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- Multidisciplinary Response – Paramedic, Mental Health Professional, and Crisis Intervention Team Officer
- Alternate Response: – Paramedic and Mental Health Professional
- Opioid Response – Paramedic and Peer Recovery Specialist
We present results from an implementation evaluation of this pilot intervention.
Methods: Qualitative interviews were designed in accordance with the Consolidated Framework for Implementation Research (CFIR) to explore perspectives on program logistics, contextual and internal-organizational facilitators and barriers, partner relationships, operational successes and challenges.
We conducted forty-four qualitative interviews from September 2022 through January 2023. Respondents included 911 professionals, direct service staff, and leadership from the City of Chicago Office of the Mayor, Chicago Department of Public Health, Chicago Fire Department, Chicago Police Department, Chicago Office of Emergency Management and Communications, and Emergency Medical Services Region 11. Data were initially analyzed utilizing the Stanford Lightning Report Method (SLRM), followed by Rapid Qualitative Analysis.
Results: As identified by program leaders, implementation successes included increased trust across agencies, alignment on CARE’s mission, and positive feelings toward the interagency partnership. Respondents acknowledged the critical importance of piloting innovative approaches to address the individualized needs of people in crisis. Identified implementation barriers included the need to navigate preexisting agency cultural dynamics, operations, and missions. Differences in agency policies and protocols, standard operating procedures, and approval processes posed significant implementation challenges. For example, existing agency policies created situations where frontline staff working together on a team had different shift start/stop times and break/lunch hours. Similarly, varying agency approval processes led to extended timelines for operational decisions related to vehicle configurations, uniforms, and mobile/handheld technologies.
As identified by direct-service staff, successes included enhanced service delivery through multidisciplinary collaboration and service delivery. Direct-service staff reported feeling valued and highly supported by direct agency leadership. Staff-identified implementation barriers included lack of resources in the community and safety concerns. In particular, some respondents identified the need for police when responding to calls in settings with high rates of community violence.
Conclusions and Implications: Leaders and direct service staff from all agencies embraced CARE’s core mission of alternative first response. Obstacles to effective implementation included cross-agency cultural differences, lack of community-based referral resources, and unresolved differences in agency policies, protocols, and operations. Respondents identified community- and event-specific safety concerns that tend to arise during specific types of 911 service calls.
Our findings provide critical lessons for Chicago and contribute to a growing body of knowledge regarding alternate response programs. CARE’s implementation findings underscore the value of a common mission, shared goals, and complementary organizational practices across first-response agencies. Finally, our findings underscore the importance of addressing safety concerns that constrain CARE teams’ ability to reduce the police footprint in emergency response.