TRANSFORM911Blueprint Chapter Seven

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Ensuring the Right Response at the Right Time

A diverse ecosystem of responses reduces reliance on the police by default.

What are we calling for? We are calling for significant investment in a diverse ecosystem of response options so that callers can be met with the right response at the right time. These response options can and should include the availability of experts in triaging crises in ECCs as well as connections that enable 911 professionals to transfer calls to hotlines or virtual and on-scene responders skilled in managing a host of community needs, including homelessness, mental health crises, substance use crisis, and domestic violence.

Why is this essential? People call 911 for a wide swath of reasons, ranging from noise complaints to mental health crises to requests for information and much more, and though only a small fraction require a law enforcement response, nationwide 911 professionals do not have a diverse ecosystem of responses to deploy. For this reason, it is critical that the 911 system move away from police as the default response by tapping into a more robust, relevant ecosystem including, but not defaulting to, police. This transformation is essential to ensure that 911 can provide access to a full range of appropriate immediate responses around the clock to support callers’ wellbeing and relief from distress when their social networks and the people and resources around them are not sufficient to address the crisis appropriately.

While police are one resource that may merit deployment, they are the default for most 911 systems nationally, even though more than 75% of 911 calls for service dispatched to the police are not related to public safety threats that obviously merit a law enforcement response.[1] This is an artifact of the history of 911,[2] attitudes and assumptions within the first responder ecosystem, and the general public (where 911 and the police are often conflated), and the reality that many ECCs currently are divisions within, and therefore subordinate to, law enforcement agencies. This creates significant mismatches for both the community and the police.

In a qualitative study of the history of 911 conducted by Transform911 partners from the Black Belt African American Genealogical and Historical Society, people who were in or around Haleyville, Alabama, in 1968 (911’s birthplace and year, respectively) who were interviewed in focus groups reflected predominately on medical emergencies, not police encounters. This same group expressed the opinion that emergency services differ greatly between urban and rural areas, with callers in rural areas having to endure long response times and ultimately not receiving the right response with the right tools for their needs. Due to this inconsistency of services, some expressed concerns about calling 911. These interviews highlight the need for consistent, reliable, timely, appropriate, and accessible responses.

Many communities have semiformal and formal resources that allow them to address crises in ways that are responsive and sensitive to the particularities of the community that can fill out the first responder ecosystem. Ensuring that these responders are reflected in the response options available to 911 call takers and dispatchers is vital, as is ensuring a robust ecosystem of response options more generally. Many promising practices have been introduced to provide people with augmented access to appropriate medical, social service, and community resources in lieu of or in addition to EMS/fire/police response.[3] These responses can be in-person or remote, with the COVID-19 pandemic rapidly expanding the use of telemedicine for emergency services.[4] First responder ecosystem responders other than police, fire, and EMS can include non-law-enforcement government actors, professionals who accompany traditional responders, contracted community-based organizations, and community collectives. The ecosystem should address not only mental health and substance use but also false alarms, animal control, domestic altercations, traffic, and calls involving low-level crimes, among others.

The most important elements of the field responder ecosystem are that they are both responsive to community needs and tailored to those experiencing the emergency. The choice between responses that involve police and those that don’t may be a false choice. There are credible reasons for deploying both types of responses, depending on the circumstances. For example, some localities may be hesitant to send non-police teams to calls that involve a crime in progress. However, in many cities, trespassing is a crime—and often one that may involve unhoused individuals. Similarly, in some places, there may be hesitancy to send non-police response teams when it is unknown whether the subject of the call is armed with a weapon. However, while one may be able to say with certainty whether someone in their household has access to a weapon, one can never be certain of this when calling about a third party, like a stranger on the street who appears to be experiencing a mental health crisis. Many would agree that responding to either types of these calls should involve social workers or others who are trained to address the underlying needs. Whether or not the response should also involve police will depend to some degree on local circumstances. We therefore support not one over the other but instead support responses that truly meet community and individual needs.

