For today’s Daily Critical Issues Report, PERF Executive Director Chuck Wexler spoke with officials from Fort Collins and Boulder, Colorado about their co-responder programs.

The Fort Collins Police Department recently established a Mental Health Response Team, which partners a police officer, a community paramedic, and a mental health co-responder. Chief Jeffrey Swoboda spoke with PERF about the program.

In Boulder, the co-responder clinicians were just brought on as city employees after seven years of partnering with the police department as contractors. Boulder Chief Maris Herold and Lucy Larbalestier, who leads the co-responder team, discussed their city’s program.

FORT COLLINS

Wexler: Tell me about your co-response team.

Chief Jeffrey Swoboda: Our team is in its third iteration. About two and a half years ago, we had a grant with a local mental health professional service, and they provided us with a co-responder to go out with different officers on different nights.

For phase two of this, our local health care provider, UC Health, partnered with us and took over the co-responder program. They also added a community paramedic to the partnership. They recognized early on that a trip to the emergency room could cost tens of thousands of dollars, while a co-responder and the mental health professional going to a call averaged less than $100  per call.

The third iteration is teaming up specific officers to work with co-responders. They’re housed in the police department, but the only thing we pay for is the police officers. The mental health professionals are paying for the community paramedic. We have partners who work in the mental health area. So we’re not increasing the police department budget at all, but we have two different teams, each with a community paramedic, social worker, and a police officer, who are able to go out and address issues.

Wexler: When a call comes into 9-1-1, how do you determine whether to assign one of these co-responder units?

Chief Swoboda: There are certain types of calls they are always sent to. One is a suicidal subject, or someone threatening suicide. Another is welfare checks. The officers working will also proactively speak up and take calls, especially when they hear the location or who is involved.

Wexler: Are these co-responders in the same vehicles? And do you have 24/7 coverage?

Chief Swoboda: The community paramedic and the social worker are in one vehicle. We wanted the police officer in their own vehicle, because they may have to transport someone, or leave that call and go to something else.

We are in the process of getting our second team, so we are not at 24/7 coverage yet. We’ll be hiring our sixth person soon, then we’ll cover 20-24 hours a day, 7 days a week.

Right now our coverage is 7 days a week for 10 hours a day. To set our hours, we looked at the data. Generally speaking, we try to get coverage from noon to 10 p.m., but on Thursday-Sunday, they’re starting a little bit later.

Wexler: Who is in charge of this team?

Chief Swoboda: We have a lieutenant running this program. He also runs our SWAT team and other special teams. The team is going to a lot of our repeat call locations, to proactively look at the area and where hazards may be. We felt that we should coordinate that with our SWAT team.

Whenever our officers are working, they report to our sergeants on the street. The officer, community paramedic, and social worker go out as a team, and if they need a supervisor, they would ask for one who is on the street.

Wexler: How much does this program cost?

Chief Swoboda: It’s not saving any money, because we still have the police officers, but that’s the only portion we pay. Our officers are spending about 25% more time on these calls than our patrol officers were able to. Because these officers are not tied to the radio, they’re able to do more problem-solving.

They’re also able to skip the emergency room on many occasions, because we now have a specially-trained social worker who can get them into resources that a police officer traditionally would not be able to get them into. That’s a time-saver.

We looked at frequent call locations and people we interacted with frequently. We’ve really driven those numbers down, because we were able to get people sustained help.

The best part of this program is that when there’s not a call, this team goes back out to follow up on previous calls. So if we were with Joe because he was having suicidal thoughts, within 48 hours our team is back at Joe’s house, talking to him and asking him if he’s had his medication. Having a paramedic there is huge, because they’re able to talk about the person’s medications and take their vitals. When there’s no crisis going on, this team is out building rapport.

Wexler: What is your goal for this program?

Our goal for this team was to increase the safety at the scene for everyone: the person in crisis, the police officer, and community members. And we want to route community members to the appropriate level of care, not just take them to jail or the hospital.

Wexler: What happens if this team is involved in a situation that escalates to a use of force?

Chief Swoboda: If there’s any use of force, our social service people are out of it. It’s not uncommon for one of our mental health officers to ask for another officer to come when they see a situation may escalate. The mental health professional and community paramedic are witnesses and don’t get involved. It becomes a standard use-of-force investigation by the police department.

