Sunday, January 29, 2023

How Health One Builds an Alternative Response Model for Seattle Rescue Services

“If you saw this woman on the bus, you would think of her as someone’s grandmother,” said Seattle firefighter and paramedic Roger Webber.

She is a frequent customer of Health One, an urban mobile response team stationed outside the fire department. And like many of the team’s clients, the woman faces a combination of poverty, homelessness, and behavioral health problems.

The group’s mission is to work with people who frequently call 911 as an alternative response to better address their concerns by connecting them to resources, social and health services, including primary care providers and shelters.

On a recent Monday, Webber, firefighter Heather Reichmann and social worker Donna Andrews were summoned to meet this woman, aged 70, at a homeless shelter in downtown.

She usually calls 911 and complains of breathing problems. Before Health One intervened, the fire department usually took her to the hospital., although the oximeter showed no problems, she was eventually discharged and called 911 again.

She had slept in a temporary bed the night before, and when the shelter asked her to leave in the morning, she said she had difficulty breathing. This time, the fire department called Health One.

V The original plan was to coax her into staying at Starbucks until she could return to the shelter for one more night in a temporary bed. But while they were there, Webber said that a bed in the house had opened and she agreed to stay.

Shortly after the Health One team leaves, the shelter calls them again. The woman will not sign the contract that all residents must sign, and now she is leaving.

The team believes that in the past they have had traumatic experiences with shelters or social workers that make them fearful of anything that appears to be a threat to their independence.

The orphanage agrees to hold the bed for several hours while Andrews and Reichmann return inside to reassure the woman that the orphanage will not take the money from her and require her to meet with the host. After another 30 minutes of hearing and reassurances, she agrees to stay.

Since its founding in 2019, Health One has grown from one unit to two and plans to launch a third. Each vehicle has two firefighters and a social worker who answer calls on weekdays.

Seattle politicians see the program as a successful alternative response system because, they say, they insist on rethinking and rethinking public safety., following massive protests against racial injustice and law enforcement in Seattle and across the country in the summer of 2020.

So much so that in July, Seattle Mayor Jenny Durcan announced plans to create a Triage One group that would send non-sworn police officers to certain non-criminal or medical emergency calls. The team will initially be housed as part of the Fire Service’s Mobile Integrated Health Program, along with Health One.

The 2022 budget includes $ 1.19 million for Triage One, down from the $ 2.15 million proposed to reflect program delay between December 2022 and January 2023.

How does Health One work?

Webber says Health One’s unofficial mascot is a sloth. While firefighters are working quickly to move on to the next call, Health One is taking a different approach, he said. The team endeavors to spend as much time with each client as is necessary to resolve issues that keep them calling emergency services all the time.

On one occasion, a group spent over 50 hours over several weeks moving a man to a nursing home. They first met him at his home and found him using a long-broken toilet, John Ehrenfeld said: which operates the Mobile Integrated Health One and Seattle Fire programs.

Health One focuses on “short-term case management,” which can last anywhere from a week to several months before a case is referred to another service, such as a housing office, general practitioner, or long-term care facility.

“We are building a bridge. We are filling this gap until some system that is supposed to be used takes over, ”said Webber.

Bridging this gap, however, means that team members take on tasks that go beyond the job descriptions of paramedics and social workers. They gave out Ensure food drinks called Ubers to humans, fixed wheelchairs, handed out prepaid phones, and received prescriptions.

Around 20% of their clients come directly from 911 dispatchers who put them in touch with someone who wants to get a medical check or might be slightly injured. For Health One to respond directly, calls must be subtle and medical in nature. Forty percent of cases are referrals from firefighters to patients in real time. The rest are self-made calls when Health One visits regular customers or individuals previously directed to them by firefighters or other service providers.

Each Health One team costs about $ 475,000 a year, Ehrenfeld said, with $ 100,000 in start-up costs. One team oversees the Pioneers Square; the second is in Belltown, but also answers calls from Ballard and the University District. A third unit will oversee the Mount Baker area.

Health One receives 1,000 to 1,200 referrals every six months, of which the team can usually take over two-thirds.

According to Ehrenfeld, the most serious obstacle to the network of social services is the lack of qualified medical institutions, shelters, primary health care and treatment centers for drug addiction and alcoholism.

“The biggest need for our program is not in the field,” he said. “These are reception facilities.”

How will Triage One be different?

In July, Durkan’s office released a report that analyzed the 685,000 dispatch calls that the Seattle Police Department responded to between 2017 and 2019 to see what cases could be dealt with with an alternate response.

Seattle police agreed that there were about 30 types of calls – roughly 12% of total calls and 6% of total employee hours – when an armed police officer called. does not have to be the primary respondent.

Two of these types of calls are social security checks and personal calls, where people call emergency services to report sleep or intrusion. homeless, said Chris Lombard, interim director of the newly created Center for Public Safety and Communications, which now takes emergency calls. Triage One, at least initially, will primarily target these types of calls, which could reach 8,000 per year, he said.

By comparison, according to Lombard, the busiest fire trucks and medical units perform between 3,500 and 4,000 starts a year.

The traditional 911 emergency response system works on the principle of a dichotomy between the police and the fire department, he said. Dispatchers only have 120 seconds to determine which agency will best answer the call. He said that Triage One will hopefully introduce a third option to the system.

Ideally, first responders will conduct an assessment within 20–90 minutes of arrival and then either take care of the case on their own or refer it to the fire department, police, or possibly Health One.

While Health One has focused heavily on social work, Triage One will focus more on fact-finding and assessing the situation, Lombard said. situation.

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