Mental health care provider returns to profitability and starts building a cash reserve

Cascadia Behavioral Health recovers from near collapse
Mental health care provider returns to profitability and starts building a cash reserve

Portland Business Journal – by Courtney Sherwood Business Journal staff writer
Cathy Cheney | Portland Business Journal
Under Derald Walker’s leadership, Cascadia Behavioral Healthcare quietly turned itself around.

Two years after a financial meltdown nearly destroyed Multnomah County’s safety net for the mentally ill, the nonprofit at the center of the crisis has rebounded.

Cascadia Behavioral Healthcare Inc. is a shadow of its former self, and will bear the burden of its April 2008 near collapse for many years. Even at half its former size, however, the Portland nonprofit remains a key component of the county’s safety net.

It returned to profitability in March. CEO Derald Walker, appointed in the midst of the crisis to turn Cascadia around, hopes to build a $500,000 cash reserve by early 2011.

Two years ago, these results seemed inconceivable.

Cascadia Behavioral Healthcare runs clinics for people struggling with addiction, offered counseling to people with severe mental illness and housed poor people with mental illnesses.

But in spring 2008, poor bookkeeping put all that at risk.

State Medicaid officials had ordered Cascadia to repay $2.7 million when the nonprofit could not provide documents backing previous years’ claims. Capital Pacific Bank had demanded repayment of a $2 million loan.

Leslie Ford, who had been CEO since Cascadia Behavioral Healthcare was founded through the 2002 merger of several smaller nonprofits, had been forced out. Two consecutive chief financial officers hired to turn Cascadia around had quit, after declaring the company’s books a mess and uncovering still more liabilities.

By summer 2008, it appeared as though Cascadia Behavioral Healthcare’s programs would be dismantled and farmed out to other nonprofits.
Instead, the nonprofit is paying down its debt

“They still have to watch their pennies,” said Kathy Tinkle, business services director for Multnomah County Human Services. “But they’ve made significant progress.”

Under Walker’s leadership, Cascadia obtained a $2.2 million loan from Multnomah County and the state. It negotiated its Medicaid assessment down to $1.2 million, payable over five years.

It also relinquished its role as Multnomah County’s pre-eminent mental health care provider by transferring several of its programs to other area nonprofits in order to cut expenses.

In August 2008, Lifeworks Northwest took over Cascadia’s Gresham clinic and Central City Concern took control of a downtown clinic at Southwest 12th and Stark streets. Luke-Dorf took control of Bridgeview, a residential treatment center.

Surrendering these programs cut Cascadia’s expenses, and the nonprofit cut costs still further by consolidating office space and leaving administrative jobs unfilled.

By drawing down the county-state loan, Cascadia invested in a $250,000 medical billing system aimed at further improving the nonprofit’s finances. The system prohibits Cascadia from submitting incomplete Medicaid claims, so that it can never again be reimbursed without adequate documentation, Walker said.

These cuts are paying off for the organization, but they have also left Cascadia much smaller.

It lost $2.1 million on revenues of $55.9 million in the year ending June 30, 2008, and lost $514,000 on revenues of $42.5 million the following year. Walker expects to end this fiscal year with a surplus of at least $200,000 from a budget of $38 million.

In 2008, Cascadia provided about 80 percent of Multnomah County’s mental health services. Now it provides only 32 percent of these services.

Meanwhile, county mental health officials have undergone their own transformation aimed at avoiding more surprises like the April 2008 Cascadia meltdown.

“We have realized that we can not be in a situation where we are so dependent on a single agency,” Tinkle said.

County mental health leaders now meet quarterly with their largest nonprofit contractors, and monthly with Cascadia, to track the performance health of the nonprofits that they fund.

Jason Renaud, volunteer and secretary of the board of the Mental Health Association of Portland, applauded Cascadia Behavioral Healthcare’s turnaround, and the county’s renewed oversight.

But he also lamented a mental health system that faces stagnant funding and growing demand.

