Crisis Response Podcast E002: Integral Care - Mental Health Crises in Austin, Texas

Episode #2: Mental Health Crises in Austin | Integral Care

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Episode Transcript

*This transcript was compiled using automated software — spelling and punctuation errors are possible

Jason: Welcome Marissa and Kedra, thanks for joining us today. It’s so great to have you here.

Kedra: Good to be here.

Marisa: Thanks for having us. Thanks. Yeah, thanks for

Jason: having us. So we’d like to start talking about EMCOT, which is a part of Intergral Care. Your organization. Tell us about the expanded mobile crisis outreach team.

How did this start? Where, where, where did this begin?

Marisa: I guess let me first start off by saying Kedra and I are, we work for the local mental health authority at Integral Care in Austin, Texas, and our original mobile crisis outreach team, our MCOT team started in 2006. They receive all of our referrals from our community helpline. The EMCOT team started in 2013 when we identified that the majority of the calls that our community was receiving for individuals in crisis were funneling through our 9-1-1 call center and not our community hotline. So we were able to utilize a [Medicaid] transformation waiver to expand our EMCOT team and establish EMCOT where, uh, we partner with first responder partners who have identified someone that is in crisis and will request our assistance to respond and provide services where that individual is experiencing a crisis.

Jason: So you had been providing this program. And then when they wanted to expand it, the city of Austin wanted to expand it into mobile crisis. They put out an RFP or they came directly to you and said, “We wanna do this program”?

Marisa: So we actually applied for the [Medicaid] waiver in 2013 to get the funding to start, so Federal waiver to expand the services that we were already providing.

Our original team started with county funding, so the team that’s deployed out through our hotline received funding through the county. And then about two years later, we got state funding through crisis redesign. So the expansion started with the waiver, the federal funding, and then in about 2019 when the transformation waiver ended, the city and the county assumed funding for the EMCOT team, because, how well the project had done and really seen the outcomes and the benefits to,our community the individuals in crisis, and just, you know, other benefits such as cost savings and things of that nature.

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Jason: How does the program actually work? I remember we met at NENA, the National Emergency Number Association Conference in Louisville. And I remember a gentleman from Austin [Police Department] explained that previously if you called 9-1-1 in Austin, they would say, “Austin, 9-1-1, do you need police, fire, or ems?” And now they say, “Austin 9-1-1. Do you need police, fire, ems, or mental health?” Is that, is that accurate? Correct. Yes. And, and so, mm-hmm. , when, when they say, if they say mental health, please, How does it work? What? What happens? Okay.

Kedra: Correct. Yes.

Jason: And so when they say, if they say mental health, please, How does it work? What? What happens? Okay.

Kedra: Good question. So, and this leads to an expansion of the expansion, right? So what Marissa was alluding to is like our crisis teams responding to first responder partners in the community.

But then in December of 2019, we built upon that and then we embedded counselors in the 9-1-1 call center. So when someone calls 9-1-1 in Austin they do get that fourth option of mental health services. The call taker still screens the call to ensure that there are no immediate safety concerns or medical concerns or fire right before they’re sending that over to our clinician who then takes over that call.

And when someone is in need of mental health services, right? And they call 9-1-1 they have that option and they have the ability to talk to a counselor, and then our counselors and the 9-1-1 call center can also page out or send out our EMCOT response team. So if someone is still needing a response, but police are not needed, right, and counselors are a more appropriate response, they have that option.

Jason: So you’re getting right into the thick of it right now, which is we hear all over the place, mobile crisis response teams, they’re at danger, right? They’re, they’re in danger of harm or violence, especially with agitated persons. Or if there’s substance abuse involve, do, do the call takers screen. Like what?

What is the criteria or what kind of questions are they asking and how well does it work?

Kedra: Well, actually it works very well so our counselors are able to divert about 80% of the calls that they receive at the 9-1-1 call center and divert, I mean, divert from a police response. So the majority of the calls that they take, they actually handle over the phone, and then only about probably 13, 14% of the time are EMCOT clinicians actually responding out into the community to those calls.

Okay. What I will say though, in terms of safety, cuz we hear it too is I feel like a lot of law enforcement or community members don’t know that these traditional EMCOT teams have been in existence for many, many years. Right. So counselors in the traditional role, like somebody’s calling to helpline, they’ve been responding in the community for a very long time.