BOULDER

Wexler: Tell me about your co-response team.

Chief Maris Herold: The Boulder Police Department has had a pretty traditional co-response team. Lucy Larbalestier has led that for about six years. Due to budget changes and because of all the outreach our Department of Housing and Human Services has done regarding mental health and people experiencing homelessness, Lucy and her team were transitioned to the Department of Housing and Human Services. They are still stationed here in the Police Department, and we still have a strong relationship with them.

The team is all licensed mental health clinicians. They can sign mental holds, which I think is unique. So it’s a slightly different spin on the traditional co-response model.

Lucy Larbalestier: We’re located in the Police Department, so we can respond on calls. Our office is right next to the patrol/report-writing area. We listen to the radio. If it’s folks we know, we will stage on a call. Just this morning an officer came by our office, said he was following up with someone who he thought might be having a psychotic break, and asked us to go out with him.

We go on all types of calls. The data from last year showed that we responded on calls with people ranging from age 9 to 94. We go to family disturbances, people who are suicidal, people having a first psychotic break, and people who are having a meth-induced psychosis. We see people who are just really struggling and need somebody to talk to. We see people with dementia, brain injuries, and chronic mental health issues.

We try to avoid hospitalizing people whenever possible. We try to avoid an unnecessary trip to the ER. One of our goals is to keep people in the community as much as possible. Because the clinicians on the team all have experience assessing people for that level of care, we’re able to provide essentially the same assessment they would receive in a hospital ER.

Wexler: How do you determine who is dispatched to calls?

Larbalestier: We don’t ride with police officers. We have a vehicle and ride separately. Officers are dispatched first, and our involvement is somewhat up to dispatcher and officer discretion. There are times when dispatchers will get us going right away, and there are times when officers will get us going right away. They hear the nature of the call, it sounds like mental health, and they ask us to start going right then and there.

Other times it might take a little time to figure out what’s going on with the call, or we don’t know where the person is. Then they might wait until there’s actually contact before requesting that we respond out.

So either the dispatcher, officer, or clinician will recognize there’s a behavior health element to a call.

Wexler: How long has this program been operating?

Larbalestier: The program has been in existence for seven years, and I’ve been on the co-responder team for six of those years. We just transitioned to being city employees.

Wexler: How do you assess the effectiveness?

Larbalestier: That’s the million-dollar question with co-response: How do we measure effectiveness, and what does effectiveness mean for your community? I think different communities will have different answers to that question.

It’s hard to say what would have happened if we weren’t there. When this was a contracted program, I think one of the challenges we had was communicating outcomes between the mental health center and the city. I think one reason the city wanted to bring it in-house was so they could have more usable data.

To me, the city bringing us on board is a measure of the success. The Police Department recognizes that this is something officers want. They use this program and see its value.

Chief Herold: I’m happy that Housing and Human Services is taking this project on, because now we can be more evidence-based than we have been with the co-response model. I think there’s going to be a lot of pressure on us to look at programs like CAHOOTS, so I really want to understand what’s happening after Lucy and her team are dispatched to these risky situations.

Wexler: Chief Herold, how does this tie into the ICAT training program?

Chief Herold: The center of ICAT is the sanctity of human life. When you’re coming at tactical decisions based on that concept, it changes the dynamics of behavior and use of force. So I think those two pair well together. I think ICAT is perfectly aligned with the concepts Lucy and her team train on.

Wexler: What does this program cost? Would it be expensive for other cities to implement?

Larbalestier: It’s not our situation, but I think there’s a lot of grant funding available, at least in our state. Colorado has made this a huge priority, and the Office of Behavioral Health offers a lot of grant money for municipalities to start co-responder programs.

Wexler: Is there anything else you’d like to add?

Chief Herold: I think this is a great model, and I know Fort Collins has a robust system as well. I love the fact that everyone on the staff is a clinician. I’ve called Lucy on the weekend about a call, and she has records, can make phone calls, and understands people.

Chief Swoboda: These are homegrown systems that aren’t all identical. I like that every community is doing it a little differently, instead of just taking one model and trying to replicate it.

The PERF Critical Issues Report is part of the Critical Issues in Policing project, supported by the Motorola Solutions Foundation.

PERF also is grateful to the Howard G. Buffett Foundation for supporting this work.