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Boosting behavioral health services with innovative partnerships

Cape Fear Valley MIH collaborates with community organizations to enhance care for mental health and substance use challenges

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In this episode of the EMS One-Stop podcast, host Rob Lawrence sits down with Fayetteville, North Carolina’s Cumberland County EMS Chief David Grovdahl and Behavioral Health Community Paramedic Tara Tucker to discuss the Cape Fear Valley Mobile Integrated Health Behavioral Health Community Paramedicine programs.

The Cape Fear MIH Team is composed of four community paramedics, one social worker and a peer support specialist. The team focusses in particular on overdoses/request for substance use treatment, suicide related calls – ideation/attempts as well as youth calls related to mental health and substance use, and also EMS referrals and associated case management.

Fayetteville is home to Fort Liberty and Pope Army Air Base, and is the sixth most populous city in North Carolina with a high number of uninsured and underinsured patients. Fifteen percent of Cumberland County’s population is military-affiliated and it is the third busiest EMS system in North Carolina. Cumberland’s affiliated ED, CFVMC Emergency Department, had 90,595 visits in 2021 for adults, and 30% of those (27,300) were for behavioral-health related issues, creating the need for a Behavioral Health service line employing community paramedics.

In addition to discussing their mobile integrated healthcare system, Grovdahl also shares about the North Carlina whole blood programs and their progress.

Top quotes from this episode

“Our crews can make a referral in our PCR system, but we also go a little beyond that and pull some reports as well that I think are important. One is that overdose report, so that we can follow up with people post overdose – trying to get them options, and one of the big things that we do is, if you’re not ready for treatment yet, we still give you resources that show we care. For example, ‘To never use alone’ hotline and teach you, if you’re going to use and be by yourself, here’s a phone number to call, they say on the line with you, and they call 911 if that line goes silent.” — Tara Tucker

So this is one of our really unique partnerships, I think. And we’re partnering with a group of bikers called ‘Broken Chains’ and they’re all people in recovery themselves and they really just meet people where they are. They love on people and try to address social determinants of health with us.” — Tara Tucker

“The outreach events that we’re doing each month. So again, focusing on that framework of partnerships where we’ve built, we offer an outreach once a month and all these partners come together to address the needs of people. So, it may be things from getting them signed up for Medicaid or food stamps, to a haircut. That’s and I mean, it’s amazing. Just the difference a haircut can make and somebody being able to get a job.” — Tara Tucker

“We want to try to handle everything ourselves. Partnership is the key: partnership, partnership, partnership. So don’t try to be the end-all, be-all for everything. Our own team is partnered. We have a social worker and peer support in addition to our community paramedics – use the power of all of those different skill sets and use the partnerships in your community. You don’t have to be the counselor and the provider of all the social determinants.” — David Grovdahl

“Don’t immediately take anything off the table. When Terry came to me and said we’re going to partner with a biker group, my initial thought was why? But it turned out to be the greatest partnership ever.” — David Grovdahl

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Episode contents

01:25 – Introductions

03:30 – North Carolina whole blood projects

04:50 – Following the San Antonio whole blood project

06:00 – Blood coalition

07:52 – Who is paying for it?

09:00 – The behavioral health community paramedic concept

13:20 – Tara’s background in an Assertive Community Treatment (ACT) Team

15:13 – Referral sources/frameworks and relationships

16:20 – Report monitoring/OD report monitoring

17:00 – Pathways and services

18:15 – Youth mental health team

18:40 – Medical examiner data on OD death

19:53 – PCR data referral

20:30 – Cape Fear team composition

21:04 – Partnering with the Broken Chains biker group

22:15 – Broken Chains creating awareness, naloxone distribution

23:05 – 988-line awareness

24:30 – Data, resources and attending the NAEMSP QA/QI course

26:30 – Monthly outreach events

27:30 – Reach out to your state resources and insurance carriers and start the conversation with them.

28:10 – Partnership, partnership, partnership – use the power of all the difference skillsets

28:40 – Don’t immediately take anything off the table – there are no crazy ideas, there are just self-imposed limitations!

Additional resources
Cumberland County EMS Mobile Integrated Healthcare Services/Cape Fear Valley Health

Rob Lawrence has been a leader in civilian and military EMS for over a quarter of a century. He is currently the director of strategic implementation for PRO EMS and its educational arm, Prodigy EMS, in Cambridge, Massachusetts, and part-time executive director of the California Ambulance Association.

He previously served as the chief operating officer of the Richmond Ambulance Authority (Virginia), which won both state and national EMS Agency of the Year awards during his 10-year tenure. Additionally, he served as COO for Paramedics Plus in Alameda County, California.

Prior to emigrating to the U.S. in 2008, Rob served as the COO for the East of England Ambulance Service in Suffolk County, England, and as the executive director of operations and service development for the East Anglian Ambulance NHS Trust. Rob is a former Army officer and graduate of the UK’s Royal Military Academy Sandhurst and served worldwide in a 20-year military career encompassing many prehospital and evacuation leadership roles.

Rob is a board member of the Academy of International Mobile Healthcare Integration (AIMHI) as well as chair of the American Ambulance Association’s State Association Forum. He writes and podcasts for EMS1 and is a member of the EMS1 Editorial Advisory Board. Connect with him on Twitter.