San Diego Police and Fire-EMS Innovation to Address Recidivism

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Presentation transcript:

San Diego Police and Fire-EMS Innovation to Address Recidivism Jim Dunford, MD, FACEP City EMS Medical Director Professor Emeritus (Emergency Medicine) UC, San Diego Medical Center

City of San Diego 1.3 million population 8th largest U.S. city 4th largest homeless population

SD Homeless Outreach Team SDPD HHSA PERT

Serial Inebriate Program (SIP)

SIP partners Police Department Fire-EMS Mental Health Systems Sheriff’s Department Alcohol and Drug Services City Attorney Public Defender Superior Court Medical Clinic

SIP approach Convict - 647(f)PC Treatment in lieu of custody Case manage w services Positive support groups Negative reporting

SIP funding 2001-2003 2003 - present Alcohol & Tobacco Settlement City - housing County - treatment

SIP: acceptance vs. duration of sentence Dunford JV et al. Impact of the San Diego Serial Inebriate Program (SIP) on use of emergency medical resources. Ann Emerg Med. 2006;47(4):328-336

Average charges per month, serial alcoholics: accepted (156) vs Average charges per month, serial alcoholics: accepted (156) vs. declined (112) treatment Dunford JV et al. Impact of the San Diego Serial Inebriate Program (SIP) on use of emergency medical resources. Ann Emerg Med. 2006;47(4):328-336

SIP: graduation and completion rates Completion remain sober x 6 months attend 4, 90-minute sessions/week show effort to obtain housing and employment Graduation “ “ and become financially stable and procure drug-free housing Dodson J. The effectiveness and efficiency of SIP. The Sage Project. San Diego State University. Spring 2016

Resource Access Program (RAP) http://centerforhealthreporting.org/project/health-care-911

RAP community paramedics

RAP alerting registry HIE StreetSense RAP is a paramedic-based surveillance and case management system. Identify frequent 9-1-1 callers or other patients requiring additional resources Monitor EMS activity of patients on a watch list Intervene with appropriate public safety partners

RAP: real-time situational awareness Screen shots – case management, ranked users by week > year, by problem type (psych, homeless), by individual chief complaint

Effect of RAP: contacts and charges n = 51 clients Tadros AS, et al. Effects of an emergency medical services-based resource access program (RAP) on frequent users of health services Prehosp Emerg Care 2012 Oct;16(4):541-7.

Effect of RAP: Fire-EMS resources Tadros AS, et al. Effects of an emergency medical services-based resource access program (RAP) on frequent users of health services Prehosp Emerg Care 2012 Oct;16(4):541-7.

Project 25 36 individuals Homeless High impact Selected by: SDPD SD Fire-EMS Mental health

Project 25: impact on public services 2010 Base to 2013 * Includes crisis houses, detox centers, homeless shelters, legal assistance, Psychiatric Emergency Response Team Reaser L. Project 25: Housing the most frequent users of public services among the homeless. Fermanian Business and Economic Institute. Pt. Loma Nazarene Unversity. 2015

Project 25 results Reaser L. Project 25: Housing the most frequent users of public services among the homeless. Fermanian Business and Economic Institute. Pt. Loma Nazarene University. 2015

Spice awareness: EMS vs. Poison Center §52 Spice awareness: EMS vs. Poison Center §52.3301 San Diego Municipal Code

America’s Finest City