Written by the reviewer from the ASR + docket; [verbatim-ASR] = quoted machine transcript; [paraphrase] = reviewer's wording, not a quote.
0:00 Okay, it's 630 and all members of the committee are here. I will call the July 20th Public
0:06 Safety Committee meeting to order pursuant to like what codified ordinance 109.01 be
0:14 section B, section one. As chair, I am calling for this evening's Public Safety Committee
0:19 to be held partially by video conference under ordinance 109.01. Council members
0:25 participating remotely need not be present for the purpose of voting and determining
0:29 a quorum. So with that, all members are present. And we have two items on the agenda. The first
0:37 is approval of the March 9th, 2026 Public Safety Committee meeting. Do I have a motion?
0:42 So moved. Do I have a second? Second. All those in favor? Aye. That motion carries.
0:54 So the second item on the agenda is a communication from Chief Fairbanks requesting
0:59 an audience to share an update on the neighborhood paramedic program. I look forward to hearing
1:04 this update. And so if we don't have any other objection or discussion, I'm ready
1:11 to turn things over to Chief Fairbanks, a paramedic, Harper, for their presentation.
1:19 Thank you. Good evening, everyone. This is our annual neighborhood paramedic program
1:23 update. This is something that we've been doing probably the last three to four years
1:28 just so we can get in front of the Public Safety Committee and Council to ensure that
1:35 we explain exactly what the neighborhood paramedic program is up to. And we also
1:41 like to discuss roadblocks and any pinch points that we found along the way while
1:46 Oliver's been out there doing an amazing job. So tonight, Oliver is going to be
1:53 our key presenter. But we also have Nicole Zierenberg from Human Services. These two have been
1:59 working pretty well together over the last several months. And then we also have
2:03 Captain Michael Tripodi from the fire department. He is our health and safety officer, but
2:09 also on the side, he is a physician's assistant, and he has been a resource
2:14 for Oliver while he's been running this program essentially. So without further ado,
2:21 I will turn it over to Oliver so he can get started with his presentation.
2:25 Yep, all right. And just a little more, Mike actually works at a mental health facility, too.
2:38 So he can give a little more insight later on here where the issues we're finding of people
2:44 going to ERs and EDs with mental health problems, getting chewed up and spit out,
2:48 has been a recurrent problem. So he'll shed a little more light on that in a bit here.
2:53 You can go next slide please. So since the last year, it's been a very busy year.
2:59 I partnered with Cleveland Clinic Fairview. They've started doing kind of a pipeline with
3:05 discharged patients that have chronic conditions, congestive heart failure, COPD, diabetes.
3:11 So they'll send me referrals to these patients that live within the confines of Lakewood
3:16 and send me some information about what they were held with and then some ideas of what they
3:21 think will help bridge the gaps in their care when they get back home. So I kind of get a little
3:25 spiel and I can go and visit them and see where they're at. And it's been enlightening to see
3:30 kind of the people that get lost between going to the hospital, coming home and having nothing
3:35 to show for it. So it's been super helpful to have them kind of in our back pocket,
3:39 some of those patients. The centers is a mental health urgent care we're working with.
3:45 We would send some of the lower acuity mental health folks there. They would send an Uber
3:49 out. Instead of having an ambulance take them to the hospital for them having a minor
3:54 mental health crisis, they would send them to this facility that was kind of a one stop shop
3:58 and it was awesome. They would do same day care. They'd walk in. They'd have a psychiatrist.
4:03 They'd have case management, pharmacy. Everything they needed to do all wrapped up into one
4:08 and not get in an ER and sit there for eight hours and not get any definitive care.
4:13 Human Services, Nicole here, she's been super, super helpful. She's managing the
4:18 18 to 59 age group that has been underserved and it's really hard to find
4:23 resources that are better for them specifically and then with VA patients.
4:28 She's spent a number of years at the VA so she's been super helpful navigating
4:32 these patients' care in the field. With the Cleveland Clinic access,
4:37 they gave me access to Epic so I can send messages directly to doctors and kind of help them
4:42 with patient care appointments. Let them know that I visit these patients and kind of
4:46 help them transition back into the community. I have contractor status for the clinic
4:51 so I can go to the facilities and visit patients on site while they're still admitted
4:55 and let them know that they have access to resources here in the community.
4:58 And I've been having some doctors, nurses, and case managers ride along with me
5:02 in the field so they can see the patients that we're caring for and witness
5:06 the roadblocks to care happen live and it has happened.
5:10 Every time they ride with me, they'll call nurse triage line, calls get dropped.
5:15 They send us to the ER for things that are innocuous, that are easily managed in the field.
5:19 So it's been super helpful to have them watch the things that fall apart fall apart.
5:24 Next slide. This is a recap of what I said already.
5:33 There's just a ton of things that get lost when people leave the hospital in the
5:37 first week or two when all the resources are getting sent to them.
5:42 People don't answer their phones, disconnect, people don't answer their phone ever.
5:46 So they're not getting home care, they're not getting follow-up care, they're not getting transportation.
5:50 So this has been a really important part of the thing in the last year is
5:54 helping people connect with the services that are being sent so they have access to that.
