Yale Psychiatry Grand Rounds: "Elm City COMPASS: A Comprehensive Approach to Crisis Response"

April 05, 2024

April 5, 2024

"Elm City COMPASS: A Comprehensive Approach to Crisis Response"

Speaker: Jacob Tebes, PhD, Professor of Psychiatry, Yale School of Medicine; Director, Elm City COMPASS

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ID: 11548
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00:00It's really a pleasure to be here with
00:02you all the talk about Elm City Compass
00:05when I begin by indicating first that
00:08I'm going to turn on this flicker,
00:16that I have no disclosures.
00:18So I'll be talking about Elm City Compass.
00:20And as you can see,
00:22this is a partnership between the City of
00:24New Haven Consultation Center at Yale,
00:27Continuum of Care and then a lot of
00:31other organizations that provide in kind
00:33support the Connecticut Mental Health Center,
00:35the Connecticut Department of Mental
00:37Health and Addiction Services and
00:38our own Department of Psychiatry.
00:40And you'll see that this is just
00:41the tip of the iceberg of all
00:43those involved in Compass.
00:45I feel very fortunate to be a part of a
00:48large group of collaborators on this project.
00:51Derek Gordon,
00:52the Co Director of Compass John Lebeneck
00:55and Wanda Joffrey from Continuum of
00:58Care who are leaders of the Crisis team
01:01but provide input on so many other
01:03things about the broader initiative
01:05that you'll hear about and the City
01:08of New Haven including Carlos Sosa
01:11Lombardo who was gave rise to Compass
01:13working for the city as director
01:15of community Resilience now tears.
01:17Kemp is now in that role and is
01:20working with the closely with Liza
01:22Halsey and Lorena Mitchell to support
01:25Elm City Compass as we move forward.
01:28But if you can just look at this team
01:30and you're going to discover that the
01:32compass colors are dark green and white.
01:35And that's why today you're going to see
01:37a lot of dark green and Forest Green.
01:38I do like the color,
01:39but that's why we had that color
01:41in the presentation.
01:42But just a wonderful group of
01:44colleagues and collaborators at the
01:46consultation center at Continuum of
01:48Care that are doing City Compass,
01:50including Public Safety answering
01:51Point for the City of New Haven,
01:54the Police Department,
01:56New Haven Fire Department and
01:58the Mayor's office.
02:00But one of the best things about Compass
02:02is our Community Advisory Board.
02:03These are 19 New Haven residents who
02:06are committed to the kinds of issues
02:09that that face individuals who are in crisis.
02:12They're a wonderful group.
02:13You're going to hear quite a bit about
02:15the work that they're doing to move
02:17forward with Elm City Compass today.
02:19So why Elm City Compass?
02:20Well, first of all,
02:22New Haven is the Elm City, right?
02:24And Compass, as Stephanie said,
02:26is Compassionate Allies serving our streets.
02:28It's intended to be a community based
02:31initiative to create a system of
02:33sustainable supports for individuals
02:34in New Haven experiencing mental
02:36health or substance use crisis.
02:38So today I'll provide an overview of
02:42what we know about Crisis Response.
02:44Tell you a little bit about the
02:47origins of Compass and our four
02:49part vision with progress made and
02:51results from embedded evaluations.
02:53As part of Elm City Compass.
02:55That includes performance of
02:56the Crisis Response team,
02:58the views of services to
03:00stakeholders about crisis response,
03:02How do we assess effectiveness of
03:04Elm City Compass at multiple levels?
03:06And finally,
03:07how the views of New Haven residents
03:09may shape the way we deal with crises.
03:12In New Haven,
03:13I'll end with future directions,
03:15so beginning with what we
03:16know about crisis response.
03:22So crisis is something that's an
03:23intensely difficult or threatening event,
03:25a situation or a period.
03:29It's also can be a turning
03:31point or an opportunity. I said
03:34there's a lot of types of crises we can
03:36experience that can be an everyday crisis.
03:38Like we locked our keys in the car, right?
03:41That could be a crisis and we don't make an
03:43appointment and let's say it's a big deal.
03:45Let's say it's a wedding.
03:46That's maybe even a bigger deal that
03:47was in movies made about those things.
03:49Those are kind of everyday crises
03:51that can turn into bigger things.
03:52But there are a variety of crises
03:55that are much more long lasting.
03:57Relationship breakup, an illness or injury,
04:00a death of a loved one.
04:01And you can see here just
04:03the range of crises,
04:04ranging from a natural disaster,
04:05which effects most everyone,
04:07like the Pandemic did as well,
04:09but also more behavioral health crises,
04:11like an overdose, panic attack,
04:13a psychotic episode.
04:14Someone has a delusion that leads
04:17to other kinds of difficulties,
04:19and then we have crises dealing with housing,
04:21such as eviction or homelessness
04:23or food insecurity.
04:27People have described what we
04:30might want to think about to
04:32create an ideal crisis response.
04:33So in a recent report by the National
04:37Council for Behavioral Health Group,
04:39part of the Group for
04:40Advancement of Psychiatry,
04:41they identify the Deal crisis system.
04:43And this has been very helpful in
04:45shaping what cities and states are
04:47trying to put together to meet the
04:49needs of individuals in crisis.
04:51So you can see here we have
04:53crisis call centers and call lines
04:56and a crisis stabilization hub,
04:58hospital care,
04:59first responders who are trained in
05:01DE escalation and crisis response,
05:03mobile crisis, behavioral, urgent care,
05:07ongoing care and residential care as
05:10well as transportation and support.
05:11These are all critical components of crisis,
05:14but one of the things that they leave
05:15out is that system community stakeholders
05:18are mostly missing from this ideal system.
05:21Many stakeholders,
05:22such as individuals with lived experience
05:25of receiving a crisis response,
05:27family members of that, peers with lived,
05:29relevant lived experience,
05:31community organizations, faith communities.
05:34Many faith communities are often on
05:35the front lines of dealing with people
05:37who are in crisis in their economy,
05:39as well as businesses who often
05:41have customers or other folks who
05:43come into a business,
05:45then create a dilemma for other
05:46customers because they're in crisis
05:48schools and urgent care and education,
05:50say community.
05:52Stakeholders,
05:52in our view,
05:53need to be at the table in order
05:56to ensure that a community crisis
05:58response is meets local needs,
06:00priorities and values.
06:03So let's talk about the formal crisis
06:05systems in New Haven and Connecticut.
06:07There's three major ones.
06:09There's 911 system, the 2988 system,
06:11and the 211 system.
06:13The 911 system is a 24/7 national
06:16emergency response system.
06:18It's managed by local jurisdictions
06:20through a Public Safety Answering
06:22Point for P SAP where a call
06:25takers dispatch police,
06:26fire and emergency medical to a crisis.
06:30New Haven happens to be the highest
06:33volume PCAP center in the state,
06:35having 165,000 calls last year
06:39or about 450 calls a day.
