Connections walk-in center reports rising use, highlights barriers to diverting patients from ERs

Connections Behavioral Health Crisis Walk-in Center staff told Cumberland County commissioners at their Sept. 24 finance meeting that the center has served more than 1,300 Cumberland County residents since opening, but said hospital referral patterns, emergency medical services payment rules and gaps in county dispatching limit use of the center instead of emergency departments.

The update, delivered by Britney McCarthy, strategic account manager for Connections, and Kimberly Jones, vice president of clinical operations, summarized service lines, response times, staffing and a plan to increase youth outreach. "We are now up to more than 1,300 individuals that have been served in Cumberland County," McCarthy said, citing data through Aug. 31.

The presentation laid out the center's services and performance: mobile crisis response for the three-county region (Cumberland, Dauphin and Perry), a walk-in urgent care option, and a 23-hour observation unit for crisis stabilization. McCarthy reported an average mobile response time specific to Cumberland County of 19 minutes and said the center records an average of under five minutes for law-enforcement backdoor drop-offs. Door-to-dock times were reported at 38 minutes for youth urgent care and 44 minutes for adult urgent care; the observation-unit average length of stay was 15 hours.

Why it matters: Connections aims to provide rapid behavioral-health care outside hospital emergency departments, which advocates say can reduce ED boarding and free hospital capacity. Commissioners pressed staff on whether the center is fully capturing law-enforcement and mobile-team activity in its reports; McCarthy said some local departments rely more on the mobile team than on backdoor drop-offs and that the center will expand its crisis-activity report to include mobile interactions.

Staff described several barriers to using Connections instead of hospitals. McCarthy and Jones said community habits and prior referral patterns—residents and some providers historically directed to Holy Spirit Hospital—mean many people still go to EDs. They also noted a Pennsylvania EMS payment rule that effectively prevents ambulance services from dropping patients at alternative sites unless payment language changes; Connections said its government-affairs staff are working with the Ambulance Association of Pennsylvania and state medical leadership to seek a change.

Dispatching differences between counties also affect volume. Commissioners and staff said Dauphin County launched a dispatching app with Connections in August and that Perry County currently lacks a comparable dispatch process; as a result, many Perry calls have come via state police or 988 rather than local dispatch. McCarthy said that in August the mobile team recorded 36 Cumberland mobile calls and that adult urgent-care walk-ins numbered 63 for the month; she said the center can provide county-specific tabs in the monthly spreadsheet to make those figures easier to track.

Connections highlighted efforts to strengthen partnerships and referrals: a youth marketing campaign launched Sept. 12, a monthly "connections youth roundtable" beginning in October to engage youth providers, and plans to present regularly in county Crisis Intervention Team (CIT) trainings and dispatcher trainings. McCarthy said Connections recently began providing training pieces to the county's case managers and will continue monthly presentations through the end of 2025.

Staff also described capacity and placement challenges for the most acute patients. Jones explained that "acuity" is driven by behaviors and clinical presentation, not by census, and that a small number of high-acuity or "familiar faces" can consume staff bandwidth and make placing patients in higher levels of care difficult. The center sends packets to more than a dozen inpatient facilities when transfer is needed and is working with county partners to streamline processes for patients under involuntary evaluation orders (referred to in the meeting as "302" cases) to reduce transfers and ED boarding; officials said a change of process would require further discussion and documentation review.

Workforce and sustainability were discussed. Commissioners were told Connections faces hiring barriers for certified peer recovery specialists and is partnering with Dauphin County on certification training; the provider plans to add approximately six new mobile-team staff. On financing, the presentation said Connections has about $3 million remaining from an ARPA grant that the state has allowed to be spent through the fiscal year ending June 30, 2026, plus existing alternative-payment arrangements with PerformCare, a Medicaid managed-care vendor, and ongoing Medicaid invoicing. McCarthy said the organization is pursuing additional third-party contracts to move toward long-term sustainability.

Commissioners asked for additional data on calls involving safety concerns (weapons or similar issues), on missed opportunities tied to single-team coverage, and on the frequency of law-enforcement vs. mobile-team referrals; Connections agreed to provide more detailed month-by-month and county-specific breakdowns. The presentation closed with staff asking the county for help in continuing outreach to hospitals, EMS and law enforcement to shift referral patterns toward Connections when clinically appropriate.

Votes at the meeting included approval of the minutes from Sept. 17, 2025 and a motion to adjourn. No county action or new funding for Connections was voted on at the meeting.

The commissioners' finance meeting will return to other agenda items at future sessions; Connections staff said they plan a round of briefings with law-enforcement agencies in early 2026 and ongoing monthly coordination with county MH/IDD staff to address placement and process issues.