Right. And we are very, very well versed in responding, we typically respond in pairs right to the initial visit for that safety reason to ensure that the scene is safe. But our counselors in the 9-1-1 call center, they do an extensive screening. So when you think about somebody calling 9-1-1, that call taker is trying to determine very quickly within 30 to 60 seconds, who’s responding to that?

Our clinicians have a lot more leeway and get to spend a lot more time with the person on the phone really dialing into what is happening in that crisis situation. So they’re asking lots of safety questions around weapons in the home, about aggression, about history of violence about current presentation, right, about substance use.

So yes, we do not want to send our clinicians into harm’s way either. So we’re gonna be asking all of those. If a safety concern is identified those calls we do route back to police. But that’s actually not a high percentage. and I would say of the calls that go back to police, only about 50% are for a safety concern.

And then we’re able to communicate, you know, to the police responding police officer, why, you know, We are referring them back and what that safety concern is. The other 50% is the person simply wants a police officer and we can’t deny that to them. Right? If they’re wanting police, we will send it back.

But giving them options, right, of what is available and what services are available to them.

Jason: That’s really impactful stuff. 50%. That’s a pretty good number. What are your numbers in terms of responses? Both the number of calls that your clinicians are taking in the 9-1-1 call center, and then the number of calls that they’re actually dispatching to the EMCOT team.

Kedra: So on a week, we’ll go a week’s worth, right? Typically, our clinicians are responding from anywhere to like a hundred to 150 calls per week. Again, only about 13 to 14% of those are dispatched out to our clinicians, so typically that’s like two to three per day, right? That they’re requesting a team to go out.

Again, that’s only like that small snippet, right? We’re still getting all of the other calls from EMS, from our law enforcement partners. and the community as well.

Jason: So there are more ways than one to get in touch with EMCOT. You can do it through 9-1-1. And how else, how else do folks get in contact with you?

Kedra: So the traditional way before we expanded and put our counselors in the 9-1-1 call center is that. Say someone calls 9-1-1 and they end up requesting EMS or a police response. Once EMS or police are on scene and they determine it is a mental health crisis, right? There’s no law enforcement needed this person isn’t in need of medical attention.

It’s not acutely medical, they don’t need to go to the hospital, then they can page out one of our clinicians to that scene. So they stay on scene and then we just send one clinician out. They’re able to get the information from EMS or law enforcement, and then our clinician engages with the person in the community, provides a safety screening.

And then our goal is to get our community partners back into the field within 15 minutes, right? So we get on scene, we’re doing that safety assessment and if we feel comfortable to continue that crisis assessment without police or EMS presence, we’re gonna say, “Hey, we got it. Y’all can go on.” And then we stay with the person in the community to finish that assessment.

Cuz the assessments can take, you know, 45 minutes to an hour, just depending on what’s going on.

Jason: I remember hearing a story at the NENA conference. Correct me if I’m wrong, but it was that someone was saying that when your team arrives on scene they’re often applauded by EMS and by police. Am I remembering that correctly?

Kedra: . They do like it? Yes,

Marisa: I think so. I think, so a couple different things. What you might be remembering is, uh, Lieutenant Murphy with apd, he oversees the call takers at the 9-1-1 call center. when we started the project and we were identifying call types that we were appropriate to be transferred over to our.

Clinicians as opposed to police. One of the call types that we got applause from the police was behavioral issues from, or parent child conflict. and that those were more appropriate for a counselor response or an EMCOT response as opposed to a police response. They really liked that that was something that could.

Be diverted away from their response and, and more appropriate as well. But I think that in general, uh, when we do arrive on scene, there’s benefit to the person in crisis cuz we’re, that’s our expertise in, in doing that assessment for them. But it also provides that first responder with an expert resource so that they can be released and go back into the community and be really available for their area of expertise.

Jason: Absolutely. I, remember when the nation started talking a lot more and more about crisis response and let’s reconsider 9-1-1. A lot of the naysayers were coming out and saying, “Oh, you wanna send a social worker instead of the police”, as if that were a bad thing. And the reality is, yes, that’s exactly what we wanna do, we want to send social workers to folks that need social workers and we wanna send the police to folks that need the police.

So you’re really at the forefront of demonstrating how it can work, and especially if you haven’t had any of the safety issues that people also talk a lot about. It’s just resounding support for your program.

