CAHOOTS: A Model for Prehospital Mental Health Crisis Intervention

By Ben Adam Climer and Brenton Gicker, January 2021 – Psychiatric Times

CAHOOTS (Crisis Assistance Helping Out On The Streets) is a mobile crisis intervention program that was created in 1989 as a collaboration between White Bird Clinic and the City of Eugene, Oregon. Its mission is to improve the city’s response to mental illness, substance abuse, and homelessness.

CAHOOTS is operated by White Bird Clinic, which was formed in 1969 by members of the 1960s countercultural movement. They were interested in alternative and experimental approaches to addressing societal problems. Today, White Bird Clinic operates more than a dozen programs, primarily serving low-in-come and indigent clientele.

The CAHOOTS model was developed through discussions with the city government, police department, fire department, emergency medical services (EMS), mental health department, and others. The name CAHOOTS is based on the irony of White Bird Clinic’s alternative, countercultural staff collaborating with law enforcement and mainstream agencies for the common good.

cahoots medic

Photo by William “Bill” Holderfield

When it began, CAHOOTS had very limited availability in Eugene. It has grown into a 24-hour service in 2 cities, Eugene and Springfield, with multiple vans running during peak hours in Eugene. The program—which now responds to more than 65 calls per day—has more than quadrupled in size during the past decade due to societal needs and the increasing popularity of the program.

Programs based on the CAHOOTS model are being launched in numerous cities, including Denver, Oakland, Olympia, Portland, and others. Federal legislation could mandate states to create CAHOOTS-style programs in the near future.

Senators Ron Wyden of Oregon and Catherine Cortez Masto of Nevada have proposed a bill that would give states $25 million to establish or build up existing programs. 

How Does It Work?

When CAHOOTS was formed, the Eugene police and fire departments were a single entity called the Department of Public Safety. CAHOOTS was designed to be a hybrid service capable of handling noncriminal, nonemergency police and medical calls, as well as other requests for service that are not clearly criminal or medical.

Eugene’s police and fire departments eventually split. CAHOOTS was absorbed into the police department’s budget and dispatch system. It continues to respond to requests typically handled by police and EMS with its integrated health care model.

CAHOOTS operates with teams of 2: a crisis intervention worker who is skilled in counseling and deescalation techniques, and a medic who is either an EMT or a nurse. This pairing allows CAHOOTS teams to respond to a broad range of situations. For example, if an individual is feeling suicidal and they cut themselves, is the situation medical or psychiatric? Obviously, it is both, and CAHOOTS teams are equipped to address both issues. Typically, such a call involving an individual who engaged in self-harm would result in a response from police and EMS. This over-response is rarely necessary. It can also be costly and intimidating for the patient. They are not criminals, and their wounds are often not serious enough to require more than basic first aid in the field. These patients are usually seeking help, and a CAHOOTS team is trained to address both the emotional and physical needs of the patient while alleviating the need for police and EMS involvement. If necessary, CAHOOTS can transport patients to facilities such as the emergency department, crisis center, detox center, or shelter free of charge.

CAHOOTS is contacted by police dispatchers. If you call the nonemergency police line or 911 in the cities of Eugene or Springfield, you can request CAHOOTS for a broad range of problems, including mental health crises, intoxication, minor medical needs, and more. Dispatchers also route certain police and EMS calls to CAHOOTS if they determine that is appropriate.

CAHOOTS, to a large extent, operates as a free, confidential, alternative or auxiliary to police and EMS. Those services are overburdened with psych-social calls that they are often ill-equipped to handle. CAHOOTS staff rely on their persuasion and deescalation skills to manage situations, not force. Only in rare cases do CAHOOTS staff request police or EMS to transport patients against their will.

CAHOOTS Crisis Worker

Photo by William “Bill” Holderfield

A Backup Plan

If a psychiatrist or other mental health provider in the Eugene/Springfield area is concerned about a patient, they can call CAHOOTS for assistance. This usually results in a welfare check.

Let us say, hypothetically, that you are concerned about a patient with bipolar disorder. After a lengthy period of stability, they have been complaining to you that they feel like their prescribed medication is no longer working effectively. You begin receiving phone messages and emails from them consisting of fanatical rantings and incoherent gibberish.

You are concerned, but it is not so severe that you feel compelled to call the police. Perhaps you are reluctant to call law enforcement for a variety of reasons. What do you do? You call CAHOOTS.

Having responded to a similar scenario recently, let me describe what occurred. The patient, although not expecting us, welcomed our response. They explained to us that they felt like their medication was ineffective, and, after days of mania, they were feeling depressed and suicidal.

The patient recognized their own decompensation, and eagerly accepted transport to the hospital. Their mental health care provider was informed that we were transporting them and called the hospital to provide additional information.

We transported the patient to the hospital, and they were admitted to the inpatient psychiatric unit for stabilization. Collaboration between prehospital, hospital, and outpatient services facilitated that incident as smoothly as possible.

Barriers and How to Help

Prehospital mental health crisis response is underdeveloped. Most often, police and EMS are the only options. In some cities, clinicians with masters or doctoral degrees are sent with first responders. Unfortunately, the supply of these clinicians is not enough to meet the demand, but does it need to? Ambulances do not staff medical doctors. Why should prehospital mental health care require masters/doctoral level licensed clinicians? Telepsychiatry services, while important, are no substitute for direct human contact, especially given that some patients will need to be transported to a higher level of care and many do not have the means or ability to participate in telehealth services (because of lack of capacity or lack of resources).

The biggest barrier to CAHOOTS-style mobile crisis expansion is the belief that without licensed clinicians and police, prehospital mental health assistance is ineffective and unsafe. If psychiatrists want a program like this in their area, they can help by using their considerable authority to assure the community that response teams like CAHOOTS can work. Because of their direct lines of communication to the police and familiarity with police procedures, CAHOOTS staff are able to respond to high acuity mental health crisis scenarios in the field beyond what is typically allowed for mental health service providers, which often facilitates positive outcomes and can even prevent deadly outcomes. Their support is vital for program success.

Mr. Climer worked for CAHOOTS as a crisis worker for 5 years and an EMT for 2.5 of those years. He now lives in Pasadena, CA where he helps Southern California cities develop CAHOOTS-style programs. Mr. Gicker is a registered nurse and emergency medical technician who has worked for CAHOOTS since 2008.

IMSA catches up with Section 9813

What AMSA knows about Section 9813 – as of March 24, 2021


Q – What qualifies an operator to receive funding?

A – Operators must be approved for Medicaid billing. Basic other qualifications are listed in the initial rules.

Q – What’s the urgency?

A – Funding for services will not be available for 15+ months from now. Limited funding for planning will be available in a couple of months.

Q – Who’s in charge at the Federal level?

A – Chiquita Brooks-LaSure has been nominated to be the next director of the Centers for Medicare & Medicaid Services (CMS). Leadership will be announced some time after confirmation – a couple of months.

More about Chiquita Brooks-LaSure

Q – Will there be more rules issued by CMS?

A – CMS always has additional rules.

Q – Who’s in charge at the state level?

A – Likely someone with your state Medicaid office. IMSA will have a list of contact people for our April meeting.

Q – Which state agency will provide the funding?

A – Medicaid. At this point funding will be available by Medicaid through a claims process.

Q – Will states need to do anything to be eligible for these funds?

A – Maybe not. Some states and territories already have a CMS Section 1115 waiver. Section 1115 waivers to the Social Security Act are vehicles states can use to test new or existing ways to deliver and pay for health care services in Medicaid. Section 9813 is within this waiver.

These states and territories DO NOT have a 1115 waiver – Arizona, Connecticut, Kansas, Nevada, New Jersey, Puerto Rico, Tennessee, Utah.

A month into pilot program, Portland Street Response Team brings hope to the streets

Published March 19, 2021 @

Members of the Portland Street Response Team discussed how the pilot program is going and its future on this week’s episode of “Straight Talk with Laural Porter.”

Portland Street Response Team paramedic Tremaine Clayton was on one of the most difficult calls yet in the team’s first month operating in the Lents neighborhood. He and team member, Britt Urban, a mental health clinician, weren’t sure they were going to be able to help their client, but then, finally, there was a connection.

Clayton called the moment a “glimmer” when you realize hope is possible.

