Problems and Purpose

The problems and purpose behind HEART (Holistic, Empathetic, Assistance, Response Team) is found in the creation of the Community Safety Department in Durham, North Carolina. The department stems from a deep commitment to address the safety and wellness needs of residents in a more robust and equitable manner. Durham City Manager Wanda Page emphasizes the dual concerns of rising violent crime and the historical impact of policing on people of color [1]. Recognizing the limitations of traditional first responders, Page asserts the need for innovative approaches beyond police, firefighters and paramedics. The department aims to fill this gap by responding to diverse needs, such as mental and behavioral health, crisis intervention and social services. This desire sparked the creation of HEART. The establishment represents a shift in the understanding of public safety in Durham, acknowledging that not all issues require a traditional officer response. The sentiment is echoed by Crisis Response Clinician Jessica Laube, who sees the department as the alternative solution that communities worldwide have been calling for [2]. The initiative was prompted by a growing feeling within the Durham Police Department that officers were unable to fully address community needs, especially during the uncertainties of 2020 and 2021. Concerns grew among many residents regarding the establishment of HEART, as they feared potential resource reductions for the police force [2]. However, these concerns about resource allocation between the police and HEART were alleviated as the community grew more confident and knowledgeable about the role of HEART. The Durham Community Safety & Wellness Task Force increased collaboration between various stakeholders in the area [3]. This effort underscores the community-driven nature of this initiative. The task force's extensive engagement with the community, including town hall sessions and surveys, developed a level of trust among residents, particularly among black populations. The desire for trauma-informed, non-judgmental mental health professionals who can properly conduct deescalation tactics became apparent, reflecting the community's aspiration for a more inclusive and responsive approach to public safety [4]. The creation of the Community Safety Department followed by the establishment of HEART represents a crucial first step in redefining public safety in Durham and fostering trust between the community and those responsible for their well-being.

Background History and Context

In June 2022, the City of Durham pioneered the launch of an unarmed first responder program known as HEART. This pilot initiative marks a groundbreaking and innovative approach to public safety by substituting armed police officers for specific calls and prioritizing resources for mental health-related issues. Since its start in June, HEART has rapidly expanded with a team ranging from EMTs to administrators and clinicians. Notably, some team members shifted from emergency room settings or private therapy offices as they felt driven by HEART’s mission and addressing the root cause [5]. The HEART team comprises a mental health clinician, peer support specialist, and emergency medical technician, avoiding traditional uniforms for a more approachable attire of jeans and 'HEART' T-shirts [6]. The creation of HEART highlights a multifaceted and new approach to enhance mental health resources within the realm of public safety. 

Organizing, Supporting, and Funding Entities

The Durham Community Safety Department (DCSD) was established on July 1, 2021, by the Durham City Council with a budget of $4,015,465 [7]. On June 28, 2022, the DCSD launched HEART [8]. The program covered specific territories within Durham during weekday business hours [8]. After its successful pilot phase, the 2022-2023 budget for HEART was increased by approximately 22.7% to $4,787,854 [7]. The program allocated $1.8 million in personal services for 20 full time employees and $2.0 million in operating expenses [9]. The City Council approved another funding increase for the HEART program during the 2023-2024 annual budget meeting. The HEART program funding was increased by approximately 35% to $6.4 million [10]. The new budget allowed for the program to hire 27 additional employees [10]. Additionally, HEART now responds to citywide calls for an extended 12 hours a day [11]. External contract partners include Bull City United, Durham Expunction and Restoration program, and two local research institutions for HEART program successes evaluations [9]. For context purposes, Bull City United is a community-based effort to reduce gun violence in highly focused areas [12]. Additionally, the Durham Expunction and Restoration program works to remove barriers to employment and housing by providing free legal services to Durham residents who cannot afford attorneys [13].

The HEART program’s significant increase in funding for the 2023-2024 year was at the top of the City Council priority list, but achieving the raise required deliberation. Durham City Council Member Jillian Johnson was among one of the first to propose expanding the budget further for it to become a 24/7 agency [14]. The problem council members faced was how to pay for such a significant increase in funding and to decide how quickly it would be manageable. There was continuous debate about the appropriate place to pull the money from. Many officials had publicly emphasized the importance of not taking from the police budget. They expressed concern that doing so would create an environment of competition between the police and HEART members. The mayor of Durham at the time, Mark-Anthony Middleton, addressed the potential tension between the Durham Police Department and the Community Safety Department and promoted cohesiveness [14]. However, other officials like Johnson, advocated strongly for the HEART expansion regardless of where the money came from [14]. The support for an increased funding for the HEART program during the 2023-2024 year was not only a priority among officials but also a matter of importance to the citizens of Durham.