5:58 I've made an effort to kind of help,
6:02 this is an effort to prevent people from calling an ambulance, but
6:06 helping them educate themselves on symptoms and giving them a green, yellow, and red
6:10 If we're visiting them and they're out of green, to know that if you're out of yellow, we can manage it at home
6:14 and not get too red. And I think it's been an important
6:18 part of what I'm doing is helping them be more involved
6:22 in their own care at home. I hope you'll register for
6:26 MyChart, which is one of the more arduous tasks is helping someone
6:30 who doesn't know how to use their phone log in 15 different ways of emails
6:34 and all that. I organize their medications. I use grant money to buy
6:38 medical organizers to help people get that set up, because adherence is
6:42 incredibly low for people taking a ton of meds, so it's one less step for them
6:46 at the beginning of the week. Decluttering has been super important for fall prevention
6:50 helping people set realistic goals between visits to say, next time I come
6:54 I'd like to see your kitchen table clear of things. I'd like to see your bed
6:58 decluttered. And again, empowering patients to be a little more
7:02 involved in their own care, because I don't think they have many advocates when they're lost between the cracks there.
7:06 Next slide. Pain points has been, I can only see
7:12 so many patients a day, and a lot of these folks need a lot of touch points
7:16 to handle a lot of their complex needs.
7:20 Other hospital systems, other than Cleveland Clinic, have been incredibly hard to get into.
7:24 They don't send referrals. They're not super responsive to emails or phone calls for me.
7:28 Transportation, universal issue. It's been challenging to make sure
7:32 people get to appointments that are homebound. A lot of transportation services
7:36 won't touch patients to help them get downstairs. So, again,
7:40 just another way, it eats up time, but I go to their home and make sure they get down their steps
7:44 in the cars, etc. Program expansion
7:48 constraints, obviously the financials of it, it's hard
7:52 to replicate what I'm doing for another person with an outside agency.
7:56 Because I have paramedicine, I kind of do a little bit of social work
8:00 and a little bit of everything, so it's been challenging to
8:04 grow with outside agencies that aren't involved in the fire service, too.
8:08 Mental health follow-up protocol, we really don't have anything standardized
8:12 to say that if someone's having a mental health crisis, what are the next steps
8:16 that we can do. They're a hard patient population to get in front of
8:20 and to contact, unfortunately, and one of the huge ones, hoarding assistance,
8:24 has just been rampant. I don't know what happened in the last month, but there's been
8:28 six or seven different hoarding people, and I'm not sure what
8:33 to do, but we're working on it to get creative and see what we can do.
8:37 Next slide, please. So mental health calls have been something we've been trying to
8:44 get a better grasp on. Currently, we did
8:48 about 300 last year of varying degrees of
8:52 severity, and like I said before, we were sending people to the centers
8:56 to kind of get that wraparound care, and those are for folks who are nonviolent,
9:00 not actively trying to harm themselves or somebody else.
9:04 moderate severity was also these folks who are having a crisis, but again, not
9:08 an immediate risk of violence to anybody else. So it kind of has been a
9:12 hard to find a different facility with the same access that doesn't
9:16 eat up an ambulance and cause this person to sit in the ER for an entire
9:20 evening and not actually get definitive health care.
9:24 So that's, actually, Mike, if you want to chime in here a little bit,
9:28 if you may, just a little bit of kind of how the process looks right now
9:32 for mental health folks. Hear me?
9:36 So a lot of people have a very poor understanding
9:40 of what happens to a mental health patient when they get sucked into the emergency system.
9:44 Unfortunately, it's not a great
9:48 access to care, but it's built on the principle to protect
9:52 the providers, the physicians, the PAs.
9:56 It all kind of covers all of the malpractice in case the patient leaves
10:00 the facility and harms themselves. So the protection is provider first.
10:04 And what happens when you enter the emergency room is you can sit 8, 12, 16.
10:08 Flu season could be two days. They sit and rot in the emergency room
10:12 under pink slip with minimal medication adjustment and no
10:16 therapy. Then they get moved to a facility where their pink slip actually starts
10:20 and 99% of the time they don't get that information.
10:24 On any given patient, three to five days is reasonable,
10:28 but you could disrupt your life for the better part of a week for
10:32 saying something or feeling a certain way. Excuse me, Chair. I'm sorry.
10:36 Could you back up again and explain to me what you mean by rotting away in the
10:40 ER room? So to give you a picture of what happens
10:44 if you threaten to harm yourself or you
10:48 have feelings of harming others and you come into the emergency room,
10:52 they'll do what's called medical clearance. They do some laboratory workup.
10:56 They ask you why you're there. And you enter this process called central intake.
11:00 That's what Cleveland area uses. And it uses all the mental health facilities
11:04 and it tries to access you care. And it doesn't matter where you go,
11:08 but they'll say we can get to them in two days or a day
11:12 or 18 hours. And the patient will just sit there with no
11:16 assistance for that amount of time until they can be transferred to whatever facility
11:20 they're going to. And that time is just lost time.
11:24 You can imagine if you're having a mental health crisis that there's no help there.
11:28 Arguably worse. So a lot of what Oliver's been trying
11:32 to do is find this spread, this low, medium,
11:36 high, to find those patients that maybe don't need
11:40 to go sit in an emergency room and wait and disrupt an entire week of their life
11:44 to get minimal care. That's not even the beginning of the
11:48 process. They go to a facility where they sit. They talk to a
11:52 psychiatrist for a very short amount of time for acute stabilization.
11:56 Some medication adjustment. And then they come up and meet social work.
12:00 Social work gives them a plan for discharge. And that's really when their
12:04 foot exits the door, we're talking five to seven days later,
12:08 that's about when their plan starts. Worst case scenario.
12:12 So I think what we're at is that Oliver,
12:16 through the centers, which I know there's been some issues there, we're trying to find
12:20 a solution to a problem for these patients that
12:24 doesn't end up in disrupting a week of their life and
12:28 potentially making their mental health crisis worse.
