Inspiring Crisis Intervention Team (CIT): a Model to Address National Problems

Co-response teams in Upper Arlington successfully address the root causes of mental health issues, substance abuse, homelessness, and chronic conditions in their community.

When the city of Upper Arlington’s Fire Division started its STAY UA community paramedicine initiative in 2009, the program focused on helping older populations remain healthy and independent, reducing hospital admissions and 911 calls. In 2017, the Fire Division expanded the program into UA CARES (Community Assistance, Referrals and Education Services), broadening its focus to include younger, at-risk populations struggling with chronic issues like mental illness and substance abuse. Then in 2021, Upper Arlington took the next step by expanding UA CARES into a formal partnership between Fire, Police and EMS – and the result has been inspiring.

One notable case began with a family stressed to the breaking point, trying to help their adult son live with autism. The police encountered the young man in a public park, where a trigger stimuli had led to an unfortunate meltdown. Rather than simply returning him to his home, the police – having the benefit of UA CARES training – recognized that a follow-up visit could help avoid future, potentially tragic, incidents. They referred the young man to UA CARES’ Fire branch, where a community paramedicine team worked to help him and his family. The team investigated improvements to the son’s medication, they suggested changes to the home environment, and eventually the police got a second call – this time from the young man’s mother, asking for a mock traffic stop to help her son learn to drive. “In working with him, we attended monthly calls with his CARE support team,” says Christine Leyshon, UA CARES Manager. “After some medication changes, he was more stable. Our team was checking in on him, building a relationship with his family, and ultimately, this gentleman has become a successful community member.”

But this young man and his family are not unique. Day after day, vulnerable populations throughout the country struggle with mental health issues, substance abuse, homelessness, and other chronic conditions. In Upper Arlington, UA CARES continues to help as many as it can, now using the coordinated resources and expertise of Fire, Police, and EMS to provide even more widespread and comprehensive community care.

This kind of collaborative success is only possible with good communication, and HealthCall has been happy to facilitate that with its patient-centric documentation tools. “When CARES formalized, about five years ago … HealthCall was very important for us to document and create a workflow,” says Leyshon. “As a place for documentation, it helps me as a program manager to be able to monitor what’s happening on a day-to-day basis without having to talk with each officer and each firefighter.” Members of each branch can access HealthCall and add information to a patient’s record, making it available to everyone else in UA CARES who needs to see it. As Detective Michele Sussi says: “It’s just been huge being able to connect all of our shifts to stay in communication and completely up-to-date on each client.”

However, Upper Arlington knows the importance of preventing unwarranted access to sensitive patient information, and HealthCall provides tools to help them. “We have two different monitoring groups,” says Leyshon. “We can have our police officers only have access to patients in our PD monitoring group. That’s how we can keep it separate so that police officers don’t necessarily have access to all of our medical patients and medical information … we know that is very important, for patients to know, and for the greater healthcare system. But that still gives me oversight of both programs.”

By using HealthCall to securely share relevant records and stay in contact, UA CARES is able to gain insight into many underlying issues that present as simple disturbances. One key issue is alcohol abuse: “Alcoholism is a lifelong fight; we recognize and understand that,” says Sergeant Heather Galli, Peers Coordinator with CARES PD. “Alcohol dependency also comes with health-related issues. We see some of our folks say that this is a police run or a fire run, but it’s all stemming from that primary issue of alcohol dependency. The CARES team has been very successful in connecting with some of these frequent callers … providing connections and getting them into supportive programs.”

When dealing with such chronic conditions, one of the strengths of the CARES program is its flexibility: when a client is doing well, the CARES team can put them in a suspended state with only one or two check-ins per year, but if the client experiences a flare-up the CARES team is ready to ramp up their support. “We know that, with substance dependency and mental illness, there can be times where it is very manageable and times where we move into crisis mode,” Sergeant Galli says. “HealthCall is such an essential part of this for documentation because we can see: do we have some type of pattern, what has worked in the past, and what’s not working now? That information is all available right at our fingertips.”

HealthCall’s documentation tools also help UA CARES as it looks to the future, by allowing greater scalability and sustainability. While finding the right experts to spearhead the project was vital in the pilot phase, Christine Leyshon and Sergeant Galli think it’s important now to ensure that expertise is not lost: “We’re not going to be around forever … how do we take the subject matter expertise from specific individual officers and firefighters and make sure that it’s a known resource and it doesn’t just leave with the individual?” asks Galli. “[With HealthCall], as we bring in new team members and team members move and transition to other jobs and responsibilities, it’s seamless … we can make sure of the needs of the program so that everybody knows what [the program] is, how the resources work, and how they’re applied to the program in the community.”

As for how UA CARES might continue to grow, Sergeant Galli believes the sky’s the limit, and hopes their example can help others grow as well. “We’re excited to share what we’re doing. I think it works for our community, and I think it could definitely be impactful for others.”