The QRT deflection model was first developed in 2014 in Colerain Township, Ohio — a 45-square-mile suburb in Hamilton County, just northwest of Cincinnati.

 

Colerain's then-public safety director, Daniel P. Meloy — who had previously served as the township's police chief and, later, as the township's administrator — oversaw the development of its pilot QRT program, in collaboration with the community's assistant fire chief Will Mueller (who is also an adjunct instructor of Fire Science at the University of Cincinnati), and the Greater Cincinnati Addiction Services Council, CEO (Ret.) Nan Franks and social worker Shana Merrick.
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Concurrently and independently of the Colerain program, Lucas County, Ohio, developed its similar DART model, which it also first deployed in 2014.

 

Impetus

 

Meloy and other Colerain officials saw the need to develop more innovative, person-centered approaches to reduce the rising number of narcotic overdoses in their community, which had been particularly hard-hit by the United States' mid-2000s opioid epidemic.

At the time of the QRT pilot program's development, Colerain Township had approximately 60,000 residents, usually covered by just 33 fire/EMS personnel and six police department patrol officers at any given time.

Whereas in 2011, Colerain reported 51 total overdoses, by 2014, the annual number of overdoses in the community had risen to 141 — a 176% increase in just three years — according to statistics provided by the township's Department of Public Safety.

 

In 2015, the year Colerain's QRTs were first deployed, the township reported that it made 167 emergency response runs to overdose victims, comprising 2.2% of the community's total emergency response volume for that year.

 

Organization


In the original Colerain model, a special tactics-trained police officer, a specially-trained firefighter- medic, and an addiction counselor from the community were partnered to form a single QRT.

 

The community's initial QRT emergency responder candidate pool included 6 of the community's firefighter paramedics who had previous experience serving as military, SWAT, or Hostage Rescue Team tactical medics (TACMEDs) and five police officers with special tactics training (through their service in the military, with SWAT, or on narcotics squads).

 

The chosen firefighter, and paramedics, received additional self-defense, chemical irritant deployment, and de-escalation training.

 

Special tactics training was deemed necessary, in township officials' estimation, due to the often-volatile circumstances that prevailed on-scene during narcotics-related responses.

 

Licensed substance use counselors were provided to the QRT program through a partnership with the Addiction Services Council of Greater Cincinnati.

 

The QRT program included a "360 Solution" component, under which all Colerain patrol officers were equipped with nasal-delivery naloxone (Narcan), provided by the Ohio Department of Public Health and Hamilton County Department of Public Health.

 

Additionally, the police department canvassed the community several times door-to-door, delivering brochures that informed citizens about the township's efforts to respond to the opioid epidemic.

Colerain's QRT members were trained to use "motivational interviewing" principles — an expression of empathy to build rapport with the opiate user, helping the user to elicit the pros and cons of entering treatment, respecting the user's right to choose, and communicating to the survivor that they are capable of change — during their post-incident follow-ups with overdose victims, to attempt to divert users into addiction treatment programs.

 

They were also trained to identify barriers to treatment, to assist users and their families in preparing to remove or overcome those barriers, to move the user toward a firm commitment to action, and to engage the victim's family and enlist its help in moving the survivor to action.

 

Outreach and engagement were directed to build trust, maintain discretion and confidentiality, protect the individual's right to choose their own care, and comply with all state and federal (HIPPA) regulations on patient privacy.

 

Efficacy


From January through June 2015 (the six months immediately preceding the unit's first deployment), Colerain's first responders made 96 overdose-related emergency runs (19 of which involved associated cardiac arrests). In the six months following the QRT units' deployment, the township made 71 overdose-related emergency runs (7 of which involved associated cardiac arrests).

 

Although those initial positive indications were insufficient to prove the pilot program's effectiveness, they were nonetheless encouraging. A subsequent year-over-year analysis lent support to its developer’s hypothesis that the QRT program could effectively reduce the number of overdoses in the community.

 

From January through June 2016, the township made 67 overdose-related emergency runs (just 6 of which involved associated cardiac arrests), representing just over a 30% reduction in such runs from the same 6-month period in the preceding year.

At 2016's year-end, Colerain Township's Department of Public Safety reported that its QRT units had conducted approximately 250 overdose follow-up encounters since July 2015, when the units were first deployed, and nearly 80% of the survivors counseled by the unit had entered substance use treatment.

 

Nearby Middletown, Ohio's QRT arguably did not succeed in reducing overdose rates or overdose- related deaths in its first year of operation.

According to then, Middletown fire chief Paul Lolli, in 2016 (the year its QRT was implemented), the city's emergency response agencies made 532 overdose-related runs (comprising 5.7% of its total response volume for that year), with 74 deaths recorded. But, from January 1-June 17, 2017, the city's agencies had already made 577 opioid overdose responses (comprising 12.4% of its EMS run volume to that point in the year) with 51 recorded deaths.