Cascadia’s front-line workers, in particular, have borne a difficult burden through this transformation.

They have not received pay hikes since 2008. With a recent increase in the portion that many pay for health insurance, a number are now taking home less than they did two years ago.

Walker also cut vacation days.

A new program that manages counselor productivity can allow some employees to boost take-home pay if they increase billings as a share of total hours worked. Though many workers have embraced the program, others grumble on the growing emphasis on money in a caring profession.

Since the nonprofit’s fiscal crisis, employees have had to accept paper checks because Cascadia does not have enough of a cash buffer to implement a direct deposit system.

But unlike the crisis of two years ago, these are challenges that observers expect Cascadia Behavioral Healthcare to survive.

“Unfortunately, any nonprofit with the county is in this boat,” Tinkle said. “Our dollars aren’t growing as fast as our personnel and expenses.”


Is it Safe to Call 911 in Crisis? Maybe, Maybe Not

Posted by Jenny on February 19th, 2010

Despite a recent warning in The Skanner, Derald Walker, CEO of Cascadia Behavioral Healthcare, thinks Portlanders can, and should, call 911 in crisis, if needed. It’s appropriate, Walker said, and can connect people with resources.

The Skanner’s warning came after the shooting death of Aaron Campbell on Jan. 29. Campbell was, according to The Oregonian, “an unarmed African American guilty of nothing except being suicidal and distraught.” Rev. Jesse Jackson called the death an “execution.”

Walker said he realizes that people have concerns and fears, which he called unfortunate, but, to some extent, understandable.

He added, “I think the Portland city police are trying to handle a lot of things on the streets that, quite frankly, if mental health services were more available, they probably wouldn’t be confronted with.”

Resources Needed

Walker believes that Portland police are trying to reduce the number of bad outcomes. The bureau has adopted crisis intervention training, which is now required for all officers.

But additional resources are needed, said Walker.

“We need more housing for people with mental illness, more after-hours service for people with mental illness – for everybody. And people aren’t always eligible for treatment. If you’re not on the Oregon Health Plan, you may not have access to mental health treatment; we need universal funding for mental health services. Funding is just not adequate at this point.”

Build Networks

Dan Handelman, of Portland Copwatch, said that police shootings are actually down in recent years.

Still, in the past five years, at least five people with mental illness, or in crisis, have been killed by Portland police:

Aaron Campbell, 2010
James Chasse, Jr., 2006
Jerry Goins, 2006
Tim Grant, 2006
Raymond Gwerder, 2005

Handelman points out that it’s difficult to pinpoint the exact number of cases, since mental illness is not always reported, and “crisis” is open to interpretation.

Asked whether people should call 911 in crisis, Handelman said ideally, people wouldn’t have to.

“In my opinion, people should build networks with family, friends, coworkers and neighbors so that, to the extent possible and reasonable, there is no need to call police. I also believe that a person should be able to call 911 and explain they have a mental health crisis situation and that should be able to be resolved without an armed police presence.

“People need to make up their own minds about what to do, but certainly given the possible outcomes I hope that more community building and less reliance on armed intervention is in this city’s future.”

Clients Grateful as Garlington Center Reopens

Faith Cathcart/ The Oregonian

By Nikole Hannah-Jones, The Oregonian
September 18, 2009

Faith Cathcart/The OregonianGladys Howard of the Garlington Center plays Uno with clients Roxanne Taylor (left) and Sharon King on Friday. After a 2008 fire, the center reopened last week on Northeast Martin Luther King Jr. Boulevard. The center offers mental health and addiction treatment.

A few months after the Garlington Center avoided closure by Multnomah County last year, a fire closed it anyway.

But the same fighting spirit that saved the mental health and addiction clinic from the county’s ax brought it back to life. The center reopened last week on Northeast Martin Luther King Jr. Boulevard.

