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Talking Headways Podcast: The Vital Link Between Health and Transportation

This week we’re joined by Gail Nehls and Leslie Patterson of Envida, a transportation and home care organization. We chat about how transportation can help those with behavioral health concerns such as opioid addictions and schizophrenia, how innovation can change people's health outcomes, and the systems people need in rural areas to thrive.

The audio player is below, followed by an edited transcript — in case you prefer to read rather than listen.

Jeff Wood: So how did you get started with Envida and, and moving towards the transportation solutions that you all are working on now?

Gail Nehls: After five years attending some meetings in the community and people kept talking about how there wasn't any transportation in rural El Paso County. We decided to step up and take some calculated risks and apply for some grants. And we were frankly surprised that we were able to combine federal, state and local grants to deliver a rural route, which is like a 30-mile route from Colorado Springs to the plains of Eastern El Paso County.

We learned a lot by delivering and implementing that service. And so that's why we felt confident to apply for the federal grant to look at providing rides to behavioral health clients in a more innovative approach in Teller County because you're right, fixed routes would be ridiculous. I'm not sure anyone would really get on the bus. It's very expensive to do that run regularly because as most people in transit know that for people who ride a bus, the most important characteristic is frequency.

And it's hard to justify running up and down a pass when you're probably gonna get three miles to a gallon and no one riding a bus. So after what we learned out in how to communicate with rural communities, what people want and what they're going to do should be the same. So we attend numerous community meetings and often there are groups represented from churches Kiwanis clubs, federally qualified health centers, domestic violence groups, substance abuse groups, and food support networks and housing networks.

Anyway, we attend these kinds of meetings and gather what the community is looking for and asking for. And we developed a service. And in preparation for this call with you, Jeff, I reached out to one of our organizers that administrates the Medicaid in our area. And she suggested that we talk about how well we listen to what the people want and tailor our services to what they want and need. And what we also found though is often what people articulate is not what they're gonna do.

And so we just kind of roll the dice and begin the service and reevaluate. And continuously meet the needs of the community. And what we're finding is we do a more of a fixed route if there is a population density of a town. And then we're doing more demand response if there is scheduling. But what's unique in what we're talking about today is how to work with behavioral health. Because people don't schedule their opioid abuse crisis, they don't schedule their schizophrenic episode. And so how do we as a community support their health needs?

And in many of the rural counties, what we've seen here in Colorado, it's these emergency EMT districts that support them. And I think of course that's important for the EMT is to be there during the crisis and to take them to the mental health hospital, which might also often be in Colorado Springs, but when they're released after maybe 72 hours, sometimes their only way to get home is for that EMT.

And that's a very expensive ride. And so we are looking at how do we support people getting back home in a less costly, less resource-intense way. But also you're not going to send an Uber or Lyft, you know, to travel 40 miles or 50 miles and sometimes on a dirt road for five miles. So what does that look like? And that's what we're trying to implement in listen in the communities that we're working in.

JW: I read somewhere where you had mentioned that basically an Uber or Lyft or any sort of ride hailing trip would be about $160 round trip to get from where people are and to where they're going. And so how much does it cost to take a trip on your service?

GN: Well, we're implementing that right now. So we are looking at, so what is a Ford Explorer look like with you know, high clearance and with a trained driver that can handle, you know, someone who might go into crisis when even if they were released, that's not to preclude that they might have, I have an episode in the next hour or two and to make sure that we have a trained driver and of course all the background checks and familiarity with who could support the driver and the person that they're transporting if there was some kind of emergency.
So we haven't rolled out the case yet. I mean we're still building the case. We have an infrastructure grant from the FTA and it will be looking for other funding to support the operating costs of that.

So let's talk about what are the factors that go into the cost. So not only is it the fixed asset of the vehicle, you know, the variable because of the driver's time, because there's not many volunteers are going to sign up for this kind of thing. And, and I'm not sure we really want a volunteer at least one that is not trained. And so we're looking at those in the insurance can tell you that insurance is no small matter in transport.

And we are looking at, you know, the supportive infrastructure for the phones or radio systems or tracking system to support that driver on the road with a passenger. So I would suspect we can develop a per-mile cost per hour cost. I think part of what we're doing with the FTA dollars is to inform people at the state and federal level: What does that look like in rural? I know we will save money if we are supporting the EMT vehicles that they could be deployed most appropriately because they are a very expensive vehicle that mean so is it $50 a ride $100, ride?

It's gonna really depend on the mileage that we're going to have to travel in the amount of time we spend with a person riding with us.

JW: How intense is the issue in the area that you all live in and work in?

Leslie Patterson: So obviously the opioid epidemic has hit us also, but when you have rural areas, you tend to have higher incidents of behavioral health. I mean there's this assumption: is it because they don't have access to the care or is it because they don't get the care? And so when we're looking at the people that we're servicing, we're going through the emergency departments up to find out who those people are because they already have relationships with them and they have told us that it is very prevalent and the need is very high up there because once they have them out of crisis, like Gail mentioned, the intention is that they have to get to follow up care and follow up care is really a mandatory part of the behavioral health continuum.

And many of them, because they don't have transportation, they can't. So then they're going back into crisis. So absolutely there's a problem. How many of those people are repeat? We don't know yet. And it could be a large percentage. Are the same people continuously going into crisis.

JW: Do we know the percentage of folks in that situation that don't have transportation? Do you have any numbers on that?

LP: That's what we're collecting right now. I'm meeting with three organizations tomorrow to pull up that data. We do know that UPRAD, which is Teller County's ambulance district, they did anywhere from 600 to 700 rides last year that were an EMT ride.

So the information we got last week from UPRAD was Teller County data is 18 percent of residents experience mental health distress, frequent mental health distress.

JW: And have the case has been going up or has it leveled off or is it something that you expect will increase over time?

LP: It's similar to like child abuse reporting, you know, because the information is out there more and more people are talking about it. Is it really that there's more or is it because there's more awareness and trying to reduce stigma? So more people are getting help.

GN: I'd also like to bring out that in El Paso County, in Teller County, there's a high rates of suicide. And personally at our agency we've experienced key senior staff member commit suicide. We've had other staff members, family members commit suicide. So what we're seeing is a personal matter for us as an agency and anything we can do to support people with suicidal thoughts and divert them to get help so that they don't commit suicide.

We're looking at the overdoses from the opioids. We're looking at alcoholism and there's a lot of isolation with people in the rural areas. I mean, I think initially they may choose that, but it only exacerbates some of these mental health and behavioral health conditions.

JW: Well, that's why transportation so important because it can connect people together and also like you said, bring them to their appointments and such

GN: And you know, too, Jeff that from a transportation perspective and people and specialized transit, it's that relationship between the driver and the rider that really is important for older adults as well as people with developmental disabilities. And I think we can only conclude that it's also going to be very important for people with behavioral health. They're going to trust the person that's driving with them. They might even speak more freely with the driver than their behavioral health therapists. And so we really are going to take the effort to train our drivers because they might be acting as a therapist.

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