Amid national conversation in recent months about reducing policing’s footprint in behavioral health matters, the Crisis Assistance Helping out on the Streets (CAHOOTS) program in Eugene, Oregon, has received particular attention as a successful and growing alternative to on-scene police response. Staffed and operated by Eugene’s White Bird Clinic, the program dispatches two-person teams of crisis workers and medics to respond to 911 and non-emergency calls involving people in behavioral health crisis—calls that in many other communities are directed to police by default. CAHOOTS units are equipped to deliver “crisis intervention, counseling, mediation, information and referral, transportation to social services, first aid, and basic-level emergency medical care.”White Bird Clinic, “CAHOOTS FAQ,” accessed August 18, 2020, https://whitebirdclinic.org/ca.... All services are voluntary. If the situation involves a crime in progress, violence, or life-threatening emergencies, police will be dispatched to arrive as primary or co-responders.Ibid. CAHOOTS teams deliver person-centered interventions and make referrals to behavioral health supports and services without the uniforms, sirens, and handcuffs that can exacerbate feelings of distress for people in crisis. They reduce unnecessary police contact and allow police to spend more time on crime-related matters. Eugene police may also request assistance if they arrive on-scene and determine that a CAHOOTS team can help resolve a situation.

This case study explains how CAHOOTS teams are funded, dispatched, staffed, and trained—and how a long-term commitment between police and community partners has cemented the program’s success.

Funding CAHOOTS through the police

The City of Eugene has long supported CAHOOTS through the Eugene Police Department (EPD) budget as an essential part of the community’s crisis response system, beginning in 1989 when EPD funded the first CAHOOTS shift.Tatiana Parafiniuk-Talesnick, “In Cahoots: How the Unlikely Pairing of Cops and Hippies Became a National Model,” The Register-Guard, October 20, 2019, https://www.registerguard.com/....In June 2016, the Eugene City Council increased the program’s funding by $225,000 per year to allow for 24/7 service.Ellen Meny, “CAHOOTS Starts 24-Hour Eugene Service in January 2017,” KVAL, December 12, 2016, https://kval.com/news/local/ca....Funding increases have continued over the last few years to allow for overlapping, two-van coverage as the call volume for CAHOOTS has grown.City of Eugene Police Department, “CAHOOTS,” https://www.eugene-or.gov/4508/CAHOOTS.

After years of working with police in Eugene, White Bird expanded CAHOOTS services to the neighboring community of Springfield in 2015, when Lane County administered an Oregon Health and Human Services grant for the program.Parafiniuk-Talesnick, “In Cahoots,” 2019; Tim Black, operations coordinator, CAHOOTS, April 17, 2020, telephone call. Between Eugene and Springfield, CAHOOTS is now funded at around $2 million annually—about 2 percent of their police departments’ budgets.Anna V. Smith, “There’s Already an Alternative to Calling the Police,” High Country News, June 11, 2020, https://www.hcn.org/issues/52.....

Dispatching CAHOOTS for ‘better customer service’

A key element of White Bird’s partnership with police is that CAHOOTS staff carry a police radio that emergency dispatchers use to request their response to people in crisis on a special channel. The channel can get “overwhelmed,” Eugene officer Bo Rankin explained, by the increasing number of requests for CAHOOTS teams.Officer Bo Rankin, Eugene Police Department, February 25, 2020, telephone call. Of the estimated 24,000 calls CAHOOTS responded to in 2019, only 311 required police backup, and in Eugene, CAHOOTS teams resolved almost 20 percent of all calls coming through the city’s public safety communications center.Black, September 10, 2020, email; and Trevor Bach, “One City’s 30-Year Experiment with Reimagining Public Safety,” U.S. News & World Report, July 6, 2020, https://www.usnews.com/news/ci....

Of the estimated 24,000 calls CAHOOTS responded to in 2019, only 311 required police backup...

