Accelerating access to behavioral healthcare

How the Clark-Cowlitz Fire Rescue Co-responder program is improving patient outcomes

First responders regularly face crisis situations they need to deescalate, often requiring assistance when administering deescalation tactics. The co-responder team model, which provides this type of assistance, typically consists of clinicians working with law enforcement to respond to crisis situations. Data indicates that the co-responder model reduces in-hospital visits and police detentions.¹

Crisis Intervention Team (CIT) programs inspired the co-responder model, which has been gaining momentum over the years. In the United States, over 2,700 CIT programs existed as of 2019. The programs educate law enforcement on how to respond to individuals experiencing a behavioral health crisis.²

Co-responder models show such promise that a recent study indicated individuals in crisis were more likely to be referred to community services when a co-responder team was involved in the intervention. The study indicated an increase of 29.5%, compared to the 4.5% associated with police-only interventions.³

Other programs have experienced similar success. One program indicated co-responder teams fielding calls averted 98% individuals from arrest. The teams also provided behavioral health assessments and community resource referrals to 86% of individuals on active calls.⁴

Clark Cowlitz Fire Rescue Co-responder program

The Clark-Cowlitz Fire Rescue (CCFR), which provides fire and emergency medical services, is partnering with Carelon Behavioral Health on a co-responder pilot program in Southwest Washington. The program’s goals are to accelerate access to appropriate care for people experiencing behavioral health emergencies, and to help take some of the pressure off 911.

The Southwest Washington pilot is unique in that paramedics work together with mental health professionals to resolve behavioral health issues. “Law enforcement has had to shoulder too much of the burden in addressing behavioral health issues. They don’t always have the resources available to respond to someone experiencing a behavioral health crisis, so they need help,” says Leah Becknell, Account Director, Carelon Behavioral Health.

Becknell emphasizes how paramedics and mental health professionals going on calls together makes an impact. “Social workers who partner with paramedics to respond to calls are trained in how to engage individuals. While some people may have a negative reaction to law enforcement, they generally welcome fire rescue or paramedics arriving with mental health professionals. These teams rarely get turned away.”

"Our partnership with Carelon Behavioral Health on this pilot has already proven valuable. The program provides well-trained behavioral health professionals for people in immediate and critical need,” says Mike Jackson, Division Chief – Prevention, Clark-Cowlitz Fire Rescue. “This Co-Response unit is unique to our area and is working to implement a new and much-needed level of service.”

If the pilot is successful in improving patient care, outcomes, and cost effectiveness, the program will be ideally positioned to obtain sustainable funding to continue operations.

How the program operates

There are two full-time paramedics on staff, and a rotating roster of mental health professionals targeting 80 hours per week. The program dispatches through 911 and is in touch with local resources such as community centers, housing, food banks, disability, and elder care. “This is a huge advantage since the resources are all locally focused,” observes Becknell.

The program provides referrals to adult mobile crisis, youth mobile crisis, substance use disorder and mental health services, social services, and housing.

Jackson elaborates: “The team directly connects individuals in need with resources and referrals. The program also helps lessen the demand for emergency response, ambulance transports, and emergency room visits. Because of that, we can provide better immediate care for people experiencing behavioral health crises while also improving our availability and response times to other emergencies.”
 

Metrics the program measures

“The primary metrics we measure are improved patient care, outcomes, and cost effectiveness. If the program is successful, the evaluation metrics should identify a net benefit to the system and promote program continuation,” notes Christal Eshelman, Program Manager, Carelon Behavioral Health. “The soft launch of the program was in March 2023, and will run through the end of June 2024, operating Mondays through Saturdays, 10 a.m. through 10 p.m. We will collect data during that period.”
 

Program data to date

The preliminary CCFR data from March to July 2023 indicates the following successes since the program’s launch:

• 38 responses by the unit
• An average of 50 minutes spent on scene with patient
• 19 calls successfully diverted patients from ambulance transport and from the emergency department to behavioral health resources
• Out-of-service time savings
  • Over 530 minutes for fire units
  • Over 500 minutes for ambulances

 

CCFR success stories

Case study 1

A CCFR Co-Responder unit met with a patient reported to be drunk and depressed. The patient’s family and friends were worried about his potential for self-harm. The patient was a father of four who was suffering from a traumatic head injury, depression, and alcoholism. He also had a history of negative interactions with the police and noncompliance with the courts.

