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Together we are stronger

Interdisciplinary response: Public safety in the continuum of care

14 Sep 2020 2:05 PM | International Public Safety Association (Administrator)

By Jennifer Leftwich, Graduate Clinical Social Work Student, IPSA Mental Health, Fitness & Wellness Committee Member

The public safety system evolves in perpetuity to meet the changing needs of communities. Many leading public safety agencies use a combination of empirical data and qualitative information to create standard operating procedures, inform best practices and aid in decision-making processes.

Collaboration between human services and public safety professions, as well as ongoing emphasis on trauma-informed practices, are important in today’s climate. The current practices of contacting “on call services” post-incident referrals and operating in distant silos are no longer sufficient interventions.

Globally, interdisciplinary mental health programs have proven successful as both preventative and responsive measures. They bring trained peers and professionals from different systems together to address the needs of individuals who interact with the 911 system. Current events continue to emphasize the need for these multidisciplinary programs and public safety agencies must continue to change their dynamic to address community expectations and priorities.

What might this look like? To look forward, looking backwards is necessary.

Gaps in the continuum

When state hospitals that historically housed and treated mental health treatment consumers closed rapidly during the era of deinstitutionalization, a chasm formed in the human services system/continuum. Ineffective plans and underfunding contributed to increased homelessness and unmanaged serious mental health conditions. Interacting with these individuals rolled downstream to the criminal justice and public safety systems.

People in crisis call 911. These systems had to expand their scope to include preventing and responding to general social problems creating an overlap with human services.

Memphis Model CIT was developed as the progenitor interdisciplinary program that secured public safety’s role in responding competently to mental and behavioral health crises. This expansion of scope inspired other models and methods of crisis intervention training and interdisciplinary prevention for a host of social problems that can become life-threatening emergencies. CIT is a staple program and model, but it does not preclude securing more holistic preventative programs at the community level.

While commendable and heartening in the spirit of compassion, service and protection, and while many public safety agencies do provide psychosocial supports for their communities, traditional human services are not the primary role of public safety.

Professions trained for this specific work, like social work, provide competent, logistical support to agencies concerning these pressures that may have been incorrectly assigned to them. This removes room for error, or unintentional harm, on the agency. Whatever the originating problem, 911 comes when called. Thanks to collaboration and working together from shared values, every system with a critical role is represented by a professional who makes up the interdisciplinary team composition.

Preventative and proactive measures through linked spheres

Being proactive requires knowing the chain of response and continuum of care to anticipate what services are needed next. As the gatekeeper for emergency services, 911 telecommunicators set the tone for a seamless transition of empathic, trauma-informed and crisis-theory supported care. To best prepare 911 telecommunicators for their role as gatekeeper in the continuum of care, a combination of CIT training, psychological/mental health first aid training, knowledge of community resources and an enhanced EMD program are indicated. Developing an Emergency Medical Dispatch supplement, specific to interdisciplinary response, is helpful and should incorporate:

  • Trauma-informed communication.
  • CIT training.
  • Knowledge of the role of co-responders and their scope of work.
  • Psychological/mental health first aid or combination thereof.
  • De-escalation.

This supports the call-taker in selecting the most appropriate call type with corresponding triage level and responders so that a highly competent and comprehensive interdisciplinary team is dispatched. Through this initial interaction, the call-taker has provided an empathetic, compassionate and competent tone for the caller’s upcoming encounter with responders.

CIT is a popular choice for an interdisciplinary crisis response program due to its success. CIT brings 911 telecommunicators, law enforcement officers, mental health stakeholders, mental health peers and mental health clinicians together to respond to mental and behavioral health emergencies.

CIT seeks to ensure safety of all responders and individuals. This approach also helps prevent injury and reduces use-of-force occurrences, ascertaining voluntary help-seeking versus TDO/ECO. Finally, it also creates a path that connects the individual with necessary community and health resources.

Similarly, co-responder teams for social problems that create connection, show compassion and initiate the sequence of case management or care coordination are prudent. Models that embed the direct hire of a social worker with a graduate-level education are incredibly effective in the communities where these programs exist. Some of these social workers have been dubbed “police social workers,” however, for the purposes of a comprehensive approach, “public safety social worker” is a more holistic title. In addition to behavioral and mental health crisis calls, they may respond to the following types of calls:

  • Domestic disturbances.
  • Homelessness.
  • Sexual violence.
  • Reports of child or older adult neglect or abuse.
  • Other call types that need the immediate attention of a mental health clinician.

With the clinician’s attention toward the psychosocial-emotional needs of the individual/family, this allows other responders to perform their roles. The unreliable routine of making a referral call to social services and handing someone a pamphlet is replaced with the presence of the actual clinician trained to engage, assess and help intervene with solving these problems.

Advocacy for providing field placement and clinical training opportunities within public safety agencies at the undergraduate or graduate level, as well as developing courses designed for public safety cultural competency and interdisciplinary work are indicated.  

Embedding a social worker within fire-rescue agencies is also promising. These co-responders’ services are indicated for mental and behavioral health crises, displacement due to fire or natural disaster, mass casualty incidents, or domestic assault where the physical wounds of survivors are triaged along with the application of psychological first aid as immediately as possible.

Additionally, developing community paramedicine programs that employ a clinician for care coordination are a comprehensive and proactive model for prevention. This co-responder model addresses social determinants of health risks that compromise health and safety, which are especially beneficial for rural and/or impoverished individuals, families, and communities.

Whatever the composition or model of team, the obvious and consistent overlap of required services necessitates responding to the complex needs of communities.

Strengthening the continuum through shared values

Interdisciplinary response is a steadily growing facet of public safety, widely endorsed by a variety of stakeholders and participants. Involving community level supports for ongoing case management and care cannot be a disconnected event or be presented in the form of a pamphlet. It must start at the scene (assuming scene safety) in the heat of the problem so intervention doesn’t fall through the cracks but, instead, guides the person along the continuum of care.

The professionals that comprise interdisciplinary teams share compassion and a moral impetus to protect and better the lives of the people in their communities. It’s why they went into their respective lines of work. Separated by silos along this continuum of care, they address individuals’ and groups’ needs ineffectively and inconsistently. Together in integrated and interdisciplinary work, they are stronger and can promote prevention as well as competent response that is holistic, trauma-informed and provides for safety and well-being.

Agencies must advocate for the value of these forms of intervention and care, and they need to continue to work from shared visions about the safety and well-being of the communities served.   

About the Author

Jen Leftwich is a former Emergency Communications Officer for Powhatan County Public Safety Communications and Powhatan Sheriff’s Office where she formed the agency’s CISM/Peer Support team. She is certified CISM through UMBC and the ICISF, CIT certified, earned an M.A. in Trauma and Crisis Counseling, a Forensic Social Work certificate, and will complete her Clinical M.S.W. at Virginia Commonwealth University in May 2021. She plans to practice clinically and independently with uniformed and protective service populations, while also advocating for continued collaborative interdisciplinary partnerships between social work and public safety. She is a proud LE/Fire/Rescue/Military family member and advocate.

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