Central City Concern: Providing Access to Harm Reduction Services for People Experiencing Homelessness with Substance Use Needs

October 2023

Overdose mortality rates continue to rise in the United States, with most deaths linked to opioids. Addiction can significantly disrupt the lives of people with substance use needs, including disconnection from friends and family, jobs, and housing. Although it is difficult to obtain an accurate count, a 2010 assessment from the U.S. Department of Housing and Urban Development found that roughly 35 percent of sheltered homeless adults had a chronic substance use condition and 26 percent had a severe mental illness.

While there is no single “silver bullet” that can fully address this crisis, more providers are needed to meet people with SUD “where they are.” Harm reduction is an evidence-based approach designed to mitigate the negative consequences of drug use through practical strategies such as overdose prevention education, linkage to health and social services including SUD treatment, and distribution of sterile syringes.

Central City Concern, a federally qualified health center (FQHC) in Portland, Oregon, provides comprehensive, judgment-free services for people experiencing homelessness with SUD, including primary care, behavioral health treatment, housing, and other supports, some of which are delivered by peer counselors and peer case managers. Harm reduction is integral to their approach, such as providing naloxone and linkages to substance use treatment, including medications for addiction treatment (MAT). Their approach has demonstrated results, including a reduction in the number of patients dying of overdose.

This webinar, made possible through the Seven Foundation Collaborative, featured presenters with on-the-ground experience implementing the harm reduction approach at Central City Concern. It focused on:

  • Innovative approaches to integrating harm reduction across a large FQHC that provides medical, behavioral health, housing, and employment services;
  • Key program elements including specific treatment services, team roles, training, and workflows;
  • Lessons on integrating peers into staff teams; and
  • Guidance on building a culture of harm reduction across a health care organization.

Presenters from Central City Concern included:

  • Juliana DePietro, MPH, Overdose Prevention Program Manager;
  • Chrystal Hohn, PSS, CRMII, QMHA, CADC-R, Peer Supervisor;
  • Sarah Holland, MSW, MPH, Senior Director of Supportive Housing and Employment; and
  • Amanda Risser, MD, MPH, Senior Medical Director of Substance Use Disorder Services.

This webinar was part of the Better Care Playbook Implementation Lab series. These sessions explore implementation strategies for specific models or tools with demonstrated evidence. Ample opportunities were available for participants to ask questions to help further their understanding of moving evidence to practice.  

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