Hey there, Spencer Lee, STAR paramedic on the STAR van today.

We were called out by park rangers in Civic Center Park on a well person check.

They found a woman lying prone.

They just want to check on her, make sure she was doing okay.

After they encountered her and woke her up, she was expressing some suicidality so they requested the STAR van.

When we arrived - initially a little hostile with us but we were able to de-escalate her and see what was going on today.

And she's been off her meds for a long time, hasn't been taking her antidepressants.

She's a veteran with PTSD.

And unfortunately, there was a witness nearby that stated they saw her take an unknown amount of ibuprofen, an ambulance was requested and she got to the appropriate facility.

And hopefully Chris can follow up and the VA will follow up and get her some resources that she needs if we get her back on medication and stabilized.

Call me weird, but I love a good ride-along -- like love them.

I've been on ride-alongs across the world.

In Amsterdam, in Canada, in Boston and even right here in Denver.

And what I've learned is that people call the cops for a number of reasons.

Anything from a lost cat, to a neighbor they just want to know more about, to maybe a loved one or a stranger having a mental health crisis.

But really, at the heart of it, people call 9-1-1 because they just don't know what else to do.

- State Representative Leslie Herod is a face you've seen many times on our newscast.

- Representative Leslie Herod - The woman behind some of the most progressive laws in our state.

- Trailblazer: one of only ten African-American women to serve in the state legislature.

I have been fighting for criminal justice reform my entire career.

And sometimes it can seem so daunting.

For millions of Americans, judges, attorneys, correctional officers cops, mass incarceration is a livelihood.

To fix the criminal justice system we must look critically at every piece of the puzzle.

Find out what's working and fix what's not.

Caring for Denver is a nonprofit foundation that was created by Denver, for Denver, passed the ballot in November of 2018, raised sales tax by a quarter percent to fund Denver's mental health and substance misuse needs.

We had heard about an innovative model in Oregon; Cahoots.

I remember working on Caring for Denver and having the support of then Commander, now Chief, Paul Pazen, talking about, you know, the need for more mental health response so that his officers can focus their time on something else.

And he kept saying, Cahoots.

- Cahoots.

- Cahoots.

- Cahoots.

Cahoots, which has been around for 30 years is finally catching the eye of the whole country.

It stands for Crisis Assistance, Helping Out On The Streets.

Cahoots was founded in 1989.

They say Cahoots has saved about $8 million on public safety and $14 million for ambulance and emergency room treatment annually.

Normally, when you call 911, you get a firefighter, a police officer or a paramedic.

But in Eugene, there's a fourth option: a mental health professional and an EMT who ride along in a van and respond to mental health calls.

So -- I went along to Eugene to learn more.

What I found was this innovative, amazing program where law enforcement was working in parntership really with the Cahoots Van to respond to people in crisis and in need in Eugene, Oregon.

And what I saw was true understanding of whose responsibility it is to stabilize versus secure a scene, and I saw that van save lives.

I don't think people understood we don't always need law enforcement to respond to 9-1-1 calls.

But if you ask a firefighter or an EMT, they know, because they're dispatched and first responders as well.

And so what can we do to expand that first responder network to make sure we're meeting the needs of the people of Denver or any city.

And that's what Cahoots really put into place and did so well.

And so we took it as the first major city in this country to take that Cahoots model, expand it larger and now we have it running throughout Denver... and it's working.

The STAR program is basically a van where two folks ride along and assist people who need maybe more access to resources, access to treatment, and need to stabilize before they move on to the next step.

We're excited to have it in Denver, but I gotta be honest with you, we didn't invent it.

It all came from the Cahoots model in Eugene, Oregon.

As a foundation, We can fund these innovative ideas and figure out how they work in community.

So we funded the pilot and in that first six months, for six months to a year, they were able to show that we could have this number of interactions and divert 100% of folks away from the justice system.

And based on that pilot, able to get it fully funded city-wide.

So STAR Van call number two today was two individuals that were identified as trespassing in an alley and so we made contact with them.

Turns out they were just getting the day kind of started.

They did identify that they were pretty dehydrated so we were able to get them all the stuff that we had in the vans, from snacks, water and actually were walking next to them just kind of said, hey, can we get you somwhere that's a little safer and off the beaten path, And they agreed to that -- so we transported them over to one of our local parks and talked a little bit about their connection with the Colorado Coalition for the homeless and some housing options and stuff like that.

So we're able to reserve kind of take care of that call in a pretty peaceful manner and connect them to the right places and reestablish places that are already -- that they're already in services with.

So a pretty positive outcome.

An experiment in police reform in the shape of this white van.

Carleigh Sailon is a licensed social worker and addiction counselor with the Mental Health Center of Denver.

She and paramedic Chase Lindquist are part of the city's new STAR program.

