Central City Concern

Providing comprehensive solutions to ending homelessness
and achieving self-sufficiency.

She Learns from Her Patients... Old Town Clinic

Jul 14, 2014

by John Rumler
Reprinted with permission from the Portland Physician Scribe

The idealistic medical student at Dartmouth College yearned to work as a family doctor in the underserved backwoods of Maine. Instead, she found her calling working with underserved people in the heart of a big city.

Rachel Solotaroff, MD,medical director for Central City Concern (CCC), which serves about 13,000 people annually with health care, housing, peer support and employment, received the Karen Rotondo Award for Outstanding Service at the National Healthcare for the Homeless Conference last month. Rotondo, who died earlier this year of cancer, was an RN who was instrumental in building the nationwide health care network that exists for the homeless today. (photo by Heidi Hoffman)

The award recognizes hands-on caregivers who demonstrate vision and creativity in advancing the goals of ending and preventing homelessness, and who have made a significant contribution to improving the health and quality of life of people experiencing homelessness.

Solotaroff, who still spends 18 to 20 hours a week seeing patients, is credited with transforming CCC’s Old Town Clinic into a patient-centered primary care home model and was recognized last year by the Robert Wood Johnson Foundation as “a national exemplary practice of patient-centered health care.” In addition to leading the Old Town Clinic, which serves about 4,000 patients yearly, Solotaroff has championed the development of a chronic pain program, which has become a national model for its innovative and effective approach to addressing chronic pain among homeless patients with histories of addiction.

Her unique dual role as CCC’s medical director and faculty member at Oregon Health & Science University has brought dividends: Solotaroff helped develop the social medicine curriculum for OHSU residents, and now all internal medicine residents rotate through Old Town Clinic twice.

Chief Medical Officer of Health Share of Oregon David Labby has known Solotaroff since she started at CCC in 2006. “Rachel listens very deeply to the community she serves. She seeks connections, she learns from her patients and is guided by their experiences,” he said. “We’ve all gained from Rachel’s commitment and passion for helping others, and she can be counted on to add a perspective you didn’t think of yourself, which is wonderful.”

Solotaroff’s father was an English professor at the University of Minnesota and her mother was general manager of the St. Paul Chamber Orchestra. Her parents divorced when she was 8. Her stepfather, Bernard Mirkin, MD, PhD, was a neuropharmacology researcher and founded a research institute at Childrens’ Memorial Hospital in Chicago. “It would be nice to say that Bernard affected my decision to go to medical school, but that wasn’t the case,” Solotaroff said. “His line of work was so different than what I do. I’ve tried research and I am terrible at it,” she said.

The decision to become a doctor came to Solotaroff in an odd way. After graduating with an English degree from Brown University, she lived near Swans Island, Maine, a tiny fishing community where the family had spent summers vacationing. She lived deep in the woods in a shack without heat or running water and happened to read “Heirs of General Practice,” an article in the July, 1984 New Yorker by John McPhee. “I read it with the zeal I usually reserved for their movie reviews and when I put it down I thought: ‘This is what I want to do with my life,’” she said.

But it was five years before she returned to New England to study medicine at Dartmouth, where she graduated with honors. In between, she worked for City Year, a cutting-edge youth service organization.

“I cut my teeth on community service and learned about diversity, idealism, organizational culture and visionary leadership,” she said.

Humble, approachable and compassionate, Solotaroff has benefitted from many mentors over the years, but two stand out. Alan Khazei, one of the founders of City Year, encouraged her funny and creative side. “My father is very gifted comically and he taught me a love for impersonation and performance, but that desire to be onstage seemed selfish to me. Alan encouraged me to nurture and develop that part of me, and he taught me that leadership can be charismatic without being self-aggrandizing.”

The other mentor, Michael LaCombe, MD, she met during her third year in medical school when she was doing an internal medicine rotation. Solotaroff was struggling, wanting to stay true to her goal of becoming a family physician, but feeling that the internal medicine experience challenged and engaged her in a whole new way.

“Dr. LaCombe gave me the most valuable advice imaginable when he told me, ‘You can always step down and work anywhere you want, but when you have the option to learn and train, pick the most rigorous option, because you may never get that chance again.’” LaCombe continued to mentor Solotaroff personally and professionally through med school, her residency and beyond, and he officiated her wedding in 2005.

Solotaroff was an internal medicine resident at the University of Virginia when she met Tony Iaccarino, her future husband. A teacher at Reed College, he happened to be doing a research fellowship in Charlottesville. That brought Solotaroff to Portland, where she garnered a fellowship at the VA hospital.

Executive Director of the Oregon Primary Care Association Craig Hostetler has known Solotaroff for seven years and describes her as humble, approachable and compassionate. “But when it comes to her patients, she’s very smart and aggressive,” he said. “We need more doctors like Rachel who factor in the psychological and socioeconomic issues her patients face and make greater strides to improve their health outcomes while lowering the overall cost of care.” 



Winning Rebound

Jun 19, 2014

Carl Appleton, Jr., slides his 6’ 3” frame into a small arm chair at a local coffee shop and begins speaking softly about his journey to Oregon State University as a recruited tight-end for the football team, his turn into addiction and trouble, and his rise back as scholar, athlete and potential basketball recruit for one of Oregon’s most prominent private schools.

“I decided to go to more parties than classes,” Carl reflects. That lifestyle, plus a high-profile incident, got Carl kicked off the team and resulted in jail time. Once released and without his identity as a revered athlete, he drifted in and out of addiction. “I never had an adult male in my life with no strings,” he says. “Everybody involved wanted to be attached to my athletics or attached to my successes in some other way. It was hard to fill the football gap in my life.”