“It was really not an option to close this location,” said Derald Walker, chief executive officer of Cascadia Behavioral Healthcare, which operates the center. “It would leave the community of color here with no place to turn.”

Even before the fire, uncertainty shadowed the center’s future. Cascadia — which handled most of Multnomah County’s mental health services –was wracked by financial woes and required a government bailout to keep going.

The Garlington Center served a low-income and largely African American clientele and was the agency’s least profitable. Cascadia recommended closing it and sending clients elsewhere.

But a community used to being pushed aside because of income, race, mental illness and addiction said not this time. They fought the closing and won.

Walker says the outpouring sparked a realization about the need for the clinic to help those who often don’t feel comfortable in clinics in other areas that serve a less diverse group and with less diverse staff.

Then a spark of another sort took hold. The kind that doesn’t save, but destroys.

“When we saw the fire, when we lost Garlington, we thought it was the end of the world,” says Sharon King. “It’s something we cried about. We thought we’d never see it again.”

King, 63, is a Northeast Portland resident who’s come to the center in one of its incarnations for more than two decades. She gets treatment for schizophrenia and bipolar disorder at least three days a week.

King, like other clients, never lost services. The day after the fire, Garlington staffers dispensed medicine and saw clients from the parking lot.

Director Tasha Wheatt-Delancy said meeting needs was the first priority.

For months, staff met clients in trailers and an RV just feet from the blackened building. Clients were dispersed to other Cascadia clinics and to temporary clinics set up at the Salvation Army and a church nearby.

But it caused a hardship for people who found stability at the center and now had to go from place to place. What was a five-minute bus ride for one client turned into an 1 1/2-hour one.

And it wasn’t always pretty, either.

Gwen Ferrell, a 22-year-old who came to Garlington for a marijuana addiction, says the trailers were drafty and cold in winter. But, she says, she never thought of going anywhere else.

“It’s diverse here and you meet all types of people,” says Ferrell. “The staff understands you and even if they don’t, they’ll get into your shoes for that moment just so they can.”

And on a sunny September day, the hardship seemed to have paved the way for the blessings.

Insurance paid for a $2.1 million rebuilding, and clients now fill a lobby scented with the fresh taupe-colored paint on the walls. Nearly a year ago, in October, those walls took the charred brunt of a fire, whose cause was not determined, that destroyed about 80 percent of the building.

As part of the redesign, four interview rooms are decorated in colors and themes that reflect African American, Native American, Latino and Asian identities. And the center now provides space for two other groups that had cramped, inadequate facilities, the North by Northeast Community Health Center — a free clinic — and the Sexual Minority Youth Resource Center.

For King and the up to 600 people of all races who use Garlington’s services, the beauty of the center once cloaked in ashes is a metaphor for their lives.

“I was really in a fix and this center brought me through it,” King says. “I’m glad someone thought we were important enough to bring it back for us.”

As King leaves the center, she walks past a T-shirt tacked to the reception desk.

Above a proverbial rising phoenix, it reads: “The fire is in all of us.”

— Nikole Hannah-Jones;

Rain Garden: 29-Unit Housing Complex Offers Mentally Ill Independent Living

From its inception, Wilsonville complex for people with mental illness unlike any other in country

by Dana Tims
The Oregonian

Gwen Watson

Rain Garden offers mentally ill adults independent living

WILSONVILLE — Gwen Watson picked up her acoustic guitar, gently placed her fingers along the frets and softly launched into John Denver’s “My Sweet Lady.”

Her silky soprano soared effortlessly into the song’s upper register as she plucked the steel strings in mistake-free accompaniment.

For all her musical virtuosity, 51-year-old Watson is the first to say her life hasn’t always been this in tune.

“Starting at age 17 and lasting for the next 21 years, I was so medicated that I was living in unreality,” she said. “The drugs they gave me were the drugs they give murderers.”

After decades of living in adult group homes and struggling with mental illness, Watson finally has a place of her own at Rain Garden Apartments, a 29-unit housing complex for adults with mental illness that officially opens Friday.

