The Wall Street Journal featured CAHOOTS as a model for reducing risk of violence in a November 24, 2018 article by Zusha Elinson. It is included below and as a PDF with permission from the publisher.
Serenity Lane honored White Bird’s Kimber Hawes in an award ceremony in honor of front line staff in our local recovery community as an Unsung Hero for the impactful work she does as a CAHOOTS worker.
Champions in the field of drug and alcohol treatment were recognized in the following categories:
- Addiction Professional Award
- Community Leadership Award
- Dwight Lee Spiritual Advisor Award
- Emergency Services Professional Award
- Health Care Professional Award
- Mental Health Professional Award
- The Unsung Hero Award
This past weekend represented an unusually high number of heroin and other opiate overdoses in the Eugene/Springfield area, but these overdoses have been in keeping with recently observed trends. There have been two distinct patterns of heroin and other opiate related overdoses occurring with increased frequency: poly-substance OD’s and fentanyl contaminated OD’s:
- Poly-substance overdoses present a unique frustration to first-responders because they generally combine opiates, alcohol, and other substances often including benzodiazopenes or other prescription pharmaceuticals, which requires field stabilization and hospital treatment.
- Fentanyl contamination has been detected in various street drugs and counterfeit prescription medications in the Pacific Northwest, and has been particularly common locally in a strain of heroin that has been encountered by users and first responders in recent weeks.
Lane Co. EMS, EPD, SPD, and CAHOOTS all carry the opiate overdose reversing medication Naloxone, commonly referred to by its trade name, Narcan. Naloxone is administered to treat overdose patients presenting with respiratory distress caused by the overdose, the medication enters the respiratory center of the brain stem and flushes neural synapses by out-competing the opiates present in the blood stream to to temporarily reverse respiratory inhibition; for patients whose breathing has ceased Naloxone is frequently administered along with CPR.
CAHOOTS, specifically, has not experienced a significant increase in overdose responses, largely because the increased public awareness of the opiate crisis has increased the aggressiveness of EMS and law enforcement responses to these emergencies. White Bird’s main clinic staff including the Crisis Team and Front Rooms/Reception staff have, on the other hand, reported a significant increase in interventions this year, with three incidents of Naloxone and CPR administration in the past 2 months. White Bird has begun the process of standardizing Naloxone training for all staff in addition to First Aid and CPR requirements.
Locally, the increased frequency of opiate overdoses has not been accompanied by a proportionate increase in overdose deaths. Increased public awareness has led to increased public involvement, with bystander-administered Naloxone and CPR saving brain tissue and lives prior to professional responders arriving on scene, and with increased awareness of Oregon’s Good Samaritan Law amongst drug users reducing the fear and stigma associated with calling 911 to seek assistance in an emergency.
The lives saved have demonstrated the benefits of harm reduction policies:
- Public health education and outreach efforts increase awareness of the situation, increasing the likelihood of an overdose being recognized and treated.
- Good Samaritan Laws provide bystanders who interact with law enforcement temporary respite from prosecution, decreasing the likelihood of an overdose patient being abandoned.
- Broad availability of Naloxone—it is available over-the-counter at most pharmacies free of charge for individuals covered by private insurance or OHP and is also available free of charge along with training through HIV Alliance—increases the likelihood of the medication being available in the event of an emergency.
- Bystander education including CPR training for community groups and Naloxone administration training for users, their peers, families, and those who work with them facilitates rapid overdose intervention.
- Aggressive EMS and police responses to overdoses due to their increased public profile decreases the likelihood of overdose patients fleeing the scene of their resuscitation, only to cease breathing again due to lack of follow-up care.
The Eugene HIV Alliance, through their syringe exchange program, has made the injectable form of Narcan available. It also provides training to individuals and groups on how to administer it.
The syringe exchange is held five days a week at different locations, and the service is free.
When you walk in the Out of the Darkness Walks, you join the effort with hundreds of thousands of people to raise awareness and funds that allow the American Foundation for Suicide Prevention (AFSP) to invest in new research, create educational programs, advocate for public policy, and support survivors of suicide loss.
CAHOOTS will be tabling and answering questions about what services we provide and how to access them. We will also be facilitating a safe space for anyone struggling with emotions in reference to the event.
Walk Date: 09/30/2018
Walk Location: Alton Baker Park – Eugene, OR
Check-in/Registration Time: 09/30/2018 at 10:00 am
Walk Begins: 11:00 am
Walk Ends: 1:00 pm
For more information, please contact:
Contact Name: Sara Scofield
Contact Phone: 541-513-5937
Contact Email: firstname.lastname@example.org
Online registration closes at noon (local time) the Friday before the walk. However, anyone who would like to participate can register in person at the walk from the time check-in begins until the walk starts. Registration is free and open to the public. Walk donations are accepted until December 31st.
