Police officers and social workers have very different jobs. But in Providence, RI, some are working together, responding in pairs to scenes where the social worker’s training in mental health and trauma can help officers resolve distressing situations, get folks into treatment when needed, and keep everyone safe. The city’s innovative approach to crisis response, which LISC has long supported, can be a model for other municipalities looking to “reimagine public safety.”
Photo at top: The Providence Journal
If police are called to a scene, there’s a pretty good chance somebody there is having a bad day. That scene might represent a singularly traumatic moment in the life of an individual or family. Or sometimes, what’s unfolding is the result of longstanding distress and dysfunction that bubbles over, occasionally or routinely, into the kind of disturbance that prompts a call for help.
When Providence, RI, police officers respond to situations like these, they may be accompanied by a key civilian partner—a social worker, in some cases a licensed mental health clinician—who in this context also acts as a first responder. The cop on the scene is responsible first and foremost for keeping everyone safe and enforcing laws. The social worker is there to start off by addressing the behavioral health problems and psychosocial needs that may be fueling the present crisis and seeding the next.
This practice, known as “co-response,” has its roots in partnerships going back nearly 20 years between the Providence Police Department (PPD) and two nonprofit agencies—Family Service of Rhode Island (FSRI), a 125-year-old human services organization whose programming includes mental health counseling, and The Providence Center (TPC), the state’s leading provider of mental health and addiction treatment.
More than a platform for referrals or policy talks, these are rubber-meets-the-road operational partnerships. They serve as a guide for other municipalities that are rethinking traditional responses to support people in crisis, and as the foundation upon which Providence itself is now expanding the role of clinicians in responding to 911 calls. Definitive data on the efficacy of co-responses is still being collected, but it’s already clear that these practices can help resolve incidents while improving safety for all parties.
In Providence, on a daily basis, social workers ride with police officers as they work their shifts and patrol their assigned posts. FSRI dedicates three full-time social workers to its PPD “Go Team,” who together cover the day shift and the evening shift that ends at 11 p.m., Monday through Friday. In addition, on-call FSRI personnel may be summoned to a scene around the clock. TPC staffs its ride-alongs with two full-time mental health clinicians covering the day and evening shifts, Monday through Friday.
The social workers ride with different officers according to the day’s needs. But police working anywhere in the city can request FSRI or TPC personnel, whose patrol units then make their way to the scene. “The Providence Center we try to have in parts of the city where we’re facing more mental health calls, or individuals that we suspect could benefit from mental health treatment,” says 25-year PPD veteran Major Henry Remolina, commanding officer of the Uniform Division. “And then Family Service we’ll keep on the outside of the city, just to spread our resources.”
Staff from the two organizations can do some of the same things (connect people to services, for example), but their functions in the police collaboration are quite different.
FSRI gets called into action “anytime a child or family has been exposed to any type of trauma or victimization,” says Candace Johndrow, FSRI director of victim services. While police do their work, co-responding FSRI staff will tend to kids whose parents are being arrested, for example, or whose mom is experiencing domestic violence. They assist witnesses of harrowing events from shootings to apartment fires, support young victims of sex trafficking during raids, and help children having disruptive breakdowns in school. The goal is to intervene in the moment of crisis to stem traumatic fallout. About a quarter of victims engage with FSRI long-term, getting help navigating legal processes, finding resources like housing and childcare, and healing emotionally and physically.
The TPC clinicians, on the other hand, are summoned when a person, typically the target of a call for service, is exhibiting signs of serious mental illness or substance use disorder. The person might be experiencing a psychotic episode, heavily inebriated, suicidal. Here the goal is to help resolve the incident in a way that protects the public as well as the subject from harm. Nationwide, people with serious mental illness are far more likely than other civilians to be killed in encounters with police, and they are overrepresented in American jails and prisons.
“Our core mission is diversion from unnecessary and costly criminal justice involvement and hospitalizations,” says Jacqueline Mancini-Geer, TPC director of acute care. At the scene the co-responding clinician will assess whether a person can remain safely in the community and identify resources to achieve that or, if need be, recommend transport to the hospital. Unlike a PPD officer, a TPC licensed clinician can order a temporary involuntary commitment if a person demonstrates imminent threat to themselves or others. In the vast majority of police calls where TPC is involved—98 percent—no arrest is made.
