Since 2023, Leigh Richards has been assisting first-time mothers through what can be one of the toughest periods in their lives.
Working as a registered nurse with Multnomah County’s Nurse-Family Partnership, Richards offers medical care, guidance, and advocacy, helping low-income mothers navigate early childhood challenges and the healthcare system.
However, come July, her position might be eliminated.
“What we’ve been told really is that the likelihood of the program being saved is quite slim,” Richards, who is part of the Oregon Nurses Association, remarked.
Richards represents one of many Health Department employees facing potential job losses as Multnomah County struggles with a significant budget deficit. Proposed cuts from county Chair Jessica Vega Pederson will be voted on by the Board of Commissioners soon, with plans to eliminate positions, limit services at the county’s STD clinic, and cut the long-standing Nurse-Family Partnership.
These cuts not only threaten to undermine the largest public health provider in the Portland area but could also strain an already overworked workforce at the Health Department, which handles health clinics, mental health services, veteran care, illness data collection, and more. Department leaders are concerned that the stress could result in increased turnover and turmoil in the future.
“It’s something I want to minimize,” said Health Director Rachael Banks, “But I think it’s inevitable.”
The county is navigating a challenging financial situation, with its overall operating budget reduced by $77.3 million—or about 3% from last year’s figures. This includes a $15.5 million shortfall in its general fund, which amounts to the largest reserve of discretionary funds available.
To address the deficit, Vega Pederson has suggested more than 8.6% in cuts, roughly $7 million, to the Health Department budget—the largest percentage cut of any department—with potential reductions impacting up to 81 positions across multiple divisions. This comes alongside the end of a $3.2 million grant from the Centers for Disease Control and Prevention and losses from other federal funding supporting disease prevention.
“We are responsible for the health—physical, behavioral, and oral—of everyone in Multnomah County,” Banks emphasized. “We are the only health entity that does that.”
Employees already feel burned out
Prior to these proposed budget reductions, health department staff were already facing significant understaffing and fatigue.
A survey conducted last August revealed that over half of department employees reported feelings of burnout, with many suggesting that more staffing could alleviate their stress. It’s not clear what, if anything, the county did in response to these results.
By March of this year, about 53% reported feeling burned out, with roughly 11% of 253 respondents stating they were so fatigued they might need changes or help.
“Whether it’s the public health workforce or providers, they were under strain even before these cuts,” Banks remarked.
Vega Pederson has suggested that the upcoming budget will “absolutely have impacts on Health Department capacity,” although she insisted it avoids deeper cuts to frontline workers and programs.
“The Health Department has undergone several challenging cuts,” Vega Pederson noted in a statement. “We specifically aimed this year to limit reductions that directly impact services.”
Proposed layoffs might mean those who remain will have to take on more responsibilities as they deal with complex and vital work, according to department leaders.
While the largest cuts will affect administrative staff to protect frontline services, there are still substantial reductions slated for those providing medical care, outreach, and disease monitoring, which may lead to frontline staff taking on additional administrative tasks.
“We need those support systems to function effectively,” Public Health Director Kirsten Aird stated.
Workers have known about potential layoffs since February but won’t know the future of their jobs until the final budget passes. County commissioners have presented various amendments aiming to save some programs while reducing others.
Banks commented that her department has experienced notable turnover in recent years, and the ongoing tumultuous budget process hasn’t helped matters.
“If you know your job might be impacted, it’s only natural to start exploring other options,” Banks said, acknowledging that the instability leads to attrition.
Increasing uncertainty at the federal level compounds the issue, with possible cuts to Medicaid and other federal grants creating even greater financial implications for the county, which relies heavily on federal funding.
“We’ll need to reassess based on what we understand about both state and federal funding,” Banks added.
For Kate Horn, a nurse on the county’s communicable disease team, the restructuring has felt unsettling. As her team shifts from relying on nurses to disease investigators, she anticipates likely losing her job after a decade with the county.
“I understand these choices are difficult for everyone involved,” she said. “But the work we do is crucial for the community.”
Doing less with less
In conversations about tightening budgets, the Health Department’s mantra is straightforward.
“We’re going to have to do less with less,” Banks stated.
The reductions will affect nearly every aspect of the department’s operations, with corrections health being the only exception.
Proposed cutbacks threaten to diminish certain public health services and eliminate others entirely. The county’s immunization clinic, which provided free vaccines, is expected to close soon due to the expiration of temporary COVID-era federal funding. Keeping it operational would cost around $1.45 million annually, so residents and schools will lose access to those services—though at least two staff will remain to work on childhood vaccinations.