“I kid you not, a rainbow came out,” Clayton said. “So, we said, you know what, that’s the glimmer. It was the best possible outcome we could have had. The rainbow was shining. That’s the hope we are talking about.”

Clayton said the person they had come to help eventually understood they were there to support them and not just to run them through the system. He felt they made a difference that day. And that’s the ultimate goal of the new Portland Street Response Team, which offers a non-police response to assist people in a behavioral or mental health crisis, or experiencing homelessness.

After a review of the Portland Police Bureau, the city auditor’s office confirmed a report from The Oregonian that found about half of the arrests made in 2017 and 2018 were of people who were homeless. Portland Street Response is designed to offer an alternative.

Clayton and Portland Street Response Team program manager Robyn Burek discussed how the pilot program is going so far and its future in this week’s episode of “Straight Talk.”

After months of delays because of the pandemic, the team began taking calls on Feb. 16. Burek and Clayton had been working together on the program since 2019. Burek called getting the Portland Street Response Team underway deeply emotional and gratifying.

“There are not a lot of things we work on in our lives where you see the culmination of things and get to experience it in the moment. So, it has been great,” she said.

Portland Commissioner Jo Ann Hardesty has led the way on the team’s development. She said she was giddy about the launch and can’t wait to get information back from the pilot year of the program.

“We are going to learn everything we can with this pilot so we can roll it out citywide, and we are being informed by what is happening on the ground,” Hardesty said.

In its pilot year, the Portland Street Response Team is operating only in the Lents neighborhood, which includes roughly five square miles from Southeast 72nd to Southeast 111th and from Clatsop up to parts of Powell and Division.

The team chose Lents because of its cultural diversity. Burek said 150 languages are spoken in the neighborhood. It also has a growing homeless population and is an under-served community.

Another reason Lents was chosen for the pilot is the volume of calls from the area to 911. It’s been outpacing the growth of calls across the rest of the city.

“The need was there. All the pieces were in place. It just seemed like the perfect spot for us to run this pilot,” Burek said.

Commissioner Hardesty said the team spent a lot of time in the Lents neighborhood preparing to launch its first unit. Team members met with neighbors, businesses and neighborhood associations to explain the work they would be doing on the ground.

She said those meetings were key. The Lents community welcomed them and asked, “What do you need?” Hardesty thanked them for their support.

“I want to give a big shoutout to the Lents community who embraced this project with open arms and are true community partners with us,” Hardesty said. “They want this program to succeed as much as I do, and I want to make sure those neighbors understand how much I appreciate their support.”

For now, Portland Street Response is only taking calls in Lents. People needing help or calling for someone else in need of assistance can call 911 or the non-emergency number at 503-823-3333.

Dispatchers are trained to triage calls and will ask a series of questions to determine the appropriate response, whether to send an officer or Portland Street Response.

“They are very excited to send us. If you call them, they will definitely be triaging,” Burek said.

Many of the calls referred to the Portland Street Response team involve people who are homeless. Burek pointed out that homelessness disproportionately impacts Black, Indigenous, and people of color. According to a 2019 count by Transition Projects, she said, they make up 38.1% of the homeless population.

And they tend to fall into two systems; the jail system and the emergency department, both of which have long-term ramifications.

“We are not going to cure homelessness,” Burek said. “But, we can intervene and divert people into resources that will help them find housing, that will help them get the treatment they need. Our hope is we help improve their lives and help them get out of that cycle sooner rather than later.”

According to Commissioner Hardesty, one of the biggest issues the team faces right now is having enough places to take people in crisis that aren’t jails or emergency rooms.

“We don’t have enough mental health service providers to serve the needs of people on the street or in the community,” Hardesty said.

“And we don’t have enough culturally competent or culturally-specific providers to meet the extraordinary need that we have,” she said.

Hardesty is hopeful the program will get significant resources from the passage of Oregon ballot Measure 110, which decriminalized drug possession and established a drug treatment program funded in part by cannabis taxes.

“That would help a lot. We also need the state to be a partner in investing in mental health treatments in our community,” Hardesty said.

The Portland Street Response Team is going to need more sources of funding to achieve its goal of expanding citywide. One source of funding could come from Congress.

Sen. Ron Wyden has introduced the “CAHOOTS Act.” CAHOOTS is the alternative first responder model in Eugene that inspired the Portland Street Response Team. Wyden’s bill would provide a 95% Medicaid match for cities that start similar programs nationwide.

Robyn Burek said they’re also hopeful the Oregon Legislature will approve a $10 million grant to be distributed across the state for programs like Portland Street Response.

Portland Street Response currently has one team that answers calls Monday through Friday from 10 a.m. to 6 p.m. However, Burek said they hope to add an additional team in July or August that would take calls from 4 p.m. to midnight and cover some weekend shifts.

“We won’t have 24-7 coverage in Lents, but we will try to get as close to that as possible with our second team,” she said.

The ultimate goal is to expand the program throughout the city of Portland.

“Here’s what I know for sure. Portlanders want Portland Street Response in every neighborhood in our community, and it’s my job to figure out how to get it on the fast track in a way that keeps the integrity of the program intact,” Commissioner Hardesty said.

In February of 2022, Portland Street Response team members will go before the Portland City Council to report their findings on the pilot program. In addition, Portland State University is doing its own independent evaluation and will also report its findings to the council.

Burek said she’s hopeful the council will agree to fully fund Portland Street Response to expand across the city.

“We will use this pilot year to collect the data and really understand what the scale of that might look like,” Burek said.

As the team looks at expansion, Hardesty says it is important to her team members are paid a living wage.

“The people we hired reflect the community they serve in the Lents neighborhood. They are multi-lingual, and they are paid a living wage,” Hardesty said.

Many people who work in the mental health industry make low wages and Hardesty said they can burn out. Burek, who has a Master’s degree in counseling, agreed with Hardesty.

“I am a licensed therapist and when I started in 2007, I was making $28,000 a year — with a Master’s degree,” she said.

Not a lot has changed since then. Burek said CAHOOTS in Eugene typically pays its workers between $15 and $18 an hour.

“It’s really important we set the bar in Portland and say we value the work these individuals are doing and this industry has to offer,” she said.

Hardesty said it’s important to her in building the Portland Street Response program to do it right, not fast.

“I am intent on hiring people who can provide empathy and empathetic responses to people on the street, and those people shouldn’t have to worry about where they’ll sleep or whether or not they can pay their light bill or whether they can afford gas to get home,” Hardesty said.

Burek said they get calls all the time from people who want to know how to help and if they can volunteer with Portland Street Response. She said they are amazed at the generosity of so many people reaching out. But, she asked potential volunteers to wait while the team works with the city’s new community engagement coordinator to figure out what volunteerism should look like with Portland Street Response.

“Honestly, it makes you realize you are not in this alone. There is a whole community of Portlanders who really want to make a difference,” Burek said.

The team’s paramedic, Tremaine Clayton, added you don’t have to be on their team in order to help.

“Just by being a compassionate person,” Clayton said. “You can do that on your own. Safety is a concern, of course, but a lot of these people just need hope and help. They don’t want to be hurting anybody.”

Burek summed up how she and the team are feeling after a month on the job working with people who need help in the Lents neighborhood.

“The ability to go out and make an impact and be accepted and received the way we have is really gratifying,” she said.

Background | Jason Renaud

Jason Renaud
Jason Renaud
Jason Renaud is a nonprofit consultant with over 35 years of open recovery from alcoholism. He’s a well-known public speaker and writer on recovery from alcoholism and the experience of people with mental illness, and is an active advocate for people who have fallen through the cracks in the public safety net.

Jason is a coordinator of the International Mobile Services Association.

He has been the board secretary of the Mental Health Association of Portland since 2003 and is the organization’s voluntary managing director. He coordinates five enduring projects for the organization; the Law & Mental Health Conference – in 2021 on Reducing the Impact of Alcohol on State and Local Governments; the Public Housing Conference – in 2021 on Recovery Residences; the Mental Health Alliance which advises courts and government agencies on police reform; Washington Recovery Services, which owns and operates housing for women exiting homelessness and addiction.

Renaud worked in managerial positions for diverse organizations, including three executive positions for the National Alliance for the Mentally Ill, the Washington State Department of Corrections, the Chicano Concilio on Alcohol & Drug Abuse, The Oregonian newspaper, Central City Concern, and Cascadia Behavioral Healthcare. In 2010 he ran for Portland City Council on a police reform platform. In 2014 Renaud produced the award-winning documentary Alien Boy: The Life and Death of James Chasse. He has been amicus to US DOJ v City of Portland since 2015. He is a former CIT trainer, and has been trainer for the Oregon Department of Public Safety Standards and Training since 2017.