Instituting additional response options simultaneously free up law enforcement officers’ time so that they can redirect their efforts where they can be most impactful, and it provides appropriate responses for all community members, including those who face crises but who won’t call 911 for fear that doing so could precipitate an uncomfortable, distressing, or even lethal encounter with law enforcement.[5] This concern may be particularly salient among people of color; people who are undocumented; people who have unmet mental health needs or substance use concerns; people who are engaged in sex work or other illegal activities; and/or people with intellectual, developmental, and/or physical disabilities.

Hotlines serve an important role for community members who have been inadvertently harmed by institutional emergency responses to crises and could provide continued support as efforts are made to transform the operations of, and available responses by, centralized emergency response centers. A key piece of the ecosystem is the new 988 suicide prevention and mental health crisis hotline that will launch nationwide in July 2022. Individuals who call or text 988 will be connected to a trained counselor who will listen and provide support and connections to needed resources. 988 offers opportunities to decouple care and support from enforcement and is long overdue. Of course, implementing 988 will require us to address many strategic and operational details. Many of the recommendations from this blueprint should also be applied to the new 988 system.

A comprehensive ecosystem of responses should include robust, well-marketed, and transparent hotline options, including both those directly connected and not connected to centralized emergency response centers. When effective, widely known hotlines are available; they may also reduce the burden on the 911 system while channeling callers more efficiently to appropriate resources. This transformation is essential to ensure that 911 can provide access to a full range of appropriate immediate responses around the clock to support callers’ wellbeing and relief from distress when their social networks and the people and resources around them aren’t sufficient to appropriately address the crisis.

Actions Regarding Alternative Responses

1. Prioritize connecting 911 to the least restrictive, most therapeutic responses possible. Consider that even in some dangerous situations, police may still not be the right response or be equipped to successfully resolve the acute need. Unnecessary police encounters introduce risk of arrest, trauma, and injury.[6]

  • Review 911 data to identify community needs that are best met by service providers other than armed police officers. These needs will likely include mental health and substance use concerns, homelessness, domestic abuse, and minor conflicts.[7]
  • Conduct a community asset map to identify existing resources; build on what is already there and identify what is missing.
  • Create structures for data sharing and coordination.
  • The city of Albuquerque, New Mexico, created the Albuquerque Community Safety (ACS) department, which responds both to 911 and 311 calls to provide an alternative to a police response to mental illness, substance use, and homelessness issues. Calls are triaged by 911 or 311 to the ACS department, which then sends either a co-responder team (police officer and mental health professional), a mobile crisis team (two behavioral health responders), or community responders. The agency also has street outreach to provide assistance in coordination with other city agencies to address problems related to homelessness.
  • In Raleigh, North Carolina, city leaders are exploring the creation of a non-police auto accident response program. Currently, North Carolina state law mandates that police officers investigate all traffic crashes, and an analysis of Raleigh’s calls for service suggests that officers spend an inordinate amount of time on such calls. However, rather than attempting to change statewide law, Raleigh and several other North Carolina cities are seeking to pass local legislation, which would then be recognized by the state, allowing them to send non-sworn personnel to accidents that do not involve injury.
  • Washtenaw County, Michigan,[8] recently launched its Community Responder Services program, a mental-health-related response partnership between the Washtenaw County Sheriff’s Office (WCSO) and Washtenaw County Community Mental Health (CMH). This multidisciplinary response program will deploy a sheriff’s deputy and a trained behavioral health clinician who will respond together to provide full spectrum, trauma-informed care. Prior to launching the initiative, WCSO and CMH conducted extensive focus groups with people with lived experience, service providers, and service provider leadership. The program’s primary stated goal is to provide the most appropriate service possible to individuals experiencing mental- or behavioral-health crises.