The center is housed in EPD and tasked with receiving and dispatching all police, fire, and CAHOOTS calls.Marie Longworth, communications supervisor, Eugene Police Department, May 4, 2020, telephone call. With the CAHOOTS program embedded in Eugene’s communications system, Eugene dispatchers are empowered to use this non-police alternative to handle non-police issues.

The police department and CAHOOTS staff collaboratively developed criteria for calls that might prompt a CAHOOTS team to respond primarily, continuing to adapt them based on experience; the protocol is used as a guide rather than a rule. For example, when a call arrives at Eugene’s communications center, through either 911 or the community’s non-emergency line, call-takers listen for details that might fit these criteria. As Eugene communications supervisor Marie Longworth put it, sending CAHOOTS rather than police is often regarded as “better customer service” for community members requesting assistance for themselves or others.Ibid.

Official Eugene communications protocol for CAHOOTS

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Longworth also notes that CAHOOTS’s relationships in the community help dispatchers connect people with appropriate responders. The communications center sometimes gets direct requests for CAHOOTS. In other cases, because of their familiarity with community members and their specific needs, CAHOOTS teams have demonstrated comfort taking on calls that would otherwise go to police.Ibid.

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Photo by Todd Cooper

Staffing and training

Robust recruitment and training underpin the success of CAHOOTS teams. CAHOOTS medics typically bring EMT certifications and experience within fire departments. CAHOOTS crisis workers may have undergraduate degrees in a human services field, but some people bring experience working crisis lines or in shelters, whereas others have lived experience with behavioral health conditions. Increasingly, the program has sought multilingual candidates who can help extend the reach of CAHOOTS services to Latinx communities.Black, April 17, 2020, call. CAHOOTS team members undergo a months-long training process, in cohorts whenever possible. In addition to at least 40 hours of class time, new staff complete 500 to 600 hours of field training—specific timelines depend on cohort needs—before they can graduate to exclusive, two-person CAHOOTS teams.

Although most EPD officers receive CIT training, CAHOOTS staff take on a more specialized set of issues and benefit from extensive field training focused on crisis incidents.Rankin, February 25, 2020, call; Rankin, September 10, 2020, email. The CAHOOTS training process is incremental, ranging from field observation to de-escalation to the nuts and bolts of working with police radios, writing reports, coordinating with service partners, and starting and ending shifts.Black, April 17, 2020, call.

White Bird also engages CAHOOTS trainees in a mentorship process that lasts throughout their careers with the organization, with the understanding that they take on difficult work and need outlets to process experiences together to carry out their jobs.Ibid. The practice demonstrates the importance of wellness for first responders and community members alike.

Cahoot Collaboration V2
© Chris Pietsch – USA TODAY NETWORK

Sustained and inclusive collaboration

Over time, CAHOOTS and police have developed strategies for supporting one another as calls evolve on-scene and require real-time, frontline collaboration. As noted above, requests for service involving a potentially dangerous situation will require early police involvement, but officers may engage alternative responders once the scene is stabilized and they have gathered more information about what the person in crisis needs. For example, Eugene officers can request assistance when they determine that CAHOOTS-led de-escalation might resolve a situation safely for all parties involved, especially when a call appears to involve underlying substance use or mental health issues.

In addition to bringing expertise in behavioral health-related de-escalation to a scene, CAHOOTS teams can drive a person in crisis to the clinic or hospital. This transportation, which must be voluntary, eliminates the indignity of a police transport, which necessitates the use of handcuffs per standard police protocols.Rankin, February 25, 2020, call.

More rarely, CAHOOTS teams may determine that police involvement is needed when they gather more information, or as a situation evolves on-scene. If they respond to calls involving people who pose a danger to themselves or others, CAHOOTS teams may see the need for an involuntary hold without the authority to carry one out.Black, April 17, 2020, call. For example, a person may be so severely intoxicated that they cannot care for themselves and will not consent to a sobering center.American College of Emergency Physicians, “Sobering Centers,” https://www.acep.org/by-medica.... In this case, CAHOOTS staff might call in patrol officers to execute an emergency custody order. For mental health calls that end in involuntary hospitalizations such as these, CAHOOTS vans follow patrol vehicles to the emergency department to share their transfer sheet, which lists observations of and items discussed with the community member. This facilitates continuity of care for the client.Black, April 17, 2020, call.