STAR stands for Support Team Assisted Response and it's an alternative response model that we've started here in Denver that pairs a mental health clinician with a paramedic or EMT, and they respond to low risk, low acuity calls coming into the 9-1-1 emergency system.

Our call takers here at 9-1-1 are asking certain questions about risk, is there a weapon involved?

Is there a time sensitive issue where we may need to send a lights and sirens response?

Is anyone injured?

Those call takers are screening and triaging calls as STAR appropriate so if all of those risk and crime and injury answers are no, they are flagging the calls as STAR appropriate, that gets sent to the dispatcher and our dispatchers send the STAR Van to the call.

So this is our van that actually we, uh -- got donated to us when we were starting the pilot up and we didn't know exactly, like what what van was going to look logistics and all that stuff.

And this was sitting around in a bay and they were like, hey, we'd like to start the program, Department of Safety loaned us this and it's kind of been our STAR One since since the very beginning of the pilot.

A lot of what we're doing is in here.

We're bringing people in as needed.

You know, sometimes it's an easy way to just have a conversation with someone.

The reality is a lot of these calls that are coming up that come to us are there's no legal issues and there's no safety issues.

It really is stuff that has been historically -- keeps piling up on 9-1-1's radar and the response has always been paramedic, fire or police and instead we're giving a fourth option to be able to actually go to something that is more social in nature, that has you know, doesn't have those those components that need those 3 responses, but instead needs an alternative response.

And so that's where we get to step in and say, you know, we'll take some of these social issues and we get those on a consistent basis where it's, you know, I didn't know I could get this.

I didn't know I could access this.

Or honestly, like you treated me kinder than most responses I've had in the past.

So I think it's you know, it's that spectrum of full-blown, like someone gets a whole life-changing situation or can be those little tiny ones of just feeling like you gave someone dignity and they felt heard and respected or just time to vent and -- and have a moment, so...

If someone's in suicidal crisis but is not in imminent risk, it's safe enough to wait for a non-emergent response to get there.

Resource requests We get a lot of folks who -- who call in needing access to a shelter or access to food or just any -- any resource that they may be in need of that day.

So our response to those kind of calls; trespass, unwanted parties, syringe disposal, assist calls, really anything that someone may call in to the emergency communication system about that doesn't really fit into those traditional first responder pathways.

Chief Pazen's been a huge advocate for how do we get support, how do we get more resource out into the community?

How do we help our community in any way possible, regardless of what's coming across?

And so that relationship started with him, with him acknowledging that we need more resources.

Many of these individuals are in crisis but they're not posing a threat to the community or the public and in those circumstances, those lower level crisis calls, the police officer doesn't necessarily need to be part of that response.

And in some of those situations, sometimes the uniform can escalate the situation.

So we certainly do not want to escalate any situation where an individual is in crisis.

The need, the value was recognized immediately that we can get a paramedicine professional, a mental health professional in a car for these situations where the individual is not armed, not displaying any violent behavior, and we can work towards better outcomes for our community.

It was important that there was no stigma attached to the acronym or the words that made up the acronym.

And, and that just shows the -- the level of detail and part of the partnership with our community that, the STAR program and each word was carefully chosen and people weighed in with lived experiences because we didn't want to stigmatize what that response looked like.

The STAR van covers District 6, District 3, and District 2 every day, And on the off chance that we have an extra van available, they would just go fill in other places in the city where they're needed.

Our primary concern as a paramedic when we encounter a client on the street is determining if they have a medical condition and if that could be the root cause of their mental illness.

If they need to seek immediate medical attention or if it is just an underlying mental health issue.

Oftentimes medical problems can present like a mental health issue so we have to make sure we roll those things out before we move them into mental health help or mental health services.

The clientele that we deal with also have underlying medical problems, so it is really important that we take the time to assess them and make sure that their mental health complaint is not actually a medical complaint.

It really depends.

It's very much dictated on what the client requests.

So my move is based on whatever it is the client asks for from me.

I think the thing that sticks out the most for me with clients that we have interacted with and had a positive outcome is when we see them when we're driving down the street, they'll wave.

Or when we get to a call that we've, a call for service they will be there and they're like, hey, you -- you gave me a bottle of water.

Thanks.

Do you have any more water?

And I think for me, the positive outcome is just building the connections with people and having being a resource that's positive for them instead of being something that could potentially be negative.

I came into this work from a non-traditional lens.

I have experienced my own set of life challenges which include homelessness, mental health, substance misuse, and criminal justice challenges.

I went from suburbs to streets, which was you know, I think it took everybody by surprise, my family and all.

But I was in real estate, owned a home, you know, did that 9 to 5 every day.

And my family broke up.

And it was that stress of that situation that, you know, kind of created this decline in my own mental health.

And I was also, you know, in and out of jail.

I was struggling with heavy addiction at this point.