His mother watched him warily for 10 years as he struggled to find his way. He deftly avoided tough conversations with her. His sister, with two young children, cut him off entirely. Intermittently, he slept on friends’ couches and under bridges on the east side of Portland. From the ages of 18 until 28, Carl committed petty crimes to support his addiction and he was never out of jail for more than six months.

Two years ago, after another arrest and release, he entered an inpatient drug treatment center. While at the treatment center, Carl attended a group meeting where he met guest speaker, David Fitzgerald, a Recovery Mentor at Central City Concern. David laid out what it takes to achieve long-term recovery. Carl was excited to learn that CCC’s  Mentor program combines clean & sober housing with, regular meetings,  one-on-one counseling and access to employment services. “We work on the transitioning people from treatment back to the community,” says David. “Carl had never had that kind of support before.”

Over a few one-on-one conversations with David, Carl was convinced that he would benefit from the Mentor Program. (Carl is flanked by Mentor staff in photo below.) He says “I wanted this to be the last time that I got my life together.”

Living in Central City Concern housing with other participants in the Mentor Program was key for Carl. “The Mentor Program gave me an opportunity to take the steps in a controlled environment instead of just talking about it,” Carl says. He also joined CCC’s Community Volunteer Corps, participating in 80 hours of mentored volunteer work in the community.

After completing the Mentor Program, Carl moved into a clean and sober housing environment and began taking classes at Portland Community College. He has a 3.3 GPA and is focusing on sociology with an eye toward earning a masters degree.

He has also been a leader on the school’s basketball team that recently won the NW Athletic Association of Community Colleges Championship. Carl was named the tournament’s most inspirational player.  At age 29, he says, “I’m the old guy on the team.” His coach credits him with being a continual, level-headed inspiration to the younger members.

Carl grins as he recalls the Championship game and the options for his future. He smiles as he talks about how his sister’s young children (ages 2 and 4) now run to hug him with cries of “Uncle! Uncle!”

“It’s amazing how much traction you can make in your life when people give you another chance.” he says.

********

This blog post also appears in our Chronicle newsletter, available online and in print format.
Read more about Carl's basketball success in this article from the Portland Tribune.



Rachel Solotaroff Receives National Honor

May 29, 2014

Today in New Orleans, LA, Rachel Solotaroff, Medical Director for Central City Concern received the Karen Rotondo Award for Outstanding Service today at the National Healthcare for the Homeless Conference that draws more than 800 medical and housing professionals from across the country. The award has been bestowed since 1996 and was renamed in honor of Massachusetts nurse Karen Rotondo in 2013.

The award recognizes hands-on caregivers who demonstrate vision and creativity in advancing the goals of ending and preventing homelessness, and who have made a significant contribution to improving the health and quality of life of people experiencing homelessness.

Dr. Solotaroff has worked at Central City Concern since 2006. In addition to leading Central City Concern’s Old Town Clinic, a Federally Qualified Health Center, serving about 4,000 patients yearly, Dr. Solotaroff has led the development of a chronic pain program, which has become a local and national model for its innovative and effective approach to addressing chronic pain among homeless patients with histories of addiction.

Her dual role as CCC’s Medical Director and faculty at OHSU helped develop the Social Medicine Curriculum for OHSU residents, through which all Internal Medicine residents rotate through Old Town Clinic twice.  Dr. Solotaroff currently spends 18 – 20 hours a week as a physician seeing patients during daytime and evening clinic at Old Town Clinic, in addition to her Medical Director role, leadership of the agency as part of the senior management team and involvement in many projects with community partners.

Dr. Solotaroff has been responsible for leading Old Town Clinic into a new model of care, the patient-centered primary care home model.  This model is based on care teams dedicated to building long term supportive relationships with their assigned patient panels with the goal of not simply providing services, but improving health and life outcomes.

Last year, the Old Town Clinic primary care home model was recognized by the Robert Wood Johnson Foundation as a national exemplary practice of “patient-centered health care” through the “LEAP Project,” an acronym that stands for “Learning from Effective Ambulatory Practices.” The clinic was one of 30 clinics nationwide selected for this recognition.

CCC’s Leslie Tallyn, Senior Director of Clinical Operations and Quality, said “Rachel is the heart, soul, and conscience of Central City Concern’s health care programs. She sees the forest and the trees, linking the individual experiences of her patients to big, systems-level issues, and her systems-focused work to what she hears in the exam room every day from patients. She challenges us every day to be the health system our patients deserve, the best health system we can be.”

Dr. Solotaroff earned her BA from Brown University and her Doctor of Medicine with Honors from Dartmouth College.

Central City Bed®

Central City Bed ® - unfriendly to bed bugs, stackable, easy to clean and reuse.We'll be at the National Alliance to End Homelessness Conference, July 29-31, 2014.  Learn more »


Data Event »

National Health Center Week

August 10-16, 2014 - On Friday, August 15th at 9:30 a.m., join Old Town Clinic and the Oregon Primary Care Association in recognizing the work of Congresswoman Suzanne Bonamici and honoring individuals who have helped enroll thousands of Oregonians in quality health care coverage. Event held at Old Town Recovery Center, 33 NW Broadway. Learn more »

Central City Coffee

Through craft roasting coffee in Portland, OR., Central City Coffee supports the clients and mission of Central City Concern. Central City Coffee now available at local retailers! Learn more »
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