Substance Abuse Is Rampant on the Streets. Require Providers to Coordinate Services.

“To say the system isn’t working is not relevant,” Ed Blackburn says. “There is no system.”

Problem: Substance abuse is rampant on the streets.

Idea: Require providers to coordinate services.

Nobody wants the titles Oregon currently holds: According to federal stats, we’re No. 1 in the abuse of meth and misuse of prescription opioids. Combine that with one of the nation’s highest rates of unsheltered homelessness and you have a disaster.

“We can get people into treatment, but when they are discharged, they often don’t have housing options,” says Ed Blackburn, retired executive director of Central City Concern, a Portland social services nonprofit. “They just cycle through and get worse.”

Last year, Blackburn teamed up with Dr. Bruce Goldberg, the former director of the Oregon Health Authority, and other experienced providers and concerned citizens to form Homeless Strategies and Solutions Initiative. That group hired researchers to figure out why, despite the variety of government and nonprofit agencies tasked with helping homeless people—particularly those dealing with mental illness and substance abuse—get off the streets, conditions were worsening.

The takeaway: The providers are not communicating with each other or coordinating their services.

“To say the system isn’t working is not relevant,” Blackburn says. “There is no system.”

Researchers found that the various service providers competently perform their functions: referral, treatment, job search, housing. But too often they provide the services in a vacuum: “A substance use disorder system of care for people experiencing homelessness does not currently exist,” explains the report HSSI commissioned.

The solution, Blackburn says, is deceptively simple. Those writing the checks, including the Oregon Health Authority; Health Share of Oregon, the metro region’s Medicaid provider; and county governments, must insist that providers coordinate their services.

That way, when a client leaves rehab or a residential treatment facility, they’re not just deposited on the street but connected to housing, job opportunities or other services. Blackburn says getting the payers to demand teamwork from the service providers is an idea he’s shared with Gov.-elect Tina Kotek and her new director of the Oregon Health Authority, James Schroeder.

“It’s easier not to coordinate, and you are not required to,” Blackburn says. “That has to change—and it can.”

See all 13 Big Ideas to Save Portland here.