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Community Safety Crisis Response Pilots

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1. Why did the City start with “pilots”?

Other U.S. cities are building confidence in the new types of first responses that Durham has been piloting, by sending unarmed responders to 9-1-1 calls and showing this can be done in a way that meets the needs of those in crisis and is consistent with the safety of all involved, including the responders. You can find successful alternative response programs operating in cities across the U.S. that are similar to each DCSD pilot. 

So, why pilot? 

The most important reason to start small is so that we can learn how to do this well here in Durham. While others are seeing success with these new approaches to crisis response, there is still a lot to learn and figure out. For example, cities have different eligibility criteria and different staffing models. By calling these pilots, we mean that we do not believe we have everything figured out at the outset. By starting small and paying close attention to the data, we can learn what approaches work best before scaling them citywide and 24/7. In this way, we intend to refine and make changes to these models to best meet the needs of Durham residents. 

2. What is Crisis Call Diversion (CCD)?

CCD embeds clinicians in Durham’s 9-1-1 call center so we can quickly connect you to a mental health professional when you or a loved one is experiencing a behavioral health crisis.

When we launch, DCSD will have 1 clinician embedded in 9-1-1.  This will grow to two clinicians by late Summer 2022.

3. What is a Community Response Team (CRT)?

CRT dispatches unarmed, 3-person teams as first responders instead of police when you call 9-1-1 about non-violent mental health crises or quality of life concerns. DCSD currently has 3 Community Response Teams in the field. 

4. What is Co-Response (CoR)?

CoR dispatches Clinicians alongside Police Officers when to 9-1-1 calls about mental health crises or other quality of life concerns that have a higher risk for violence. 

5. What is a Care Navigator (CN)?

After meeting with one of our responders during a crisis, you may need additional support connecting to community-based care. Care Navigation provides follow-up, either in person or over the phone, from our clinicians and peer support within 48 hours after the initial 9-1-1 interaction. 

6. Where do these HEART units operate?

Crisis Call Diversion runs citywide in Durham. The other pilots will primarily operate in 12 police beats (111, 114, 112, 113, 122, 214, 223, 411, 413, 511, 512, 513) represented in this HEART service area map. 

7. Why don’t all units operate citywide? Will they ever?

During the initial pilot phase of this work, DCSD has not had sufficient staffing to support citywide responses. For pilots that demonstrate they better position the City to meet the needs of residents in crisis, we plan to increase staffing over time to expand crucial crisis response services citywide. 

8. How did you select the service area and why use police beats?

Because we do not have enough responders to staff a citywide service area, we prioritized beats that had the highest number of eligible 9-1-1 calls for our units to start. We then created a contiguous service area (one connected service area instead of multiple smaller areas) for efficiency purposes (reduces transportation time between calls allowing teams to serve more people). We selected police beats because these geographic areas already exist within our 9-1-1 system and creating all new service boundaries would have taken more time and been too complicated for a pilot.

9. What are the hours of operation for each pilot?

Community Response Teams (CRT) currently operate 7 days a week, 10:00am – 9:00pm. Crisis Call Diversion (CCD), Co-Response, and Care Navigation currently operate Monday – Friday, 9:00am – 5:00pm. DCSD will update Durham residents when these changes in hours of operation go into effect. 

10. Why don’t units operate 24/7? Will they ever?

During the pilot phase of this work, DCSD has not had sufficient staffing to support 24/7 responses. For pilots that demonstrate they better position the City to meet the needs of residents in crisis, we hope to increase staffing over time to expand crucial crisis response services 24/7, similar to what we expect from other first responders. We ultimately want successful HEART response available to Durham residents whenever they are needed. 

11. How did you select the hours of operation?

We ultimately plan for pilots to run 8:00am – 11:00pm. In examining the data for eligible 9-1-1 calls to see when calls most often occur, we selected hours of operation that would make our pilots available during hours where they when they were most often needed. 

12. Will these new responses slow down 9-1-1 in sending a response as call takers have to learn about the new responses?

We have taken time to fully integrate these new responses into our 9-1-1 system and to provide training to call-takers and dispatchers. The benefit of integrating our new responses into the 9-1-1 system is that it does not place added burden on call-takers to learn a new system. 