06:42The vast majority of these are for a
06:45public safety or a medical emergency.
06:47I'll just think about what call takers
06:50staffing A911 system have to deal with.
06:53Here's just a small list of what they
06:55have to deal with. Shortness of breath.
06:57Gunshots. A missing person.
06:59Welfare check and overdose.
07:00A domestic dispute. Unusual behavior.
07:02Someone calls about someone's crossing
07:04the street and does not seem to be
07:06in touch with reality and doing so
07:08in a danger to themselves or others.
07:10Smoke in a house.
07:12Intoxication.
07:13Someone with suicidal intent or
07:15a noise complaint.
07:16And that's just not among hundreds
07:18of kinds of calls that 911
07:20call takers have to dispatch.
07:22And so the way they do that is they
07:24use a computer assisted system
07:26that has a protocol for identifying
07:28who to dispatch based on what
07:30they hear the call taker does.
07:31And they do that in seconds,
07:33seconds they do that.
07:34So it's either a public safety
07:36emergency usually,
07:37or a medical emergency and they have
07:39to make that decision with the aid
07:41of this computer assisted protocol.
07:44There's a 988 system.
07:45The 98 system is a relatively new system.
07:47It is intended to replace the
07:49suicide prevention hotline,
07:50the national suicide prevention hotline.
07:53It's now getting implemented across states.
07:56It's intending to make sure that anytime
07:59someone needs to talk to someone by phone,
08:02they can read someone by phone or text.
08:05So it is an urgent crisis response system.
08:07It's not yet in most jurisdictions connected
08:10to dispatching individuals in a robust way,
08:13but I think that's the
08:14vision for the 90 days.
08:16And the 211 system is also
08:18a national 24/7 helpline.
08:19It's again managed by the States
08:21and local jurisdictions to access
08:23essential Health and Human services.
08:25And in Connecticut,
08:27people receive coordinated access housing.
08:30People who are unhoused can be part of
08:321/4 exit Network for housing to get on
08:34a list to have equitable distribution
08:36of housing for people who are unhoused.
08:39But it also is a way to to access
08:42child and youth crisis services.
08:45So that's the landscape of the crisis
08:48response system in New Haven in the
08:51state for behavioral health crises.
08:53For those here who are familiar
08:55with the CMAC,
08:56it's really a fulcrum for the system.
08:59It's the local,
09:00the lead mental health authority
09:02for our state and through either
09:04directly the CMAC or through its
09:06Mobile Crisis Intervention Unit.
09:10The CMAC is available 8:00 to
09:125:00 PM on Monday through Friday
09:15during the week and then South
09:17Central Crisis is available in
09:19the evenings and on the weekends
09:25quickly. The foundation for our system
09:29medical side is again New Haven Health
09:31System through its emergency department
09:33which provides 24/7 emergency services
09:36and it is the responsible hospital
09:39for the 911 system in New Haven.
09:42In recent years,
09:43the New Haven Police Department has
09:46established Crisis Intervention Teams.
09:48It's a targeted, smaller initiative,
09:50but this is one in which officers
09:52receive 40 hours of mental health
09:54related training and DE escalation
09:56and trauma informed practice,
09:58but also mental health issues.
10:00They go out usually and
10:01respond with a social worker,
10:03sometimes in the same cruiser,
10:04sometimes separately,
10:05But they get to the scene and both
10:07a social worker and a police officer
10:09who's CIT trained respond to a crisis.
10:12Again has some limited availability
10:14at this point but then the broader
10:17crisis response is really done
10:19by community stakeholders. St.
10:22Outreach and Engagement teams
10:23such as the CMAC, St.
10:25Psychiatry,
10:26Liberty Community Services,
10:28housing and residential providers such as
10:30New Haven Office of Housing and Homelessness
10:32which coordinates a lot of that work.
10:34Columbus House,
10:36Continuum of Care and then clinical
10:39and health service providers.
10:40Community based organizations
10:41like ULA which is shown here,
10:43drop in centers which is the desk
10:47downtown evening soup kitchen which is
10:49going to be having a major renovation
10:51expansion this summer for drop in
10:53centers and full service drop in center.
10:55And then over here faith communities.
10:57This is Vera Memorial AME Zion
10:59Church which has been really
11:01supportive of variety of behavioral
11:03health initiatives in New Haven.
11:05So that's the broader landscape.
11:06It is a formal system combined
11:09with established structures.
11:11But think about the impact this larger
11:13group below has on the overall system
11:18and where does Elm City Compass fits in then?
11:20And this is part of the way that
11:22we started to think about this
11:23when we looked at the landscape
11:24of what's happening in New Haven,
11:26we realized Elm City Compass needs
11:28to find a role that complements
11:30and supports what's in this system.
11:32How can we leverage this Civilian
11:35Crisis Response initiative to
11:38improve and support the hosts?
11:40The three models that are that for doing
11:43that they can do it with a 911 with
11:46a separate line or perhaps even now
11:48with 988 and there's no one way to do this.
11:50But the three models used
11:51is a Co responder model.
11:53The CIT is the most prominent one
11:56where it's a police and a social
11:58worker usually come together.
12:00As I mentioned earlier,
12:01there's an EMS,
12:02an ambulance based model in which
12:05a crisis worker and a nurse or
12:07a medic goes out.
12:08That's actually the system,
12:10the original kind of system that led
12:12to this work by cahoots in Eugene OR.
12:14But there's also the STAR program in Denver,
12:16which is a more recent iteration of that
12:18that's doing using a model like that.
12:20And then there's mobile crisis teams.
12:23It's usually a clinical social worker,
12:25often teamed with a peer with
12:27lived experience and that's an
12:29example of compasses doing.
12:31So what's the evidence
12:32to date of these models?
12:33It's actually quite limited.
12:35There have been very few
12:38rigorous evaluations done,
12:40but they all show some promise
12:42and a little review.
12:43With a member of our team,
12:45Sydney Simmons,
12:46has provided some real support
12:47to looking at this literature to
12:49complement what we did before.
12:51We're really not seeing rigorous
12:54evaluations done of crisis response services.
12:57So cities and states are doing
12:59kind of what makes sense,
13:01often responding to a political
13:03need because it's urgent,
13:04crisis is urgent,
13:05you need to put something in place
13:08but then not really having the kind
13:10of data on randomized controlled
13:12trials and rigorous other evaluations
13:14to determine whether that's the most
13:16or least effective way to do it.
13:18But they're all promising because
13:20most of these systems have arose
13:22in response to local needs and
13:24representing local values.
13:26So there there's not one I would
13:28say you should do over another,
13:30but there's been no study that's
13:32examined the multi level impact
13:34of a program at the individual,
13:36the service system and the community
13:38level and very few have included
13:40significant community engagement
13:41and that's what we're trying to
13:44do in Elm City Compass.
13:45We begin by centering the voices
13:48of community stakeholders with
13:50all those folks I described.