Contact Jason Renaud
503-367-6128 – PO Box 3641 Portland, Oregon 97208

Portland aims to dispatch better first responders for homelessness calls

As the sun began to set, Chelsea Swift and Amanda Smith pulled their white van up near a man tucked between some bushes on the side of a busy street. He was grumbling and yelling at passing cars. He grasped a handful of toys and a flashlight as he held a conversation that only he could understand.

Swift and Smith work for Crisis Assistance Helping Out On The Streets – most commonly called CAHOOTS – a 48-person program that provides medical and behavioral health services as an official third arm of Eugene’s public safety system. It’s become the national model that many cities are trying to emulate. But few have.

Portland joined that list this year when the City Council dedicated $500,000 to figure out how to adapt CAHOOTS to a larger urban area. The city’s working group is expected to put a proposal before the council in November.

The idea was spurred by an editorial from Street Roots, the Portland nonprofit newspaper focused on problems faced by people living in poverty. Editor Kaia Sand called for an alternative method for helping homeless people who are in mental health or drug-related distress. The editorial drew from an investigation by The Oregonian/OregonLive that found 52% of all arrests in the city were of homeless people — the vast majority of those for low-level crimes.

Portland homeless accounted for majority of police arrests in 2017, analysis finds

Most often, Portland officers arrested homeless people on property, drug or low-level crimes. The vast majority of the arrests, 84 percent, were for non-violent offenses, the analysis found.

Those are exactly the kinds of arrests CAHOOTS is trying to deter.

Swift and Smith left the man alone after unsuccessfully trying to cajole him into a ride to a place to chill out, away from the concerned — and sometimes fearful — public eye.

Even interactions like that one — that seem to go nowhere — are important, they say. Now they are aware of him and a little bit about his mental state. If they get three more calls that night, each time they will build more of a relationship. Maybe on the fourth, they say, they’ll be able to help him access services he might need — a place to sleep, food or a ride to the pharmacy to pick up medicine.

And maybe the next time, he’ll call them for help as many people do when their phone is out of minutes and can only dial 911. That’s why Swift is willing to work within a system that is so closely tied to law enforcement.

“If they have one number, we want to be part of what that number calls,” Swift said. “If we want to keep the scope of our work, we want to be part of that system.”

She thinks that by addressing those issues with CAHOOTS, she can help the man avoid becoming more aggressive in the future and interacting with police, who have more limited options: jail or the hospital.

Eugene garners attention

On one of the first chilly September nights this year, Swift drove the darkening streets of Eugene like a veteran cab driver. She’s worked the night shift for three years and is used to navigating the city and its highways, running after vague descriptions of people in distress — sometimes from hours-old calls.

But it was a wrong turn that brought her to Linc, a middle-aged man lying on a grassy median that separated a residential neighborhood’s sidewalk from the street. Three women sat on the sidewalk nearby.

One of the women said she’d called for a CAHOOTS response, but the dispatcher told her it would take too long and opted for a paramedic. That frustrates Swift. CAHOOTS is sent when 911 dispatchers recognize the person in crisis may respond better to a civilian than police.

Some people ask for CAHOOTS specifically, a growing habit the program wants to encourage.

Early on, the relationship between CAHOOTS and the city’s other first responders was more adversarial. The program sprouted from a group of radical hippies who began helping people in drug crisis who needed a place to sleep for the night. Eventually they shifted, aiming to be “in cahoots” with police when they turned their grassroots approach into a program that city officials chose to fund over hiring more police.

But over the last 10 years, CAHOOTS staff have invested more time building relationships with police and dispatch workers by being open to receiving feedback as much as giving it. While some officers embrace the program more than others, the first responder and broader Eugene-Springfield community has come to see CAHOOTS as an equal resource.

That night, the fire crews were happy to have Smith already taking Linc’s vitals by the time their two engines pulled up.

Linc was an alcoholic, he said, and wanted to walk to the hospital to enter a detox program. He had been denied over the phone, but in the past, he had found that he could get in this way. Problem was, he’d overshot the hospital and was in too bad of shape to keep walking.

Swift said Linc’s was a typical call. It’s also the kind of call that she is glad to respond to instead of police or even the fire department, which likely would have taken Linc to the nearest hospital. There, he would rack up a medical bill before being released to go home after he sobered up — or maybe he actually would get into a detoxification center.

Instead, Swift and Smith helped him to the van, which is set up with a few seats bolted to the wall and a wide space on the floor, where Linc lay down.

As the sun set, they drove him to the Buckley Detoxification Center. The nurses there recognized the van and its occupants and helped Linc check in for the night.

While Portland has more beds for people in Linc’s situation, Eugene is more limited. A homeless couple with a toddler who called Swift and Smith to ask where they could sleep safely for the night ended up with no options other than to walk the streets to stay awake.

Eugene has one shelter and it only had room for the mother and child, but the father said his post-traumatic stress syndrome acts up when he is separated from them and could become violent and end up in jail.

CAHOOTS answers a variety of calls in addition to drugs and mental health. They even notify families when a loved one dies on the street and provide grief support.

Program Manager Tim Black said it’s an approach that has shown measurable impact over the past 30 years. He estimates CAHOOTS saves $7 million annually in medical costs because the people they help would otherwise end up in emergency rooms.

Today, the lean operation deploys two vans with two workers each who log about 110 hours daily in staggered shifts. Combined, they field about 20% of calls that come in to 911 and the non-emergency line.

Only about 10% of CAHOOTS responses require help from other public safety agencies. Black said the key is that his team works with public safety, but isn’t beholden to them. That allows them to respond with different tools — and a different mindset.

“The type of response that an officer is going to have is completely different than the response we would have,” Black said.

CAHOOTS has become the frontline defense for the area’s homeless, even though it was never meant to provide homelessness outreach. But the calls they respond to coincide with the area’s population of people who struggle to be able to pay rent.

Now, about 60% of all the people CAHOOTS work with are homeless.

Expanding its reach

Likewise, officials say the majority of calls to Portland’s 911 system are about homelessness. And when police receive a call, they say they are obligated to check it out.

Data shows many of those interactions end in arrest, creating a disproportionate number of homeless people in jail or cited for low-level crimes. Advocates say that doesn’t need to be the case.

Sand, the Street Roots executive director, said she proposed the street response idea after a series of articles in local media made it clear the current system isn’t working. She also heard from homeless Portlanders who said interactions with law enforcement made it harder to find housing and other employment.

City Commissioner Jo Ann Hardesty is leading the charge to create a CAHOOTS-style program, and is in the early stages of deciding who would be involved and in what capacity. Part of that work has been to collect data from people living on the street.

“Getting the right first responder to the right incident means we need to talk to the people who will interact with these first responders,” she said.

Representatives from nonprofits, advocacy groups, public safety agencies and various bureaus meet regularly to iron out other issues.

Robert King, who is Mayor Ted Wheeler’s public safety policy adviser, also helps lead the planning and is focused on defining what a pilot project might tackle with the first infusion of cash.

He sketched out a two-person walking beat with a distinct boundary, such as the downtown core or a section of Southeast or North Portland. The street responders would work like CAHOOTS, but only for calls about unwanted people or welfare checks – calls that might be low priority for police on a busy night.

The street responders would also plug into the police radio channels, so they could head for scenes where they’d be helpful. Or be called directly by police and fire officials. They would likely be stationed within the fire department or be contracted to do the work, King said.

“It’s going to be a bit of a learning curve for the street response folks and for council and for the community,” King said.

Followers adapt their models

Portland isn’t alone. Olympia, Wash., hired Eugene’s former police chief and this year, became one of the first cities to adopt the CAHOOTS model.

The new chief insisted Olympia would benefit from the program, so city officials worked with residents, community leaders and business owners to create the Crisis Response Unit. It is housed within the police department and responds when asked by police, fire or social service agencies.

About two-thirds of their calls are self-initiated: They see someone charging into traffic and intervene. City data also showed that the unit showed up at the same place as police in at least half of the first six months’ worth of calls.

Washington’s labor laws block emergency medical technicians from working in the unit, so instead two mental health workers patrol the streets. The first team was deployed in April.