Responding to someone in crisis can be difficult, and knowing someone is suicidal can be scary, especially when we’re not sure how to respond. For many of us, our natural reactions to crisis can quickly escalate a situation and make things worse. That’s why professional crisis workers seek out training and practice crisis intervention strategies so that they’re prepared to navigate a crisis situation and offer support. When we develop a plan for offering support in crisis situations, it is more likely we will not go into crisis ourselves when assisting someone.
Often, for those experiencing suicidal thoughts, help can be as simple as having someone to talk to. For many, social isolation, history of trauma, mental health issues, or belonging to historically oppressed groups can lead to periods of suicidal ideation. But how do you know if someone is experiencing suicidal ideation? Often there may be signs of suicidal thoughts or behaviors.
Some warning signs of suicidal ideation can include:
- Threatening to hurt or kill oneself
- Seeking access to means to hurt or kill oneself
- Talking, thinking or writing about death, dying or suicide
- Increased use of alcohol or drugs
- Withdrawing from family, friends or society
- Showing rage or talking about seeking revenge, appearing agitated or angry
- Talking about feeling empty, hopeless, or having no reason to live, or being a burden to others
- Making a plan or looking for a way to kill themselves, such as searching online, stockpiling pills, or buying a gun
- Talking about great guilt or shame
- Feeling unbearable pain (emotional pain or physical pain)
- Acting recklessly or engaging in risky activities that could lead to death, such as driving extremely fast
- Giving away important possessions
If these warning signs apply to you or someone you know, get help as soon as possible, particularly if the behavior is new or has increased recently. Suicidal ideation is complex and there is no single cause, people of all genders, ages, and ethnicities can be at risk. In fact, many different factors contribute to someone making a suicide attempt. But people most at risk tend to share certain characteristics known as risk factors.
Often, family and friends are the first to recognize the warning signs of suicidal ideation and can be the first to assist in reaching out and getting help. Showing someone who may be experiencing a crisis that you care can make a world of difference in their life. Know how to start the conversation. Know how to ask, “Are you suicidal?” Know how to say, “I’m here for you,” and really mean it. Be aware of resources available in your community like the White Bird Crisis Line, CAHOOTS Mobile Crisis Services or the Help Book.
Risk Factors vs. Protective Factors
Characteristic and attribute that reduce the likelihood of attempting or completing suicide are known as Protective Factors. They are skills, strengths, or resources that help people deal more adequately with stressful events. Protective Factors enhance resilience and help to counterbalance Risk Factors.
- Effective clinical care for mental, physical, and substance abuse disorders
- Easy access to a variety of clinical interventions and support for help seeking
- Family and community support (connectedness)
- Support from ongoing medical and mental health care relationships
- Skills in problem solving, conflict resolution, and nonviolent ways of handling disputes
- Cultural and religious beliefs that discourage suicide and support instincts for self-preservation
Risk factors impact our ability to manage high stress situations. Being aware of these factors can assist if you are in crisis or helping someone in crisis.
- Being exposed to others’ suicidal behavior, such as that of family members, peers, or celebrities
- Depression, other mental disorders, or substance abuse disorder
- Certain medical conditions
- Chronic pain
- A prior suicide attempt
- Family history of a mental disorder or substance abuse
- Family history of suicide
- Family violence, including physical or sexual abuse
- Having guns or other firearms in the home
- Having recently been released from prison or jail
Suicidal thoughts can come on at any time like a tidal wave. Like a tidal wave, suicidal thoughts can leave a wake of destruction in their path. It is important for someone experiencing these strong thoughts and emotions to have an anchor during one these episodes. Suicidal ideation can make it seem like death is the only way out in that moment. Our rational mind may not be able to see any other solution when amid suicidal ideation. If we can help someone ride out the wave until they receive professional help, the likelihood of suicide is greatly reduced. Below are 10 steps to assist you in helping someone in crisis.
Ten Steps to Help a Person in Crisis
Step 1. Encourage the person to communicate with you.
Step 2. Be respectful and acknowledge the person’s feelings.
Step 3. Don’t be patronizing or judgmental.
Step 4. Never promise to keep someone’s suicidal feelings a secret.
Step 5. Offer reassurance that things can get better.
Step 6. Encourage the person to avoid alcohol and drug use.
Step 7. Remove potentially dangerous items from the person’s home, if possible.
Step 8. Encourage the person to call a suicide hotline number. You as the helper can also call.
Step 9. Encourage the person to seek professional help.
Step 10. Offer to help the person take steps to get assistance and support.
For our 24/7 CAHOOTS mobile crisis services, call the police non-emergency numbers 541-726-3714 (Springfield) and 541-682-5111 (Eugene). For our 24/7 crisis hotline, call 541-687-4000 or toll free at 1-800-422-7558.
Congratulations to CAHOOTS medic and crisis workers Rose Fenwick and Kimber Hawes, who were honored at a ceremony yesterday by the Eugene Police Department with the 2018 Partnership Award! Thank you for your care and compassion in serving our community.
On April 10th, CAHOOTS was selected by the Lane County Board of Commissioners as a recipient of the 2018 Excellence in Public Health Award. The award was presented during the Commissioners’ meeting to recognize the CAHOOTS team’s work in the field as behavioral health first responders, as well as their efforts in outreach, training, education, and support for individuals and groups throughout the area.