12:32 Because that's the road that you get on when you call the ambulance and you say
12:36 I want to harm myself or I'm thinking of jumping off a bridge or something terrible
12:40 to yourself. That's the road you walk down and it's
12:44 kind of an ugly one. If you
12:48 do any research on community paramedicine, this started a number
12:52 of years ago. It started out west. And all of the research on
12:56 it kind of comes to the conclusion, yeah, it's great. It costs money.
13:00 It's good for people. But by the way, it doesn't work for mental health.
13:04 I think that we understand that
13:08 but we're trying to find a solution to make that not true for us.
13:12 If that makes sense. Be happy to expand further
13:16 if that's not clear.
13:21 Could you define pink slip?
13:25 Pink slip is when either a police officer, social worker or physician
13:29 feels that you don't have capacity to make
13:33 decisions for yourself and then take your rights for 72 hours.
13:37 That time is not a clock, I've found out. It has a lot to do with
13:41 the courts being open. It has a lot to do with holidays and whether or not
13:45 there's a physician or psychiatrist available for evaluation.
13:49 A lot of times, I was saying worst case scenario, say July 4th is on a
13:53 Friday. You end up in the emergency room. You sit there until Monday. You don't get
13:57 transferred until Tuesday. Your 72 hour starts Tuesday. You might not
14:01 leave until Friday, Saturday.
14:05 That's an entire week of your life because I had a
14:13 I would feel like that would
14:17 discourage people from calling again. Correct, it does.
14:21 It definitely does.
14:32 great briefing. Thank you. I don't want to interrupt the flow. I do want to
14:36 get a clarification. Are we saying that Lakewood's community paramedic program
14:40 is primarily or exclusively mental health at this point?
14:44 No, I would say quite the opposite. There's a wide spectrum
14:48 of growth there. He does a lot of things for a lot of our elderly
14:52 people and a lot of assisted living. I would say the reason
14:56 that we're talking about this is because this is where we think we can make a difference
15:00 where he has not been accessing enough
15:04 for our residents. Oliver, I don't speak for you. Do you feel that's
15:08 appropriate? I think it's built into the system currently.
15:12 I think that's where we're trying to change the paradigm that these people don't need to be
15:16 in an ER, as you heard. It's super intrusive, but that's just the way
15:20 that they get to something. It's hard to get them to the definitive
15:24 care another way, especially if they're having a crisis.
15:28 It's even happened that they call the crisis line, and the crisis line calls 911.
15:32 Even with the other agencies that are out there, it seems like all
15:36 roads lead to the emergency room. We're trying to find the
15:40 calls in a route, because again, there's no treatment that happens there.
15:44 They're just kind of locked away and sequestered until they get to the next
15:48 stop. There are times when somebody may be
15:56 in the midst of a psychotic episode, and they
16:00 do need to safely be hospitalized.
16:04 There are other times where someone may have had passive suicidal ideation
16:08 without intent, without a plan, without access to lethal means.
16:12 In that case, when they're going in, that's not really
16:16 appropriate. That's more so something that Oliver and I
16:20 work on. I would follow up. What resources do you need?
16:24 What led you to this? How did you get to this place? What are the barriers
16:28 in place? Having that prevention from reaching that
16:32 crisis again and following up with them. He and I have worked together
16:36 and spent many, many hours with multiple people where
16:41 it's a lot of time that you're working with them, one-on-one
16:45 talking about their needs and developing a plan together. It's not this
16:49 quick discharge plan. Oh, you just need to have access to this benefit
16:53 and it'll make your life better. No, there's reasons you got to this place
16:57 and having that support in your home to find out how
17:01 you got there and what you need to do next is critical.
17:05 I think that's kind of the thing we're looking to do is like
17:09 we're going to their home post-crisis and we're meeting them in their own space
17:13 and it could be cluttered. It could be they
17:17 can't get their medication because they can't get transported. They have no other social support.
17:21 We're trying to do the things in the back end. I think that's where the future plan is
17:25 to get more creative with follow-ups for mental health things to prevent the need
17:29 for activating the crisis options
17:33 in a nutshell. Yeah, and to support that, human services
17:37 did obtain a $100,000 grant for a two-year term where we are
17:41 helping. We're working on the transportation component
17:45 where we'll have our own Uber health account to help these people
17:49 when they need to get to that next day appointment where Oliver will be able to tap into that.
17:53 If there are specific resources that they need, we'll have specialists
17:57 that will be able to go out to the home and navigate that as well
18:01 as well as additional support services that we're working on too because of
18:05 all the work that he's done and a lot of these pain points that have been
18:09 brought up. We're working on developing a better model to address
18:13 the mental health needs. Go to the next slide.
18:20 Yeah, hoarding has been, again, it is the thorn in our side here.
18:24 It is a hazard to the resident. It is a fire
18:28 hazard for the people in the home. The home's adjacent.
18:32 It's a problem for us getting in, us getting out.
18:36 I think we had a meeting with folks so you can cite these people
18:40 and a lot of these folks are immobile. They're unwell. They have no transportation.
18:44 So the citation that requires them to leave their home to go to an appointment
18:48 or a court date and they can't get to it, and then they're like, well, we'll send someone,
18:52 we'll send mental health to you. And a mental health person's like, I'm not going to that house. That is a hazard.
18:56 With the hoarding, there's pests, there's bed bugs, and
19:00 it just has turned into this bloated problem that has so many
19:04 multi-factorial issues that it seems impossible right now.
19:08 So currently what I do is take a contractor bag and I take
19:12 one bag at a time of agreed upon things and it's not enough to
19:16 make a dent, but it's something.
