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Brief Description
= Introductory Paragraph =
= Introductory Paragraph =


Law enforcement officers and other first responders, such as emergency medical technicians, firefighters, and paramedics, are on the front lines of the illicit substance use epidemic, frequently responding to drug overdoses and calls for services involving individuals with substance use and co-occurring disorders. In response, a variety of law enforcement-led diversion and fire/emergency medical services (EMS)-led responses have emerged across the country. In partnership with substance use disorder (SUD) treatment providers, peers, and recovery personnel, these multidisciplinary programs are helping to reduce overdoses by connecting individuals to community-based treatment.
In addition to law enforcement officers, other first responders, such as emergency medical technicians, firefighters, and paramedics, are on the front lines of the illicit substance use epidemic. They frequently respond to drug overdoses and calls for services involving individuals with substance use and co-occurring disorders. As a result, a variety of law enforcement-led diversion and fire/emergency medical services (EMS)-led responses have emerged across the country. In partnership with substance use disorder treatment providers, peers, and recovery personnel, these multidisciplinary programs are helping to reduce overdoses by connecting individuals to community-based treatment. First-responder diversion programs represent a pivotal opportunity to redirect individuals with SUDs, mental health disorders, and co-occurring disorders away from jails or emergency departments and toward community-based treatment for substance use, mental health services, recovery support, housing, and social services.<ref>https://www.cossapresources.org/Content/Documents/Articles/CHJ_Pathways_to_Diversion_Self-Referral.pdf</ref>
 
<br/> &nbsp;Law enforcement and first-responder diversion program models represent a pivotal opportunity to redirect individuals with SUDs, mental health disorders (MHDs), and co-occurring disorders away from jails or emergency departments and toward community-based treatment for substance use, mental health services, recovery support, housing, and social services.<ref>https://www.cossapresources.org/Content/Documents/Articles/CHJ_Pathways_to_Diversion_Self-Referral.pdf</ref><br/> <br/> .&nbsp;
 
&nbsp;


= Key Information =
= Key Information =


<br/> There are two approaches used by first responders-&nbsp;&nbsp;“deflection” and “pre-arrest diversion.” Deflection and pre-arrest diversion are&nbsp;complementary practices of a systems approach at the intersection of first responders, SUD and MHD treatment, recovery support, and community. These two practices, always taken together as a single coin, are simply referred to as the “field of deflection.”&nbsp;
There are two approaches used by first responders -- “deflection” and “pre-arrest diversion.” These are detailed in the SAFE article titled, "Expand Law Enforcement Assisted Diversion and Deflection Programs." <ref>https://www.yoursafesolutions.us/wiki/Expand_Law_Enforcement_Assisted_Diversion_and_Deflection_Programs</ref> It is important to note, as two sides of the same coin, deflection and pre-arrest diversion are complementary practices of a systems approach at the intersection of first responders, behavioral health service providers, recovery support, and community. These collaborative interventions connect public safety with public health systems to create community-based pathways to treatment and services for people who have SUD, mental health disorders, or co-occurring disorders. In partnership with SUD treatment providers, other service providers, peers, deflection specialists, and recovery personnel, these multidisciplinary programs help reduce overdoses.


'''Deflection''' is the practice by which law enforcement or other first responders (i.e., fire and EMS) connect individuals to community-based treatment and/or services when arrest would not have been necessary or permitted, or in lieu of taking no action when issues of addiction, mental health, and/or other need are present. Deflection is performed without fear by the individual that if they do not “accept the deflection” they will subsequently be arrested.
= Relevant Research =


'''Pre-arrest diversion''' is the practice by which law enforcement officers connect individuals who otherwise would have been eligible for criminal charges to community- based treatment and/or services in lieu of arrest, thereby diverting them from the justice system into the community. Some pre-arrest diversion programs have policies that mandate holding charges in abeyance until treatment or other requirements, such as restitution or community service, are completed, at which time the charges are dropped. Although pre-arrest diversion is facilitated by justice system stakeholders (usually police and sheriffs but sometimes prosecutors or a local government agency), clients are diverted to community-based services.
'''PTACC''' published a research report on the benefits of diversion programs. Key findings indicate that despite the lack of large-scale and multi-site evaluation efforts, there are important trends emerging from early research on pre-arrest diversion initiatives across the US. Here are some key results drawn from empirical research on a variety of programs. <ref>https://secureservercdn.net/198.71.233.33/lpo.969.myftpupload.com/wp-content/uploads/2020/06/PTACC_Key_Research_FINAL.pdf</ref>