It it progressed, you know, went from alcohol to other other substances.

And when I started journeying through what does it look like to get out of homelessness and what does it look like to recover from drugs and alcohol and be a productive member of my community again?

I had to get my needs met by three different organizations One was a reentry organization.

One was a homelessness services organization.

One was a treatment organization And, you know, it was -- healing was a full-time job.

I had some experiences where I was jailed for my mental health and, you know, that just didn't seem like the appropriate responses to a crisis that really needed, you know, some medical and mental health attention.

That's kind of how I came into the work and my pathways just kind of illuminated along the way.

You know, before STAR, we had co-responders -- co-responders who came with law enforcement -- responded right here in this capitol building sometimes.

And that worked really well, too, But sometimes just having a uniform or having someone who knows that they're associated with law enforcement, it just doesn't work, you know?

And so STAR really does pull in a lot of those folks who are trained as co-responders, you know, to then become folks who lead the STAR van which I think helps to build the relationship with law enforcement that you need.

- Police are bound by call volume and call times.

They need to go to the next call We can go poking around the house.

We can make phone calls.

We can do a little bit more and go a little bit further to make sure we're able to set eyes on somebody and check on them, as opposed to sometimes law enforcement is just, you know, we got to get to that next call.

And so knock, knock, knock, no one's answering, I gotta go.

So, I do love that we're able to put a little bit more dedication in -- and time in there and sit down with people if we're able to find them and check on them and just do a -- give them all around about like assessment if it gets to that, if it's necessary, as well.

But a lot of times it's just, hey, let's just let's just talk.

We have all the time in the world right now.

Let's just talk and check in on you and see how you're doing.

I think for STAR and for me personally as a clinician, it is a privilege to work with the people and work with the community.

And we all know that the system is flawed and it's not perfect.

But every day and every hour and in every moment, we have an option to make a choice to be the change.

And I think that's what STAR's doing in this time and it's uncomfortable and it's messy, but it's needed and we're seeing such positive response between paramedics and persons served alike with first responders, as well.

Sometimes it can take an hour or two just to talk someone down to get them their medication, to stabilize them.

You know, law enforcement simply doesn't have the time to do that and so we need an alternative response, not just telling someone to call another number, but provide that response right then and there.

That's what the STAR van does, you know, not only stabilize, but then have a conversation about how we can get you ongoing care and resources.

STAR van call number seven for the day today: We were called out for a male who needed assistance with a wheelchair.

He was recently discharged from St Joseph's Hospital and was in a power wheelchair that was no longer working.

He was able to help himself though, we were able to get him a manual wheelchair which gave him mobility and allowed him to utilize the bus system to get himself to a shelter tonight so he could be safe.

STAR does not respond to any call with a weapon or a violent situation.

So for those sort of situations, we still want that clinical perspective and in that trauma- informed approach on that scene.

So we would send our co-responder team with the police officer so that the police officer can assess and maintain scene safety and the co-responder clinician can still provide those behavioral health supports to the individual who is in crisis.

Of the calls for service that STAR has responded to more than 30% are actually generated by Denver police officers, meaning an officer may have an interaction with an individual, realize that this is a low-level crisis situation they're getting on the radio; Hey, is the STAR van available?

Can they meet me at this location?

And we do that warm hand-off, right?

And so that's why this partnership, this collaboration is absolutely key to the situation, key to getting the better outcomes for individuals in crisis.

What feels really good about calling STAR is that everybody's safety is addressed.

The person, the program, and the clinicians.

I think this iteration of STAR has kind of been born from a gradual process, you know, it was cops responding, and then it was cops and a clinician responding, and now we're clinician and paramedic.

So it's evolved which which tells me that they're -- they're finding that there are better pairings for responding to mental health crisis than, say, the cops.

STAR is a really great opportunity to get the right people to the right response and a harm reduction initiative such as this, much like many other harm reduction initiatives, syringe exchange, naloxone distribution, increases public safety.

We all want a healthier and safer community.

Calling 9-1-1 and getting a law enforcement response may not be the right thing for a lot of different issues.

So we're super-pleased that we have STAR in our community to push forward for a healthier and safer you, today.

And if it's not for you, it's for a community member or someone you love.

So so far, we have never had to call for backup on anything that had a safety concern.

What we do realize in this profession and we've been doing it for a very long time, is that yelling is not an indicative thing that police need to be a part of.

Like, yelling is sometimes just something people do where they feel like, hey, the situation's not great, I just need a sounding post.

And so we're there to be able to kind of have that gauge of like, Yeah, I can be a sounding post for you, and then I'm going to redirect it in a way that's more positive and solution-focused.

I think up 'til now we're probably at 3,000 calls and we have yet to have to call police for backup on anything safety-related.

And I think we can do that mainly just from our -- not only clinical acumen, but just the approach that we take with people to be able to say like, hey, we're here for support and if you don't want it?

