Beyond 911: South King Fire unit helps vulnerable individuals

24 emergency calls in six months is an unusually high number for one individual person.

Six months since its inception, the Mobile Integrated Health (MIH) team at South King Fire has helped reduce that individual’s call rate by 94 percent by meeting needs and connecting them to resources.

Excessive calls to 911 are often a sign that someone needs help — but doesn’t know how to get it — with an issue that can’t be solved with a typical emergency response.

The MIH program allows firefighters to refer this type of caller to a support team consisting of a social worker and a registered nurse who can act as a bridge to connect them to more long-term solutions.

Last week, a second unit went into action, bringing the MIH team total up to four. This includes social workers Lily Alfaro and Tamara Liebich-Lantz and registered nurses (RNs) Celi Moser and Maria Gorodyuk.

While MIH responds to a variety of situations, many referrals relate to aging, such as falls, chronic disease management, support with basic needs, or the onset of cognitive issues.

Within the first six months of the program, 16 out of 18 individuals tracked by the program had reductions in 911 calls, with 13 of those seeing reductions in calls over 60 percent, according to initial data shared with the Mirror.

Other ways to track success aside from 911 call reduction can be seen as MIH staff follow up. Some examples include “seeing them get connected to that resource” and “seeing caregivers in the home” or “seeing their quality of life improve.”

“I think those are the things that are a little harder to measure, but are still very evident,” Moser said.

The South King Fire MIH program was developed by Deputy Chief Lisa Defenbaugh who gleaned the best practices from the multiple programs in King County that all run a little differently.

After assessing all these options, she felt that pairing social workers with RNs would work best for the community rather than other models that pair a social worker with a firefighter instead. One difference is that RNs have a bit more capacity to do non-emergency medical procedures such as wound care or changing a colostomy bag. Defenbaugh added that nurses can also be a great fit with social workers because they often have some experience with case management and that the two roles assess and support the patient with different but complementary perspectives.

After a year of positive impact, Defenbaugh said they are focused on helping the whole team at South King Fire know when to utilize MIH as a resource, especially now that they have two teams, and continuing to build up utilization of the impactful service.

Social worker Lily Alfaro has experience with both models after being part of a team with a firefighter in the past and said while it has been great to “see it from both sides,” in her opinion “working with an RN works better.”

Firefighters tend to focus on a more urgent and immediate response, compared to nurses, who tend to have a bit more long-term mindset about patient care, Alfaro explained.

Connection is key

The MIH model allows for staff to meet patients where they are at, both literally with their mobile unit and emotionally as the team builds trust.

“It’s not just navigating all those changes externally. It’s also really supporting the patient emotionally in making all those changes … and moving to another transition of life requires a lot of support,” social worker Tamara Liebich-Lantz said.

This conversation can be especially difficult when cognitive impairments are a factor like dementia or Alzheimer’s, and also depends on cultural values and familiarity with local systems around independence, doctors, hospitals and care in general.

Language and shared experiences can also help build trust.

“This happens every time that I have a Spanish speaking patient, you just see the relief,” said Moser, who is fluent in the language. “You just see their shoulders drop. You see them open up. You see them start showing personality and connecting with you.”

Alfaro speaks Cambodian and some Spanish as well, and newer nurse on the team Maria Gorodyuk speaks Ukrainian and Russian.

Even when she doesn’t speak the language, Alfaro said her experience as a member of a family of refugees also can help her connect with those navigating an unfamiliar system in a new country.

“Being able to work with them and help guide them,” is a huge step forward in building that trust with someone to help them access and accept care and support, Alfaro said.

This trust building and the work of MIH in general is especially important because “there’s this gap of vulnerable seniors who can’t independently take care of themselves, but they’re cognitively impaired enough that they don’t know that,” Liebich-Lantz said.

She explained that this gap is because in Washington state, “the threshold to get guardianship is very, very high…meaning you have to be extremely, extremely disabled to be able to get guardianship.”