1051: Meeting People Where They Are: Mobile Crisis Response and Expanding Access to Naloxone

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This is Public Health Review
Morning Edition for Tuesday,

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January 13th, 2026.
I'm John Sheehan with news from

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the Association of State and
Territorial Health Officials.

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Today, as we continue our
legislative prospectus series,

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which highlights the public
health policy trends set to

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shape 2026, we'll hear how youth
focused mobile response and

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stabilization services are
providing rapid in home crisis

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care and keeping children out of
emergency departments.

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Later, we'll discuss the
evolving policy landscape around

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naloxone, including efforts to
expand access in schools,

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libraries and other public
spaces to prevent overdose

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deaths.
But let's begin with Doctor

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Jerry Larkin.
Ask DON'T member and the

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director of the Rhode Island
Department of Health, Doctor

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Jerry Larkin, welcome to the
show.

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Thank you.
Doctor Larkin, What's?

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Our mobile response.
And stabilization services.

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So this is a youth focused
mobile crisis model and the goal

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is to have a quick and nimble
response for stabilization

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services.
And it's to provide immediate

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appropriate in person care and
follow up to children and

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families in crisis so that we
can prevent as many children as

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possible from needing to seek
hospital and out of home levels

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of care.
And there are really a few key

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service components of this
mobile response.

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The first is that referrals are
accepted 24 hours a day, seven

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days a week, 365 days a year.
They are always available.

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The family defines the crisis.
This is what's going on with

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them.
This is what they need help

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with.
And the service response teams

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include at least two people.
One of them has to be at least a

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masters level clinician and the
second is a paraprofessional,

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someone who's actually going to
help them in with support and

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stabilization.
And what they're looking to do

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is create follow up
interventions and coordination

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and case management for up to 30
days after the initial

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assessment.
So they go in, they really

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assess the situation, they try
and provide service right there.

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But then it's also a follow on,
you know, not just one time do

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we go in and fix the problem.
We actually understand the full

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parameters of the problem and
try and address a comprehensive

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plan or build up comprehensive
plan for the family and the

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youth.
So as opposed to requiring

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families to come into A to a
site, they're meeting them where

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they are.
Right.

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So, so let me gloss a little bit
how this has been handled

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traditionally, which is that
it's been handled by the only

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real resources that's always
readily available, which is an

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emergency department.
That's probably the worst place

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for someone to go if they're
having a behavioral health

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crisis.
Clearly, the team that will goes

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in and sees that there's a
medical issue will call 911 and

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have the person transported to
the most appropriate place for

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them to receive care for their
medical issue.

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But it's very rare that a person
who's dealing with a behavioral

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health issue that that's going
to be improved by showing up in

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an emergency room, which can be
a very chaotic place and a place

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that is not necessarily well
suited to trying to address

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their needs.
They do everything they can, and

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there's actually often times a
lot of resources and support

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there.
But the idea is to take this out

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of the emergency department,
take this out of acute

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hospitalization, and meet the
patient quite literally where

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they are.
And Rhode Island is going to

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require insurance coverage for
these services.

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What's the idea behind that and
what's the benefit?

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Well, we recognize that there
was a gap in our system related

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to youth mobile crisis services
coupled with an increase in

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acuity levels and behavioral
health challenges that youth

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were facing.
So we had this pilot program.

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We're actually able to evolve
this model that was very

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effective.
And we've actually been able to

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as well ship some of this to
certified community behavioral

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health centers beginning in
2024.

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But the step to making sure that
it was covered by third party

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payers, including Medicaid, was
to make the service sustainable.

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So in the most recent
legislative session in Rhode

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Island, the legislature mandated
that Rhode Island Medicaid seek

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authority to provide this
service and that commercial

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insurers to cover mobile
response and stabilization

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services.
And what was the impetus for the

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original program?
What was the what was sort of

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the crisis that spurred it?
Well, I think seeing that that

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gap in services where children
would, you know, be brought to

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the emergency department and
require acute hospitalization on

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a medical ward awaiting a bed or
a service to be provided to

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them.
Also, we had, you know, a large

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number of children who wound up
having to be admitted to

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facilities out of state because
we just didn't have the

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sufficient capacity within Rhode
Island itself.

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With with the context of sort of
uncertainty around federal

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funding, what can states do and
what can health agencies do to

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sort of continue sustaining
programs like the mobile

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services?
Every state, every jurisdiction,

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every health department is
facing a lot of challenges right

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now in terms of funding,
particularly around cuts to

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Medicaid and Medicare and the
subsidies for insurance so that

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they'll be more uninsured
people.

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And right now we're trying to
solve this one last piece of the

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puzzle of how how do we fund
services for children who don't

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have commercial insurance or
some other type of insurance to

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pay for these services.
I think the way you sustain it,

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at least during this short term,
what I hope will be a short term

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instability, is that you
recognize the cost savings and

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you make sure that the public,
the legislature, the third party

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payers, the federal government
really recognizes the savings

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that are here.
Not unlike if you will vaccines,

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if you calculate the economic
savings from vaccines, if you

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calculate the number of lives
and years of productive life

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that are saved by vaccines, the
number that are astronomical.

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There actually is no medical
intervention that does better.