13:51They need to be a part of the system
13:53and at the table to design it and
13:55sustain it once the evaluation part is done.
13:58And we need to look at
14:00multiple impacts throughout.
14:01So today,
14:01what you're going to hear is
14:03coming back to that idea,
14:05and our design tries to
14:07address those things directly.
14:08So how did we get here?
14:12It began with
14:15local and national protests that
14:18stimulated for racial justice that
14:20were stimulated after the murder of
14:22George Floyd New Haven then engaged
14:25in an extended planning process to
14:28build a civilian Crisis Response team.
14:30It was coordinated by the city through
14:33the Department of Community Resilience
14:36and then carried out by the Program
14:38for Recovery and Community Health,
14:40or PERCH and the Consultation Center, TCC.
14:43And there was additional expertise
14:45provided by Continuum of Care,
14:48Community Care and the CMHC,
14:50particularly the Mobile Crisis Intervention.
14:52We did 4 sorts of things.
14:55Perch carried out focus groups
14:57and community forms and Co design
15:00sessions with individuals with
15:02lived experience in the community.
15:04This was an incredible invaluable piece
15:08shaped system that eventually they also
15:11commissioned A sequential intercept
15:13mapping process with 50 community
15:16providers from 35 organizations.
15:18This was done by Madeline Baranowski
15:21and Reena Kapoor.
15:23We also work closely together with
15:25the City of New Haven and Dimas,
15:28as well as first responders,
15:30to shape what the system would look like.
15:32And then there was a bunch of training.
15:33We were very fortunate through
15:35Dimas to be part of a National
15:37learning collaborative carried out
15:39by Samson on civilian community,
15:41on community crisis response,
15:43which helped us identify best
15:45practices and the state of the field.
15:47And finally,
15:47we did other research looking at
15:49the literature but also contacting
15:51programs about what they did.
15:55The focus groups, I just want to
15:57show you was were representative of
15:58New Haven in many different ways.
16:00We have a report online about this
16:03and individuals that were in there,
16:06You see, 83% said that they were
16:08satisfied that they were heard
16:10and that their input was valued.
16:13So what did community members tell us in
16:15those focus groups and community forums?
16:18Well, they said crisis response
16:20is sometimes ineffective,
16:22including how police respond to mental
16:25health crises and substance use crises.
16:27That the support for civilian
16:29crisis response was critical,
16:31particularly by mental health experts,
16:34including peers that can respond
16:36independently or with the police so
16:38to complement and support the police
16:41but also work separately for police.
16:43Third, there was support for post crisis
16:46supports that would use that would use
16:49alternatives to jail or the emergency room.
16:52Thing we heard a lot about was people
16:54thought the options were often Yale,
16:55Young, even hospital or jail.
16:58And that's that's not a good
17:00crisis response system.
17:01There needs to be a continuum of services.
17:04There was a call for ongoing
17:06feedback from community residents
17:07about crisis response and the
17:09need for deeper community change,
17:10such as dealing with poverty and
17:12inequality that often gave rise to crises.
17:16So what does service providers
17:17tell us in those that sequential
17:19intercept mapping process?
17:20We learned there that there's just not
17:22enough services and resources for people
17:24in crisis that services that do exist
17:26are not well coordinated or integrated.
17:28Sometimes people don't know
17:30where the services are accessed.
17:32There's also insufficient use of
17:33peer and family support within the
17:36service system for people in crisis.
17:38And there were additional barriers,
17:39such as practice guidelines around
17:41discharge protocols that would direct
17:43people not into crisis services,
17:45language barriers to crisis services
17:47and stigma, all of which prevented
17:50people from accessing crisis services.
17:53So based on this,
17:56we took a step back and we realized that,
17:58yes, we want to create a system of
18:02sustainable supports for people in crisis,
18:04but we need to do this in
18:06a comprehensive way.
18:06It begins with the team.
18:09One of our core priorities is the team,
18:11a social worker and appear with
18:13lived experience and with Continuum
18:15of Care as our partner.
18:16This team, this work has been exceptional.
18:18It's nice to see Sarah here today.
18:21She's one of our clinicians and our team,
18:24and it's just a wonderful work that
18:26our team does for individuals in
18:29crisis through Continuum of Care.
18:31And they respond with police,
18:33but also separately from police,
18:35as community members have told us to do.
18:37And they also do outreach to 911 calls.
18:40But second, in addition to the team,
18:42we needed to work with the service system.
18:44We need to think about how can we
18:46leverage what Elm City crisis is to
18:48improve all those crisis services that
18:50are already happening in New Haven.
18:52To bring them together in
18:53a collaborative way,
18:54not to lead them but to support what is
18:57already in place and have the leadership
19:00happen as it's happening in our community.
19:03It would.
19:03The intention is to find something
19:05between the Yale and jail,
19:07something that would be a continuum of
19:09services that would be preventing arrests,
19:12preventing unnecessary Ed
19:14visits and hospitalizations.
19:16Third,
19:16how can we establish a community Advisory
19:19Board and ongoing community input?
19:22That was another priority that
19:23we wanted to make sure to do,
19:24to make sure that Compass reflected
19:26community needs and values,
19:27but also that we were accountable
19:29in some way to community members.
19:32And finally,
19:32we wanted to implement an evaluation
19:34that would be comprehensive,
19:36that would have both quality
19:38assessment improvement about the
19:39team's operations as part of what
19:41we did and then effectiveness,
19:43the individual services to
19:45the community level.
19:46That became
19:49our shared and strategic vision.
19:51It shared because this doesn't work
19:53unless everyone in the system shares
19:55those values of those four priorities.
19:58And it's strategic because each
19:59part of it informs another part.
20:01So it's strategic that the more that
20:03we learn about what the team is doing,
20:04the better the team's operation is,
20:06the better the team's operation is,
20:08the more that informs the system and so on.
20:10So we we need it to have the strategic
20:13vision in order to move forward.
20:16So usually at this point
20:17when I present about this,
20:18I begin talking about the team
20:20and then talk about the system and
20:22then talk about the community.
20:23Today I'm going to begin actually
20:25with the evaluation,
20:26partly because the nature of this
20:28kind of presentation and in a more
20:31academically oriented presentation
20:33that the evaluation in many ways
20:34is an equal partner in this and
20:36it's also shaping what we do,
20:38but doing it in a collaborative
20:39way with our community state.
20:45So what's the OM City Compass?
20:46Evaluation consists of quality,
20:49improvement and effectiveness
20:50is what we're looking at,
20:57Seems like. There we go.
20:59So we began with a logic model.
21:00I didn't put the multiple
21:01pages of the logic model here.
21:03I only included outcomes.
21:06Cindy Crusto, who's been teaching
21:08logic models for decades now,
21:09she knows about what these,
21:11the models can look like and
21:13how overwhelming they can be.
21:14But this has the four parts on the left.
21:16These are our activities as our
21:18problem and our objective and the
21:20resources that are available to us.
