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Expanding Safe Station’s in New Hampshire

  • Manchester Fire Chief Dan Goonan is proposing expansion of Safe Station to include a “fly car” or mobile unit to do more outreach. Photo by Pat Grossmith

Granite State News Collaborative
Published: 12/23/2019 7:46:43 AM

Manchester Fire Chief Daniel Goonan is working on a plan to expand Safe Station services to the addicted in anticipation of receiving $225,000 in state funds in each of the next two years. Safe Station didn’t receive any of the $60-plus million the state received in federal funding to battle the opiate epidemic.

“It’s [Safe Station] an idea that is still going across the country,” Goonan said of Safe Station.

In March 2018, President Donald Trump visited the Manchester Fire Department and praised Safe Station, saying the entire country was talking about how it was saving lives. Safe Stations, he said, recently opened in Tacoma, Wash., Chattanooga, Tenn., Ohio, Virginia and Maryland. Yet, New Hampshire, where Safe Station began has not expanded statewide.

The state opted to put in The Doorways, nine regional centers across the state, where people seeking help for addiction can go, be assessed and referred to needed services.

However, smaller fire departments around New Hampshire inspired by Safe Station’s mission but with fewer resources have found ways to allow local first responders to act as bridges for those in need to treatment. Concord Fire Department has tapped into federal dollars through Project FIRST (First Responders Initiating Recovery, Support and Treatment). Other towns, like Auburn, Berlin, Dover, Keene, Laconia and Portsmouth, are also using existing emergency response systems to connect people to recovery services.

Keene

When NH Doorway opened last January, Keene was in a good position to transition to it because it had been part of the Cheshire County Addiction Assistance Recovery Initiative (CHAARI), according to Keene Fire Chief Mark Howard.

CHAARI, funded for 18 months with a state grant, was a component of the Coordinated Access Point Program, that the state-funded for 18 months as a pilot program to address the opioid crisis.

It was in development for a year before it opened on May 1, 2016, the same month Safe Station in Manchester debuted. Howard said it began when then Keene Mayor Kendall Lane called Keene police and fire officials and others to discuss how to address the problem.

Before the pilot program was started, a person who overdosed would be taken by fire department ambulance to the hospital. The hospital would provide treatment the patient would allow and then the patient would walk out and not be connected to any treatment service.

“When we took them to the hospital we saw it as a revolving circle,” Howard said.

Then State Senator Molly Kelly and John Manning, CEO, of Southwestern Community Services (SCS), worked together to put a model together, reaching out to fire and police chiefs, the sheriff, state police and the hospital.

Regular meetings were held by the mayor concerning the structure of CHAARI with about 20 city, state and county agencies, along with businesses and agencies providing addiction and mental health services participating.

Ultimately, the state awarded a grant to SCS for an 18-month pilot program.

The result was a program where a person who needed help for addiction would be taken to the hospital. Once there, he would be seen in the emergency room if needed, if not he would go to a private area of the hospital where an on-call recovery coach, trained by the hospital, would meet with him and connect him to the services needed.

“We didn’t want the recovery coaches coming to the street or someone’s home or location from a safety standpoint,” he said.

Howard said the Safe Station program wouldn’t work for the city or surrounding towns because of staffing issues — many have only part-time police departments or volunteer fire departments — and because it was decided a regional program was needed.

“So that model wasn’t going to work,” he said. There were also times when Keene’s two stations were unstaffed because of the increase in emergency calls.

“We were having 911 encounters anyway and we were just going to get them to the hospital. Right off the bat, there were a number of successes,” he said.

The CHAARI program today is non-existent, replaced by The Doorway and Hub and Spoke system.

CHAARI had some issues such as accountability of recovery centers and staffing of recovery coaches, who were mostly volunteers, he said.

Still, he said, there were a lot of great things that came out of it and the reason why the transition to the Doorway was easier than in other parts of the state.

Now, the emergency room connects to the Doorway program which then links to the Hub and Spoke agencies for treatment.

