County Commissioner Brings Expert on Millionaire Migration Into Preschool Debate

WW Headline: “County Commissioner Brings Expert on Millionaire Migration Into Preschool Debate”

by with No Comment All BlogsTranslating the News

I generally appreciate attempts to bring outside experts into government conversations, because it’s generally good for politicians to have someone around who understands the issues at hand. In this instance, however, the effort to bring in a professor from Cornell to talk about real-world problems in Multnomah County was misguided at best and led to dangerously misleading conclusions at worst. Link to article

Commissioner Moyer’s Cornell expert said nothing whatsoever about Multnomah County or Portland, let alone offering “cold, hard data”. He mentioned a nationwide academic study showing little direct correlation between wealth mobility and small fluctuations in tax rates, which isn’t at all surprising. We know people are willing to pay a premium for quality of life. Manhattan is a prime example, with population growth despite some of the highest taxes in the nation. The more relevant question is what happens when taxes are sky high, while the quality of life has eroded?

In Portland, this is not an academic question that requires an opinion based on theory, but a real-life question that has been emphatically answered by, well, “cold, hard data”. ECONorthwest just looked at our local data and found that high-income earners have, in fact, left the region, taking with them over $2 billion in personal income in 2022 and 2023 alone. That’s the equivalent of 1000 millionaires leaving the region per year, if you want to put things in terms of millionaires.

And it’s not just the wealthy who are leaving. As most other urban cores across the country are seeing population growth, Portland is one of only a few major cities showing net out-migration. Although underneath that trend, some people do continue to move in, those coming in are often looking for jobs that yet another study has shown don’t exist, as downtown non-occupancy rates reach 30%, corresponding to a missing 30,000 jobs. Meanwhile, a larger number of people who have lived in the region for years, who have spent their careers and have homes and raised their children here, are leaving. With them go more than their tax dollars – we are losing community members, well-rooted neighbors and a ton of social and creative capital.

This is the story of a community in decline. Commissioner Moyer’s expert and the WW article extolling the expert’s irrelevant presentation, while neglecting the real data, just led people to believe that there isn’t a glaring problem with Multnomah County losing its tax base as it drives long-term residents away. I hope that there is more open and frank conversation about this topic that leads to urgency and action, because this should be deeply troubling to anyone who calls this region home.

What is a by-name list why is it so crucial to ending homelessness Does the county have one (1)

What is a by-name list? why is it so crucial to ending homelessness? Does the county have one?

by with No Comment All BlogsThe Big Issues

A By-Name List (BNL) is a comprehensive list of every person in a community experiencing homelessness, updated in real time.

“Using information collected and shared with their consent, each person on the list has a file that includes their name, homeless history, health and housing needs. By maintaining a BNL, communities are able to track the ever-changing size and composition of their homeless population. They know current and detailed information on every homeless person in a given subpopulation.” (Built For Zero – Community Solutions – “What is a By Name List?”)

A BNL provides a baseline assessment that would enable the County to focus on what should be its primary goal: Reducing the actual number of people living outside. 

The actual number of people living outside reflects the entire homelessness to housing (H2H) continuum, including the number of people becoming homeless (inflow) and those leaving homelessness (outflow), as well as those living on the streets and in shelters. The number allows the County to use real information to drive change, assess progress, course-correct, and promote meaningful outcomes. 

If the number of people living outside is increasing, the County is failing at preventing homelessness, transitioning people into treatment or other needed services, and/or housing people. If the number is decreasing, the County is succeeding in its efforts.

This approach, coupled with the focus on each person’s unique needs and barriers, can provide a roadmap to both optimize individual pathways to housing and guide collective investment.

Other counts, including the Point In Time Count (PITC) and the County’s version of the Homeless Management Information System (HMIS), are NOT BNLs.

The HUD-sponsored Point In Time Count (PITC) relies on volunteers and service providers who are deployed across the county on a couple of days each year to pose a set of standardized questions to people they encounter who appear unsheltered. There is no effort to seek people out who are off the beaten path, and people who are sleeping, having a behavioral health crisis, or otherwise are not able to engage do not get counted. Meanwhile, these are the people most in need of identification.

There is no way to track people to get them what they need. The questions are typically awkward, poorly phrased and do not get at vital information that will help people transition out of homelessness. If there are fewer volunteers, the numbers will be lower. The PITC is a fundamentally flawed process that wastes valuable time and resources that would be better spent on a BNL. 

The County has needed to consolidate and restructure its BNL, HMIS, and PITC processes for years. It has not done so. The HMIS process is discussed in more detail below. 

A BNL uses a common-sense approach to achieve not only individual progress by getting people stably housed, but global progress by optimizing investment. 