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But this is also true of this
model of behavioral health

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intervention where again, you're
meeting the patient or the

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client where they are.
You know, that's a that's a

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truism in medicine is, you know,
you meet the patient where they

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are.
And that's always been something

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of a metaphor in that you try
and figure out what is the

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status of the patient in order
to take care of them.

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This is quite literally meeting
the patient where they are at

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home, not an emergency
department, not on a medical

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ward in the hospital, or even
worse, not at some later crisis

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that evolves into a medical
emergency because the behavioral

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health issues were not
addressed.

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And, and I think in realizing
that I think you can build

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support not just within the
states, but even within the

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federal government to, to, to
continue to support these really

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cost saving interventions.
The other place you go with

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this, and again, it's a huge
cost savings is, but that's not

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why we do it.
We do it because this is the

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most appropriate way to help
people in their crisis is that

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you look at the entire family.
It's rare that there's only a

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single person in a family who is
affected by a behavioral health

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issue that affects everyone in
the family.

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And that's actually the really
strong component of our

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certified community behavioral
health centers is that they can

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respond not just to the person
who has the most acute or the

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most obvious behavioral health
issue, but they can actually

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respond to the whole family.
They can respond to the sibling,

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they can respond to the parent
or the custodial adult.

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You know, whoever it is, it is
being affected by this issue.

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The other important thing is
that the mobile crisis

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stabilization model allows us to
really actualize the idea of no

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wrong door.
So if someone has a problem that

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they need help with, the way the
system is often times organized

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is they have to know what door
to knock on.

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You know, if I have a broken
bone, I have to go to the

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emergency department.
The no wrong door concept means

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that it doesn't matter what the
point of access for a person in

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crisis is.
The point at which they access,

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you know, the person they meet
at that point of access should

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understand that it's now their
duty to guide that person to the

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most appropriate service for
them.

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And certified community
behavioral health centers are a

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huge improvement in that idea as
and as are these mobile response

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units because as they're, you
know, the patient doesn't need

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to know what door to go to
anymore.

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The door, in a way, is coming to
them.

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Doctor Jerry Larkin is the
director of the Rhode Island

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Department of Health and an ASTO
member.

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Now let's change gears and
discuss another topic related to

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overdose prevention, naloxone.
Here's Risha Ranade, ASTO senior

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director of overdose prevention.
So naloxone is an opioid

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overdose reversal medication
which is designed to rapidly

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reverse an opioid overdose.
So because of the way that it

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works, it's one of the most
effective life saving tools that

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we have to prevent overdose
deaths.

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And because naloxone is so
effective, state public health

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leaders across the country have
been working to make sure that

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people understand the life
saving potential of naloxone,

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know where to access it, and can
feel confident using it if they

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witness an overdose.
So earlier on, we saw that many

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states passed laws to make a
naloxone easier for both first

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responders and the general
public to obtain.

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They also enacted protections
that shield laypeople from civil

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or criminal liability if they
administer naloxone in an

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emergency.
And So what we saw was that

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those policy changes really
helped naloxone become more

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widely accessible through places
like community distribution

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programs, local health
departments and public health

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organizations.
And then since the FDA approved

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naloxone nasal spray for over
the counter sale in 2023, it's

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now available in many pharmacies
as well.

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So, with the 2026 perspectives
in mind, what?

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Is on the.
Horizon for increasing or

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expanding naloxone.
What we're seeing now is states

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taking the next step by placing
naloxone in schools, libraries,

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community centers and other
public spaces.

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For example, Colorado recently
passed a law to support youth

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overdose prevention by
clarifying naloxone access in

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shared school areas, including
buses, and giving the State

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Board of Health authority to
determine which organizations

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can receive naloxone for
distribution.

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And we know that at least eight
states have considered similar

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legislation to expand naloxone
access for youth. 2nd, the focus

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is really on policies that help
the people most likely to

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experience, witness or respond
to an overdose and make sure

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that those folks have access to
naloxone.

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Risha Ranade is ASTO senior
director of overdose prevention.

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Earlier we heard from Doctor
Jerry Larkin, the director of

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the Rhode Island Department of
Health and an ASTO member.

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They joined us today as part of
our Legislative Prospectus

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series examining the policy
trends set to shape public

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health in 2026.
Public health data modernization

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is a collective effort by
federal, state, local, and

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tribal organizations to
strengthen public health data

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and surveillance systems.
The ultimate goal is to move

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from siloed public health data
systems to a connected,

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resilient, adaptable, and
sustainable response ready data

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ecosystem.
Asto's Data Modernization Primer

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provides state and territorial
health officials with a high

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level understanding of the
objective and significance of

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data modernization, as well as
the roles that they play in a

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successful data modernization
initiative.

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The five tactical guides detail
key strategies and tactics for

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implementing and maintaining
data modernization initiatives

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within public health agencies.
Find a link in the show notes.

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Public health data is evolving
and interoperability is the next

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frontier.
Join us Thursday, January 22nd

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for a webinar titled The Next
Frontier of Public Health

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Interoperability, TEFCAHDUS, and
What comes Next.

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Experts from state and local
public health, health

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information exchanges and data
networks will explore how

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intermediaries like HIES and
health data utilities are making

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real world data exchange
possible and what it means for

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public health action.
This has been Public Health

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Review MORNING Edition.
I'm John Sheehan for the

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Association of State and
Territorial Health Officials.