Heather Barr has worked in the health sciences and social services sectors in King County for more than 30 years, often in connection with marginalized, homeless or incarcerated populations and people struggling with substance-use disorders.

Substance-use disorder never occurs in a vacuum, Barr says, but is part of a much larger medical, social and behavioral picture. The most effective way to treat it is a holistic approach that considers the whole person and all their circumstances, including housing issues, physical/mental health and overall security and well-being.

That is the client-care model at Evergreen Treatment Services, which promotes health equity and community justice by delivering client-centered services to more than 7,000 people in the Puget Sound region, including clients at three opioid treatment clinics in Seattle, Renton and Lacey.

All ETS clients are dealing with substance-use disorder. Many have co-occurring mental and physical disorders. More than half lack stable housing.

“People often have a whole spectrum of things happening to them, especially people who’ve been living outside on the street,” Barr notes, adding that delivering health services to that population during the coronavirus crisis has been “hugely challenging.”

Since the pandemic’s onset, many social service providers have adapted their services to meet the needs of their clients. ETS shifted to telehealth for patients to interact with counselors and medical providers, and its REACH team, which provides street-based services and case management to people who are unhoused, stepped up services to fill the gaps in the system as a result of many food programs, shelters and government offices being shuttered.


The REACH mission is to meet and accept clients on their own terms while offering them support with no strings attached. Barr likens that approach to “putting arms around a person all the way.”

Barr worked closely with ETS during her years on the staff at Neighborcare Health, helping to manage medical care for ETS patients. She works for King County now.

She says robust community outreach is essential to serving a population that is often reluctant to ask for help, and whose needs often go far beyond substance-use treatment.

“People who are living homelessly need predictable, consistent outreach in order to build trust,” Barr says. “They need access to vaccinations. They need access to HIV screenings. A lot of times, they may just need a pair of socks. Or a cup of soup or a cup of coffee. Or a listening ear.”

In January, ETS began a one-stop-shop program using pop-up tents near area food banks and other essential partners so clients can access a range of services. They also offer space to charge a phone or apply online for Supplemental Nutritional Assistance Program benefits.

ETS meets people where they are. If someone is unhoused and using substances, they are not required to enter treatment to get support.

“They’re ready [to address their substance use] when they’re ready,” Barr says. “What helps is being present, and holding hope for people when they can’t hold hope for themselves.”

Despite advances in education and heightened public awareness of the opiate epidemic in the U.S., Barr says public misconceptions about substance-use disorder persist.

“No one wakes up one morning and decides to have a substance-use disorder. To someone on the outside, it’s baffling. They can’t understand what the drive to ‘use’ feels like,” she says. “It is one of the hardest things that can happen in someone’s life, and it’s very hard to come out of without support.”

Because hiding and isolation are habitual coping methods for people with substance-use issues, a large part of the recovery process involves relearning healthy coping methods and people skills, Barr says. That is why a healthy recovery journey out of substance use is often rife with turning points and eye-opening experiences.

“There’s an aspect to recovery which is learning to experience joy and access joy,” Barr says. “I know a lot of the women I’ve worked with had very challenging, punitive lives, and the idea of play and lightheartedness didn’t really come naturally to them. If someone can find a good time without using substances, that’s a victory.”

Evergreen Treatment Services has been transforming the lives of individuals and their communities since 1973. ETS provides a continuum of social services for more than 7,000 people in the Puget Sound region who are experiencing homelessness, addiction or both.