2. Emphasize and prioritize trauma-informed, culturally sensitive, person-centered responses that conform to the following principles:

  • Empower the community to lead and direct response:
    • Listen to community voices every step of the way—starting with and consistently returning to the people most impacted for feedback and ideas.
    • Build community ownership.
  • Ensure that response organizations are based in and know the culture of the communities they serve. Fund and contract with existing organizations and nonprofits to respond.
  • Focus on community knowledge and supporting existing community solutions, which may be informal but are centered in people’s real experiences and needs. Invest in the people who have done this work historically without compensation.
  • Recognize that crisis response may not look the same every time or for every person.
  • Honor the individual’s particular needs.
  • Think about the solution that the community wants, and then what tools are needed to get to that solution, when designing alternative response systems.
    • An example of an approach to gathering community input on decision-making in the police department is the Tucson, Arizona, Police Department’s recent community safety survey, which launched in partnership with Just Communities Arizona. The survey will gather community reactions and suggestions for the department’s Community Safety, Health and Wellness Program, which aims to address race disparities.
  • 911 should offer a menu of responses that are tailored to the need. In some cases—including, for example, those where violence is occurring or is likely—police involvement is likely warranted. However, in many instances, police may not be necessary and may in fact be counterproductive. Responses should be tailored to the situation as well as the milieu and context in which the response is occurring.


Actions Regarding Alternative Hotlines

3. Develop a streamlined process with protocols to receive and transfer emergency calls from 911 centralized ECCs to hotlines for particular calls for service types.

  • For example, in Harris County, Texas, behavioral health specialists are embedded with traditional 911 call-takers to decrease reliance on police to respond to non-emergency mental health calls. This partnership between the Houston Police Department, the Houston Fire Department, the Houston ECC, and the Harris Center for Mental Health and Intellectual and Developmental/Disabilities allows all of the partners to work from the same technology platform, allowing for streamlined call handoffs, faster response times, and more appropriate responses.

4. Ensure marketing of hotlines and training for call-takers to assist in developing trust amongst partners and callers by promoting transparency in what to expect during a call for service and emphasizing that callers make their own informed decisions.

  • An example of this is the Policing Alternatives and Diversion (PAD) initiative in Atlanta, Georgia, which accepts calls from 311 to connect to people in crisis. PAD organizers are active in their communities to introduce the resource and accept opportunities to participate in media about the resource.
  • The Trans Lifeline provides support to the trans community when they need it through a 24/7 bilingual crisis hotline staffed by trans people. The lifeline abides by several key principles to care for the privacy of those who call them—all information is kept strictly confidential, and no other party will be engaged in the call unless the caller provides consent.

5. Position hotlines—both those that fall within the 911 interoperability infrastructure and those that don’t—to provide immediate access to personalized supports for callers through the following:

  • Offer comprehensive training to hotline call takers, instructing them on how to identify the caller’s need, prevent or de-escalate an emerging crisis, and advocate on behalf of the caller to ensure timely warm handoffs to community services and resources as appropriate.
  • Have a mechanism in place to follow up with a caller after the crisis has been resolved, as appropriate and consented to by the caller. We refer to these approaches as “second response.” Why is this important to consider in the context of 911? First or crisis response is really about how to manage an event. While improvements to first response are both critical and necessary, they are also insufficient because even the best iteration of crisis response will do little to meet underlying needs. Typically, what happens in the aftermath of a 911 call is nothing. Second response is about intervening after the fact to prevent that next 911 call from happening. It involves following up with individuals, but doing so when they are not in crisis to make sure they are connected to the social support and treatment they need.
  • Equip hotlines with the capability to deploy mobile responses where and when appropriate.

6. Establish hotlines that are cost free, sustainably funded, widely accessible, and equipped to support high call volumes around the clock.

  • In the context of 911, the FCC requires wireless carriers to transmit all 911 calls regardless of whether the caller subscribes to the carrier’s services or not. This same rule should apply to all similar hotlines.
  • We also note that the rules regarding the transmission of a 911 caller’s geolocation continue to evolve. We strongly support an ever-increasing standard for geolocation accuracy for 911. It is important to note, however, that while most 911 callers may expect their location to be shared with great accuracy, callers to other hotlines may have a different expectation of privacy,[9] particularly given the potentially sensitive nature of their calls (e.g., in the context of mental health crises or suicidality). Thus, in the context of these other hotlines, the transmission of caller geolocation should be considered with great care and attention paid to properly balancing the helpfulness of accurate geolocation with these privacy expectations.
  • Create safe and accessible options for support to as many people as possible, by providing technology for multiple access points (i.e., phone, text, chat, email, website, including access to certified interpretation services: e.g., ASL, spoken language).
  • Offer hotlines at no cost to callers, whether they call from pay phones or cell phones.
  • Equip hotlines with the infrastructure to operate 24/7 as would align with centralized ECCs and the capacity to support callers during times of high 911 call volumes for relevant calls for service.
  • Many cities already offer hotlines such as 311. Funding for these hotlines varies, but some cities, like New York City, offer a model for sustainable funding by incorporating 311 into the Department of Information Technology and Telecommunications’ annual operating budget.
  • As recommended in chapter five on workforce, action item 7, we must ensure that 911, 988, and other hotlines are sustainably funded and that one system isn’t deprioritized in order to fund the others.