It is possible, though, that temporary spikes in the available supply of illicit opiates, or sudden "bad drug" shifts in opiate quality, could artificially depress QRT/DART success rates. Success rates might be more readily quantified over more extended data-gathering periods.

 

For example, in 2017, Lucas County Sheriff John Tharp stated that the county's DART program had achieved a similar success rate in the three years since its first deployment, with 74% of contacted individuals having either entered detox or connected with other substance use treatment programs. Three Million in Grants for DART and QRT Teams

Proliferation


The Colerain QRT's initial successes in addressing that township's opiate epidemic garnered close attention from officials in surrounding communities, many of whom expressed interest in adopting the model. Within the QRT's first two years of operation, communities in North Carolina, southern and northern Ohio, Texas, and West Virginia contacted Colerain to inquire about its program.

 

By June 2016, Ross County, Ohio, and its seat, Chillicothe, had launched their joint, multi-agency Post- Overdose Response Team (PORT) based on Colerain's QRT. PORT visits 14 sites seeking answers to overdose surge.

 

In August 2016, Butler County, Oxford, Ohio, had "loosely" formed a QRT.

 

By September 2016, another Cincinnati suburb, Norwood, had developed and deployed a Colerain- model QRT.

 

In January 2017, the Funders' Response to the Heroin Epidemic — a Greater Cincinnati-based, private funding collaboration operated by InterAct for Change, a nonprofit subsidiary of Interact for Health — awarded both Colerain Township and Clermont County, Ohio, $100,000 grants to support (respectively) their QRT operational and development efforts.
Both grants were to be paid over three years.

 

By March 8, 2017, two other Tristate communities — Lawrenceburg, Indiana, and Kenton County, Kentucky — had developed and launched their versions of the QRT program.

 

In contrast to the Colerain model, Kenton County's QRT — developed by Kenton County Police Department chief Spike Jones and Independence (Ky.) Fire District chief Scott Breeze — was operated by part-time staffers. Unlike Colerain's QRT members, who are full-time employees and pull normal fire/EMS, police patrol, or unique tactics team duty, Kenton County's part-time staffers are not responsible for non-QRT duties.

 

Middletown, Ohio, implemented its QRT program in 2016; the city's fire chief, Paul Lolli, reported that 92% of users contacted by the unit had "been able to enter treatment," although he acknowledged that the program had not recorded the results experienced by those who entered treatment, rendering the program's efficacy unclear.

 

In June 2017, citing opiate addiction as his community's "No. 1 public safety issue," Boone County, Ky., Judge-Executive Gary Moore announced that the county's launch of its own Colerain-inspired overdose response team.

 

By July 2017, several other Ohio communities — including Colerain-neighboring Greene Township, the cities of Cincinnati, Cleveland, Hamilton, Mansfield, Oxford, and Troy, and Logan and Richland Counties — had developed and implemented QRT programs.

 

Summit County (near Cleveland) developed its QRT in partnership with the non-profit drug education and prevention organization Cover2 Resources, with significant advisory support from Colerain Township's Meloy. The county deployed QRT units in Akron, Barberton, Coventry, Cuyahoga Falls, Green, Hudson, Munroe Falls, Norton, Stow, and Tallmadge, under partnership agreements with those communities. 

Indianapolis, Ind., and Raleigh, N.C. had also deployed QRT units as of July 2017.

 

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In June 2017, Butler County Mental Health and Addiction Recovery Services received a $660,000 federal grant, funded by provisions of the 21st Century Cures Act, to develop a mobile overdose response program in that Southwestern Ohio locality.

 

Also, in June 2017, Ohio governor John Kasich signed into law a state budget that allotted $3 million in grant funding to assist Ohio communities in developing their own QRT or DART programs. The grants were to be administered by the Ohio Attorney General's Office, and the initial application period was set to begin in mid-July 2017.

 

In September 2017, Ohio Attorney General Mike DeWine announced that QRT/DART development grants had been awarded to 40 Ohio law enforcement agencies and their partner organizations. Hancock County received $87,500 and, by the end of the year, its QRT was operational; Ottawa and Wood Counties also received funding. The Mahoning County Sheriff's Office was awarded a $150,000 grant to develop a county-wide QRT program. The Newton Falls Police Department in Trumbull County and the East Liverpool Police Department in Columbiana County each received $50,000 grants.

 

Tuscarawas County was another of the first communities to receive an Ohio QRT/DART development grant; its sheriff's department was awarded $83,500 to start a county-wide, multi-agency program, which became operational in mid-October, 2017.

 

In December 2017, Meloy retired from his role as Colerain Township CEO/Administrator to become a consultant to build public safety and community collaboration efforts through training and education, helping other communities to start their own deflection programs.