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About Aftercare
The Aftercare program provides voluntary, relationship-based support to community members following an initial response from Portland Street Response. Through ongoing outreach and case management, community health workers and peer specialists help individuals access housing, healthcare, recovery services, benefits, and other community resources.
By building trust and providing support over time, Aftercare helps people facing complex challenges move from crisis toward greater stability and connection to long-term care. If Portland Street Response responds to the immediate crisis, Aftercare helps people navigate what happens next.
This approach allows the program to:
- Build trust with individuals who are often difficult to engage;
- Address multiple barriers at once (housing, health, income, etc);
- Prevent repeated crisis cycles; and
- Support long-term stabilization rather than short-term fixes.
More information about Aftercare.
Key Outcomes
- 12 MSST assessments completed
- 5 referrals to the Portland Solutions Family Reunification Program
- 6 Safe Rest Village referrals submitted through Portland Solutions/311
- 45+ community resource referrals across healthcare, housing, recovery, food, benefits, employment, transportation, domestic violence, veteran, and shelter services.
Community Resource Connections
- Benefits - 6
- Food - 5
- Medical/Mental Health - 5
- Recovery - 5
- High Barrier Shelter - 4
- Set Aside Shelter - 3
- Clothing - 2
- Day Shelter - 2
- Veteran - 2
- Domestic Violence - 1
- Coordinated Entry - 1
- Hygiene - 1
- Overnight Shelter - 1
- Transportation - 1
- Employment - 1
- Family Shelter - 1
Aftercare Client Impact Highlights
Family Reunification & Parenting Support
- Following the birth of her child, who was subsequently placed into CPS custody, a client was hesitant to enter a mothers-and-children residential program but remained open to discussing other treatment options. Aftercare coordinated admission to Atlas Treatment Center and supportive housing through Atlas and Sober Living Oregon.
- A former client who previously completed residential treatment, achieved reunification with his children, closed his CPS case, and maintained 309 days of sobriety later returned for support after a relapse, demonstrating the lasting impact of relationship-based care.
Behavioral Health & Recovery
- Aftercare supported a client experiencing severe suicidal ideation related to homelessness, job loss, and violence. Staff provided emotional support, assisted with housing tours and financial assistance applications, and connected the client to intensive outpatient treatment.
- Aftercare supported a client who struggled in outpatient treatment and was initially resistant to residential care. Through motivational interviewing and ongoing engagement, the client entered CODA's 90-day residential treatment program.
- When a client left a residential program because the environment felt too restrictive, Aftercare helped identify a better fit through Atlas Treatment Center and Sober Living Oregon.
Housing & Shelter Stabilization
- Aftercare supported a client in applying for accessible housing through Quad Inc., helping navigate the application process and coordinate documentation.
- A client arriving in Portland from Idaho after neck fusion surgery was left sleeping in her truck while recovering. Aftercare connected her with EQUI Institute, transferred benefits, coordinated medical care, and explored housing options.
- Staff helped a client reconnect with hygiene services and establish a reliable mailing address, improving access to benefits, healthcare, and housing resources.
Medical Advocacy & Disability Support
- Aftercare partnered with a client through the long-term care application process, assisting with paperwork and documentation to maintain access to essential healthcare services.
- Aftercare supported a client in securing housing and attending long-awaited hernia surgery by coordinating transportation and providing emotional support.
- Staff coordinated transportation and wound care for a client using a wheelchair who had been unable to access hygiene services.
- Aftercare assisted a client living with multiple disabilities by coordinating Social Security appointments, transportation, housing referrals, and reconnecting the client with art and community resources.
Survivors, Safety & Specialized Services
- Aftercare supported a client new to Portland who was living with complex PTSD related to sexual assault and sex trafficking. Staff connected the client with mental health care, shelter resources, and volunteer opportunities before helping secure placement in a domestic violence shelter.
- Aftercare supported the parent of a child on the autism spectrum in connecting with IDD services, resulting in approval for Applied Behavior Analysis services.
Benefits, Basic Needs & Recovery Supports
- Aftercare assisted a client who had lost access to SNAP benefits by helping navigate the renewal process and obtain a replacement benefit card.
- Staff helped coordinate methadone treatment and assisted a client in verifying an upcoming court date.
- Although a client lived outside of Portland Street Response's service area and was ineligible for enrollment, Aftercare provided a warm handoff to ASIST and My Father's Heart to ensure continuity of care.
Community Partnerships & Systems Coordination
- Aftercare collaborated with the Cross Sector Case Conference, Aging and Disability Services, CareOregon, Portland Street Response, and Central City Concern to coordinate care planning and long-term supports for a client.
Program Themes
Across these stories, several themes emerged: the importance of long-term relationship building, the need for intensive systems navigation, the value of multidisciplinary partnerships, and the role of trauma-informed engagement in supporting community members beyond crisis.