Case Studies: Alternatives in Action

The Support Team Assisted Response Program in Denver, Colorado, deploys a team of emergency medical technicians and behavioral health clinicians to engage people experiencing crises related to mental health, poverty, homelessness, and substance use. It is available by calling 911 or the city’s non-emergency number. The program is starting to show some positive impacts and was recently expanded citywide and 24/7.
The Crisis Assistance Response and Engagement program in Chicago, Illinois, takes a multi-pronged approach to alternative crisis response. First, the city is embedding mental health clinicians into the ECC to provide support to callers, dispatch, and response teams to preempt cyclical calls with a mental health component by attending to underlying needs and resolving issues without the need to dispatch response teams where feasible. Chicago is also deploying three alternative response models, including a multidisciplinary response team (which includes a crisis intervention team–trained officer) as well as two forms of non-police response teams (one model is composed of a community paramedic and a mental health professional; the other includes a community paramedic and a peer support specialist). Post-response, the program will work to link residents to community-based services to address the underlying needs and will offer geographically distributed drop-off sites for persons experiencing a behavioral health crisis, as alternatives to emergency rooms, to provide more comprehensive care.
Domestic Violence Incident Response and Support Team in St. Joseph County, Indiana, is a dedicated domestic violence multidisciplinary response team, including a police officer and a social worker, both of whom are trained in trauma-informed approaches. The team responds to the scene together to ensure safety and immediately link survivors with mental health resources, shelter options, food, and/or transportation. As part of the grant supporting the program, officers in the department get training in how best to respond to domestic violence situations and the influence of trauma on survivors and their families.
Homeless Outreach and Medical Emergency (HOME) Team in San Francisco, California, delivers comprehensive care, including linkages to social services and medical treatment, to frequent 911 utilizers who compose as many as 40% of the medical transports in some cities. The HOME team primarily serves people experiencing homelessness, poverty, mental illness, substance use, or living with disabling conditions.
Case Assessment Management Program (CAMP) in Los Angeles, California, manages cases involving people with a history of mental illness, ranging from those with a history of violent criminal activity caused by mental illness to those who frequently utilize police resources. Mental health professionals’ pair with detectives to explore solutions to persistent situations that result in large numbers of calls to the police. CAMP was selected as a Bureau of Justice Assistance learning site and offers technical assistance to other agencies.
Certified Community Behavioral Health Clinic (CCBHC) Medicaid demonstration programs have been launched in 10 states across the US. The CCBHC model is congressionally approved, creating a new Medicaid reimbursement approach for mental health and substance use prevention, treatment, and recovery service delivery. CCBHCs focus on delivering whole health care and comprehensive access to a full range of medical, behavioral, and supportive services to meet the needs of their communities. CCBHCs must be able to provide clinicians and paraprofessionals who can respond on site to a person in crisis and thus make good partners as alternative responders. Staff can also be embedded in a 911 call center. In Austin, Texas, for example, integral care clinicians are embedded into the Austin Police Department’s 911 Call Center and were able to divert 82% of calls from law enforcement response.

Domestic Incident Recommendations

Domestic violence incidents and domestic disturbances are potentially volatile and unfortunately a relatively common type of 911 call that often results in police response. Yet the presence of police is not always the most calming or supportive option for the involved parties, who may include children and other family members. Moreover, these calls tend to cause police officers, agencies, and municipal governments great concern, as they can pose grave risks for police officers, 911 callers, and other community members.  Due to the critical and sensitive nature of these incidents, and the scarcity of innovative alternatives to police responses and police co-responses that have been developed and implemented to date, Transform911’s Alternative First Responders workgroup worked diligently over the course of this effort to devise a novel set of recommendations and considerations on how best to respond to them. This diverse workgroup consisted of law enforcement officers, community advocates, and other stakeholders with unique experiences. The recommendations were further refined in response to edits from experts in the domestic violence community.