The sexually transmitted disease clinic is poised to see nearly a 50% budget cut, leading it to close on Fridays and cut four positions. The clinic, which offers low-cost appointments, plays a key role in addressing outbreaks of diseases like gonorrhea, syphilis, and HIV and does not turn clients away, serving many low-income or homeless individuals.
Further mental health programs face cuts, including one that assists families with medical necessities and another that funds care and medication for individuals lacking insurance.
The county’s Promoting Access to Hope Team—a program aimed at outreach to those battling substance use or homelessness—would also be scaled back.
While Vega Pederson had suggested deep reductions to school-based mental health counselors, some commissioners have stepped in with amendments to protect those positions, and conversations about preserving funding to the STD clinic are ongoing.
In addition to losing staff across various programs, the Health Department will face millions in funding cuts for supplies at the STD clinic, harm reduction materials, behavioral health services, addiction treatment, and disease prevention efforts like mosquito control.
Fewer places to turn
Despite these cutbacks, the proposed budget aims to retain nearly all programs within the Health Department—with one major exception.
The county’s longstanding Nurse-Family Partnership program, known nationally for its success, is unlikely to continue serving expectant mothers in Multnomah County if the proposed budget goes through. This program aids low-income mothers for up to two years as they navigate the challenges of parenthood.
“We meet people where they are instead of requiring them to come in,” Richards explained. “We see a significant number of young parents and those who face various barriers to accessing care, and now they’re dealing with pregnancy and family planning.”
Nurses in the program conduct health assessments, connect families with further medical resources, and refer mothers to additional support. They also build personal relationships with vulnerable mothers, helping them envision their futures, Richards mentioned.
Funding the program for the next fiscal year would require around $1.17 million. It is one of three programs recommended for elimination by Vega Pederson amidst tough budget decisions.
Currently, eight nurses in the county program support 207 families, with each nurse managing about 25 clients.
County officials anticipate relying more on other programs to fill this gap, pushing responsibilities onto initiatives like the federally-funded Women, Infants and Children Program, which provides nutritional and breastfeeding support, as well as the Healthy Families program, which offers in-home assistance for new parents, and the Healthy Birth Initiatives for pregnant Black women.
However, staff in those programs will need to juggle the additional caseload from the Nurse-Family Partnership, even as they themselves face uncertainties tied to federal funding. The Trump administration has suggested cuts to the benefits of the women and children’s program.
Richards expressed concern about the impact this would have on parents “who are facing more barriers than ever.” She emphasized how essential the county’s support system for new mothers is.
“I ended up triaging one client to the hospital, and they were admitted for preeclampsia, which is a serious situation,” Richards recounted. “Fortunately, they engaged with the care system and were able to have a healthy baby.”
The Nurse-Family Partnership had been a crucial resource for Jenna Brett during a tough time nearly a decade ago. After meeting her nurse, Thea Nealschneider, in 2015, Brett faced significant challenges, including navigating a complicated relationship with her child’s father.
Things took a turn when her son, Augustus, was born more than ten weeks prematurely.
“Thea visited me” in the neonatal intensive care unit, Brett recalled. “She helped me stay calm during what was definitely the most stressful time of my life.”
Brett noted that the Nurse-Family Partnership was pivotal in her journey as a parent, providing connections to resources for clothing and housing, in addition to support with breastfeeding and medical issues.
“She was there to help me maintain my sanity,” Brett stated. “I never expected this kind of support.”
The last dash
On Thursday, the Board of Commissioners will make definitive decisions on funding allocations. They have been vocal about their priorities throughout the discussions surrounding the $4 billion fiscal plan, emphasizing the need to restore homelessness abatement programs, improve staffing in the District Attorney’s Office, and fund a memorial for Chinese Americans once buried in Lone Fir Cemetery.
However, it seems less likely that substantial funding will be restored for the Health Department, except perhaps some efforts towards saving the school-based mental health program and certain portions of the STD clinic budget.
Once the budget is finalized, county employees, who have been anxiously awaiting the outcome, will learn their job status. Officials have indicated that human resources is preparing to assist some affected staff in transitioning to vacant roles.
Forecasts suggest that this challenging budget cycle may not be a one-off occurrence, as the county expects continued deficits in its general fund in the coming years. Health officials are actively seeking ways to enhance program self-sufficiency and reduce dependency on shaky funding by exploring new insurance billing methods. Banks also mentioned implementing a workforce retention plan aimed at limiting turnover through new training and academic opportunities for staff.
“I want people to feel secure about working here,” Banks expressed. “We’ve accomplished great work and will continue to do so. Our focus remains on our mission and core services.”
