WILMINGTON — Wilmington’s Quick Response Team (QRT) is something of an experiment, a pilot program designed to see how state-funded outreach can help impact the opioid epidemic. The idea is simple: build relationships with overdose survivors and get them into treatment. The logistics, and costs, are more complicated and sent the program over-budget in its early months.
Related: Opioids in the Cape Fear: ‘One of the most frightening issues of our time’
Announced over the summer, the QRT is the result of a year and a half of conversations between local officials and state representatives, culminating in a bill providing $500,000 for a two-year pilot program.
That funding provides at least three positions: a “peer support specialist” (someone with personal experience with addiction), a behavioral health specialist, and part-time support from a medical professional.
The plan: visit people in the days immediately following an overdose, build a relationship (importantly one that doesn’t involve law enforcement), and help them navigate the daunting path to treatment and recovery.
In reality, the QRT involves far more — it requires over a dozen people, including the administrative and supervisory staff at Coastal Horizons, the health care facility that has contracted with Wilmington to run the program. It also requires as considerable support from other agencies, namely New Hanover Regional Medical Center (NHRMC). The program’s activities, too, are far more complicated than just following up on overdoses.
The program’s success, and its financial viability are important because the QRT will essentially serve as a test-run for future programs, both in Wilmington and beyond.
More than house calls
The QRT has thirteen Coastal Horizons employees on staff, according to an interim report compiled by Tony McEwen, the program director and Wilmington’s liaison for legislative affairs.
That staff collectively put in an average of over 600 billable hours each month, 3,628 in the program’s first six months.
While the house calls are the core of the program, they make up just a part of the work that goes into QRT. Over six months, the team spent around 400 hours with overdose survivors (between at-home visits, phone calls, and visits to outpatient facilities) and 250 hours on consultations and case discussions. Beyond individual survivors, the staff also spent over 500 hours on community outreach, much of it paired with NHRMC or other community partners.
The staff has also spent a lot of time – around 250 hours – on “marketing and development.” That’s part of the QRT’s goal of getting more people to take advantage of their services. As State Senator Harper Peterson put it on Tuesday’s legislative update meeting for the QRT, “I hate to call it marketing, but I mean a way to let people know about the services being offered.”
The QRT also requires a lot of logistical support and – in many ways – the administrative functions you’d expect to see in a business. Accordingly, in half a year the staff spent hundreds of hours on training (170 hours), staff meetings (349 hours), reporting and data entry (402 hours), and administrative tasks (224 hours), as well as basic business tasks like payroll (66 hours) and accounts payable (95 hours).
Course correcting after early budget overruns
The QRT’s personnel include the staff mentioned in the program’s rollout: one full-time therapist and three part-time peer support specialists (handling the equivalent workload of one and a half positions). The total payroll for these positions over the first six months has been $42,835.
It also includes four part-time supervisory positions at a six-month cost of approximately $32,000, as well as five part-time administrative positions, including Coastal Horizons Clinical Director Kenny House, costing $23,900.
While the “core” team ran under-budget, spending less than the approximately $68,000 budgeted for six months, the part-time administrative and supervisory staff ran over by about $21,000. The supervisory positions ran about $7,000 over budget in the first six months, and the administrative positions ran $14,000 over, exceeding the annual budget in its first few months.
According to McEwen’s report, at the end of October, a special meeting of the QRT’s oversight committee was called to discuss the program’s finances, following a quarterly review by Wilmington’s senior accountant.
“During this meeting, budget overruns, projected overruns and work performed outside the Scope of Work were reviewed and discussed,” according to the report.
According to Chuck Bower, a Wilmington fire chief and QRT’s project manager, Wilmington’s financial oversight has since been very tight.
“I think some people thought we would just throw this money at someone, but we have monthly meetings and we hash these things out. I truly believe we are the best possible stewards of this money,” Bower said.
According to wage records from Coastal Horizons, two administrative and one supervisory position – including House – stopped billing hours in October. House, who continues to assist with the program, would likely be considered an “in-kind” contribution from Coastal Horizons, although he’s not alone.
‘In kind’ contributions
Much of the time, the process of getting overdose survivors to treatment doesn’t begin with QRT, it begins with NHRMC paramedics — who aren’t part of the program’s budget.
According to Sarah Rivenbark, NHRMC’s liaison to the QRT, EMS workers respond to the vast majority of opioid overdoses, and they’re often familiar to the victims. But because of medical confidentiality concerns, NHRMC can’t simply pass their information along to the QRT.
“There are some places where they just hand the information over, but at NHRMC our policy is, as medical professionals, we can’t do that without consent,” Rivenbark said.
So, NHRMC does the initial follow-up with community paramedics; this is an extension of the work the hospital already does, checking up on patients will a variety of medical conditions.
NHRMC staff are tasked with getting overdose survivors to agree to meet with the QRT, who then handle possible paths for treatment. According to Rivenbark, it can take multiple visits until the person is “ready” to even consider treatment.
Rivenbark said NHRMC receives no money from the QRT funding for this, and it is considered an ‘in-kind’ contribution to the program. According to Bower, the quick response team also relies on some in-kind assistance from Coastal Horizons, beyond House’s participation, as well as assistance from the Wilmington Fire Department and Police Department.
2020 and beyond
QRT is a quarter of a way through its two-year experiment. So far, QRT has made contact with 66 overdose survivors; out that 53 have accepted treatment. That’s initially shy of the QRT’s hopes of reaching 200 people per year, but House said he’s seen an increasing number of secondary referrals — in other words, when QRT gets someone in treatment, friends and family members follow suit. The ripple effect could help QRT catch up with its goals.
House said that the cost of getting these 53 people into treatment was “not an expenditure if you think about it, but a cost-saving method,” since it would reduce the financial strain on tax-payer funded medical services, law enforcement, and court costs.
So, will others local governments follow Wilmington’s lead?
According to Rivenbark, Brunswick County is considering its own versions of the QRT, and Pender may follow suit. Those counties will undoubtedly have to address their own transportation challenges; they may also have to find their own community partners to help provide “in kind” assistance like the QRT relies on.
Moving forward, there will also be the issue of scope. The QRT is focused on “a little niche that no one was serving,” according to Bower, focusing on opioid overdoses. But Bower acknowledged the need for similar outreach efforts for other substance abuse – alcoholism, for example – and, more broadly, for mental health.
“Absolutely,” Bower said. “That was one of the first things I brought up with Representative [Ted] Davis.”
Bower met with Davis, who helped spearhead the bill funding QRT, as the program was being launched to discuss the issue of expanding the scope of the QRT in the future. Both Bower and Rivenbark both noted the need to address underlying, but often undiagnosed, mental health issues in the community.
In many ways, it’s too early to say if the QRT will be viewed as successful enough for renewed funding, let alone expanded funding to cover more territory and more health issues. Officials have been cautiously optimistic, following an early-January announcement from NHRMC that overdoses were down considerably from 2017 to 2018. Still, with law enforcement, EMS, and harm reduction still reporting high numbers of overdoses, there’s a lot of work left to be done.
For more information on the Quick Response Team, you can visit the Coastal Horizon’s Facebook page for the program.
Send comments and tips to Benjamin Schachtman at email@example.com, @pcdben on Twitter, and (910) 538-2001.