What is the size of your coverage area? Is it all of Austin?mIs it the county?

Kedra: So it’s all of Travis County.

Jason: And did it start like that or did you grow. Did you scale it up or, or from the outset, was it, this is going to be for the county?

Marisa: So that’s a really good question. At the different points that we do intercept with the various teams. the original EMCOT team that receives referrals from our community hotline has always been county response when EMCOT

Is taking calls, uh, from first responder partners, referrals after they’ve identified someone is in need of support it That was also the county and then, Originally when we integrated into the 9-1-1 call center, we only received funding from the city of Austin. So we were only, uh, available for people that were in the city limits.

However, this past fiscal year, we’ve now expanded to the county as well for that diversion for this upstream at the 9-1-1 call center. So we’re really excited about the ability to provide. That full package for the, for the whole county.

Jason: Where do you recruit your team members from? Are they taken from within the organization and, you know, work their way to become members of the team?

Or are they hired directly into the team and, and whichever way, what are the qualifications that you’re looking for?

Kedra: Yeah, so a lot the majority of our team members come from the community, right? So just and we have, especially on our response team, we’re very lucky and we’re over 50% licensed professionals. So, and what I mean by that is either a licensed counselor or a licensed social worker. and then the rest of the team has their masters in social worker counselor.

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And counseling and typically are working towards licensure. that’s mostly on the response team. The call taker side. The majority are what we call qualified mental health specialists. And so they meet a certain level of credentialing as being a local mental health authority that’s kind of outlined for us various degrees, right?

Bachelor’s degrees meet those qualifications. so they’re, you know, pretty strenuous. but like they have to have a certain level of degree in order to come on the team. I will say as we were expanding, we did utilize internal personnel for that expansion, right? People who are well versed already in the crisis continuum, providing crisis assessment screening, and then we use those individuals to kind of expand and build on a program and then hired to like fill out the teams

Jason: What are the interventions or, or what is the goal of what they’re providing? Is it purely deescalation or is it getting them into referral or wraparound services? Do you ever transport people?

Kedra: Yes. So, You know, it, it varies wildly right in crisis situations, like what the needs are of the person that you’re gonna be speaking with.

But ultimately our goal is to complete what we call a crisis assessment, but we are wanting to assess the individual. And you’ll really ask those questions, Can they safely remain in the community? Right. Is like our top tier. and then we kind of worked down from there. The majority of the people that we intervene with remain in the community.

Right. And if you think about like why mobile crisis teams came into existence, really it was to divert people from going to higher levels of care that didn’t need to go there. Right? A lot of people were sent to emergency rooms or psychiatric hospitals that really don’t meet that threshold of meeting that higher level of intervention.

And if you think about it besides cost – The intervention with that person – It wasn’t a great outcome, right? Because they’re receiving way more services, way more restrictive services than they’re really needing. So our goal is really, yeah, to go in, provide that crisis assessment, do a thorough risk screening, safety planning, and then determine like, where, where does this person where’s the best fit right now?

And then to provide follow up services. So if a person is voluntary and say they do meet that threshold and need to go to an inpatient psychiatric inpatient hospital voluntarily, we can transport there. Our agency also has residential and respite facilities, so like a step down from inpatient hospitalization where they still have kind of those wraparound services.

They have access to prescribers, case managers, you know, they can do a lot of discharge case management planning. And if they are able to go to one of those facilities and want to, we can transport them there as well. and. Again, the majority of the people remain in the community, and then our teams can follow up with them up to 90 days.

And we have psychiatric nurse practitioners on our team that can go out and meet with them, and then our clinicians as well, really to help stabilize the crisis and then link them to services, right? And providing referrals. So we do a lot in that first visit, but you can do everything, and so then we’re gonna do that follow up piece to help prevent future crises.

Jason: What types of relationships or agreements did you have to come to with these other providers or, or, uh, facilities? And were they willing to do this or did it take some convincing. Maybe even the city or the county coming in and mandating it. How I’m sure working with such a wide range of, of partners, it’s not all gonna happen the same way.

Marisa: Yeah, I think that’s a really good question. you know, our, our three main, I think, uh, partner community partners that we would receive referrals from are our jail system, our law enforcement partners, and then also our EMS partners. And I think what really helped is that that original EMCOT team would have, they had a relationship with the crisis intervention team with law enforcement where we partnered in instances where people did meet the threshold for maybe an involuntary commitment to, uh, inpatient hospitalization for their safety.

