Let’s play “what happens when?” What happens when a senior falls and no one there is strong enough to help her up? What happens after an adult overdoses in their driveway? What happens when a friend shows signs of a manic episode, talks about religious conspiracies, and spends hundreds of dollars carelessly? Or, a man rings your doorbell asking for help? Suddenly we, the neighbors, friends, pastors, and relatives wonder where to find resources to help.
None of these seem 911-worthy. These are just a few services that Crawfordsville’s Quick Response Team provides, and what distinguishes them from hundreds of other QRTs around the country, most of which developed in as communities grappled with skyrocketing substance use disorders in the opioid crisis.
A minority of counties around the country have adopted the QRT response model to alleviate pressure on law enforcement and jails. Last year, just 17 of West Virginia’s 55 counties had QRTs, according to the state’s Office of Drug Control Policy. Ohio, where the QRT model originated, listed 20 back in 2017. According to the Center for Health and Justice, a Cincinnati-adjacent community, Colerain, Ohio innovated its QRT under the leadership of an experienced police chief, Dan Maloy. He had been discussing critical questions about collaborative responses to active shooter incidents at a national law enforcement conference in 2013. Law enforcement leadership proposed bringing together more departments. After Colerain struggled with a spike in overdoses, Maloy proposed bringing together fire and police, then extended to all the community stakeholders: faith-based organizations, behavioral health, politicians, shelters, parks department, and any other community leaders.
As an innovator, Maloy’s police and fire departments had to educate the community to be proactive rather than reactive to its substance use epidemic.
“We have a responsibility to serve and that is our job,” he said of educating about what to do if a needle is found in a park and not seeing people as a threat. “It was a big community education piece in understanding that there is a proactive side to this and our responsibility is to problem-solve. Problem-solving brings a lot of people together. We’re there to solve problems and work with our community to make it safer and better for everybody.”
Most QRT programs have a mission to divert and deflect people who’ve overdosed, trying to avoid arrests by engaging people who’ve overdosed with treatment and support options. QRTs are multi-disciplinary. Staffed with social workers, peer recovery coaches, paramedics, and nurses, they serve as the first and follow-up responders who offer medication-assisted treatment from Narcan administration to regular suboxone treatments for people with substance use disorders. Here in the county, social workers, nurses, and volunteer peer recovery coaches help with building trust and finding the right resources.
Samantha Swearingen, project manager for Montgomery County’s QRT, overviewed what makes our local program unique at the Lunch with the League on Jan. 6. The catalyst that distinguishes our QRT team from others came from high readmission rates at Franciscan Hospital. People released within the past 30 days were returning, so they looked at who was coming back to the ER and why. They looked at common conditions — congestive heart failure, at-risk pregnancies, and infant health, diabetes — and realized that social determinant factors were causing residents to return to the hospital when other services might prevent or better treat their conditions.
The hospital partnered with county paramedicine services and created several programs for Franciscan patients, including Project Swaddle which aims to improve maternal and infant health. The March of Dimes reported that Montgomery County had a 2022 maternal vulnerability score of 60 out of 100, about a D, due to lack of reproductive healthcare, poor physical health, behavioral health problems and substance abuse, lack of general healthcare, poor socioeconomic determinants and risky physical environments. Project Swaddle allows paramedics to provide some medical support, including administering a Makena shot to help women with prior preterm labor, an important intervention for a county with no labor and delivery services.
The QRT began with just paramedics but looking at the spike of 911 calls related to mental health, especially during the pandemic, and substance use, they expanded services. Now their team has a paid staff of two social workers, two nurses, a project manager, and four paramedics who respond to calls. They help find beds at out-of-county emergency shelters or find local solutions. If someone has a behavioral health problem, they can refer to treatment. They support mothers-to-be who are not Franciscan patients with a program similar to Project Swaddle, called Project Bundle, and they plan to expand with an “Age in Place” program to support seniors.
Not only do they respond to emergency calls, or calls/texts to their hotline, but they also follow up 24 to 72 hours after an overdose with the goal of non-judgment and no stigma about getting treatment. They find programs, shelter options, health insurance, and transportation resources for people who end up in jail. Each month they regularly support 28-40 different clients and have seen a drop in jail recidivism by thirty-eight percent. That’s a significant drop that helps law enforcement and the jail manage their workload, as well as provides substantive programs that save lives.
The value of the QRTs efforts is profound. In 1999, fewer than 20,000 people died of overdoses according to the National Institutes of Health, but in 2020, more than 91,000 died, a leap of 20,000 from the year before. Behavioral and mental health stressors, along with a multitude of addictive technologies and substances, not to mention the significant lack of healthcare coupled with increases in fentanyl and meth, have complicated life and community-saving measures in rural areas like ours. Notice that last sentence. That’s a lot of factors. We can support our QRT by using them and destigmatizing services. Their number is 765-401-6200 Monday through Friday from 8 a.m. to 4 p.m. and calls to 911 outside of business hours will be referred to them.
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