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Secondary Responder ModelCopyrighted February 20, 2023 City of Dubuque Action Items # 05. City Council Meeting ITEM TITLE: Secondary Responder Model SUMMARY: City Manager recommending City Council approve utilizing the Internal Working Group as the backbone to a secondary responder model, allow for the exploration of co -locating services in the Federal Building and identify community partners to support the efforts of secondary responders. City Manager additionally requesting City Council approval to continue to pursue funding for co -responder position(s). City Staff will make a presentation. SUGGESTED Receive and File; Approve; PresentationSuggested Disposition: DISPOSITION: ATTACHMENTS: Description Type MVM Memo City Manager Memo Secondary Responder MVM Memo Staff Memo THE CITY OF 1-6-7 D U B TEE Masterpiece on the Mississippi TO: The Honorable Mayor and City Council Members FROM: Michael C. Van Milligen, City Manager SUBJECT: Secondary Responder Model DATE: February 16, 2023 Dubuque All-befica Ciq 2007-2012-2013 2017*2019 Chief of Police Jeremy Jensen and Housing and Community Development Director Alexis Steger are recommending City Council approve utilizing the Internal Working Group as the backbone to a secondary responder model, allow for the exploration of co - locating services in the Federal Building and identify community partners to support the efforts of secondary responders. Additionally, I request City Council approval to continue to pursue funding for co -responder position(s). City Staff will give a presentation. I concur with the recommendation and respectfully request Mayor and City Council approval. Micl�ael C. Van Milligen LVA 14 &TA LVA WA Attachment cc: Crenna Brurnwell, City Attorney Cori Burbach, Assistant City Manager Jeremy Jensen, Chief of Police Alexis Steger, Housing and Community Development Director THE CITY OF DUB.: ji� UE Masterpiece on the Mississippi TO: Michael C. Van Milligen, City Manager FROM: Jeremy Jensen, Chief of Police Alexis Steger, Housing and Community Development Director DATE: February 13, 2023 RE: Secondary Responder Model INTRODUCTION Dubuque MI-Amedugly 2007-2012-2013 2017*2019 The purpose of this memorandum is to describe the options available for the City of Dubuque to address individual needs of residents that are identified during first responder calls for service, and during other interactions with city employees. BACKGROUND The issues surrounding brain health, substance abuse, homelessness, hoarding, poverty, etc. are very complex. As a society we tend to silo these as separate issues, but in reality they are often interconnected. Individuals in crisis, have a difficult time navigating the system of care holistically or even initially. Within the City organization traditional first responders (Police, Fire, 911), and city employees addressing nuisance compliance such as the Housing Department, Health Department, Public Working, and Zoning are the first contact many individuals have. For a number of years, the City has had an Internal Working Group (IWG) which consisted of all departments, with the intention to efficiently and effectively problem solve, particularly around issues that are repeated and labor intensive. Additionally, the group was to communicate among each other so that they were not "reinventing the wheel" each time a department responded to an issue. Recently, the IWG has been revamped. The IWG is now being facilitated by the Housing and Police Departments, with co-chairs being action oriented and "in the field". The IWG has a core team of departments, with the authority to include other departments as needed. This is the City's action team, with true autonomy to address problems in real time-, however, the IWG has limitations. To be truly effective, the City needs to rely on private partnerships. The partnership between the city and private partners, to address problems in real-time while an individual is in crisis, is called Secondary Responder or Second Response. ser� ice People Integrity Responsibility Innovation Teamwork A Secondary Responder is a subject matter expert that responds as a co -responder with the first responder, or responds as a referral from a first responder. In many instances this is very broadly defined as a "social worker". In recent years, there has been discussion and even movement to remove or limit first responders from the response, particularly to brain health issues. This is not being recommended because there are too many variables such as physical safety, fluid and often dynamic situations, brain health manifesting through criminal activity, and the incidents happening at all hours and all days. The City, has been involved in the Brain Health initiative for a number of years and liaises with various private entities in an effort to address this complex issue. Last fall a task force was created to look into Secondary Responder models that have been implemented across the country and to dissect what is being done in Dubuque and identify needs. City Internal Structure In 2022, the City received an increase in calls for service for first responders to assist the unhoused, those with untreated brain health issues, and chronic substance misusers. Additionally, the City received an increase in public nuisance calls for neighbor disputes about things such as trees overhanging yards, dogs barking, retaining walls failing, grass/weed height, trash accumulations and general noise disturbances. First responders, i.e. police and fire, are being utilized for these call types when the call comes in through dispatch (non -emergency and 911). Many of these calls are not related to criminal behavior, and are civil matters that require consistent follow-up and community resource referrals to resolve. Essentially these types of calls are labor intensive and if not properly referred, result in more calls for service. The primary response to the issues outlined above is the first responders (police and fire), with the Police Department being the first response in most instances. In Dubuque, the culture is to call 911 for crisis issues. It