It’s hardly unusual for police departments to work with social service agencies. What is atypical is the extent to which social workers are embedded with Providence police. That became clear to Remolina last summer when he described PPD’s co-response protocols to other law enforcement officers at a national training for upper management. “They’re like, ‘You let them ride with you?!’ They thought I was crazy,” Remolina recalls.
Not all Providence patrol officers relish sharing the confined space of a police cruiser for eight hours, but they overwhelmingly support the co-response programs, says Remolina. They’ve learned that social workers help them resolve issues that aren’t exactly in their wheelhouse, but crop up again and again in their work. “That’s the selling point for the officer,” Remolina adds. “They see that ‘hey, if we work with this group, they’re going to take this problem off our hands.’”
Before the Family Service “Go Teams” were available, PPD could do little to assist a chronically brawling family or evidently neglected and frightened children besides hand out a pamphlet with phone numbers to call. And without the Providence Center’s on-scene clinicians, cops could do very little to address chaotic situations involving someone suffering from mental illness—a person screaming and throwing things at a 7-eleven, for instance—other than make an arrest.
One model for an enhanced “helping” response
Today, in cities and towns across the U.S., there’s a push to “reimagine” public safety—to replace police enforcement with proactive community investments, and to establish systems of crisis response that go beyond the default of dispatching armed officers. What do such alternatives look like? Providence’s co-response model offers a successful example, albeit one tailored to a specific place and set of players.
One secret of its success is the program’s relatively efficient design, with a few “flex units” that both cover a regular patrol and are available throughout town on an as-needed basis, says Sean Varano, a professor of criminal justice at Roger Williams University, who has worked closely with PPD, TPC, and FSRI as a research consultant. “One of the challenges that communities face is, how do we properly staff something like this?” says Verano. “Do we embed every single patrol unit with a social worker? You want to try to avoid the habit of a special unit out there that’s floating in the city and isn’t tied to calls for service, because you have to handle your call volume. I think there’s a lot to be learned from [the Providence PD’s] very simple administrative approach.”
Another important strength is the mutual trust and respect that exists between PPD and its social-service partners, on both personal and institutional levels. This is partly due to the partnerships’ longevity. Folks like Remolina and PPD chief Colonel Hugh T. Clements, as well as leaders at FSRI and TPC, have championed these relationships over long careers.
Younger officers are exposed to the value of co-response in their earliest training, and social workers are carefully screened for an ability to work well within the rough-and-tumble, shift-based world of policing while maintaining a clear commitment to their separate function.
“I think a lot of people that interview for Jackie [Mancini-Geer] or for me are people who think it's going to be like CSI, and they're going to have a stun gun, they're going to walk in and help catch bad guys,” says FSRI’s Johndrow. “That is not at all what the job is. It's social work.” This focus on partnership itself makes possible a pragmatic, problem-solving collaboration between two sectors with disparate and at times clashing cultures, professional standards, and legal and ethical mandates.
PPD’s co-response programs also illustrate some critical challenges municipalities face as they try to incorporate “helping professions” into crisis response. As in most cities, PPD is budgeted as a core function of city government, but the nonprofit social-service agencies have been largely responsible for their own funding. Managed care isn’t set up to pay for behavioral health services on an on-call basis. So the agencies work to raise philanthropic dollars and rely on federal and state grants that come and go. TPC’s program has recently been funded through city government for the first time in its history, with dollars dedicated from the American Rescue Plan Act—but because the money was slow in making its way to TPC the nonprofit’s co-response work ran a total program deficit for months, something that wouldn’t be possible if the agency weren’t connected to a larger health system.
Both FSRI and TPC would love to expand availability of their social-worker first responders, increasing hours and covering more of the city’s geography at any given time. That’s expensive. Says Remolina, “I mean, we all agree: it's a collaboration that needs to exist and it's extremely beneficial, especially the way we implement it, where it's embedded. But who's going to pay for these clinicians to work with us full time?”
To learn more about what co-response looks like in Providence, read these Q&As:
TPC clinician Rachel Armada & PPD officer Luis Tavares [+]
FSRI clinician Rachel Caruso & PPD officer Kirsten Doldoorian [+]
The evolution of co-response in Providence
The urgent nationwide conversation around policing reform taking place in 2022 represents an intensification and coming-together of several core concerns. There’s the concern that, for lack of more humane alternatives, our society has in essence criminalized mental illness, addiction, homelessness, and poverty. And there are concerns over community trauma due to over-policing coupled with a lack of accessible mental health supports and other vital services.