It’s a place unlike any other in the country.

Rain Garden, along with two group homes and two apartment complexes for adults with mental illness, is situated squarely among the 700 upscale houses and condos at Wilsonville’s Villebois “urban village.” Developers, along with state and county mental health experts, say this is the first place in the United States where mental-health housing was part of a larger master-planned community from its inception.

“We had to go back to Washington, D.C., to ask for federal guidance on how we do this,” said Ruby Kadlub, founder of Costa Pacific, which developed Villebois. “They said they couldn’t tell me, because it hadn’t ever been done before.”

The land’s history has everything to do with why new residents such as Watson finally have a place to call home.

From 1961 until 1995, Dammasch State Hospital was located here. Hailed at its opening as a national model for progressive treatment regimens, the hospital eventually succumbed to the move to deinstitutionalize the mentally ill.

Legislators, recognizing that Dammasch had been dedicated to mental-health uses, passed a bill stipulating that money from its sale to private developers be set aside for grants to groups wanting to build housing there for people with mental illness.

As a result, Villebois’ rows of townhouses, condos and detached single-family houses include 10 acres that will eventually be filled with projects such as Rain Garden.

With the exception of one Villebois resident who complained about the inclusion early on, the ability to blend adults with mental illness into the larger population has been seamless.

“We’ve spent a lot of time out there dispelling myths about mental illness,” said Cindy Becker, director of Clackamas County’s Department of Human Services. “The goal is to have people integrated, so no one even knows they live in a mental-health facility.”

Rain Garden’s tenants range in age from 18 to mid-60s, said Royce Bowlin, senior director of residential treatment services for Cascadia Behavioral Healthcare, which provides round-the-clock on-site services for residents.

Residents come from a variety of places, including group homes, family situations or the state hospital. All are screened to ensure they are capable of living on their own, he said.

“With proper medication management and regimen of counseling, these folks are able to function at a remarkably high level,” said Dennis Keenan, executive director of Catholic Charities of Oregon, Rain Garden’s owner and developer. “These folks are fitting right in there.”

Watson quickly agreed.

“I love it here,” she said. “I just love it. It’s first-class all the way.”

In the three weeks since moving from a group home in Tigard, she has taken her first guitar lesson, decorated her studio apartment with heart-felt items such as a rug her mother wove for her and started venturing regularly to Villebois’ Sunday farmers’ market.

“I understand what it’s like to hit rock bottom and be all alone,” she said. “I’m finally in a place where I don’t think that will ever happen again. Believe me, I couldn’t be happier.”

— Dana Tims;

Cascadia begins to pay back $2.3 million government loan

Cascadia begins to pay back $2.3 million government loan
Posted by mhaberman July 06, 2009 18:01PM

More than a year after its financial crash threatened to upend mental health care services in Multnomah County, Cascadia Behavioral Healthcare made its first payment on the $2.3 million government bailout that allowed the agency to stay afloat.

Cascadia, the county’s largest provider of mental health care services, came near to collapse in April 2008 under the weight of poor business practices.

The nonprofit company last week paid $90,000 toward the loan, said Althea Milechman , a Multnomah County spokeswoman.

Forty percent of that amount will go to the state Department of Human Services and the rest to the county. Payments are scheduled in increasing increments through February 2021.

At the time of the crash, Cascadia provided about 80 percent of the county’s adult mental health services, including housing, treatment and crisis services for mental illness and drug and alcohol addiction.

In the aftermath, Cascadia has transferred several clinics in Multnomah and Washington counties to other providers.

“We don’t want to put all of our eggs in one basket,” said Mindy Harris, Multnomah County chief financial officer .