19:22 Vice President Baker, yeah. Thank you. Sorry, I didn't mean to knock my glass over.
19:26 So I serve ex officio on the Lakewood Live Board and the problem that
19:30 they've, I'm sure you've coordinated a lot with them, one of the problems is like
19:34 obligations of stealing, right? So you're trying to help and then they're like, you took
19:38 this really important thing and police reports and everything, so
19:42 I mean, I'm interested in ways you can help
19:46 and it sounds like you're throwing a bucket into the ocean.
19:50 But sorry, I just... And there's been times
19:54 where it's kind of like Storage Wars, where one of those shows
19:58 where once they get them to buy something, then they're like, okay, I can get rid of that, I can get rid of this.
20:02 My goal is usually just to get a path. I'm okay with
20:06 we can get in, we can get out. Should there be a fire, yours are exit.
20:10 So mitigating as much risk as we can, but
20:14 yeah, it's complex and there's not a lot of agencies that are willing
20:18 to be involved because of those other complex issues.
20:22 Go to the next slide please.
20:29 Just a recap with some cute pictures.
20:33 Another issue has been, I don't know what the treatment plans
20:37 look like in some of these high rises, but it's ineffective, whatever they do.
20:41 It's room to room, they'll spray once every two weeks, the sprays don't
20:45 work, there's clutter that exists, so it's been a huge amount
20:49 of time trying to help folks navigate and talk into management and
20:53 that's a very ugly situation as well. But again, trying to get creative, but
20:57 it seems like an endless problem. Next slide please.
21:03 I did send an email with the additional slides
21:11 that came up missing. It was a little busy week, so it was
21:15 trying to get it to Marine in a timely fashion
21:19 and a little mistake was there.
21:23 Do you guys have access to it? It's kind of just a recap of what Nicole was saying
21:27 and Mike was saying. We're trying to bridge the gap in mental health care.
21:31 Currently I think after hours access has been an issue.
21:35 Mental health care and post discharge finding a plan and working together
21:39 with Nicole to get folks connected after these
21:43 incidents. The practicality of outpatient plans, sometimes they have these
21:47 several meetings a week that they can't get to. They have
21:51 medications they can't afford to get to. So again, just big picture
21:55 things where we're trying to work through. An issue has also been
21:59 that it eats up a lot of time with the MS, a lot of the CIT officer time
22:03 with these repeat folks who are having crisis. So the hope is to be
22:07 is to work together to prevent them from having
22:11 repeat crisis or at least if they have 10 this year they have 8
22:15 the following year and 6 the following year. We're not trying to set too lofty of goals
22:19 but we're trying to take a bite out of the mental health issues because it is
22:53 That's the long and short is that hopefully the next year will be the year where we can
22:57 put our heads together and try to work more towards the mental health
23:01 things and taking the pressure off the system here with those.
23:05 From an administration side
23:09 what this team is doing is, you know, it's incredible
23:13 except we, until we can legalize
23:17 the cloning of Oliver, it's extremely difficult.
23:21 You know, he's busy all day.
23:25 He's at capacity. He's probably working at 110% capacity.
23:29 So administratively we've been looking at other ways of
23:33 securing funding. We've been speaking with the Cleveland Clinic about
23:37 a partnership, more grant dollars to secure
23:41 another position to not clone Oliver but
23:45 have another neighborhood paramedic.
23:49 So even diving into the data, a lot of things are driven by
23:53 data and they'll say, well, are your EMS calls reducing?
23:57 That answer is no. Our call volume will
24:01 always be going up. It's just the nature of the American
24:05 fire service as it is. The one key
24:09 metric that I look at is the patient
24:13 or the resident that was calling 50 to 100 times a
24:17 year, they're now calling 10 times a year. So
24:21 those folks that Oliver is actually going out and making an impact with
24:25 their frequency of EMS usage is considerably
24:29 down. So that, in my book, is a win and
24:33 it shows the effectiveness of the program and what Oliver and Nicole
24:37 are doing. So we've been trying to come up with
24:42 a creative way to, you know, find
24:46 funding, secure funding to increase
24:50 Oliver's team at least by one. Unfortunately
24:54 for me in the grand scheme, a lot of my budget is tied
24:58 up with emergency operations and I can't start pulling people out
25:02 of those emergency operations to assist
25:06 Oliver. So that's kind of where we're stuck between a rock and a hard place.
25:10 We do have a meeting with the Cleveland Clinic on Friday. Hopefully
25:14 they have some good news for us, but we will also be reaching out to
25:18 university hospitals. It's more than a Cleveland Clinic
25:22 issue, it's a global issue. So anything that we can do
25:26 to try and bolster this program
25:30 to make more of an impact, like the amount of impact
25:34 that Oliver has made is incredible.
25:38 But just think about what we could do
25:42 with another Oliver. So that's kind of
25:46 where we're looking internally and administratively.
25:50 It's just been difficult, but
25:54 he's doing a great job. This whole team, they're
25:58 impressive. They just, I can't say enough about them
26:02 and the impact that they're having and the relationships they're building
26:06 with our residents and with other stakeholders in the community.
26:13 Anything else? Any questions?
26:17 Thank you Chief Fairbanks and thank you Paramedic Harper.
26:21 This was great, this was a great overview.
26:25 And I'm sorry I did not ask this at the beginning. I should have
26:29 just for people that may be tuning in and watching this or watching this
26:33 playback, if you could just give us a brief history of the Neighborhood Paramedic
26:37 Program and how it started. That might be helpful
26:41 and then I have some questions. Actually the perfect person to give
26:47 us the history of the Neighborhood Paramedic Program is Assistant Chief
26:51 Sam Buhler. This was a brainchild of his several years ago.
