This story has been corrected to reflect the author of a January 4 letter to the auditor's office was the fire chief.

Amid lagging emergency response times, auditors say Portland’s health-focused, alternative response programs play a key role in freeing up police and fire resources, but have languished due to a lack of clear leadership and strategic goals.

A report from the Portland City Auditor’s Office released Wednesday found not enough has been done to ensure the success of programs like Portland Street Response and the Community Health Assess and Treat (CHAT) program, both of which are part of Portland Fire & Rescue (PF&R).

Portland Commissioner Rene Gonzalez oversees PF&R. Gonzalez acknowledged the value in the programs, but says he's in no hurry to expand or ramp them up, noting Portland Street Response (PSR) was the brainchild of "previous elected leadership."

The two programs–previously housed under the fire bureau's Community Health Division–were created as a way to provide “a more appropriate, less resource-intensive, response” to lower-priority 911 calls. CHAT deploys basic medical responders to handle calls involving low acuity, or non-emergency health issues, rather than a full fire crew or ambulance. PSR utilizes social workers and mental health professionals, rather than armed police, to respond to calls involving behavioral health crises, where no crime is reported.

Both programs were developed to help reduce the overall burden on the region's emergency systems.

A graphic demonstrates the fire bureau's response models. city of portland

In a recent review, auditors said the Community Health Division programs “appeared to have been caught in a no-win situation” due largely to inconsistent commitment to the programs, and a lack of stable management. Last summer, the Community Health Division was disbanded within the fire bureau, and the programs were moved under a training and operations division.

“Our audit found the Fire Bureau had not provided consistent guidance or leadership for the programs of the former Community Health Division, making it more difficult for the programs to demonstrate their value,” auditors noted, citing a lack of clear goals and priorities that stymied each program’s success. 

Auditors also noted a disconnect within the bureau. Fire crews are increasingly being asked to respond to calls involving mental health issues and unaddressed medical needs, which strain resources, but there’s been an apparent lack of recognition that the Community Health Division programs have helped in alleviating the problem. 

“That was especially true in the case of Portland Street Response,” the audit notes.

PSR was established as a non-police, trauma-informed, mobile crisis intervention unit in early 2021, designed primarily to respond to people in mental distress. PSR was championed by former City Commissioner Jo Ann Hardesty and was rolled out under her leadership. The program was initially launched on a limited basis, focusing on outer Southeast Portland during designated operating hours. It now operates 14 hours a day, city-wide. 

Hardesty lost her reelection bid in 2022 to Gonzalez, who was later assigned to oversee the fire bureau and the alternative response programs within it. 

With a change in bureau leadership came a change in priorities for the fire bureau. Almost immediately after taking office, Gonzalez announced he would bar PSR from distributing tents or tarps to unhoused people, citing concerns over fires from heating and cooking devices being used inside tents. While PSR was not built as a homeless services program, the majority of people its workers encounter don’t have stable housing. Gonzalez also signaled his intent to have PSR employees attend homeless campsite removal operations, or “sweeps,” reportedly as a means of connecting people with shelter and services. The shift in priorities led to discord among PSR employees, many of whom quit.

Later that year, Gonzalez implemented a hiring freeze within the program, despite police and firefighters often being saddled with overtime, and other program evaluations that recommended expanding staffing, and providing “more structure and support.” Auditors note the hiring freeze has since ended, but the program never expanded.

A two-year evaluation of PSR, completed by Portland State University and released last June, found PSR reduced police call volume by 3.5 percent. It also underscored “numerous areas of misalignment between PSR and the Fire Bureau.”

Gonzalez and PF&R leaders told the Mercury last year that PSR grew too quickly, without clear guidelines, and was beginning to function like a homeless services agency. 

In a January 4 letter to Portland City Auditor Simone Rede's office, Fire Chief Ryan Gillespie asserted part of the problem was that PSR, unlike CHAT, was developed within city hall, without meaningful input from PF&R.

Gillespie took exception to the audit team's assertion that the Community Health Division's goal was to reduce the workload of frontline crews, noting PSR was "designed to respond almost exclusively to calls for service that would otherwise go to Police." The fire chief argues neither CHAT nor PSR were created to reduce firefighter workload. The city's website states both programs were designed to reduce the volume of non-emergency calls being responded to by firefighters and police.

Auditors said PSR and the CHAT program were never set up properly, and never had stable funding or leadership. 

“Performance measurement is especially important when public resources are involved, programs are new, and important work is at stake,” the audit notes.

But while auditors concluded the health division programs likely help streamline the city’s emergency services and reduce waste, PSR has appeared to flounder. Under Gonzalez’s leadership, there’s been no funding to grow the program, and its future remains unclear.

The audit indicates Gonzalez is open to shifting PSR to Multnomah County, or to an independent nonprofit group to manage. 

In response to the program’s publicized woes, a community-led group called Friends of Portland Street Response formed, delivering a petition to city hall with more than 10,000 signatures, urging Gonzalez and city leaders to expand PSR staffing and support. Last month, after a follow-up letter to the commissioner and requests for meetings, the group said it had largely been brushed aside by Gonzalez.

Notably, PSR is uniquely positioned to qualify for Medicaid funds under the federal program's new rules. The city's audit team says Medicaid reimbursement is now available for community-based mobile crisis intervention services. PSR doesn't currently meet the criteria, but it could if it expanded to 24/7 service and provided ongoing care, similar to what Eugene's Cahoots program provides.

CHAT gets retooled

Last week, Gonzalez announced a new focus for the CHAT program. The commissioner said CHAT members will start deploying an overdose response team focused on Old Town, where the majority of drug overdose calls originate.

“I heard consistently from frontline first responders that the volume of overdose responses is killing the system, with the same patients overdosing repeatedly, typically refusing emergency room transport afterwards and often already being administered Narcan prior to arrival of Portland Fire,” Gonzalez said in a news announcement. “At the same time, the county is experiencing substantial shortage of ambulances. Concerned about the impact on our firefighters and on our system, I asked Portland Fire to evaluate an alternative overdose response and I am excited to see this pilot.” 

The OD response team will utilize two EMTs for each call it responds to. Gonzalez’s team didn’t respond to questions about how the new priorities for the CHAT team differ from how the program was already operating.

Even with the new OD team in place, Gonzalez signaled no plans to immediately implement the changes recommended by auditors, or bolster the Community Health Division programs.

In a response letter to the city’s audit, Gonzalez acknowledged CHAT and PSR are “critically important" and said he's committed to their success, but implied efforts to quickly expand the programs were Hardesty’s goals, not his.

“The specific programmatic opportunities for improvement your team identified reflect a desire on the part of previous elected leadership to expand Community Health as quickly as possible,” Gonzalez wrote. “While the urgency may be understandable, the need to ensure these programs are structurally sound, grounded in articulable, actionable goals, and financially cost-effective can no longer be ignored. As commissioner in charge of Portland Fire & Rescue, I am committed to these programs' long-term success and have full confidence in both bureau and program leadership to guide us there. Your audit serves as an important reminder that sometimes we need to ‘slow down to speed up.’”

Gonzalez’s team didn’t respond to the Mercury’s questions about the plans for the alternative response programs.