<br/> Pre-arrest diversion programs should not be confused with prosecutorial diversion, which occurs after individuals have already been arrested and become involved in the justice system; in contrast, pre-arrest diversion occurs before the filing of charges.
*Pre-Arrest Diversion represents the first intercept with the criminal justice system, making it a prime opportunity to redirect adults with mental health conditions and substance use disorders from jails and to connect them with community-based service providers.
*The majority of adults booked into local jails require mental health services and treatment for SUDs, which are typically not provided in local facilities.
*Behavioral health conditions are associated with repeat criminal justice contact, and SUDs are the strongest predictor of jail readmission.
*Pre-arrest diversion programs assess and address behavioral health needs associated with continual involvement in the criminal justice system.
*Preliminary results indicate participants who fully engage in pre-arrest diversion programs tend to have low rates of recidivism for extended periods of time.


There are five pathways in the field of diversion for first responders highlighted below. Each of which has the goal of providing a structured response that diverts a person exhibiting&nbsp;behaviors due to substance use, mental health disorder, or other treatable condition to an appropriate medical or treatment agency. For each of the pathways, the targeted population or circumstance appropriate for the pathway is elaborated.
<br/> In 2014, Treatment Alternatives for Safe Communities (TASC), Center for Health and Justice (CHJ) developed the first iteration of the Five Pathways to Treatment, which offered different pathways for deflection that first responders could use to move someone from the justice system at the point of contact with law enforcement to community-based treatment. Each pathway has unique characteristics that make it appropriate to address particular problems such as SUD, OUD, MHD, homelessness, and other issues. Identifying and naming these pathways created a common language for practitioners to use in the new, emerging field of deflection.<ref>https://www.cossapresources.org/Content/Documents/Articles/CHJ-TASC_Nation_Survey_Report.pdf</ref>
These programs are collaborative interventions connecting public safety (e.g., law enforcement, fire, and emergency medical services [EMS]) with public health systems to create community- based pathways to treatment and services for people who have SUD, mental health disorders (MHD), or co-occurring disorders. In partnership with SUD treatment providers, other service providers, peers, deflection specialists, and recovery personnel, these multidisciplinary programs help reduce overdoses through connection to community-based treatment and services. For law enforcement, deflection programs can enable individuals to receive referrals to services without fear of arrest if the individual does not accept deflection (in cases when law enforcement would have otherwise taken no action) or can serve in lieu of arrest when charges are present and an arrest would have otherwise occurred.
&nbsp;
*''Self-Referral'': An individual voluntarily initiates contact with a first-responder agency (law enforcement, fire department, or EMS) for a treatment referral. If contact is initiated with a law enforcement agency, the individual makes that contact without fear of arrest. Individuals with SUDs are targeted population.<ref>https://www.cossapresources.org/Content/Documents/Articles/CHJ_Pathways_to_Diversion_Self-Referral.pdf</ref>
*''Active Outreach:'' A first responder intentionally identifies or seeks out individuals with SUDs to refer them to, or engage them in, treatment; outreach is often done by a team consisting of a clinician and/or peer with lived experience. Individuals with SUDs are targeted population.
*''Naloxone Plus'': A first responder and program partner (often a clinician or peer with lived experience) conducts outreach specifically to individuals who have experienced an overdose recently to engage them in and provide linkages to treatment. Individuals with opioid use disorder are the targeted population.
*''First-Responder/OfficerPrevention'': During routine activities such as patrol or response to a service call, a first responder conducts engagement and provides treatment referrals. If a law enforcement officer is the first responder, no charges are filed or arrests made. The targeted population are persons in crisis, or with noncrisis mental health disorders and SUDs, or in situations involving homelessness or&nbsp; sex work.&nbsp;
*''Officer Intervention:'' (applicable only for law enforcement) During routine activities such as patrol or response to a service call, a law enforcement officer engages an individual and provides treatment referrals or issues noncriminal citations for that individual to report to a program. Charges are held until treatment and/or a social service plan is successfully completed.&nbsp; The targeted population are persons in crisis, or with noncrisis mental health disorders and SUDs, or in situations involving homelessness or sex work.
.
= Relevant Research =
<span style="background:white"><span style="background:white"><span lang="EN" style=""><span style="font-style: normal;">PTACC Key Findings<ref>https://secureservercdn.net/198.71.233.33/lpo.969.myftpupload.com/wp-content/uploads/2020/06/PTACC_Key_Research_FINAL.pdf</ref></span></span></span></span>
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= Impactful Federal, State, and Local Policies =
= Impactful Federal, State, and Local Policies =