When the team arrived, the patient was inebriated and guarded, not wanting to speak with anyone. The team spent over an hour engaging with the individual, finally getting him to talk about his experience. He admitted to the problems he was facing, talking about wanting to be a better father.

When asked if he would go into treatment, if the team were to set up an intake appointment for him, he said yes.

The team set up an intake appointment for the individual the next day. His family also received information on support and therapy for families of alcoholics.

The individual began treatment and is currently sober as well as complying with the courts.
 

Case study 2

The CCFR Co-Responder unit met with a patient reported to be unresponsive and laying in the grass. When the team arrived, they were able to get the individual to respond so that they could perform a brief risk assessment.

The patient reported that she had ended up where she was after having left her abusive boyfriend. She was currently homeless because she could not find anyone she used to know in the area.

The team located a nearby cooling station for the individual, helped her call the YWCA and the housing authority, and assisted her with the application process.

Since the individual had internet and phone access at the cooling station, she now had the ability to get in contact with friends. The team provided her a card for the Community Assistance Referral and Education Services (CARES) follow-up team. They let her know they would return to the cooling station before closing to see if she had made any progress.

The patient let the team know that she would be contacting the housing authority at 9 a.m. the next day.

Case study 3

The CCFR Co-Responder unit met with a patient who was reported to be sleeping on the side of the road on a freeway off-ramp. He did not want any help from the fire department, but seemed to be experiencing behavioral health issues, so he was referred to CCFR Co-Response.

The team engaged the individual and asked if they could help him find a safer area to sleep. He responded that he was trying to head north to be with his family but kept hearing voices that told him to stay where he was.

The team informed him that he could stay at a safe campsite down the road. The patient provided his sister’s contact information. The team left a voice mail for the sister, requesting a call back. The patient agreed to wait at the campground in hopes that his family would pick him up. The team let him know they would also give his information to the HART team, who would provide homeless outreach resources in case his sister did not call back.

Toward the end of the shift on the same day, the individual’s sister returned the team’s phone call. She informed the team the patient had been homeless in the three years since his divorce and losing custody of his children. He also suffered from schizophrenia and substance use issues. The sister communicated to the team that she and their parents had been looking for the patient because they wanted him home, and that they would pay for treatment.

The team member communicated to the sister that the patient would stay and wait for his sister. The patient’s sister followed up with CARES via phone the following day, confirming that she had been able to locate her brother and get him into treatment.

Defining CCFR’s success

Becknell believes there are many benefits to community members being better served. “There are cost savings associated with reduced time for an ambulance dispatch, fewer transports to the emergency department, fewer high-volume 911 callers, and callers connecting to resources that better serve their needs.”

Eshelman sees benefits beyond the immediate reach of the program. “We want to achieve savings in resources and time as well as improved patient care and outcomes, all of which will help to further fund the program and its sustainability. In the long term, we want to extend the program’s geographic reach and pick up more calls.”
 

How to replicate the program

“Society focuses too much attention on law enforcement serving behavioral health, so we are trying to direct money and diversion from law enforcement. This pilot is filling a gap; an intersection of where it’s been and where it’s going,” explains Becknell.

“In order to replicate the program, we need to collect enough data to demonstrate the program’s success. We also need advocates such as a fire chief, or an emergency medical services (EMS) medical director, so that we can in turn acquire a sustainable funding mechanism, whether it’s from the county or a municipality,” says Eshelman.

Ultimately, programs such as these will help individuals experiencing mental illness receive the help they need, rather than getting funneled in the wrong direction. “There’s a perception that people with mental illness are dangerous, though that is changing, because data indicates differently,” emphasizes Eshelman. “Programs like these help individuals experiencing mental illness get the help they need rather than being treated as a danger to the community.”