Durham, NC

Holistic Empathetic Assistance Response Team (HEART) — Durham, NC

September 18, 2024

In 2022, the City of Durham’s Community Safety Department (DCSD) launched its crisis response program, the Holistic Empathetic Assistance Response Team (HEART), with the goal of connecting residents experiencing nonviolent mental health crises or quality of life concerns with the right care. HEART consists of four response units: (1) a Crisis Call Diversion program; (2) community response teams; (3) co-response teams; and (4) follow-up care navigation. The community response teams feature unarmed, skilled, and compassionate staff who serve as first responders that promote harm reduction by distributing Narcan (an opioid overdose reversal medication) and safer sex kits, carrying wound care supplies, and connecting people to community-based support and resources. Staff are also trained on ways to safely collect and dispose of needles. 

• Learn more about HEART’s model: Program FAQs. 
• Watch a documentary film about HEART. 
• Listen to a three-part podcast highlighting HEART’s efforts. 
• Request a site visit and access HEART’s resource library to aid in your planning efforts.

The following information outlines HEART’s efforts since its inception; it follows the sections of the toolkit. Readers can connect to other parts of the toolkit by clicking the headers for more details.

 

Photo credit: Durham Community Safety Department

Community Engagement and Collaboration 

• Since its inception in July 2021, DCSD has been coordinating with community stakeholders to learn and build a department that reflects the needs and desires of the Durham community. Read DCSD’s 6-month Community Engagement Summary from July 2021 to January 2022. 
• Since January 2022, DCSD has met with over 250 Durham community members to hear their thoughts about community safety.  

• • In partnership with a community-led taskforce, DCSD held in-person and remote listening sessions (conducted in both English and Spanish), as well as focus groups and workshops with Durham residents, first responders, mental health professionals and other health care providers, peer support specialists, local nonprofits and community-based organizations. 
  • DCSD co-hosted a two-day bilingual townhall with a round table including skilled crisis care responders from Durham’s community safety and wellness task force.  
  • DCSD conducted an initial survey to allow Durham residents the opportunity to weigh-in on questions related to HEART’s work. This survey is ongoing and lives on their website, so that community members can consistently offer feedback.  
  • DCSD also continues to update their website with community engagement events and materials. 

• Prior to launching HEART, DCSD formed a multi-agency planning team that included representatives from the police, fire, emergency medical services (EMS), and emergency communications departments, as well as various behavioral health providers, schools of Social Work, and homeless services providers, among others. This group met regularly for six months to learn from one another, analyze data, and provide feedback on DCSD’s plans as they developed.  
• Since the launch of HEART, DCSD has continued to meet regularly with Durham’s police department and the emergency communications department. These teams debriefed weekly in the first few months after HEART’s launch to review data, address any issues, and monitor program operations. These meetings now occur quarterly. 
• Most recently, DCSD has been conducting surveys and focus groups with residents who are unsheltered, so that they can better understand their perspectives on the homeless services offered in Durham, gaps and barriers to accessing these services, and ideas for improvement. 

• • People who opt to participate in these surveys and focus groups are paid for their time. 

Needs Assessment

• RTI International, a nonprofit research institution, conducted a data analysis of 3 years of Durham’s 911 calls to identify the types of calls best suited for DCSD and its responders. 
• In that analysis, RTI found that 15 percent (18,710) of all Durham’s 911 calls (approximately 129,000) were quality-of-life or behavioral health calls.  
• Those calls included requests for assistance, someone in a mental health crisis, follow-ups, indecency alerts, notices of an intoxicated person or panhandling/solicitation, suicide threats, concerns related to trespassing, and welfare checks.  
• Of these 9 call types, less than 5 percent resulted in any kind of police incidence report, and only 9 calls per year resulted in police use of force.  
• These data were derived from Durham’s Open Data Portal. 

• • Community Safety Nov Dec 2021 Update 
  • Calls for service research RTI Feb 26 2021 

Call Triaging 

• HEART responds to calls through Durham’s 911 dispatch system (CAD) primarily, and sometimes receives referrals from the police or fire departments or EMS. 
• HEART responses are fully integrated into Durham’s 911 system. That means HEART responders are dispatched like other responders, are visible to 911 through automobile vehicle location, carry public safety radios that allow them to communicate with other first responders and request backup, have tablets in their vehicles connected to CAD, and are able to access all notes, history of calls at a location, and alerts in the CAD system. They are also able to use the CAD system to communicate with other responders. 
• All 911 calls in Durham are answered by Emergency Center call takers who gather critical information and prioritize calls for service. The 911 call takers categorize and triage calls for service using the Emergency Priority Dispatch System (EPD).  
• Calls are assigned priority based on the severity and level of immediate need for response. CAD automatically recommends the most appropriate response for calls depending on their eligibility and how people respond to the call takers’ questions. One benefit of this system is that call takers do not have to memorize new response plans.   
• Integration into Durham’s 911 system has many benefits, ranging from safety and operational efficiency to improved data collection. DCSD’s system is set up to identify all eligible calls for HEART 24/7, regardless of whether HEART units are operating. 
• This has helped DCSD obtain the information needed to prepare budget requests that meet the level of need in the Durham community.   
• Integration into 911 also means that when HEART units are not available, callers can still expect to receive a timely response. The system will automatically recommend the next most appropriate unit.  
• A list of eligible call types by response program is included below: 