<span style="background:white"><span style="background:white"><span style="color:black">Strategies are often locally designed and implemented, they do not operate in a legal or political vacuum. Communities are subject to state laws and regulations that directly impact their ability to institute pre-arrest diversion and other crisis response strategies.</span></span></span>
Communities are subject to state laws and regulations that directly impact their ability to institute pre-arrest diversion and other crisis response strategies. Often, strategies are locally designed and implemented and do not operate in a legal or political vacuum. Laws that grant local officials noncriminal responses to crises can propel diversion efforts or provide alternative, supplemental crisis responses. Laws that require criminal responses or otherwise circumscribe when and how non-law enforcement responders are able to intervene can impede them. Current statewide barriers exist in pre-arrest diversion and crisis response strategies.
<div style="border-bottom:solid #a2a9b1 1.0pt; padding:0in 0in 10.0pt 0in">
<span style="background:white"><span style="background:white"><span style="color:black">Laws that grant local officials noncriminal responses to crises can propel diversion efforts or provide alternative, supplemental crisis responses. Laws that require criminal responses or otherwise circumscribe when and how non-law enforcement responders are able to intervene can impede them. Current statewide barriers exist in pre-arrest diversion and crisis response strategies.</span></span></span>


<span style="background:white"><span style="background:white"><span style="color:black">R Street Statewide Policies report reviews all fifty states relating to Pre-arrest diversion and crisis response including legal status and legislative actions. </span><ref>https://www.opioidlibrary.org/wp-content/uploads/2019/12/R_Street_Statewide_Policies_Relating_to_PAD_Crisis_Repsonse.pdf</ref></span></span>
'''R Street''' has a Statewide Policies report which reviews legal status and legislative actions in all fifty states relating to pre-arrest diversion and crisis response. <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/12/R_Street_Statewide_Policies_Relating_to_PAD_Crisis_Repsonse.pdf</ref> Policies relating to pre-arrest diversion and crisis response include:
*Emergency Mental Health Hold laws authorize certain first responders to take an individual experiencing a mental health crisis into a form of civil custody in order for them to be evaluated by appropriate mental health or medical personnel.
*Protective Custody. These procedures operate as the substance use analog to emergency mental health holds by authorizing first responders to place an individual experiencing an acute substance use episode in temporary civil custody.
*Citation Authority statutes permit or require law enforcement officers to issue a citation to individuals alleged to have committed certain specified offenses, instead of detaining them or placing them under arrest.
*Good Samaritan laws offer immunity from arrest, criminal charges, prosecution or conviction for limited, drug-related offenses as an incentive for individuals to call for assistance for someone experiencing a suspected overdose.
*Ambulance Transport laws and regulations can influence where emergency medical services may take an individual experiencing a crisis, potentially by requiring transport to a hospital emergency department or otherwise discouraging the use of alternative destinations.


'''<span style="background:white"><span style="background:white"><span style="color:black">STATEWIDE POLICIES RELATING</span>&nbsp;<span style="color:black">TO PRE-ARREST DIVERSION AND CRISIS RESPONSE:</span></span></span>'''
'''Illinois Senate Bill 3023''' is one example of legislation on deflection. The 2018 Community-Law Enforcement Partnership for Deflection and Substance Use Disorder Treatment Act authorizes and encourages local law enforcement leaders to partner with treatment and community members on programs that deflect individuals who have overdosed or who have substance use problems away from the justice system and into addiction treatment services. <ref>https://www.centerforhealthandjustice.org/chjweb/tertiary_page.aspx?id=84&title=SB-3023-Community-Law-Enforcement-Partnership-for-Deflection-and-Treatment#:~:text=Illinois%20Senate%20Bill%203023%2C%20signed,that%20%E2%80%9Cdeflect%E2%80%9D%20individuals%20who%20have</ref>


<span style="background:white"><span style="background:white"><span style="color:black">Emergency Mental Health Hold- Emergency mental health hold laws authorize certain first responders to take an individual experiencing a mental health crisis into a form of civil custody in order for them to be evaluated by appropriate mental health or medical personnel.</span></span></span>
= Available Tools and Resources =
 
<span style="background:white"><span style="background:white"><span style="color:black">Protective Custody -Protective custody procedures operate as the substance abuse analog to emergency mental health holds by authorizing first responders to place an individual experiencing an acute substance abuse episode in temporary civil custody.</span></span></span>