An activist-led campaign called “Have a HEART” supported the increase of the Durham city’s budget for the HEART program [15]. Activist members believe that all of Durham deserves access to skilled and unarmed care in moments of crisis. The campaign sought to unite the small business, houses of faith, agencies, and organizations of Durham to support their cause [15]. A petition was created to gather signatures from Durham residents to help convince council members to adopt a plan to grow the HEART program in the 2023-2024 budget. The coalition recommended increasing funding to $10.7 million to sustainably support and staff the Durham Community Safety Department to operate the HEART program 24/7 and citywide [9]. To arrive at this suggested value, campaign members investigated the financial breakdown of current expenses for funding the weekday operation. The determined cost for the city to employ, equip, train, and support a HEART staff member is about $150,000 [9]. The number of additional employees and teams needed for 24/7 coverage of the entire city was also calculated. It was found that there would be a need of 24 more staff members for the Community Response team, 16 Co-Response teams, six Care Navigation teams and two full time employees for the Crisis Call Clinician team [9]. The campaign suggested that Durham Council Member’s should use public dollars to meet this funding need over a period of three years [9]. The Durham City Council increased the budget to $6.4 million for the 2023-2024 year but was not able to offer 24/7 coverage [10]. However, on October 23, 2023, HEART began providing services to all locations within the city limits, seven days a week for 12 hours each day [11]. For the HEART program to become operational 24/7, more social work, peer support and emergency medical services professionals will be needed.

Participant Recruitment and Selection

There are three categories of HEART responders; licensed mental health clinicians, peer support specialists, and EMTs. Licensed clinicians screen and assess people experiencing a crisis of mental health or substance use [16]. They provide therapeutic intervention, connect people to local health care providers, and manage cases on an ongoing basis. Peer-support specialists are members of the community who have relevant experience in dealing with mental health and substance use [16]. They foster relationships between community members and the rest of the HEART team, de-escalate situations, and build relationships in the community to help people in crisis be more open to receiving help [16]. EMTs assess for and treat physical health emergencies. 

The HEART program is divided into 4 different units that each require different operational credentials; the Crisis Call Diversion (CCD), Community Response Team (CRT), Co-Response (CoR) and Care Navigation (CN) [16]. The CCD responds and speaks on the phone with individuals that have been determined to involve a non threatening individual experiencing a crisis [16]. The CRT functions as alternative first responders and is sent out in response to calls that have been classified as a mental health crisis, trespassing, welfare checks, prostitution, etc [16]. The CoR unit is dispatched for higher risk mental health crises or quality of life concerns. Specifically, calls classified for the CoR unit are attempted suicide, domestic violence, etc [16]. The CN unit serves to follow-up with an individual who had prior contact with one of the other HEART teams [16]. For each unit, responders must undergo a four-week training led by DCSD employees [16]. This training addresses topics such as de-escalation, mental health first aid, racial equity, HIPAA and confidentiality, motivational interviewing, situational awareness for scene safety, trauma-informed care, suicide prevention, mental health disorders, substance-related disorders, developmental disabilities, and more [16].

Methods and Tools Used

DCSD formed a multi-agency team to create the HEART pilot. These agencies include the Criminal Justice Resource Center, Housing for New Hope, Alliance Health, the UNC School of Social Work, Research Triangle Institute International, and Recovery Innovations. Also on the team were municipal public safety agencies including Durham Police, Fire, and Emergency Services Departments. They also conducted interviews with local community support workers, mental health professionals, and peer support specialists. Program developers also went on ride-alongs with Durham police officers [16].

The Research Triangle Institute International (RTI), a nonprofit research institute, was especially central in the development of HEART. Durham city leaders, seeking to find a better way to respond to both emergency and non-emergency 9-1-1 calls for service, formed a cohort of seven cities across North and South Carolina. RTI and the University of Chicago Health Lab were brought on as research partners. The goal of the study was to “analyze 911 call data and develop recommendations for improving responses by law enforcement and other first responder agencies” [17]. The study began by analyzing three years of 9-1-1 calls in each city, tracking calls by volume, frequency, location, risk level, and response time [16]. Next began a cooperative endeavor to explore scenarios in which a non-law enforcement response, or a response involving collaboration between the police and other service providers, might offer a more efficient and enduring resolution. The RTI researchers assembled and distributed these alternative response strategy summaries to each city for the assessment of pilot possibilities. These materials, in conjunction with the outcomes of the 911 calls analysis, were then presented in a meeting with the Durham City Council and other city leaders in February, 2021 [18].

