing. 

Farewells to Ebony Clarke & Dr. Jennifer Vines

Health Department Director Ebony Clarke has been with the County for twelve years. When I first met her, she was the Deputy Director of the Mental Health and Addictions Services Division of the County Health Department. During the past few years of unprecedented turnover in Health Department leadership, I’ve watched Ebony ascend to the role of Health Department Director. And through all of the transitions, over years of service and challenges she could never have anticipated, Ebony has been a voice of reason, vision, compassion and leadership. It is no wonder that the State tapped her to be the next Behavioral Health Director for the Oregon Health Authority (OHA), a role she starts next month. Though this will be a huge loss for the County, it will be an incredible opportunity for Ebony to lead the State’s behavioral health work at such a critical moment in time. I look forward to having a true partner and leader heading this work at the OHA. Valdez Bravo, currently the County’s Deputy Health Department Director, will serve as Interim Director while the County conducts a nationwide search to fill the position.  

Another rock star that the County is losing is Public Health Officer Dr. Jennifer Vines. Dr. Vines was an exceptional leader long before the onset of the COVID pandemic, but during the past three years of challenge and uncertainty, Dr. Vines has been a beacon in the storm - the public face of reassurance, reason and information not only for Multnomah County but for the state. Dr. Vines has accepted a Health Officer position in British Columbia. 

As a physician-commissioner, I have had a deep connection to the Health Department at the County, and have worked closely with Ebony and Dr. Vines. Their loss will be felt throughout the County, but I know they will change the landscape of healthcare in their new roles. I wish them all the best!

Conclusion

In closing, I’d like to wish you a mindful and reflective Black History and Futures Month. I encourage you to research and reflect on the racist history of Oregon and anti-Black systems of oppression that still exist today, and take action to fight injustice and uplift Black and Afro-Indigenous people and organizations. 

I have two years remaining to serve you on the Multnomah County Commission and I plan to make the most of them! I look forward to hearing your priorities, responding to your concerns and answering your questions. Please, as always, stay in touch.

In good health,

Sharon

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