<span style="background:white"><span style="background:white"><span style="color:black">Citation Authority- Citation authority statutes permit or require law enforcement officers to issue a citation to individuals alleged to have committed certain specified offenses, instead of placing them under arrest, booking or detaining them.</span></span></span>
'''SAMHSA''' provides a guidebook titled, "Crisis Intervention Team (CIT) Methods for Using Data to Inform Practice: A Step-by-Step Guide. <ref>https://www.opioidlibrary.org/document/crisis-intervention-team-cit-methods-for-using-data-to-inform-practice-a-step-by-step-guide/</ref>


<span style="background:white"><span style="background:white"><span style="color:black">Substance use Good Samaritan- Substance abuse Good Samaritan laws offer immunity from arrest, criminal charges, prosecution or conviction for limited, drug related offenses as an incentive for individuals to call for assistance for someone experiencing a suspected overdose.</span></span></span>
'''SAFE Project:'''
</div>
*'''SAFE Connections.''' This SAFE Project subprogram of the SAFE Choices portfolio provides an opportunity to impact youth recidivism and redirect young lives toward reaching their full potential.<ref>https://www.safeproject.us/safe-choices/connections/</ref>
*<ul style="list-style-type:circle">
*'''Bridging Prevention and Recovery (BPR): A Community Approach to Systems Change.''' This SAFE Project program, offered in-person and virtually, guides community leaders through an action-oriented model to systemically integrate prevention and recovery systems to strengthen programs and improve outcomes. BPR is a 3.5 day training program that culminates with 6 technical assistance sessions tailored to each community’s unique set of needs to support implementation and sustainability of joint prevention and recovery community projects.<ref>https://www.safeproject.us/bridging-prevention-recovery/</ref>
</ul>  </ul>
*See the wiki titled "Improve Links to Treatment for People who Experience Non-Lethal overdoses or Naloxone Revivals" for more detailed information on ways to improve linkage to services for those who have experienced a non-lethal overdose or have survived a Naloxone revival. <ref>https://www.yoursafesolutions.us/wiki/Improve_Links_to_Treatment_for_People_who_Experience_Non-Lethal_Overdoses_or_Naloxone_Revivals</ref>
</ul>
</ul>
 
*<span style="font-size:11.0pt"><span style="font-family:">AZ Good Samaritan Law</span></span>
*<span style="font-size:11.0pt"><span style="font-family:">IL Good Samaritan Law<ref>https://www.centerforhealthandjustice.org/chjweb/tertiary_page.aspx?id=84&title=SB-3023-Community-Law-Enforcement-Partnership-for-Deflection-and-Treatment#:~:text=Illinois%20Senate%20Bill%203023%2C%20signed,that%20%E2%80%9Cdeflect%E2%80%9D%20individuals%20who%20have</ref></span></span>  
*<span style="font-size:11.0pt"><span style="font-family:">PPD Naloxone Directive</span></span>
&nbsp; <div style="border-bottom:solid #a2a9b1 1.0pt; padding:0in 0in 10.0pt 0in">
<span style="background:white"><span style="background:white"><span style="color:black">Ambulance Transport Destination- Ambulance transport laws and regulations can influence where emergency medical services may take an individual experiencing a crisis, potentially by requiring transport to a hospital emergency department or otherwise discouraging the use of alternative destinations.<ref>https://www.tasc.org/tascweb/article.aspx?id=529&title=Criminal-Justice-Reform:-Non-Law-Enforcement-1st-Responders%E2%80%94EMS-and-Fire%E2%80%94Eligible-to-Lead-Deflection-Programs-&date=Jan-25-2021</ref></span></span></span>
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= Available Tools and Resources =


Crisis Intervention Team (CIT) Programs: A Best Practice Guide for Transforming Community Responses to Mental Health Crises<ref>https://www.opioidlibrary.org/wp-content/uploads/2019/10/CIT-guide-desktop-printing-2019_08_16-1.pdf</ref>
'''Crisis Intervention Team International''' published "A Best Practice Guide for Transforming Community Responses to Mental Health Crises." <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/10/CIT-guide-desktop-printing-2019_08_16-1.pdf</ref>


Crisis Intervention Team (CIT) Methods for Using Data to Inform Practice: A Step-by-Step Guide<ref>https://www.opioidlibrary.org/document/crisis-intervention-team-cit-methods-for-using-data-to-inform-practice-a-step-by-step-guide/</ref>
'''The National League of Cities''' offers "Working Across Systems for Better Results: City Efforts to address Mental Health, Substance Use and Homelessness Through Emergency Response and Crisis Stabilization" highlighting case studies in cities in Kansas, Texas, and West Virginia. <ref>https://www.opioidlibrary.org/wp-content/uploads/2020/01/YEF_MentalHealth_IssueBrief2_Final.pdf</ref>


