By Sam McLaughlin
The Arizona Daily Sun
FLAGSTAFF, Ariz. 鈥� Leaders of Flagstaff鈥檚 CARE Unit 鈥� the 鈥渁lternative response鈥� team established three years ago through a contract with Terros Health to assist individuals in crisis without relying on law enforcement 鈥� spoke to the Flagstaff City Council on Tuesday, July 1, about the unit鈥檚 accomplishments so far.
The unit is achieving its intended purpose, they said, but team members see a need for more in-patient alcohol and substance abuse treatment facilities in the city.
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鈥淪ubstance use disorder and intoxication dominates the presenting concerns on scene,鈥� Terros regional manager Thea Sherman told the council, 鈥渃onsistently making up 65 to 70% of all calls each year.鈥�
And Seth Gregar, the Emergency Medical Services battalion chief for the Flagstaff Fire Department and project manager for the CARE Unit, said the unit鈥檚 overarching mission would benefit from the creation of 鈥渁 client-centered detox [and] substance use facility, offering comprehensive wraparound services.鈥�
鈥淲e knew this going into this program,鈥� Gregar said. 鈥淎 lot of the data and a lot of the models that we looked at around the country showed that you needed a detox center in the community.鈥�
CARE stands for Community Alliance Response and Engagement. The program operates out of Flagstaff鈥檚 Fire Station No. 6 on Lake Mary Road. Seven days a week, from 9 a.m. to 7 p.m., the CARE van responds to calls involving substance use, intoxication or mental health with an emergency medical technician (EMT) and a behavioral health specialist.
In 2024, the unit was dispatched 1,780 times for an average of almost five times per day. That was about a 12% increase in total call volume over 2023, when the unit went out 1,588 times.
Average response time in 2024 hovered around 12 minutes.
鈥淭he CARE Unit is designed to respond safely, quickly and within a reasonable timeframe, but we鈥檙e not a lights-and-sirens response,鈥� Sherman noted.
The two most common outcomes of a CARE response last year were individuals 鈥渓eft in care of self鈥� or dropped off at a shelter, each accounting for about 30% of calls. The proportion of shelter drop-offs has increased each year since the program鈥檚 inception.
鈥淲e鈥檙e transporting more individuals to the shelter,鈥� Sherman said, 鈥渁nd this may indicate a need for more resources in the area, such as a detox center or services geared toward the unsheltered population.鈥�
Calls that ended up requiring police involvement were rare: just 18 out of 1,780 last year, or about 1%. Calls requiring a more robust emergency medical response were more common: the CARE Unit requested assistance from Guardian Medical Transport 240 times, or about 13.5% of cases.
Still, the program has been successful in reducing the number of individuals transported to the Flagstaff Medical Center鈥檚 emergency room by police, Gregar noted, and along with that, reducing the number of hours police officers spend at the hospital with arrestees. The unit has been effective in diverting 鈥渓ower-acuity鈥� calls away from the police and fire departments, he said, and thus ensuring that those units remain available for more serious emergencies.
Getting on the same page
The CARE Unit also works proactively to connect people to resources, clinical supervisor Danielle Simmons said.
鈥淲hen we鈥檙e not on all of our many calls, we are doing proactive outreach throughout the city, making connections with our unsheltered population and just community members throughout Flagstaff,鈥� she explained.
Part of that work is helping to meet individuals鈥� basic needs. The unit distributed over a thousand sandwiches supplied by the Flagstaff Family Food Center last year, according to Simmons, along with hundreds of bus passes donated by Mountain Line.
Other items given out included blankets, sleeping bags, winter coats and the anti-overdose drug naloxone. And other partners supporting the unit鈥檚 efforts, Simmons said, include Flagstaff Shelter Services, the Guidance Center, the Salvation Army, the outdoor equipment consignment store Snow Mountain River and Native Americans for Community Action.
While the unit used to be staffed by a Flagstaff Fire Department EMT and a Terros behavioral health specialist, Terros recently hired three new EMTs to provide all of the unit鈥檚 staffing.
鈥淭he transition has been very smooth,鈥� Sherman said.
Gregar said that one of the current challenges is interagency data collection and sharing, as the fire department and Terros do not use the same platform.
鈥淚t doesn鈥檛 match up,鈥� he said, although he added that Terros鈥� data collection is 鈥渧ery comprehensive.鈥�
Moreover, he emphasized the need for an alcohol detoxification and substance use rehabilitation facility in the community.
Simmons, in response to a question from Councilman Anthony Garcia about challenges, echoed the same point.
鈥淲e deal with a lot of alcohol use, and within our community, we are very limited, being a rural area,鈥� she said. 鈥淲e have the Guidance Center鈥� 鈥� which offers residential substance abuse disorder treatment 鈥� 鈥淸but] they are very limited on beds. And the process to get some of our clients in takes a while. So by the time they are even being seen or being able to be admitted into the program, they are already relapsing.鈥�
鈥淚n the future,鈥� Simmons added, 鈥渋t would be very, very beneficial to have a detox center, a substance use rehab, for adults and even adolescents as well.鈥�
Members of city council expressed support for the program鈥檚 ongoing work, and some agreed with the suggestion that Flagstaff would benefit from the establishment of a larger detox center.
鈥淎s a fairly new councilperson, it makes the gears start turning ... . Seeing this develop and watching it grow to where it is, I think we鈥檙e still in a gestation period,鈥� Garcia said. The CARE Unit was an important step away from the criminalization of mental health and addiction, he added.
鈥淚 love this program, for so many reasons,鈥� Councilwoman Khara House said. 鈥淥utside of my work on council, I also work in behavioral health, and so seeing this sort of program coming to our community and being successful in our community is very, very meaningful.鈥�
House noted that she had participated in a ride-along with the CARE Unit and was 鈥渧ery thankful that we鈥檝e been able to figure out some of the personnel challenges.鈥�
And Councilwoman Lori Matthews said she鈥檇 recently spoken to the owner of alcohol rehabilitation facilities in other Arizona cities about the challenges 鈥� and possible roads forward 鈥� to opening such a center here. She added that she鈥檚 been part of similar conversations for over a decade, dating back to her time as interim director of Flagstaff Shelter Services.
鈥淭he hospital was going to do it, we were going to do it, and then nobody did it,鈥� Matthews said. 鈥淎nd the need hasn鈥檛 gone away. It鈥檚 just gotten worse. I鈥檇 like to get together and just continue that conversation.鈥�
The council has discussed a detox center in recent years, but the conversations have not yet borne fruit. In the fall of 2020, the possibility of establishing such a facility here was part of the early conversations ultimately leading to the formation of the CARE Unit. And in 2022, the council considered annexing a 10-acre parcel at 7000 N. Highway 89 to provide sewer, water and city services for a potential in-patient detox and rehab center there 鈥� a plan that evidently withered on the vine.
More recently, the Coconino County Criminal Justice Coordinating Council (CJCC) has also taken up the conversation. Dianna Kalandros, the council鈥檚 director, said a detox or sobriety center 鈥渋s being discussed at the CJCC as a need within the county as a deflection point from the criminal justice system.鈥�
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