Putting the People in 911

Community partnership is essential to a 911 system that works for everyone.

Why is this essential? 911 is a vital resource for the general public, but its operations and outcomes are often experienced as opaque by that same public, who may not know exactly how to get the data and information they seek. This results in a 911 system in which accountability and transparency currently aren’t consistently available to the public. Ensuring that 911 is equitably accessible, effective, and responsive requires partnering with the people and communities who are served by the 911 system to help each caller achieve wellbeing and relief from distress for themselves and for those around them.

Focusing on community is a full recommendation because designing and implementing by, for, and with community is deeply countercultural in many systems in America, including 911. Distributing power and accountability with the broader community, particularly those communities currently less likely or willing to call 911, will not happen without purposeful, sustained effort. Even with the best of intentions, such efforts can flounder and create whole new harms when sprinkled on to existing practices. Community members are true assets; they are resources and serve as supports to each other and can be to public safety agents through trusting alliances. Building alliances with the public involves educating the community about how the 911 system works and engaging the community, particularly marginalized community members where disparities are prevalent. Seeking out and listening to the expertise of people about their lived experience and engaging that expertise and insight to continuously examine relationships, practices, policies, and structures allows for the development of a relevant, accountable, effective, and curative emergency response system.

Those who have been adversely impacted by a system have a unique and critical perspective on what would heal or help. Likewise, 911 professionals who have expertise in response protocols and processes are well positioned to make decisions about these elements. However, both group’s experiences have historically been left out, resulting in ECCs that are not reflective of and appropriately responsive to the people who serve in and are served by ECCs. ECCs must therefore adopt mechanisms that allow for community voice and accountability to the people served, as well as to 911 professionals.

Actions

1. Create a Callers’ Bill of Rights, potentially modeled on the Patients’ Bill of Rights, but with greater attention to equity and prioritizing the experience of people and communities whose relationship with 911 has historically been least productive.

• Creating and implementing a Callers’ Bill of Rights will help dispel the myth that the community is not worthy or capable of making decisions about their wellbeing by building transparent system accountabilities into the bill of rights that outlines and provides guidance for what community can and should expect when accessing 911, including how callers are treated, what is done with the data they share and who has access to it, and whom they can talk to about their experience to share gratitude/praise for what works well and/or help improve future response for what does not.
• If ECCs are not able to meet these minimum standards, they should consider consolidating and/or sharing resources with another ECC to bring them into compliance.
• One such model to learn from and build on is the burgeoning effort facilitated by Trans Lifeline that is being developed for responses to nonconsensual emergency interventions specifically for trans people who have called or texted a crisis hotline call and are presumed to be at “imminent risk” of suicide. Trans Lifeline has developed a Fact Sheet, Crisis Callers’ Bill of Rights, and community-based resources (apart from police/clinical interventions) for trans people to help address the unintended effects of nonconsensual emergency interventions.

2. Engage community members in the development and delivery of 911 professionals’ training to maintain relevance to community needs, help document and create paths to existing community resources, and align priorities as well as resources for current and emerging needs.

• One example of involving the community in 911-related training is that provided by thousands of policing agencies and their partners for Crisis Intervention Teams (CIT).^[2] This training^[3] is often provided by National Alliance on Mental Illness (NAMI) affiliates, those with lived experience with mental illness and police encounters, and community-based behavioral health resources. These local community members share their stories to reduce stigma and provide guidance for how police officers can make encounters safer and more dignified for all involved parties.
• In Raleigh, North Carolina, stakeholder sessions were held with 911 professionals to explore how well equipped they felt in handling and categorizing mental health calls for service. These discussions suggested that call takers felt unprepared for this aspect of the job. In response, the city is examining training platforms that will train staff on how to handle mental health calls. Call takers will be trained in and tasked with de-escalation of callers who are experiencing mental health crises.

3. Partner with community members—particularly those who have experienced unintentional harm or trauma by the existing 911 emergency response system—in the development, delivery, and accountability of 911, hotlines, and alternative responses to maintain relevance to community needs.

