Webinar presenters JC Adams, Dr. John Colburn, Karla Ramirez and Frank Webb answered a number of your questions after their presentation, Co-Responder Programs: Keys to Successful Implementation for Justice Professionals and their Partners. Here are just a few of their responses.
Audience Question: When we’re talking about addressing the mental health crisis that law enforcement or first responders are experiencing with their communities throughout the United States, what are perhaps some of the biggest or most common mistakes that communities are making when they’re looking for solutions to help their communities?
Dr. John Colburn: I’ll take a shot. Frank and I are the old gentlemen in the crowd and we’ve been working on answering that question forever. You know, the biggest issues are, how do you manage the complexity of the needs that come forward. In many communities, when it comes to mental health, our leaders have been raised on an issue that is often described as a kind of a two-tiered system. Medical care has been elevated. It was always covered from the first day somebody thought of the HMO or health insurance, medical was covered. The second what I call a parallel universe was created to manage mental health and substance use. Separate funding mechanisms were created, particularly for those who were of low income. Eventually, insurance providers came along, and as many of you who are a little older may remember those days when, you know, if you had health insurance that would cover, it would be limited to 20 outpatient visits a year and no more than 30 days inpatient, you know. If you had family or friends who were suffering from major depression, and they ended up in the hospital, their insurance would stop covering them. Well, back in 1998, part of that was addressed through what’s known as Mental Health Parity Laws. Now, for commercial insurance and Medicaid insurance, and Medicare, the same types of payment must be used regardless of whether it’s mental health or medical, physical issue. That is a major issue that we’re still trying to overcome but beyond that, I think, the community that makes mistakes or they try one-shot approaches. Let’s get an extra person hired on our crisis team at the mental health center if there is a mental health center. Or let’s, you know, give 16 hours of training in the Academy to officers and hope they can manage the whole situation. I can tell you we didn’t say enough about how effective crisis intervention teams and crisis intervention training are for officers. It helps them learn how to de-escalate really scary situations and difficult situations but many of those officers, for example, those that work with Frank know how much it can help to have the additional resources connected to them and that’s part of our solution. Any other thoughts, my colleagues?
Host: Absolutely. And folks, by the way, on the recording page for today’s webinar, I’ve added a couple of links to the Tucson programs that the team here have referenced. So, establishing mental health support teams beyond CIT, etc. So, you’ll find that again on the recording page for today’s webinar.
Audience Question: Next question, Christy asked, I think this is a fabulous concept. Do you think it’s something that you could see expanding to other regions or areas of the US? She specifically talked about that she was trained in Houston. She got a lot of our professional experience in Houston and now lives back East and in a major metropolitan area. Could this be applied to more rural settings, small towns where resources are just difficult?
Frank Webb: I think that’s the beauty of the program. It can be used anywhere. It’s technology. There is a huge lack of psychiatrists and behavioral health professionals across Texas, the region, and the country. That’s what’s nice about this because it’s a force multiplier. It can be used anywhere that you can get connectivity. So, in other words, you have one behavioral health professional in a room. That person can do assessments, wherever they have connectivity. I think that’s the beauty of it. It can be used anywhere. In Texas, I think that it is a big issue. This program is being discussed right now and JC may know more about this but there are conversations taking place just for rural areas of Texas because of the lack of behavioral health professionals in the rural areas. So definitely it can be utilized and that may be more advantageous in rural areas than in larger areas that have more resources.
J.C. Adams: Yes, just to echo that, there’s a shortage nationwide of mental health clinicians. It’s more extreme in rural America. We want to see ways to expand care. I think using peer support is one way we can more rapidly expand this but we’re really just limited to wireless connectivity. So, rural America can have this today. Just look at an AT&T, T-Mobile, Verizon coverage map. What we’re concerned about is the frontier areas, very remote, where you cannot get a phone or data signal. That could be changing in the near future. There are new programs being rolled out to expand broadband coverage throughout even the frontier areas, even to the middle of the ocean. You look at Elon Musk’s Starlink. I don’t know when those are going to be available but until then, that’s our only limitation.
Dr. John Colburn: You know, Elon launched 120 satellites this week and our dear colleague Jacqueline from Alaska, called in, wrote in, to say hello and we appreciate that. Part of the pilot, we’re going to be working with her just to look at how we can connect to these. If you want to talk about remote areas to take a look at the map of Alaska, or if you’ve been there, you know, how beautiful it is, but it’s, it’s very much rural frontier area. Thanks to forward-thinking folks who are developing new ways to build Internet connectivity, we believe, at some point, this will make sense in every part of our country. Not to be too grandiose, but we hope in other parts of the world.
