CAHOOTS, the Lane County program that’s been a model for mobile crisis services around the country, has been facing challenges at the local and federal level.
Services in Eugene came to an end earlier this year as the city managed a budget shortfall.
Lane County offers crisis services that are funded through Medicaid, but CAHOOTS also specialized in homeless and community outreach.
While CAHOOTS is no longer serving Eugene, its contract with Springfield has been renewed. It currently offers 12 hours of service, seven days a week to the city. Justin Madeira is the CAHOOTS program coordinator. He joins us with details about what’s next for the organization and what crisis response efforts look like in Oregon.
Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.
Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. CAHOOTS is a Lane County program that’s been a model for mobile crisis services around the country. But as it’s been emulated in other states, it’s seen an erosion of support at home. Eugene ended its contract with the nonprofit earlier this year as the city has been managing a budget shortfall. Its contract with Springfield has been renewed.
Justin Madeira is the CAHOOTS program coordinator. He joins us now to talk about what’s next for this organization. It’s good to have you on Think Out Loud.
Justin Madeira: Yeah, so happy to be here.
Miller: In the big picture, how would you say your organization is doing right now?
Madeira: We’re in a transformative place. Right now, we’re in a little bit of a slump. We are doing some reorganization and really trying to just re-stabilize. There’s been a lot of changes federally and in the state of Oregon about social services and specifically crisis services. So, while we have seen a reduction in staffing and hours, right now we’re building towards a more stable place and, I think, a better future for the program.
Miller: We talked briefly about this a couple of months ago when CAHOOTS and the clinic that runs it had said, “we’re going to drastically reduce our hours of operation in Eugene.” Since then, it’s been fully cut. So I think our listeners could probably use a reminder here. What happened? Why did you lose that contract?
Madeira: What it came down to is, White Bird used to do a lot of support for the CAHOOTS programs for a parent agency here. They did a lot of the background funding that some of our contracts, like our contract with the city of Eugene, just couldn’t cover. It can be, at times, a large financial burden to run a 24-hour a day, 365-day a year program. When some of those federal cuts came around, White Bird was no longer able to continue to pick up the back end funding that our contract with Eugene wasn’t able to support. So when that happened, Eugene at the time, was facing a budget crunch for a multitude of other reasons. And we just weren’t able to come to a good place between White Bird and Eugene where it was fiscally responsible for either entity to continue to support the program at the time.
Miller: One of the confusing pieces of this story, to me at least, is that, if I understand correctly, you didn’t meet the requirements of a relatively recent state law whose nickname is your organization, the CAHOOTS bill. What does this new law, named after your organization, require?
Madeira: A lot of it was done with such good intent, but because crisis programs as a whole are still relatively new, some of it was made very specific and very challenging. Some of those things that make it so challenging are being Medicaid billable. Senator Wyden put that out to make it easier to fund these programs and the idea behind it was wonderful. We do want to be Medicaid billable. That’s a great goal.
Miller: Meaning you could get federal Medicaid and state, although the feds put a lot of money as we have talked about and we’ll talk about a lot more in the coming days. But the idea was you could actually get some federal money in return for providing these services.
Madeira: Exactly, yeah.
Miller: So what was the problem with that?
Madeira: The problem with that is when we created our model over 30 years, [it was] not meeting those requirements. So when some of those requirements came up, we just weren’t ready for it. It’s a long process to make sure we are ready for it. A great example of that is our electronic health records. The way Medicare wants those managed and the information that they want us to collect was kind of antithetical, at the start, to our program. Collecting information for things like measures and systems tracking, MOTS, and the new roads, which really requires a lot of client information to be collected, was antithetical at the time to how we ran our CAHOOTS model, which was zero barrier. If you didn’t want to give a name, you don’t want to give info, great, you don’t have to do that.
So, as we’ve come up with new ways and work with a new EHR [Electronic Health Records], to be able to track and manage client data, and make sure that appropriate data is shared with the state at the state’s request, like any other mental health or physical health program, it’s just a slow process. It’s a long change. So when some of those mandates were required sooner – and we let people know realistic timelines for us – for some, those timelines just weren’t their timelines.
Miller: After we talked about the city of Eugene’s initial cuts to CAHOOTS back in April, we got an email from a listener saying that Eugene residents can still get support through Mobile Crisis Services of Lane County. They basically said, hey, you missed the boat here, you focus too much on CAHOOTS. Things are fine in Eugene because there is a totally separate crisis intervention system run by Lane County and they’re picking up the slack. What’s the difference between these two programs?