Dispatchers faced learning curve

Portland’s Bureau of Emergency Communications, which houses the 911 call center, is already used to weighing various options when considering how to respond to Oregonians in need.

In 2011, the U.S. Department of Justice stipulated that Portland needed to fix how officers handled interactions between mentally ill people and police. As part of the settlement, the Multnomah County health department agreed to take on some calls from suicidal people with its federally mandated crisis line.

The line is staffed by mental health counselors with advanced degrees. Neal Rotman, who heads the county’s mental health programs, said it only made sense to divert similar calls from 911.

Of the more than 80,000 calls the crisis line handles a year, about 500 are diverted from 911.

County officials have also tried to reduce the number of calls that must be diverted. They posted advertisements on buses and elsewhere hoping to provide an alternative to calling 911 for mental health issues. Rotman also met with business groups and others to urge them against calling police on the person who appears to be homeless and yelling outside their door.

His staff has access to a vast database of health records. They can see whether a caller was put on a psychiatric hold recently after being picked up by police or if they were seen at a hospital for similar behavior over the past two years. If a caller is on Medicaid, their case manager will be notified, allowing the crisis center to alert a familiar face to check in on the caller within hours.

In some cases, the contracted mobile mental health intervention team Project Respond is sent out immediately. Otherwise, a county clinician or other mental health worker is supposed to follow up within 24 hours.

Rotman said that many callers prefer to deal with someone who is not in uniform.

“In many cases, people will engage because it’s not the police,” he said, “because they don’t have that fear.”

The diversion was a change for dispatchers. They had to learn to evaluate who would be best served by a crisis counselor and who needed a police officer.

Lisa St. Helen, who runs Portland’s 911 center, said that the policy has been tweaked as dispatchers ran into gray areas. No other city had tried this strategy, she said, so it was challenging to figure out how to keep a caller on the line as they were transferred. City officials also had to consider liability when telling a suicidal caller to hold on the line.

Now, the guideline is whether someone is in immediate danger — standing on the bridge — or whether they are still in the phase of talking about stepping on to the bridge. Dispatchers might ask if there is a gun in the house, and if so, where. Is it loaded? Is it unloaded but ammunition is on the table?

Police, who sometimes face life-or-death situations without the training to talk someone off the ledge, saw the benefit of shifting that burden elsewhere.

Providing more options to the people handling calls makes sense to St. Helen.

“911 is ever evolving and change is a part of the process,” she said. “When you find there is a better way to respond or handle calls, we have to make those changes.”

September 15, 2019

With ‘PET team,’ Ada County Paramedics saves lives and dollars

August 1, 2019

BOISE, Idaho — As mental health-related calls increase in Ada County, the role of paramedics is expanding. Now, an initiative at Ada County Paramedics is working to save your hard-earned dollar.

Meet the PET Team. No– there’s no dogs cats or gerbils here. PET stands for Psychiatric Emergency Team, and they help folks in crisis in Ada County.

“It’s just more beneficial for the patient and safer and healthier for the patient,” said Rene Miller, Captain, Ada County Paramedics.

The Paramedics’ PET Team monitors all calls law enforcement go on.

“So we’ll go on a call that is somebody that is on a psychiatric emergency– maybe they have kind of slipped and aren’t taking their meds, or they’ve missed some appointments and just feeling, kind of, maybe having some suicidal ideations, homicidal ideations,” Miller said.

Ada County Paramedics are leading the way with how mental health calls are addressed in Idaho, and that’s more important now than ever.

As we previously reported , Boise Police data shows that calls for attempted suicide nearly doubled from 2017 to 2018 in Ada County.

The PET Team assists law enforcement, alongside Idaho Department of Health and Welfare’s Mobile Crisis Unit, by responding to the patient’s home or part of the community.

“We perform vital signs, blood glucose monitoring… a breathalyzer,” Miller said.

It wasn’t long ago when patients had to go to an Emergency Room to be screened or cleared by a doctor before going to a psychiatric facility. But now, if they meet certain criteria– “then at that point we’ll call directly to the psychiatric facility,” according to Miller. “Intermountain, St. Al’s Behavioral, Cottonwood Creek in Meridian, Lifeways here.”

The patient receives immediate care from clinicians including medication management while Ada County taxpayers are saved thousands of dollars.

“Cost savings within the hospital, hospital hours, law enforcement staying with that patient,” said Miller.

But perhaps most importantly, the PET team works to lower the high rate of suicidality.

“There have been several times where we were able to intervene and get those patients exactly where they needed to be, and they were so thankful, and just had tears in their eyes and hugged us and just said thank you,” said Miller.

Heat wave response: Philly’s quadrupling homeless outreach for Code Red

The “feels like” temp could hit 113 degrees.

The incoming heat wave had only started to tease Philadelphia on Thursday morning, but the 85-degree thermometer reading was already paired with an uncomfortable dose of humidity.

In Logan Square, Carrie Wagner and Owen Riordan were working their way around the park.

Not everyone accepted the bottles of water they offered, but most did. Fewer took them up on the suggestion to come back with them to a shelter, where air conditioning would provide a respite from the sweltering air.

With the mercury forecast to reach the high 90s, bringing “feels like” temps up to 113 degrees, the National Weather Service has issued an excessive heat warning for the region, and the city extended a heat health emergency through Monday evening.

For Philly’s homeless population, that means a Code Red is in effect — and outreach workers are scrambling to get them inside.

On regular weekends, the Department of Behavioral Health and Intellectual disAbility Services and the Office of Homeless Services typically deploy one or two groups of workers. But this weekend, they’re sending out four team, all-in-all quadrupling the number of people on the street.


Help coming for homeless in Glynn County


Three local organizations have been awarded a combined total of more than $439,000 in state grants to help support homeless and HIV/AIDS populations in the Golden Isles.

Coastal Georgia Area Community Action Authority, Inc. was awarded two grants, collectively worth $90,000, for homeless prevention and rapid rehousing.

Gateway Behavioral Health Service was awarded four grants worth more than $129,000 to help support rapid rehousing, street outreach, shelter plus care support services/harm reduction programs.

Safe Harbor Children’s Shelter, Inc. was awarded five grants worth over $220,000 to help support emergency shelter, street outreach, hotel motel voucher, Emergency Solutions Grants support services and Georgia Homeless Management Information System programs.

The grants awarded by the Georgia Department of Community Affairs were announced Wednesday by state Sen. William Ligon, R-St. Simons Island.

“I am thankful that DCA realizes the hard work, dedication and funding it takes to keep these life-saving services available to vulnerable populations,” Ligon said in a statement. “These organizations serve as valuable resources to many people in Glynn County and the surrounding areas. These groups provide assistance to those who are struggling with difficult life situations and work to help them mend their lives and renew family relationships.”

Downtown homeless encampment now at ‘crisis’ stage, Milwaukee business leader says


A sprawling homeless encampment beneath the Marquette Interchange has reached a “crisis” stage after a stabbing, increased heroin use and recruitment of occupants for criminal activities, a downtown business leader said.

The encampment beneath the I-794 overpass has swelled to more than 60 tents — more than 50 that are inhabited — since being nearly empty in April, according to Milwaukee County housing officials.

Known as “Tent City,” the camp has become increasingly squalid, unsanitary and dangerous, said Elizabeth Weirick, CEO of Milwaukee Downtown Business District #21.

“No human being should have to live under these conditions, period,” Weirick said.

“For us to continue to allow people to live this way, I believe, is inhumane.”

An update on the encampment was presented to the district’s board of directors this week by Eric Collins-Dyke, outreach services manager for the Milwaukee County Housing Division’s Housing First/Street Outreach program.

The growth of the camp has occurred despite the best efforts by outreach workers, who placed 89 occupants of the camp into housing from October to February, Collins-Dyke said.

“We’ll house three people one day and get five new people coming to the camp the next day,” Collins-Dyke said Friday.

“The bubble is bursting in terms of those living in entrenched poverty and the inflow into our homeless services system is rapidly increasing.”

The encampment, on property owned by the state Department of Transportation, was once an almost unnoticable cluster of makeshift shelters between 6th and 7th Streets south of Clybourn Street.

It has now spread west of 7th Street and south toward St. Paul Avenue.

Tents — some large enough to shelter multiple people — have replaced cardboard and plywood structures, and couches, coolers and barbecue grills now sit amid piles of garbage and debris.