So we had good working relationships with law enforcement and then we had a history of providing mental health training as well. So they, we had good relationships to begin with and I think a lot of how it was helpful to not only sustain our program, but to continue to. To expand our services was that relationship piece.

And so we, we were able to, with the partners, APD and EMS, to be very fortunate in that we had champions. In their leadership department who really advocated and pushed for this collaboration and ensuring that we were meeting the needs of the community for individuals in crisis and having that warm transfer process.

When they identified that individuals were in crisis, we did have to establish inter-local agreements and memorandums of understanding so that we could provide the services.Aand we’ve even been integrated in their department’s policies and procedures about how to utilize us, which is, is really great and beneficial for our ongoing relationships with the departments.

I think where more recently with the integration into the 9-1-1 call center that was met with a little bit more hesitation, you know, throughout the nation there were a lot of models with EMCOT teams that were already established. So our city could look at other models and really look at how the benefits of what other communities were doing as well.

When we started the integration into 9-1-1, there weren’t very many communities that had that established already, and we utilized the relationships that we had existing relationships with Austin Police Department to really go to you know, building the relationship and, and getting integrated into the 9-1-1 call center and starting with a very narrow focus to ensure that when we started this project, we were doing it in a way that was safe for the clinicians and that because it was so new for our clinicians and the call takers, the operators, that everyone felt comfortable and confident in this new project.

And it’s really, it’s been really successful and it’s taken off really well, and I feel like we’re almost three years in and it, it feels almost like a well-oiled machine now.

Jason: It sure sounds like it. That point about making sure that they felt comfortable and confident — how did that happen? At what point did they, I’m sure they didn’t come out and say, “Hey, we’re comfortable and confident with you now”, but at some point they, they sat a little easier in their seats. And I’m wondering if you could just share about maybe what it took or, or how you demonstrated that you were up to the task. And and equals in this partnership.

Marisa: I think a lot of it was what was so beneficial was specifically talking about the 9-1-1 call centers that. We were integrated into their center.

So we had the ability to form relationships with the operators and call takers. we started with a very narrow focus and really I think built a mutual respect and trust between the two different disciplines to get a better understanding of one another’s goal and purpose. And how we did that was really through training and constant feedback and communication.

We had people observe our operations and ask questions. They listened to our calls. We sat with the operators as well to get a better idea of the calls that they, that they received that weren’t necessarily mental health. We provided mental health first aid training to all of the operators so that they did feel more comfortable and confident and really being available to have real time feedback and discussions about calls or cases was, I think, very crucial in ensuring that we were all working together the same goal to help people.

And I think that feedback loop was really helpful to ensure that we could continue to expand call types and services that we were providing. Kedra was, is there anything else that you wanted to add?

Kedra: No. Just acknowledging it started off really. So this isn’t something that, you know, we’re talking about.

We take 100, 150 calls a week now, like when we first started, it was like, one to five. Right? So building on those relationships really helps, you know, expand it. We’re a new service. Something that, you know, call takers and dispatchers are not really accustom to knowing. Like what we’re able to do, what we’re able to handle.

So yeah, we had to go in there and earn their trust. and once they saw, right, they’re like, “Oh, okay, I can send these over. They are gonna handle them.” Then it just, yeah, it just kind of domino effect from there and continued to expand.

Jason: You’re talking about it started with a limited number of crises and then it expanded.

Can you share which ones you started with and which ones did you expand to later? And maybe what was the rationale for starting with those and then expanding to others later? I think this is something where a lot of groups get hung up is, “We’re going to respond” and then the question is, “Well, what are you going to respond to?”

You know, then they have to define it. And that’s where things start to get sticky.

Kedra: Yeah. No, I think we definitely started with you know, suicidal persons who have not taken action. So someone who’s expressing suicidal thoughts, but they haven’t taken pills.

There’s nothing has happened yet, and so that, those were ones that were somewhat easier to identify specific, like High utilizers, right? Of the 9-1-1 call system who are calling back frequently. I think the call takers saw usefulness. And trying something different because it’s kind of the same request right over and over again.

And, you know, they’re not seeing, you know, any results or any like resolution there. The ones that we kinda added on later were definitely welfare. So that’s something that has evolved. specifically welfare checks. When there’s a known mental health component, maybe someone has expressed suicidal ideations and the idea behind that is right, like if they’re having a mental health crisis, our clinicians are gonna at least attempt to reach out to them first.