21:22And it has the output,
21:23which are the deliverables
21:24of those activities.
21:25Each of those first two columns
21:27has many different components.
21:28So establishing A-Team,
21:30creating protocols,
21:31creating a data dashboard that's entered.
21:33That's all part of the team activities,
21:35Same for the system and and so on.
21:37But these are the outcomes we
21:38want to achieve and we're done.
21:40We're identifying 3 levels,
21:42the individual level,
21:43the service system level
21:44and the community level.
21:46And we have goals that are short
21:48term and intermediate term and long
21:49term on this page right down here,
21:51for example,
21:52that look very much like the intermediate
21:55term but just hold out further.
21:57This is what's driving our
21:58thinking in many ways.
22:00We want to increase access to
22:02behavioral health and support services,
22:04including housing,
22:04because the housing often leads to
22:06mental health behavioral crisis.
22:08We want to increase positive
22:10perceptions of 911 service
22:13of crisis response services.
22:15Those are critical.
22:17We want to increase collaborative ties
22:19at the service system level among providers.
22:21The more providers work together,
22:23our theory of change is that the
22:25better the service system will
22:27operate at the community level.
22:29We want to increase awareness of
22:30crisis response services and you'll
22:32see at the at the end how we're
22:34trying to do that and then increase
22:36comfort in calling 911 when you
22:37have a behavioral health crisis.
22:39Now that's that could be difficult
22:41there's there's good reasons for
22:42people might not want to call
22:4391 all the time but and we've
22:45come to understand why.
22:46But there's ways that that we can
22:48work with that try to improve the
22:50responsiveness of the assignment system,
22:52which I think is happening.
22:54Those same outcomes carry
22:56over to the intermediate term.
22:57But that's what we hope over 2
22:59years from now, a year and a half,
23:00two years after Compass started,
23:02we will show some change in arrests and
23:05in visits to emergency department rooms.
23:09So how do we evaluate that that logic model?
23:13We have a multi level mixed
23:16methods study design,
23:17evaluation study design
23:19at the individual level.
23:21At the index crisis response,
23:23the team fills out a data dashboard
23:26that tracks the response itself,
23:29the time location, the type,
23:31the PSAP code that people were given
23:33when 911 called them to the scene,
23:36referrals that were made,
23:37the disposition of what happened
23:39and then demographics of the person
23:41served among a few other things.
23:43We then the team that does short
23:46term follow up up to 24 to up
23:48to 72 hours and then for some
23:50individuals continues with them for two
23:52more months until they get connected
23:55to services provided case management
23:57but the longer term follow up.
23:59The evaluation team then reaches
24:01out to those same individuals,
24:03to the ones that they can get two to
24:05six months later to see how satisfied
24:08were they with the services and what
24:10barriers do they find on the way there.
24:11I'll show you some early data on that today.
24:15The service system evaluation
24:17has three components.
24:18One is we're looking at the network
24:20collaboration among service providers,
24:22service system partners and you'll hear
24:23about the range of service system partners
24:26that we are engaging at this point.
24:28We'll be collecting that data
24:29retrospectively for last year and
24:31then be doing it twice yearly going
24:33forward for the rest of the project.
24:35We are also working with New Haven Police.
24:36I'll tell you a little bit more about
24:39that later To get arrest data and
24:42disposition data about Ed visits that
24:44will allow us to compare those who
24:47received Compass services versus those
24:49who did not but have comparable CPAP,
24:52PSAT codes.
24:52And then finally a focus group with service
24:56system partners to understand why the
24:58findings happened the way that they did.
25:01And finally,
25:01at the community level,
25:03we're doing interviews.
25:04We've already started with two cycles
25:06of that with community members,
25:08their views about crisis response and
25:11about adult residents of New Haven,
25:13and then focus groups to follow up to
25:16explain the findings that we do see.
25:18As you can see here,
25:19the data is collected by different groups.
25:21It's highlighted in the model.
25:23And So what I'm going to do,
25:23I'm going to come back to this
25:25throughout the show.
25:26Which evaluation there's six embedded I
25:28want to cover very briefly today to give
25:30you a flavor for how this is playing out.
25:32So let's begin with the Crisis Response team.
25:37This begins with a special order by
25:40the NHPD and a memo of understanding
25:43by the NAFD to allow for Compass to
25:46work closely with these two services.
25:49That led to training that we did in the
25:52fall of 22 just before we launched and
25:55on November 1st in which we met with did
25:58roll call training Derek Gordon's here
26:01we we did 7A Co Director of Compass.
26:04There were seven trainings that were
26:06done that we did that were from 7:00 AM
26:09to midnight with individuals with with
26:12officers across two days seven different
26:14times and you can just see that the the,
26:17the amount of time that took was
26:19considerable but it was very well worth it.
26:21We covered a couple of scenarios
26:24with officers and that was helpful
26:26to launch Compass.
26:27But well then since then we've also
26:29done training with district managers.
26:30These are the supervisors essentially
26:33of all officers in spring of 2023,
26:36in the summer,
26:38we went back and did 2 days of
26:40training with officers again,
26:41got their feedback about how
26:42things are going,
26:43what we could do differently
26:44to make things better.
26:45And then in the winter more recently
26:48Wanda Joffrey has worked closely
26:50from Continuum worked closely to
26:52do of the the part of de escalation
26:54training refreshers that all
26:56officers are getting right now.
26:57And so it's important to point out
26:59that this is the training we did.
27:01But everyone from the leadership team
27:04and the crisis response team all also got
27:07trained by police and fire with right alongs,
27:09went out and learned about what the
27:11life is like to go on a call and the
27:14kind of responses that are needed.
27:15This was critical for us as well to
27:18understand that it's a two way St.
27:19in a collaboration between police
27:22and fire and us.
27:24This is the launch as you can
27:27see a press event there,
27:28the van that goes out on calls.
27:31Two of our community Advisory Board or
27:34CAB members are speaking at the launch.
27:37Theresa Green and Talana, Monique,
27:39Austin Dickerson are both speaking
27:41at the press event.
27:45And so right now, where are we?
27:46We are in the second of three
27:48phases of implementation.
27:49Last year we completed the pilot phase.
27:51Now we're in the first implementation phase.
27:54There's two teams currently in place.
27:56They operate from 8:00 AM to midnight,
27:59seven days a week.
28:02We respond at the request secondary early to
28:05police for fire requesting our assistance.
28:08We also do outreach and we do some
28:10primary direct response to 911
28:12calls that are low public safety
28:14or medical emergency call,
28:16not a medical emergency.
28:17The team continues to do follow up up
28:20to 60 days for certain individuals
28:22that are not connected to services
28:24at all and then the evaluation team
28:26takes over and makes a contact to
28:29hear about how things went and
28:31barriers to service.
28:32Next year there'll be three
28:34teams starting in July,
28:35probably will be not 24/7,
28:37probably be overlapping hours because
28:39having two teams at the same time
28:41could help deal with some of the
28:43the challenges sometimes people
28:45encounter, but we're not sure.