Tents and an armchair sit in a tent village near 7th and Clybourn Streets, underneath the I-794 overpass, on Friday, July 19, 2019. (Photo: Colin Boyle / Milwaukee Journal Sentinel)

Heroin use has sprung up in a small quadrant of the camp, along with consistent reports of violence and physical assaults, Dyke-Collins said.

On July 11, a 69-year-old man was stabbed during a domestic dispute by a 45-year-old woman with whom he shared a tent, according to Milwaukee police.

The man’s injuries were not life-threatening, police said.

“When you introduce drugs and alcohol into this environment it is a dangerous mixture,” Weirick said.

Some camp residents have been recruited for illegal activities, including some by a group from Georgia who travel the country cashing forged checks, Collins-Dyke told the district board.

Compassion or enablement?

The camp has grown in part because of well-meaning and compassionate individuals who regularly drop off tents, food and other provisions, Weirick said.

“Is the way we are enabling people to stay at this encampment compassionate? Absolutely not,” Weirick said, urging those who want to help people who are homeless to donate time or money to shelters, meal programs or other resources.

Shelly Sarasin of the Milwaukee Street Angels, which provides tents and meals to people who are homeless, said her organization is as concerned about the situation at 6th and Clybourn as BID #21 or anyone else.

“But we are not responsible for this surge in numbers,” Sarasin said.

“Frankly, (providing) a meal three times a week does not entice someone to live under the freeway.”

In contrast to previous occupants who were chronically homeless, 89% of the people currently living at the camp have been homeless six months or less, Collins-Dyke said.

Both he and Sarasin pointed to people moving to the camp after leaving the Milwaukee Rescue Mission.

Twenty-five camp occupants have recently left or have been asked to leave the mission at 830 North 19th Street, Collins-Dyke said.

“This is a very concerning trend,” he said.

Sarasin said her organization is alarmed by the number of people who say they choose to live on the street because, “living outside was better than the dehumanizing treatment they received in shelter.”

Rescue Mission president Patrick Vanderburgh said people are asked to leave its single men’s shelter for being violent, and that reasons people say they’ve left on their own must be taken at “face value.”

“There is definitely a segment of individuals who don’t like being in an institution with any kind of rules,” Vanderburgh said.

“However in our situation, in which we serve such large numbers of people, (rules) are a necessity.”

Both Collins-Dyke and Weirick said more financial resources are needed to address homelessness, as well as more sustainable solutions, such as the county’s Housing First program.

“At this point, we are trying to mitigate the inflow into the encampment,”Collins-Dyke said.

“To keep everyone safe so we can efficiently and comprehensively serve the individuals that are currently there.”

Homelessness outreach workers to update Newport Beach on accomplishments


The recently convened homelessness task force in Newport Beach will meet Monday to discuss land-use regulations for emergency shelters and the accomplishments of its new street-level outreach contractor.

The 10-member task force, made up of City Council members and citizens, will hear from City Net, a Long Beach-based nonprofit the city partnered with in March to enhance social services provided by the Police Department.

The department also partners with the Orange County Health Care Agency to help homeless people with social, health and housing needs.

City Net has a five-year, $1-million contract with the city to help people transition into an initial shelter and find and stay in longer-term housing. It also assists the city with community outreach.

Between April and June, City Net workers helped eight people leave the streets, according to a report from the organization.

The task force also will hear about where a potential emergency shelter could be built in Newport under current zoning.

Theoretically, a shelter could open in areas zoned in the private institutions or office-airport categories, which are scattered around town and total about 190 combined acres. Staff reports do not indicate that building a shelter is imminent, and the item is for review only.

This is the task force’s second monthly meeting since its formation.

The task force meeting starts at 4 p.m. in the Friends Room of the Central Library, 1000 Avocado Ave.

Downtown SF businesses to tax themselves to pay for clean streets, homeless outreach


San Francisco businesses rarely celebrate new taxes.

But when given the choice to pay a little extra for more street cleaning, trash collection, power washing and street-beautification — all of which help attract tenants and customers — most landlords and businesses embrace the idea.

Merchant corridors have for years created commercial benefit districts, or CBDs — special zones where primarily commercial property owners elect to tax themselves a little extra to pay for additional services.

And at a time when the city is straining to keep its streets clean and attend to its homelessness and mental health crises, CBDs are increasingly stepping in to fill gaps in services.

On Tuesday, the Board of Supervisors unanimously approved the city’s newest CBD — the Downtown Community Benefit District. It’s also one of the largest: Extra assessments on the 669 parcels on 43 blocks that make up the district will raise nearly $4 million annually to “help augment the city’s baseline services on everything from pressure washing to homeless outreach,” Supervisor Aaron Peskin said in a statement Wednesday.

Peskin was a longtime supporter of this CBD and represents the district where it resides. While merchants take a vote on whether to create CBDs, they have to be approved by the Board of Supervisors.

Supervisors also renewed CBDs encompassing portions of the North of Market/Tenderloin districts and Union Square. The board is scheduled to vote to renew and expand the Civic Center CBD next week.

CBDs began cropping up in places like Fisherman’s Wharf, Noe Valley and the Castro district in 2005. With the support and encouragement of city officials — the districts are overseen in part by the Office of Economic and Workforce Development — they’ve flourished. The Downtown CBD is the city’s 18th.

“A lot of cities are not set up the same way,” said Marco Li Mandri, the president of New City America who’s helped steer the formation of 10 CBDs in San Francisco and others in Los Angeles and San Diego. “The machinery is in place to make the whole thing work in San Francisco.”

Debra Niemann, executive director of the Noe Valley Association, a CBD, stressed that each district is different, offering varying services in response to the unique needs of individual neighborhoods and the size of the district overall, since smaller districts mean smaller revenue streams to pay for services. Unlike some CBDs, Niemann’s, for example, doesn’t hire extra security guards, focusing more resources on installing amenities like flower baskets and benches.

“Everyone is different. The problems in central Market or Union Square are very different than Noe Valley or even the Castro,” Niemann said. “I’m one of the smaller CBDs. But I’ll shamelessly tell you I’m one of the mightiest in terms of the improvements on the street.”

Each CBD has somewhat different priorities. The Yerba Buena Community Benefit District employs two full-time social services workers tasked with connecting people in need to services. The Lower Polk Community Benefit District partners with UC Hastings College of the Law, La Voz Latina and the San Francisco Bar Association to operate a landlord-tenant clinic meant to smooth out housing disputes that can lead to displacement — in addition to a host of daily street-cleaning services.

“We’re out there seven days a week, cleaning and doing maintenance work, picking up trash, needles, feces, abating graffiti — just basically adding extra boots on the ground to stay on top of those issues that affect quality of life for businesses, residents and visitors to the neighborhood,” said Christian Martin executive director of the Lower Polk CBD.

Coalition for Police Accountability – Non-Police Alternatives to Certain 911 Calls

June 26, 2019 – Oakland community meeting with “CAHOOTS” – a non-police crisis intervention team that responds to nearly 20% of 911 calls in Eugene/Springfield OR. Organized by Coalition for Police Accountability, Faith In Action – East Bay (formerly OCO), Urban Strategies Council and City Council Members Rebecca Kaplan and Noel Gallo. 165 attendees. The meeting was at St. Columba Catholic Church.

The Coalition brought CAHOOTS team to Oakland to meet with public officials, service providers, Police & Fire Departments to introduce an alternative model of crisis response and begin the process of developing an Oakland version of this successful model.

(Main Presentation begins at 10 minutes, 37 seconds)

Denver Police Testing Idea Of Civilian Teams Responding To Some 911 Calls, June 14, 2019

Denver police are developing a pilot program that would dispatch civilian teams to certain 911 calls. Instead of a police officer, a team of mental health workers and medics would respond.

Denver Police Chief Paul Pazen says when it comes to crisis calls that do not involve a weapon or threat to other community members police may not always be the best response.

“If we have a team of dedicated individuals with those types of backgrounds, we feel like we can have a positive impact on our most vulnerable population,” Chief Pazen said.

Fayette Street Outreach opens much-needed community center in west Baltimore


BALTIMORE — In 1993, some west Baltimore residents, seeing the great need for so much in their community, formed Fayette Street Outreach. Their mission was to build a better, safer and healthier community.