Indeed, arresting and prosecuting people experiencing these problems has helped drive an unconscionable U.S. incarceration rate, the highest in the world. There is outrage over repeated viral videos showing police violence against Black Americans, and a sense that in many communities, police are experienced as a racist occupying force. All this has culminated in calls to not just create alternative service models but to strip police agencies of some or all of their funding.
It’s a conversation taking place in Providence today. But PPD, FSRI, and TPC first developed their co-response relationships in a very different climate. The crime wave that peaked in the 1990s—and inspired a lock-‘em-up mentality across the nation—had subsided. Yet few communities were focused on shrinking the role of police in favor of alternative, public-health approaches to maintaining community wellness and safety.
Instead, the Providence model was born out of the community policing movement, which encourages neighborhood beats that allow officers to get to know residents, and organizational partnerships that expand police agencies’ ability to participate in tackling root causes of crime.
FSRI Go Teams were launched in 2004, inspired by a program in New Haven, CT that focused on children exposed to violence. The Go Teams evolved over the years to address all kinds of trauma experienced by witnesses, family members, and victims.
Several years later, The Providence Center also approached the police about a serious problem the mental-health organization was confronting. Many of its clients were getting arrested. They often came out of prison struggling even more with mental illness than when they went in, and saddled with a record that made it even harder to get affordable housing and other crucial supports. Incarceration, says Mancini-Geer, “creates this whole slew of other psychosocial problems, when really the genesis of the problem behavior was psychiatric to begin with.”
TPC’s answer to this conundrum was two-pronged: it began working to provide mental-health services to clients during their incarceration at the Adult Correctional Institutions, a state prison complex just south of Providence, and it partnered with PPD (and eventually other police agencies) to help officers evaluate, on scene and in real time, whether a subject could be diverted to treatment and avoid incarceration altogether. “We had the right support at the police department,” says Mancini-Geer. “They were as willing to take a risk on us as we were to take a risk on them.”
Looking at alternatives to police response
Following George Floyd’s murder by a Minneapolis police officer in May 2020, Providence, like cities across the country, experienced a summer of protest. Activists, ordinary residents, and several city council members were calling for change to, at a minimum, reduce law enforcement’s footprint in the community in favor of other investments and services.
In September 2020 Mayor Jorge Elorza announced an audit of the city’s public safety department, which includes police and fire/EMS departments, as a basis for “reorienting” public safety efforts toward prevention.
One of the audit’s findings was that PPD had become “a catch-all for non-criminal issues” with the “ability and willingness to respond to all types of events.” The report said that only 3.9 percent of PPD’s calls for service in 2019 involved serious Part 1 crimes (homicide, rape, and robbery, for instance). The top 15 call-for-service types included such matters as traffic incidents without injury, well-being checks, business alarms, suspicious person/activity, and public disturbance.
The report recommended that a new Department of Neighborhood Services be established and, over several years, replace PPD as the “hub” of community response, managing outside vendors that would be responsible for calls involving mental health, substance abuse, and chronic homelessness. Diverting calls for non-dangerous incidents of this type to a robust system of alternative response would in time allow the city to reduce PPD staffing by attrition, the report said.
But as it also noted, mental health, substance use, and homelessness are not specifically identified in call-for-service codes. The term “public disturbance,” for instance, is suggestive but far from definitive. As Providence’s co-responding partners attest, it’s often not at all clear what the underlying issues are until responders are on the scene. Even situations where behavioral health problems predominate can be dangerous or become so quickly.
These are among the issues tackled last year by TPC, FSRI, and a host of community stakeholders and consultants in a six-month planning project looking at possible alternatives to police response in behavioral health crises. LISC Safety & Justice (S&J) took part in this study by providing a scan of alternative crisis-response approaches around the country. For two decades the national S&J team and LISC Rhode Island have incorporated safety strategies in their capacity building for Providence community-based organizations, and helped to facilitate collaborations with police geared toward reducing crime while advancing community well-being more broadly.
“I do think there are calls that we can dis-involve law enforcement from,” says TPC’s Mancini-Geer. “But to be able to discern on the front end which calls can be diverted and which need co-response is very challenging. We don’t have great training models or algorithms for that. We have to involve dispatch in deciding.”