28:49The team uses a trauma informed approach
28:53is listed here and it's informed by
28:55SAMSA principles of trauma informed
28:57practice as well as best practices
29:01for behavioral health crisis care.
29:03And the team embodies using peers
29:07with lived experience, peers.
29:10Someone who's in recovery from mental
29:12illness and or addiction can often be
29:14a real lifeline for people in crisis.
29:17They've they've been there.
29:18They understand.
29:18They feel trusted immediately,
29:20often based on that history that the person
29:23knows that someone else who's appeared,
29:26which is critical to our model.
29:28What we can and can't do is we can.
29:31We can request respond to crises that
29:33request the police and fire through outreach
29:36or directly for low public safety calls.
29:39We can refer to people in crisis.
29:41We can consult the police and fire on
29:44the scene and help with any involuntary
29:47hospitalization that's needed.
29:49We can transport a person, unless,
29:51but not for medical reasons,
29:53We can't do is.
29:54We cannot hospitalize on the scene.
29:56You have to be either at the hospital or
29:59through the CMHC to do the hospitalization.
30:02We not cannot provide services outside New
30:04vision and we can't split up the team.
30:07So I want to now share some data
30:09from the team that's the quality
30:11improvement about the first evaluation
30:13that's embedded here today.
30:15As of last month,
30:16we had over 1100 calls split
30:18about 505911 and outreach
30:25about 80% of the time that's coming
30:28at the request of police and about
30:314% of the time the direct calls going
30:34out about 20 or so pressed to fire.
30:38We respond every day of the week
30:40and every time of the day during
30:42from 8:00 AM to midnight right now.
30:45And the reason the daytime hours are
30:47more prominent there is simply because
30:49we had a whole gear of daytime responses.
30:52Takes us about 13 minutes for
30:53the team to get on the scene.
30:55We spend about 49 minutes at the scene.
30:58So this is pretty much real time data
31:01that we get whenever an event happens.
31:04There's two kinds of responses
31:05that the team does.
31:06They assist people with mental health
31:08or substance use challenges about 56%
31:10of the time and they assist people
31:13who have need housing and resources,
31:15resources supports for housing and other
31:17service needs about 44% of the time.
31:20Now embedded here are codes as you
31:22can see on the slide that P SAP
31:24using it necessarily our terms,
31:25our terminology,
31:26but this is P SAP code terminology
31:29that we embedded and we organized
31:32it into these two areas.
31:34And then the team makes a referral and this
31:36is the kind of percentage of referrals.
31:38Some people get more than one referral,
31:40but these are the percentage of referrals.
31:42And so you can see about 26%,
31:44the first two up there get a behavioral
31:47health kind of referral and about 29%
31:50get a housing related referral of some kind.
31:53But importantly 23% get no referral.
31:57And why is that?
31:58It's because they either refuse
32:00services or they're already in
32:02services but they had a crisis.
32:04They may already be connected to service,
32:05but they had a crisis,
32:06which is normative for some individuals,
32:08so no referral is appropriate,
32:11but it combines those two categories.
32:14This is the demographics
32:16of the individual serve,
32:17so we have this information as well.
32:19And about half or more of individuals
32:22that we serve are on housed about 1/4
32:27need transport to another location
32:29and about 5% of the time child
32:31is on the scene
32:35services. On the left of the slide
32:37is the 91 responses in a Geo map of
32:39New Haven and on the right of the
32:41slide is the outreach responses,
32:43very similar in the middle is
32:45the growing direct responses
32:47that we have thus far the 4%
32:51so critical to crisis response is the longer
32:55term follow up after the index crisis.
32:58So those that 26% behavioral health at
33:0029% housing and what is it with this 23%?
33:03No. So what how can we understand this?
33:06The key questions is did people
33:09get connection connected to the
33:12people referred to and did the
33:15person benefit from the service,
33:17do they feel satisfied or have they improved.
33:19So some of our archival data
33:21will help get at that,
33:23but some of our interview data will as well.
33:25And so this is the second evaluation,
33:27is the early data that we have
33:29on a longer term follow up.
33:33Aaliyah Henry is one of the people that's
33:36coordinating this now from our team.
33:37She does a wonderful job.
33:39And we have 4 individuals
33:41that contact individuals.
33:42We're using a phone call system
33:45where we call individuals for.
33:48We have numbers for.
33:49We originally were worried about this,
33:51but when we did a pilot study where
33:53we actually went out and did home
33:55visits compared to the yield that we
33:57got that way versus the phone call,
33:59it was the same.
34:00So he said no,
34:01we can let's stay with the phone call
34:03and at the end of the project we'll
34:05do a more extensive home visiting
34:07initiative to see if there's real
34:09differences between a home visiting long
34:10term follow up and a phone follow up.
34:12But for now we have the phone follow up.
34:15So there were 1000 people or so that
34:17had phone numbers that were eligible.
34:19Of those that have phone number were 560.
34:22Of that 560,
34:24sixty percent were 911 calls and 40% were
34:28outreach services and we've reached 120.
34:31So that's our sample,
34:32about 20% and that's the number
34:34we tend to get 20 to 25%.
34:36It's really where we're at.
34:39The barrier survey was one that's
34:41based on established measures,
34:42some that I've used with a colleague
34:45UU more recently and we asked
34:47people what are some challenges you
34:48encountered and then we asked it
34:50again in a slightly different way.
34:51So we get 13 barriers that combines most
34:56barriers and most studies done well,
34:59established surveys about why
35:02people don't get care.
35:05So about half the people were
35:07able to connect with one service.
35:09But this is what we learned about barriers.
35:11Look at these numbers.
35:1459% said they I did.
35:15I decided I did not want help.
35:17This could be individuals that decided
35:19before they even accepted a referral
35:22or these could be individuals start
35:24a treatment or service and said,
35:25you know what, I I said I'm just going
35:28to do this on my own without help.
35:30And then, but this is important to us
35:32because we're going to want to track
35:34this over time with a larger sample.
35:36We can't really look at individual services,
35:39mental health, substance use,
35:41housing, do we get variations here?
35:43But we will eventually be able to say
35:46something that will help our service
35:48providers know more about that.
35:50But when we asked people how satisfied
35:51they are, they were actually satisfied.
35:53Those that got a service,
35:55a little over half,
35:56they were satisfied with the
35:57service for the most part.
35:59And those that got Compass services,
36:01which was everyone there,
36:02they're satisfied with Compass services.
36:04So we're pleased about that.
36:07We'll talk now about the price
36:09of service response system.
36:10That's the second part of
36:12our four part commitment.
36:13So shortly after we launched,
36:16we conducted listening sessions
36:19with service providers,
36:21advocates and active activists and
36:23faith leaders in our community.
36:25We did this at City Hall and at the
36:28Public Library on Main Street like
36:30like we've now done several times.