Working Across Systems for Better Results: City Efforts to address Mental Health, Substance Use and Homelessness Through Emergency Response and Crisis Stabilization<ref>https://www.opioidlibrary.org/wp-content/uploads/2020/01/YEF_MentalHealth_IssueBrief2_Final.pdf</ref>
'''Advanced Recovery Systems University''' provides an online library of webinars specific to mental health and substance use within the first responder community. <ref>https://arsuniversity.thinkific.com/collections?category=ba5e2b</ref>


= Promising Practices =
= Promising Practices =
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<span style="background:white"><span style="background:white">'''<span lang="EN" style="font-size:11.0pt"><span style="color:black">Anne Arundel County, Maryland: Safe Stations-</span></span>'''<span style="color:black">. Safe Stations is an innovative new program that shifts barriers to treatment for those members of our community who are eager to recover from drug addiction. Persons seeking treatment for addiction can visit any police or fire station across the county, day or night, to dispose of any paraphernalia and find assistance gaining access to care.<ref>https://www.annapolis.gov/1325/Safe-Stations</ref></span></span></span>
&nbsp;
<span style="background:white"><span style="background:white">'''<span lang="EN" style="font-size:11.0pt"><span style="color:black">Dixon, Illinois: Safe Passage-</span></span>'''<span style="font-size:11.0pt"><span style="color:black">People who realize they need help can go to one of the participating law enforcement agencies in Lee and Whiteside Counties, ask for help with their drug addiction, turn in their drugs (without fear of being arrested) and be placed into a treatment facility, usually within 24 hours.<ref>http://safepassage-saukvalley.com/</ref></span></span></span></span>
<span style="background:white"><span style="background:white"><span style="font-size:11.0pt"><span style="color:black">Once initial paperwork is completed, persons will be paired with a volunteer who will guide them through the process. Safe Passage is partnered with treatment centers throughout Illinois and the Midwest.</span></span></span></span>
<span style="background:white"><span style="background:white"><span style="font-size:11.0pt"><span style="color:black">'''Hope Not Handcuffs '''is an initiative started by Michigan based Families Against Narcotics (FAN), aimed at bringing law enforcement and community organizations together in an effort to find viable treatment options for individuals seeking help to reduce dependency with heroin, prescription drugs, and alcohol. It is a solution.<ref>​​​​​​​Hudson Valley, New York: Hope Not Handcuffs- https://www.familiesagainstnarcotics.org/hopenothandcuffs-ny</ref></span></span></span></span>
<span style="background:white"><span style="background:white"><span style="font-size:11.0pt"><span style="color:black">A person struggling with any drug addiction can come to any of the participating police agencies and ask for help. They will be greeted with support, compassion, and respect. If accepted into the program*, the individual will be guided through a brief intake process to ensure proper treatment placement.</span></span></span></span>
<span style="background:white"><span style="background:white">'''<span lang="EN" style="font-size:11.0pt"><span style="color:black">New Hampshire: Manchester Safe Station Program-</span></span>'''<span style="font-size:11.0pt"><span style="color:black">Victims of substance misuse disorder may seek help at any MFD Station. The Firefighters will arrange for or provide a medical assessment not to exceed their scope of training. If there is cause for concern that there is something else medically wrong with the patient, transportation to an appropriate level medical facility will be arranged for and provided by Manchester’s contracted 911 service AMR.</span></span></span></span>


<span style="background:white"><span style="background:white"><span style="font-size:11.0pt"><span style="color:black">Each individual seeking assistance will be required to drop any needles and/or paraphernalia in to a collection bin located at each fire station prior to speaking with coaches or seeking treatment.<ref>https://www.manchesternh.gov/Departments/Fire/Safe-Station</ref></span></span></span></span>
*'''Maryland.''' Safe Stations is an innovative new program in Anne Arundel County. It shifts barriers to treatment for those community members who are ready to recover from drug addiction. Persons seeking treatment for addiction can visit any police or fire station across the county, day or night, to dispose of any paraphernalia and find assistance gaining access to care. <ref>https://www.annapolis.gov/1325/Safe-Stations</ref>