“We’re, like, a beacon in the middle of an ocean that people can come to for rescue,” said Edna Manns-Lake, founder of Fayette Street Outreach.

Manns-Lake started Fayette Street Outreach to make a brighter future for every resident of the community. It took 20 years to build a center, which opened in April.

“The community needed a place to call their own so they could come in and have community meetings. A place where we can have activities for our youth,” Manns-Lake said.

The center was built with a lot of help. Rep. Elijah Cummings helped secure $100,000 in Department of Housing and Urban Development money to get the ball rolling back in 2002, and the community law center pitched in with its skills.

“FSO approached us about 20 years ago to acquire these two vacant buildings in their neighborhood, and they had a vision for a community center, where everything else was leaving the neighborhood. The library left. The bank left. The supermarket left,” said Kristine Dunkerton, of the Community Law Center.

But Manns-Lake pressed on and got the building together. It is a meeting space, a place for job development, GED classes and more. Some students are learning coding.

“It’s really cool to come here and learn how to do a new thing,” said student Destiny Brown. “To learn how to do something new — instead of being negative, being positive.”

The center took the lot behind it and turned into something beautiful and sustainable for the neighborhood.

“We’ve got summer squash, tomatoes, peppers in these beds, Tulsi basil and Genovese basil,” said farmer Rich Kolm. “We’re trying to grow food and have access for fresh healthy food for people in the neighborhood.”

“This community has a lot of needs — unemployment is very high in this community, low income families, some families can barely make it from week to week,” Manns-Lake said.

Mann-Lakes hopes the center will be the place they learn new skills and find a way to make their lives better.

FSO is not done yet. It hopes to obtain seven vacant homes in the unit block of north Smallwood Street and open a food training program and catering hall.

FSO still needs to raise money to fund many of the classes they hope to bring to the community. You can click here to donate or call 443-438-7938.

Minneapolis pledges $300,000 a year for St. Stephen’s homeless outreach team

February 12 2019


St. Stephen’s wins contract because of past success.

The St. Stephen’s Human Services street outreach team was awarded $300,000 by a Minneapolis City Council committee on Tuesday, renewable for an additional four years.

Day after day, the street outreach team for St. Stephen’s Human Services goes outside to find and assist the hundreds of homeless people in Minneapolis.

They look under bridges, peek down stairwells, follow railroad tracks and go wherever else people without housing are likely to stay. Now, funding from the city of Minneapolis will allow them to continue their work for the next five years.

A City Council committee on Tuesday awarded $300,000 for the nonprofit’s six-person team. The funding — a $150,000 annual grant from the U.S. Department of Housing and Urban Development matched by the city — is renewable for up to four years.

The city has contracted with St. Stephen’s since 2007 as part of its efforts to end homelessness. Renewing the group’s funding will allow the team to keep working during the winter to connect people with necessary services and get them one step closer toward permanent housing.

John Tribbett, the program manager for street outreach, said the city’s funding is the “backbone of support” for his team. “That is what allows our team to continue to function,” he said.

The need for help is great, particularly because of the rising cost of housing, he said. The nonprofit found more than 520 people without shelter during its July count and interacted with more than 1,700 people in 2018. The homeless are disproportionately people of color.

Deep relationships

St. Stephen’s street team, which has been around for 13 years, is one of several groups reaching out to the city’s homeless population, including People Inc. and the American Indian Community Development Corp. These groups frequently collaborate, and helped relocate residents of the encampment that grew along Hiawatha Avenue in south Minneapolis last summer. They also work closely with Hennepin County’s Office to End Homelessness, which helped the city develop its latest grant.

While the outreach team’s more immediate goal is to make sure people stay safe outdoors and have access to health care and other services, the team also works to move those they contact into housing. More than 80 percent of St. Stephen’s past clients have been placed in permanent housing, according to the city, one of the reasons the group’s contract was renewed.

“They’ve developed a very efficient model,” said Andrea Brennan, the city’s director of housing policy and development. “They have done a really great job of making sure that they can meet the outreach needs in the city.”

Three other organizations applied for the city funding. However, each of those proposals would have resulted in at least a 90-day gap in services and fewer total outreach workers, according to the city.

“Especially this time of year, it’s really critical we don’t have a disruption in service,” Brennan said.

The St. Stephen’s team has built deep relationships in the years they’ve moved around the city. The work attracts people with a desire for social justice and what Tribbett called a “front-line attitude.”

“As difficult as it is for us, it’s nothing compared to the difficulty that the people that are actually living on the street unsheltered are experiencing,” he said.

How street outreach meets homeless individuals where they are

February 6 2019

When the human brain experiences trauma, it changes.

As the brain develops over time, the intensity of childhood trauma can lead to a range of mental health and behavioral problems, including addiction, domestic violence and medical issues, according to the Adverse Childhood Experiences study conducted by Kaiser Permanente and the Centers for Disease Control and Prevention in the 1990s.

Since that study was published, experts have investigated how the brain changes in response to trauma. When the brain is exposed to traumatic experiences, the prefrontal cortex, the part of the brain responsible for decision-making, may be smaller than normal. The amygdala, the part of the brain responsible for decoding emotion, may be larger than normal. Rational decision-making processes are stunted while emotions are unchecked, often leading to what might seem like unreasonable distrust.

According to Matt Bennett, an author and expert in trauma-informed care, street outreach has proven to be one of the most effective ways to exercise trauma-informed care with the homeless population. “Once we understand the neurobiology, it helps us understand why some of our historical solutions haven’t worked,” he said.

When Catherine Crosland, a physician with Unity Health Care, approaches a homeless individual on the street, she typically starts out by asking how they are and whether they would be amenable to a blood pressure test. If they comply, Crosland proceeds with the test while asking the patient questions about their health care. “We approach people to build relationships, check on folks who haven’t seen doctors in years… we try to meet them where they are,” said Crosland.

“Trust me man, you’re a great deal, you’re the real deal,” said a patient as Crosland examined his foot injury.

While street outreach specialists may develop some semblance of trust with clients, it is often difficult to connect homeless individuals with resources they need.

“Many clients will refuse medical treatment on non life-threatening conditions,” said Tanner Reel, a street outreach specialist with Pathways to Housing D.C., “and part of our job is to accept that and continue engaging them until, hopefully, they’re comfortable enough to engage with us on moving forward towards housing and treatment.”

Before street outreach specialists with Pathways to Housing can begin their work, they must complete a one-month training to learn how to meet clients where they are and move at the client’s pace.

“We’re told to keep a respectful, but friendly, distance, employ active listening, and, most importantly, engage on what they’re wanting to talk about, even if it means having to push back the agenda,” Reel said. “While it can be frustrating at times, an important note to keep in mind is that we are working with our clients to hopefully improve their futures.”

But street outreach is not a method limited to a few D.C. nonprofits. The Substance Abuse and Mental Health Services Administration (SAMHSA) within the U.S. Department of Health and Human Services recommends and implements street outreach programs to connect with homeless clientele. SAMHSA launched the National Child Traumatic Stress Network in 2001 and the National Center for Trauma-Informed Care in 2005 to assist with individual traumatic events.

“When I was homeless, there wasn’t a lot of street outreach, [none] that I knew of anyway,” said Waldon Adams, now an employee with Pathways to Housing. “There were drop-in centers, but if you didn’t go to them, they wouldn’t come to you. I love that we bring services to people where they are, develop relationships with people on the street that can make someone feel that they really matter, that they have a friend to say hi to, and help them navigate through barriers.”

Trauma-informed care should be exercised at all levels of development, Bennett said. Through his programming and advocacy efforts, he said he encourages people to shift from asking “What is wrong with this child?” to “What is happening to this child?”

“Whether we’re a medical provider, policy maker, teacher, police officer, if we understand the people were working with,” Bennett said, “we need to start making system and policy changes to craft interventions around the science behind trauma.”

Street Outreach Team Regroups

December 12 2018

The Street Outreach Worker program, a city-supported initiative aimed at saving young lives, is winding down at the New Haven Family Alliance. A bigger version might take its place at a new nonprofit seeking to expand gun-violence interventions to hospital emergency rooms across the state.

Leonard Jahad, the Street Outreach Worker program’s manager since 2015, has set up a new nonprofit, Connecticut Violence Intervention Program, Inc., that seeks to partner with Yale-New Haven Hospital and other municipalities on a stepped-up violence intervention program.