26:55 Good evening. Is this working? Can you hear me?
26:59 Okay, so years ago we had like the first
27:03 iteration of the Community Paramedic Program
27:07 that was in partnership with the Cleveland Clinic but it was hospital based.
27:11 The goal of that program was to
27:15 reduce hospital readmissions which is hugely beneficial for
27:19 the hospital system itself, not as beneficial for the patients
27:23 the population at large when you're looking at the global
27:27 program as it's laid out.
27:31 That was not as successful and it had shut down
27:35 and so years ago I think actually
27:39 it was brainchild again at one of the Fire Department
27:43 members' weddings. Former Human Services
27:47 Director, Jill Samino, was there and her and I got to talking about
27:51 a rebirth of the program through the Fire Department because that's where
27:55 if you look at research and the Fire Department based
27:59 Community Paramedic programs were most successful and most impactful.
28:03 So we partnered with the team from UH and
28:07 that's actually who our current medical direction for that program is still under
28:11 and we decided to narrowly scope
28:15 the population that we can make the most impact with which was
28:19 the elderly population that were fall risks. By doing
28:23 a fall prevention program it gave us access to the home and
28:27 when we get the access, you know, why do people fall? Well it can be a number of
28:31 reasons whether it's trip hazards, if it's hoarding conditions, so if there's social needs
28:35 but it also opens the door for Oliver or whoever the
28:39 Community Paramedic is to identify some of those needs. So food insecurities
28:43 if there's other medication in compliance and stuff
28:47 that's going on in their actual patient care
28:51 they could make an impact that way. So that's where it started
28:55 we went for what we call the low-hanging fruit and we got into
28:59 a lot of patient access. There was progress made with
29:03 the previous and now fire marshal birth when he was the neighborhood paramedic
29:07 and then since Oliver took over
29:11 the relationships as Chief mentioned with the stakeholders
29:15 and different hospital systems, the centers, you know, Oliver and I would
29:19 take drives down and talk to people to get different access points and
29:23 he's expanded it well beyond what I thought
29:27 could happen in such a short period of time when this brainchild
29:31 idea happened and I think what he's doing
29:35 now is as Captain Tripodi identified
29:39 the mental health piece has always been something that, you know, we knew that
29:43 there's a need there and we got to figure out how to kind of
29:47 have that paradigm shift a little bit so where we can have an impact and get these people
29:51 into the proper pathways to care and not
29:55 the rinse and repeat of getting brought to the ER, discharged,
29:59 they go home and then it happens again week later, month later,
30:03 two months later so I hope that answers the history of it.
30:07 Yes, thank you so much. Thank you. And I was hoping not to have to speak tonight but
30:11 thank you. Sorry about that.
30:15 So I just have one question and I want to give time for my colleagues.
30:19 I mean I could probably talk with you for hours about this and as you're talking
30:23 I just had all sorts of wheels turning in my head so maybe we could have
30:27 even a follow-up meeting. So does the centers
30:31 offer partial hospitalization programs?
30:35 And are you familiar with partial hospitalization, right?
30:39 Yeah, PHP. So essentially what a PHP
30:43 program is is it's a step down from a full
30:47 hospitalization so it would address a lot of the needs where the people
30:51 they don't need to be in, have a psychiatric 72 hour
30:55 hold but they definitely need some sort of intensive
30:59 care and support because when you're in a hospitalization
31:03 and you're in there for however long that they're going to have you
31:07 you have that intensive therapy that's happening, you're having
31:11 that psychiatric medication that's being monitored and you're
31:15 having even group sessions that are happening. So the partial hospitalization
31:19 program takes what would happen over three days
31:23 and there's some people that they may need that but then once they're
31:27 out they may have another episode but that episode may not
31:31 deem them eligible to be hospitalized again so they need
31:35 something else and so the partial hospitalization
31:39 can be from 8 to 5, 8 to 6 depending upon the program
31:43 and they're getting that group therapy, they're getting that
31:47 one on one therapy, they're getting a care plan, they're having
31:51 that support and resources and they're having their medication monitored
31:55 so it can be anywhere from 6 to 8 weeks and then they'll evaluate them again and see
31:59 if they need to stay longer or they graduate out of that program and then from there
32:03 they can do intensive outpatient therapy
32:07 or they're getting their regular psychiatric
32:11 care and their therapy as well so I don't know if the centers
32:15 has that but that might be something that we can look at
32:19 partnering with agencies and making sure that we can help patients
32:23 get access to partial hospitalization and the people
32:27 that need that care might not be aware that there is this option available
32:31 as well so that may be something to look into.
32:35 I think we were using it for the, we'll call it
32:39 having a bad day folks, they called an ambulance because again this is
32:43 normal route to care and we would get on scene and say hey I think you're actually
32:47 a really good fit for centers because you're having a bad day, you're not
32:51 a risk to yourself or other people and the beauty was we kind of
32:55 could get them to this place and they managed all, they had case management
32:59 and all that and the pharmacy so it was our way of
33:03 keeping this person safe from the ER routine and hopefully coaching them
33:07 that this is the new way to manage those moments
33:11 but I think what you're describing sounds actually super helpful. There's a number of
33:15 PHP programs around the area, I'm not sure if there's one in Lakewood, maybe Signature Health offers something like that
33:19 the problem is that you still run through that same
33:23 washing machine because if you go to
33:27 be direct admitted to a PHP program and you threaten harm yourself
33:31 then there's the liability piece of the coin that
33:35 punches the button that gets the ambulance call that drags you to the ER
33:39 that starts the motion forward and I agree, we have a PHP program
33:43 everybody's always happy there, the patients that are coming to that
33:47 they're in a good mood, they're happy to be there, they're happy to participate, they get to go home
33:51 at the end of the day, they're fantastic. I think it's a good idea if we could find somebody
33:55 who'd be willing to accept people into a partial hospitalization for a low risk
33:59 situation but I'm not sure if
34:03 Signature Health's the only one I can think of but we take
34:07 people out of that building I feel like every day.