&nbsp;
*'''New Hampshire.''' The Safe Station Program offers help to anyone with substance use disorder at any Manchester Fire Department. The firefighters will arrange for or provide a medical assessment within their scope of training. If there is cause for concern that there is something else medically wrong with the patient, transportation to an appropriate level medical facility will be provided. Each individual seeking assistance will be required to drop any needles and/or paraphernalia into a collection bin located at each fire station prior to speaking with coaches or seeking treatment. <ref>https://manchesterinklink.com/as-safe-station-ends-those-in-need-of-addiction-treatment-and-recovery-services-directed-to-call-2-1-1/</ref>


<span style="background:white"><span style="background:white">'''<span lang="EN" style="font-size:11.0pt"><span style="color:black">County, Alabama: Mercy Project-</span></span>'''<span style="color:black">The county had the fifth-highest per capita rate of overdoses in the United States and the highest overdose rate of any county in the state. As a result, County Sheriff Nick Smith wanted to create a program to help people struggling with SUD and reduce the recidivism rate resulting from substance misuse. Interested participants fill out an application and then receive consultation. People are ineligible for program entry if they are facing drug charges or have outstanding warrants. However, the consultation allows a potential participant to turn in any drugs or drug paraphernalia without the threat of arrest, and although the individual must still enter the justice system, drug court is an option. If the person is accepted into the program consultation determines individual treatment needs.<ref>https://walkercountysheriff.com/mercy-project.html
'''Ohio.''' The Hamilton County Heroin Task Force partnered with law enforcement, fire departments and social workers to create the Quick Response Team. It follows up with overdose victims and offers them addiction treatment. The goal is to have a first responder follow up with overdose victims within the “recovery window” (72 hours after an overdose reversal) and to provide a warm hand off to treatment options. Teams work to find overdose survivors using a database maintained by the Greater Cincinnati Fusion Center, a public safety data-collecting agency. Teams also use “predictive analysis” to track drug activity to target potential overdoses with the help of University of Cincinnati’s Institute of Crime Science. QRT has since been launched as a national model. <ref>https://www.cossapresources.org/Content/Documents/Diversion_Library/HCTF_Hamilton_County_OH_Program_Policy_508.pdf</ref>


</ref></span></span></span>
''' Tennessee.''' The Crisis Intervention Team (CIT) program is a community partnership working with mental health consumers and family members. Officers are part of a specialized team which can respond to a crisis at any time, and they will work with the community to resolve each situation in a manner that shows concern for the citizen’s well-being. The CIT is made up of volunteer officers from each Uniform Patrol Precinct. CIT officers are called upon to respond to crisis calls that present those officers, face-to-face, with complex issues relating to mental illness. CIT officers also perform their regular duty assignment as patrol officers. The Memphis Police Department has 268 CIT officers who participate in specialized training under the instructional supervision of mental health providers, family advocates, and mental health consumer groups. Due to the training, CIT officers can, with confidence, offer a more humane and calm approach. These officers maintain a 24/7 coverage. <ref>https://www.memphistn.gov/government/police-department/crisis-intervention-team/</ref>


&nbsp;
</div>
= Sources =
= Sources =

Latest revision as of 14:23, 24 October 2024

Introductory Paragraph

In addition to law enforcement officers, other first responders, such as emergency medical technicians, firefighters, and paramedics, are on the front lines of the illicit substance use epidemic. They frequently respond to drug overdoses and calls for services involving individuals with substance use and co-occurring disorders. As a result, a variety of law enforcement-led diversion and fire/emergency medical services (EMS)-led responses have emerged across the country. In partnership with substance use disorder treatment providers, peers, and recovery personnel, these multidisciplinary programs are helping to reduce overdoses by connecting individuals to community-based treatment. First-responder diversion programs represent a pivotal opportunity to redirect individuals with SUDs, mental health disorders, and co-occurring disorders away from jails or emergency departments and toward community-based treatment for substance use, mental health services, recovery support, housing, and social services.[1]

Key Information

There are two approaches used by first responders -- “deflection” and “pre-arrest diversion.” These are detailed in the SAFE article titled, "Expand Law Enforcement Assisted Diversion and Deflection Programs." [2] It is important to note, as two sides of the same coin, deflection and pre-arrest diversion are complementary practices of a systems approach at the intersection of first responders, behavioral health service providers, recovery support, and community. These collaborative interventions connect public safety with public health systems to create community-based pathways to treatment and services for people who have SUD, mental health disorders, or co-occurring disorders. In partnership with SUD treatment providers, other service providers, peers, deflection specialists, and recovery personnel, these multidisciplinary programs help reduce overdoses.

