The Portland Street Response program is expanding beyond its trial boundaries in the Lents neighborhood. The program dispatches a firefighter paramedic, a licensed mental health crisis therapist and two community health workers to respond to calls about people experiencing homelessness or mental health crises. Portland State University’s Homelessness Research & Action Collaborative recently evaluated the first six months of the program, and recommended it be expanded citywide. Program manager Robyn Burek and medic Tremaine Clayton join us to talk about how the program has been going, and what the future might hold.
The following transcript was created by a computer and edited by a volunteer.
Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. Back in February, after almost two years of planning, Portland Street Response started up. The program was modeled on one in Eugene where, for decades now, non-police teams could be called in to help people who are dealing with homelessness or behavioral health issues. The Portland version started small: a four-person team only available during business hours on weekdays in the Lents neighborhood. Now we have data from the first six months of that pilot came in a glowing review from researchers at Portland State University.
So, city leaders are talking about expanding the program’s hours and reach. The details of that expansion still need to be figured out. But we wanted to hear directly from members of the initial Street Response team to hear what their work has been like and to get their thoughts on how the program could expand. I’m joined now by Tremaine Clayton, a paramedic and community health assessment team coordinator for Portland Street Response, and Robyn Burek, the program’s manager. It’s good to have both of you on the show.
Robyn Burek: Thank you so much.
Tremaine Clayton: Thank you.
Miller: Robin Berg, first. Can you just remind us the basics of how Portland Street Response works?
Burek: If you wanted to request our services, you would call 911 or the non-emergency line. We respond to calls that are only outside, so right now we’re not going into residences. If you see someone who’s experiencing a mental health concern or crisis, substance use intoxication, or you’re just generally concerned about their welfare, you can call either 911 or the non-emergency line and asked for us to be dispatched. We have a multidisciplinary team. We’ll have Tremaine, who’s our paramedic on the team, along with the mental health crisis worker. And then we have two community health workers who can also provide after care support.
Miller: And it’s the team of all four people that go out on all calls?
Burek: No, that’s a really great question. Only the paramedic and the licensed clinicians. So, Britt, who is a licensed clinical social worker will go out to the scene. When they get out there and they engage with the individual, if it becomes clear that the person would like to get connected to resources and referrals, they’ll actually request a community health worker to come out to the scene and make contact then and begin building that relationship.
Miller: Tremaine, can you give us a sense for the range of calls that you’ve gone out on over the last eight and a half months?
Clayton: Yes. Most of the calls that we have gone out on are usually perceived calls where someone’s either in a mental health crisis or drug affected, and we’re getting phone calls from concerned homeowners and/or business owners when someone is having these moments on their property. So, while we’re not just trying to send somebody along, what we’ll do is try to engage the individual and see what those needs might be. Often times, it is just basic needs like [a] snack [or] water, and just a ‘hey, how’s it going’, and giving that person an opportunity to let us know how their day is, really, and try to problem solve with them. It’s usually in those moments where we can see if there are services that we could provide in terms of those ongoing services. Connecting them to a primary care doctor or other resources like that is where we’ll call our community health workers to come out and help facilitate some of those ongoing needs.
Miller: How do you start these interactions?
Clayton: Usually it just starts with a basic introduction [and] explaining. Like I said, a lot of times these folks don’t know that we’re on our way. People will call for them. So we’ll introduce ourselves and [let] the individual know that we have some services that might be able to help in that moment.
Miller: Do you ever lead by saying, ‘hey, I’m from Portland Street Response. I’m not from the Portland Police Bureau’?
Clayton: It’s not a lead in, but sometimes, given that we do have a vehicle that has Portland Fire and Rescue logos in addition to the Portland Street Response logos, if they’re concerned that we might be with the police and/or just seeing that government presence, if they feel like they’re in trouble, will reassure them that they’re not in trouble, that we are not with the police, and that we just really want to help them with whatever needs they may have.
Miller: Robyn Burek, three quarters of unhoused community members in the Lents neighborhood had never heard of Portland Street Response. That was one of the analyses done by researchers at PSU. What does that tell you, that in the limited area where you’ve been working, the majority of people who you might be called in to help still don’t know who you are yet.
Burek: You know, it’s both surprising and not at the same time. We’ve been working with Street Roots to help canvass some of the camps that are out there to get the word out for us. But I think what that demonstrates is just what a what a big job it is to do community engagement and outreach, and to begin to build the word out there. A lot of our communication and marketing is done through social media and through these platforms that those that are experiencing houselessness may not have access to. So one of the objectives that we have going into this next half of our pilot is to rethink how are we getting the word out and how are we engaging with the population that we’re trying to serve.
Miller: What are some ideas you have for doing that?
