Non-police emergency response

Before making investments in this strategy, city and county leaders should ensure it addresses local needs.

The Urban Institute and Mathematica have developed indicator frameworks to help local leaders assess conditions related to upward mobility, identify barriers, and guide investments to address these challenges. These indicator frameworks can serve as a starting point for self-assessment, not as a comprehensive evaluation, and should be complemented by other forms of local knowledge.

The Urban Institute's Upward Mobility Framework identifies a set of key local conditions that shape communities’ ability to advance upward mobility and racial equity. Local leaders can use the Upward Mobility Framework to better understand the factors that improve upward mobility and prioritize areas of focus. Data reports for cities and counties can be created here.

Several indicators in the Upward Mobility Framework may be improved with investments in non-police emergency response. To measure these indicators and determine if investments in these interventions could help, examine the following:

• Access to healthcare: Ratio of residents to primary care physicians. These data are available from the U.S. Department of Health and Human Services’ Area Health Resource File.

• Safety from trauma: Number of deaths due to injury per 100,000 people. These data are available from the National Center for Health Statistics’ Mortality File and the CDC’s WONDER database.

• Just policing: Number of juveniles arrested per 100,000. High rates of juvenile arrests provide a strong indicator of overall system involvement and over-policing. These data are available from the Federal Bureau of Investigation’s Crime Data Explorer.

• Holistic and rigorous training for responders: Response teams should receive extensive, ongoing training to ensure that they are well-equipped to de-escalate and provide services to residents in a wide array of situations. Training programs should ensure that responders are capable of addressing a range of crises that often unfold simultaneously with callers who have complex needs. Training topics frequently include scenario-based training, mental health first aid, suicide safety planning, cultural sensitivity, and more. Training programs must take into account factors including quality-of-life concerns, poverty, homelessness, and family dysfunction.
• Set clear diversion criteria: Effective alternative emergency response begins at the point of contact with 911 call takers or 988, the Suicide and Crisis Lifeline. Skilled call takers need well-defined criteria to make decisions about what type of response is most appropriate and whether the call is directed to response or co-response teams. Call takers should be trained to assess the risk of each call based on available information and determine if diversion to an alternative response is appropriate. Some programs categorize calls for eligible diversions, such as mental health issues, suicide threats, mental health transports, substance use, neighborhood disputes, welfare checks, or trespass or “unwanted persons” calls, while some programs allow the teams to decide if they are well positioned to respond. Call takers are trained to identify risk factors, collect necessary information, and communicate it to response teams.
• Well-established safety protocols: Programs should develop and train responders on protocols that minimize risk to all parties. This may include requiring responders to respond to all emergency calls in pairs–one of whom is the primary responder while the other takes note of context, assesses risks, and provides support.
• Provide mental health training and support to non-police emergency response staff: Studies show that response teams frequently experience high rates of depression, anxiety, suicidal ideation, and PTSD. Non-police emergency response programs should establish standardized mental health training and support services for all program staff, including 911 call takers, who provide support to individuals experiencing a severe crisis to reduce stress and burnout.

• Communities and residents: Implementing successful programs requires support and engagement from residents, community-based organizations, and local leaders. These groups can play a critical role in helping residents understand the new approach to emergency response. This can be a slow, painstaking process due to longstanding notions about police work, but it is critical to success.

• Elected officials: Securing buy-in from elected officials and government leaders is part of the advocacy and engagement needed to win wider support and reduce fears. Awareness campaigns should be early in the development stage and continue through implementation and operation to show that community concerns are taken seriously and that programs prioritize community sensitivities and needs.

• Law enforcement: A collaborative relationship with law enforcement is essential to success, especially within a co-response model. Programs should introduce police to crisis intervention and de-escalation tactics. They may also offer grounding in mental health awareness, such as how to recognize common symptoms and offer best care practices. Response teams and police develop protocols for referrals and co-response when police are on the scene first and strategies to support one another during crisis events. It is also critical to train police on crisis intervention and de-escalation.

• 911 professionals: All those involved with 911 response, including leadership, along with EMS and fire department officials should be considered vested parties in designing and implementing programs and ensuring they are run successfully.

• Social services: A variety of community-based social services play a vital role in non-police emergency response. Whenever individuals do not require emergency medical attention, they may be directed or referred to ongoing social services, an agency providing housing assistance, a community center, or an agency providing housing assistance. In addition, crisis response and co-response teams provide post-crisis follow-up and linkages to care.

