“Co-response” means a multidisciplinary partnership between first responders and human services professionals that responds to emergency situations involving behavioral or mental health crises and people experiencing complex medical needs. First responders include public safety telecommunicators, law enforcement officers, firefighters, emergency medical technicians, and paramedics. Human services professionals include social workers, behavioral health clinicians, advanced registered nurse practitioners, registered nurses, community health workers, and peer support specialists. Co-responders may provide call-for-service crisis response and follow-up care including case management, resource navigation, and transportation.

The goals of co-response are to de-escalate situations, divert people from criminal justice and emergency medical systems, and bring medical and behavioral health care into the field to serve vulnerable populations.

A co-response program integrates expertise from multiple sectors, such as mental health, law enforcement, and social services, to provide holistic support to individuals experiencing behavioral health crises and other social challenges. By deploying trained professionals alongside first responders, these programs enhance safety, reduce criminalization, improve access to services, foster community engagement, generate cost avoidance, and lead to positive outcomes for individuals in crisis, ultimately promoting community well-being.

• Improve safety
• Increase access to behavioral healthcare
• Decrease repeat encounters with the criminal legal system
• Cost avoidance
• Improved community engagement

Co-response programs are based in police, fire/EMS, EMS, or public safety departments. Co-responders may work directly for these departments or behavioral health agencies or serve as contracted employees.  Co-response teams are dispatched by 911 and/or first responders, ideally, in close collaboration with 988.  There are generally three approaches:

1. A first responder and behavioral health professionals ride together in the same vehicle for an entire shift
2. The behavioral health professional is called to the scene and the call is handled together
3. The behavioral health professional receives a referral from a first responder and follows up after the call.  It is a flexible, collaborative approach that can meet community needs for rapid response, even in rural and frontier areas.

Co-response is also referred to in Washington State statute as mental health field response and is sometimes referred to as mobile integrated health.  Not all co-response is behavioral health co-response but this approach is increasingly popular.

• To serve people experiencing behavioral health crises in their communities as much as possible.
• Provide care in the least restrictive environment through a coordinated system-wide approach.
• Facilitate alternatives to arrest and emergency department use.
• Relieve first responders after emergent issues are resolved.
• Reduce the potential for harm.

Co-response offers several essential elements and services:

• Some teams offer on-scene crisis response, specifically, crisis de-escalation, brief screening and assessment, brief intervention, transportation, and call disposition planning.
• Some teams offer follow-up services to facilitate crisis prevention, transportation, referral and linkage to community services, peer support, and care coordination with systems of care.

• Addressing the challenges inherent in responding to emergency situations involving behavioral or mental health crises and individuals with complex medical needs demands the dedication and involvement of numerous community stakeholders. These stakeholders encompass a wide array of individuals, groups, organizations, government entities, and businesses who are directly or indirectly affected by the services provided or have a vested interest in improving responses to mental health crises. Their roles are pivotal in identifying resources and strategies essential for the success of co-response programs.

  Local partners should include:

  • Mental health service providers
  • Mental health advocates, such as NAMI
  • Substance use treatment providers
  • First responders
  • Homeless advocates and housing officials
  • Hospital and emergency room administrators
  • Other criminal justice personnel such as prosecutors and jail administrators
  • Elected officials
  • State, local, and private funders
  • Community members
  • Individuals with lived experience

Step 1: Needs Assessment

• Identify target issues through a needs assessment to identify priority areas that require a co-response approach, such as homelessness, behavioral health crises, substance abuse, and other relevant factors.

Step 2: Stakeholder Mapping

• Identify and engage key stakeholders, including government agencies, law enforcement, healthcare providers, community organizations, advocacy groups, and individuals with lived experience.
• Foster collaboration and establish partnerships to ensure a comprehensive approach to program design and implementation.

Step 3: Establish Goals and Objectives

• Clearly define the goals and objectives of the co-response program, aligning them with the identified community needs and stakeholders’ priorities.
• Establish measurable outcomes to track the program’s effectiveness and impact.

Step 4: Program Design

• Explore different co-response models (e.g., police or fire/EMS) and select the most appropriate model based on local context and resources.
• Customize the program model to fit the unique needs and dynamics of the community.
• The co-response framework adapts to changing circumstances and needs, allowing for agile responses to evolving challenges.

Step 5: Resource Allocation

• Identify and allocate resources, including funding, staffing, training, and infrastructure, necessary for program implementation.
• Ensure adequate support for mental health professionals, first responders, and other personnel involved in the co-response team.

Sample Job Description

Sample Interview Questions

Sample Crisis Responder Interview Questions

Step 6: Training and Capacity Building

• Provide comprehensive training for co-response team members on topics such as crisis intervention, de-escalation techniques, cultural competency, and trauma-informed care.

Offer ongoing professional development opportunities to enhance team members’ skills and knowledge.

• Trainings: Principles, Philosophy, Practice:
  • Harm-Reduction
  • Trauma-informed & Client Centered Care
  • Motivational Interviewing
  • Situational Awareness
  • Cultural Competency
  • Racial Equity
  • Housing First
  • Involuntary Commitment
  • Mandatory Reporting and Vulnerable Adults

Step 7: Policy and Procedure Development

• Develop clear policies and procedures for responding to various crises, ensuring consistency, safety, and respect for individuals’ rights and dignity.
• Establish protocols for information sharing, coordination with external agencies, and handling confidential information.

Sample Transportation Procedure

Sample Fire-On Call Expectations Procedure

Sample Client Lift- Physical Contact Procedure

Sample Police Department-On Call Expectations Procedure

Sample Suicidal Client Interactions Procedure

Sample Naloxone Leave Behind Procedure

Sample Interlocal Agreement

Step 8: Community Outreach and Education

• Conduct outreach activities to raise awareness about the co-response program and its services within the community.
• Provide education and training to community members on how to access support and engage with the program effectively.

Step 9: Data Collection and Evaluation

• Implement data collection systems to track program outcomes, including metrics related to crisis interventions, referrals, and client outcomes.
• Regularly evaluate the program’s effectiveness and identify areas for improvement based on data analysis and feedback from stakeholders.

Step 10: Continuous Improvement

• Foster a culture of continuous learning and improvement within the co-response team and across partner agencies.
• Regularly review and update program policies, procedures, and practices to ensure alignment with best practices and emerging needs.

Starting a co-response program requires careful planning, collaboration, and commitment from all stakeholders involved. By following this step-by-step guide, organizations, agencies, and communities can lay the foundation for a successful co-response initiative that effectively addresses complex challenges and improves outcomes for individuals and communities alike.