Determinants of When Community Behavioral Health Clinics Partner With Emergency Response Systems: The Role of Capacity in 911 Referral and Co‐response Models.
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| Title: | Determinants of When Community Behavioral Health Clinics Partner With Emergency Response Systems: The Role of Capacity in 911 Referral and Co‐response Models. |
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| Authors: | MAURI, AMANDA I. (AUTHOR), LINDENFELD, ZOE (AUTHOR), WILLISON, CHARLEY (AUTHOR), TODD, THERESE L. (AUTHOR), PURTLE, JONATHAN (AUTHOR), SILVER, DIANA (AUTHOR) |
| Source: | Milbank Quarterly. Dec2025, Vol. 103 Issue 4, p1160-1182. 23p. |
| Subjects: | Health services accessibility, Interprofessional relations, Multiple regression analysis, Crisis intervention (Mental health services), Descriptive statistics, Surveys, Odds ratio, Emergency medical services communication systems, System integration, Confidence intervals, Data analysis software, Medical referrals |
| Abstract: | Policy PointsCertified community behavioral health clinics (CCBHCs) commonly partner with emergency response systems in mobile crisis response through 911 referral arrangements, wherein behavioral health practitioner–only teams respond to 911 calls, and co‐response partnerships, wherein a CCBHC clinician joins a police or emergency medical services team.Both the internal staff capacity of the CCBHC and external police capacity are associated with when CCBHCs partner with emergency response systems in mobile crisis response, although their effects differ by partnership: Co‐response is more likely when CCBHCs have greater internal capacity, whereas 911 referral is more common in communities with lower police capacity.Stakeholders seeking to increase CCBHC–emergency response system partnerships may need to apply different strategies depending on the type of arrangement they aim to expand. Context: Individuals with behavioral health disorders are more likely to experience substantial harm from a police encounter, prompting reforms to minimize encounters between police and people experiencing a behavioral health crisis. One strategy involves expanding partnerships between certified community behavioral health clinic (CCBHC) mobile crisis teams and emergency response systems, often through two models: 911 referral, wherein a CCBHC's behavioral health practitioner–only team responds to 911 calls, and co‐response, wherein a CCBHC clinician joins a police or emergency medical services (EMS) team. We examine whether the internal capacity of the CCBHC and external police capacity influence when CCBHCs engage in these partnerships. Methods: Using data from the only national survey of CCBHCs, this study applies multivariable logistic regression to assess whether CCBHC staff capacity and police capacity are associated with CCBHC–emergency response system partnerships in mobile crisis, controlling for organizational characteristics of the CCBHC and demographic and socioeconomic features of its service area. Findings: One‐third (33.0%, 95% confidence interval [CI], 26.0‐40.0) of CCBHCs report a 911 referral partnership, and nearly half (48.5%, 95% CI 41.1‐55.9) report a co‐response arrangement. While police capacity is not significantly associated with co‐response, a one standard deviation increase in police capacity corresponds to an 11.0‐percentage‐point (95% CI −19.5 to −2.5) decrease in the predicted probability of a 911 referral partnership. CCBHC capacity is not associated with 911 referral arrangements, but CCBHCs in the top tertile of CCBHC capacity are 19.2 (95% CI 4.3‐34.2) percentage points more likely to report a co‐response partnership. Conclusions: The internal capacity of CCBHCs and external police capacity are associated with when CCBHCs partner with emergency response systems in mobile crisis. Because a robust behavioral health crisis system likely requires multiple response models with varying police involvement, stakeholders may need different strategies depending on the type of partnership they aim to expand. [ABSTRACT FROM AUTHOR] |
| Copyright of Milbank Quarterly is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) | |
| Database: | Psychology and Behavioral Sciences Collection |
| FullText | Text: Availability: 0 |
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| Header | DbId: pbh DbLabel: Psychology and Behavioral Sciences Collection An: 191298545 AccessLevel: 6 PubType: Academic Journal PubTypeId: academicJournal PreciseRelevancyScore: 0 |
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| Items | – Name: Title Label: Title Group: Ti Data: Determinants of When Community Behavioral Health Clinics Partner With Emergency Response Systems: The Role of Capacity in 911 Referral and Co‐response Models. – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22MAURI%2C+AMANDA+I%2E%22">MAURI, AMANDA I.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22LINDENFELD%2C+ZOE%22">LINDENFELD, ZOE</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22WILLISON%2C+CHARLEY%22">WILLISON, CHARLEY</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22TODD%2C+THERESE+L%2E%22">TODD, THERESE L.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22PURTLE%2C+JONATHAN%22">PURTLE, JONATHAN</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22SILVER%2C+DIANA%22">SILVER, DIANA</searchLink> (AUTHOR) – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="JN" term="%22Milbank+Quarterly%22">Milbank Quarterly</searchLink>. Dec2025, Vol. 103 Issue 4, p1160-1182. 