To have that conversation, to be able to check in. and we actually have quite a success reaching people, say a third party caller has called and you know, is expressing concern about Susie and we are able to reach out and make connections and provide, you know, that really like screening assessment and then again, send out counselors if we need to or if that’s appropriate in those situations.

Jason: That’s really interesting. So somebody can call you and, “I’m worried about my sister. Can you give her a call and you say yes.?” Yes. Wow. And and how does that conversation usually go? I mean, are they receptive to it or They, I’m sure you get a little of both, but you know, that’s, I do a lot of cold calling myself.

That’s a whole other level of cold calling. Right.

Kedra: I think when you, you know, explain like who you are and that you’re just there, like no one’s in trouble, right? We’re just, you know, someone is worried about you and we’re just wanting to make sure that you’re safe. And if, once you’re able to have that conversation, I mean, most people are fairly receptive.

I mean, there will be the cases of like some, maybe some familial conflict or, you know other situations, but most people can be receptive to — this person was so concerned that they called 9-1-1, and they were worried about my safety. And once that is conveyed, you know, most people are at least receptive to have a conversation.

Jason: On that piece, you’re dealing with a lot of intersection, you know, like you’re dealing with a lot of problems that overlap mental health. There’s oftentimes a lot of substance abuse or homelessness tied into this. How do you, Well, do you kind of mark off your, for lack of a better word, territory or do you ever get other groups involved that aren’t normally, that aren’t officially a part of EMCOT?

Like reach out to homeless services or, or you know, substance abuse, harm reduction groups, whatever it may be.

Marisa: Yeah. So that’s definitely what we do, our EMCOT team, so I would say that we have, we’re generalists, so our specialty really is in that crisis intervention. Suicide lethality risk assessment. But we also have the ability and knowledge of our system to not only refer internally to our local mental health authority partners if it’s substance use or sometimes it’s intellectual and developmental disabilities or, uh, someone with medical component.

We have integrated clinics, medical clinics within our, our services as well. we connect them either internally or externally to whatever. The resource and best fit is for that person. and sometimes what happens is, you know, we’re helping them navigate, uh, those resources and referrals within our ability to, to keep them on our caseload for up to 90 days, and ensuring that they’re linking to those, to those services to help reduce crisis, further crisis episodes from reoccurring.

We also have an another component to our services in wherein we have, uh, our EMCOT team who’s partnered with our EMS, community health paramedics, and they’re responding to calls where there’s a mental health and a medical component. So, really, ensuring that if there’s, we’re looking at the whole health of a person and ensuring that, you know, early intervention is the best intervention.

And if we can have the two disciplines that have that expertise come together and start working with both, that that’s another benefit that we have in our, our crisis continuum, which is, has been really great and beneficial for people.

Jason: What kind of metrics do you use to demonstrate the efficacy of your program? So many of, especially if you’re getting municipal funding, but even for a lot of the groups that are getting private funding through philanthropic giving or grants, they’ve gotta show their value. What metrics are you showing to say, you know, “we’re here and we’re getting the job done and this is how we do it”

Marisa: It’s really good . And you know what? I think the data has really. you know, I, I talked about the relationships and how that’s so beneficial and crucial. but the data piece is also really beneficial and crucial, especially if you’re looking at sustaining or continuing funding or building a project.

, so the output measures that we look at are number of people served, unduplicated, We really break it down to what the different partners are providing. So, law enforcement, ems, our criminal justice system. we also track how many of our first responders were training and how many calls we are unable to get to, to really show any capacity constraints or how to scale the program.

But what really I think speaks to the success of the project, and I think what most people are interested in are outcomes. so those would be and this has been historical, uh, since the beginning of the project when the waiver started in 2013 with EMCOT is how many people are we able to divert from?

How many people are we able to divert from an EMS transport or an admission to an emergency department? And then how many people are we able to divert from a peace officer’s emergency detention? Cause here in Texas, as. Clinicians, we don’t have the ability to place someone on an involuntary commitment that is at the officer’s discretion to do that.

So we look at ways in which we can be, be there to help support diversion from that involuntary commitment if possible. And then at the 9-1-1 call center, we’re looking. How the percentage of times that we’re able to divert the incoming calls from a police response.