Currently, through New Haven Family Alliance, street outreach workers — some of whom went straight after years in the criminal life — respond to the hospital emergency room after every shooting. They try to deescalate, talking down friends and family who might be aching to retaliate against the gunman.

Under a new partnership, which is still being worked out and hasn’t been formalized, street outreach workers would respond to a wider range of crimes, including domestic violence and sexual assaults. They’d also connect the victims and their families to case management for long-term support.

The Street Outreach Worker program “was founded by New Haven Family Alliance. It’s become a very valuable program, and they’ve found other ways to support it,” Mayor Toni Harp said on the latest edition of WNHH FM’s “Mayor Monday” program. “I think that actually it’s a new day.”

Concerned about New Haven Family Alliance’s sustainability, Jason Bartlett, the city’s youth services director, said he decided to put the program’s $174,000 contract out to bid for the first time in a decade. Bartlett wanted to see if another organization might be able to expand the program’s reach, particularly by connecting with local hospitals.

At the beginning of the fiscal year, he told New Haven Family Alliance that he’d pay month-to-month through the end of November. When money ran out, the Family Alliance dismissed all five street outreach workers. The Youth Services Division has since hired them all back part-time on the city’s payroll until a contract is awarded, which is expected to happen early next year.

“We’re continuing the relationship [with Yale-New Haven Hospital], even though it’s not with the Family Alliance,” Jahad said. “The work hasn’t stopped. Hopefully, we’ll expand it with grants and partnerships with other hospitals.”

After the proposals are evaluated and a winner is selected, the Street Outreach Worker program could return bigger than before. Many of the employees will likely be the same, but they could return to the job with a deeper relationship with the city’s hospitals.

The hospitals have “seen the importance of the work in stemming violence,” Mayor Harp said on air. “They want to work with the city.”

In September, Jahad attended the National Network of Hospital-Based Violence Intervention Program’s annual conference in Denver to present with Yale-New Haven Hospital’s staff. That led him to the idea to expand statewide, including the 15 hospitals with urgent-care centers within Yale-New Haven Hospital’s network.

Jahad registered Connecticut Violence Intervention Program the following month. He said he hoped to broaden the work that New Haven Family Alliance had done for years, bringing it to hospitals in Bridgeport, New London and the rest of Connecticut.

“With the Family Alliance, when someone gets shot, we respond to the hospital and calm things down,” Jahad said. “I send out a text: ‘Major incident.’ They respond, ‘Where do you need us?’

“We go to the emergency room and make sure everything’s calm,” he continued. “Sometimes, the boys are going off; people are there with weapons. One of them can give you a hug, and you’ll feel it. We’ll tell them, ’You don’t need to be here.’ We’ll get them Lyfts and Ubers or go to Dunkin’ Donuts to get coffee.”

Jahad said that they’ve built up trust with doctors and security guards, too. Sometimes, he’ll ask the trauma surgeon to stay with the family for “10 more seconds” to clarify the victim’s condition.

Once the situation’s under control, the outreach workers turn their attention to supporting the victim. “We start to talk to them. It’s not ‘What happened?’ It’s ‘What can we help you with? What do you need? A job? Whatever led you to this, we’re going to try to help you.’

“It’s been a good partnership, and we want to expand that,” Jahad concluded. “Now that they’re going to issue a [request for proposals], I may take a look at that. We’ve actually done the work, and we’ve gotten really good at what we do.”

A spokesman for Yale-New Haven Hospital said that there’s “no formal relationship” with Jahad’s group.

“While we have no formal relationship, over the last several years we have worked with street outreach workers dedicated to the de-escalation of violence,” said the spokesman, Mark D’Antonio. “We do not fund these positions, which are primarily based in the community, but we have provided uniforms for those involved.”

Barbara Tinney speaks to the Board of Education about New Haven Family Alliance.The New Haven Family Alliance kicked off the Street Outreach Worker program in 2007, based on a model that contributed to a drop in homicides in Providence, R.I.

The nonprofit initially hired nine full-time workers — all with “street cred,” sometimes from past criminal records — to function as mentors, social workers, advocates and mediators

At first, they focused on approximately 200 city kids, ages 11 to 21, whom the police had identified as most likely to commit dangerous crimes.

Barbara Tinney, the Family Alliance’s longtime executive director who just retired, called them the “throwaway kids” whom no one had tried to reach.

At first, the police couldn’t figure out how to keep their distance from the program, as the outreach workers openly negotiated truces between warring gangs without the threat of arrests. “Its felons helping felons,” then-Chief James Lewis said some of his officers felt, a year in.

Jahad said that relationship has flipped, with law enforcement now referring teens to the Street Outreach Worker program rather than locking them up.

“Before, all they did was prosecute,” he said. “Now, we’ll get calls from the police, especially locally. Even the feds, they’ll call us up and ask us to talk to kids before it gets too far.”

Their work eventually became a foundational part of Youth Stat, the Harp administration’s initiative to put students in danger of dropping out or being locked up back on track to graduate.

Jahad said that the street outreach workers contributed to a ceasefire, after several bloody years of gun violence.

“We’ve always had good success with what we do,” he said. “When you compare us to Bridgeport and Hartford in shots fired, the non-fatals, we’re way under.”

Aware of the recent shakeups at New Haven Family Alliance, city officials decided to put their contract out to bid.

The solicitation says the city is looking for someone who has “demonstrated experience” partnering with the federal government and neighborhood groups, an agreement with a local hospital, a proposal for integrating Youth Stat within the schools and a plan for targeting services in the Quinnipiac Meadows area.

Jahad said Connecticut Violence Intervention Program might fit the bill, though he hadn’t submitted anything to the city yet.

He said the non-profit uses the research-based Cure Violence model that’s reduced shootings in New York City. “It treats crime like you’d treat a disease, addressing the symptoms and stopping the spread,” he said.

He added that the non-profit will try to formalize a partnership with Yale-New Haven Hospital and the Housing Authority of New Haven. “We want to continue the work in whatever capacity,” he said. “We just want consistency, whatever it’s going to be.”

Mobile Integrated Healthcare comes to Siuslaw region


Jan. 31, 2018 — Western Lane Ambulance District (WLAD), in partnership with PeaceHealth Siuslaw Region, is looking to change how healthcare is administered in western Lane County.

Through a $200,000 donation from the PeaceHealth Peace Harbor Medical Center foundation, the organizations have created a new Mobile Integrated Healthcare (MIH) program that will help reduce the rates of emergency room returns in the region, and, in the process, save the quality of life for hundreds of residents — with the potential to save millions of dollars.

Managed by WLAD Operations Manager Matt House, and staffed by Chris Martin, who came from another MIH program in South Carolina, the initiative is a two-year pilot program that will eventually be rolled out throughout Lane County.

“We manage the operations of the MIH Program, and PeaceHealth identifies patients and provides computer software such as the Epic Program,” House said. “The goal is to bridge the gaps of community patient care needs.”

As of right now, MIH provides in-home services to three types of patients: 30-day readmissions, emergency room (ER) high utilizers and Emergency Medical Services (EMS) high users. Other types of users may be identified as the program progresses.

“These are all patients that are referred to the hospital system that have been deemed ‘high risk’ of falling back into the emergency department several times for follow up,” House explained.

For example, a patient is diagnosed with congestive heart failure, which is exacerbated by not taking their medications correctly or not eating the right meals.

“So, they go back home and into their own habits,” House said. “They’re eating a salty steak diet, and not taking their medications on top of it. They become exacerbated, call 911 and the whole process starts over again. So the whole goal is trying to prevent these patients from falling back into the system.”

Patients may return to their habits for multiple reasons. During the stress of an emergency room visit, specific instructions by a doctor can be missed or misinterpreted. In other cases, environmental factors at homes can make it difficult to make healthier choices. In addition, old habits simply can be hard to break.

Whatever the reasons, to prevent a return, the doctors will contact MIH after a patient is discharged, requesting a patient checkup. That’s when Martin steps in.

Instead of having the patient come back in to the hospital for a checkup — or have the patient reach emergency status again — Martin will visit the patient at their home.

“Sometimes people are more relaxed in their house and I can go in and explain things a little bit better,” Martin said.

With a home visit, Martin can see the entire environmental picture of a patient, something that can be lost in translation between a patient and emergency personnel, particularly during a stressful period.

