OSAGE COUNTY  — Osage Ambulance District Administrator Josh Krull is pleased that the Mobile Integrated Health (MIH) program is still going strong after the first year of a four-year, $3.2 million grant award through the Substance Abuse and Mental Health Services Administration (SAMHSA).

“We’ve had a lot of success,” said Krull. “We’ve posted a little bit about it here and there, but it’s pretty significant.”

Established by Congress in 1992, SAMHSA is an agency within the Department of Health and Human Services (HHS) that leads public health efforts to advance the nation’s behavioral health.

“We started building the program in September 2023 and capturing data,” said Krull. “We were a little bit ahead in terms of training because we had a vision of providing community paramedicine. However, the idea was to form partnerships, start building the program, train people, start getting equipment, and start training the public.”

A significant aspect of the project is assisting those with mental health issues.

Krull explained that historically, people suffering from mental health issues were taken to jail or the hospital. “There weren’t many options,” he said. “A lot of people fell through the cracks. With the number of mental health calls increasing, we wanted to do better.”

OAD sent several community paramedics and the leadership team to Crisis Intervention Team training and wrote into its grant a partnership to study alternate destinations for these patients by taking them to the Compass Crisis access centers in Jefferson City and Rolla.

“We did a handful of transports under the grant,” said Krull. “Before completing year one, we and many other pilot programs across the state were doing these alternate transports.”

Krull added that overwhelming data supported this being the best way to handle mental health situations and an emergency rule was passed by the State of Missouri, saying a crisis center was an allowable destination for EMS.

“If a patient is suffering from a mental health crisis, we strongly feel like the emergency room is the wrong place to take them a lot of times because that’s for people suffering from medical emergencies, and they have medically trained physicians there,” said Krull.

Through MIH, and the partnership with Compass Health Network, which has 24-hour intake options, OAD’s  trained mental health workers can decide to bypass the ER and take patients to the crisis center, where they will get the help they need. “In our first grant year, we transported 11 patients to these crisis centers by use of our crisis intervention team and community paramedics, diverting them from the ER to these mental health facilities,” said Krull. 

Lead Community Paramedic Matthew Whitworth has taken charge of the program. “Switching from a traditional paramedic to a community paramedic role has been one of the most challenging and rewarding experiences of my career,” he said. “While traditional paramedics focus on lifesaving care in emergencies, as a community paramedic, I’ve found myself addressing root causes of health issues — helping patients manage chronic conditions, access necessary resources, and avoid preventable emergencies using creative problem-solving skills. I’ve experienced firsthand the fulfillment of solving unique problems, like arranging in-home care for someone without insurance or helping a rural family find affordable pest-control services, knowing these small interventions can restore independence and improve quality of life. This role has opened my eyes to the unseen challenges people face daily and shown me how creativity and compassion can make a lasting difference.”

Krull is pleased with Whitworth’s efforts. “He’s doing most of the work, going to a lot of network meetings, and doing an absolutely fantastic job with the program, helping it grow and build,” he added.

OAD has also partnered with the Osage County Health Department (OCHD) in Linn to help two homeless patients by providing personal hygiene items. The district is also providing immunizations for homebound patients on behalf of OCHD.

The agency is also working with Good Shepherd Food Pantry in Linn to deliver food to those who cannot make the trip. A third collaboration has been established with Linn Drugs to provide medicine on days the drug store doesn’t offer delivery. Just last week, Krull said crews conducted an in-home infusion for a patient who needed antibiotics.

The SAMHSA grant also provides education to people who may have accidentally overdosed, not just people who intentionally abuse substances. That includes emergency services personnel, especially deputies, who sometimes encounter fentanyl in the course of their duties.

“We have provided Narcan kits for free as well for opioid overdoses,” said Krull, adding the district continues to provide hands-only CPR training as well.

Additionally, OAD is working on a partnership with Chamois and Belle to place a vending machine to distribute some personal hygiene items. “We’re thinking it would be like some shampoos, conditioner, soaps, toothpaste, toothbrushes, and condoms,” said Krull. “We’re going to try to put those in the community for free so people can access them when they need something.”

OAD purchased a gently used 2023 Ford Explorer police package. While the grant did not cover the cost of the SUV, SAMSHA included equipment and a graphic wrap to match OAD’s colors.

At the board’s last meeting, members agreed to offer a Memorandum of Understanding to Maries Osage Ambulance District which would allow OAD to provide MIH services to MOAD residents if referred. With the existing grant that OAD has been awarded, funds can be used within the county boundaries of Osage, Maries and Gasconade. “If they need a community paramedic, they could refer patients to us, and we can help provide services,” said Krull. “We could provide reports to their board, like I do to our board. I know paramedics and services are hard to come by, but a majority of the services we’re offering are in the Maries County area right now, within our ambulance district boundaries. I feel there is a greater need down there.”

Krull added that OAD is working to establish a partnership with Four Rivers Community Health Center in Rolla. “Their physicians plan to do some ride-alongs with our community paramedic program. Likewise, our community paramedics plan to work some shifts in their clinic because we will be doing some direct medication treatments under their direction. We plan to dual train.”

Krull noted that the district already has a partnership with the Community Health Center for medical direction and will expand with the Four Rivers Community Health Center.

Finally, OAD has hired and is training a peer support specialist who will be certified within the next 30 days.

The position will include a staff EMT who has a role in the mobile integrated health team to work with individuals struggling with substance abuse disorder. “This individual will serve as a peer support person who can personally relate with a patient based on the fact that they’ve overcome past struggles,” said Krull.

As Thanksgiving approaches, Krull announced he plans to continue offering transportation to anyone who is homebound or confined to a wheelchair and needs a ride to a family gathering at no cost. “We’re here to help you make it to your holiday party,” he added. “If you’re living in the district or have someone close and physically cannot get to your party, give us a call.”

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