The city’s long-awaited Crisis Outreach Response and Engagement program, which will use a separate team of first responders to address nonviolent homeless emergency calls, is expected to start in the next two weeks.
The program has evolved over time. Originally, the program was supposed to divert nonviolent, homeless-related 911 calls away from the Honolulu Police Department and send social workers in their place.
However, the CORE teams will now comprise emergency medical technicians and community health workers.
CORE will be housed within the Emergency Medical Services department. There will be two trucks to start, staffed with three to four EMTs and at least one community health worker.
Due to the medical and mental health components in many nonviolent homeless-related 911 calls, the city determined CORE should be housed in EMS.
“Right now … if a homeless person calls 911, they’re going to get the police, they’re going to get EMS, and a lot of times they need that if it’s a true emergency,” said EMS Director Jim Ireland.
“But if the call is … some minor complaint, it really is tying up a lot of emergency resources.”
911 dispatchers ask callers a series of questions to determine whether the situation is critical, serious or minor. If the dispatcher evaluates it as critical or serious, they will send traditional emergency services that include the Honolulu Fire Department, the Honolulu Police Department and EMS.
However, if the dispatcher decides it’s a minor call, they would normally dispatch an ambulance, but with no sirens or lights. Once CORE begins, if the minor call is homelessness- related, the dispatcher would send the CORE ambulance instead.
“By minor calls I mean things like a foot wound, a cough, with normal vital signs, people calling that say, ‘I’m hungry.’ All those are legitimate complaints, but they don’t need a 911 ambulance,” Ireland said.
“We want to give care, but we want to give appropriate care.”
CORE will operate within the Honolulu urban core in downtown, Chinatown and Waikiki for about 12 hours a day.
This was also a change from the original concept, in which it would have been islandwide and operate 24/7.
Ireland said this is just the start of the CORE program and that EMS found from previous experience that most 911 calls after midnight that are homelessness- related require traditional services.
“They need a regular 911 ambulance,” he said.
“It’s assaults, overdoses, things that have to go to the emergency room.”
CORE will differ from regular ambulance services because it will follow patients after they are released from the medical service provider and get them placed into some type of housing, such as a shelter or transitional housing.
“When (traditional) EMS takes the patient to the hospital, that’s the end of the relationship,” Ireland said.
“We want to interrupt this cycle of street, ambulance, ER, street.”
CORE also plans to contract psychiatrists and other mental health or substance abuse service providers to assist with the mental health aspect of many of the calls.
CORE is not being staffed fully with social workers, as was the original idea, for two main reasons, said Ireland.
First, the CORE trucks are rebranded ambulances that would have otherwise been retired. Ambulances are required to be operated by at least two EMT workers.
Second, social workers are harder to find and hire.
However, Ireland hopes to be able to add some social workers to the CORE team in the future.
“Social workers, if we can hire them, they will be on the team, possibly more supervisory or helping with the case management side,” he said.
“But again, just like nurses, physicians, there’s not a lot of them.”
The city chose to use the older ambulances instead of a regular transport vehicle because it is safer to carry people in the back, it is easier to clean internally if patients have hygiene issues and the public is more likely to recognize an ambulance in the street attending to a homeless individual.
The CORE ambulances also will have basic life support equipment like any other ambulance, so in an emergency could be used to respond to a life-threatening emergency nearby, even if it is not homelessness-related.
CORE workers will not wear the traditional EMT uniforms, but an identifiable red CORE polo shirt and jeans.
Although CORE will be housed in EMS, city Office of Housing and Homelessness Director Anton Krucky spearheaded the effort.
He originally obtained $1.5 million in federal American Rescue Plan Act funding for the program, but said that has since been increased to $5 million.
In a document posted by the city, it reports that $4.9 million of ARPA funding will be used to hire 10 EMT workers for CORE for four years.
Krucky also said he expects to receive congressional funding for the program as well.
CORE was originally expected to begin this past summer, and then September, but due to delays in the release of ARPA funding, it has been postponed until this month.
CORE will begin with two ambulances, but Ireland estimated that in six months the program will have enough staff to run four.
To measure the program’s success, the city will look at metrics such as the number of engagements it takes to convince individuals to receive services, the number of calls CORE responds to and whether patients stay in programs after interacting with CORE.
“As we assess the program and how it’s going, and as we expand it, then we move it into the regular budget,” Krucky said.
“When I first got into this position, it was only, ‘There’s a shelter or you can do nothing.’ We’re trying to expand those decision- making scenarios.”