The concerning piece that still remains is the individual who doesn’t want the help, Howard said.

“That is a frustration of emergency services because we are there to help people,” Howard said. There have been times when a firefighter resuscitates someone who then gets up, walks down the street and says he doesn’t want any more help.

“We are still persistent. But two to three days later we’re dealing with that same patient. It’s wearing on responders,” he said. The buzz words for it are “compassion fatigue,” he said.

He once resuscitated someone who 10 minutes later started arguing with him saying, “Why did you save me?”

And then there’s the call of an overdose of a man or woman found down in a hall where a young child is crawling on the patient saying, “Mommy, wake up. Or Dad wake up,” Howard said.

“A lot of us have young kids, so you leave that call and you say, “What the hell just happened?” he said.

Firefighters, however, sign up to provide emergency services and Howard said “in our career, those needs are going to change. What is alarming is the frequency of the various serious calls when someone is unconscious, not breathing and may not have a pulse. The frequency of those alls has increased greatly over the past 10 years.”

Before then, he said he might have gone one five to 10 calls of someone in cardiac arrest — from a motor vehicle accident or medical event — in a year.

“Now, guys sometimes go to five calls in a single day or five calls in a week in the last five years,” he said.

Push for statewide safe station access

“The relationship between the local doorways’ director and the Manchester Fire Department has always been good and I continue to work with them to improve the system,” Goonan said. “The real disconnect is the lack of transparency, information sharing competition and politics from state powers that be. We have been pushing for fewer hubs statewide, 24-hour coverage in all Doorways coupled with a Safe Station Access point in the remaining hubs. We need respite associated with all doorways because we are losing people in the system, waiting the few days for placement.”

Goonan is hoping the Governor will allow a Doorways 2.

“We know where the gaps are,” he said. Manchester pitched statewide Safe Stations — because fire departments operate 24/7 and helping people is the job of a firefighter who also has medical training — but the Governor opted for the Doorways which qualified for federal funding. However, Nashua and Manchester’s Safe Stations are expecting to share a total of $750,000 in state funds with Manchester receiving 60 percent or $450,000.

Benjamin Vihstadt, communications director in the Office of the Governor, said the funding is from the state’s general fund, the result of the bipartisan compromise budget Gov. Chris Sununu signed into law this fall. The cities have yet to receive the funds, however, because the state Department of Health and Human Services is currently working with Manchester and Nashua officials to understand the needs of the community to determine and develop the scope of the contract, he said. When that is finalized, it will go before the Governor and Council for approval. Additionally, he said the Governor has provided state funding to cover the cost of Safe Station transportation to Doorway Hubs, which for Manchester is The Doorway at Granite Pathways.

“Safe Stations are an important part of the solution, which is why in the budget I signed earlier this fall provided an additional $750,000 for safe stations in Nashua and Manchester, which will help individuals get the services they need,” the Governor said.

There were growing pains when the Doorways opened last year across the state. Because they were new, people continued to go to Manchester’s Safe Station where they knew they could get help. That led to the city being swamped with people seeking help for their addictions. City officials complained more money was needed and that other communities needed to step up and do their part.

Safe Station began in May of 2016 to address the opioid epidemic in the city. Anyone seeking help for addiction can go to any fire station in the city. Once there, an individual’s condition is assessed and he is linked up to needed services. The fire stations provide a stigma-free environment, Goonan said.

“The fire department just made sense,” he said. “We’ve been here 180 years and it’s where people come when they need help.” We know where the gaps are. Hopefully the governor can allow a Doorways 2.”

Safe station expansion

Goonan now has drafted a plan for a downtown “fly” car or “squad” car “to roll out during peak times, which is noon to 8 p.m. He says it will be staffed by two firefighters, one an advanced EMT. That will result in a quicker response and provide a bigger presence in the inner city where most of the overdose calls take place and hopefully save lives.

“This money gives us the opportunity to step up our game and provide better Safe Stations,” he said. “Instead of waiting for them to come, maybe we can do some outreach to the homeless.”