Relevant Research

PTACC published a research report on the benefits of diversion programs. Key findings indicate that despite the lack of large-scale and multi-site evaluation efforts, there are important trends emerging from early research on pre-arrest diversion initiatives across the US. Here are some key results drawn from empirical research on a variety of programs. [3]

  • Pre-Arrest Diversion represents the first intercept with the criminal justice system, making it a prime opportunity to redirect adults with mental health conditions and substance use disorders from jails and to connect them with community-based service providers.
  • The majority of adults booked into local jails require mental health services and treatment for SUDs, which are typically not provided in local facilities.
  • Behavioral health conditions are associated with repeat criminal justice contact, and SUDs are the strongest predictor of jail readmission.
  • Pre-arrest diversion programs assess and address behavioral health needs associated with continual involvement in the criminal justice system.
  • Preliminary results indicate participants who fully engage in pre-arrest diversion programs tend to have low rates of recidivism for extended periods of time.

Impactful Federal, State, and Local Policies

Communities are subject to state laws and regulations that directly impact their ability to institute pre-arrest diversion and other crisis response strategies. Often, strategies are locally designed and implemented and do not operate in a legal or political vacuum. Laws that grant local officials noncriminal responses to crises can propel diversion efforts or provide alternative, supplemental crisis responses. Laws that require criminal responses or otherwise circumscribe when and how non-law enforcement responders are able to intervene can impede them. Current statewide barriers exist in pre-arrest diversion and crisis response strategies.

R Street has a Statewide Policies report which reviews legal status and legislative actions in all fifty states relating to pre-arrest diversion and crisis response. [4] Policies relating to pre-arrest diversion and crisis response include:

  • Emergency Mental Health Hold laws authorize certain first responders to take an individual experiencing a mental health crisis into a form of civil custody in order for them to be evaluated by appropriate mental health or medical personnel.
  • Protective Custody. These procedures operate as the substance use analog to emergency mental health holds by authorizing first responders to place an individual experiencing an acute substance use episode in temporary civil custody.
  • Citation Authority statutes permit or require law enforcement officers to issue a citation to individuals alleged to have committed certain specified offenses, instead of detaining them or placing them under arrest.
  • Good Samaritan laws offer immunity from arrest, criminal charges, prosecution or conviction for limited, drug-related offenses as an incentive for individuals to call for assistance for someone experiencing a suspected overdose.
  • Ambulance Transport laws and regulations can influence where emergency medical services may take an individual experiencing a crisis, potentially by requiring transport to a hospital emergency department or otherwise discouraging the use of alternative destinations.

Illinois Senate Bill 3023 is one example of legislation on deflection. The 2018 Community-Law Enforcement Partnership for Deflection and Substance Use Disorder Treatment Act authorizes and encourages local law enforcement leaders to partner with treatment and community members on programs that deflect individuals who have overdosed or who have substance use problems away from the justice system and into addiction treatment services. [5]

Available Tools and Resources

SAMHSA provides a guidebook titled, "Crisis Intervention Team (CIT) Methods for Using Data to Inform Practice: A Step-by-Step Guide. [6]

SAFE Project:

  • SAFE Connections. This SAFE Project subprogram of the SAFE Choices portfolio provides an opportunity to impact youth recidivism and redirect young lives toward reaching their full potential.[7]
  • Bridging Prevention and Recovery (BPR): A Community Approach to Systems Change. This SAFE Project program, offered in-person and virtually, guides community leaders through an action-oriented model to systemically integrate prevention and recovery systems to strengthen programs and improve outcomes. BPR is a 3.5 day training program that culminates with 6 technical assistance sessions tailored to each community’s unique set of needs to support implementation and sustainability of joint prevention and recovery community projects.[8]
  • See the wiki titled "Improve Links to Treatment for People who Experience Non-Lethal overdoses or Naloxone Revivals" for more detailed information on ways to improve linkage to services for those who have experienced a non-lethal overdose or have survived a Naloxone revival. [9]

Crisis Intervention Team International published "A Best Practice Guide for Transforming Community Responses to Mental Health Crises." [10]

The National League of Cities offers "Working Across Systems for Better Results: City Efforts to address Mental Health, Substance Use and Homelessness Through Emergency Response and Crisis Stabilization" highlighting case studies in cities in Kansas, Texas, and West Virginia. [11]

Advanced Recovery Systems University provides an online library of webinars specific to mental health and substance use within the first responder community. [12]