34:11 The pink slip people quite a bit over there.
34:15 Yeah, so I think in my mind it would almost
34:19 have to be a specific candidate, you know, so someone
34:23 that might have cycled through the hospitalization
34:27 and they're having another episode but they're not
34:31 threatening to harm themselves
34:36 obviously once you start doing that then you take that serious
34:40 even if they're like, oh I was just joking, like no, we don't joke about that
34:44 that's not something we joke about. So then that's when they might
34:48 cycle back through and then the hospital might say, okay
34:52 they've done that and so maybe the hospital recommends
34:56 a partial hospitalization day. So I think
35:00 there's some opportunities we just might have to do a little bit more digging and research
35:04 I know there's one specifically for
35:08 young people, I'm not familiar if they're, you know, for the 18 or 59.
35:12 We'll put our hands together, we'll sort it out.
35:16 I'm going to start with Councilman Evans.
35:20 Thank you Chair. First of all I just want to say
35:24 thank you to everybody. I'm incredibly proud to be sitting here to having this conversation.
35:28 This is a huge issue in our community and I'm glad
35:32 we're tackling it in this way and the work that LFD and the administration
35:36 have done is just amazing and I'm really excited
35:40 to see what more we can do and how we can support you. So thank you for that
35:44 and just so you know, I mean, a council priority of I think all of ours
35:48 but you know, a few of us are working on it, are ways to
35:52 how can we keep people out of that loop
35:56 really understanding that yes, ER is not the best place, jail is not
36:00 the best place. So what more can do to help
36:04 and I'm really excited to have more conversations with
36:08 LFD, LPD and obviously
36:12 Human Services Department to see alright, where are the gaps
36:16 and how can we help close them through additional resources.
36:20 So I mean, mainly I have a ton of questions but we're running
36:24 short on time so my main message is thank you. I mean, I'm really appreciative
36:28 of the thoughtful approach we've taken to this and the understanding
36:32 of the need in the community and I think you'll find very willing
36:36 partners on this day to help you advance these
36:40 causes because I think mental health is not going away
36:44 and it's a really important issue to me
36:48 personally as well. So thank you. I hope
36:52 to be of service in any way that I can moving forward.
36:56 Thank you Councilman Evans. Councilman Bixenstein, did you have any questions?
37:02 Yes. Thank you first of all for being
37:09 here today. Thank you Chair. Thank you for accommodating my absence
37:13 and thank you very much. I've heard this program
37:17 described as innovative and vital and those seem like appropriate
37:21 adjectives in this case. So thank you very much LFD and Oliver
37:25 for all that you do. My question is
37:29 in this circumstance we found ourselves in of late with
37:33 power outages affecting
37:37 a particular grid. Have you found that the services you provide
37:41 are of use in this circumstance
37:45 in any particular way? I don't think as much. I'm
37:53 kind of on the back end when the power outages have been in the evenings and I'm
37:57 off duty. I get back to work and there's voicemails and texts from residents that are curious
38:01 on how to prepare for the next ones. I've kind of been trying
38:05 to navigate finding inexpensive
38:09 home generators that are battery operated that will stay plugged in
38:13 until the time of an outage to give them 6-12 hours on their
38:17 concentrators and things like that. I helped them call their
38:21 durable medical companies to get back up cylinders for oxygen which seems to be one of the
38:25 biggest problems is their machines go out and they have only a couple of breaths left
38:29 before they're sitting on the top floor with no elevator access. That's been
38:33 one of the ways of just preparing for the follow-ups.
38:39 Thank you Oliver and I look forward to supporting the program as much
38:43 as we can moving forward. Thank you Councilman Bixenstein.
38:54 have one quick question but I also wanted to extend my thank yous
38:58 to all of you that are working in this area because this
39:02 is an unsolvable problem. It's basically
39:06 maintenance and management and I think you're doing a very fine job
39:10 of that. I appreciate all the work that you do. I just
39:14 wanted to go back to Nicole. I'm sorry I didn't get your title. If you could just
39:18 talk a little bit about the Uber. I think you said there was an Uber program
39:22 for transportation. If you could just talk about that for a minute.
39:26 My name's Nicole Zierenberg. I'm a licensed independent
39:30 social worker. I work for Human Services.
39:34 In this capacity, I provide support services to those
39:38 who are 18 to 59 or in crisis. At this point
39:42 what that looks like is accepting people who may walk into Cove, who may
39:46 have been referred from the prosecutor's office, from the police
39:50 station, who there was a resident who saw someone who was homeless.
39:54 They needed support with that or mostly working
39:58 with Oliver, providing that support. He had
40:02 identified that when individuals are coming home from the hospital
40:06 a lot of times there's a follow-up appointment the next day. You need to
40:10 get to that appointment that day or it's six months later as we've all
40:14 experienced with our healthcare system. Something that I've been in process with
40:18 is modeling something similar that other healthcare systems do, which is utilizing
40:22 a program called Uber Health, where you can have an account.