Audience Question How did you go through the process of getting the money together, convincing your county government that this is the way to go? Especially in this day and where age funding is such a challenge. Any advice you might have?
Frank Webb: Well, if I may. Again, we utilized the pilot to collect data then we continued to collect data during the different phases of the pilots. As JC mentioned, you have to have the data. You have to have data to back up your requests. They are not just going to give you the $900,000 because you’re asking for it. You have to prove that it’s effective. It’s useful. So, the midterm evaluation that we went over, you saw the statistics. Everything was positive. So, I think that’s how we get the funding. They just saw the value of it. It was beneficial to the deputies. It’s beneficial to the consumers. it’s just a great program.
Karla Ramirez: I’d also like to comment on funding because so many communities are so different, depending on where you are in the country. I have seen so many different models for this but when you grab the stakeholders together, depending on who’s at the table and also who this population is costing a lot of money to? You can really get people to kind of contribute in different ways. So, I have seen like healthcare systems contribute quite a bit of funding for these things when it’s a need to reduce hospital utilization. I have seen when you do have a really good champion who’s a community leader advocate at the legislative level for this funding. I have seen so many different ways. So, I would really highly recommend not to let funding be the reason why you don’t try this and really, you can always start small. There are so many creative ways, especially right now, with all of the funding that’s available related to COVID, to other things especially for technology, to not be the reason why you don’t try something, even if it’s the smallest thing to just get started and then you collect data. Once you have the data, and it will show a reduction in many costs, then you look for the bigger kind of program.
Audience Question: What kind of training was required for the deputies? So, Frank, I’m betting this one is for you.
Frank Webb: Our CORE deputies all have a 40-hour CIT class. In addition to that, they all get a two-hour class prior to being issued the iPad. The class goes over how to use the iPad and some other issues. Do you use it with juveniles? Yes, you can. The training addresses other issues also. If you have technical problems, what do you do? Here in the Harris County Sheriff’s office real quickly, each deputy is assigned the iPad and it’s more or less theirs while they’re on the program. But again, two-hour class right before they get it.
Audience Question: Just kind of following up on those kinds of things. How have the deputies received this training? Are they positive? Are they seeing a difference? What’s the feedback you’ve been getting from the guys on the street?
Frank Webb: They love it. The deputies love it. The supervisors love it. When we first started, people were saying, well, the consumers won’t use it. They are not going to want to talk on an iPad. We’ve had no problem with that at all. Clinicians love it. The clinicians that were hired for this program, they tell us they really love it. Of course, you know, it’s nice for them because they can work from home. We did take our co-responder clinicians out of the cars for, I think, about a month during the peak of COVID for their safety. So anyway. Now, the deputies love it and it has no negative at all.
Audience Question: Well, piggybacking on that for the last question of the day. Folks were asking, the last question is coming in about consumers, and they are interfacing with the technology. So how hard is it for the consumer after the crisis has abated, to follow up with the provider? Is this also done through telehealth? And then the other question, How easy or how difficult is the app to navigate?
JC Adams: Very simple. We are a design firm first. It has to be very intuitive, very easy to use. The co-responder facing app has four simple big buttons on it. John, please speak to the patient-facing version.
Dr. John Colburn: Yeah, I’m the patient-facing. It has less than four buttons. It has one. They can look at a screen and see if their clinician or their clinician’s colleagues are available press one button, and they’ve got a live video voice. They also can use text messaging to send questions. Clinicians can send out their own text messages or other reminders to the client to keep them engaged in the whole process. So, we have, as JC was just implying, it is a design question. It was designed and tested with lots and lots of users. It’s been used by people who are living in poverty with serious mental illness. 100% of those folks when interviewed after the project said that they had no problems whatsoever learning it and they loved being able to not have to travel in three busses across town, find Childcare, be subjected in here in Texas, where we did the pilot to 110-degree heat. But, no, they could connect when they wanted and to whom they needed. One thing I can say to all of you who are curious about this or wondering if it’s appropriate, please reach out to us. We’re more than happy to actually go live with you in a video call and demonstrate how the app actually works and show you some of the results.
Click Here to Watch a Recording of Co-Responder Programs: Keys to Successful Implementation for Justice Professionals and their Partners.