The Durham 9-1-1 call center relies on a highly programmed and automated system. Based on how you answer the the call-taker’s pre-defined script of questions when you call 9-1-1, that system generates one of over 1,000 call types. The system then recommends the appropriate type of first responder to the call-taker, so that the call-taker doesn’t have to make a decision about who to send.  We have taken the time to program in our new responses into this system, which will help us avoid adding strain on the 9-1-1 system or slowing down a system designed to quickly send the right response. 

13. How are you going to keep unarmed responders safe?

Keeping our responders and other people on the scene safe is a top priority of DCSD and we have taken time and care to plan our pilots to mitigate safety risks. Our safety plans include the following: 

• We have selected eligible calls types where arrests, assaults, and violence are incredibly rare occurrences – less than 1% of 1%. 
• We have excluded call types that would otherwise be eligible if a weapon is present or if there is physical violence toward others. 
• Our responders are fully visible to 9-1-1. We will know where our responders are and will be able to communicate with them. 
• Our responders will have radios and will be able to call for police backup, if necessary. 
• Our responders will receive one month of intensive training prior to responding to calls, including training in situational awareness and de-escalation. 

Durham is not the first to dispatch unarmed responders to non-violent calls for service. For instance, Denver, CO has been doing so since 2020 and has responded to over 3,500 calls (common calls include trespass and welfare check) and have yet to call police for back up a single time. San Francisco, CA and Eugene, OR both dispatch unarmed responders who radio for backup on average 2% of the time – with none resulting in arrests or violence. 

14. Can I request one of these responses?

Call 9-1-1 for all emergencies. If your call is eligible for one of DCSD’s pilots and one of our responders is available, 9-1-1 will dispatch the appropriate response. In general, while you may request a specific kind of response, 9-1-1 dispatchers will send the response that is most appropriate given the needs of the caller. 

15. Is there a number other than 9-1-1 to request these services?

You may call the non-emergency line at (919) 560-4600, but that number is also answered by our 9-1-1 Call Center staff. All DCSD’s responses run through 9-1-1 at this time. 

16. Why do I have to go through 9-1-1 to get an unarmed response?

Integrating our responses into the 9-1-1 center makes sense for many reasons. First, it is the one number people know to call in an emergency. So, if we want to send the right response to crises, it makes sense to start with the most common number people call. Second, reliably staffing call centers is extremely difficult, and it takes a lot of people and resources. So, it makes sense to start off by integrating our pilots into an existing system that runs 24/7 and that has the infrastructure already in place to support our needs. 

17. What kinds of personnel are staffing these units, and what kinds of training have they had prior to starting with DCSD?

DCSD first responders fall into three broad categories of skills, training and expertise:

Licensed Clinician	Peer Support Specialist	EMT
Someone who has a Master’s degree, if fully licensed, over 1,000 hours of supervised work and over 3 years of post-graduate experience. This role includes: Screening and assessing people experiencing crisis with mental health and substance use; providing therapeutic interventions, case management, and personalized services that connect people to community-based mental health providers.	Someone who knows the community, has relevant lived-experience, and has been trained and formally certified as a specialist. This role includes: De-escalating situations, promoting engagement in care, fostering relationships between residents and other community responders, and making connections with residents to gain trust and move them to be open to care.	Someone who has been trained to provide basic life support care and is credentialed by the state. This role includes: Assessing people for potential medical emergencies, providing life support and pre-hospital emergency medical care to individuals, and helping identify underlying medical needs that may present initially as mental health needs.

18. What kinds of additional training will DCSD staff have prior to responding to calls for service?

DCSD responders will participate in over 4 weeks of intensive training that includes but is not limited to: de-escalation, mental health first aid, racial equity, HIPAA and confidentiality, motivational interviewing, situational awareness for scene safety, trauma-informed care, suicide prevention, mental health disorders, substance related disorders, developmental disabilities, and more. We will be posting our staff onboarding plan soon. 