40:26 It's a universal account for our organization. It would be for generally
40:30 the city of Lakewood, where Oliver, maybe our
40:34 other partners with the police department would be able to help if they saw
40:38 oh, this person has an appointment tomorrow. This is causing an immense amount of stress.
40:42 They can't get there. They don't know how they're going to get there. So what can
40:46 we do? We can maybe reduce that barrier by just providing a ride there.
40:50 So that's something that we're working on right now.
40:54 The city, not through the person. We have an Uber account?
40:58 No. Human Services was
41:02 awarded a grant through the Healthy Lakewood Foundation
41:06 for the crisis response. One of the interventions
41:10 that we're going to do is have an account through that grant where we can provide
41:14 that transportation for individuals. But currently you're just helping
41:18 them basically set up an Uber? Right now, yeah.
41:22 We're not getting bus passes or we're getting an Uber gift card.
41:26 But to make it more cost effective, if we know it's going to cost $17
41:30 to get to their appointment, we'd rather have a direct account that uses the funding
41:34 through that grant.
41:38 Our vans are not available?
41:42 If they are a senior, they can sign up for senior transportation connection.
41:46 However, there's a limited amount of space that they can go to
41:50 if they are going to say Cleveland Clinic downtown,
41:54 they can't use that service. So it's a very small radius.
41:58 I have worked with other people with connecting them
42:02 with other community resources like paratransit and connecting them
42:06 with their Medicaid providers to show them these are the
42:10 different transportation options available through your managed care plan. But sometimes
42:14 there are people who fall through that crack and they don't fit that.
42:18 Even with those managed care providers or paratransit usually requires a three-day
42:22 notice to set up that appointment. If someone came home Sunday, their follow-up
42:26 Tuesday, they're not going to be able to arrange that. So if we can have
42:30 something for those emergency times like this,
42:34 that's where it comes into effect. Thank you, I appreciate that.
42:38 Vice President Baker?
42:43 Thank you. I'll echo all my colleagues' comments about this program.
42:47 My question the past four years when I've heard it is how can we do more?
42:51 It sounds like you guys are looking to do more. That's really good. So as I've
42:55 heard these presentations, I see the two barriers
42:59 that we have is like finding the right way to show the data
43:03 and the metrics of the good we do because I think we can all recognize it.
43:07 Because what that data and metrics does is it helps you get more funding, which is the second problem
43:11 I think we have. Now what I will say is that like my
43:15 colleagues said, however we can be more supportive on the funding side, I will say
43:19 just understanding the city budget,
43:23 there's CBDG funds, there's opioid funds, there's cannabis
43:27 funds that are new that I think council directed
43:31 that they be spent on a couple issues. I think mental health was one of them.
43:35 And so I think there's probably a funding formula
43:39 by which the city can put up some funds and then seek outside funds from other
43:43 entities. Sounds like Healthy Liquid has already been a tremendous partner.
43:47 I just see this as something as ripe to
43:51 you know, to your point chief, we can't show
43:55 that calls for service are going down. But I think a
43:59 really good chart about calls for service for people
44:03 in extreme need, right, going down is a helpful metric.
44:07 So it's not just the overall trend or
44:12 similar communities have gone up 15%, we've gone up 10% or something like that.
44:16 So I think that there are ways to use that data to show the benefit.
44:20 I think it's clear to us and the people that live here that there's a benefit
44:24 to this program. I think the key is showing that with data and metrics.
44:28 However we can be helpful to show that, I think we'll then unlock the next side,
44:32 which is funding, assumingly we want a fully loaded position
44:36 to add to this. So however council can be helpful. But I do
44:40 think that the cannabis funds-funds, potentially CBDG, and then
44:44 potentially some of the opioid funds might be able to help depending on what the
44:48 rules and regulations are with those funds. So thank you.
44:54 Thank you. So I'm just going to echo
44:58 a couple key points. So first, thanks to the
45:02 team, it sounds like we've got really high performers in
45:06 Captain Tripodi, Oliver, and Christine, right?
45:10 Nicole, I'm sorry. I just lost my slide.
45:14 Nicole Zierenberg. Okay, so
45:18 I just want to acknowledge what the chief
45:22 said is that when you've got a high performing team, then
45:26 you're helping more people and also it bestows confidence
45:30 that we could do more of what
45:34 some of my colleagues are saying. I also acknowledge Assistant Chief
45:38 Sambula for his long leadership on this and
45:42 engagement. So you guys have been willing to go the extra mile
45:46 and then work hard at it, and that's a big deal. It doesn't always happen.
45:50 So thank you for doing that. And I also heard the captain say, it's not unclear that
45:54 other agencies view the difficult
45:58 mental health nut is too difficult to crack, but we're giving it a shot.
46:02 And so I think Councilman Baker kind of anticipated
46:06 where my head was going, which is could it, after the meeting maybe
46:10 it would be great to get, at least for me, the
46:14 macro numbers as we have. You don't have to prepare them in any
46:18 special way, but it is good to know. So there's non-mental
46:22 health patients too. What's that picture look like overall?
46:26 I know we've been focusing on mental health tonight.
46:30 And then as Councilman Baker said, if we understand
46:34 the justification, I think it's twofold.
46:38 One is we're delivering service to people, and people that need it
46:42 and it's important service. And it sounds like in many ways
46:46 there's few to no other alternatives. Or we're
46:50 expanding the reach of agencies
46:54 that are typically pretty understaffed
46:58 and the demand way outpaces it. So that makes sense.
