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### **A Public Health Approach to Nonviolent 911 Calls: Harris County’s Holistic Assistance Response Team**

August 2023 | Volume 16 | Issue 8

Whether it’s because many agencies are overburdened by recurring calls for services outside their public safety duties or skill sets or because of the public demand for gentler police responses to nonviolent situations, some law enforcement agencies are seeking alternative methods of 911 emergency response. Among those that have implemented a successful alternative response program are Texas’s Harris County Public Health (HCPH) and Harris County Sheriff’s Office (HCSO), which both serve the greater Houston region outside of the city.

Their program has had remarkable success in its nearly 18 months of operation. In this short time, these agencies saw what Barbie Robinson, HCPH Executive Director, called “incredible results” from the implementation of the health department’s Holistic Assistance Response Team (HART) initiative and its wraparound program, ACCESS (Accessing Coordinated Care and Empowering Self-Sufficiency).  

Developed and housed in HCPH, these programs take a public health approach to responding to calls for social services that typically come to law enforcement but, like many such calls, do not require a public safety response. By focusing on public health, these programs made more resources available to jurisdictions, enabling them to connect residents with appropriate services without having to involve public safety officers. Not only did these programs free law enforcement to respond to mission critical calls related to violence and other crimes but they also greatly improved services to vulnerable populations. 

##### The most effective response to frequent nonviolent callers

The impetus for launching HART and ACCESS was the 2020 death of George Floyd, who was originally from Houston, at the hands of police in Minneapolis. Recognizing the need to rethink existing approaches to answering nonviolent calls, the Harris County commissioners provided HCPH with funding for developing new methods that would not only reduce recurring calls from the same individuals but also address the homelessness, drug addiction, mental health, and other problems that often prompt them. 

HCPH reached out to Baltimore, Denver, and other metropolitan areas with robust alternative response programs to learn best practices for developing its own approach and in 2021 partnered with the HCSO to launch the HART pilot program in a district of the county in which there were a high number of repeat callers. Now, when a call comes into 911, the dispatchers—who are trained to triage each call and have a screening tool to determine whether it’s appropriate for HART responders—send out teams of two responders if it is safe to do so.   

The responders go out unarmed, in vehicles that identify them as a HART team, and respond to nonviolent calls for individuals who are experiencing substance use problems; mental health challenges; welfare checks; and calls related to social services such as mental health, homelessness, and issues involving minors and their parents.

If the HART team determines that a law enforcement response or presence is needed, they call for them. If law enforcement can stabilize the incident, the HART team can resume control of the situation. If not, the HART team leaves the scene.  

##### Professionals with crisis intervention experience respond

Said Robinson, “We have strong coordination, communication, and partnerships with our law enforcement partners to ensure that we’re able to address ever-changing situations on the scene.”  

Moreover, HART members—who include emergency medical technicians (EMT), social workers, mental health clinicians, and other professionals with crisis intervention experience—are trained in scene safety, trauma, informed care, cultural competency, and harm reduction. They are also able to build rapport and trust quickly. 

If warranted, they will transport an individual to the emergency room or other systems that address psychiatric or medical needs, then work with community partners to get the individual into the appropriate long-term services. This work is accomplished with the help of the ACCESS care coordination teams, who work with these individuals to develop a comprehensive plan to address their mental health, housing, medical, food, employment, or other needs. 

##### ACCESS provides long-term solutions

ACCESS team members provide a wide variety of services, including Black maternal health care, reentry programs for the formerly incarcerated, support for youth transitioning out of foster care, and services in other areas of need. 

By addressing the entire range of challenges an individual faces, the ACCESS initiative can keep them from cycling through social service systems or experiencing repeat encounters with law enforcement. And by reducing the number of 911 calls these individuals make, HART and ACCESS also free the police to do the job the public wants them to, which is to fight crime. 

Said Mike Lee, Chief Deputy of the Harris County Sheriff’s Office, “Too often, law enforcement agencies find themselves caught up in the mix of three prevalent social issues—homelessness, poverty, and addiction—situations best addressed by social services and mental health systems. Almost all law enforcement officers can count endless times when they’ve responded to a 911 call and questioned why they were there. 

“Law enforcement should be able to focus on keeping the community safe from crime, especially violent crime. This is where the HART program comes in. Since going live in March 2022, HART has responded to more than 3,400 calls, freeing up over 3,000 manpower hours for response to more serious matters requiring a law enforcement presence.

“Our deputies support the HART program and proactively seek their teams’ assistance because they recognize the value of the resources that HART brings to the table, especially the ever-so-vital follow-up and connection to support services. Since the program began, they have requested a HART unit to take over their scene 135 times.  

“We have more than enough work with violent crime, property crime, and traffic safety, and if a program like HART can lighten the load by responding to mental health, substance abuse and other low-level calls for service, that enables our deputies to focus on serious crime. And that is a win for all of us.” 

Robinson agreed, saying, “Police are being asked to respond in areas that are beyond the scope of their expertise, and they really need to focus on crime and safety as their number one priority. This is what drove the success of our partnership with law enforcement officials.  

“We’ve seen great progress since implementing it,” said Robinson, noting that when HART was launched in March 2022, it was expected to respond to 750 calls in the first year, but by March 2023, HART had helped more than 1,000 individuals in need. And because of this success, the county commissioners asked HCPH to expand HART to an additional district and provide 24/7 coverage. 

“But it’s not just about reducing calls, but also, with our response, trying to bring services and interventions to change the life trajectory of those individuals who are finding themselves in crises,” she added.   

##### Advice for developing an alternative response program

Asked how other municipalities and law enforcement agencies can set up similar programs, Robinson said, “It’s essential to have elected leadership championing these models, as well as the strong support of the executive level at the sheriff’s office or police department and in the public health system. This way, you’re able to get not just the political will but the funding to support the development and implementation of these kinds of programs.   

“Also make sure you get buy in from the rank and file, as well as the dispatchers. This model will be supported by law enforcement partners when they realize that it takes the burden off them to respond to repeat calls for services outside of their discipline. 

“An agency doesn’t have to be large to develop a program like ours,” she adds. “In fact, this model is even more compelling in small departments given their limitations on resources. And every jurisdiction has the ability to provide some level of EMT or mental health services. Look at existing resources and try to leverage those. 

“We’re more than willing to share our learning and best practices because these type of programs can really help law enforcement as well as individuals who are living in communities where there are these needs,” she added.

For more information about HART, please see the Holistic Assistance Response Teams and Harris County’s Community Violence Prevention and Health Services web pages or email HCPH directly at ViolencePrevention@phs.hctx.net.

To hear an interview with Barbie Robinson in the COPS Office’s The Beat podcast, please go to The Holistic Assistance Response Team: Changing Responses to Certain Nonviolent Calls for Service.

Faye C. ElkinsSr. Technical WriterCOPS Office

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