  1. Using information to help individuals: Using individual information, intensive care teams can establish relationships, follow people through the H2H continuum, help with transitions, get people what they actually need, problem-solve in real time, and facilitate their flow along a pathway to housing. 
  2. Using information to guide investment: Aggregated information can identify what’s collectively needed to get people off the streets into the shelter/housing that meets their needs. It can inform an effective evidence-based plan to reduce the number of people living outside. This data is essential to guide responsible investment by the City and County in a Homelessness-to-Housing continuum.

Despite years of spending, Multnomah County still does not have a BNL.

Having brought the concept of a BNL to the County four years ago with City Commissioner Dan Ryan, I directly observed the County’s failure to build one and witnessed the reasons why. There was initially overt antipathy of County leadership toward implementing a BNL. Then, there was masked antipathy as the County began to implement the program, but delayed and did not invest. Then, there was a misunderstanding, further delay, and posting of information that was inaccurate.    

Over the past year or two, the desire to create a BNL seemed more authentic than it had in the past. However, there never seemed to be an authentic understanding of what BNL actually was, or its power as a tool to effect change.   

Without an accurate and complete BNL, the County does not know how many people live unsheltered on its streets, what they need, or how to best invest resources to achieve the most good. Most importantly, the County will not be able to assess programs or track progress in terms of impact on real people and the community.

The County calls its Homelessness Management Information System (HMIS) a BNL. It isn’t.

Summary of HMIS:

HMIS is a federal database containing information about people who are homeless. Entry of certain information into this system is required by jurisdictions receiving HUD money to address homelessness. The County took over HMIS from the City after a protracted and opaque process. 

The local HMIS was archaic even when it was first adopted over 20 years ago. Over the past two years, the County has talked about updating its HMIS, even though it hasn’t done so yet. It has spent money on HMIS, but because investments were made through different departments and with different funding streams, it is virtually impossible to follow the money. 

At the time I left the board, it was not possible to identify exactly how much had been spent on “updating” HMIS, what departments were involved, how the County engaged with its partners around use of HMIS data, where the County was in terms of implementation, what information was being collected by whom, or how effective its investments had been. The board has the power to demand this crucial information during the County budget process and beyond.

Even if the HMIS does what the County says it’s doing, it is still not a BNL.

Although an HMIS can potentially constitute a BNL, the County’s HMIS doesn’t. 

The County’s HMIS offers a passive, retrospective, grossly incomplete, and often inaccurate list of people who are treated as numbers in order to comply with HUD regulations. It is not used to guide investment in a functional H2H continuum. 

In stark contrast, a BNL offers an intentional approach to identify all people living outside so as to understand their needs and get them stably housed. It is used to proactively guide collective investment in a functioning H2H system and treats the people it identifies as human beings. 

Here is a specific breakdown of the fundamental differences between the County’s HMIS and a BNL:

  • Purpose: Compliance vs. People. 

HMIS is a required compliance tool for HUD, wherein people are treated as numbers. A BNL provides information about real people in order to get them what they need to get and stay housed, and make sure this gets done. 

  • Engagement: Retrospective and passive vs. real-time and proactive. 

County HMIS contains information passively obtained through different providers that is retrospective and static.  A BNL engages teams to proactively and intentionally engage with people in a structured way to identify their needs and barriers in order to directly address them. 

  • Accuracy: Limited vs. Full 

County HMIS includes names of people who have died, variations on multiple names counted as separate individuals, and people who have moved away, gotten housed, gone to jail, or gone to the hospital. Although they are working to deduplicate names and scrub data, the problems are unavoidable given the County’s approach. A BNL identifies and actually follows people to know what is happening with them. Their information is updated in real time.

  • Completeness: Limited vs. Full

County HMIS only contains information submitted by a subset of County service providers for people already engaged in County services. Numbers can be off by hundreds to thousands. A BNL contains information about everyone living outside, because teams intentionally and directly reach out to people in a planful way to establish and build relationships and regularly update information. 

  • Collective impact: None vs. Foundational

County HMIS is not used to identify how collective investments can be optimized to provide the most good for the most people. A BNL considers driving effective investment to be a core purpose.

The County’s false reliance on the HMIS as a BNL has resulted in false promises of false deliverables, leading to false claims of success in its supposed Homeless Response Action Plan (HRAP). 

As a commissioner, I openly conveyed my concerns about the HRAP. These included: (1) Creation of a huge new bureaucracy on top of an already dysfunctional one with no clear chain of command or purpose; (2) Added cost and confusion with no clear benefit; (3) Governance that was not independent of politics and lacked expertise; and (4) Metrics and deliverables that were severely flawed and would not lead to a decrease in homelessness. It flew under the radar and was approved with virtually no attention by County commissioners or the media.