• Acknowledge that the community shouldn’t make decisions about call-handling, dispatching, and response processes they don’t understand—education needs to go hand in hand with public engagement and involvement.
• Support clarity among all stakeholders about where specialized expertise is warranted and needed and where non-specialists are capable of learning the necessary information to make informed decisions and recommendations.
• NAMI advocates for the involvement of key stakeholders in the development of CIT.^[4] These stakeholders offer perspective on what is likely to be effective in responding to community members in crisis who call the police and provide needed resources external to the police response.
• Another widely disseminated model, Crisis Assistance Helping Out On The Streets (CAHOOTS), developed in Eugene, Oregon, and replicated in other places, deploys a medic along with a crisis worker to respond to people experiencing mental health crises.
• Yet another example is the Community Response Team (CRT) program being piloted in Durham, North Carolina. Durham’s CRT program sends a team including a licensed clinician, peer support specialist, and an advanced paramedic to provide rapid, trauma-informed care for 911 calls for service involving nonviolent behavioral and mental health needs and quality of life concerns. For high-risk mental health calls, Durham will deploy a peer support specialist with a CIT trained police officer to connect the person in crisis with community-based care where and when appropriate.

4. Create opportunities for ongoing community dialogue about 911: Acknowledge the community as people with valid lived experience (positive and negative, direct and indirect) impacted by the action or inaction of the emergency response system in the locality served. Use the information learned about their experience to troubleshoot systemic issues, identify gaps in service delivery, and strengthen best practice.

• Here we look internationally—to South Africa—for inspiration. South Africa has developed an innovative constitutional doctrine of “meaningful engagement” between government and communities in local matters. Developed in the aftermath of apartheid, this legal duty requires policymakers to collaborate with the community on a host of socioeconomic matters, including housing, healthcare, food security, and social assistance, in order to help ensure that public services are delivered effectively and have a positive impact on people’s lives. While we are not calling for a constitutional amendment here, the concept of meaningful engagement is particularly relevant for communities—including those in the US—that have been marginalized and/or disadvantaged.
• Utilize community sit- and listen-alongs to provide insight into ECC operations and practices. This can help enhance the public’s understanding of how 911 operates locally and work to dispel some of the common misunderstandings of how 911 systems operate.
• Facilitate listening sessions with diverse constituencies. For example, the Transform911 911 Hotline Alternatives workgroup invited representatives from several crisis service response organizations specializing in marginalized populations (diverse ethnicities and cultures, trans people and LGBTQ youth) to attend a workgroup meeting and share their reactions to emerging recommendations. The key feature of the listening session was that workgroup members did not ask questions of these attendees; they simply listened and learned.
• Identify ways to gather data to determine how to make 911 work for the community.
• Utilize technology solutions to obtain 911 callers—customers of the 911 system— feedback by phone, text, and other means and/or offer return calls to discuss callers’ experiences so that users feel valued and their experiences are part of a quality improvement process, as well as evaluating the performance of the professionals staffing 911 and hotlines.
• When administering surveys, gather demographic information so that data can be disaggregated by age and zip code, for example. Several communities are already capturing this information^[5] by linking community members to online surveys.

5. Ensure that membership in governing authorities and boards that control or provide oversight of ECCs is representative of the communities they serve, to include representation from historically underrepresented groups.

• For example, the Securities and Exchange Commission recently announced a board diversity public disclosure requirement for any company listed on the NASDAQ exchange in order to encourage greater board diversity. This rule requires NASDAQ-listed companies to disclose their gender, racial, ethnic, and sexual orientation diversity annually. A similar approach could be adopted by the cabinet-level interagency 911 taskforce (see chapter nine on national support, action item 1) or undertaken by the National Academy of Sciences panel (see chapter nine on national support, action item 6) if either of these recommendations are followed.

6. Create, use, update, and publicly post dashboards and/or other transparency mechanisms that track how closely the 911 workforce, governing boards, and community partnership mechanisms reflect the demographics of the larger community and the community of callers, that track the first responder ecosystem’s responses and related outcomes, and that provide visibility in metrics and outcomes to understand impact, strengths, and areas for improvement and ensure that system-wide response honors the community.[6]

• See, for example, Chicago’s violence reduction dashboard, developed by the Chicago Police Department with technical support provided by the University of Chicago Crime Lab, which is a national model for transparency of critical, virtually real-time data.