should be noted the State of Iowa has implemented 988 for mental health support, but so far that has gained limited traction. Additionally, and frequently, a person in crisis, requires an in -person response. Since 2018, the Police Department has been utilizing a Critical Incident Team (CIT) as part of the response to brain health issues. The CIT consists of twelve officers that assist Patrol Officers and other City Departments when responding to someone with brain health issues and chronic/acute substance users. In CY2022, the Police Department responded to 662 calls for mental health referrals. Of these calls, 248 calls consisted of 82 individuals who required more than one contact. The CIT was used 577 times with 217 individuals. Actions requiring more time and effort included 77 mental health committals on 45 individuals. Substance abuse was a co-occurring condition in 62% of these cases. Iowa code requires individuals to be released to the least restrictive treatment option. Often multiple committals are needed to determine the best course of treatment. A review of the statistics from the CIT made it clear that the same individuals are requiring the services of first responders repeatedly, as community resources and referrals fail to effectively Service People Integrity Responsibility Innovation Teamwork address underlying issues. The 2021 and 2022 CIT annual report are attached to this memo for additional information. The Community Oriented Police (COP) unit in the Police Department focuses on neighborhood issues that may be persistent, and calls that require continual follow-up for positive outcomes. This unit responds to calls for the unhoused, calls for neighbor disputes, or issues that require long term solutions to short term problems. The COP unit focuses on community outreach through partners to strengthen police/community relations and make connections to resources. Additionally, they look for solutions to problems to prevent excessive fines and/or criminal charges, as well as looking at long term solutions. COP officers respond to a lot of non -criminal cases that take a lot of staffing hours to resolve. From January 1, 2022, through September 26, 2022, the COP unit helped with the unhoused 47 times. This included checking on the unhoused during cold weather, cleaning up old camps, and assisting the Housing and Community Development Department for referrals for the unhoused. The individuals being assisted are most often repeat contacts with known unhoused individuals (75%). COP officers work with unhoused individuals to connect them to resources if the person wants resources. A recent example is where COP officers responded to a "homeless camp" on State of Iowa property. Officers were able to help the subject find substance abuse treatment, and found a location to store the individual's property while seeking that treatment. School Resource Officers (SRO) are located in the Dubuque Community School District (DCSD) and are a direct partner and partially funded by the DCSD. The purpose of the SRO's is to educate, mentor, and facilitate the use of restorative practices or divert potential criminal charges to resources other than the criminal justice system. SROs often work closely with families that are identified as unhoused, children identified by counselors as needing assistance, and also those that have made poor decisions that have led to or could lead to criminal charges. The goal of SROs is safety of everyone in the school, but this often means the SRO must complete significant follow-up with families to get basic needs of the children met, to address problems that are brought from home into the school. In 2022, the reports of Criminal Offenses showed a significant increase in almost all areas (505) except weapons violations which showed a decrease. It should be noted that 2021-2022 school year was the first school full academic year with students in the classrooms since COVID. Additionally, SRO's conducted 751 classroom talks, made 67 referrals to the Restorative Practices, and of the 505 incident reports, only filed charges in 173 of those incidents. Again with the purpose of looking at long term solutions. In these cases, SRO's work directly with Juvenile Court Services to find the best solution. The Fire Department Emergency Medical Services received 1900 calls for service related to mental health or substance misuse from January 1, 2020 through November 1, 2022. These 1900 calls were for 1336 unique individuals; however, 42% of the calls were for individuals needing service more than once. Eight of the individuals served required assistance more than 10 times, up to as many as 35 calls for one individual. Departments responsible for enforcement of nuisance issues within the City organization are also reporting a small number of cases account for a significant portion of their time/effort. The types of cases creating a significant amount of time and effort, include hoarding, nuisance trash/garbage, structure failure on a home, and inoperable vehicles. Departments responsible Service People Integrity Responsibility Innovation Teamwork for fielding complaints for these issues include the Police, Housing and Community Development, Engineering, Planning, Parking/Transit and Public Works. Complaints are often cross -departmental because more than one issue exists. The underlying cause of the issues is often mental health, substance use, and lack of resources, but none of the Departments are situated to handle the underlying issues. This leads to negative outcomes for residents that need the most assistance. DISCUSSION Models from around the United States were reviewed. Each model had some things that may work in Dubuque, but the common theme was that Dubuque needed a customized model. Models Researched for Use in Dubuque MPACT (Marshalltown, 1A) This Secondary Responder Model is staffed by two community advocates housed at the police department. This provides daily coverage from 2:00 pm to 12:00 am. When a call comes into the 911 communications center, first responders are dispatched and assess the safety of the environment. When appropriate, the first