• Health departments or institutions: Community-based health and behavioral health agencies, hospitals, and crisis-receiving centers, especially those that reach underserved populations and areas, work closely with non-police response teams to deliver a range of health services, including mental and behavioral health. These may be required when responders cannot resolve a health-related problem on-site. Healthcare providers also inform the design and delivery of training and support initiatives so that teams and communities better understand the medical conditions they may encounter and the lived experiences of callers.

• City or county attorneys: Liability issues are a common concern when sending unarmed non-police responders to a crisis, as these can be tense encounters, even when deemed low risk. While sending community responders to answer low-risk calls reduces overall liability risk, there can be serious consequences when something goes wrong. The alternative response programs must engage with city and county attorneys sooner rather than later to work through liability concerns and how to avoid such liabilities before they occur.

• Researchers: Researchers play a vital role in evaluating program implementation and outcomes through community and practitioner engagement through feedback and data analysis. They also help define program success and key performance indicators and help develop quality assurance processes.

• Include processes for ongoing improvement: Alternative response operations must constantly evolve to adapt to the changing needs of the community. This requires near-constant communications and feedback loops between managers and staff involved in dispatch and response to share information about new developments and tweak day-to-day operations to fit changing conditions.

• Provide technical assistance to support potential implementation partners: Given the criticality of securing an implementation partner that is trusted within the community, program leaders should seek to encourage RFP responses from small community-based organizations. To do so, leaders should consider providing technical assistance to organizations that may be unfamiliar with government procurement processes.

• Collaborate closely with stakeholders: To carry out their work effectively, alternative response teams may rely on relationships with a variety of local stakeholders and should keep open communication links with hospitals, the school district, and the transit agency. Some partners play a vital role during the call response process, while others receive service referrals. This enables navigators to quickly link the residents they serve to the support and services they need.

• Pilot and iterate models: In many jurisdictions, the diversion of 911 calls to alternative responders represents a significant departure from previous practice. Depending on the community context, geographic area, partnerships, and capacity, initiatives may be implemented gradually as pilot programs on a precinct-by-precinct basis to test infrastructure and response times and build community buy-in. However, with more than 100 non-police response programs in place nationwide and a growing body of data showing positive outcomes, some jurisdictions have started on a larger scale (e.g., citywide in New Orleans) and operate their diversion programs on a 24/7 basis rather than only during specific hours.

• Invest in strong, public-facing data and evaluation infrastructure: Most non-police emergency response programs have some overlapping and some distinct data collection needs compared to other first responders (e.g. broader health and social need documentation) and other non-crisis health and social service providers (e.g. data collection in the field), so software and hardware may need to be tailored to those needs. This requires infrastructure, human resources, and training to support data collection for regular operations, quality improvement, evaluation, and public transparency. Many implementing jurisdictions partner with universities or other institutions that can conduct a program evaluation to determine the program’s success, opportunities for improvement, and effects on related issues like homelessness, public health, and more.

• Upgrade technology: 911 call centers should have adequate telecommunications technology to enable call takers to communicate with and locate callers easily. Sub-par technology can result in callers being put on hold too long, generating frustration and potentially increasing the risk of the situation becoming life-threatening.

• Referral success rate and types: Programs should seek to track the rate at which 911 calls are promoted to alternative response teams and how many result in linking a resident to services. Additionally, referral types, contact modes, and follow-up needs can help refine the program, along with information about frequent callers and any data about any changes in services requested and utilized.

• Diversion to right responders: Data on call volume, origin, type, response time, and call locations will help call takers triage and refer calls to the appropriate responders. Also important is data concerning on-site factors such as duration on the scene and actions taken.

• Emergency medical calls, injuries, and arrests: Programs should collect data on the number of emergency medical calls that are eventually addressed by medical services, including when no emergency room transfer occurred. To reduce the number of arrests and injuries, teams require data about when force was used during an alternative response call and whether it led to an arrest.

• Adequate training and staffing: Leadership must determine whether frontline responders–including 911 professionals–are given the training they need in alternative emergency response and if they are receiving the necessary support. Also important is data on occupational well-being, health, and job satisfaction, whether a responder felt safe or threatened in a crisis, the number of staff retained or turned over, and its impact on recruiting.

• Service-recipient demographics: Data on the quality of service and individuals’ age, race, area of residence, and the number of types of complaints received can help improve the quality of service. In addition, recipient feedback can help response teams identify any service disparities and possible gaps in service, how residents are impacted, and whether they view the alternative response model favorably.