19. What kinds of calls for service are eligible for HEART and how did you select them?

Our Community Response Teams (CRT) focus on the following 9-1-1 calls for service: nonviolent mental health crisis, suicide threat, trespass, welfare check, intoxicated person, assist person, panhandling, indecency, and prostitution calls. If these calls involve a person in possession of a weapon or exhibiting physical violence towards others, they will not be eligible for an unarmed response. Instead, they are eligible for our Co-Response unit. 

20. How are these programs being evaluated?

DCSD is committed to rigorous, third-party evaluation on all of our HEART units. Currently, we are partnering with RTI and UNC Center for Health Equity Research to conduct evaluations of our program to better understand what is working well and what aspects of HEART need to be refined or even overhauled. DCSD will share the results of the evaluations on our website and with City leaders upon their completion. 

21. How can I follow the progress of the HEART program?

DCSD is committed to transparency. Starting in August 2022, DCSD began publishing updated dashboards accessible through our website that shares a range of information on our program, including: 

• the number of calls we've responded to by call type;
• the number of eligible calls we were not able to respond to due to staffing levels; 
• the percent of calls where our responders had to radio for police backup and the outcome of those calls;
• the average response time; 
• the percent of calls that resulted in a transportation to the ER versus community-based care; 
• the percent of calls where we were able to follow up with our neighbors within 48 hours of an encounter with one of our crisis response teams; 
• the percent of individuals who were connected to the care they needed and wanted.

22. How did you develop these pilot plans? Who did DCSD work with to plan?

Over the past 9 months, DCSD has lead a thorough, careful planning process that was community-informed, highly collaborative, data driven and evidenced based.

Community-Informed: We have been conducting in-person resident interviews, focus groups and listening sessions. We also held two bilingual virtual town halls with Durham Community Safety and Wellness Task Force. We have directly engaged over 400 residents to date. You can view past town halls and read about what we learned from our community engagements on our website. 

Highly-Collaborative: We formed a multi-agency planning team with our public safety partners (Emergency Medical Services, Durham Police Department, Department of Emergency Communications Center [911], Durham Fire Department), Alliance Health, Criminal Justice Resource Center, UNC School of Social Work, Housing for New Hope, Research Triangle Institute (RTI), & Recovery Innovations to plan pilots. We also conducted multiple ride-alongs with Durham police officers & interviews with peer support specialists, community health workers, mental health professionals, and met with local community organizations to help plan.

Data-driven: We analyzed 3 years of Durham 911 calls to better understand which calls are appropriate for our pilots. We also conducted a use-of-force analysis and built data tools that allow us to analyze calls by volume, frequency, location, risk level, and response time.

Evidence-based: We’ve taken time to learn from many US cities leading similar work, including Albuquerque NM, Austin TX, Atlanta GA, Charleston SC, Denver CO, Greensboro NC, Houston TX, Philadelphia PA, Portland OR, & San Francisco CA, among others. We’re also part of a national cohort of five U.S. cities launching pilots this year. You can see a few of those cities' presentations to Durham residents at our October 2021 virtual town hall. 

23. Why did the City create the Community Safety Department?

Statement from City Manager Wanda Page about the creation of the Community Safety Department: “One of the highest priorities areas we think about, and work on daily, is how best to keep our residents safe and well. It’s no secret that there is great concern about violent crime in Durham. At the same time, there is concern about the history of policing in our country and its impact on people of color. Right now, Durham has an opportunity to lead the way and find new, equitable, and innovative approaches to keep our community safe and well.    The creation of this department reflects our belief that responding to the safety and wellness needs of all of our residents requires more than police officers, firefighters, and paramedics. Our first responders remain absolutely necessary and crucial to our public safety services moving forward. We still need policing to help protect our community.  But, it’s unfair to expect them to address every single issue our residents experience. For example, to expect that - on top of everything they must do - they address mental and behavioral health needs or connect residents to social services to help them through a crisis. I’d like to note that many of our officers also support exploring other ways to address 911 calls that don’t need an officer response. Meeting these sorts of diverse needs requires that we broaden our imagination of what public safety and first responders look like in Durham. I believe, as does the City Council, that creating this department is an important first step in that journey.”