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Program Spotlight: CHART

Many of our neighbors who live with mental health and/or substance use challenges struggle to meet their complex and varied needs. Often, they turn to emergency medical systems and/or social services agencies for support and repeatedly use these services with often multiple visits daily and weekly. That’s the idea behind the South Snohomish County Chronic-Utilizer Alternative Response Team, or CHART. This team is comprised of criminal justice, emergency response, and social service agencies who collaborate to reduce the impact of chronic utilizers on these systems. CHART’s goal is to identify frequent utilizers and provide them with intensive case management and cross-provider care coordination. This allows the team to identify the right intervention for every person and what organizations or systems are best equipped to support them.

The Verdant Health Commission identified the need for a high utilizer program in south Snohomish County in 2017. Community leaders and providers showed strong support for adding this vital program to help reduce the associated costs of high utilization. Nancy Budd, Verdant’s Social Worker was instrumental in getting the program started in 2018. As the program grew, the team identified that CHART could be handled more effectively with 24/7 coverage, and outsourced the program to The Extra Step, led by Omar Gamez, Program Manager.

Individuals are identified based on the frequency and severity of the individual’s contact with the various systems. Once an individual has been identified by a CHART team member, his/her utilization of each of the respective systems is examined to determine the impact across the entire criminal justice and emergency response systems. The team then decides together if an individual should be added to CHART program.

Since its founding in 2018, the CHART program has served 32 clients, 17 of whom are still actively receiving services today. CHART has seen tremendous success in the lives of its clients, including enrollment in and completion of substance use/behavioral health treatment, securing housing after homelessness, gaining employment, completing Drug Court, and more. CHART clients have complex needs, and it can take years of working closely with a client to address their needs. Overall, for most of the CHART clients, we have seen an overall decrease in law enforcement activity, calls to 911 and emergency department visits at the hospital.

CHART attributes much of its success to the Social Services Team, which is comprised of representatives from many organizations, including Verdant Health Commission, South County Fire & Rescue, and local police departments, among many others. The team meets quarterly to collaborate, provide intensive care coordination, and effectively address the underlying issues that result in chronic or avoidable use of emergency response systems. The importance of CHART’s work continues to deepen as our community faces ongoing challenges related to substance use, overdose deaths, and a lack of mental health treatment providers who accept state health insurance. Verdant is proud to be a member of the CHART Social Services Team and to support the program through grant funding. To learn more about CHART, visit The Extra Step’s website at