responder radios the secondary responder to respond on -site. The secondary responder provides on -site intervention and an assessment. They then complete an action plan with the family and follow-up with referrals and timeline of the action plan. Marshalltown presented this model at HUD conference dealing with homelessness, as a way to connect people to resources effectively. The first responders report amazing success with this model and are looking at adding a third secondary responder in 2023 to expand coverage. Take aways for a Dubuque Secondary Responder Model? Direct connection to first responders, alleviates time first responders are being used as caseworkers. Coverage options — can't be 24/7, so need to look at call for service times. Family assessment, action plan and follow-up model for serving residents. CAHOOTS (Eugene, OR) In this model, a non-profit runs the services but is contacted directly through the 911 communication center for drugs, alcohol, mental health, or shelter needs. They transport those that are willing to seek treatment and try to treat in place if the person is unwilling. If they are unwilling to be transported for treatment, police are dispatched to handle the case. Take aways for a Dubuque Secondary Responder Model? • Call types identified are important, dispatch training is essential. • Identifying transportation needs of those needing assistance is essential. Support Team Assisted Response (STAR) Program (Denver, CO) This model works in tandem with a crisis hotline, but can also be accessed through 911 communications. It is staffed 1 Oam to 6pm and dispatched for welfare checks, trespassing, intoxicated people, suicide response and indecent exposure. 911 communications dispatchers identify when to send STAR to a call for service. Take aways for a Dubuque Secondary Responder Model? ser� ice People Integrity Responsibility Innovation Teamwork Call types identified are important, dispatch training is essential. Co -located with other agencies for ease of resource referrals. Secondary Responders (Alexandria, VA) This model is different than others reviewed based on a secondary response after a police call for service is completed. Social workers get a list of call locations and persons in need of additional assistance and make contact as their caseload allows. In limited circumstances, they respond to the scene with first responders. Take aways for a Dubuque Secondary Responder Model? 0 Secondary responses do not need to be limited to First Responder initiation. 911 Crisis Call Diversion (Houston, TY� In this model, a call comes into the 911 communication center and dispatchers are trained to identify a mental health concern that is in need of a risk assessment. The call is transferred to Crisis Call Diversion for a risk assessment, safety planning and mental health referrals. A clinician can be dispatched to the scene instead of Police as necessary. Take aways for a Dubuque Secondary Responder Model? A crisis intervention team member on the phone could decrease police response for mental health crisis. After reviewing this model, it was determined that Dubuque needed a customized version of the above This was based upon several key take aways. 1 . The City organization will never be out of this business. We are the constant in this issue and are the primary first responders in almost all incidents. 2. Dubuque does not have a private entity (for -profit, or non-profit) with the capacity, direction, willingness, or business model to take on these issues holistically. Private entities consist of for - profit with business models. Dubuque Secondary Responder Model The MPACT model results/outcomes has shown that people are more likely to respond favorably to assistance from a secondary responder when they are present in their moment of crisis. Due to this the following model is being proposed: 1 . Resident calls 911 Communication Center 2. Dispatch sends first responder. 3. First responder identifies a need for ongoing services. 4. Secondary responder is called on -site. 5. First responder leaves the call when no threat of safety concerns remains. 6. Secondary responder completes a family assessment and develops a plan of action with the family. 7. Secondary responder completes referrals to community resources based on the plan of action. 8. Secondary responder follows -up with family until services are properly established for long-term success. 9. If possible, respond to incidents as the first responder. Service People Integrity Responsibility Innovation Teamwork *Secondary responder may also receive referrals from city departments completing enforcement on nuisance issues. Developing the process above, one of the first items established was the outcomes expected from a secondary responder model. The outcomes identified are: 1 . Reduce the amount of time first responders spend on resource referrals and casework follow-up (time on call reduction) 2. Increased connection to resources for individuals in contact with City Employees for enforcement or first responders for assistance. 3. More efficient initial response, which in turn reduces the amount of referrals, and a customized and prioritized referral for the individual 4. Reduce repeat contact by first responders with the same individuals. 