“I can go out and figure out, is the place clean? Do they have the right type of food? I can see with my own eyes what’s going on in their residence,” he said. “And it does help because the (patient) thinks it’s one thing, but it’s really not. They think (the home) is clean, but maybe there’s mold growing and that’s the cause of their respiratory problems.”

In some cases, Martin can use the time to educate the patients on how their lifestyle may be affecting their health.

“I can sit there and educate them on their diet. ‘The reason your ankles are swollen are because of all the salt that’s in that food,’” he said.

Or maybe the patient is having frequent falls, and the unknown cause is as simple as a loose mat on the floor.

“We can’t find any other reason why they’re falling other than education on fall prevention,” House said. “We look at the triggers. How do we prevent them falling and getting hurt, which would enter them into the hospital system?”

Sometimes, the help Martin provides can go beyond just education.

“If we’re talking about a mold issue, that may not be something that (Martin) can impact directly, but he may know the resources that we can plug (the patient) into and eventually get them help,” House said. “By having an official visit, if there is an issue with a landlord, that person then has documentation that’s substantial that says, ‘Hey, there’s a mold issue in here and it does seem to be affecting their health.’”

Even though the program is in its infancy — it officially started Jan. 2 — the program has already assisted 34 patients and the results have been noteworthy.

“This month alone, Chris was referred two patients from the emergency department just to go visit, watch and maintain,” House recalled. “These were really high users, five to seven times a week. Almost every day.”

But since the program?

“They haven’t been back yet because he goes out there visiting,” House said. “And if he’s not visiting, he’s still calling to check in, asking if they need anything.”

While the MIH program has had early success, House and Martin do foresee some possible hurdles in the future, particularly with how the program, and emergency medical services as a whole, is viewed. These concerns can be seen in why there is such a preponderance of emergency visits in the first place.

The reasons that people don’t visit primary care physicians and rely on emergency visits vary. One reason is convenience.

“Some people say, ‘Well, I can’t get into the hospital for three days, but I can get into the ER right now,’” House said. “You can always get into EMS services, as they’re open 24 hours a day.”

But more often than not, it’s a lack of availability.

Peace Harbor’s resent physician shortage made headlines, though House stated that PeaceHealth has made strides in correcting the issue.

“The hospital has done a really great job recruiting and they’re not down on the staffing in the way that they were three years ago,” House said.

However, the shortages in staff and availability are a global problem.

“We were having a discussion about the healthcare system in general, and it’s stressed in its capacity,” WLAD Chief Director Jim Langborg said. “I remember receiving an email last year where there were two or three hospital beds left in the state. This isn’t just a local or state problem. We all knew this was coming when the baby boomers came to retirement.”

Programs like MIH could help relieve that stress, not only by freeing up physical space in the hospitals but by focusing on preventative care that would alleviate the need for patients to check into facilities in the first place.

In order to practice preventative medicine, the patients have to accept the help. Some people still have a fear of services like MIH.

“We’re trying to change their lives for the better, if they’ll accept it,” Martin said.

People have offered several reasons to not want MIH services.

“There’s a lot of people out there that are essentially isolationists who prefer to be by themselves and not have anybody bother them,” House said. “Or they feel like they’re being bothersome to us.”

Martin added, “And sometimes it’s fear that they have of being taken out of the home or not being brought back to their home. It’s all on a case-by-case basis. I have people who are afraid to come to the hospital because they’re scared they aren’t going to come home. And so, you have to talk to them and reassure them that they will come home, and if not, there’s a reason behind it.”

The MIH program won’t come out to a patient’s home if uninvited.

“If they say not to come out there, we’re not going to go,” House said.

“But the irony of it is, if they accept the help, their chances of independence is much greater,” Langborg said.

It’s not just patient independence that the program can help with. MIH, and programs like it, can also contribute to financial independence for the entire healthcare system.

“From a long-term funding standpoint, people are trying to prove the value of these programs,” Langborg said. “Because the reality is, through prevention and decrease in the number of ER visits and admissions in the hospital that are more costly, they’re hoping to fund this and ultimately save money. They’re preventing strain on the system and their finances.”

As an example, House pointed to MedStar Mobile Healthcare out of North Texas, which was one the first national systems to offer the MIH program. It prevented 1,893 emergency department visits, which saved Medicare more than $800 million.

It’s those types of savings that Martin, House and Langborg are looking to pass on to the district.

As for the future of the MIH program, the current iteration is only the starting point. The program is starting small right now, collecting data from each visit and looking at the gaps in the healthcare system that it can help fill.

“A lot of what we’re seeing is anecdotal,” Langborg said, “But I don’t think we know the scope of what we can do with this yet. I’m sure it’s a lot larger than what we are doing. But I imagine that within 10 years, this program could easily have three (techs) that are going out and staying busy the entire day. I think it’s entirely feasible, but a lot of it goes back to finding out where it’s appropriate.”

The MIH program is not looking to overtake any existing program, but it is looking for gaps in the system as a whole to see where additional support can be given.

This can be particularly important for those who are unable to enter the large healthcare system due to lack of insurance and who rely solely on emergency services.

Medical systems in Lane County are closely watching how the MIH program progresses, and what challenges it decides to address. As the pilot program for the entire country, Florence’s MIH work is vital to shaping the future of healthcare in the region.

The program is up to the challenge.

“I’m not patting myself on the back here, but we’ve got a very good EMS system,” Langborg said. “It has a reputation in the county, the region, and it’s starting to get to the state level, as being one of the best EMS systems in the entire state. The district is trying to be cutting edge. By stepping out there a little bit and taking these projects on, it sets the whole county up for future success. We hope that our community sees that.”

MIH program between paramedics, hospitals produces significant results


Individuals enrolled in the MIH program receive home visits from paramedics over a four-week period

The “First 100 Days” is typically a time metric reserved for elected officials, but in St. Charles County, a collaborative effort between paramedics and BJC Healthcare posted some impressive results of its own during the first 100 days.

The initiative, called Mobile Integrated Health, has resulted in an estimated $149,000+ expenditure savings and vast improvements in patients’ health status self-assessments.

The program starts at Barnes-Jewish St. Peters and Progress West Hospitals, where physicians and case managers identify patients at high-risk for readmission to the hospital following an in-patient stay for certain serious health conditions: congestive heart failure, chronic obstructive pulmonary disease, acute myocardial infarction or pneumonia.

“Without strict adherence to care plans and medication regimens, conditions such as these can become exacerbated quickly,” explains Jill Skyles, VP of Nursing for both hospitals. “They can be particularly challenging for those who are newly-diagnosed and trying to adjust to new healthcare routines.”

Enter St. Charles County Ambulance District advanced practice paramedics Russ Allen and Kimberlyn Tihen, who meet with the patient and BJC case managers prior to discharge. Together, the group works to identify needs and goals specific to each patient. Individuals enrolled in the MIH program receive home visits from paramedics over a four-week period, where their health condition is monitored through physical exams, medication reviews, dietary compliance discussion and disease management education. Lab and other diagnostic tests and interventions also may be performed in-home as needed, and results are reported back to enrolled individuals’ physicians. The program’s overarching goal is to teach patient self-management while avoiding unnecessary readmission during the 30-day post-discharge period.

From Nov. 1 to Feb. 15, the program enrolled 28 patients; 17 successfully completed the program and 11 were actively enrolled on Feb. 15. Of the 17 who completed the program, 13 successfully avoided readmission and four were hospitalized – a program success rate of 76.5 percent. Using data from Centers for Medicare and Medicaid Services regarding costs related to emergency department and hospital admissions, direct avoidance of 13 patients from readmission potentially saves $149,097 in unnecessary care and associated cost to the healthcare system with subsequent hospitalization.

In addition, patients indicated significant gains on health status self-assessment, with those who completed the program reporting average improvements of 46.7 percent in ability to perform usual activities and 37.7 percent in overall health status. Level of pain/discomfort, anxiety/ depression and mobility also saw notable improvements. According to those enrolled, the program’s success can be attributed to those canvassing St. Charles County, visiting patients from all walks of life.

“Keep hiring the same quality of employees – people with compassion, concern and kindness,” said 88-year old Mary Walters, who even after graduation from the program continues to stay in touch with Allen and Tihen.

Given the success achieved during the MIH program’s pilot period, BJC and SCCAD are working closely to develop strategies for making the initiative a permanent fixture in St. Charles County.