I prepared a memo (detailed) and summary (less detailed) that explained my concerns to the Chair, the former Mayor, the former city council, and the former county board at the time the HRAP was being voted on. Many of these concerns have borne out.

One example shows how the County’s treatment of its HMIS as a BNL leads to false promises, misleading deliverables, and potentially absurd results:

  1. The promise: The HRAP promised to decrease the number of people living unsheltered by 50% by the end of 2025, according to the County’s “by name list”. 
  2. The reality: The HRAP agreed to take the number of people listed in its HMIS as of January 25, 2024 (5400), divide that number by 2 (2700), and promised to shelter or house that number of people by the end of 2025. It did not promise to do anything about the actual people on the HMIS list, or to house half the number of people actually living unsheltered as of January 25, 2024. 
  3. The implication: Erroneously using the HMIS as a BNL allowed the County to start with an inaccurate baseline, count anyone they could find living on the street over the next two years, and claim success if they moved them somewhere, even transiently. 
  4. The absurdity: JOHS could claim success even if it did not help a single person on its original list; if the net number of people living unsheltered actually increased; or if people who moved into shelter or housing ended up back on the streets the next day. 

If this were a BNL, People on the list would be individually followed, the list would be updated as people came and left, and the County would ensure that the number of actual people living unsheltered was going down because people were actually being served. 

The same problems exist with all of the HRAP’s deliverables, such as the promise to eliminate discharges from hospitals to homelessness (a ludicrous promise, made even more so by the fact that the County did not engage with hospital administration or understand the extent of discharges to homelessness before making the promise).

CONCLUSION – Multnomah County needs to urgently complete a real BNL.

Last year, I proposed a budget amendment that would have urgently established a meaningful BNL by the end of the calendar year. It invested in an incident command-style structure to deploy dedicated teams in a coordinated way to proactively and intentionally identify people living outside and create a consistent list. The budget amendment was voted down by the board. 

The investment itself was relatively small, but the return on investment in terms of finally understanding who the County is serving and what’s needed to serve them would have been invaluable. A BNL would not only answer basic questions about the County’s homeless population and homeless services system, but also allow the County to invest effectively in what’s needed to actually reduce homelessness, assess the effectiveness of programs, and track progress in achieving one clear goal: Reducing the actual number of people living outside. 

As the number of people dying outside has skyrocketed, and massive budget shortfalls loom, it is even more urgent that the County invest its limited resources in a coordinated, data-driven, measurable, and cohesive way to save lives and help the most people.

Why are things as bad as they are

Why Things Are As Bad As They Are?

by with No Comment All BlogsThe Big Issues

A Yiddish word, “far-potshket”, does a great job of encapsulating the problem – it refers to efforts to fix things that end up making them worse. The following diagram of Multnomah County’s “homelessness response system” shows why efforts to address homelessness to date have failed. We have a nonsystem created by plastering more layers of dysfunctional bureaucracy onto the previous layers that have been unable to function. A picture speaks a thousand words, reflecting the non-system we have established, better referred to as “chaos”.

The solution to homelessness is not as complicated as we’re making it. Although the problem of homelessness appears intractable, the approach to addressing it is actually straightforward. It is a matter of defining a comprehensive shared vision with meaningful goals, a clear chain of command, and an effective and accountable governance structure led by independent subject matter experts. Although these things have not yet been done, they are eminently doable.

Multnomah County Reaches Agreement With Ambulance Provider

WWeek headline: “Multnomah County Reaches Agreement With Ambulance Provider”

by with No Comment All BlogsTranslating the News

Translation: Multnomah County Chair Reaches Agreement With Ambulance Provider after unnecessarily delaying for 18 months, putting untold numbers of lives at risk.

Link to original Willamette Week article by Anthony Effinger, published August 1, 2024

The Multnomah County Chair finally answered the County’s 911 call almost two years too late. Signing an agreement with the ambulance service provider to do something that could and should have been done 18 months prior is not an accomplishment. Rather, it is a testament to the Chair’s willingness to put lives at stake and allow untold suffering, even when a clear solution with an implementation plan was offered to her on a silver platter.

Whistleblower suit alleges Multnomah County

Oregonian Headline: Whistleblower suit alleges Multnomah County’s mental health system turned into “the wild west”

by with No Comment All BlogsTranslating the News

This whistleblower action should include the leaders in charge of perpetuating Multnomah County’s failed mental health system.

A year and a half ago, as a Multnomah County Commissioner, I wrote to fellow board members calling out the County’s egregious failure to fulfil its responsibility as the Local Mental Health Authority. I asked Governor Kotek to intervene. I’ve copied my January 2024 communication below.