Deploying unarmed alternative responders, including trained conflict mediators, crisis de-escalators, social workers specializing in trauma, and other appropriate professionals, could result in a response that better meets the needs of the involved parties and sets them on a path to healing and conflict reduction. These responders may be dispatched with or instead of police, or after/before police, depending on the situation, and should be held to rigorous minimum training and supervision standards. Unarmed alternative responders can de-escalate immediate conflict, assess danger, provide support and resources, and conduct follow-up care, creating support structures for safer communities and families.

Action Items:

  • Collaborative response models, including police and unarmed conflict mediation/de-escalation/social work professionals/domestic violence advocates/victim service providers (“alternative responders”), should be implemented to respond to incidents of intimate partner violence, domestic violence, and domestic disturbances. These incidents may include different combinations of family members or partners and particular care needs to be taken when children are present. The role and involvement of each responder should be based on the volatility of each situation, as determined by a 911 call taker, in conversation with an involved party or witness, and with care for the involved parties (survivors of violence, people accused of perpetrating violence, and other people present, including children) as a priority. Care should be taken to consider that the presence of armed police and/or an arrest may heighten tensions in the situation, particularly for people of color.
    • For example: if firearms are not known to be present and no physical injury has been reported, it may be appropriate for an alternative response unit to respond to the incident alone, without law enforcement officers.
      • Police may then arrive later to take statements or file reports, as needed or requested, after the conflict has been de-escalated.
      • If the conflict escalates to physical violence, alternative responders should be able to request police support.
    • When ongoing physical assault or battery is reported, conflict mediators and/or trauma counselors should respond along with police and medical personnel.
    • If a caller is not in immediate danger, either reporting ongoing abuse or a past incident, it may be appropriate to send alternative responders without police, particularly if the caller makes frequent calls for service about the same issue.
  • Alternative responders should be selected based on community knowledge and credibility, including community regard/existing roles and previous intervention as a bystander or volunteer. Legitimacy needs to be built within the neighborhood—responders should be trusted as individuals and as competent responders.
    • This goes beyond being in a “peer” or “lived experience” category—ideally, responders will have existing relationships within the community/neighborhood in which they work. Having expertise or skills in de-escalating conflicts in their neighborhood is an important asset.
  • All responders should take a trauma-informed approach and be prepared to de-escalate incidents, prioritize safety, and provide resources. Alternative responders should also be equipped to mediate interpersonal conflict, offer advocacy, and provide other support.
    • For example, Dayton, Ohio, has developed an unarmed mediation response unit to intervene in minor, nonviolent issues. Mediation staff are trained in de-escalation techniques and can spend more time with parties than police can.
    • Depending on the safety and risk assessment by the 911 professional, law enforcement or alternative responders can be dispatched.
    • Mental health crisis de-escalation training alone is not enough, nor is de-escalation training designed for a controlled environment (e.g., jail, inpatient unit) sufficient; specific minimum training standards for multiparty conflict in the field are necessary.
    • Responders should also be trained and required to assess for homicide danger and escalating risk of violence or trauma, using an appropriate tool. These assessments should be logged and stored so that repeat calls can be checked for a pattern of escalation over time.
      • Technology vendors and 911 governing bodies should enable and require careful logging, secure storage, and monitoring of data related to domestic violence incidents, with special care paid to the privacy and security of involved parties as well as to monitoring for increasing threat.
      • Responders should have training in intimate partner violence, gender identity, child neglect, elder abuse, signs of traumatic brain injury, confidentiality laws, and other relevant topics.
  • Alternative responders should follow up with individuals, perhaps through secondary responses, or through referrals (and, ideally, warm handoffs) to service agencies.
    • Follow-up care providers could be introduced by the alternative responder in person and/or via video call or other telehealth service to facilitate a virtual handoff.