36:33And I want to share with you some
36:36data from this third evaluation today,
36:38which is the focus group interviews
36:40we did with those providers.
36:41Those
36:44were 126 participants.
36:46In those that they came to the listening
36:49sessions from 85 organizations,
36:51we did a 45 minute focus group with them.
36:56So there were a total of 12 focus groups.
36:59They we asked people three questions,
37:01how can Compass benefit the people you serve?
37:04What challenges will Compass create for you
37:06and how can those challenges be addressed?
37:10And two members of our team facilitated
37:12those focus groups and two members
37:13of the city that were also part
37:15of the broader team facilitated.
37:20We use thematic analysis to analyze the data.
37:23It's a qualitative method to understand
37:25patterns of meaning in text or speech.
37:27Helps us integrate different questions.
37:29So it's not a one to one by question.
37:31We can code it across questions and
37:34then code it beyond those questions
37:36based on underlying meeting.
37:383/4 from the compass
37:40evaluation did the coding.
37:41We ended up with 32 final themes shared into
37:448 shared priorities that were identified.
37:47We also used two other qualitative methods,
37:52standard content analysis and
37:53grounded theory, to help us track
37:56frequency and look at the codes.
37:57This is what we find.
37:58We published a report in November,
38:00sent it to everyone in the service
38:02system that was connected to this,
38:04and identify these priorities.
38:07What we learned from these focus
38:10groups was that everyone was the
38:12large group was promoting access
38:13to and public awareness of crisis.
38:15Direct access of 911,
38:17direct access to 91 to Compass was
38:19it was essential for many of the
38:21participants in the focus group.
38:23They also emphasized partnerships
38:25and relationships to make the
38:27service system happen.
38:28So the idea that we wanted to work with
38:31providers and strengthen relationships
38:32was reinforced by folks that were there.
38:36Thirdly,
38:36they talked about using Compass,
38:38leveraging Compass to improve post
38:40crisis continuum services and I have
38:43to say the partnership that we've had
38:46with Continuum of care and the city
38:48has yield that already and it's it's
38:50very little work that we directly,
38:52I can say personally directly have
38:54done other than support this.
38:56But Continuum of care with the city
38:58has now and the state has now going to
39:00be soon opening a crisis stabilization
39:02center which was not in our community
39:05and will be in within the month.
39:07And have now gotten state and city
39:10funding for an emergency housing program
39:12that allows individuals to stay in
39:15housing for up to 90 days and bring a pet,
39:18be there with a partner,
39:20keep their stuff.
39:20So it's unlike a shelter where
39:22you have to take everything out.
39:24So it's the beginning of a transition
39:26away from only shelters in our community.
39:29It's not fully they don't have
39:32all the all the beds available,
39:33but it's already making a big inroads.
39:35It's open several months ago.
39:37So those two initiatives are a way in
39:40which leveraging post crisis support
39:41is already happening and particularly
39:43with the continuum of care in the city.
39:46Members also talked about reducing
39:47restrictive crisis responses
39:49such as the Ed visits and the
39:51hospitalizations of the arrests.
39:52And a strong emphasis was made by
39:55focus group members on building trust
39:57community members that we had to do
39:59what we could to build the trust.
40:01The team did, but Compass in general did.
40:05Finally, additional priorities.
40:05We're trying to do things to reduce
40:07stigma and regulatory barriers,
40:09support training and crisis response,
40:11and conduct ongoing evaluation
40:14research about crises.
40:17So what we did is we after the report
40:19we just reconvened 2 months ago,
40:20we did this all again.
40:22We had listing sessions with
40:23the same set of faith leaders,
40:25advocates and service providers.
40:26We also did one on Zoom,
40:29so there were 4/2 hour sessions this time.
40:32This time they were led by members
40:33of our community Co led by members
40:35of our Community Advisory Board.
40:36So here we have Sun Queen,
40:38we have Brian Bonilla,
40:40Theresa Green and four or
40:42five other cab members.
40:44Co LED these groups for direct
40:46community engagement in the process
40:48of trying to support our service
40:50system and this was intended to follow
40:52up recommendations in our report to
40:54strengthen crisis response services.
40:55Out of that came four new work
40:59groups that we're starting now.
41:00One is increasing public
41:01awareness about crisis response.
41:03You'll hear more about that when
41:04we talk about the community,
41:05improving community collaborations,
41:07especially between the Christ the Child
41:10system for crisis and the adult system.
41:12We're working now with Clifford
41:14Beers because we've learned who
41:16managed the child crisis system.
41:17We've learned that when the team goes
41:19on a crisis and the child is a crisis,
41:21we're not really authorized
41:22to work with a child.
41:23So we need to have a faster way to
41:27get to the child crisis service work
41:29or while that's happening so that we
41:31don't want to just leave that hanging
41:33at the moment when that's happening.
41:35And that planning group will help
41:37us do that with community input.
41:39We also want to inform legislators
41:42about some statutory issues that
41:44are preventing crisis response from
41:46happening the way it it needs to happen.
41:49And so in the next legislative session,
41:52we hope to have something ready for that.
41:55And finally,
41:55we're working closely with the
41:57city to provide training for a
41:58variety of different folks on
42:00mental health and crisis response.
42:01The city, through Lorena Mitchell's office,
42:03already has a robust training
42:05initiative in place.
42:06We don't want to replace it.
42:07We want to compliment it.
42:08We're working closely with
42:10Lorena and her team about that.
42:13It's going to be intended to work with
42:15businesses as well as other service
42:18providers and community agencies about
42:20responding to crises in their midst.
42:22As a pilot,
42:23we were requested by the Community
42:24Service Administration,
42:25Eliza Halsey to work with the
42:27library system in New Haven.
42:29So this last January we did training
42:32with all library staff in New Haven.
42:35They do an incredible job with
42:37patrons coming in,
42:38many of whom are in crisis or unhoused.
42:41So we did three different sessions
42:43with all library staff and supervisors,
42:45created a a protocol for how they
42:47can get direct access to the Compass
42:49team when they have individuals
42:51in crisis instead of having to
42:53call the police every time.
42:54So I want to share some data from.
42:57I want to want to talk to you
42:58a little bit about the next set
43:00of data that we want to collect,
43:02which is going to be happening
43:03soon is the social network data.
43:05So getting data on social networks
43:09of service providers and community
43:11stakeholders is critical to get a
43:13sense about what is happening at the
43:16system level as a program like this
43:18or similar programs get implemented.
43:20And So what we're hoping to have happen
43:22is happening in other communities.
43:23And my colleagues Cindy Crusto and Joy
43:26Kaufman have done a lot of work in this area.
43:28This is work some I did with colleagues in
43:30the Greater Philadelphia area in a community.
43:33Pottstown, PA, which is a really a.
43:35It's a small community but it's a hub for
43:38about 7 or 8 towns in that area because
43:40they have a hospital and foundation,
43:42a lot of other core resources
43:44that the area takes advantage of.