Following recent events at the Academy of Arts and Academics in Springfield, counselors from CAHOOTS and White Bird Clinic’s Crisis office responded to the school to provide grief and loss counseling to students, staff, and their families. An extension of the weekly Mobile Mental Health Resource Clinic already staffed by members of the CAHOOTS team, these counselors facilitated both individual and group counseling and will continue to work with A3 and the Springfield School District to support everyone affected by this tragedy.
CAHOOTS mobile crisis counseling services are available in Springfield 24 hours a day, 7 days a week, and can be requested via Springfield Police non-emergency dispatch at (541)726-3714.
Additional crisis support is also available 24/7 by phone at (541)687-4000, or walk-in at White Bird’s Crisis clinic, 341 E. 12th Ave in Eugene.
The CAHOOTS (Crisis Assistance Helping Out On The Streets) program began in Eugene in 1989 as a collaboration between the city of Eugene and White Bird Clinic.
CAHOOTS started small: one van equipped with medical supplies and trained personnel, operating part-time in Eugene. Its mission was simple: to offer help to individuals and families, housed and unhoused, in crisis.
The idea was that it would be better — and cheaper — to have people trained and experienced in counseling and medical care to respond to these calls, which had been going to police and fire departments.
The wisdom of that decision has been amply borne out since then by CAHOOTS’ exponential growth over the last three decades and the place it has made for itself in the Eugene-Springfield community.
It has more than tripled its local presence with two vans in Eugene and one in Springfield, and gone from part-time patrols to 24-7 service.
The two-person teams that staff each van respond to an average of about 15 to 16 calls in a 12-hour shift in Eugene, although it can be as many as 25 calls per shift — slightly less in Springfield, CAHOOTS employee Brenton Gicker says, which works out to tens of thousands of calls per year.
Gicker is a registered nurse and emergency medical technician; his partner on a recent night, Maddy Slayden, is a paramedic.
They and their co-workers are a welcome presence on the streets of Eugene-Springfield, greeted with warmth by police officers, with relief by business owners who prefer the option of calling CAHOOTS to calling police, and with respect by the people they help.
CAHOOTS is a significant part of the network of organizations and agencies that provide help to the growing number of people who are homeless locally — about half of CAHOOTS’ calls are to help someone who is homeless, ranging in age from children to seniors.
The CAHOOTS teams have earned respect in the homeless community not just for the help they provide — from distributing socks and bottles of water to emergency medical care and help accessing resources such as medical treatment and emergency shelter — but by the way they do it.
The CAHOOTS employees offer dignity and courtesy, which are often in short supply for people who are homeless.
A typical shift — if there were such a thing — for a CAHOOTS team might include responding to a call about a homeless person disrupting a business; working with a family in crisis; helping someone who is suffering from substance abuse, mental illness or developmental disabilities access services and find safe shelter for the night; treating injuries; picking up people who are being discharged from a hospital or clinic with no place to go and taking them to a safe place where they can get help; and responding to a call from a landlord worried about the welfare of a tenant.
They are trained to address issues such as mental illness or substance abuse and skilled in coaxing people to agree to get the help they need.
Many of their calls involve driving people who are suffering from mental illness or substance abuse to an emergency
room or, if their problem doesn’t merit medical care, to a safe place to spend the night.
Despite more than tripling the size of CAHOOTS in the past few years, the need for its services continues to grow faster than CAHOOTS’ resources.
“I’m frustrated because we can’t be everywhere at once,” Gicker says. “There’s always things we’d like to be involved in, sometimes we don’t have the resources we need, or access to information. I feel like we’re often only scratching the surface.”
CAHOOTS is a uniquely local response to local needs — people familiar with the program say they don’t know of anything quite like it elsewhere.
Its growth in recent years has shown the need for its service; the response within the community, its ability to meet them given the resources.
It’s time to start thinking about expanding a program that has been successful and that serves a need that continues to grow.
Ideally, adding another van would be a step toward meeting this growing need, as well as allowing expansion of service to areas such as Santa Clara and Goshen that have few resources. It also would allow CAHOOTS staff to respond more quickly to calls seeking help, reach more people who are in need of help, and spend more time working to connect people with the resources they need.
It’s hard to put a dollar value on what CAHOOTS does — how do you determine, for example, how many people didn’t die on the streets because of CAHOOTS? How many people who were able to get help that allowed them to stabilize their lives, or medical care that relieved suffering? How do you quantify exactly how much taxpayer money was saved by using CAHOOTS instead of police or firefighters, or the value to businesses of knowing they can call CAHOOTS for help?
But the role the CAHOOTS teams play in Lane County is a critical one, and likely to become even more critical in the coming years.
This editorial is part of a Register-Guard series focusing on productive responses to homelessness reposted with permission from http://registerguard.com/rg/opinion/36272835-78/helping-people-in-crisis.html.csp