Promising Practices

  • Maryland. Safe Stations is an innovative new program in Anne Arundel County. It shifts barriers to treatment for those community members who are ready to recover from drug addiction. Persons seeking treatment for addiction can visit any police or fire station across the county, day or night, to dispose of any paraphernalia and find assistance gaining access to care. [13]
  • New Hampshire. The Safe Station Program offers help to anyone with substance use disorder at any Manchester Fire Department. The firefighters will arrange for or provide a medical assessment within their scope of training. If there is cause for concern that there is something else medically wrong with the patient, transportation to an appropriate level medical facility will be provided. Each individual seeking assistance will be required to drop any needles and/or paraphernalia into a collection bin located at each fire station prior to speaking with coaches or seeking treatment. [14]

Ohio. The Hamilton County Heroin Task Force partnered with law enforcement, fire departments and social workers to create the Quick Response Team. It follows up with overdose victims and offers them addiction treatment. The goal is to have a first responder follow up with overdose victims within the “recovery window” (72 hours after an overdose reversal) and to provide a warm hand off to treatment options. Teams work to find overdose survivors using a database maintained by the Greater Cincinnati Fusion Center, a public safety data-collecting agency. Teams also use “predictive analysis” to track drug activity to target potential overdoses with the help of University of Cincinnati’s Institute of Crime Science. QRT has since been launched as a national model. [15]

Tennessee. The Crisis Intervention Team (CIT) program is a community partnership working with mental health consumers and family members. Officers are part of a specialized team which can respond to a crisis at any time, and they will work with the community to resolve each situation in a manner that shows concern for the citizen’s well-being. The CIT is made up of volunteer officers from each Uniform Patrol Precinct. CIT officers are called upon to respond to crisis calls that present those officers, face-to-face, with complex issues relating to mental illness. CIT officers also perform their regular duty assignment as patrol officers. The Memphis Police Department has 268 CIT officers who participate in specialized training under the instructional supervision of mental health providers, family advocates, and mental health consumer groups. Due to the training, CIT officers can, with confidence, offer a more humane and calm approach. These officers maintain a 24/7 coverage. [16]

Sources

  1. ↑ https://www.cossapresources.org/Content/Documents/Articles/CHJ_Pathways_to_Diversion_Self-Referral.pdf
  2. ↑ https://www.yoursafesolutions.us/wiki/Expand_Law_Enforcement_Assisted_Diversion_and_Deflection_Programs
  3. ↑ https://secureservercdn.net/198.71.233.33/lpo.969.myftpupload.com/wp-content/uploads/2020/06/PTACC_Key_Research_FINAL.pdf
  4. ↑ https://www.opioidlibrary.org/wp-content/uploads/2019/12/R_Street_Statewide_Policies_Relating_to_PAD_Crisis_Repsonse.pdf
  5. ↑ https://www.centerforhealthandjustice.org/chjweb/tertiary_page.aspx?id=84&title=SB-3023-Community-Law-Enforcement-Partnership-for-Deflection-and-Treatment#:~:text=Illinois%20Senate%20Bill%203023%2C%20signed,that%20%E2%80%9Cdeflect%E2%80%9D%20individuals%20who%20have
  6. ↑ https://www.opioidlibrary.org/document/crisis-intervention-team-cit-methods-for-using-data-to-inform-practice-a-step-by-step-guide/
  7. ↑ https://www.safeproject.us/safe-choices/connections/
  8. ↑ https://www.safeproject.us/bridging-prevention-recovery/
  9. ↑ https://www.yoursafesolutions.us/wiki/Improve_Links_to_Treatment_for_People_who_Experience_Non-Lethal_Overdoses_or_Naloxone_Revivals
  10. ↑ https://www.opioidlibrary.org/wp-content/uploads/2019/10/CIT-guide-desktop-printing-2019_08_16-1.pdf
  11. ↑ https://www.opioidlibrary.org/wp-content/uploads/2020/01/YEF_MentalHealth_IssueBrief2_Final.pdf
  12. ↑ https://arsuniversity.thinkific.com/collections?category=ba5e2b
  13. ↑ https://www.annapolis.gov/1325/Safe-Stations
  14. ↑ https://manchesterinklink.com/as-safe-station-ends-those-in-need-of-addiction-treatment-and-recovery-services-directed-to-call-2-1-1/
  15. ↑ https://www.cossapresources.org/Content/Documents/Diversion_Library/HCTF_Hamilton_County_OH_Program_Policy_508.pdf
  16. ↑ https://www.memphistn.gov/government/police-department/crisis-intervention-team/
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