The Cabarrus County First Responder Collaborative Crisis Assistance Program (CCAP) is an initiative to provide community mental health first response to our citizens by responding to crisis involving mental health, addiction, and homelessness collaboratively.  The partners involved in this initiative are the Cabarrus County Department of Human Services, Cabarrus County Emergency Medical Service, the Cabarrus County Sheriff’s Office, and Partners Health Management.  This program will be partially modeled after the Crisis Assistance Helping Out On The Streets (CAHOOTS) program in Eugene, Oregon.

The CAHOOTS model mobilizes two-person teams consisting of a medic (a nurse, paramedic, or EMT) and a crisis worker who has substantial training and experience in the mental health field. The CAHOOTS teams deal with a wide range of mental health-related crises, including conflict resolution, welfare checks, substance abuse, suicide threats, and more, relying on trauma-informed de-escalation and harm reduction techniques. CAHOOTS staff are not law enforcement officers and do not carry weapons; their training and experience are the tools they use to ensure a non-violent resolution of crisis situations. They also handle non-emergent medical issues, avoiding costly ambulance transport and emergency room treatment.

The initial phase of the Cabarrus County CCAP initiative will take place in the Cabarrus County Detention Center to supplement the virtual mental health provider that is currently being contracted through Southern Health Partners.  The new model would utilize a licensed mental health clinician employed by Cabarrus County Department of Human Services to meet with and provide services to inmates at the Cabarrus County Detention Center placed on Special Watch status per NC Administrative Code for Jails and Local Confinement Facilities, 10A NCAC 14J.

Special Watch shall be used for the following reasons:

1. an inmate with a medical record maintained and preserved by the jail as required by Rule .1001(b)(7) of this Subchapter that indicates the inmate has attempted suicide at a previous time, unless the inmate is seen by a physician who determines a special watch is not needed.

2. an inmate who reports a previous suicide attempt or threatens to commit suicide during their initial screening upon admission required by Rule .1001(b)(1) of this Subchapter, unless the inmate is seen by a physician who determines a special watch is not needed.

3. an inmate who has been assigned to special watch by medical or mental health personnel of the jail or an officer.

4. an inmate who displays any of the following behavior:

   1. physically hitting or trying to hit an officer.

   2. verbal abuse of other people.

   3. threatening other people or threatening to or engaging in self-injury.

   4. screaming, crying, laughing uncontrollably, or refusing to talk; and

5. an inmate who is intoxicated by alcohol or drug use as determined at intake by one of the following:

   1. a blood alcohol content level of .15 or greater as measured.

   2. use of slurred speech; or

   3. the inability to control body movement.

The goal would be to coordinate with the Stepping Up program in providing needed services to the detention population and move inmates from Special Watch status to general population allowing them to receive post release services. A later goal would be to completely replace the contracted mental health services received from Southern Health Partners. This clinician would be under the supervision of the Department of Human Services while coordinating with Detention Center supervision.  Appropriate office space would be provided by the detention center as determined once the workflow of the process is developed.

The next phase of the CCAP initiative would be to split the daily work activity between the detention center and working in the field.  In the field, the Mental Health Clinician would partner with a Cabarrus County Emergency Medical Services Community Paramedic to respond to mental health related calls and needs in the county.  This two-person unit would be dispatched by the Cabarrus County Communications Center to calls deemed appropriate for their services.  Dispatchers would be trained to recognize non-violent situations with a behavioral health component.  This training would be provided by Partners Health Management.  As parameters are established, this team could work in conjunction with Partners Health Management Mobile Crisis as a valuable resource to provide services to our citizens while preventing law enforcement services from being dispatched when their services are not needed, or to clear officers from a de-escalated scene quicker.  The CCAP team may be dispatched independently or in conjunction with law enforcement in call types such as:

• Welfare checks

• Suicidal subjects

• Disputes or conflict resolution

• Substance abuse

• Trespass/homeless.

After meeting with the individual, the CCAP team could assist in connecting them with services provided by Partners Health Management. The CCAP team could also follow-up in the community to provide or assist with services as determined with healthcare partners. 

The overall goal of this program would be to provide first responder mental health services, both in detention and in the field, to fill gaps in the system.  Dispatching of this team should reduce the calls for service to law enforcement and reduce their workload, but more importantly to keep law enforcement officers from attempting to provide services that are beyond their training and abilities.  Although law enforcement may be needed to respond to some of these incidents for safety and security purposes, ideally, after an incident has de-escalated and deemed secure and safe, the absence of a law enforcement officer may make the individual in crisis feel more comfortable and ready to accept services.  Officers would continue to receive CIT training to better equip them to assist those in crisis through better communication and recognition of when CCAP or Mobile Crisis services could best serve the individuals.