The development process was also informed by the Durham community. Two virtual town-halls were facilitated by the Crisis Response Roundtable of the Community Safety and Wellness Task Force, with the assistance of staff from the newly established DCSD. The first meeting, in October 2021, residents of Durham were asked to discuss their experiences seeking assistance during moments of crisis, and to initiate conversations about their vision for the future of crisis response. A second town-hall was held in April 2022 to review the launch of the pilot program. This meeting provided Durham residents with departmental updates from the various agencies involved, and facilitators also solicited feedback and ideas for the implementation of the pilot [3].

The HEART pilot program initially served one-third of the city. During the pilot program, three of the four response teams were active from 9-5 on weekdays. The pilot launch was successful and on October 23rd, 2023, the program was expanded to serve the whole city. DCSD Director Ryan Smith said the expansion will allow HEART to respond to 13,000 additional calls, create 19 new positions, and hire 50 additional employees [19].

What Went On: Process, Interaction, and Participation

The four units in HEART each play a different role in crisis response, and interact with the community at different stages. CCD places licensed mental health clinicians in the city’s 9-1-1 Call Center. The types of calls that are referred to the CCD unit include suicide threats, mental health crisis, or any other call that is presenting behavioral health concerns. CCD counselors begin by assessing the needs of 911 callers, formulating safety plans, and determining the appropriate response. Additionally, they divert crisis calls of a non-emergent nature that do not require an in-person response. These counselors establish connections with individuals, informing them of the resources available to address future mental health-related needs. They dispatch Community Response Teams when necessary, and de-escalate situations before the arrival of first responders. Once first responders are on the scene, CCD counselors offer support as unforeseen mental health issues arise, ensuring a comprehensive approach to crisis intervention.

Community Response Teams offer swift and trauma-informed assistance for 9-1-1 calls related to non-violent behavioral and mental health needs, as well as quality of life concerns. These teams dispatch groups of three unarmed first responders to address the diverse needs of the community. They arrive at the scene of the crisis within thirty minutes of dispatch, and deliver person-first, trauma-informed care. When necessary, they transport individuals to the appropriate care centers. 

CN provides care after an initial encounter with a CRT. CNs work in two-person teams, with one peer support specialist and one mental health clinician. Their response depends on the specific needs of the individual, and CN teams may follow up multiple times to ensure the individual has access to the care they want and need. CN increases the likelihood that individuals will receive ongoing care, thereby decreasing the number of people who experience multiple crises. 

CoR is HEART’s most recent addition. This unit was created in September 2022, after the successful launch of the pilot program. CoR responds to highest-risk mental and behavioral health crises. CoR pairs licensed clinicians with Durham Police Officers trained by HEART’s Crisis Intervention Team. CIT-trained officers assess the scene for safety and de-escalate unsafe situations. The clinicians assist in de-escalation, as well as perform the duties of a CRT responder. Although HEART responders report feeling safe 99% of the time– and to date only .01% of response teams have called the Durham Police Department for backup– DCSD created CoR to enable responses to a wider range of crisis calls, including those with a risk of violence. CoR also provides data vital to the further expansion of HEART. They safely explore different types of calls to see which ones would be eligible in the future for an unarmed response by a CRT [3].

Influence, Outcomes, and Effects

HEART Program Report Data ( June 28, 2022, and March 31, 2023) [20]. 

HEART Calls for Service:

 The HEART program engaged in 5,055 service encounters. The average is 23 call responses per day.

Reference Exhibit 2.

Crisis Call Diversion Response:

“The  CCD responded to 1,753 calls.  56% of CCD services were for neighbors requesting additional support. Among the 911 calls (759 calls), most frequent call type was crisis diversion (265 calls), with mental health crisis in second (231 calls)”.  

Reference Exhibit 3.

Reference Exhibit 4.

“The CCD resolved 49% (372) of 911 calls without any in-person response.  Among the remaining 911 calls, CCD supported police for 23% these calls (184), supported CRT on 20% (N=163), and supported COR calls on 9% (69)”

Reference Exhibit 5. 

Community Response Team Activities: 

The CRT responded to 1,720 events. 78% of  CRT service encounters were in response to resident 911 calls.  The most frequent call natures are trespass calls, mental health crises, and urgent welfare checks. “The self-initiated service events represent 21% (N = 369) of the service encounters, most of which are self-initiated “HEART Assists” (N = 303)”. 

Reference Exhibit 6.

Across all call types, CRT have an average response time of 9 minutes and an average call duration of 32 minutes. 

Reference Exhibit 7.

Reference Exhibit 8.

Co-Response Team Response: 

COR responded to 803 calls.

Reference Exhibit 9.