Burek: We’ve been partnering with a number of outreach groups, not just Street Roots. We’re partnering with East Portland Collective and PDX Saints, and they are largely based within the Lents community. Right now, we’ve actually started some pop up events. Every Monday, we are joining a number of partner agencies to provide mobile showers, hot meals. Meals on Us is another outreach group that’s been out there. We’re partnering with Providence. On Thursdays, we’re also offering vaccine clinics. Again, the same groups, plus more, are coming out in Lents Park and we’re trying to reach specifically that community. When we have opportunities, we’ve been canvassing some of the area as well. We’ll knock on doors [during] heat events, like this last summer during June we actually went out and they handed out bottles of water to the camps. So we’re doing what we can with a very small team, but we know that we need to definitely increase our efforts there.
Miller: Tremaine, to me, one of the most striking numbers in the PSU analysis based on the first six months of your calls was that in one out of four calls, 25% of them, the client was evaluated in the field and then no further treatment was required. Nothing else really happened after you or your team talked with this person. What might happen in those interactions. And I’m curious what it tells you that one out of four times it’s just your team going out, talking for a bit, and then leaving.
Clayton: Well, first of all, when we’re making contact, like I said, a lot of the phone calls are coming from a third party calling on someone’s behalf. So when we make contact with the person that we’re identifying, what we’re realizing is that they are just needing some assistance with problem solving. The behaviors that we’re seeing that are being exhibited are perceived by someone else as crisis. But for that individual, they may have some coping skills already. So we’re really just trying to connect them with the proper resources.
Miller: Have there been times when you’ve arrived there and you, too, have thought ‘this person is not in a crisis’? In other words, are there times when you agree with the person that you’ve arrived to help out that the caller was mistaken?
Clayton: Yeah, I could see how many of our calls are that - it’s just the perception of crisis. Like I said, really we just are offering some assistance. And so the behaviors they are exhibiting is because the person is limited on resources. So when we assure them that there are some resources, and that we can connect them with their own skill set to those resources, they’re able to then thrive on their own and not needing that further service.
Miller: 90% of the calls that you handled in the first six months are ones that otherwise would have been handled by police. If those had been outside of the Lents neighborhood, it would have been police responding, not Portland Street Response. Tremaine Clayton, how is your response different?
Clayton: I think our response is different in the sense that police officers may not get to these calls, given the nature of these calls, there are likely other high-priority calls that the police would be able to get to. This is just my assumption that police may not have the same amount of time that we do to help an individual process those calls. Whereas if the police officer is trying to help, they may hear another call that requires a police response that’s more appropriate for a police responder. So, that’s really just my assumption of the difference between our services, that we are dedicated to these types of calls whereas police have higher priority calls that they may need to get to.
Miller: Robyn Burek, there’s another number from the PSU analysis that stands out, that the calls that your team responded to in Lents during the pilot’s operating hours led to a 22% reduction in police response to welfare checks and unwanted or suspicious persons calls. As we just heard from Tremaine, it’s not just a question of differences in response if different teams are getting there, but a difference in whether or not team would be there in the first place. But let’s assume that police did respond. What the PSU research told us is that there was a decrease in police responses because you were taking some of these. What do you see as the differences in these two organizations’ response protocols?
Burek: I think, for one, we’re not enforcement. Were a voluntary service. So our reason for being on scene is completely different than police arriving on scene, and that’s such a different tone in different expectation of what we can provide. Additionally, I think one of the key things that stands apart between our service and police is the work that the community health workers do. So, being able to have additional resources, you can do that follow up care. First responders, traditionally, they go in and they go out. It’s a one- time contact. We’re reinventing that a bit, and we’re saying it can be a one-time contact, but it can also include follow up if there’s need to be. So we’re looking at how do we actually change the response as a first responder and get upstream so that we can divert these calls from even being placed to 911 at the very at the very end of all of this, when it’s all said and done.
Miller: How does the voluntary aspect of this work in practice? I mean, Tremaine, do you ever arrive and someone says ‘I don’t have to and I don’t want to talk to you, so leave me alone’?
Clayton: Yes, actually we get that quite a bit. Especially for certain individuals, it takes a couple of interactions. So, people initially will see us and they’re just not trusting, and they tell us to go away. But then when their behavior doesn’t change and more people call, we share that information. It’s just we’re concerned about this behavior, and if you really don’t want us to come back we need to problem solve with this behavior to try to understand what’s going on. There’s one individual where it took multiple conversations and contacts, but our last interaction with them, they sat down with Britt and told Britt that they respected her like she was their sister, and it was really having this great contact. But that took probably four or five contacts before we got to that point.
Miller: Tremaine, I’m curious, what do you wish you had known at the beginning of this pilot that you’ve learned in the first eight and a half months?
Clayton: Really, I think it’s not something I wish I had known, I’d known it in the past, is that we do have services that are limited here in Portland in terms of where we can take folks. So the great thing about our program is the ability to meet and treat needs in the field, because sometimes these individuals don’t need to go to the hospital, that’s for sure, when we can take care of those needs. But just having another place for respite to go to, I wish that we could have had these respite centers in place prior to the launch so we would have a place to take individuals when they were ready to be connected to those services.
