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Building It While We’re Flying It: Challenges in Building and Running a Co-responder Program

Most of us are on new ground here. Some co-responder programs have been around for a long time, but each community’s needs are unique. Each will have its own local requirements, and will need to develop its own policies and procedures. Rural areas will have different issues than urban areas; they will work with geographical size problems, issues finding qualified staff, and will have fewer level-of-care options. Urban areas will wrestle with call volume, clinical team size, a larger law enforcement group to sell the idea to. Here, though, are some challenges I’ve observed to be universal:

Funding: A co-responder program has to be paid for and that part always is, and probably always will be, a challenge. There are two main things to keep in mind:

First, a co-responder program is almost certain to save significantly more than it costs.

One of the programs I worked with had a distressed community member who was calling 911 up to four times a day. That program had peer support as part of it's design, and a gifted peer spent very carefully calculated time with that client, slowly backing out, until in 2015 he only called 911 once. That probably paid for the entire program by itself; and perhaps more importantly, frustration is reduced for emergency services staff and this client has an observable--if not measurable--improvement in quality of life.

Which brings us to the second thing to remember about funding: we are still learning all of the hidden benefits (see our blog post "It's Not Just the Money"). A well-designed co-responder program saves money and improves quality of life. there a better way to spend our dollars?

Collecting the Right Data: It's hard to prove the value of a co-responder program because you can't say for certain what would have happened if the mental health staff hadn't been there. So, let's plan ahead, get a baseline at the beginning, and look for data-driven policy once we can demonstrate the difference. This also highlights another data challenge: since this is an emerging field, we change as we learn. Once a change from the original design has been made--necessary for success, unless you have a crystal ball--you'll need different data than we expected and planned for.

Safety For the Clinician: Should they wear a vest? Or does that increase their likelihood to be a target? Should they help de-escalate, or just do an assessment after the scene is cleared? Where do we draw the line? It's far better to have these questions answered ahead of time when possible.

When Should Clinicians Engage? Example: you have a respondent threatening to jump from a bridge onto a busy highway. The negotiator is forty minutes out, but the co-responder is here, now. They are not trained to negotiate. Should the mental health staff engage...

Training: ...or should they be trained to negotiate? The training staff will need will be informed in part by the policies and procedures chosen. Also, it’s important to realize that this is not standard mental health work. They cannot and will not teach clinicians how to do this work in graduate school.

Hiring: Again, this is not typical mental health work. Howard Schultz, former CEO of Starbucks, famously said: "If your company mission was to climb a tree, which would you rather do--hire a squirrel, or train a horse?"

A specific set of staff characteristics enhances success. If the clinician is of a more vulnerable constitution, the frequent exposure to trauma and crisis can cause early burnout. On the other hand, if the clinician is in it for the action, if they are too forward on-scene, or if they are indifferent to the suffering they are working with, a different set of challenges arises. Getting the hiring right the first time save a lot of hassle.

Supervision of Clinical Staff: All staff need supervision. Will your budget support a supervisor as part of the team? Or will your clinical staff be supervised by law enforcement staff (how much sense does that make)? When law enforcement entities work with community mental health centers to build their program, this issue is often resolved. But then personnel issues can arise; if there is a conflict between mental health staff and law enforcement staff, how will that be dealt with?

Information Sharing and Documentation: Law enforcement records management systems are not well suited to health care documentation. How will your staff document their interventions? And how will that documentation remain private from non-clinical agency staff? Again, when law enforcement entities and mental health centers work together, this issue is resolved because mental health staff will document in the mental health center’s health record. But another challenge arises: health providers are required to protect the privacy of their clients. What information can be shared, and under what circumstances? States as well as local areas and agencies often have restrictions beyond just HIPAA.

These are some of the challenges that need consideration when building a co-responder program. Each community will plan differently, but each will need to answer at least these basic questions.

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