Reference Exhibit 10.

Reference Exhibit 11.

Care Navigation:

The  CN staff recorded 779 service encounters. The  Care Navigators typically spend an average of 20.3 minutes with each contact. 

Neighbors and Service Needs:

Reference Exhibit 12.

Reference Exhibit 13.

Analysis and Lessons Learned

HEART has reached out for feedback as of January 2022 from Durham residents through resident listening sessions, the Durham first responders, Housing for New Hope, Alliance Behavioral Health, Recovery Innovations, Durham Center for Senior Life, Urban Ministries Durham, Durham Rescue Mission, Straight Talk Support Group, Durham Regional Association of Realtors, the LGBTQ Center, and Downtown Durham Incorporated. HEART uses these organizations to garner holistic feedback regarding the efficacy of HEART operations and outcomes. An important part of HEART is that Durham community residents have positive, efficient interactions with HEART staff, and these organizations add focus to the voices of at-risk individuals and communities directly impacted by HEART responders. 

Reference Exhibit 14 [21].

Specifically, resident listening sessions have provided in-person, valuable feedback, such as that in “Conversations with Community Partners”. Conversations with the organizations involved with marginalized individuals and communities in Durham (listed above), have resulted in real feedback such as: 

Reference Exhibit 15 [21].

Residents of Durham as feedback have placed emphasis on continuing/prioritizing an accessible and inclusive response team, harm reduction in their communities, familiar and empathetic responders, and reliable and predictable response measures. Accessible and inclusive would entail responders who speak other languages than English, as well as open-minded individuals who are cognizant of cultural differences in dispute resolution. Harm reduction entails deescalating situations rather than using force, and a patient team that is willing to commit the time necessary to effective solutions and collaborative decision-making tailored to individual needs. Familiar and empathetic teams mean responders and community members can build a system of trust, thereby contributing to more efficient conflict resolution. Reliable and predictable response measures entail consistently responding with non-armed measures. This part is looped in with “familiar and empathetic”, in which trust is a building block of positive outcomes and resolutive interactions with community members. Additionally, residents have expressed they value the privacy of their information, and it is important for HEART in the future to maintain confidentiality with this kind of information, which could lead to increased trust and further positive interactions. Durham residents emphasize that they want to be able to expect a certain kind of response, and reliably receive this non-armed, patient, collaborative, inclusive response when interacting with HEART [21].

Other cities’ outcomes:

Crisis Call Diversion (CCD):

Houston

“In 2020 CCD talked to 4,566 callers to City of Houston 911. CCD COMPLETELY diverted 2,116 of these callers away from HPD/HFD.  For every HPD call diverted the cost deferment is $183. For every HFD call diverted the cost deferment is $1404.  That is $1,455,603 costs deferred back to first responders.  Even after the City of Houston contributes $230,000 annually to CCD that leaves $1,225,603 of first responder resources deferred back to the community”.

https://houstontx.gov/arpa/public/documents/06.03.2021-911-Crisis-Call-Diversion.pdf

 Austin

“In 2021, 82% of calls with a mental health crisis component were “diverted,” meaning clinicians were able to help the caller without the need to send a police officer”. 

https://www.kxan.com/news/local/austin/austin-911-has-successfully-transferred-thousands-of-mental-health-calls-to-crisis-clinicians/

Community Response Teams (CRT):

San Francisco

“ The Street Crisis Response Team is a collaboration between the San Francisco Department of Public Health, Fire Department, and Department of Emergency Management, and is supported by community-based providers HealthRIGHT 360 and RAMS, Inc.”. 

Reference Exhibit 16 [22].

Reference Exhibit 17 [22].

Other locations where programs similar to HEART have been implemented:

A Co-Response (CoR) program has been implemented in Raleigh, NC. The City of Raleigh’s ACORNS (Addressing Crises through Outreach, Referrals, Networking and Service) program is similar to HEART. Care Navigation programs have also been implemented in Raleigh, Greensboro, and San Francisco. 

References

[1] “City Manager Wanda Page on New Community Safety Department.” City of Durham, 25 June 2021, www.durhamnc.gov/CivicAlerts.aspx?AID=2876&ARC=3962#:~:text=One%20of%20the%20highest%20priorities. Accessed 10 Dec. 2023.

[2]  “Heart: Serving Our Neighbors in Crisis.” Www.youtube.com, RTI International, 13 Apr. 2023, www.youtube.com/watch?v=N-Ak0-ED9gQ&t=6s. Accessed 10 Dec. 2023.

