The Triage Project is a collaborative project in Aurora, CO. This is a joint program of Arapahoe House, the substance abuse provider and detox center, Aurora Mental Health Center, and first providers (fire, police and EMS). The program is entering its third year of operations and is an innovative program designed to meet the needs of both the city and the needs of the highest utilizers of 911 services. The Triage Project impacts the overutilization of community resources by reducing emergency calls, emergency department visits and police intervention. During the second year of the project new ways of working directly with the first responders were implemented in order to make a greater impact on those served. The goal of the project is targeting the most frequent users of 911 for non-emergency calls that are motivated by behavioral and substance abuse issues. The Project works with the high utilizers to create a longer term solution to reduce their calls and over utilization of emergency services and law enforcement. By integrating nursing, mental health and substance abuse services, and linking to other appropriate community services, high utilizers become less reliant on 911and take an active part in caring for their own health.
Triage is a central component of meeting the behavioral health needs of Aurora while supporting first responders. The goal is to provide the right care, at the right time, in the right place. This project created a team (total cost of only $150,000) to engage these individuals in care and a sustaining treatment plan. Previously, a call would result in EMS and police arriving at the scene and then transporting the indivdual to detox, jail or the emregency department where they would be released soon after with little or no follow up. Now the entire team reviews call frequency and offers innovative quality access to cost effective care. Treatment brings care directly to the individual in their home or community, increasing access and availability. The nurse or case manager transport clients to and attend medical appointments, advocating for appropriate primary healthcare and integrating mental health with medical care.
The team holds monthly Triage Project meetings which are attended by EMS representatives. During these meetings, project updates, including efforts to market the project to Aurora Law Enforcement are discussed. Arapahoe House detox staff usually talks to police when they drop off clients. and helps spread the word about the project, how the Triage Project works and the services it can provide to directly aid police.
We have direct interaction with EMS (fire and paramedics) in the field. At this time, with the coordinaton of the Aurora mayor, the team has expanded to include both major hospital emergency department directors
Staffing is done collaboratively between AuMHC and Arapahoe House. Staff use a team approach to treating each client. Staffing includes the current core team of a community case manager from Arapahoe House, a mental health therapist from Aurora Mental Health Center and a nurse with on call linkages to the Medical Director and other emergency case management staff at Aurora Mental Health Center. Additional support will be provided by the Aurora Coverage Assistance Network for benefits acquisition through the benefits exchange, the local FQHC for health needs, and the support of the PATH case managers for additional linkage and support for the homeless clients in the Triage Project. The project team that meets monthly consists of the 3 staff members above, a member of the PATH team, the EMS director, and a staff member from each of the 2 Aurora hospital systems
The target population for the Triage Project are adult residents with chronic and persistent behavioral health issues including mental illness or substance use disorders; that frequently call 911 to get the services they need or desire. Every communtiy has these issues and as long as a community has buy in from the necessary agencies – police. EMS, substance abuse treatment, behavioral health treatment and political backing – this program can be replicated.
- 120 Individuals served in 2013.
- 60% reduction in number of EMS calls for the top ten utilizers of EMS services (reduction of 214 calls)
- Number of EMS calls for the top ten utilizers of EMS services Year End Numbers:
- CY 2012 (before the Triage Project): 360 calls, CY 2013: 146 calls
- 122 Individuals served in 2014. The project is continuing to realize a decrease in the number of EMS calls for high utilizers.
- 70% of high utilizers decreased EMS calls within one month after contact with the Triage Project.
- Calls were reduced by nearly 60% as shown below:
- Number of EMS calls for 20 of the highest EMS utilizers
- Month of initial contact with Triage team: 99 calls
- One month after initial contact: 44 calls
- Percentage of reduction in EMS calls: 58.6%