Some meetings were held, promises were made that the County would do better, and things have only gotten worse. The County’s failed mental health system continues to cause devastating harm to countless individuals and families, plays out in the region’s worsening homelessness crisis, impacts public safety, and wastes hundreds of millions of dollars.

Many experts have been whistleblowing for decades about the failure. Meanwhile, County leadership distracts and deflects by blaming the state and federal governments and calling for more money. Legislators tout their commitment to behavioral health by spending hundreds of millions of dollars. But what they all fail to understand (or admit) is that money isn’t the problem. The problem is a lack of leadership, a lack of a comprehensive plan to coordinate and use existing resources effectively, and a lack of accountability.

Here is the email I sent to the Multnomah County board and Governor Kotek:

Dear Colleagues,

Oregon State law directs counties to act as the Local Mental Health Authority (LMHA) for their regions.  For years, Multnomah County has not fulfilled this obligation on either a statutory or moral basis.

Throughout the past seven years of my term as County Commissioner, I have expressed concern about this both publicly and privately, and have pushed for the County to do more.  At this time, I have lost confidence that the County can fulfil its role as the LMHA.  I believe that this requires intervention at the State level.

At the start of my term, I commissioned an analysis of the Multnomah County Mental Health System.  The final 134-page Report was presented to the Board, the former Chair’s office and the public in August 2018. It spurred the next phase of work – a stakeholder engagement process called Analyse, Align and Act, which led to the development of the Blueprint for Better Behavioral Health, a framework for creating a functional and coordinated behavioral health continuum. I was hopeful that this effort would transform our behavioral health system to serve individuals in our community with the compassion, services and supports they need and deserve to live their best lives.

Unfortunately, the former chair deprioritised this project before its completion.  And since then we have seen many additional failures to fulfil the County’s obligation as LMHA:

  1. Decimation of the original BHECN process
  2. A failure to address the fentanyl crisis
  3. The failed relationship between the Health Department and the jails, condemned in the scathing National Institute of Corrections’s report
  4. The unprecedented number of deaths occurring in our jails over the past year
  5. The turnover of five Behavioral Health directors in six years and seven Health Department directors in seven years
  6. The failure to hire a new permanent Behavioral Health director after almost a year, when mental health and addiction issues have been at the heart of virtually all the major issues facing our community
  7. The failure to have a coherent, coordinated plan around the youth mental health crisis

While the County has some scattered elements of a behavioral health system, our failure as the LMHA has led to terminal dysfunction in coordinating, convening and planning. It has also led to other entities stepping in to compensate for our deficits, for example:

  1. The City of Portland, with Portland Street Response and the Police Bureau’s Behavioural Health Unit
  2. CCOs CareOregon and HealthShare are directing processes and programs to address behavioural health crisis care
  3. Central City Concern and OHSU are investigating systems gaps and making recommendations to fill them

It must, of course, be acknowledged that the COVID pandemic placed additional strain on our system as a whole. But it was troubling that when our behavioral health crisis worsened during the pandemic, and the County, as LMHA, should have been bringing people together like never before, County leadership used the pandemic as an excuse for failing to meet our statutory responsibilities, not a call to action.

Details about the role of an LMHA have never been shared with commissioners by the Behavioral Health Division. I have some unique insight into LMHAs, given my experience as a physician providing behavioral health crisis services, and also as a lawyer who enjoys getting into the nitty-gritty of statutes. I have therefore prepared a summary version of the Oregon Revised Statutes section establishing counties as LMHAs for your convenience, and have linked the actual ORS sections here. I also offer the following ultra-condensed summary:

ORS 430.630 directs counties to establish community mental health programs and substance use disorder treatment continuums and establishes counties as regional LMHAs. The primary responsibility of an LMHA is to establish a Comprehensive Local Plan for mental health and make sure that it is being implemented.

To my knowledge, Multnomah County does not have a current Comprehensive Local Plan (CLP), even though the requirements are outlined quite well in statute.  It certainly does not have a functional continuum of behavioral health care, nor has it coordinated or led efforts to create one.

Our failure in fulfilling our statutory and moral responsibilities as the Local Mental Health Authority has directly led to and/or exacerbated multiple behavioral health crises in our community.  You only need to look at recent headlines to see some of the tragedies that have occurred due to a lack of an effective behavioral health continuum, and these heartbreaking stories are just the tip of the iceberg. As one of the many people working in healthcare and social services, I see the impacts regularly in the ER and as a volunteer caring for people experiencing homelessness.

At this time, I do not believe that the situation is salvageable without external intervention, and the State must step in to ensure that our legal obligations under ORS 430.630 are met for the people we are meant to serve.

I therefore formally request that Governor Kotek intervene to address Multnomah County’s failure to create and implement a comprehensive local behavioral health plan.