[3]“Community Safety & Wellness Task Force | Durham, NC.” City of Durham, www.durhamnc.gov/4448/Community-Safety-Wellness-Task-Force#:~:text=In%202021%2C%20the%20Durham%20Community. Accessed 10 Dec. 2023.

[4]“CSD Engagement Summary Jan 2022 by CommunitySafety - Issuu.” Issuu, Community Safety, 22 Mar. 2022, issuu.com/communitysafety/docs/csd_engagement-summary_issuu_6fbede05a51e37?utm_medium=referral&utm_source=www.durhamnc.gov. Accessed 10 Dec. 2023. 

[5] Kummerer, Samantha. “Durham’s Unarmed First Response Team Makes Big Impact in First 6 Months.” ABC11 Raleigh-Durham, ABC, 21 Dec. 2022, abc11.com/heart-program-unarmed-response-durham-mental-health-police/12598634/. Accessed 10 Dec. 2023.

[6] Kummerer, Samantha. “Durham Tackles Mental Health Crises in New Ways as Law Enforcement Agencies Seek Change.” ABC11 Raleigh-Durham, ABC, 29 June 2022, abc11.com/hearts-durham-mental-health-response-team-pilot-program-police-department-crisis-intervention/12004432/. Accessed 10 Dec. 2023.

[7] “Durham, NC | Official Website.” City of Durham: Adopted Budget 2022-2023, July 2022, www.durhamnc.gov/DocumentCenter/View/46235/Final-FY23-Budget-Book. 

[8] “Community Safety.” Community Safety | Durham, NC, www.durhamnc.gov/4576/Community-Safety. 

[9] “Executive Summary Community Safety Department (DCSD) 24/7 ...” Have a Heart Campaign , 2022, static1.squarespace.com/static/64023b01c897762ba05fe8bd/t/647e43dd32e0b101e344b9fd/1685996510127/Full+Funding+for+24_7+Citywide+Community+Safety+in+Durham.pdf. 

 [10] Moore, Mary. “Durham Wants to Respond to More 911 Calls without Guns. Heres How.” The News & Observer , 24 Oct. 2023, www.newsobserver.com/news/local/crime/article280898288.html. 

[11] “Durham’s Heart Program Expands Services Citywide, 12 Hours a Day Starting October 23.” Durham, NC, 20 Oct. 2023, www.durhamnc.gov/CivicAlerts.aspx?AID=3523&ARC=5192. 

[12] “Bull City United.” Departments A-e | Durham County - DCONC, 2023, www.dconc.gov/county-departments/departments-a-e. 

[13] “DEAR Durham.” DEAR, 2023, www.deardurham.org/. 

[14] Billman, Jeffrey. “A New Model for Public Safety in Durham.” The Assembly NC, 16 May 2023, www.theassemblync.com/politics/criminal-justice/durhams-new-model-for-public-safety/.

[15] “Have a Heart Durham Campaign.” Have a HEART Durham Campaign, 2022, www.heartdrm.com/. 

[16]“FAQs about the ‘HEART’ Crisis Response Programs.” City of Durham, CivicPlus, 2020, www.durhamnc.gov/Faq.aspx?QID=775. Accessed 10 Dec. 2023.

[17] “New Study to Help Cities Evaluate First-Responder Services Based on 911 Calls.” RTI International, 8 Dec. 2020, www.rti.org/announcements/new-study-help-cities-evaluate-first-responder-services-based-911-calls. Accessed 10 Dec. 2023.

[18] Strom, Kevin, et al. “Implementing and Evaluating Alternatives to Traditional Police Responses.” RTI, RTI International, Aug. 2022, pp. 1–5, www.rti.org/sites/default/files/cohort_of_cities_final_report_09292022.pdf. Accessed 10 Dec. 2023.

[19] Piggott, Sharryse. “The HEART Program Expands Its Mental Health Crisis Response Services to All of Durham.” WUNC North Carolina Public Radio, 23 Oct. 2023, www.wunc.org/news/2023-10-23/heart-program-expands-mental-health-crisis-response-durham. Accessed 10 Dec. 2023.

[20]“For Non-Emergencies, You Can Call 919-560-4600.” HEART Program, www.durhamnc.gov/4576/Community-Safety. Accessed 10 Dec. 2023. 

[21]Publisher, CommunitySafetyFollow this. “CSD Engagement Summary Jan 2022.” Issuu, 22 Mar. 2022, issuu.com/communitysafety/docs/csd_engagement-summary_issuu_6fbede05a51e37?utm_medium=referral&utm_source=www.durhamnc.gov. 

[22]Admin, Charles Belov. “Reports & Documents.” SFMTA, San Francisco Municipal Transportation Agency, 20 Sept. 2021, www.sfmta.com/reports-documents.