Madeira: First and foremost, CAHOOTS vans, when we were operating in Eugene, were specifically for Eugene. So the county vans are for the county. You may face increased response times, there may not be an availability as they’re responding countywide. Lane County is a large county in Oregon. So the CAHOOTS van, we had one specifically for Eugene, one specifically for Springfield. So those vans were very local and they were always very local.
There’s also just some slight differences in the programming. The Lane County model is a great model, but it is purely behavioral health. So you only get crisis counselors to handle mental health crises. The CAHOOTS model is an integrative health model. We really believe that physical health and mental health are intertwined in a way that can’t be separated. So when we send a van out, we have a crisis worker and an EMT or a medic. And we really strive to treat the whole person, all the problems that are presenting.
We really believe that mental health problems aren’t going to get better if you’re facing physical health problems, if you’re unhoused, if you don’t have clothing or food. And vice versa, physical health problems aren’t going to get better when you’re still suffering mental health crises. Taking your medication on time, caring for a wound appropriately, is really challenging when you are in psychosis or having other mental health problems.
So their model is just different, still great for those behavioral health crises, but so many crises are more than just behavioral health problems.
Miller: It’s now been about three months since CAHOOTS stopped operating in Eugene. Just a couple of days ago, The Register-Guard reported that county officials said that they’re getting a fraction of the calls that CAHOOTS previously reported. And officials with Eugene Police and Eugene Springfield Fire said that their calls have been flat. They haven’t seen an increase, which makes me wonder how you explain this. I mean, what do you think is happening with the people who used to call you?
Madeira: I think there’s a couple of different reasons for that. First and foremost, this came out fairly recently in a study that the University of Oregon did. When studying the call volume that CAHOOTS took from our local emergency services, especially our police services, one thing that came up was this recurring idea that a lot of the calls we responded to just aren’t calls that police or fire would respond to ...
Miller: And also not calls that people would call police or fire to respond to? In other words, are you saying that many of the calls you’re getting would only happen if CAHOOTS exists?
Madeira: Not necessarily if CAHOOTS exists, they’re just calls that maybe no crime has taken place and it’s not a circumstance that the police or fire EMS feel is important enough to address with their specific model or how they operate. So a lot of those calls might be welfare checks on someone who is laying on the side of the road and hasn’t moved too much in a couple of hours. The police may say, “Yeah, that’s not a priority for us. There’s no crime being committed. He’s not clearly deceased. So we’re not going to respond to that.” Or someone in the street yelling as they walk down the street, That’s still gonna occur whether or not CAHOOTS exists. But that’s not something an emergency service may address, even if it’s still a community concern.
So I think some of those calls remain flat because they’re still addressing all the calls that they would have addressed otherwise. And the calls that CAHOOTS used to address just aren’t being addressed or are now starting to go towards other crisis services, other social services in the area.
Miller: What’s the latest that you’ve heard from the city of Eugene?
Madeira: They just recently passed a new budget proposal that did have some money for alternative mobile crisis response in their budget. We’re still waiting to get more information on that. So until we know how that money is going to be spent, until we get an RFP (request for proposals), which really outlines what they’re looking for, what they’re wanting and how they want to spend that money, it’s hard for us to speak anymore on what we’re going to be doing next. But we are so excited to see that the Eugene City Council really believes in mobile crisis response and really put forward a strong message that it’s necessary, by including that funding in their budget proposal and asking our city director to find more funding still, for alternative mobile crisis response.
Miller: Because how much more additional funding would be necessary in order for you to be able to operate in Eugene the way you used to, 24-hours a day, and even more and with another team as well?
Madeira: We used to operate for 36-hours a day, with a 24-hour a day main coverage and then a second van that operated for 12 hours alongside the other two 24-hour coverage vans. It’s hard to say. Again, until they put out a request for proposals, we don’t really know what it is that they would want, whether it’s classic CAHOOTS, whether it’s something new and different, what all they’d want us to address. Right now, it’s about, I think, $500,000 in the budgets that they put forward. We would really be seeking closer, I think, to $1.5 million to fund and support our services.
So again, it’s hard to give an exact number until we know what they would be looking for, so we know what we’re here to support. But for classic CAHOOTS, it would be a fairly substantial increase from what is currently on offer. But again, we’re just so happy to see that anything is on offer because the city council’s really just listening to the citizens’ outcry for wanting CAHOOTS to be around still.
Miller: Justin, thanks very much.
Madeira: Yeah, happy to be here.
Miller: Justin Madeira is the CAHOOTS program coordinator.
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