I realise this is a very serious request, and I do not make it lightly. But we are facing numerous behavioral health crises, things are getting worse before our eyes, and we have yet to see any critical action being taken by County leadership that has the potential to reverse our trajectory. People residing in our County are suffering and dying. We need to do something NOW.

I have copied Governor Kotek, her Behavioral Health Policy Director, Juliana Wallace, and Oregon Health Authority Behavioral Health Director Ebony Clarke on this message and formal request.

I sincerely hope the seriousness of this situation results in action to help the untold, unaddressed suffering in our community, and I look forward to further engagement with each of you on the subject of the LMHA.

Respectfully,

Sharon Meieran

Multnomah County poised to pay marketing firm $238K to collect feedback on Preschool

Oregonian Headline: “County to pay marketing firm $238K to collect feedback on Preschool for All”

by with No Comment All BlogsTranslating the News

A reporter should investigate how many consultants Multnomah County (read as JVP) has hired over the past 2.5 years in the core work of the county – homelessness, mental health and addictions, emergency medical services, corrections health, the overarching health department, animal services, and Preschool For All. Not to mention the ridiculous investment of hundreds of thousands on a county “mission, vision and values” statement. I estimate there have been at least 10-15 consultants, but I don’t have access to the information. The County is welcome to provide the details.

Then the reporter should calculate how much money and time have been spent on all of this consulting in fields that are supposed to be the county’s core responsibility. Here’s a hint: The money can be measured in millions, and the time can be measured in years. This is clear from reviewing County budgets.

The reason for all this waste is straightforward and predictable, albeit tragic: The chair has surrounded herself with department leaders who are political allies rather than subject matter experts. Lacking the background and expertise necessary to run departments in an organization as big and critical as the county, they end up having to hire others to do the jobs they were hired to do. Aside from wasting tons of time and money, the situation has resulted in unprecedented turnover of county department directors, further destabilising county systems. For example, in the past eight years, there have been seven health department directors, six behavioral health directors, and five homeless services directors (not counting the three additional “homelessness response system” directors the chair hired in the past two years alone). If this were a business, it would have failed many times over. But Multnomah County keeps getting a pass.

This is what happens when politics is prioritized over policy in a government responsible for crucial human services.

Understanding what’s ailing Multnomah County continues to be a simple matter of connecting the dots and recognizing the patterns of failed leadership. Fixing them requires the current board to acknowledge the tremendous instability and waste this has caused and do something about it.

Downtown Portland, Oregon with Mount Hood in the background as seen from the Pittock Mansion viewpoint.

Void of subject matter expertise in county departments Has Led to institutional dysfunction

by with No Comment All BlogsMultco 101

Department function is directly tied to the background, expertise and experience of directors. Currently, too many directors do not have a background in the departments they’re supposed to be leading, leading to departmental and institutional dysfunction.

Multnomah County used to be a centre of excellence. Leaders of county departments were respected leaders in their professions – medicine, public health, social services, and animal services. They had directed research, written books, and were on the cutting edge of their fields. 

Amidst a toxic culture of fear at the County, there has been unprecedented turnover of department and division leaders. The core knowledge base of County department heads has diminished to an unacceptable level, yet it’s been accepted. This is illustrated by a plethora of recent examples and has occurred as the need for leadership and guidance has never been greater.

