'Street medicine' project with fire departments aims to ease burden on hospital ER

Kitsap County will expand its innovative CARES Program next year through a new state initiative that aims to improve outcomes for unhoused populations and deliver street-level health care.

Poulsbo Fire Chief James Gillard said a $200,000 grant from the Washington Health Care Authority will allow Kitsap’s three Fire CARES teams to take on additional referrals from homeless outreach teams; place medical providers in the field through a partnership with St. Michael Medical Center; and deliver life-saving opiate medication.

“We’re addressing our two main limitations with our CARES programs,” Gillard told the Kitsap County commissioners this week. “It’s sustainable funding and our limited capacity to help these vulnerable community members.”

Poulsbo launched its CARES (Community Assistance, Referral and Education Services) Team in 2021. It was the first program of its kind in the county. The model pairs firefighters and paramedics with social workers to better respond to 911 calls involving behavioral health challenges. CARES members currently respond from referrals by EMS teams.

Central Kitsap Fire and Rescue and South Kitsap Fire and Rescue created CARES teams over the last year. The three teams now collectively cover all of unincorporated Kitsap County, plus the cities of Poulsbo, Bainbridge Island and Port Orchard.

Related: ‘The way of the future for the fire service’: CARES programs spreading in Kitsap County

Gillard said the program has been overwhelmingly effective at reducing 911 calls and emergency room visits. They saw a 65% reduction in emergency department visits and a 69% reduction in 911 calls for individuals for a six month period after intervention by their CARES Team, he said.

“That is so amazing,” he said. “We know behind those metrics medical emergencies were prevented and – more importantly – lives have been saved.”

Expansion of CARES is part of the Health Care Authority’s Street Medicine Pilot Program, which is sponsoring five street medicine teams across the state. The program aims to improve health-care access for homeless residents and reduce unnecessary hospital visits.

Legislators allocated $3.7 million in general fund dollars towards teams in Kitsap, Tacoma, Everett, Spokane and King County.

The concept of street medicine — care outside of a traditional hospital or clinic in places like shelters or encampments — was developed in the 1990s, according to an article in the National Library of Medicine . Advocates of the model say it provides a low-barrier,  cost-effective way to treat vulnerable populations who often have difficulty accessing care through traditional means.

In Kitsap, the additional funding provided by the pilot will give the three CARES teams the capacity to work directly with the county’s HEART – or Homeless Encampment Action, Response and Transitions – programs, Gillard said. Their social workers will now have the ability to take referrals outside of 911 calls.

What's the HEART team?: In Silverdale, addressing encampments in compassionate way

Expansion will also allow for the implementation of the CARES/Advanced Provider Program, a partnership with St. Michael Medical Center. Under the agreement, the Silverdale hospital has agreed to hire either a physician's assistant or nurse practitioner to join the current CARES Team.

A hospital spokesperson said they are currently hiring for the position, and expect to have a full-time staff member on board in the next few months. The staff member would not join for any initial 911 calls, but would receive referrals from those instances.

Gillard said the program will allow for the physician follow-up necessary to deliver buprenorphine, a medication used to treat opioid use disorder by reducing dependency and withdrawal symptoms, to people who are homeless.

In a statement to the Kitsap Sun, St. Michael President Chad Melton said the mobile unit – including a firefighter/EMT, social workers and advanced practitioner –  will see patients for a variety of medical needs, helping to reduce the frequency of unnecessary 911 calls, emergency department visits and hospital readmissions.

“St. Michael Medical Center is proud to support the CARES program to continue to expand access to care in our communities, especially for the vulnerable,” he wrote in an email. “We look forward to our continued partnership on this important program.”

This article originally appeared on Kitsap Sun: 'Street medicine' project with fire departments aims to ease burden on hospital ER