Imagine you were Jacob, a 68-year-old with comorbid chronic pain and Major Depressive Disorder, who’s had more than his fair share of ED visits. Your distress has gotten worse and now you’re feeling unsafe. You have to call 9-1-1, but you hesitate. Picking up that phone will start a chain reaction; a call that once initiated, will insert a series of doctors, social workers, and nurses in your life—all of whom will undoubtedly refer you to someone else within the system—leaving you to piece together disparate information, diagnoses and resources.
Although Jacob’s experience is fictional, it is reflective of an all too real population of clients that struggle to navigate healthcare and receive services. In our own geographic area—Maricopa County, Ariz.—61% and 48% of residents indicated that mental health and access to healthcare were key issues within their communities, respectively.
In Chandler, first responders were often the first to engage clients experiencing psychiatric emergencies, so, in 2004, the Chandler Fire Department (CFD) integrated Crisis Intervention Specialists—professionals with behavioral health backgrounds—into its service delivery model. The Crisis Response Team, along with the whole of CFD, leveraged technology to enhance the client experience, deliver cost-effective care, and provide referrals and follow-ups to the city’s most vulnerable populations.
Crisis Response Team
Persons with serious mental illness (SMI) are often overrepresented in prisons and jails throughout the United States. In an effort to divert those experiencing SMI to medical and social services, many police departments have adopted mobile crisis intervention teams, staffed by both behavioral health professionals and volunteers. This traditional approach, although effective, doesn’t account for the needs of clients experiencing medical, rather than legal crises.
At CFD, the Crisis Response Team (CR288) is dispatched by computer-aided dispatch, and deploys personnel, alongside fire and/or police, to incidents throughout the city. Consisting of an established team of behavioral health professionals and graduate school interns, CR288 provides evidence-based intervention services on calls that range from traffic collisions to suicide attempts. CR288’s primary goal is to provide immediate care for the emotional needs of the client, allowing police to focus on law enforcement and fire on medical emergencies and fire suppression.
Our service delivery model, although unique to the traditional approach, has proven effective in addressing all of a client’s needs in a single-point in time. Our technology partner, ImageTrend, enable real-time access to client information, ensuring that members of the team are able to provide relevant referrals and post-incident follow-up.
Enhanced Client Experience
CFD anticipates that it will respond to more than 26,000 calls within Chandler and in neighboring cities, culminating in hundreds of transports to hospitals and facilities, dozens of large fires suppressed, and thousands of client records to manage. Real-time access to information in the field allows for CR288 to deliver evidence-based interventions informed by the unique needs and circumstances of the client.
Using a single application, ImageTrend Elite’s Community Health module, CR288 can access medical and fire-related records and determine how many times a client was treated (and by whom), their demographics and medical history, and what resources were provided to them at the time of the incident. Documentation of failed attempts to connect clients with community-based services, however, can also inform how CR288 makes referrals to keep recalcitrant clients accountable for their actions—or often, inaction. Lastly, decreasing the time a client has to spend retelling their story or conveying medical information is time that CR288 devotes to providing emotional support and interventions to stabilize the client.
A significant benefit of using an electronic record management system is the vast amounts of data you’re able to compile through each client encounter. CFD is an organization that routinely uses data to support key decisions such as the number of staff to deploy in the field, which equipment to purchase, and what community programs will provide the greatest benefit to the community. Similarly, CR288 leverages data to understand metrics that range from call times to district-level trends in incident types. This culmination of data paints a picture of both gaps and opportunities in areas such as service delivery, response times, and referral needs.
Data is also used to drive training decisions amongst CR288 personnel. There’s a well-known substance abuse crisis in the United States, for example, with opioid overdose deaths increasing five-fold since 1999, according to statistics from the Centers for Disases Control. Although Chandler has not experienced the staggering increases in overdoses observed across the nation, CR288 has implemented a unit-wide Screening, Brief Intervention, and Referral Treatment (SBRIT) training to better serve those that are suffering in the community, which was integrated seamlessly as a worksheet into the Crisis Response Incident From.
Using this SAMHSA-HRSA evidence-based practice, CR288 is better equipped to both recognize and reduce problematic substance use and dependence. Because each tablet contains the SBRIT tool and is deployed on-scene at the time of the incident, clients are served immediately. By integrating crisis response into its service delivery model, CFD is able to provide value to residents beyond standard EMS practice.
Traditionally, crisis response teams are embedded in police departments and used as a means to divert those experiencing psychiatric emergencies to behavioral health resources and away from the criminal justice system. The Chandler Fire Department, however, has integrated crisis response into its service delivery model in an effort to provide holistic medical and behavioral health prehospital treatment.
Throughout the years, CR288 has used technology and data to enhance their work in the field and fuel their decision-making both administratively and operationally. Above all, the treatment provided by CR288 has made a lasting impact for the client experiencing a psychiatric emergency, the client’s loved ones, and the surrounding community.
Editor’s Note: Allen Blaine, Robin Miller, Jessica Westmiller and Nicole Harris are finalists for the 2018 Hooley Award in the Innovation category. The Innovation, Service and New Frontier Hooley Awards will be presented at ImageTrend Connect on July 18th.