  1. The Health Department: The Health Department (HD) director plays one of the most crucial and influential roles in the County and, in fact, the state. The position touches on all core county functions – mental health and addiction, public health, corrections health, emergency response, homelessness, and public safety. In my eight years at the County, seven people rotated through the HD director job. The current director came to the role with no background in healthcare systems, behavioral health, Medicaid, or direct clinical services, and didn’t know key health systems players in the state. 
  2. Behavioral Health Director: The County’s behavioral health (BH) director sets County policy and establishes operations around one of the County’s most crucial functions – ensuring a robust continuum of services exists to address mental illness and addictions. This position could not be more important to the community, and knowledge, background, relationships and expertise could not be more important to the position. In my eight years at the County, seven people rotated through the BH director job, and the most recent hire left last month. Only one former director had the background, skills, and vision to lead the division and left the County years ago; the others have not been qualified for the role, and the County’s approach to mental health and addictions has foundered.
  3. Corrections Health (CH) Director and Corrections Health Officer: Multiple individuals have been fired or left the division, and there has been poor integration with the Sheriff’s Correction Deputies, who have been doing clinical work with the same adults in custody. There was a report that one of the CH directors was not qualified for the position, but the standards were lowered so he could serve. An unprecedented number of people have died in custody. In my eight years at the County, four people rotated through the Corrections Health Director job and three rotated through the Corrections Officer job. Since I left the County, another CH officer (who had been hired despite complaints filed with the Oregon Medical Board) ultimately left the position.
  4. Public Health Director and County Health Officer: These core County functions rely on having consistent, expert leadership. In my eight years at the County, four people rotated through the Public Health director job and four rotated through the County Health Officer job.
  5. Integrated Clinical Services (Multnomah County Community Health Clinics): The federally qualified community health centres are the backbone of Multnomah County’s clinical services system. They are not integrated with other core County functions and services. Their providers have operated under extreme stress that has not been addressed by leadership. In my eight years at the County, five people rotated through the ICS director job.
  6. Youth and Family Services Director: Ensuring the adequacy of and overseeing a functioning system of services for youth and families is one of the most essential core functions of the County and one of the most complex. There are a number of specialized aspects of the work, including intersection with shelter and housing systems, physical and mental health systems, addictions, school-based health, dependency court, juvenile justice, social services and supports, and safety systems. People involved in this work spend years training, gaining the knowledge and skills needed to understand and interact with the systems involved, and getting to know youth and families by doing the actual work. Most recently, a sitting County Commissioner was selected for the position, even though she had no specific qualifications, background or training for the job.
  7. Animal Services: Ensuring the responsiveness and effectiveness of our Animal Services division is a core County responsibility, and the County has failed to provide adequate leadership, accountability and oversight. Three years ago, a person who had served in various mid-level management roles at the County was appointed to the position of Animal Services director, despite having no background, expertise or qualifications for the role. Per the report of volunteers who had served for years, Animal Services spiralled downward, and animals and the people adopting and serving them have been harmed.
  8. Homelessness Response System: The fact that there is both a Homeless Services Department (formerly “Joint Office of Homeless Services”) and a Homelessness Response System is a problem that will be discussed in future posts. For now, suffice to say that, in addition to the HSD/JOHS there is a HRS. The leader of the HRS is selected exclusively by the Chair, and the HRS is housed in the Chair’s office. In less than two years since its inception the HRS has had three directors. The first was the Chair’s former chief of staff, who left the County under a cloud. The second left the position after only a few months. And the current director selected by the Chair is a politicial consultant.
  9. County Homeless Services Department (formerly Joint Office of Homeless Services) Director: The utter failure of the HSD/JOHS will be addressed in future posts. This post will simply describe the qualifications of its leadership and how this has contributed to the failure of the County in addressing homelessness.
  1. The HSD/JOHS Director oversees a budget of hundreds of millions of dollars, is responsible for the intersecting systems of homelessness prevention, shelter, transitional housing, rent assistance, and permanent housing, oversees more than a hundred individual programs, and is responsible for allocation of hundreds of millions in Supportive Housing Services Measure funds.
  2. Four directors served as HSD/JOHS directors during my eight years at the County. One previous director had been serving in the JOHS for only a couple of years as an equity manager before he was promoted to be Deputy Director of the entire department, then, after a brief time, JOHS Director.
  3. After his departure, a government relations director for a healthcare organization was hired as JOHS Director. He spent his first year, including hundreds of thousands of dollars on consultants, learning the basics of homeless services and systems. During the most recent budget it was revealed that around $75 million from the SHS measure had been inappropriately budgeted. Meanwhile, there were ongoing challenges relating to getting money out the door, contracting organizations regularly expressed major challenges regarding relationships with the JOHS, and the number of people living and dying unsheltered reached unprecedented levels.  
  4. He left after two years, and the Deputy Director – who had been a contracts administrator without a background in homeless services – is now leading the department on an interim basis.

The County Chair does not have to be a subject matter expert in the work of the County. But if not a subject matter expert herself, she should be surrounding herself with people who have the experience she lacks. Unfortunately, she has not done this and the vacuum of subject matter expertise and leadership at the County is palpable. 

If any other business was facing the rate of turnover and depth of personnel challenges being seen at the County, it would have failed many times over.

PastedGraphic-3

The Structure of County Government – In many Ways a Rigged Game

by with No Comment All BlogsMultco 101

In my first post, I explained what Multnomah County does and why it’s the most important government you’ve never heard of when it comes to the biggest issues affecting our region: homelessness, mental health, addiction, public health, ambulance response, ageing, and disability.

Today, I will begin to describe how the County’s governance is structured, and why that very structure is largely responsible for the County’s dysfunction. 

Multnomah County government is composed of a board, or commission, of elected leaders. The elected leaders include a single County Chair, elected by the County at large, and four individual commissioners, each elected by district. 

On its face, this seems like a reasonable governance structure that can lead to solid and collaborative decisions, driving positive change and ensuring shared accountability. 