Collaboration between EPD and CAHOOTS extends beyond emergency response. Over the last few years, EPD has introduced the Community Outreach Response Team program to deliver case management for people experiencing homelessness who often come to the attention of emergency services.Rankin, February 25, 2020, call; see also Cameron Walker, “Police Collaboration Effort Works to Keep Downtown Eugene Safe,” KVAL-TV, August 10, 2016, https://kval.com/news/local/po.... As part of this program, the police have partnered with CAHOOTS to bring their behavioral health expertise to bear on community members who continue to experience frequent contact with the police. EPD has found that this collaborative problem-solving work complements Eugene’s ongoing efforts to support alternative first responders.Sergeant Julie Smith, Eugene Police Department, March 11, 2020, telephone call.

Close collaboration among government and community partners—including schools, shelters, and behavioral health providers—enables CAHOOTS to respond to a wide variety of situations and to assist police and other agencies with behavioral health emergencies when appropriate.White Bird Clinic, “CAHOOTS FAQ.” Such partnerships during program planning and throughout program implementation are essential to the success of efforts to improve local crisis response systems. CAHOOTS Operations Coordinator Tim Black stressed that the organization’s success did not happen overnight; there were many small, but important, details to address and a wide range of stakeholders to engage for effective implementation. “You want to make sure you have everyone who could possibly have an opinion about this topic at the table,” he explained.Black, April 17, 2020, call.It is important to include detractors of the police department in program planning, as getting these partners’ input is critical to program success. Officer Rankin noted that CAHOOTS staff themselves can be “strongly against police in many ways,” but it is “nice having all the line people trying to come up with solutions together.”Rankin, February 25, 2020, call.

Still, the Eugene and Springfield communities are more than 80 percent white, making them racially homogeneous compared to many cities.United States Census Bureau, “Quickfacts Eugene, Oregon,” https://www.census.gov/quickfacts/eugenecityoregon; and United States Census Bureau, “Quickfacts Springfield, Oregon,” https://www.census.gov/quickfa....“There’s a lot of privilege that comes along with having a healthy enough relationship with police that you can contact them,” Black acknowledged, and Eugene is now exploring a separate phone line for CAHOOTS that would be disconnected from the police department.Black, April 17, 2020, call; and Molly Harbarger, “Police Cuts Give Portland Alternative First Responder Program a Boost—But Can it Respond to the Moment?” The Oregonian, July 4, 2020, https://www.oregonlive.com/cri.... This is a vital consideration for implementing crisis response programs where relationships between police and communities of color are historically characterized by tension and distrust. Programs may find success by grappling with this distrust directly and engaging a wide variety of partners to reach communities with the greatest need.See for example Jumaane D. Williams, Improving New York City’s Responses to Individuals in Mental Health Crisis (New York: New York City Public Advocate, 2019), https://www.pubadvocate.nyc.go....

CAHOOTS credits being embedded in the community’s emergency communications and public safety infrastructure for much of its impact, while stressing that the program’s ultimate objective is to reduce policing’s overall footprint. White Bird’s website states, “CAHOOTS is designed to provide an alternative to police action whenever possible for non-criminal substance abuse, poverty, and mental health crisis.”White Bird Clinic, “CAHOOTS FAQ.” According to Black, the program aims to reduce opportunities for people to become justice-involved and lose their rights. Working with the police has made this possible: “By no means do we [ignore] what other public safety personnel are doing,” he explains. “We try to use our privilege in the public safety system to fight for compassionate and responsive services.”Black, April 17, 2020, call.