Crisis Call Diversion	Community Response Team	Co-Response
Mental health crisis	Nonviolent mental health crisis	Mental health crisis – violent / weapon
Suicide threat	Suicide threat	Attempted suicide
	Trespass	Trespass with weapon
	Intoxicated person	Intoxicated person w/ weapon
	Lost person (assist)	Custody issue (assist)
	Panhandling / nuisance	Panhandling / nuisance w/ weapon
	Indecency / lewdness	Indecency / lewdness w/ weapon
	Prostitution	Prostitution w/ weapon
	Nonurgent and urgent welfare check	Physical disturbance  Verbal disturbance  Disturbance w/ weapon  Harassment w/ weapon  Threat w/ weapon  Reckless activity  Abuse  Harassment  Threat
		Domestic violence  Domestic violence w/ weapon
		Drugs
		Involuntary commitment

Program Staffing 

• HEART staff are full-time employees in classified positions and receive full benefits. 
• The Crisis Call Diversion unit embeds mental health clinicians in Durham’s 911 call center.
• The community response teams dispatch unarmed three-person teams that include a licensed clinical social worker, peer support specialist, and emergency medical technician (EMT) as first responders to nonviolent behavioral health and quality of life calls for service.  
• HEART will sometimes dispatch two-person units, as long as the unit includes a clinician. 
• The co-response unit pairs HEART clinicians with Crisis Intervention Team-trained Durham police officers to respond to certain calls for service that pose a greater potential safety risk.  
• Care Navigation follows up with people after meeting with one of HEART’s first responders to help connect them to the community-based care they need and want. Staff include clinicians and peer support specialists. 

Use of Data to Inform Decision Making

• DCSD is committed to using data to learn how to best meet the needs of residents (who they intentionally refer to as neighbors) with compassionate care. DCSD tracks key indicators related to program operations and outcomes. For example:  

• • Number of responses by program and over a period of time 
  • Percentage of transports to other providers and community-based care  
  • Eligible calls responded to by the program and over a period of time  
  • Number of referrals made to community-based care 
  • Response time to calls 
  • Number of calls diverted from law enforcement and time saved 
  • Percentage of calls where responders report feeling safe on scene  

• Data is publicly shared through HEART’s data dashboard and in monthly data snapshots for HEART responses. 
• DCSD uses two data sources: 

• • CAD, which is Durham’s Emergency Communication Center’s call-aided dispatch system. Note: Durham uses One Solution by Central Square as its CAD system.  
  • Julota, which is clinical management software. 

• The decision to create a new public safety department and to develop alternative response units was also informed by RTI’s three-year data analysis of Durham’s 911 calls for service to better understand why people call 911, the nature of the calls and how many involve violent crime, the outcomes of calls, and the number and types of calls associated with use of force.  
• DCSD also engaged with law enforcement to better understand their experiences responding to behavioral health calls and conducted a high-level scan of examples of alternative response programs in other cities. Most of the research compiled during this project is available here: Initial 911-call analysis.  

Safety and Wellness  

• The community response teams are only dispatched to calls indicating no threat of violence or weapons on scene. Otherwise, a co-response team is dispatched.  
• Community response teams are always dispatched with 2 or 3 members, never alone. 
• Responders have multiple ways to communicate, including through the radio dispatch system used by other first responders that allows them to request backup, as well as an assigned cell phone.  
• DCSD provides multiple de-escalation trainings to all responders and works with the Durham Police Department for additional safety-related trainings.  
• After every HEART response, responders are asked a series of questions about the call, including whether they felt safe being on scene. To date, HEART responders have reported feeling safe on over 99 percent of the calls to which they have been dispatched. The survey also asks whether further debriefing with their supervisor will be beneficial.  
• HEART responders regularly debrief with their teams and supervisors to navigate challenges or issues that responders are facing.  
• DCSD has begun conducting regular staff surveys to understand how responders and other staff are feeling in relation to their sense of work satisfaction and overall wellness. Survey results are shared out anonymously with the intention of working productively toward a culture that centers team well-being.  

Financial Sustainability

• DCSD and HEART are fully funded out of the city’s General Fund. This enables DCSD to hire and retain HEART staff in full-time, classified positions with full benefits. 
• While the City of Durham decided to begin this work as “pilots,” it also established DCSD as a new city department in which the HEART program would be run out of. This decision helped provide a foundation for sustainability.   
• DCSD started with 13 full-time employees in its first year, then grew to 20 full-time employees in its second year, and 50 in its third year. 
• When HEART started, the program operated 5 days per week in one-third of the city. After one year of operations, DCSD received additional personnel to expand operations to 7 days per week, 12 hours per day, citywide.  
• DCSD’s commitment to robust data collection and evaluation has served the department well in making an evidence based case of the effectiveness and benefits of the new response models. This paved the way for Durham’s city manager, at the end of a 12-month pilot period, to declare the pilots a success and propose growing DCSD’s staffing by 150 percent in the FY2024 budget.   
• View DCSD’s FY24 budget and organizational chart.