Unfortunately, the realities of how the system is set up by the County Charter and governed by existing County Code have resulted in a self-reinforcing consolidation of power in a single leader – the Chair – who is accountable to no one. That power can be wielded in a way that is collaborative and constructive, or in a way that is alienating and destructive. 

Either way, the game is rigged in favor of the Chair. 

The Chair alone prepares the $4 billion budget, including the budgets for the Sheriff’s Office, jails, and District Attorney. She alone dictates board meeting agendas and can hear people out or cut them off at will. She is the “Chief Personnel Officer” of the County and hires and can fire the directors of all County departments and divisions. She directs County Communications and the County Attorney. She is the Chief Procurement Officer and can enter into most contracts without board approval or even knowledge. She is the gatekeeper for information. And she has a massive personal staff. In the FY 2026 budget alone, the allocation for the Chair’s office was over $4.7 million, with a dedicated staff of 15 employees (including the Chair’s salary but not including her security detail). Commissioners have three staff members, with around $950,000 budgeted for each of their offices, including the commissioners’ salaries. 

Theoretically, there are some checks on the Chair’s power, but these are all dependent on commissioners receiving unobstructed, objective information. Unfortunately, the Chair is the gatekeeper for information, controlling the timing and content of information received by the rest of the board. As a commissioner, I often did not learn about crucial decisions until they showed up in the news. I would receive press releases after the press. 

The Chair oversees all department directors, and so she can direct how department directors engage with individual commissioners. The Chair can demand that department directors notify them whenever a commissioner is spoken with, and while I was on the board, this happened regularly. 

The Chair not only has her own communications staff, but the entire County Communications office operates under her exclusive authority 

I used to think that county commissioners, as independently elected officials, had unfettered access to information, county communications, and departmental leadership. It turns out I was very wrong. The structure of County governance and the exclusive power of the Chair make for a rigged game.

I will be delving deeper into all of this in subsequent posts in order to illustrate how this plays out in terms of policy and board dynamics. In the meantime, the takeaway is that the Chair wields virtually absolute power at the County. You should never assume that individual commissioners know what the Chair knows, or that they agree with her decisions.

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What is multnomah county and why is it so important?

by with No Comment All BlogsMultco 101

Over the years, I’ve observed many different reactions when I’ve told people I was a Multnomah County Commissioner. Most often, they’ve smiled and nodded and tried to look interested as their eyes glazed over. I could sense that they had no idea what the County was or did, nor did they care. But they also appeared slightly uncomfortable – like maybe they should know and should care.

For anyone who worries about homelessness, mental health and addiction, ageing and disability, domestic violence, Veterans, public health, ambulance response, or public safety, it is crucial to know and care about Multnomah County. It is probably the most important branch of local government to address the most pressing issues facing our region.

Local government in the Portland metro region is bizarre. Not only do we have the City of Portland and Multnomah County, but a third vague and lurking government – Metro. I will focus mainly on the County, but there are so many exceptions and redundancies involving the roles and responsibilities of the different governments that I will necessarily touch on the other forms of government.

In brief, the City of Portland is largely about public safety, business development, and infrastructure: Keeping the city clean, fixing potholes, ensuring our drinking water is safe, responding to fires and crime, and building.  

The County is what I think of as the heart and soul of local government. The County oversees health-related services (mental health, addiction, public health, emergency medical services, ambulances) and human services (ageing and disability, domestic violence, Veterans, immigrants and refugees). The County is the Local Mental Health Authority – statutorily responsible for ensuring that an effective, holistic and accessible continuum of care is available for everyone in the County needing mental health or addiction services. And the County is the Local Public Health Authority – statutorily responsible for ensuring the health of the community.

Metro is a regional government whose vague authority and purpose are hard to pin down, describing itself on its website as “working with communities, businesses and residents in the Portland metropolitan area to chart a wise course for the future while protecting the things we love about this place.” Of note, it runs the Zoo, the Expo Centre, and has something to do with cemeteries.

What gets confusing is the fact that the County is responsible for several services related to public safety – including parole, probation and corrections health – while also being responsible for the budgets of the County’s independently elected District Attorney and Sheriff (including jails). 

The County houses Emergency Medical Services (responsible for ambulance response), but the director of that division is also the director of Emergency Dispatch and Fire and Rescue – both housed at the City – while his contract is administered at the County. 

Metro is responsible for administration, oversight, and accountability for Multnomah County’s use of $1 billion in Supportive Housing Services funds (the majority of the County’s homeless services budget). Metro is also responsible for hazardous waste disposal and sharps, which factor into the County’s authority over addiction services and public health, and the City’s responsibility for trash removal.

And consider the following: The County has a potpourri of other very important responsibilities, including Elections, Animal Services, Bridges, Land Use and Transportation in unincorporated areas of the County, and Libraries.

