Austin, TX

Integral Care’s Expanded Mobile Crisis Outreach Team – Austin, TX

AUGUST 16, 2022

Founded in 1967, Integral Care is the local mental health and intellectual and developmental disability authority for Travis County, Texas, supporting adults and children who have mental illnesses, substance use disorders, and intellectual and developmental disabilities. Integral Care’s Expanded Mobile Crisis Outreach Team (EMCOT) was established in 2013 and includes mental health professionals who respond to people experiencing a mental health crisis throughout the county. EMCOT offers client assessments, crisis services, counseling, case management, medication management, psychosocial rehabilitation, and rehabilitation skills training. EMCOT field responders (or responding clinicians) can also provide community-based follow-up services for up to 90 days to support people through their crisis episode, with a goal to link individuals to ongoing services.

The following information outlines EMCOT’s efforts since it began; it follows the sections of the toolkit. Readers can connect to other parts of the toolkit by clicking the headers for more details.

EMCOT

Photo credit: Colleen McCollough

Community Engagement and Collaboration

Integral Care regularly engages with first responders and criminal justice stakeholders to ensure EMCOT clinicians are providing the services most needed in the community.
- First responder partners include Austin-Travis County Emergency Medical Services (ATCEMS), who were the first entity to partner with EMCOT when the program launched; the Austin Police Department (APD); and Travis County Sheriff’s Office, as well as other local law enforcement organizations.
Integral Care’s crisis services, including EMCOT, offer crisis support to community members, schools, and businesses after a critical incident, such as a person dying by suicide.
Integral Care hosts community forums several times a year to raise awareness and address local challenges and issues, including for crisis-related topics.
ATCEMS is frequently dispatched to respond to mental health and behavioral health-related calls, averaging over 5,000 mental health related calls per year. During fiscal year 2021, EMCOT assisted ATCEMS on 1,125 of those calls and served 662 additional clients that would have previously been handled by ATCEMS.

Needs Assessment

Prior to the creation of EMCOT, existing relationships between first responder systems and Integral Care staff provided an opportunity for county leaders to discuss ways to reduce duplication of services and ensure that mental health providers were responding to calls for people in crisis. To gather data, Integral Care crisis staff rode along with ATCEMS and identified that many of their calls involved a mental health component.
Calls for service data from APD from 2016 to 2018 were compiled and assessed to inform the types of service calls that could be diverted to EMCOT.

Call Triaging

Travis County officials started with a narrow list of call types appropriate for transfer to EMCOT responding clinicians, including suicidal ideation, parent-child conflicts, and individuals with symptoms of psychosis, paranoia, and delusion. Since the program started, it has expanded eligible call types to include welfare checks called in by a third party. Additionally, EMCOT clinicians can be conferenced into mental health calls when police are assigned if there is a public safety issue or imminent risk of harm. On these calls, EMCOT clinicians help to de-escalate and gather information that can be helpful to the responding officer upon arrival.
There are two ways that EMCOT clinicians are dispatched to a crisis:
- Since 2013, first responders have dispatched EMCOT clinicians after they receive a call for service. For example, when law enforcement or EMS respond to the call received by 911 call takers, they would then page EMCOT clinicians to the scene when there was a mental health need.
- In 2019, EMCOT clinicians were also embedded in the 911 call center. If a 911 call taker determines that someone is having a mental health crisis and there is no imminent safety risks, the call is transferred to the EMCOT in-house clinician. The clinician provides a crisis screening and needs assessment over the phone and dispatches EMCOT responding clinicians, if needed.
In February 2021, Austin added “Mental Health Services” as an option when calling 911. The caller is greeted with the question: “Austin 911, are you calling for police, fire, EMS, or mental health services?” If the caller chooses mental health services, the 911 call taker will still screen the call to ensure that EMS, Fire, and APD do not need to respond to an immediate concern and then will transfer the call to an embedded EMCOT clinician if warranted. That clinician will then conduct a more thorough screening assessment.
Embedded clinicians in Austin handle approximately 80 percent of calls entirely over the phone. If Austin 911 call takers see that the embedded clinician is unavailable when an appropriate, non-urgent call comes in, they can put calls in a queue for the clinician to call back once they are available.
According to 2021 data, EMCOT responding clinicians were dispatched a total of 3,346 total times, including through ATCEMS, Austin PD, and the Travis County sheriff’s office, averaging 9 dispatches per day.
Central Booking counseling staff and Travis County Correctional Complex (TCCC) can also send referrals to EMCOT responding clinicians to assist people in accessing services post release.
ACTEMS and local law enforcement agencies can request EMCOT clinicians through the 911 call center for real time co-response for psychiatric crises.
Additional information on EMCOT’s triage process can be found by watching a recording of a conference session titled, “Identifying and Triaging Calls: 911, 311, 988, and Beyond.” This session was part of a national Taking the Call conference exploring innovative community responder models.