43:46And folks in Pottstown a number
43:48of years ago found that kids were
43:51coming to school in kindergarten
43:53not ready to learn because they were
43:55experiencing so much trauma.
43:56And so they decided yes,
43:58they needed structural interventions,
44:00but they needed a kind of a reshift
44:02to a more trauma informed focus
44:04to have providers and schools and
44:06early care and education and parents
44:09engaged in a trauma informed promoting
44:12resilience in the community.
44:14So they asked us to do this.
44:15We created a logic model,
44:17police were part of it,
44:18service providers were a part of it
44:20and we create a steering committee of
44:23about 30 representative people in that
44:25community and then created a plan,
44:28training, networking,
44:29public messaging around trauma informed
44:32practice to infuse that into the
44:35community and in the surrounding area.
44:37And this is the data from some work
44:39we did to see what happened there.
44:42And we're hoping something like
44:44this because we see it's possible it
44:46can happen around crisis response.
44:48As you can see on the left we have a
44:51steering committee pretty dispersed
44:53everything,
44:54everyone's dispersed by time to the
44:56steering committee is working closely.
44:57The other ones in red education schools,
45:00which is the main initial focus is
45:02now working more closely together,
45:03but the service providers in the
45:06social behavioral services are not.
45:07And then finally by the third phase,
45:09a year later,
45:10the social and health behavioral
45:12service providers are more connected
45:14as well because it was an explicit
45:16plan to do that.
45:17And our social network analysis showed
45:20significant effects on total connections,
45:22connections between bridging groups
45:24and then connections between those
45:26groups and others in the network.
45:27So we envision and hope that something
45:30like this which has happened in other
45:32communities can happen in New Haven,
45:33however it works in our community or not.
45:37The other kind of evaluation at
45:39the system level is the data that
45:42we're collecting with police police.
45:44We hope that soon we'll be able to get
45:46data that goes back several years that
45:49allow us to compare COMPASS served
45:51individuals based on P SAP codes with
45:54non compass served individuals and
45:57because the police have in the last
46:00several years initiated pretty extensive
46:03DE escalation focused training,
46:06trauma informed policing training.
46:08We also expect there may be some changes
46:11independent of COMPASS from prior
46:13years in arrest hospitalization for
46:16individuals who are in behavioral crisis.
46:19But we'll see.
46:21Final part of this is talking
46:24about the community.
46:24This is central to our work.
46:26I've already talked to you about our
46:30terrific community Advisory Board.
46:32Took quite a bit of planning to get this
46:34group together because we needed to
46:36have it represent different neighborhoods,
46:38people with different lived experience,
46:40diverse in terms of a
46:42variety of characteristics.
46:43And we also wanted people who knew something,
46:45sometimes not everyone,
46:46but about behavioral health,
46:48either professionally or personally.
46:51And we're activists.
46:53We didn't want to represent
46:54community Advisory Board.
46:55We wanted an activist Community
46:56Board that's going to come in and
46:58kind of make be a make sure that
47:00we're accountable to their needs.
47:02And so far we've been pleased about that.
47:04It's like good trouble as Congressman,
47:06late Congressman Lewis would say,
47:08there's good trouble that's happening in
47:10our community Advisory Board meetings.
47:12And So what do they do?
47:13The community Advisory Board
47:15has quarterly meetings.
47:16They have work groups,
47:18task groups that focused
47:19on community engagement,
47:20resources and data use and
47:22dissemination and governance.
47:24The data use and dissemination group has
47:25seen all the data that you've seen today.
47:27We meet about every other month
47:29when we talk about the data,
47:31share it and get their points of view,
47:33and we start to make changes and use
47:34that to incorporate into our messaging
47:36about the data and our stadium.
47:38The
47:40community advice reward members
47:41to outreach to the public and also
47:43other stakeholders through community
47:45management team meetings throughout
47:46every neighborhood in New Haven,
47:48they do tabling and community arts and ideas.
47:50The middle picture here is tabling at
47:53one of the festivals prior to community
47:56last year's Arts and Ideas Festival.
47:59They also Co lead meeting I already talked
48:01to showed earlier Co leading the most
48:04recent meeting with service system partners.
48:06They also work closely with first
48:11responders connected with first
48:13responders about compass priorities.
48:14Over here on the right is Assistant
48:17Chief Zanelli and Director Joe Vitel.
48:20Assistant Chief Janelli NAPD.
48:22Joe Vitel is Director of PSAP.
48:24Meeting with our the most recent community
48:28Advisory Board about improvements in
48:30policing and PSAP and hearing from
48:32community Advisory Board member.
48:34It was a terrific meeting.
48:35They were there for an hour with
48:37some really useful feedback.
48:38And then over here is Timo at
48:42another press event about Compass
48:44that brings us to the broader issue.
48:47But you don't talk about that
48:48much in studies,
48:49but in a largely community based
48:52study that's heavily engaged
48:54with community stakeholders,
48:56media publicity and public awareness
48:58is central actually to what we do.
49:01And so we we there are a lot of things
49:03when we were waiting to get a contract
49:05and getting started and about how
49:07it's taking forever and not the kind
49:09of press that you always want to get,
49:10but it was there and in the planning process.
49:12This is an example.
49:15Look at that date on that March,
49:18Connecticut TV,
49:2028th date of that event and we didn't,
49:22you know, we didn't launch until
49:24another five months later.
49:26So there's a lot of lot of stuff
49:28we had to do And then there's the,
49:32the,
49:32the broader calls once the launch
49:36happened statewide media and we
49:38see this as a part of informing
49:41the public about new development.
49:42So there's press events,
49:44other kinds of things that are happening
49:47that we do on a regular basis.
49:48It's part of the work that we do.
49:52And so back to this idea about stigma
49:56and back to the idea about 911 Comfort.
49:59We do a lot of ongoing presentations to
50:02community groups and local businesses.
50:05We have brochures that we passed
50:07out probably 2000 of these brochures
50:10at this point in the community.
50:12And if you've driven into Route 34 Connector,
50:15you might have seen the Billboard
50:17Elm City Compass.
50:18This is courtesy of Continuum of Care
50:21which purchases space on this billboard.
50:24Thank you to our partners.
50:26They they put a compass billboard
50:29like AD stigma billboard about speak
50:31out about mental health as part of
50:34their rotation of billboards we saw
50:36today on the way in that's now in place.
50:40So the final evaluation I want
50:41to share with you,
50:42take a few minutes and then have time for
50:45questions is the community level evaluations.
50:49So if Compass depends on the
50:52911 system and residents,
50:54views about calling 911 therefore are central
50:57to the success of Compass.
51:00So that allows us to identify people
51:01who call 9/1 for help in a behavioral
51:03health crisis and we can see how
51:05satisfied people are with those services.
51:07Not comfortable they would be in calling 911.
51:10Those are things we want to ask about.
51:12We want to identify disparities
51:14and help seeking and comfort and
51:16satisfaction by individuals based
51:18on demographic characteristics,
51:19neighborhood characteristics.