In May 2022, the City of Providence announced a new program, to be led by TPC, that will do just that. The city itself will fund two new positions at TPC. One will work with dispatchers fielding 911 calls. “That’s going to be a clinician trained to identify behavioral health calls, take those calls in real time, and be able to advise dispatch on the most appropriate response,” says Mancini-Geer. In some cases that might not involve a police or any emergency response, if the TPC personnel can de-escalate the crisis over the phone and, for example, send the caller over to a telehealth consultation.
The second clinical worker will ride along with fire department emergency medical technicians (EMTs). TPC already has one specially trained nurse riding along with an EMT unit Monday through Thursday during the day. The second staff person will expand the hours during which this co-response unit is available. The unit shows up not in an ambulance but in an SUV equipped with emergency supplies and the usual lights and sirens. It’s similar to a model from Eugene, OR, that TPC and its partners studied closely during their planning phase, called Crisis Assistance Helping Out on the Streets, or CAHOOTS.
Here, teams made up of a medic and a crisis counselor with mental health training are dispatched to 911 call types that indicate a non-dangerous situation involving mental health, substance use disorder, or chronic homelessness. The teams strive to de-escalate crises and divert from criminal justice involvement or unnecessary emergency services, providing on-scene medical attention for minor issues, crisis counseling, referral for services, and transport. Funded by the city through the Eugene Police Department, CAHOOTS diverts 5 to 8 percent of police calls. Very rarely do the mobile teams need to call for police backup.
TPC also has a new grant from the state Department of Behavioral Healthcare, Developmental Disabilities & Hospitals (BHDDH) to hire two part-time, bilingual clinicians available to respond independently when referred by police who encounter behavioral health needs in the course of their work.
Building on what works
Providence police are not in favor of trimming their ranks. In 2021 PPD, found itself sharply below traditional staffing levels—“critically short,” chief of police Clements told local media—even as Providence, like much of the country, saw a troubling hike in violent crime. Last summer the city council, in a split vote, approved a fiscal year ’22 budget that includes resources to bring 50 new recruits onto the force.
The Providence Police Department’s Major Henry Remolina has championed the co-response model with his department for many years and is pushing for continued support for the social worker-police officer teams. “Our mode of operating is working.”
But police and their nonprofit partners generally agree there are calls that might be usefully and safely diverted from law enforcement first response. By way of illustration, Remolina ticks off a few PPD calls from December 2021:
- December 15, Duffel bag left in front of someone’s house. (Police respond, it’s full of trash.)
- December 15, Unknown male knocking at the door, asking for Ann.
- December 23, 5 p.m. Neighbor working on a car on his own property.
- December 26, Female acting erratic. “That’s the call,” says Remolina. “That’s how we’re being introduced to this situation.”
- December 27, 5:15 a.m. Request for a welfare check of a resident. “When my officers responded there, the resident wanted water and to lower the temperature.”
Even in Providence, where innovative models of response are institutionalized and expanding, there is more work to be done to design an array of appropriate responses to situations of varying type and acuity level, and to educate dispatchers and the public about how to access and use them. For certain basic needs, Mancini-Geer says, the city could employ helpers such as community health workers who could respond on a non-emergent basis—within a few hours, say.
As they take next steps, the partners involved in Providence’s police co-response teams believe their joint approach will continue to play a critical part in upholding safety and justice in Rhode Island’s biggest city.
As a case in point, Remolina cites a much more complex and demanding call that came in on December 26, 2021: a woman reported her husband had swallowed some pills. On scene, cops learned he’d also taken pills the night before—and stuck a gun in his mouth—distraught after discovering his wife’s infidelity.
In this case, the Sunday after Christmas, no co-responding clinician was on duty. Without a clinician’s evaluation police couldn’t force the man to get help, inpatient or otherwise. They did manage to persuade him to take a ride to a mental health crisis center (not TPC), which released him the same day. That worried police. “The threat was against his own self, but there’s a fine line,” says Remolina. “We took a loaded gun out of his house. This could easily escalate to violence toward the wife.”
A co-responding clinical partner, he believes, could have observed the threat on scene and helped police ensure that in this volatile mix of suicidality and domestic conflict, nobody goes to jail unnecessarily, and nobody gets hurt. Says Remolina, “That’s a perfect example of what we do with The Providence Center. Our mode of operating is working.”