Since it’s been in operation, 6,422 people have sought help, an average of about 5 people a day, according to statistics compiled on Nov. 22 by Chris Stawasz, regional director, New Hampshire and Maine for AMR ambulance. If they are in need of medical attention, they are taken to a city hospital. If they need a detox program, they are taken to The Doorway at Granite Pathways. Goonan says if they arrive at the station after Granite Pathways closes at 11 p.m., they are taken to the Farnum Center. With winter here, the “Fatality Prevention Team,” consisting of the city’s fire, police and health departments, Families In Transitions, outreach workers, the Neighborhood Enforcement Team and the Greater Manchester Mental Health Center — currently is trying to identify the homeless and locate homeless encampments to reach out to that community. They hope to earn their trust and ultimately convince them to literally come in from the cold. Ideally, Goonan says he would like to have a GPS locator in areas where the homeless are sheltering to ensure workers can reach them “in the dead of winter” to bring them indoors.

“We’re hoping for the best and preparing for the worst,” he says. “We have all really come together. We’re trying to put together the best response for the city. We’re keeping all our options open.”

Goonan said it is not just the drug epidemic that emergency personnel are dealing with but the high number of homeless suffering from addiction and/or mental illness. Emergency personnel also are seeing an increase in methamphetamine on the streets with individuals mixing it with fentanyl or other opiates. He said no longer are individuals using only fentanyl; more and more they are using multiple drugs and/or alcohol.

The biggest problem is that too often there is no bed available. The Farnum Center, Goonan said, has 16 beds. The New Horizons shelter has 24 — 12 each for men and women who are sober. Most nights, the shelter is filled to the limit. Goonan said he is talking with people who operate sober houses to see if they would take in those individuals when beds aren’t available. He said this has been an ongoing problem for years.

“That’s always been the hole,” he said.

More emergency shelter needed

Sometimes individuals end up being housed at local hotels. Safe Station operates as an access point, not a service provider, according to Lauren Smith, Policy and Strategic Outreach Director in the Office of the Mayor. She says those agencies that have the authority to place someone in a hotel, and cover the cost, is Granite Pathways, the 2-1-1 NH emergency service, which provides access to health and human services in times of crisis, and the city’s welfare office.

Patrick Tufts, president and CEO of Granite United Way, said his agency was awarded the $200,000 state contract to provide short-term hotel and transportation. “It’s an avenue of last resort,” Tufts said.

The hotel stay is capped at two or three days, he said and is designed to be used only until a shelter bed opens Still, each year every penny budgeted is spent. He agreed with Goonan that more beds are needed, not just in the city but statewide. Initially, he said when someone calls 2-1-1 NH, the operator checks to see where a bed is available. That is not restricted to Manchester only but other places across the state such as Cross Roads House in Portsmouth or the Salvation Army’s McKenna House in Concord.

Charlene Michaud, Manchester’s welfare director, said her department is the last resort. It provides individuals with financial help for basic needs expenses when an individual and/or family does not have the ability to pay for it. “There is an eligibility process and no one is eligible simply because they are seeking substance use treatment,” she said. “As part of the eligibility process all other possible resources, including but not limited to tapping into programs utilizing state or federal funds, are explored. Expending local taxpayer dollars is the last resort. As a result, if someone came to our office specifically looking for shelter until they could get into treatment, we would refer them to Granite Pathways as they have funds for this purpose.”

She said while the department does not collect statistics as to how much it spends on hotel expenses for someone coming through Safe Station needing a bed, “I doubt we have spent any money for this specific reason. Historically, we have been able to refer homeless individuals to shelter. We typically have only placed homeless families in motels after all other possible housing options have been explored.” Michaud said the welfare office has provided financial assistance to individuals who are suffering from substance use disorder issues but those individuals are more likely to seek and receive rental assistance.

(This story was produced by The Granite State News Collaborative as part of its Granite Solutions reporting project. For more information visit www.collaborativenh.org. Follow us on Twitter @NewsGranite and like us on facebook @collaborativenh.)


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