–Gillian Frew:

Portland stalking victim stabbed to death

Portland stalking victim stabbed to death
Posted by Maxine Bernstein, The Oregonian April 15, 2009 20:24PM

Court records
Sean L. Kelly’s application for a stalking order against Ralph Williamson

Ralph A. Williams is still on the docket to appear in Multnomah County Circuit Court today to respond to his neighbor’s request for a permanent stalking order against him.
Ralph A. Williams
Instead, Williams, 54, faces murder charges, and his neighbor, Sean Liam Kelly, 40, lies in the morgue, dead of stab wounds and crushing blows to the head.

Kelly had been begging for help for at least the past month from Cascadia Behavioral Healthcare housing officials, police and the courts, citing his neighbor’s increasing threats of violence against him, court records show.
Sean Liam Kelly
He had hoped a judge would sign a permanent order today against Williams, who lived next door to him in an independent housing building for the mentally ill on North Chase Avenue.

Stalking orders between residents living side by side in special needs or public housing complexes aren’t uncommon. Judges can’t order people to move, making such orders a challenge. Judges say they must be creative to give the person seeking an order some sense of security and make sure they have a safety plan in place.

“It’s one of the most difficult things that we face,” Multnomah County Circuit Judge Cheryl Albrecht said. “In stalking orders, there’s just no ability to force someone to move from their residence. It’s not an effective remedy. It’s just not. You just hold your breath and try to be as direct and clear with the respondent about the scope of your order. It’s perilous at best.”

Kelly obtained a temporary stalking protective order against Williams last month, detailing ongoing harassment, intimidation, racial slurs and vandalism he endured from Williams.

Kelly, who was on unemployment and attending classes at Portland Community College’s Rock Creek campus, called police twice last month and documented the abuse, threats, property damage and growing tensions between him and Williams in back-and-forth e-mails to Cascadia Housing property manager Deborah Hicks.

In early March, Kelly said Williams poured six gallons of water into the gas tank of his car and then became aggressive and called Kelly a “snitch” after he reported the vandalism to police. He said Williams stuck his hand in his face, threatened to harm him, and banged on his apartment door while spewing profanity and racial slurs, according to the stalking order application.

“I was clearly not safe in my own house, and I began to be afraid of leaving my room,” Kelly wrote, noting Williams, at 6-foot-5 and more than 200 pounds, was much larger. Kelly was 5-foot-11 and weighed 160 pounds.

Cascadia had recommended mediation between the two men and urged Kelly “to stay clear” of Williams, although that was next to impossible because Williams lived in the neighboring unit and they shared a kitchen. Cascadia also recommended Kelly contact the courts or police and mailed Williams an eviction notice March 13, listing Kelly’s well-documented run-ins with Williams.

“I understand that you are fearful, and I would be too,” Hicks e-mailed Kelly on March 16. “I hope he doesn’t do anything to harm you, but you are totally within your rights to do whatever legally you can. … You want to do whatever you can to protect yourself while we wait this out.”

Cascadia does not staff the housing complex with a case manager, and the property manager is not on site.

Jim Hlava, Cascadia’s vice president for housing, said he could not talk about specifics but said the case would be reviewed internally.

Applicants must be assessed as “ready and capable” to live on their own, Hlava said. Cascadia also does a criminal background check and reviews the person’s documentation of income and disability.

Kelly moved to the North Chase Avenue unit early this year. It’s not clear how long Williams lived at the site. Williams also faced an unrelated domestic violence restraining order filed against him in March 2008, after he knocked a woman unconscious and stomped on her head, court records show.

Christy Brewfaugh, a close friend of Kelly’s mother, questioned why Williams was allowed to live in the building, considering his violent past.

Hlava said that when tenants don’t get along, Cascadia gives them options, whether it’s mediation or calls to police if there’s vandalism or violence.

“We take appropriate landlord action with the information that is given to us,” Hlava said. “We work within the landlord-tenant law.”

The court granted Kelly a temporary stalking protective order March 18. The next day, a Multnomah County sheriff’s deputy served the notice in person to Williams. It ordered Williams not to come into “visual or physical presence” of Kelly, speak with him or damage his property.

