If you saw this woman on the bus, you’d picture her as someone’s grandmother, said Seattle firefighter and paramedic Roger Webber.
She’s a frequent client of Health One, the city’s mobile response team housed out of the Fire Department. And like many of the team’s clients, the woman is experiencing a combination of poverty, homelessness and behavioral health problems.
The team’s mission is to work with people who frequently call 911, as an alternative response to better address their issues by connecting them to resources and social and health services, including primary care providers and shelters.
On a recent Monday, Webber, firefighter Heather Reichmann and social worker Donna Andrews found themselves called to meet this woman, in her 70s, at a downtown homeless shelter.
She typically calls 911 complaining of breathing issues. Before Health One became involved, the Fire Department would normally take her to the hospital, even though a pulse oximeter would show no issues and she would eventually be discharged and call 911 again.
The night before, she slept on a temporary bed and when the shelter asked her to leave in the morning, she said she had difficulty breathing. This time, the Fire Department called Health One.
The initial plan was to get her to stay at a Starbucks until she could return to the shelter for another night on a temporary bed. But while they were there, Webber said an in-residence bed opened up and she agreed to stay.
Shortly after the Health One team leaves, the shelter calls them again. The woman won’t sign the agreement all residents are required to sign, and now she’s leaving.
The team believes she has had traumatic experiences with shelters or caseworkers in the past that makes her fearful of anything that feels like a threat to her independence.
The shelter agrees to hold the bed for a few hours as Andrews and Reichmann head back inside to reassure the woman, again, that the shelter won’t take any of her money or require her to see a case manager. After nearly 30 more minutes of listening and reassurances, she agrees to stay.
Since its founding in 2019, Health One has grown from one rig to two, with plans for a third. Each vehicle comprises two firefighters and a social worker, who respond to calls on weekdays.
Seattle politicians have held up the program as a successful alternative response system, as they say they are pushing to reenvision and reimagine public safety, following massive protests over racial injustice and policing in Seattle and across the country during summer 2020.
So much so that in July, Seattle Mayor Jenny Durkan announced plans for a “Triage One” team, which will send employees who are not sworn police officers, to certain noncriminal or medical 911 calls. The team will be housed initially out of the Fire Department’s Mobile Integrated Health Program along with Health One.
The 2022 budget includes $1.19 million for Triage One, a decrease from $2.15 million proposed to reflect the late implementation of the program between December 2022 and January 2023.
How does Health One work?
Webber says Health One’s unofficial mascot is a sloth. While firefighters work quickly to move on to the next call, Health One takes a different approach, he said. The team tries to spend as much time as needed with each client, to solve the problems that lead them to call 911 repeatedly.
On one occasion, the team spent more than 50 hours over several weeks moving a man into an assisted living facility. They first met him at his home, and discovered he was using a toilet that had long been broken, said Jon Ehrenfeld, who manages Health One and Seattle Fire’s Mobile Integrated Health programs.
Health One emphasizes “short-term case management,” which can last anywhere from a week to a few months before the case is handed off to another service, like housing case management, a primary care physician or a long-term care facility.
“We build the bridge. We fill the gap until whatever system is supposed to take over, takes over,” Webber said.
Filling that gap, however, means team members take on tasks far beyond the job descriptions of paramedics and caseworkers. They have handed out Ensure nutritional drinks, called Ubers for people, fixed wheelchairs, given out prepaid phones and fetched prescriptions.
Around 20% of their clients come directly from 911 dispatchers, who connect them to someone seeking a medical-related welfare check or who may have a minor injury. In order for Health One to respond directly, the calls must be nonacute and medical in nature. Forty percent of cases are referrals from firefighters made in real time for patients. The remainder are self-dispatched calls when Health One visits established clients or individuals who have previously been referred to them by firefighters or other service providers.
Each Health One team costs approximately $475,000 annually, with $100,000 in startup costs, according to Ehrenfeld. One team oversees Pioneer Square; the second one is located in Belltown but also responds to calls in Ballard and the University District. The third unit will oversee the Mount Baker neighborhood.
Health One receives around 1,000 to 1,200 referrals every six months, of which the team can usually take on two-thirds.
The most significant chokepoint in the social services network, Ehrenfeld said, is the lack of skilled nursing facilities, shelters, primary care and drug and alcohol treatment centers.
“The single biggest need that our program has is not in the field,” he said. “It’s receiving facilities.”
How will Triage One be different?
In July, Durkan’s office published a report analyzing the 685,000 dispatch calls the Seattle Police Department responded to between 2017 and 2019, to see which cases could’ve been addressed by an alternative response.
Seattle police agreed there were around 30 types of calls — roughly 12% of total calls and 6% of total officer hours — where an armed police officer di
Two of these types of calls are welfare checks and “person-down” calls, when people call 911 to report a sleeping or trespassing homeless person, said Chris Lombard, the interim director for the newly created Community Safety and Communications Center, which now handles 911 calls. Triage One, at least initially, will primarily focus on these types of calls, which can be up to 8,000 annually, he said.
In comparison, the busiest fire engines and medic units complete 3,500 to 4,000 runs a year, according to Lombard.
The traditional 911 response system, he said, has functioned in a dichotomy between police and fire. Dispatchers have only 120 seconds to determine which agency is the appropriate response to a call. Triage One will hopefully wedge a third option into that system, he said.
Ideally, first responders will make an assessment within 20 to 90 minutes of their arrival, and then either handle the case themselves or refer it to the Fire Department, police, or possibly Health One.
While Health One has focused heavily on social work, Triage One will focus more on fact-finding and assessing the situation, according to Lombard, who said the team would act as the “eyes and ears,” for dispatchers who have limited insight on a situation.