  • Safety needs to be considered—both the safety of the responders and the safety of the parties involved in the incident.
    • 911 call takers tend to be conservative about sending unarmed civilian responders into potentially dangerous situations. However, social workers who do community fieldwork may be able to assess and defuse potentially volatile situations and should have the independence to decide to respond.
    • Situations considered “low-risk,” such as welfare checks, may be handled more safely by alternative responders than by police.
    • Legal liability and relevant statutory requirements will also need to be carefully considered as jurisdictions decide when to send alternative responders without police.
  • Care should be taken to minimize the feelings of threat that can arise from the presence of a first responder. For example, if bulletproof vests are worn, they should be worn underneath external clothing if possible.
  • It is important for communities devising new domestic abuse police responses to be aware that mandatory arrest laws can make it difficult to implement an alternative response that de-emphasizes arrest. Furthermore, collaborative response programs need to consider the fact that mandatory arrest in domestic violence situations can make situations worse for the family as a whole—that arresting a parent, sibling, caretaker, or primary source of income can increase the level of chaos experienced in a household, and arrest is associated with an increased risk of death (especially for African American families) of the partner.[10] Domestic violence incidents can also be among the most dangerous calls for police and other professionals to respond to. Moreover, the time period immediately following when a survivor tries to leave or has left is when they are most at risk of further abuse and death. Training for any responder or team should specifically address these complex issues. At the same time, care needs to be taken to seriously consider threats made against others in the household and what the best strategy is to keep people safe, including any professional deployed to respond. The collaborative response should focus on the survivor’s choice for actions taken whenever possible. The response should also include initiating safety planning for domestic abuse survivors and consider the following:
    • Creating stationary and mobile de-escalation and assessment centers or another place for people accused of initiating conflict to go voluntarily—besides jail—could be beneficial.
    • Creating, or resourcing existing instances of, temporary centers for survivors of domestic violence that prioritize the care and support of these individuals is a necessary complement to centers or units that intervene with people accused of initiating violence.
[1] S. Rebecca Neusteter et al., “Understanding Police Enforcement: A Multicity 911 Analysis,” Vera Institute of Justice, September 2020,[2] 911 was first activated in the United States in 1968, under then president Johnson, with the goals that 911 would (a) reduce first responders’ response time; (b) increase arrests; and (c) allow a more immediate response to crime. President Johnson was warned at that time that 911 would likely attract calls that didn’t involve threats to public safety or exigent harm. As jurisdictions across the country began to implement 911 locally, many of these early adoptions only included police as potential responders. New York City offers one such example. When New York launched 911 on July 1, 1968, calls for police response increased by 40% in just the first year, with fewer than half of these calls stemming from emergency situations, and resulting in 7.5% more police deployments.
[3] Matt Delaus, “Alternatives to Police as First Responders: Crisis Response Programs,” Albany Law School Government Law Center, November 16, 2020,
[4] National Highway Traffic Safety Administration, “FICEMS Releases Telemedicine Framework for EMS and 911,” Federal Interagency Committee on Emergency Services, May 2021,
[5] Matthew Desmond et al., “Police Violence and Citizen Crime Reporting in the Black Community,” American Sociological Review 81: 5 (2016);  Emily van der Meule et al., “‘That’s Why People Don’t Call 911:’ Ending Routine Police Attendance at Drug Overdoses,” International Journal of Drug Policy 88 (2021),
[6] We envision a limited scope in which 911 can directly connect with secondary responders. To be clear, we are not recommending that 911 should be a switchboard for all human and social services.
[7] Transform911: Assessing the Landscape and Identifying New Areas of Action and Inquiry,
[8] See this longform piece in Politico about the personal impacts of reforms happening in Washtenaw County:
[9] The FCC hosted a forum around geolocation and privacy challenges for 988 in May 2022:
[10] Lawrence W. Sherman and Heather M. Harris, “Increased death rates of domestic violence victims from arresting vs. warning suspects in the Milwaukee Domestic Violence Experiment (MilDVE),” Journal of experimental criminology 11, no. 1 (2015): 1-20,

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