ASHLAND — The concept of a quick response team, specifically for substance-abuse issues, can be traced back to Daniel Meloy.
As the chief of police in Colerain Township, Meloy and his team were focused on immediate needs as the Cincinnati area became engulfed in the opioid crisis, which was one of the state’s worst-hit areas.
“I was looking at (the opioid crisis) as I often refer to, from the eye of the hurricane,” Meloy said. “There’s so much volume. There’s so much happening you lose focus of the fact that there’s people involved. There’s just so much tragedy. There’s so much crime.
“There’s so many things that are secondary to the act that just overwhelm a lot of organizations, and it took me time to refocus and understand that we have to do things differently.”
Colerain started doing things differently around 2014, using insight gleaned from work with domestic violence survivors in the early 2000s, connecting them with resources and people who could help provide a safety plan.
After seeing success with this approach, Meloy made a call that led to what today is a nationwide network of quick response teams (QRTs).
“I called the 24-hour hotline number of the Addiction Services Council and said, ‘I’d like to speak to your CEO,’” Meloy said.
The Addiction Services Council in Cincinnati was supportive. From there, Meloy created a quick response team for Hamilton County — a group of law-enforcement officers, mental health treatment professionals and advocates/peer supporters who would connect with people soon after surviving an overdose, in an attempt to provide them the resources needed to enter recovery.
Initially, Meloy funded the team’s work by budgeting existing police and fire funds. Today, Meloy is doing this work on a larger scale as director of operations for Operation 2 Save Lives and Quick Response Team National, which supports QRTs across the country in various ways, including helping them find funding sources and draft grant proposals.
Ashland County has been one of several communities to pick up the approach since.
Ashland’s QRT went out on its first call in 2020, after receiving funding to start a team through a Recovery Ohio Grant under the METRICH Drug Enforcement Unit.
Ashland’s QRT tries to meet with people who have overdosed within 72 hours, said Ashland detective Cody Hying, who has gone on several of the QRT calls.
There have been instances where Ashland’s QRT has not been able to visit people within 72 hours of an overdose. In May, for example, Hying said he responded to an overdose and the QRT team could not follow up with the person afterward because the individual was jailed.
“The goal is just to engage them, provide outreach and intervention opportunities for them to seek treatment,” Hying said.
Ashland’s QRT has made some changes since its inception, including trying to speak with people via phone before making home visits, Hying said.
“The hard part is with us showing up, they think they’re being investigated again,” Hying said. “(We’re) trying to break down that barrier of, ‘Hey, we’re not here to interview you about your crime or investigate the crime that occurred. We’re just strictly here to provide you with an opportunity for outreach and intervention and try and help you out.’ ”
This is also why Hying said the team has a representative with the Ashland County Council on Alcoholism and Drug Abuse (ACCADA) do most of the talking once a connection is made. Lorie McLaughlin began joining QRT calls in 2021 when she started as a certified peer supporter through ACCADA.
The police department contacts McLaughlin when they plan visits after reported overdoses.
During a typical visit, McLaughlin will introduce herself and provide a list of resources, including information about services at ACCADA, Appleseed Community Mental Health Center, Catholic Charities, Parenting Plus, and others.
McLaughlin also provides the people they visit with her contact information, explaining she can help them enter treatment or simply be a peer they can confide in, a concept explored further in “Peer support as part of substance use issue, mental health recovery.”
“They come in for treatment and then the ball’s in their court whether they continue on,” McLaughlin explained. “So I just let people know that, if they have to have contact with us, we’re not judging and we’re here. We want to see people get help and live.”
Meloy and the QRT network partnered with Cordata to start a systematic collection of data in 2021.
Based on the data available for Ashland, from February to December 2021, ACCADA assisted on 17 post-overdose visits. Out of the 17 visits, 10 people engaged in follow-up services with ACCADA.
From January to May 2022, ACCADA assisted on five visits. Of the five, two engaged in services with ACCADA and one had already been receiving services with Appleseed Community Mental Health Center.
Nearby, Richland County started its QRT efforts earlier in 2017.
At first, the participating Richland County agencies covered their own costs, but for the past four years or so, an attorney general’s grant has funded the program, said Joe Trolian, executive director for the Richland County Mental Health and Recovery Services Board.
Richland’s QRT has done more than 700 visits since its inception, as of the end of April 2022, Trolian said. Richland County runs QRT visits more often and on a more regular schedule compared with Ashland — 2 to 3 times per week, typically at least two Mansfield calls weekly and in Shelby as needed.
As of April 31, out of Richland County’s more than 700 visits (625 visits and 78 revisits, specifically), 313 resulted in people entering treatment, which Trolian views as a success.
“Typically when you’re dealing with addiction treatment, we always traditionally operated on the rule of thirds,” Trolian said. “Usually about 1/3 of people who have had an addiction issue will come in for treatment; about 1/3 will continue to talk about treatment, they’ll come to the front door, they’ll walk around the building, but they never actually come in and engage; and about 1/3 of the people you’ll never even get them to talk about it.
“So anytime we see numbers of people engaging in treatment that’s above that 33%, we get pretty excited.”
While Cordata has collected QRT data across the country, each QRT is different.
“If you’ve met one QRT, you’ve met one QRT,” Meloy said. “The flexibility within the community to operationalize the collaborative effort, to provide outreach and engagement, can look different in every community.
“It can be fire-led, it can be law enforcement-led, it can be peer-led, it can be behavioral health-led.”
Vice president for business development for Cordata Kelly Firesheets said, based on what she has seen across the country, the most effective programs work to meet the needs of their community, rather than try to fit a community into a pre-established model.
For example, in Hamilton County, most of the teams are headed by law enforcement.
“In this community, having law enforcement leadership, with a lot of support from local community organizations, has really been successful in helping cross jurisdictions and get aligned around political issues,” Firesheets said.
In the northern part of the state, however, healthcare professionals lead many QRT efforts.
“Especially because they see patients in the emergency room, (the health system) has really been able to use their political clout and their health-care emphasis to bring partners to the table,” Firesheets said. “In this particular community the relationship with law enforcement is a little bit more challenging, and so having a health system lead makes it more approachable.”
How the success of QRTs is measured also varies.
“If you talk to experts in this field, all of us will get slightly different answers,” Firesheets said. “But, I really believe that success for these programs looks like successfully identifying and engaging people who are at risk and connecting them to the resources they need.
“And I know that probably sounds a little fluffy, and that’s because, first of all, one of the things that we see in these programs is they’re not just responding to overdoses. They’re supporting a lot of people who have mental health issues, who have broader addiction problems, and so it’s not just about overdoses. It really is about finding people who are in crisis, who are in need, and helping get them engaged in some support.”
Hying said Ashland’s QRT team is focused on response, while METRICH engages the community in preventative efforts, such as giving presentations in schools. In other communities, QRTs also engage in prevention efforts prior to overdoses, Meloy said.
He also noted a key challenge he has grappled with from the start, and continues to ponder as QRT grows, is the timing of intervention.
As Ashland and many QRTs operate across the country, they are intervening once people are at “stage four” of their addiction — after they overdose. Giving someone a few more months or a year when a disease is at a stage-four level is precious, Meloy said.
“But, what if we can figure out what stage one and stage two look like?” Meloy said. “How many more people can we save?”