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Jason: That’s a whole list of them that’s, uh, really holistic.

That’s a lot. Yeah.

Kedra: And one more

Marisa: The linkage,

Kedra: Eight. Linkage. Yeah. So the other thing is, are we linking people to services? And that could be internally within our agency or external services, if we can confirm, that they have connected to, you know, their counselor, their doctor whomever would be that they’ve identified would be of support to them, even outside of like Integral Care services

Jason: Are any of those metrics harder to demonstrate than others? It sounds like one, the calls to 9-1-1 that get diverted to you is pretty straightforward. If they hand it off, then you know, put a check in that. But I suspect other metrics that you’re tracking can be more difficult to, to show, you know, a, a direct causation between the two.

Are there any that are harder to demonstrate?

Marisa: I think with our definitions, they’re not as difficult, I think we’re, some questions come up are related to diversion from arrest. you know, of the calls that we get from law enforcement, we’re looking at what are the outcomes that are not arrest related. So what is that percentage?

And I mean, historically it’s always been 99% that we’re able to divert from arrest. But the way that we defined it and how we agreed upon it with our law enforcement partners is knowing that anytime, you know, law enforcement is involved, there could potentially be an outcome for arrest. So I think that one is, is typically where we get a lot of questions.

But when we talk about how we define it, cuz it’s so hard to, to really kind of nail it down and drill it down, what, what might have happened. it, I think that’s the one that, that has the most questions come up. But other than that, I think it’s very clear what the outcomes are.

Jason: That makes a lot of sense. It seems like there should be a box that says “The police officer was going to arrest this person until we showed up.” But I, I suspect that they can’t do that.

Do you charge for your service?

Marisa: We do we, we do charge, uh, for our services. However we never want our service, we never want fee for service to be a reason why someone doesn’t, uh, want our services. So as a local mental health authority, we are a safety net provider for individuals. So we do work on generous sliding scale fees but we have the ability to. Waive fees if it’s going to be a barrier to services. I mean, one of the reasons why EMCOT was developed is to remove barriers for people specifically related to transportation or support or financial.

And so, although we do charge for our services we, we do have the ability to ensure that that’s never a barrier for people.

Jason: I know in a lot of states now it’s possible or nationally it’s possible to bill Medicaid for crisis response, but obviously Medicaid is managed at the state level. So I’m wondering if that is an option for you.

Marisa: Yes, we do.

Jason: Okay. Is it complicated or is it, you know, Medicaid seems to be, for the uninitiated, a labyrinth of paperwork and confusion, and I’m wondering if that’s been your experience or it’s been easier for you?

Marisa: I dunno, for me, I’m not, I don’t know the complexities of it, so I’m, I’m not really sure.

Kedra: Thankfully we have a whole financial department and team that handles the majority of it, right. Which I can greatly appreciate. We focus on just getting the information right if they insurance information, you know, monthly income and then we hand it all off to the others. Although I have to say that I have They haven’t come back to us and been like, “Here, we have issues here.” So to me that sense it’s going okay.

Jason: We, on the ambulance, often ran into the problem that people said, “I’ll take myself to the hospital, Thank you very much. I don’t have money to pay for the ambulance.” And they would refuse transport based on that. Do you ever run into anything like that?

Is it people are just eager to get your support?

Kedra: Yeah, typically no. Right? I mean, cuz we’re gonna be way cheaper than an ambulance or any other form of transport. And yeah, like if there’s an issue, yeah, we’re gonna make sure that it doesn’t land on, you know, that person. Again, Marissa said this, but we, our agency does have a very generous, which is standardized, but you know, fee for service.

So a large portion, you know, of the people that we serve aren’t going to receive a bill.

Marisa: Yeah. Our populations that we serve are either uninsured or underinsured.

Jason: What’s your position or how does 988 impact you? Is that something that you, because it sounds like you are kind of already doing 988, but you’re doing it through 9-1-1. Do you have any involvement with 988 or any plans for it?

Marisa: Yeah, that’s a really good question. So our local mental health authority is one of five centers in the state of Texas that is designated to take the 988 calls. So our center takes calls from, I think it’s 76 surrounding counties. but it’s not funneled through the 9-1-1 call center.