Just before 7 a.m. Tuesday, a 9-1-1 call came to Portland police, reporting an assault at the North Chase Avenue address. When police arrived, Williams was outside the building, and said, “Arrest me. … I stabbed him with a butcher knife.”

According to Williams, Kelly had come into the common kitchen area of the building, told Williams to get out of his way, and went back to his apartment. Williams told police he had “had enough” of Kelly, grabbed a butcher knife and waited for Kelly to return.

Once he returned, Williams told police, he “let the knife do the talking.”

He said he stabbed Kelly five to seven times in the upper chest and head. As Kelly tried to run across the street, Williams tried to stab him in the back, a probable cause affidavit says.

When the knife blade broke, Williams picked up a cinder block and struck Kelly in the face as he lay dying on the front yard of a neighbor’s home.

— Maxine Bernstein;


Reported feud ends in fatal attack

Reported feud ends in fatal attack
Stabbing – A resident of a Cascadia-run apartment is dead, and another is in custody
Wednesday, April 15, 2009
The Oregonian Staff

North Portland resident Lee Jensen was awakened Tuesday morning by men’s voices.

When he looked out the window of his front door on North Chase Avenue, he saw a man lying on his back on his front lawn, and another across the street saying, “If that guy moves again, I’m going to kill him.”

The 40-year-old man found on Jensen’s front lawn died, police said. His name was withheld until family could be notified.

The man across the street, identified as 54-year-old Ralph Anthony Williams, was arrested on accusations of first-degree murder, the Portland Police Bureau said.

Both were residents of a two-story apartment building at 9126 N. Chase Ave. run by Cascadia Behavioral Healthcare for the mentally ill. The two reportedly had a long-running dispute that may have involved a restraining order, police said.

Portland homicide detectives spent most of the day sorting out the circumstances of the killing.

The victim was struck in the head with a concrete block and stabbed, Jensen said. The knife was thrown onto Jensen’s front yard.

“I saw him take his last breath,” said Jensen, 66. “Over the last 30 years, I’ve killed more than a hundred deer and gutted them out. But to see something like this is so totally different. I’m still at the point where I’m going to throw up. I’m almost overwhelmed with dread.”

Jensen said he called 9-1-1 when he saw the body on his front lawn. He said the other man stayed outside, across the street, looking agitated, until police arrived.

North Precinct officers were first called at 6:53 a.m. A caller from the apartments reported someone violating a restraining order. When police arrived, they found the dead man on Jensen’s property.

Cascadia mental health care workers also were called to the scene.

Detectives were examining evidence that suggested the dispute or fight began at the apartment building and continued across the street. By 10 a.m., the victim’s body remained on Jensen’s front lawn, a yellow tarp concealing all but one leg.

The suspect, Williams, was arrested at the scene and was being cooperative, said Detective Mary Wheat, a police spokeswoman. He was treated at a local hospital for minor injuries.

The building is managed by Cascadia and is designed as independent housing for people with mental illness, said Jim Hlava, Cascadia’s vice president for housing. Cascadia has a property manager who checks on the building but is not a clinical manager.

“It’s a horrible, horrible tragedy. I think we’ve all been really shocked by this,” Hlava said.

Meena West, who lives nearby on North Newark Street, said she noticed the police cars and yellow police tape in her neighborhood early Tuesday and went outside to see what happened.

“A police lady told me there was a fight between two mentally challenged people. One was assaulted and killed,” West said.

West said she decided to take her children to school instead of allowing them to walk to the bus stop.

Tuesday’s stabbing came nearly a year after a stabbing at the same apartment building involving two other men.

On March 23, 2008, the Portland police Special Emergency Reaction Team used tear gas to force a 46-year-old man out of a bathroom he locked himself in at the home, after stabbing another resident, age 51. Neither of those men was involved in this stabbing, Wheat said.

Maxine Bernstein: 503-221-8212;