If you’re feeling a bit confused, don’t worry – that is an entirely appropriate reaction. You just need to remember one thing – if you care about solving homelessness, addressing our addiction and mental health crises, resolving issues around jails or public health, then you need to understand Multnomah County! And that is precisely what I intend to help you to do.

Officials now have a much better idea of how many homeless

Oregonian headline: Officials now have a much better idea of how many homeless people live in Multnomah County. It’s a lot

by with No Comment All BlogsTranslating the News

Translation: Officials finally learn how to de-duplicate names in their database and realize they still have no idea how many homeless people live in Multnomah County or what to do about it

Link to original Oregonian article by Lillian Mongeau Hughes, published April 16, 2025

The scope and scale of Multnomah County’s homelessness problem is not a “stunning new reality” that’s just been revealed. What’s stunning is how surprised the County seemed to be by the revelation that there are roughly three times as many homeless people on our streets as they’ve previously talked about.

After de-duplicating names and scrubbing data – apparently a first for the JOHS – the latest numbers reveal more than 14,000 people are homeless in Multnomah County. 14,361, to be unexact. That’s 6,796 unsheltered, 4,260 sheltered, and 3,208 unaccounted for.

And… stop right there. 3,208 human beings that the County is supposed to know “by name” are unaccounted for? How is that not the headline? If it’s a by-name list, no one should be unaccounted for. They’re still fudging the numbers.

This is a far cry from a By-Name List.

A By-Name List (BNL) is supposed to be a comprehensive list of every person in a community experiencing homelessness, proactively obtained and updated in real time. The core idea is that you literally go out and identify everyone experiencing homelessness in your community, including their name, location, and needed support services, and put that into a database.

The beauty of having this reliable, accurate, complete, up-to-date list is that it allows governments to strategically invest in building what’s actually needed to end homelessness on a macro scale in their communities, while focusing on meeting the needs of the real human beings living on their streets.

If you can’t account for actual human beings in your database, it’s not a BNL. No matter how many times you say that it is. And the County has said it a lot since City Councillor Dan Ryan and I got the concept adopted in 2020.

  1. In October 2022, as if by magic, the Joint Office declared it had completed a “quality by-name list” and would soon be releasing numbers.
  2. In April 2023, the JOHS excitedly reported that it would be releasing its first data to come from its “quality by-name list” of people experiencing chronic homelessness in Multnomah County. They claimed it was “foundational” and a “major milestone”.
  3. In May 2023, they claimed that 3000 people were living unsheltered in the County.
  4. In July 2023, the JOHS re-emphasised that the “cornerstone” of their work was building and using a “quality by-name list of individuals experiencing chronic homelessness” and that, thanks to their “quality by-name list”, they could see that “providers funded through the JOHS are rehousing hundreds of people experiencing chronic homelessness.”
  5. In January 2024, the County said that the total number of people experiencing homelessness according to its “quality by-name list” was 11,153. Of those, 5,398 were unsheltered, 3,197 were sheltered, and 2,558 were unaccounted for. (Again – 2,558 unaccounted for?)
  6. Last September, I commented in a social media post that the county still hadn’t produced anything like an actual by-name list that proactively identified and comprehensively covered the homeless population. That apparently hit a nerve, because at our next board meeting, the JOHS director accused me of lying when I’d said that the JOHS had not published the number of people actually living unsheltered in our community. He doubled down that the County knew how many people were living unsheltered and that the County had a BNL. “In fact, we published that number earlier this year,” he said. “It’s 5,398.” I shouldn’t have had to remind the director that a BNL, by definition, contains real-time, up-to-date information about the number of people living outside. And that the 5,398 number, which wasn’t accurate even when first reported, certainly wasn’t accurate eight months later.

Now, back to the latest claims.

The numbers may have come as a shock to everyone who hasn’t been paying attention. But the situation is what it’s always been:

  1. Multnomah County did not have a BNL when it first said it did in 2022, and it still doesn’t.
  2. The situation is worse than the County has been reporting all along, and the numbers will continue to get worse as they arc toward reality (which is the one silver lining: The numbers do seem to be getting more accurate and more complete).

The most disturbing thing about all of this is that Multnomah County just doesn’t seem to get that this isn’t just about a “list” or about chasing random numbers. It’s about the people at the heart of the list.

The unique value of a BNL comes from linking the numbers to a plan for meeting the needs of the human beings those numbers represent. And nowhere does the County talk about the people behind the numbers, or what the plan is to get them and keep them stably housed. In fact, the Chair’s recently released budget ignores this completely.

This is what the County should be focusing on like a laser, instead of issuing more press releases inaccurately reflecting their efforts to count how many people they’re not serving.