Helping those who habitually call 9-1-1 for social problems
One of the challenges that Huron Valley Ambulance faces is the dependence on the
9-1-1 system by individuals for repetitive, non-emergency purposes.
In an effort to address this issue, HVA has partnered with Catholic Social
Services of Washtenaw County (CSSW) to begin a patient outreach and advocacy
program to work with these patients to get them the help that they need in
advance without calling 9-1-1. CSSW
serves
individuals and families of all faiths, offering more than two dozen programs,
including adoption and pregnancy counseling, food assistance, homelessness
prevention, domestic and child abuse intervention and prevention, family
therapy, and services for older adults, individuals with developmental
disabilities, and at-risk families.
The one-year demonstration project was funded by a $30,000 grant to CSSW by the
HVA Board of Trustees.
Referrals to Barbara Elliot, our case manager at CSSW, come from a number of
sources. Our Call Center tracks the frequency of requests and medics and
dispatchers report circumstances that they feel need to be addressed. For
example, our EMTs and paramedics notice the home environment when they are on a
call. If they observe that elderly patients appear unable to care for
themselves, they refer these patients to Barbara for follow up.
“You see a tremendous variety of clients but most of them
need crisis intervention. They present with intense needs and I try to meet the
most crucial needs by connecting them with resources,” Barbara explains. “It
means a lot to them just to have someone on their side. Ambulance requests have
decreased because HVA has helped them find other assistance.
They learn that having paramedics and firefighters
show up over and over is not the best way to get help.
It seems to foster a sense of accountability on
their part.”
Barbara’s biggest challenge is connecting with her clients.
Some are homeless and those with homes often do not have phones.
For many patients, Barbara will make a home visit
and leave a note with her contact information if they are not home.
Since January, Barbara has been able to follow up with many of these patients
and make progress, measured by a reduction in call volume.
Many referred patients
receive services through
Community Mental Health (CMH).
Barbara contributes to better care plans by sharing information with CMH after
receiving the client’s permission.
Much of her job focuses on case management — administrative problem solving and
care coordination. There are a
number of community resources in the area but there are also gaps, such as those
caused by waiting lists for addiction treatment programs
and scarce resources for
uninsured clients with Traumatic Brain Injuries.
Barbara has her favorite success story so far. One woman was calling 9-1-1 about
every two weeks.
She was under a great deal of stress, which resulted in panic attacks and
physical symptoms, and she had no one else to call.
It was clear that she was in a serious financial crisis and about to be evicted.
The woman clearly welcomed Barbara’s help when she called.
Barbara spent two months working with the Michigan Department of Human
Services and other community agencies, finally securing sufficient funds to
prevent her eviction. She has since found better employment and her finances are
stabilizing. It has been over three months since her last 9-1-1 call.
Since March 2010, Barbara has received 23 referrals from
HVA with the majority referred by the 9-1-1 Call Center staff.
Out of these 23 people, Barbara has had the success
mentioned previously and has contacted 15 others who she is in various stages of
assisting.
Of these 15, there has been a definite reduction in 9-1-1
calls. She is trying to locate the remaining eight, two of whom have been
confirmed as being homeless. Two are new referrals and she has left notes for
two others. One gentleman has since been incarcerated and Barbara recently
visited him in jail, knowing that he will be released in September. He was
surprised but pleased to see her and called her a “godsend”. He told her that he
will have nothing when he is released and very much needs her help.
One woman was calling 9-1-1 approximately six times a month.
Although she declined
assistance through the program, Barbara’s follow-up established some
accountability for her 9-1-1 usage.
The frequency of her calls has since declined dramatically.
Assistance for these clients may be as simple as one referral or as complicated
as working with other providers as a team to meet a myriad of client needs.
“Barbara and this program
have already made a big impact on some of our long term patients. She has been
able to assist several of them with help they really needed”, states Jane
Giffin, HVA Communications Manager, who supervises the 9-1-1 Call Center.
How does this affect HVA?
HVA is a charitable, nonprofit organization and it receives
no local government tax support for ambulance operations. The program reduces
demand for HVA services, allowing paramedics to concentrate on patients who are
in emergency situations.
Many of these patients are not insured, or they are
insured by government programs.
These unnecessary costs result in higher costs for
health care and health insurance.
Because fire departments also incur costs in
responding to many of these calls, the cost to local government is also being
reduced.
Why do some people call 9-1-1 so often?
The answer is complicated.
Barbara states that “they
all seem to be calling because some need — mental, physical, or social—is not
being met.”
They might have patterns of drinking and make bad decisions when they are
incapacitated. Or they may have a mental illness that causes attention-seeking
behaviors. Sometimes, they are hungry and know that they will receive a meal at
the hospital. Or they are just lonely. It is a crisis response because they have
no one else to call. And they know
HVA will come.
The calls come from people of all ages, both genders and varying income levels.
It is not just the poor and homeless; calls also come from upper class
neighborhoods.
Many medics (as well as firefighters and police officers) are frustrated by
these “revolving door” patients. These calls take ambulances and other emergency
vehicles out of service and cause longer response times for other true
emergencies.
“Even though we treat everyone with compassion, it’s difficult when you have the
same people calling you every week because they’re drunk again or they have no
one else to call, especially when some of them are less than pleasant. We care
about these people but there are residents with real emergencies who need us
more,” states one HVA paramedic.
Barbara does not tell the clients that she is visiting them because of their
frequent 9-1-1 calls. She introduces herself as someone from HVA who is
concerned about their recent calls and asks how we might help them.
Due to liability
concerns, Barbara never directly discourages 9-1-1 usage.
What changes would Barbara like to see in the current system that would help her
clients? “Better coordination
between social service agencies and social workers in hospital emergency
departments,” she states.
Hopefully, we can improve that link.”
Barbara reports that things may be improving. She has joined a group of
community agencies that includes the Delonis Center for the homeless and CMH.
This group meets twice a month with the University of Michigan Hospital “Complex
Care Team”, a group of U-M health care providers and emergency department staff
who create care plans for “frequent emergency department visitors”. Barbara is
an important link in this process due to her access to these clients outside the
health care system.
Barbara graduated from Oakland University and previously she has done client
advocacy work in Oakland County, Michigan.
She is married and lives in Ann Arbor. Through CSSW, she works part-time
on HVA’s project and part-time with Avalon where she is a supportive housing
advocate. The
mission of the two programs is similar — providing appropriate support for
individuals’ needs in the effort to improve their lives and reduce costly
reliance on emergency services.
“The best thing that this program does is identify the people with multiple
needs who are falling between the cracks. It is invaluable to those who before
were going unnoticed,” summarizes Barbara.