Impact
Studying Outcomes of Durham, NC’s Holistic Empathetic Assistance Response Teams (HEART) and Greensboro, NC’s Behavioral Health Response Team (BHRT)
Objective
To determine whether alternative police response programs for mental health and quality-of-life 911 calls lead to different incident-level outcomes compared to traditional policing, including incident response and on-scene times, transports, arrests, citations, and offense reports.
Approach
RTI leveraged a rare research opportunity created by two programs’ 911 call triage procedures, documentation practices, and capacity constraints. All response-eligible calls were systematically identified and recorded, regardless of whether they received an alternative response. Because alternative response teams couldn’t respond to every eligible call, researchers were able to directly compare call events handled by alternative responders against similar calls handled by patrol officers. To provide deeper context and a more nuanced understanding of the findings, we supplemented the outcome data with insights from surveys, focus groups, and interviews with leadership, staff, and officers.
Impact
Through this work, RTI established a methodology to conduct a robust quasi-experimental study that advances the evidence around alternative responses.
Providing an Alternative to Traditional Law Enforcement
Over the past decade, U.S. communities have implemented alternative responses to traditional policing for mental health and quality-of-life emergencies. With funding from Arnold Ventures, RTI evaluated two such programs: Durham, North Carolina’s Holistic Empathetic Assistance Response Teams (HEART) and Greensboro, North Carolina’s Behavioral Health Response Team (BHRT). Operated by their respective cities' Community Safety Departments, these programs share a central mission: to de-escalate crises, connect community members with appropriate care, and reduce unnecessary involvement of law enforcement.
How HEART and BHRT Operate
Durham’s HEART program features three primary response options: a crisis call diversion clinician embedded in the 911 center; an unarmed Community Response Team (CRT) staffed by a clinician, peer specialist, and EMT; and a co-response team pairing a clinician with a Crisis Intervention Team (CIT) officer. In Durham, emergency communications centers use specific call-nature codes, standardized labels used by emergency communications to describe what the call is about, and conditional logic to identify eligible 911 calls and dispatch the appropriate responders directly.
Greensboro’s BHRT uses a co-response model in which counselors and CIT officers respond together in unmarked vehicles. A community health paramedic is also available to address minor medical needs, and counselors may provide referrals for follow-up services. In Greensboro, call-takers triage incoming 911 calls and identify BHRT-eligible incidents using a set of call-natures and supplemental mental health codes. Responders may be dispatched by emergency communications or self-dispatch to eligible calls.
RTI Evaluates the Implementation, Impact, and Costs of the HEART and BHRT Programs
Building on RTI's previous work with the Carolina Cohort of Cities project, researchers conducted comprehensive evaluations of both the HEART and BHRT programs. Findings were compiled into a HEART brief report and a BHRT brief report.
Each evaluation featured a process assessment to measure program fidelity, a quasi-experimental impact review to track incident outcomes such as arrests and transports, and a cost-benefit analysis comparing the alternative models with traditional police response.
- For Durham’s HEART program, the evaluation provided strong evidence that dispatching an unarmed Community Response Team (CRT) in lieu of police significantly reduces the likelihood of enforcement-related outcomes. Among eligible calls, CRT dispatch was associated with lower rates of offense reports, arrests, and citations. Read the full report here.
- For Greensboro’s BHRT Program, responses to disorder-related call events were associated with a lower probability of offense reports and arrests. While many BHRT responses included a simultaneous patrol dispatch, when BHRT responded independently to behavioral health incidents, they resolved the calls without requiring any enforcement actions. Read the full report here.
The results from Durham’s HEART and Greensboro’s BHRT programs are compelling. Alternative responder models can successfully address 911 call events without police. These specialized teams have similar response times to police and spend slightly more time on scene to expertly de-escalate crises, assess needs, and connect individuals to supportive care. While such responses have modestly higher costs due to presence of two responders, they consistently fulfill their service-oriented mission and reduce the likelihood of arrests and formal offense reports for certain call types compared to traditional patrol responses.