Cool, we don't have to be here.

But very rarely do we have situations where someone says like, we don't want anything to do with you.

It's usually like, ok, yeah, tell me what you got... A police officer who already has many tasks and assignments getting 40 hours of training.

Do we want somebody with 40 hours of training or somebody with four five, six, seven years of training in this area?

And so that's why for those types of responses whether it's the low level with the STAR van or the higher level with a co-responder and a clinician, that additional training, that additional experience has really helped to get the better outcomes in both of these situations.

I think the needs for STAR vary so much day to day.

We are providing support to people who are in cri We're dealing with behavioral health issues or substance misuse, but also sometimes it's just A pair of socks and a snack that we have on the van that we can give to someone who's unhoused living in our community.

I think that the STAR program is providing a resource that the city's needed for a long time.

Having been a paramedic at Denver Health for as long as I've been a paramedic, I think one of the hardest things is learning that the health care system does not really serve everyone.

And I think this is such a nice shift into being able to serve everybody the way they need to be served.

And I think it also helps start to address trauma-informed care and that the population that we're serving has experienced trauma and we have the ability to help lessen that trauma going forward and make health care a positive experience for some of these people.

The clientele that benefit the most from STAR are people who have been marginalized by either the health care system the law enforcement system.

This gives them another avenue to try, hopefully with more success and with the success from those interactions we will open doors to those people being able to access other resources that they historically have not because of either poor treatment or lack of access.

The success for STAR is something that you see in each interaction that the STAR van has with community members, right?

I know that they have interacted with folks that have been surprised by it.

Like, you're here to help me?

You're here to get me what I need?

You're here to support me?

And, you know, in those daily interactions is where we see the greatest impact.

And I go out to the districts I meet with officers and supervisors at roll calls and it was very evident very early on when I had officers and sergeants in the field saying, when can we get more STAR vans?

When can they expand beyond the pilot area?

When can we get them in our district?

- Because Denver piloted this - major city - we're seeing cities across the nation taking this model and using it on their own, as well.

And right here in this building now, we actually have a bill that we're introducing using the federal dollars to expand STAR and create those $250,000 incentives like we had in Denver across the state.

So that the STAR model can be expanded wherever the communities want it.

Denver City Council has unanimously approved $1.4 million to expand the STAR program.

The money will also allow STAR to collaberate with community groups to refer people to specific resources when responding to calls.

The new contract runs through December.

- We have got additional funding through the help of Caring for Denver and city funds to be able to expand our team to ten clinicians, ten paramedics, five vans running at any given time from 6am to 10pm citywide.

So instead of being pilot-specific where it's we're only downtown now, we can say every community member in Denver has access to STAR.

There's growth on the back end of STAR to actually have a community network of providers that can be that hand-off, the direct referral from STAR.

And I think that's going to be the next evolution of what STAR is, that it's not -- we have our crisis response and we're done.

We did it and great, pat on the back.

It's always an evolution of what can we do to actually create this social safety net for people?

I came into this this job as a legislator because I wanted to make sure that my community was just treated differently and fairly.

I had seen firsthand what overincarceration does to a family because it happened to me.

You know, my sister actually struggled with mental health and substance misuse challenges all my life.

She's been in and out of incarceration for about 30 years.

Even in my household, we definitely had situations where there was crisis going on, but we were afraid to call 9-1-1, we didn't know what would happen to her.

And so oftentimes we didn't get care.

We didn't get her help.

We didn't even know ourselves how to respond.

That's why I created Caring for Denver, that's why I do the work here.

And that's why STAR was so important to me because that family I saw in Eugene, Oregon?

pretty darn close to mine and I wish we had such a compassionate response when my sister was going through what she was going through.

I would love one day for when you call 9-1-1 do you need fire, police, EMS or mental health services?

I would love that to be a fourth option just to be ingrained in us as a society and and taking that stigma away.

And I love that we're doing that bit by bit, call by call I think as long as there is discussion and as long as there's conversations and they're difficult sometimes.

And that doesn't mean that we shouldn't have them, that any community can build these things any community can make their version of what this is supposed to look like.

And it really is about bringing everyone to the table and everyone to the conversation and not just saying, I got this on my own unilaterally.

STAR is amazing.

It's everything that we ever thought that it would be.

It's better.

It exceeds our expectations, rig When a third of the calls actually come from police officers, that was not something that we anticipated.

We did not anticipate the buy in from our police officers.

And it's caught on.

You know, more and more people in Denver actually know what STAR is and they call 9-1-1 and they ask for a STAR response which is really encouraging.

You know, I think folks forget how often 9-1-1 is called, you know, it's not only called for a life or death situation, but it might be called because, you know, you're scared, right?

Mostly people are scared and they need some kind of help.

Well, let's make sure we have the right help responding!