It’s funneled through our community hotline. And so that is getting routed to the team that responds to the hotline calls. However, since that started we’ve not seen a huge increase in our dispatches or referrals to that EMCOT team. The data is showing very similar to what we see on our hotline, as well as what Kedra was talking about at the 9-1-1 call center is that the majority of the calls are able to be handled over the phone.

I think the integration into the 9-1-1 call center, because we’ve been able to integrate the technologies and our clinicians have been able to learn about the CAD system and build relationships with the 9-1-1 operators and figure out how to transfer transfer calls seamlessly. I think a lot of that is transferable to what other people are doing and looking at.

Other states as well. So I think having the, the background and knowledge of, and the experience of what we did at the 9-1-1 call center I think is helpful for what we’re doing for 988 and what’s to come for that. Cuz I know there’s a lot of changes in discussion with that.

Jason: Absolutely, there is a lot of discussion, but of course all at the state and, and local level. What are your plans moving forward? Do you have any plans to scale up or to scale out, so to speak? What do you see happening for Integral Care and the EMCOT program over the next two to three years?

Marisa: I’d love to scale it.

I think that that’s our goal and our hope is. Bring it to scale of the need for the community, although we do have several. Different intercepts of how people can get an EMCOT team out. There are still a lot of calls that don’t receive an EMCOT response because we don’t have the capacity to go to all of the calls that are appropriate or get all the calls transferred over to us that are appropriate.

And so I think that would be our goal and our hope is that we could bring it to scale so that people in crisis are getting the right care at the right time.

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Jason: So you would increase the scale by the number of calls you would respond to.

Marisa: I think the number of calls that we could get at the 9-1-1 call center intercept there.

Also the response team as well.

Jason: Fantastic. We wish you all the best luck.

Last question for you. A lot of groups are trying to do what you are doing and they’re, they’re picking up speed, but they’ve got a lot to work out. What kind of recommendations or advice could you give to these groups as they’re getting set up, you know, to any lessons learned or pitfalls that you can help them avoid that maybe you didn’t have someone advising you?

Marisa: I think what was really helpful when we started the EMCOT response team and then integration into the 9-1-1 Center was going to visit other programs that were doing this. and learning from different communities what their lessons learned, what’s worked well for them, because every community is different.

Every need is gonna be different. And then bringing back that knowledge and experience and expertise and really looking at what’s gonna be the best for your community. We learned pretty quickly at the 9-1-1 call center that having calls transferred over to an administrative line and not being connected into their technology system was not successful at all.

We had many dropped calls. So I think the technology and ensuring that people are trained and comfortable with the CAD system would be a lesson learned for us. Ensuring that you’re getting your data tracked, outcome measures and then really finding key players and stakeholders and champions with your first responder partners or in your city government to help champion getting, getting these, uh, projects moved cuz they are successful and they are beneficial.

And so I think the relationship building piece is, is crucial.

Jason: Great suggestions.

Kedra, any from you?

Kedra: I would say, you know, I think a lot of times we get people, you know, even consulting with us, right? And they’re like, “Oh, wow, y’all have, you, y’all have a lot.” And so really kind of what Marissa is alluding to is.

You know, Sometimes, us nonprofits or community, we want everything all at once, right? We want everything to happen now. and so, but just really, you know, looking at what’s like, what can we do this next year, right? And then what can we add onto it? Cuz it’s going to definitely. Take time.

You know, I mean, we’re talking about, you know, our crisis teams that have been around since 2006 and then expanded in 2013. So we’ve been doing this for a while, right? And like six years later we got into the 9-1-1 call center. So these things take time, although I think they’re moving more quickly now, you know, with just.

The pulse of, you know, communities and what they’re looking for and they’re wanting, you know, alternatives. So that can definitely help spur things forward a little quicker. but yeah, taking the time to like build those teams out and do it well and track the data is really yeah, key to like longevity.

Jason: Fantastic. Thank you so much, ladies. I really appreciate this. It’s been a real pleasure speaking with you and love to hear about all of your progress. If people want to reach out and learn more or speak with you, what’s the best way for them to get information?

Kedra: Uh, we’re happy to provide our email addresses as well as contact information.

Yeah. we set up calls all the time with people all over the country, even outside of the country, you know when we’re happy to set up times to speak to people and answer questions and share all the information that we have.

Jason: Is this run through the Integral Cares website or through Austin 9-1-1 if they wanted to get more information?

Marisa: Just from the website

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