51:20We want to track changes the extent
51:24that we do well with messaging,
51:25police do well with policing.
51:27We'll see changes in that over time.
51:30And then we want to make sure
51:32we're tracking neighborhood factors
51:33that are relevant to Compass.
51:35So that's why we're doing
51:36community interviews.
51:37So starting about a year and a half ago,
51:40we did community interviews.
51:42There's a number of people on our evaluation
51:45team that have done these done 629 thus far.
51:48New Haven was divided into
51:5010 police districts.
51:52We did about 30 to 36
51:54interviews in each district.
51:5610 are done during the weekend,
51:5710 on the weekday,
51:59and then the other 10 split.
52:00Depending on, you know,
52:01the volume of people coming in.
52:03They're done between 12:00 and 6:00.
52:05People get $10.
52:06It's an anonymous gift card,
52:08a $10.00 gift card.
52:10It's anonymous and use the
52:12demographic slightly under represent
52:14over representing a few areas.
52:18So this is a quite the key question
52:20I wanted to share with you a few
52:22slides from this Who if your family
52:24member or friend or you or family
52:25member or friend of the crisis related
52:27to mental health or substance use,
52:28who would you call for help?
52:30This is what we learned if you
52:32look in the right column here.
52:34The vast majority of people would
52:36call a family member a friend,
52:38a mentor or adult admirer or a profession.
52:42But look at the next one.
52:44It's about 2/3 of people would call 911.
52:47It tells us something.
52:48And to our knowledge,
52:50there's not been a study that's done this.
52:52So most people would call 911
52:55for behavioral health crisis,
52:57even though statutorily that's actually
52:59not what we're supposed to be doing.
53:01That's for medical emergencies
53:03and public safety,
53:05but that's not what the public is doing.
53:07The public is actually calling 911.
53:09So then 911 has to have a system in place,
53:12and that system certainly can
53:15be policing or fire,
53:17which is paramedics,
53:18but it can also have a civilian
53:20system outside of that.
53:21So this argues for something like
53:24Compass in our system of care.
53:28So about half the people have called 911.
53:31The other half have never even
53:32called 911 that we interviewed.
53:33Those that have called it,
53:34most are satisfied with it.
53:37But look at how comfortable would you
53:39be asking for police after you call 9?
53:42One 155% said they would be comfortable,
53:45very or somewhat comfortable
53:48and a lot more would be more comfortable
53:50calling for fire and ambulance.
53:52Makes sense, right?
53:52If a Firehouse is going to call for
53:55fire truck, if you have chest pain,
53:56you're going to call for an ambulance.
53:58Police, maybe not.
53:59Maybe there's all sorts of
54:00other issues that come with it.
54:02Calling police and police understand
54:04that our chief understands this as well.
54:06So keep that number in mind 55%.
54:08So rather than kind of go through
54:10a bunch of regression ones here,
54:13I wanted to kind of break the data
54:15up in a way that we can talk about
54:17directly that 55% and we know
54:19that we're looking at disparities
54:21and differences by groups.
54:23It's rarely a main effect nowadays,
54:26it's almost always an interaction.
54:28You know, Kimberly Crenshaw's work
54:31on intersectional kind of way of
54:33thinking is really relevant here.
54:35So we divided this into male and female.
54:39There were very,
54:40very small number of transgender
54:43or non binary individuals,
54:45so not enough to really include
54:47these analysis.
54:48Individuals with Hispanic
54:49ethnicity have no real differences,
54:51so they're not a part of these analysis
54:53as well as other racial groups.
54:55So we have males,
54:57whites and those individuals
54:59under 40 as the the the age,
55:01race and and ethnicity and gender and so
55:05you can see what pops out right away.
55:07You can see that one cell here is
55:10different than almost all the others,
55:12right?
55:13So we start to look at that and
55:16it looks like females who are
55:19black or over 40 are much more
55:22comfortable calling 911 and asking
55:24for the police than any other group.
55:29And the other lightly shaded green are males
55:34and consistently they're under 50%, right.
55:37And the only group that's female that's
55:40similar to them in responses are
55:43people who identify as female who are
55:46black or under 40 but that's a both
55:52sorry
55:55that I don't know why there we go.
55:59So this is a clearly a interaction
56:02effect for that one cell in here,
56:05but there's also a pretty strong
56:07gender effect and this is what we
56:11know about crime and fear of crime
56:15data that females are much more
56:18comfortable calling police than
56:19males in general in in our data.
56:22I'm just going to go right to
56:24the conclusion here. For race,
56:25there was very little differences by race.
56:28It's a small difference.
56:29It's not significant.
56:30Again, one cell is driving
56:32a lot of the results
56:35and if we look here by age,
56:37there is a difference.
56:39Again, we can have one cell, but those,
56:41although the four cells on the
56:44right are all over 40 and you know
56:47there's on average that are higher
56:49than the cells that are under 40.
56:51And so there is both an
56:53interaction effect here,
56:54but there's also a main effect here by age.
56:58So we shared these results with the chief
57:00and the Assistant Chief because this can
57:03have an impact on what policing might know,
57:05want to know about when
57:07people want to call anyone,
57:08who they get them, who to expect.
57:10It's very important for officers to
57:12know about this, who feels they can
57:15trust police when they come out.
57:17And so I'll tell you in a
57:20minute what we discovered.
57:21But first,
57:22we wanted to look at this data and
57:24think about neighborhood safety,
57:26because in our data we asked
57:28three questions about how safe
57:29you feel in your neighborhood.
57:31And we learned that the group
57:33that feels the least safe is the
57:36one that is the most comfortable
57:38calling that and that maps almost
57:40perfectly to all the data.
57:42So safety,
57:42these are averages from 1:00 to 5:00
57:45on measures of neighborhood safety for
57:47the same individuals that we asked about.
57:49So feelings of neighborhood
57:50safety may account for these
57:52differences in calling 911.
57:54And so this continued emphasis on
57:57positive police community relationships
58:00to build trust de escalation within
58:03police and civilian alternatives
58:06policing makes sense because this
58:09starts to serve to improve potential
58:12911 responses in the community.
58:15So in our future directions,
58:18we want to continue to implement
58:20Evaluate Compass for this coming year.
58:22We want to track implementation
58:23fidelity of the team's work and look
58:25at the relationship of that to our
58:27outcomes that we'll be getting soon
58:29established pathways to sustainability
58:31through grant development as well
58:33as reimbursement for services.
58:35And then finally to continue to
58:38strengthen community engagement
58:39in an ownership of Compass
58:41that's centering that in our.
58:44So there's just so many people here
58:46to think it's a you know I hate
58:49to say it's like cliche village,
58:50but it really is a New Haven
58:52village that's doing this work
58:53and I and A state as well I'm
58:55I'm really grateful for all the
58:57folks that made this possible.
58:58So any any questions I'll take from you.