Miller: Robyn Burek, let’s switch to the field going forward. Right now, as you noted, you can’t respond inside residences. You also can’t respond to calls where there are concerns about the possibility of suicide. The U.S. Department of Justice, which has a settlement agreement with the city, said that there’s nothing in the settlement that would prohibit Portland Street Response from going out on suicide calls. In fact, they said it’s just the opposite. But this is an issue that’s up for collective bargaining with the Portland Police Association, the rank and file union. What’s your argument for why the types of calls that you can respond to should be expanded?
Burek: It’s really interesting. When we started designing this program and we were meeting with the Bureau of Emergency Communications, BOEC, 911 call intakers, we had always planned throughout the pilot that we would be expanding the criteria into residences. We didn’t start there initially because we didn’t want to throw a brand new team into the deeper end of the pool. We wanted to take our time and phase it out as we learned and grew into this role. I wish that we had been more explicit about that in our conversations with the unions at the start of all of this, and that we had put that in writing. You would probably be in a different place than we are right now. But that’s a lesson learned and we’re moving forward. So, this is exactly what the CAHOOTS model is, right? In the CAHOOTS model, they responded to the residence, they go in to address suicide calls. So, this is just a natural progression of where this model would be going.
Miller: I didn’t know the name of the Eugene program this is based on that you just noted. It’s called CAHOOTS. So, you’re saying this was always a plan, even if it hadn’t been explicitly codified or discussed with the police union. But what’s the reason that you see that it should be expanded like this?
Burek: Well, mental health and substance use doesn’t just happen outside, right? It happens everywhere. I know that our program is heavily associated with the houseless population and addressing the needs there. And it is. But we’re not just here to serve the houseless community. We’re here to serve anybody that’s experiencing mental health crisis or needs to get connected to resources. There are plenty of people out there who are on the verge of homelessness who are still housed right now that we could be getting connected with and curbing that before it gets to that point. So there’s opportunity here for us to reach a much larger population and have a much bigger impact for the city of Portland.
Miller: In April after Portland Response started up, Robert Delgado was killed by police while he was experiencing a mental health crisis. He was in Lents Park, in your service area. He was holding a replica handgun. I’m curious, Robyn, what you took away from that incident when thinking about the work of Portland Street Response.
Burek: It’s so interesting when I think about the evolution of this program. Tre and I have both been working on this since 2019. When the idea for this type of response came forward first, it was about what we would call ‘response reliability’. How do we take these lower-acuity, non-emergent calls out and divert them away from police and fire so that they can really address true emergencies. And then the program also took flight around homelessness and how do we approach the homeless response in a more equitable way so that we become a stopgap for the houseless was ending up in this endless cycle of jail in the emergency department, which doesn’t help their situation. And then with Robert Delgado, I think what ended up happening is we heard loud from the community that our program was about mental health. And so between response reliability, it being a houseless solution, and I didn’t even mention the George Floyd murder and the social justice movement of 2020 and how this program also was framed as a social justice movement. And then you’ve got a mental health crisis. We are touching all of these things. We intersect with every single one of them. I think for us, it’s it’s got us asking, ‘okay, what what is Portland Street Response’? What is our responsibility and what’s the community’s expectation of our program? We’re not going to solve homelessness. But we certainly can impact those who are experiencing homelessness in a more positive way.
And the same is true for those struggling with mental health. We’re not gonna treat mental health out in the field. Were not ongoing treatment providers. But we can at least be a first response system that can be more trauma-informed and can be more appropriate for those types of needs when they arise.
Miller: When the mayor was on this show about a week and a half ago, he said he now supports the citywide expansion of Portland Street Response, but it can’t happen immediately because it will take time to staff up. Do you have a sense now for the actual or potential timeline when it will be that Portland Street Response will be citywide and 24/7?
Burek: We have somewhat of an idea. We have a little bit of a timeline. So, we actually just submitted a fall bump to counsel, and that will allow us to have six bands out across the city and for us to go citywide. That would kick in March of 2022, when we would be able to go citywide. That will not get us to 24/7. So, what that would allow us to do is have three vans that would cover a daytime shift and three vans that would cover a graveyard shift. But again, not 24/7.
And then from there, in January, we will be putting together the fiscal year 2023 budget proposal. We’ll have a better sense of the timeline of when you can get to 24/7 and how we can scale this program up. But it’s a huge, huge undertaking and I know the community and everybody wants us to scale up as fast as possible. But we have to do this very thoughtfully and make sure that we hire and recruit the right people, and then we have the training available and dialed in for that type of scale.
Miller: Tremaine, before we say goodbye, I’m just curious what the picture that emerges for you of life in Portland is like right now when your day job is Portland Street Response?
Clayton: You know, living in Portland for the last 20 years as well as working in the city, this was definitely an opportunity to take the skill set that I’ve been gifted with and trying to put it in a place for good to serve my community, to serve my neighbors. So, being in the city of Portland, I’m aware of the negatives that are being cast upon us. But having a program like this and having the political support that we’re having now, it gives me hope that we’re going in the right direction.
Miller: Tremaine Clayton and Robyn Burek, thanks for your time today.
Clayton/Burek: Thank you.
Miller: Tremaine Clayton is paramedic and community health assessment team coordinator for Portland Street Response. Robyn Burek is program manager for the program.
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