23p. – Name: Subject Label: Subjects Group: Su Data: <searchLink fieldCode="DE" term="%22Health+services+accessibility%22">Health services accessibility</searchLink><br /><searchLink fieldCode="DE" term="%22Interprofessional+relations%22">Interprofessional relations</searchLink><br /><searchLink fieldCode="DE" term="%22Multiple+regression+analysis%22">Multiple regression analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Crisis+intervention+%28Mental+health+services%29%22">Crisis intervention (Mental health services)</searchLink><br /><searchLink fieldCode="DE" term="%22Descriptive+statistics%22">Descriptive statistics</searchLink><br /><searchLink fieldCode="DE" term="%22Surveys%22">Surveys</searchLink><br /><searchLink fieldCode="DE" term="%22Odds+ratio%22">Odds ratio</searchLink><br /><searchLink fieldCode="DE" term="%22Emergency+medical+services+communication+systems%22">Emergency medical services communication systems</searchLink><br /><searchLink fieldCode="DE" term="%22System+integration%22">System integration</searchLink><br /><searchLink fieldCode="DE" term="%22Confidence+intervals%22">Confidence intervals</searchLink><br /><searchLink fieldCode="DE" term="%22Data+analysis+software%22">Data analysis software</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+referrals%22">Medical referrals</searchLink> – Name: Abstract Label: Abstract Group: Ab Data: Policy PointsCertified community behavioral health clinics (CCBHCs) commonly partner with emergency response systems in mobile crisis response through 911 referral arrangements, wherein behavioral health practitioner–only teams respond to 911 calls, and co‐response partnerships, wherein a CCBHC clinician joins a police or emergency medical services team.Both the internal staff capacity of the CCBHC and external police capacity are associated with when CCBHCs partner with emergency response systems in mobile crisis response, although their effects differ by partnership: Co‐response is more likely when CCBHCs have greater internal capacity, whereas 911 referral is more common in communities with lower police capacity.Stakeholders seeking to increase CCBHC–emergency response system partnerships may need to apply different strategies depending on the type of arrangement they aim to expand. Context: Individuals with behavioral health disorders are more likely to experience substantial harm from a police encounter, prompting reforms to minimize encounters between police and people experiencing a behavioral health crisis. One strategy involves expanding partnerships between certified community behavioral health clinic (CCBHC) mobile crisis teams and emergency response systems, often through two models: 911 referral, wherein a CCBHC's behavioral health practitioner–only team responds to 911 calls, and co‐response, wherein a CCBHC clinician joins a police or emergency medical services (EMS) team. We examine whether the internal capacity of the CCBHC and external police capacity influence when CCBHCs engage in these partnerships. Methods: Using data from the only national survey of CCBHCs, this study applies multivariable logistic regression to assess whether CCBHC staff capacity and police capacity are associated with CCBHC–emergency response system partnerships in mobile crisis, controlling for organizational characteristics of the CCBHC and demographic and socioeconomic features of its service area. Findings: One‐third (33.0%, 95% confidence interval [CI], 26.0‐40.0) of CCBHCs report a 911 referral partnership, and nearly half (48.5%, 95% CI 41.1‐55.9) report a co‐response arrangement. While police capacity is not significantly associated with co‐response, a one standard deviation increase in police capacity corresponds to an 11.0‐percentage‐point (95% CI −19.5 to −2.5) decrease in the predicted probability of a 911 referral partnership. CCBHC capacity is not associated with 911 referral arrangements, but CCBHCs in the top tertile of CCBHC capacity are 19.2 (95% CI 4.3‐34.2) percentage points more likely to report a co‐response partnership. Conclusions: The internal capacity of CCBHCs and external police capacity are associated with when CCBHCs partner with emergency response systems in mobile crisis. Because a robust behavioral health crisis system likely requires multiple response models with varying police involvement, stakeholders may need different strategies depending on the type of partnership they aim to expand. [ABSTRACT FROM AUTHOR] – Name: AbstractSuppliedCopyright Label: Group: Ab Data: <i>Copyright of Milbank Quarterly is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.) |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1111/1468-0009.70045 Languages: – Code: eng Text: English PhysicalDescription: Pagination: PageCount: 23 StartPage: 1160 Subjects: – SubjectFull: Health services accessibility Type: general – SubjectFull: Interprofessional relations Type: general – SubjectFull: Multiple regression analysis Type: general – SubjectFull: Crisis intervention (Mental health services) Type: general – SubjectFull: Descriptive statistics Type: general – SubjectFull: Surveys Type: general – SubjectFull: Odds ratio Type: general – SubjectFull: Emergency medical services communication systems Type: general – SubjectFull: System integration Type: general – SubjectFull: Confidence intervals Type: general – SubjectFull: Data analysis software Type: general – SubjectFull: Medical referrals Type: general Titles: – TitleFull: Determinants of When Community Behavioral Health Clinics Partner With Emergency Response Systems: The Role of Capacity in 911 Referral and Co‐response Models. Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: MAURI, AMANDA I. – PersonEntity: Name: NameFull: LINDENFELD, ZOE – PersonEntity: Name: NameFull: WILLISON, CHARLEY – PersonEntity: Name: NameFull: TODD, THERESE L. – PersonEntity: Name: NameFull: PURTLE, JONATHAN – PersonEntity: Name: NameFull: SILVER, DIANA IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 12 Text: Dec2025 Type: published Y: 2025 Identifiers: – Type: issn-print Value: 0887378X Numbering: – Type: volume Value: 103 – Type: issue Value: 4 Titles: – TitleFull: Milbank Quarterly Type: main |
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