After the Webinar: The 4th 911 Option – Mental Health Services. Q&A with the Presenters

Webinar presenters Ken Murphy, Colleen McCollough, and BJ Wagner answered a number of your questions after their presentation, The 4th 911 Option: Mental Here Services. Here are just a few of their responses.

Audience Question: How are you liaising or integrating with the new 988 number? And then I’ve got a follow-up right after that.

Ken Murphy: Okay, so here. You can correct me if I’m wrong, but here, we aren’t as far as an Emergency Communication Center, integrating with 988. So, in Texas, when someone calls 988 it will route to our crisis center hotline. And then from there, if the crisis center hotline believes the police response is needed or appropriate, they will transfer the call to 911, and then we will dispatch police. So, there is no direct integration in my Emergency Communications Center with 988.

Audience Question: So then, following on to that, and you may have just answered this, but I just want to make sure we’re clear. And is there any evidence of 988 transferring calls back into 911 into Austin?

Ken Murphy: Yeah, well, evidence right now, I don’t have data on it, but I know our crisis hotline locally will transfer calls to us because they feel the police response, or EMS response is appropriate. Now, if we receive a transferred call from the crisis hotline, we will not send those callers to the clinicians embedded in our operations center because if the clinician in the credit crisis hotline center could not handle the situation and believe police response was appropriate, there’s no need to further delay the response and send it to the clinician who will probably, in most likelihood, send it right back to 911 for police response.

Audience Question: Do you know how accurate you are in identifying mental health calls? Are there some calls that are inaccurately redirected or vice versa? Do you get to the call and then realize it’s actually a different issue? Do you actually update the call type information in the calls for service data?

Ken Murphy: So, the way we work to look at our accuracy is our true diversion rate and our percentage, right? So, this year, we’re on track to transfer 7,800 calls to the clinicians. Out of those 7,800, about 85% are true diversions. 6,600 of those calls will never go to the police. Now, the remaining 15%, we find if you divide those in half, the coalitions transfer those back to the 911 operators, either one because the situation on the phone or the person they’re speaking with, has degraded to the point where there’s a safety concern. And police response is required, or two, the caller on the phone will not interact with the clinician. They demand to speak to a police officer. Regarding our effectiveness, to those calls where we send police, I have not received any word from patrol that we were in, of us being inaccurate in our original titling of those calls for service. Now, we do allow our police officers, if they see a call pending in the queue, they feel a clinician might be able to handle it, our officers can contact dispatch and request a clinician, take a look at the call to see if they can handle it or not.

Audience Question: Colleen, Lisa was wanting to know, pertaining to the CCD Program Data, what percentage is that of total call volume?

Colleen McCollough: These are just the calls that actually get transferred to the C3s. So. So, in terms of those, that program data for the C3, it is 100% of the cost now. Not sure what that would be, in terms of identified calls to 911 that are then transferred to us.

Ken Murphy: So, we enter about a million calls a year. And so if we’re transferring 15% of those, on average, have some mental health component. But we’re only transmitting 7,800 calls to the clinicians. You can see it’s not a high percentage. Right? So, however, that doesn’t mean it’s not important. Because what that tells us is, is that 7800 of those calls, or we’ll say 6,600, 85% of the 7,800, were non-emergency. An officer did not need to respond, and the clinician was able to handle it, and most importantly were able to get the right service to the person in need instead of sending an officer and then getting a mental health clinician. Does that make sense?

Audience Question: How are primary presenting concerns determined? Is there a clinical algorithm being used, or is this entirely based on clinician experience?

Colleen McCollough: Thank you for that question. So, it is currently based entirely on clinician experience and their assessment. We actually, the clinicians on this item, all have to have at least a bachelor’s level in psychology, social work, or some sort of mental health-related fields, and a lot of them do actually have master’s degrees in counseling and social work. And so, they are fairly accurate when we listen to a lot of calls for quality assurance. We put a lot of information in their medical records about their presenting issues, so we are able to see quality control, the data is fairly accurate, but right now it is the clinician’s opinion.

Audience Question: Most communities don’t have nearly enough mental health providers. How are you doing it? How are you finding enough mental health clinicians to provide these emergency services?

Colleen McCollough: Well, we do our best to recruit and Integral Care is fairly well known in Austin. And we’re lucky in that Austin, the UT has a lot of graduates, that has a school social work and really robust undergrad programs and a couple of different colleges that contribute to our workforce. So, recruitment has been an issue that we recently raised some of the wages as well. And you just, I personally, also changed that the hours and the shifts and that really helped.

Audience Question: If clinicians are sent in a mobile response, are they sent with a dedicated officer like a co-responder unit, or is it a patrol officer that’s requested to accompany the clinician? How does that work?

Colleen McCollough: We do have an option for a clinician paired with an officer and an EMS professional, that’s the Austin CARES program. And that’s a bit newer. However, we, they actually go without any officers. So, when our clinicians triage, when they’re calling into the call center, the clinicians themselves will ask a lot of safety questions about the environment. Make sure that there are no weapons readily available, pets and animals are —–, and there isn’t anyone else that might be of concern in the home. And so, essentially, this is something that we’ve been doing since we establish the mobile crisis teams. And I know that not all communities do this, but our clinicians are fairly comfortable going in pairs without any officers. And, again, we make sure that there aren’t any safety concerns in the home environment that would need a response, so what we do is need that higher level response because of some sort of safety issues. That’s when we would involve police and try to arrange the co-response or get the Austin CARES involved, which is that new team with an EMS professional officer and one of our clinicians.

Audience Question: Can you discuss more how you have decreased people being on hold or not disconnecting while they are on hold?

Ken Murphy: So, a couple of ways we decreased, the people being on hold, we actually don’t place the folks on hold anymore, when they call 911. Because the clinicians are operating inside of our 911 call handling platform. It’s just a warm transfer. So, there’s very big, because now, that since they’re in CAD, and they’re in the 911 system, we created a specific call just for the clinicians in our CAD system, so we can track those calls. And, all the data the 911 operator gathers, at the beginning of the call, is entered into that call, and it populates into the clinician screen, so, the clinicians can see the data. So, there’s really not a need for a brief, if you will, at the handoff. So, that’s one way. The other way is, that we also created a queue for the clinicians. Like a sector queue for police calls for service, where if the caller is willing to wait for a call back from a clinician, if all clinicians are busy, then our 911 operator will create a call for service, and disconnect from the caller. Drop the call into the queue for the clinicians. And when the clinicians are available, they’ll go back in, open up the call, self-assigned to the call, make a callback, and then close it out.

Audience Question: What does your current center do in terms of working with local crisis centers, referring to local crisis centers or other local community services organizations? How do you make those referrals?

Colleen McCollough: Yeah, so, that’s a really good question. And so, referrals are a big part of what we do, it depends on what the person needs. So, first, that’s where triaging is really important to really understand what options that a person might need. So, if we have somebody that is experiencing domestic violence, we work with our local domestic violence hotline, and we can transfer right to them. We oftentimes transfer to the Veterans Administration line for veterans that might need more specialized care. And luckily, our agency itself happens to have a lot of services in-house that we can provide housing, substance use services, and psychiatric outpatient services for children, adults, and families. So, we are lucky in that we get to refer to them. But, you know, really, we have a really excellent staff that put together a really wonderful resource book. And they’re constantly sharing with them information with each other. And, and assisting each other to really keep that up to date and ensure that people are getting the best options available.