5. Reduce the number of calls for service first responders are required to respond to, but don't require first responders for resolution (Diversion). To meet these outcomes with a secondary responder model, current FTE's, programs and resources were evaluated for building a model that would not increase the cost to the City of Dubuque's operating budget. A new division, the Community Impact Division, was created in the Leisure Services Department in Fiscal Year 2023 with the goal of direct services for community outreach. The Community Impact Division consists of two FTE's, the Community Diversion and Prevention Coordinator and the Community Service and Outreach Coordinator. This division's two FTE's are well suited to be part of the core IWG. One of the major goals of the division is to build and maintain relationships with local nonprofit organizations to improve equitable outcomes and increase community access to information and opportunities related to service. Another goal of the division is using a collaborative process to support those in our community who would benefit from resources that help prevent unnecessary hospitalization, incarcerations and offer guidance to those who need ongoing resources. Additionally, the Police Department has received a $250,000, 3-year Community Oriented Policing hiring grant from the Department of Justice. The grant will reimburse the salaries of full-time CIT officers until fully utilized. The model is based upon a first responder triage of situations, developing partnerships through liaisons with various providers, to be more efficient in getting individuals resources and referrals. In the proposed model for the City Secondary Responder Program, co -location of key resources and FTEs working closely together will enhance the effectiveness and efficiency of the program. The following units would be co -located in the Federal Building to become a support resource group: • Community Oriented Police Unit • School Resource Officers (Home base only, this does not change the location of offices in the schools or time in the schools) • Critical Incident Team (when fully staffed) • Inspection/Construction Services • Assisted Housing Caseworkers The Federal Building is a neutral space for residents to feel comfortable visiting, and is well situated downtown by other community resources such as Fountain of Youth, HACAP, Hillcrest PATH Program, the Rescue Mission, the Teresa Shelter, and many others. This co -location for the resource group working together for the same goals/outcomes also provides the ability to prioritize issues that are experienced more than once, for a more holistic look at how to Service People Integrity Responsibility Innovation Teamwork approach the issue. It also provides connections for the best resource for the issue, not just a resource. Multiple issues that can be addressed better by one agency, instead of many, based on a family action plan can be planned/created through the resource group and community partners of that group. The secondary responder model would require employees to be trained in emotional intelligence, de- escalation, individual safety procedures, and one on one job shadowing with police officers, paramedics, and code enforcement officers. Next Steps In the Dubuque Secondary Responder model, the core organization is the City; however, a fully functional model requires commitment and accountability from community partners. No organization in the City has the core function and mission that crosses the breadth of services for a Secondary Responder model, so the City needs to remain the core organization in the model. The City organization now has the backbone and foundation, but is not economically feasible and is not the purpose of government to have a Secondary Responder model without committed partner organizations. Therefore, the IWG group will identify voids in the resource and referral systems and identify community partners to fill those voids. One void that has already been identified is the need for co-responder(s), particularly in the brain health and homeless response. The department is also currently in talks with a private entity that has a vested interest in Dubuque to fund a civilian law enforcement liaison, i.e. co -responder. This entity has provided services like this already in the Dubuque area. By identifying community partners and identifying their strengths it allows these partners to stay committed to their missions supported by their funding sources, and will give the city a true account of what services are not being provided. Additionally, with the city facilitating the program, the city can connect the dots between providers and liaison with them, thus providing a better experience, efficient processing, and effect treatment for the individual. RECOMMENDATION We respectfully request City Council approve utilizing the Internal Working Group as the backbone to a secondary responder model, allow for the exploration of co -locating services in the Federal Building and identify community partners to support the efforts of secondary responders. Additionally, I request City Council approval to continue to pursue funding for co -responder position(s). Service People Integrity Responsibility Innovation Teamwork Dubuque Secondary Responder Police Chief Jeremy Jensen A second(ary) responder is a worker who supports first responders such as police, fire, and emergency medical personnel. They are involved in identifying, preparing, and managing services. The overriding objective of these designated professionals is to quickly connect to services, thus providing effective and efficient help to a person. Because identifying and empowering second responders helps make the difference between lingering disruption and the necessary and timely restoration of daily life, many state and local governments are adopting the concept. • Police • Fire • 911 Not traditional first responders • Housing - Health Brain Health Unhoused Pove rty • Navigating services Repeat customers/consumers Not effectively connecting the service provider dots **The common theme is that they require an organization to facilitate.** We already have partners I think where we failed is that we have historically asked them to go outside of their own mission statements, priorities, and funding. Government is not designed to provide all services but is rooted in partnerships. Backbone is the Internal Working Group • History of the IWG • The IWG is boots on the ground = action • Current iteration Police �A CIT Law Enforcernen) Liaison CO Z�O) Secondary Responders Group (IWG) Facilitators Fi re 911 Dispatch Engine enn Public Right of-\\ Fire Marsha'll CC IT Way Cod9 Enforcmenj Ems:) CIT Health Housing Community Planning and Impact Zoning P ublic Health (—1 C S Diversion ZO ninL) Animal Control Case Worke r) Community Q! ternships • Timing: The right systems, right people in the right place at the right time. • Connecting the dots: Identifying service partners to fill the voids. Questions?