Lessons in First Response Policy Implementation
Since 2020, San Francisco has created three new emergency response options, which have since collapsed into two: the Street Crisis Response Team (SCRT) and the Street Overdose Response Team (SORT). SCRT fields around-the-clock units specializing in trauma-informed responses to behavioral health crises. SORT responds 20 hours a day to clients who have experienced an overdose. Since our research team left the field in December 2022, San Francisco continues to tweak the structure and tactics of these teams and create additional community- and government-based alternative response pathways.
These alternative response programs have generated significant enthusiasm from community members and government officials alike. There have been ongoing evaluations of them by the city. Still, too little is known about how this large-scale change to first response is playing out on the ground. In this report, we present learnings based on interviews and conversations with municipal actors from multiple agencies playing a variety of roles across San Francisco government. Those conversations concerned their perceptions, ideas, and attitudes toward reducing the scope of policing, increasing the use of alternative responders to address community needs, and other ways in which to transform first response systems.
Our goal in this report is to focus on amplifying the voices of frontline workers tasked with carrying out these changes in order to aid San Francisco as well as other jurisdictions interested in learning from what it has done. This report a) describes respondents’ visions of public safety, highlighting areas of agreement and disagreement, b) explores San Francisco’s motivations for creating a new alternative response portfolio, and c) shines a light on the implementation of alternative response programs, pointing out possible areas for improvement.
Research Questions
Findings
San Francisco’s investments are displaying positive results. Our data show SCRT responding to roughly 29 calls a day in an average of 16 minutes. In the vast majority of these calls, the police are never called upon for backup. This saves police resources and indicates care can be provided without police. Similarly, SORT’s performance offers reason for cautious optimism, as a significant proportion of clients accept harm reduction supplies or participate in successful follow-up visits.
Still, there are challenges. The dispatch center is facing a staffing crisis. One major question for all cities exploring alternative response is how thinly staffed dispatchers best can determine the appropriate responder to send to a call. San Francisco is using Emergency Medical Dispatch (EMD) software, which provides call takers with scripts to guide inquiries and assess call eligibility. Yet, call takers note that protocols from a medical and fire context do not transpose neatly to ambiguous behavioral and wellness situations. Another thorny issue is ensuring shared knowledge and agreement among frontline workers about responsibilities of each at the scene of an incident. Finally, many community members and some call takers believe that the alternatives should be reducing the need for social services more generally and are disappointed that they are not.
Recommendations
Our recommendations revolve around four core areas:
