For 911 calls about someone in crisis, who should respond? Many cities have decided it should not solely be police. A national poll conducted in June found that 70% of likely voters support a non-police response for 911 calls about mental health crises, and 68% support the creation of non-police emergency response programs.1
In many jurisdictions, police are the first to respond (first responders) to 911 calls about people experiencing issues related to mental health, homelessness, and substance abuse. However, they often do not have adequate training to deal with these calls.2
Programs replacing police with social workers, mental health counselors, and medical staff have been in operation for at least a year in Austin, Texas; Eugene, Oregon; Olympia, Washington; and Edmonton, Canada. Eugene’s program has operated since 1989, and in 2019 responded to 20% (24,000) of all 911 calls, with a police backup request rate of 0.625% (160).3These programs are focused on providing more appropriate services and
reducing government spending. Other cities have recently begun or approved crisis response programs of their own.4
Potential benefits include budgetary savings, diverting individuals from a higher level of care, and reducing dependence on policing and the criminal justice system to deal with people experiencing crisis. There are also obstacles, as well as many questions about program design and implementation. Some considerations are universal, and some vary based on how each program is structured, as well as its size and scope.
Although the programs vary, takeaways for local governments attempting to implement a crisis response program are to (i) include stakeholders in the program design process,
(ii) aim to build trust within the police department and community, (iii) have a designated place within the 911 and emergency-response processes, (iv) have adequate funding with access to mid-year increases if necessary, (v) have a capable host organization/agency and be appropriately administratively housed, (vi) properly train employees, 911 call-takers, and other first responders, (vii) use past and current call data to inform operations, and (viii) have the ability to transfer or refer clients to other service providers.
Who Operates Crisis-Response Programs?
The organizations that operate crisis-response programs generally do so through a subcontract with the city or police department (with the exception of Edmonton’s program, which is run by a nonprofit).5
Eugene’s CAHOOTS is administered by White Bird Clinic,6an independent nonprofit which has provided community-based healthcare services (including mobile crisis response) since 1969, and is well known in the Eugene community.7Workers “are White Bird Clinic employees, contracting with the police department, and the county.”8
Austin’s EMCOT program is administered by the Travis County (which encompasses Austin) Local Behavioral Health Authority,9 called Integral Care, which is a community-based mental health center that has been providing behavioral health services for over five decades.10In addition to mobile call-response staff, some mental-health counselors are stationed at Austin’s 911 call center.11Travis County EMS also oversees the Community Health Paramedics program, which targets frequent users of 911 and provides mobile case management, both medical and non-medical.12Workers are employed by the Travis County Healthcare District13through a contract with the city.14
Olympia’s Crisis Response Unit is administered by Recovery Innovations International, which is a mental health services provider from the neighboring county with “14 crisis programs in five states,” although it has no other alternative first response programs.15The Administrative Services Division of the Olympia Police Department handles the contract, because that division does not include sworn officers.16
Edmonton’s 24/7 Crisis Diversion program is administered by REACH, a “backbone” organization, or “community-based coordinating council” funded by the city.17 Program workers are employed by Boyle Street Community Services and Hope Mission (two local nonprofits that provide similar services in Edmonton), and the call- takers are employed by the Canadian Mental Health Association (211).18
What Kind of Services Do Alternative First Responders Provide?
They are voluntary, meaning people can refuse services and opt for a police or EMS response instead. Because they are mobile, they can engage clients directly without being dispatched, except for Austin’s EMCOT, which is dispatched by 911 or other first responders.19Currently, 911 calls about a person in crisis are generally responded to either by police officers trained in a forty-hour “Crisis Intervention Team” program, or by police officers with no training beyond the police academy.20 Current mobile crisis response programs are run either at the county level or by a nonprofit organization; workers are not
dispatched after 911 calls but at the request of law enforcement on scene. The programs are generally underfunded.21People experiencing issues related to untreated mental illness are sixteen times more likely to die during encounters with police than other civilians.22
Also, programs can either preempt other first responders from responding to a call, or allow other first responders to leave a scene when it is unnecessary for them to stay.23 911 call-takers in Eugene use the same channel to dispatch CAHOOTS and the police department, both of whom use the same radios. If a CAHOOTS worker has a relationship with the person being called about, they can communicate with the officer to either replace them as a responder or co-respond. Additionally, other first responders can call CAHOOTS workers to the scene of a call, and “leave the scene” with CAHOOTS workers. This saves time for those first responders to respond to other calls.
All programs can attend to non-emergency medical issues, although in Austin those are generally dealt with by the Community Health Paramedics.24Workers in all of the programs also all have the ability to transfer or refer clients to appropriate services or agencies with the client’s consent.25
CAHOOTS and EMCOT workers also teach methods of crisis management and conflict resolution to law enforcement and community members.26
In Eugene, CAHOOTS workers respond to a variety of other non-emergency calls, and
provide services including, but not limited to:
conflict resolution and mediation;
dispute mediation and resolution between family members, roommates, or clients at group homes or agencies;
delivering death notifications;
grief and loss counseling;
substance use and abuse counseling;
providing water bottles, socks, and other basic supplies to people;
addressing housing crises;
first aid and non-emergency medical care;
resource connection and referrals;
providing direct funds for essential items;
transportation to services, and
situations in general that do not involve emergent medical or criminal issues.27
When other first responders notice someone in distress from a call (like someone who called about a home invasion), they can ask that person if they’d like CAHOOTS to come and help them process what they’re feeling.28At least once, a CAHOOTS worker has de-escalated a situation by standing between an officer and a civilian to prevent the officer from using mace, but it is unclear if that is a common or accepted practice.29CAHOOTS did not originally have the ability to do most of these things, but as it gained expertise and trust with the department and community, its functions expanded.30
Appendices B and C are tables of available response data for 24/7 and CAHOOTS.
Connecting Clients to Other Service Providers and Programs
Organizations that host crisis-response programs are mostly local organizations that did similar work in their communities before they began administering their respective programs.31This helps them to connect clients to multiple agencies to provide sustainable support, especially for clients with more complex needs.32Common partners include healthcare providers, hospitals, homeless shelters, homeless- outreach agencies, mental-health clinics, substance-abuse programs and clinics, and other emergency-services diversion programs. Austin’s EMCOT program works in tandem with Austin’s other nontraditional 911 program, the Community Health Paramedics.33Olympia’s CRU program was funded by a 2017 public-safety levy approved by voters.34That levy also paid for a program called Familiar Faces, which targets and assists frequent users of emergency services to better support them with long-term care.35
Point of Access
The CAHOOTS program coordinator said their “biggest struggle” is figuring out how clients can access their services, and said it is the “key thing” for communities implementing a crisis response program.36 The Eugene Chief of Police testified before the Oregon legislature that the most important aspect of the program was its ability to be dispatched by the 911 call center.37
All programs can be called by other social service agencies.38Only Edmonton’s 24/7 program is not able to be dispatched directly by 911 call centers.39CAHOOTS and EMCOT did not originally have that ability,40while Olympia’s Crisis Response Unit was integrated into the 911 process from its beginning.41Austin’s original crisis response program, MCOT, is available at a standalone phone number housed at Integral Care’s clinic, while EMCOT is available to 911 dispatchers, EMS, and law enforcement.42Austin 911 dispatchers are now trained to ask whether the caller needs police, fire, or mental health services.43In Olympia, some clients have asked for a standalone number because when they call 911 and ask for the CRU, police “intercept” their call.44In Edmonton, REACH attempts to direct as many 24/7 calls to 211 as possible in order to save 911 callers and dispatchers the time of answering, assessing, and transferring calls; 72% of the program’s 2018 calls were directly to 211 in 2018.45EMCOT also receives referrals and has staff at hospitals and the county corrections complex to connect individuals who may be unable to overcome barriers to services post- release.46
Call-takers are trained to screen for calls that their crisis-response programs are able to respond to, and assess whether there is a likelihood of violence or danger.47A copy of the “911 Dispatch Call-Taking Manual” for CAHOOTS response can be found in section VIII of this report.
Except for Edmonton, where 24/7 partners with 211, each city used its preexisting 911
call center to dispatch calls. In Eugene and Olympia, program workers also carry police radios with the ability to divert calls directly from police, initiate their own interactions, or respond to first responders at a scene to provide assistance.48In Austin, EMCOT workers are stationed at the 911 call center49with iPads, where they can take calls directly from dispatchers, or from first responders at scenes.50Appendix F is a diagram of the CAHOOTS’ dispatch process.
Diversion from Higher Level of Care/PoliceResponse
CAHOOTS called for police backup in 150 of their 24,000 responses last year, or a rate of 1 in every 160 responses (0.625%).51They respond to about 70% of their calls without any other first responders.52Last year, CAHOOTS responded to roughly 20% of all calls dispatched by 911 for Eugene and the neighboring city of Springfield.53Appendix C is a table of available response data for CAHOOTS.
98.7% of law enforcement referrals to EMCOT divert from arrest, and 75.1% of EMS referrals divert from emergency- department transfer and admission.54EMCOT relieves first responders within 10– 15 minutes after arriving at a scene 85–90% of the time.55Arrests of people with mental illnesses in Austin during the program’s first year reduced by 30 percent.56Since the program began in 2013, 7,214 clients have been served, with 3,182 dispatches in 2019.57
Travis County’s Community Health Paramedics “served 1,164 individuals in fiscal year 2019.”58The program is being
expanded, and the county EMS association noted that the city’s recent efforts to decriminalize homelessness have made the program more effective.59By 2019, the program had “contributed to a 60 percent reduction in emergency calls from its target population.”60
In the first two months of Olympia’s Crisis Response Unit, it responded to about 700 calls.61
Following the previous “MAP” program, after 4 years of Edmonton’s 24/7 program, it had responded to over 6,000 unique clients and 38,000 crisis events.62In 2019, 25% to 30% of calls were referred to more appropriate services.63Appendix B is a table of available response data for 24/7.
Each program operates with mobile two-person teams.64Programs use vans that are owned by the host organization or the city and filled with supplies.65
EMCOT workers are master’s level clinicians.66The Community Health Paramedics staff of 15 is divided by the populations they serve (i.e., chronically homeless, elderly, recently incarcerated), and have an average of 15 years of experience.67Olympia’s CRU is “made up of nurses and behavioral health specialists.”6824/7 workers must have at least two years of experience in delivering community-based services, experience working with partners and stakeholders, and
a knowledge and understanding of poverty- related issues.69It is preferred that workers have a degree in social services or a related
field, but candidates who have relevant and related experience are also considered.70
Each CAHOOTS team consists of one medic (a nurse, paramedic, or EMT, who must be state certified with at least an EMT-B certification) and a mental health crisis worker who has substantial training and experience in the mental health field, with a degree preferred but not required.71Some of the medical staff are current nursing students.72Many workers are trained to perform both roles.73Training for CAHOOTS workers lasts “6 months to a year.”74Due to their training, in 31 years of the program no staff member has ever been in a major traffic collision or suffered a major injury while responding to a call.75“A non-judgmental and client-centered approach to communication and service delivery is emphasized. Trainees begin as observers, watching trained team members handle a variety of calls. They also attend weekly debrief sessions to promote better client care as well as address issues of boundaries, rescuing, and worker self-care in order to avoid burnout. Workers must also pass an extensive background check.”76 On average, the training is 500 hours in the field and up to twenty hours in the classroom.77CAHOOTS workers rely on trauma-informed de-escalation and harm reduction techniques.78The administrative coordinator of the program said there are a “trifecta” of qualities they look for: technical knowledge in the area of medical and behavioral health; a belief in client-centered care; and personal experience in crisis situations.79The coordinator said those qualities are helpful so workers can “bring the level of empathy and compassion to the work that we expect of our workers, and
that that’s a really tricky mix to sometimes find.”80
All of CAHOOTS’ services are confidential, free, and voluntary.81CAHOOTS workers log details of their dispatches, including names and addresses of people they interacted with, their mental health diagnoses (if any), and behavioral patterns.82Teams utilize these logs when they are dispatched, allowing them to know what works for specific clients based on past interactions.8324/7 workers record their interactions with clients in an app created by REACH to store client information, so the information can be shared between teams in order to best match the needs of clients.84 The app also automatically generates reports and maps with the aggregate data.85Before creating the app, REACH conducted an impact assessment to determine potential client privacy issues.86
Most CAHOOTS clients are experiencing homelessness, and just under a third have a severe mental illness.87CAHOOTS also responds to calls from the University of Oregon Eugene Campus88and local schools.89Appendix E is a chart with the most common CAHOOTS call factors. 24/7 mostly assists people who are homeless, but some disorder calls for service are diverted from police dispatch to the teams.90The City of Edmonton is in the process of analyzing its 911 dispatch data to see how many calls related to mental health, addiction, and homelessness could be diverted to an expanded 24/7 program.91Of all the people served by EMCOT in 2019, 29% were experiencing homelessness.92
How Programs Got Started
White Bird Clinic, which runs Eugene’s CAHOOTS program, ran a mobile crisis-response program directly through their clinic for years before CAHOOTS began. CAHOOTS has increased from a budget of $288,000 and a staff of 15 in 201093to a $2.1 million budget94and a staff of over 40 in 2020.95
The pilot program for Austin’s EMCOT was known as MCOT, and began in 2006 “without engagement from APD or EMS.”96 The program grew in 2012 as a result of DSRIP funding.97DSRIP is a type of “Medicaid Redesign” which compensates service providers with Medicaid funds to provide services more efficiently.98In 2013, Integral Care created the EMCOT (Expanded MCOT) program to be available to on-scene first responders.99 Later, EMCOT began to take calls directly from 911 operators and also has clinicians at the 911 Call Center to respond to calls.100 Unlike other cities’ pilot programs, MCOT still operates as a standalone service.101
Austin’s Community Health Paramedics program was created in 2009 and is a DSRIP program administered by the Travis County EMS.102The program is currently being expanded with city funding.103
Olympia’s CRU is in its second year and was integrated into the emergency response system from its beginning. For three months before responding to calls on their own, CRU workers co-responded to calls with officers to build trust with officers and the community, and also to make themselves known in the areas they were going to serve.104
MAP, the multiyear prototype for the 24/7 program, was created after a stakeholder assessment and community engagement session and operated without city funding.105 In 2015, the 24/7 program was created after input from 25 community stakeholders at two separate sessions, and 17 agencies were involved in the development of the new plan.106Edmonton also does 90-day pilots to test potential changes to the program.107In 2015, the Edmonton City Council asked REACH about options for expansion and REACH noted that “it would not be a simple linear expansion with identical resource requirements or results for” each neighborhood.108
CAHOOTS “costs on average $71 an hour.”109REACH estimates that for “every $1 invested in the 24/7 Crisis Diversion initiative, there is a social return on investment (SROI) of $1.91 in the form of savings in health care, policing, and legal costs.110Costs were reduced for ambulance transport, police, and emergency room services.111For many clients that these programs serve, the cost of an emergency room visit would otherwise fall on the taxpayer, a cost estimated at $1,010 per visit in 2018 by the Federal Medical Expenditure Panel Survey.112CRU’s $497,000 annual budget covers supplies and salaries for six behavior health specialists, working in three two-person teams from 7 a.m. to 9 p.m. seven days a week.113
Travis County (the county encompassing Austin) contributed $1 million to expand MCOT into EMCOT.114CRU, with its first annual budget of $497,000, estimated $110,100 in startup costs.115The original plan for MAP, the predecessor to 24/7, estimated start-up costs of $892,000 for an annual budget of $2,037,530.116
Wages for the programs are: CAHOOTS:
$18 an hour,117EMCOT: $150,000 annually for clinicians,118CRU: $50,992.00 to
$63,745.50 annually,119and 24/7: $20.63 to 24.27 an hour (Canadian dollars).120
Appendix A is a table with each city’s police department and crisis response program budgets, response information for both, as well as estimated savings of the crisis response program.
All of the police departments viewed their crisis-response programs positively; they generally recognize that the workers are better suited to handle certain call types and that when they do it frees up police to work on other matters.121However, there is generally a period after programs first begin when officers are hesitant to fully defer to it, but do so after seeing the program operate effectively.122In Austin, where the program doesn’t operate 24/7, the EMCOT program manager says law enforcement frequently asks when they will have overnight
staffing.123EMCOT provides training to the police department in an attempt to form stronger bonds between crisis workers and officers.124
Lack of Adequate Funding
Every program (other than Olympia’s Crisis Response Unit, which is in its second year of operation) outgrew the program’s demand at least once.125Cities tend to expand programs when they are presented with data about cost savings and hear from community members about the effectiveness of the programs.
Considerations for an Albany Crisis-Response Program
Choosing a Host Organization/Agency
Except for Olympia, each crisis-response program built upon or expanded a preexisting initiative. The programs were administered by nonprofit organizations, either directly or through a subcontract.
Subcontracting may show that the program is “collaborative but separate” from law enforcement, as well as allow for funding streams in addition to those available to municipalities or counties. However, public officials will have less control over the program. When looking for the right organization to administer the program, local governments should look for organizations with (i) a longstanding presence in the community, (ii) a history of delivering similar services, (iii) an ability to track performance and measure success, and
the ability to store client data safely and follow other statutes and regulations.
CAHOOTS is administered by White Bird Clinic, a Federally Qualified Health Center.126Albany has one Federally Qualified Health Center, the Whitney M. Young Junior Health Center,127which currently operates “Whitney on Wheels,” a mobile van unit that provides preventative care such as physicals, chronic-disease management, health and nutritional education, lab tests and screenings, and vaccinations at various partner locations.128 However, for some of the locations, the client must be a member of the partner organization, and the services are only available to clients who are willing to establish Whitney Young Health as their primary care provider.129
EMCOT is administered as part of Texas’ DSRIP (Medicaid redesign) process by Integral Care, one of the members of an Austin DSRIP network.130In Albany, the Better Health for Northeast New York PPS (Better Health) is the local DSRIP network.131One of Better Health’s eleven initiatives includes funding crisis stabilization services.132Within the Better Health network, there are three mobile crisis response programs: the Albany County Department of Mental Health’s Mobile Crisis Team, the Capital District Psychiatric Center’s Crisis Unit, and the Parsons Center’s Capital Region Child and Adolescent Mobile Team.133
Point of Access, Dispatch, Integration with Emergency Response and Service Providers
Crisis-response workers can be dispatched:
(i) directly by 911,
(ii) through a separate number,
(iii) directly by first responders, or
(iv) some combination of the above. Based
on the experience of the other programs, having all of the above as points of access would help a program be more successful, with 911 access being the most crucial.134CAHOOTS workers have found it extremely beneficial to share radios with the police.135 It allows officers to call for crisis-response workers once they’ve assessed a situation, and workers can ‘preempt’ police response when appropriate.136
All the programs can refer or transport clients to other social-service providers, some after not being originally able to do so.137This allows for direct access to long-term and appropriate care. All programs have a process in place for frequent users of their program in order to provide them more comprehensive services or to refer them to a different provider for a higher level of care.138
what call types the crisis response program may respond to,
the frequency of those call types,
locations where calls most often originate from (by police beat, census tract, etc.), and
what times of day those calls are most common.
Decide on Program Operations, Structure, and Funding
Solicit feedback from community and stakeholders on design
Decide on metrics to monitor program and measure success
Pursue various funding streams
Reallocate Police Funding Towards Program
Here is a detailed Austin City Council hearing about the costs of the then-proposed EMCOT program. Appendix D is a table of police department spending and outcomes for Albany and other municipalities in New York.
Train 911 Call-Takers and First Responders on the Role and Functions of the Crisis- Response Program
All 911 call-takers should be trained to screen for calls that the program will be able to respond to. In Austin, 911 operators are trained to ask whether the caller needs police, fire, or mental health services.146A copy of the “911 Dispatch Call-Taking Manual” for CAHOOTS response can be found in section VIII of the report here.
Police have policies and procedures on how to interact, and in some cases defer to, the crisis response programs in their cities.147
Start Pilot, Scale Up, Make Changes
Because other programs have suffered due to lapses in funding, local governments should be ready to authorize mid-year funding increases. This also gives governments additional oversight of nonprofit subcontractors. The program should be collecting enough data on an ongoing basis to analyze, and if necessary, modify its operations.
Currently, local governments have a unique opportunity to reimagine public safety and health, and potentially realize significant savings in doing so. These savings can be reallocated to address root causes of crime and poverty, reducing the needs for services over time. As shown, there is not one way to administer a crisis-response program.148 However, constants among these programs examined can inform local governments in their own efforts to start similar initiatives.
Takeaways from these programs are to (i) include stakeholders in the program design process, (ii) aim to build trust within the police department and community, (iii) have a designated place within the 911 and emergency response processes, (iv) have adequate funding with access to mid-year
increases if necessary, (v) have a capable host organization/agency and be appropriately administratively housed, (vi) properly train employees, 911 call-takers, and other first responders, (vii) use past and current call data to inform operations, and have the ability to transfer or refer clients to other service providers.
Appendix A: Comparison of Police and Crisis Response Budgets, and Estimated Savings
Springfield: $450k-500k total for 11.5 hours of daily service,188$27,394 from city189
Eugene: still $900,000
$2.1 million total budget190State grant funding ended, Springfield increased its proportion to $238,274 with the county matching 3-to-1 (overall spending for Springfield increased by about 1.5 times)191
Eugene added another van and 11 additional hours of coverage to support its two other vans during peak service hours.192
Appendix D: Police Spending and Outcomes for Several Cities in New York
Provides input to the Department of Mental Health and its Director; helps to create the annual local services plan, outlining Albany mental health services.
Albany County Patient Services Coordinating Committee
iAlbany County Department of Mental Health and Department of Social Services coordinate services “for people identified as frequent users of expensive crisis services across different public agencies,”224with “196 individuals served since program inception (2005) with total cost savings of $2,658,476” by late 2020.”225
* Matt DeLaus is in his second year of dual studies for the J.D./M.P.A. program at Albany Law School and SUNY Albany’s Rockefeller College of Public Policy. He is an Albany Law School Government Law Center Fellow and intern, a subeditor for the Albany Government Law Review, and a recipient of both an Albany
Law School President’s Scholarship and The Arthur F. Mathews '62 Endowed Memorial Scholarship. He cannot fully express his gratitude to Ruchi Patel and Professor Ava Ayers for their support in this work.
20 (as of 2019, the Albany Police Department was “continuing the process of having all [their] patrol officers trained in a 40-hour block of Crisis Intervention Team (CIT) training.”); see also Michael S. Rogers, et al., Effectiveness of Police Crisis intervention Training Programs, 47 J. Am. Acad. Psych. Law 414-421, 414 (2019), http://jaapl.org/content/jaapl/47/4/
414.full.pdf (“Studies generally support that CIT has beneficial officer-level outcomes, such as officer satisfaction and self-perception of a reduction in use of force. CIT also likely leads to prebooking [or post- arrest] diversion from jails to psychiatric facilities. There is little evidence in the peer-reviewed literature, however, that shows CIT’s benefits on objective measures of arrests, officer injury, citizen injury, or use of force.”).
21 (the Albany County Department of Mental Health 2020 local services plan found that “the level of need” for crisis services “is outweighing the available resources, time and expertise needed.”).
48 CAHOOTS: One worker said “we can hop on the radio and say like, ‘Hey, it doesn't sound like there's a crime happening, so we’ll spin around the block and we’ll go check in ... and let you know if any patrol is needed for that.’ We're able to respond to calls that come into dispatch on 911 . . . We can’t get those calls if we’re not plugged into that system the same way.” One officer recalled how officers felt about CAHOOTS when the program began, which was generally “[w]e’ve got these long-haired hippie guys driving around in a van . . . They’re on our police radios. Something’s not right.”
50 “EMS will soon also employ a tool called Telehealth” and “hire two full-time and one part-time clinician who will be able to answer video calls from paramedics or crisis intervention officers.” https://www.kxan.com/news/local/
“I think one of the primary things is the medic and crisis worker combination is what has allowed us to make such significant impacts in our community. By recognizing that behavioral health has a role in physical health, and physical health has a role in behavioral health, you're able to really kind of treat the whole patient. And there are a lot of folks out there where maybe they don't have the upbringing or the background to be able to articulate when they're not feeling well emotionally, but they will reach out to say, "My stomach hurts" – and so [you're] having that medic become this way for folks to [really] open up about what they're experiencing emotionally.”
88 See https://police.uoregon.edu/faq#cahoots (“The department works hand-in-hand with CAHOOTS on a regular basis, recognizing that police officers are not the appropriate resource to respond to every situation.”).
122 One of the CAHOOTS co-founders said at first, they “sort of had to prove [themselves] . . . It took maybe a year or two for the police and the wider community to get the idea of what CAHOOTS was and how they could use us.” However, the current CAHOOTS administrator said "[a]t this point, we’ve patiently waited out an entire generation of police officers . . . It’s been that slow of a process.” https://www.cnn.com/2020/07/05/us/
cahoots-replace-police-mental-health-trnd/index.html. CRU: The outreach services coordinator for the police department said for the program to build community trust, it had to prove it is “collaborative but separate” from law enforcement. https://www.themarshallproject.org/2020/07/24/crisisresponders. At the same time, the program has to build trust with the police department, with one CRU worker saying “I think they’re hesitant to let us just show up . . . They’re worried about our safety. But the cops are becoming more aware. We’ve been out here for over a year and none of us have been assaulted.” Id. Other workers say that police are deferring more calls to them and trusting them in a wider range of circumstances. See id.
125 CAHOOTS: From 1989 to 2011, the program consisted of one van that did not operate 24/7; the budget has subsequently been increased year over year because of demand for CAHOOTS’ services. See Jack Moran, “Second ‘Intervention’ Van Funded, THE REGISTER GUARD (Mar. 4, 2011) (on file with author). “Based on call volume, demand for CAHOOTS services has increased by over 58% from 2014-2017.” https://www.indybay.org/newsitems/
134 24/7 workers are dispatched through 211, and the manager of the 24/7 program says it is “crucial” that 211 is used so the “community feels empowered to respond.” In order to get Edmontonians to use 211, REACH ran a marketing campaign. See https://reachedmonton.ca/initiatives/24-7-crisis-diversion/. REACH is looking into the possibility of workers being dispatched directly by 911. On the other hand, CAHOOTS’ White Bird Clinic is looking at the possibility of the program having a standalone number, in addition to being dispatched directly by 911. In Olympia, clients wish there was a number other than 911 they could call. See https://www.themarshallproject.org/2020/07/24/
144 These arrangements are relatively new in the world of social-service financing, and aim to “invest” in programs that address root causes of social issues, thereby reducing long-term spending on social services. See generally https:/ /golab.bsg.ox.ac.uk/the-basics/impact-bonds/; https://youtu.be/nna8Mu-0o1E. The parties consist of (i) a service provider, (ii) one or more third-party financiers, and (iii) a government backer. The parties sign an agreement outlining specific metrics to determine the program’s success, and the service provider uses the financier’s funds. If the program meets the metrics, the government then pays back the financier, with interest. If the program does not meet the metrics, the government does not pay. This arrangement (a) allocates risk for innovative social programs to be placed with third parties, (b) allows government to distribute their payments to the third-party over time for a successful program, instead of the all-at-once funding associated with implementing the program itself, and (c) a properly constructed agreement will produce data for the length of the arrangement, which can then be used when reallocating funding for other programs.
148 The CAHOOTS administrator said that “CAHOOTS isn't some cookie-cutter [program] that you can just pick up from Eugene and just kind of plunk down in Houston and expect it to work the same, just bigger.”