‘The way of the future for the fire service’: CARES programs spreading in Kitsap County

Kitsap County is now home to two programs that pair firefighters with social workers, with hopes that a third agency could soon join to address behavioral health issues that fire departments increasingly must deal with and lower the number of calls to 911.

As programs grow in number, fire department leaders say the program, known as "CARES," will become common in fire service operations not only in the county, but across the country.

“This is the way of the future for the fire service,” said Jake Gillanders, operational supervisor for Poulsbo Fire CARES. “... It’s kind of an interesting new concept, but I think 20 years from now, this is just going to be the standard of care for fire departments around the country.”

In January 2021 Poulsbo introduced Kitsap County’s first Community Assistance, Referral, and Education Service (CARES) program, a collaborative project between Poulsbo Fire Department and the city of Poulsbo.

The goal: to serve community members facing behavioral health-related issues in hopes of improving their quality of life. This is done via a social worker, a firefighter trained in crisis intervention and a substance-use disorder professional, all of which work together to connect community members referred to the program with the care and resources they require.

Poulsbo Fire CARES was the first such program in the county, though it followed others in the state. In 2015, Washington State passed a bill to formalize these programs, which had been established in cities like Spokane, Tacoma and Bellevue.

More programs began developing after the legislation passed, including the program now in Poulsbo.

After launching in 2021, surrounding fire districts began noticing the impact. Central Kitsap Fire and Rescue (CKFR), in partnership with Poulsbo, introduced the second CARES program in the county at the start of this year. South Kitsap Fire and Rescue may be up next.

In developing their program, CKFR looked to Poulsbo’s Fire CARES model.

“I like to think of it as a hub and spoke. You've got the core model, which is the firefighter and social worker, and then all of these other ancillary services that are connected to that,” Gillanders said, explaining the Poulsbo Fire CARES model. “No one of us can do alone, what all of us can do together.”

CARES responds to referrals made primarily by emergency services, school districts and other social service partners. Through CARES, individuals facing behavioral and mental health struggles are connected with appropriate resources.

The program’s two biggest priorities are addressing suicide and drug overdoses, which Gillanders said are the two biggest killers in the community. However, around 60% of the calls the CARES team has served are 65 and older, said Kimberly Hendrickson, Poulsbo’s director of housing, health and human services and program manager of Poulsbo Fire CARES.

Through these initiatives, the program hopes to reduce 911 utilization by directing individuals to other avenues of care, depending on the issue, before they become emergencies.

Hendrickson said CARES is not required to refer to specific agencies.

“(We are) totally provider agnostic, totally insurance agnostic,” she said. "We're just there to figure out what you need and how we can best match that need to what's available.”

Hendrickson said working with providers across the county has made them more responsive to community needs and aware of health equity issues. But, she said improvements are still needed within the healthcare system.

“I think things are slowly getting better, but it's not acceptable how long it takes to make an appointment after a suicide attempt for crisis counseling. It's not acceptable that I'm working with a 75-year-old who has cancer as big as his kidney, and nobody will see him for a month,” she said. “We can only do so much. But, certainly here at the city, we're very active in pushing for any way we can to have better and higher health care standards in the county.”

Mental health, substance use and memory issues amplify these barriers to care. That's why providing support and guidance in the comfort of an individual's home without time constraints is important to CARES's success, Hendrickson said.

The CKFR program launched in January of this year through funding from an Association of Washington Cities Grant that allows cities to develop new CARES programs, in this case through the city of Poulsbo.

The CKFR Fire CARES program shares the same model and mission as Poulsbo Fire CARES. But, every CARES program is unique in that each is scaled to fit individual community needs and demographics.

“We're not the big cities, we're not overwhelmed, we're able to take time with our citizens,” said Alex McCracken, program manager of CKFR CARES. “I think that's the unique nature of what we have. We're a … smaller community, and we're able to deliver that personal service that bigger cities and bigger communities can't offer.”

South Kitsap Fire and Rescue (SKFR) Chief Jeff Faucett said SKFR CARES has been in the works since 2017, but funding has been a roadblock to the program's progress.

As SKFR looks for funding sources, Faucett said he knows a CARES program would benefit his community. However, districts must balance these programs with their primary missions and honor taxpayers' expectations of the fire service, a sentiment echoed by Gillanders.

“At the end of the day, our core mission is ambulances, rescues and fire trucks. So, …we need to make sure that whatever we do doesn't take away from that,” Gillanders said.

Kitsap County fire districts have also noted the benefits these programs provide to fire employees.

“Morale is higher in the firehouse. Our folks want to do the right thing for members of the public, and it's deeply frustrating … to see the same person over and over with the same challenges and having no means of helping them address those challenges,” Gillanders said. “ …Now, they have somewhere to send these people to, and they're seeing positive outcomes.”

As these programs spread across the county, Gillanders and Hendrickson acknowledged that more is needed in Kitsap County to improve healthcare quality and access. But, they are proud of all they have accomplished with this step forward.

“I'm really proud of the fact that while a lot of society is talking about the problems, the fire service and the City of Poulsbo are looking at solutions,” Gillanders said. “...To me, that's what I'm most proud of in this program, is that we aren't wasting too much time talking about the challenges. We're looking for solutions instead.”

This article originally appeared on Kitsap Sun: Behavioral health program added at Central Kitsap fire departments