Program Staffing

EMCOT employs personnel with provisional or full clinical licensure, including social workers, licensed professional counselors, and marriage and family therapists.
In March 2021, EMCOT clinicians began co-responding with ATCEMS Community Health Paramedics. This partnership ensures that a whole health response team is available to help people in crisis. This co-response team is available Sunday through Friday, 8:00 a.m. to 5:00 p.m.
EMCOT clinicians at the 911 Call Center are available 24/7.
EMCOT responding clinicians are available Monday through Friday, 6:00 a.m.to 10:00 p.m., and Saturdays and Sundays 10:00 a.m. to 8:00 p.m. Shifts range from 3 to 12 hours to ensure complete coverage.

Use of Data to Inform Decision Making

EMCOT utilizes several data metrics to collect and analyze key program information, such as staffing needs to cover calls, training topics to support community needs, referrals, and language access. These metrics include:
- Average number of incoming calls transferred to the clinician per day;
- Call length;
- Call outcomes;
- Call types;
- Demographic information of the caller, such as race and ethnicity, gender, and language spoken; and
- Primary reason given for the call.
For more information, view the “Annual Reports” tab on the Integral Care – Publications webpage.
See also the “Collecting and Utilizing Data in Community Responder Programs” webinar.

Safety and Wellness

EMCOT clinicians receive 400 hours of extensive, on-the-job training that helps them ensure the safety of themselves and community members when responding to people in a crisis.
EMCOT responding clinicians typically address calls in teams of two unless their assistance is requested by a first responder; during these instances, only one responder will report to the scene since a first responder is already there.
EMCOT clinicians also provide training to staff from law enforcement agencies, EMS, and first responders to better address and assist people experiencing a mental health or substance use crisis.
EMCOT is committed to providing trauma informed, culturally responsive, and equitable services. The EMCOT responder team is comprised of a diverse staff to meet the needs of the community that it services.

Financial Sustainability

Medicaid waivers helped support the original launch of the EMCOT program in Austin in 2013, which was funded as part of a 1115 Medicaid Waiver. Due to a change in the requirements of Texas’ waiver in 2017, EMCOT was no longer eligible for funding, and the City of Austin and Travis County assumed funding responsibility for the EMCOT program to sustain services.
Data demonstrating the positive impact of the pilot program—including outcomes related to the number of clients served, diversions from incarceration, emergency room transports and admissions, and involuntary psychiatric commitments—greatly impacted EMCOT’s ability to secure local and county funding, which now fully supports the program.
In 2019, the program received additional funding to integrate EMCOT clinicians into the 911 call center for purposes of diverting police responses when there was not a public safety issue present. A cost analysis completed by Integral Care during its first 8 months showed that 82 percent of calls transferred to embedded EMCOT clinicians were diverted from police response, allowing callers with non-emergency assistance and yielding a total cost avoidance of $1,642,213.00.

Legislative Strategies

EMCOT is funded by the City of Austin and Travis County. The allocation is decided yearly through budgeting processes.