47:02 But then internally, as Assistant Chief Sambula said,
47:06 at one point we were trying to reduce hospitalizations. That's a legitimate goal
47:10 because that's very high cost. We're trying to lower costs in the health care system.
47:14 I love the logic of targeting fall
47:18 reductions because that is a big deal and then it also gets you eyes on
47:22 in the home. So there's a logic there I think that's been sound.
47:26 If we can understand that, just as Councilman Baker said, I think that does
47:30 help. And I could easily see myself
47:34 supporting the cannabis fund commitment of
47:38 a certain portion and then it's always helpful
47:42 to leverage it with other sources. So maybe
47:46 that would be skin in the game, Madam Chair, that the city
47:50 could show then to other agencies that we are serious and then we can
47:54 find another high performer like Oliver. Maybe you've got a cousin or a brother
47:58 or niece or something that we can make it a family business. Thank you.
48:06 And I'll just echo my colleagues or thank you for all the good work always.
48:10 I have a couple questions. One is how much of the
48:14 issue is lack of mental health care
48:18 providers and services? So even if you get a hold of someone and you're able
48:22 to, okay, we don't have to go to the ER, we can get you, but
48:26 there's still a lengthy wait. Is that still an issue or
48:30 finding the right services? So how much of that is the issue?
48:34 There's a lot of virtual places that have reached
48:38 out to me that do three times a week individual
48:42 visits and a fourth visit for group. Now the issue is
48:46 it requires a literacy of technology, which is a barrier. There's a lot
48:50 of providers and I think it's getting all the pieces to
48:54 think up, I think, is the overall theme. There's virtual visits
48:58 plenty. There we have signature health right around the corner here.
49:02 People getting to appointments, I think there's too many factors to say there's not enough
49:06 providers, unfortunately, but there's plenty of help there and I think
49:10 access points are the thorn in the side right now.
49:14 Thanks. And then I had a question too about
49:18 how does the role of the neighborhood paramedic continue to be
49:22 defined moving forward? You're doing so many different things and
49:26 how do you and the department triage that?
49:30 How do you choose and how do you manage that?
49:34 It kind of ends up, if I went to my mom's
49:38 house and she was bedridden, everything's important when I'm in there.
49:42 She has kitty litter overflowing, there's trash, the food's rotting,
49:46 everything's important to her health and her well-being. The warm and fuzzy stuff is still
49:50 part of the healthcare. Because it's a person, I'm in their space and whether or not
49:54 they need to go to the doctor or not, I think everything that I can help to do
49:58 I do. And I think that's where the bandwidth gets stretched thin.
50:02 It's like every person needs so much help. And the difference
50:06 from a hospital-based system is they don't do that. There's so much red tape
50:10 and if their visit is for a lab draw, they walk in, they draw labs, see you later.
50:14 So I think I do more because
50:18 I care about the people that I visit. So that's where it stretches me thin because
50:22 you have a lot to accomplish with every patient. So every new problem
50:26 is still my problem. I think that's how it keeps expanding itself.
50:30 I'm trying to do the most good for every person and there's an endless
50:34 list of things in every house.
50:38 And along with that is, I'm just thinking of, I recently went through this with
50:42 my own elderly parent, they were in the hospital
50:46 and you got discharged directly to home and were like, good luck!
50:50 And if I hadn't been there to help set up the appointments
50:54 and get them connected to this, there were resources
50:58 available, but that wasn't explained well at the hospital
51:02 and so it was a lot to navigate. It was really
51:06 a full-time job and I already have to.
51:10 So I just think there's probably
51:14 a limited need out there and also
51:18 if there are other ways to support your work
51:22 in addition to like we talked about, the potential for funds in another
51:26 neighborhood paramedic, but also if there's clerical help or there's
51:30 technological help and some things may or may not
51:34 require a paramedic but might require someone with different
51:38 skills and free you up. So I'm just thinking through all those things.
51:43 As we talked about, the metrics of
51:47 that's kind of my wheelhouse of thinking about outcome-based
51:51 versus outputs and how we can creatively measure things in terms of
51:55 patient outcomes that aren't necessarily
51:59 the same. So I'd be interested to see that. I know you're sort of
52:03 you've got so much going on to try to manage it all
52:07 so any way that we can be supportive we'd definitely want to be.
52:11 The clinic does keep track of readmissions
52:15 for the patients they send me so we can probably get that
52:19 updated info. I know that the pat on my
52:23 back was that the low acuity folks they send or the low
52:27 readmission risk that they score on their own kind of proprietary system
52:31 zero of the low people they've sent to me have been readmitted and it's like new
52:35 diagnosis would be a low acuity which is still a very serious thing.
52:39 The education provided in the home after discharge
52:43 has been enough from what I'm doing to give them the support
52:47 to treat their symptoms without needing to go back. So that's been a big win
52:51 I think on the clinic side so we can provide that for sure.
52:55 Yeah, I think that's great. I just think there could also be
52:59 the potential to interview folks who've interacted with you and do surveys
53:03 and things like that about patient-based outcome in their
53:07 response. So there's a lot that can be done with enough resources
53:11 that's always the question but we appreciate and same to you Nicole, thank you for your work.
53:17 Are there any other questions?
53:21 Comments? Councilman Bixenstein? Do you have anything else?
53:36 with the presentation being completed if no one had any other
53:40 follow-ups or if we feel that this discussion is
53:45 as far as this communication is complete I will make a motion to receive
53:49 and file this communication. Second.
53:54 Alright, that carries.
53:58 So without any other objection this concludes the business in front of us today
54:02 for public safety and this concludes our meeting today.