Durham Strategic Plan Dashboard
Prosperity
Status Indicator: 
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Complete/Ongoing
Initiative: 2.11 Reduce public safety interactions with and improve outcomes for familiar neighbors
Creating a Safer Community Together
Description
From the data and experience, we know that a small number of people can contribute to a larger, disproportionate number of encounters with public safety agencies. A couple of examples highlight this point.
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This past fall, downtown businesses identified a small group of neighbors who they repeatedly had interactions with that made their employees or customers feel less safe. These neighbors, less than 10 total, had been detained in jail dozens of times each over the last year and also had many complex needs – from housing instability to mental health.
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One neighbor called 9-1-1 over 400 times in a one-month period and had complex needs around substance use that were driving his calls for service. This same neighbor contributed to 155 interactions with DCSD staff.
This initiative will (1) apply data-driven approaches to identify familiar neighbors (FN) with the highest number of interactions with each public safety agency (to include DECC, DPD, DFD, and DCSD); and (2) develop person-centered strategies and collaborations to better address the needs of these neighbors, resulting in a measurable reduction in the number of times these neighbors engage with the Durham Public Safety Portfolio.
Key Measures & Data Analysis
A small percentage of people make a disproportionate share of 9-1-1 responses. We are working to understand the data across public safety, but for HEART responses alone, 0.5% of the neighbors we serve account for 12% of all of our responses. By focusing on addressing the underlying needs contributing to these repeat calls for service from this smaller number of neighbors, we can significantly reduce utilization of first response services.
Why is it important?
By taking a data-driven, highly collaborative, person-centered approach (one that includes all public safety agencies AND extends beyond it to other health and social service agencies), the goal is to better address unmet, complex needs that are leading to an outsized usage of public safety resources.
Additionally, sending first responders to the same home 150 times over a 9-month period is the definition of inefficiency. Having call takers answer a 9-1-1 call for the same person over 400 times in single month is inefficient. Detaining persons over 20 times in a six-month period is inefficient. Figuring out how to better attend to the needs behind these calls can help save time (freeing up public safety responders experiencing significant staffing shortages for other calls), reduce risk and harm (that comes from repeated interactions with public safety they may escalate over time), and may even save money (though it depends on how much public safety costs are fixed versus variable).
What have we been doing?
Addressing the needs of familiar neighbors requires building robust networks to support better care coordination across agencies. We have made the following progress in this area.
- We created a familiar neighbors workgroup focused on supporting this pilot. The group, chaired by the City's DCSD Director and the County's Justice Services Department Director, meets monthly to develop, review and advise on pilot plans. The group includes representatives from Alliance Health, DPD, Community Development, Housing for New Hope, Lincoln Health, EMS, DSS, and Duke Health. This group reports out quarterly to a larger collection of system level leaders.
- We created a new Unsheltered Neighbors "by name" weekly meeting that brings together DCSD, Community Development, Housing for New Hope, Durham Entry Point, EMS and Open Table to discuss challenges and coordinate care for neighbors who: agencies may be struggling to engage; who are familiar to public safety or homeless services; who may have chronic or persistent mental illness.
Data sharing is also an important component of successful familiar neighbors program as it supports better care coordination. We have made some progress in this area, including:
- We are partnering with Duke to understand how public safety familiar neighbors overlap with local health systems and what the most common health related needs are for this population.
- We are working to gain access to systems such as Duke Medlink that can help HEART Care Navigation staff better coordinate care.
- We have learned from other cities who are leading the way in creating data platforms that connect data across multiple agencies. These kinds of projects are very time intensive and often difficult to advance, but, when successful, can help cities be more effective in supporting the complex needs of familiar neighbors.
In April, we launched a small pilot to begin to learn more about the needs and challenges facing some of Durham's familiar neighbors and to see if we can collectively identify strategies that can better address the needs to contribute to repeat interactions with public safety. DCSD has joined together with Durham County's Justice Services Department to create a familiar neighbor's care team that includes staff from both departments. The team currently has a small case load and is providing intensive care management for five familiar neighbors. This involves meeting people where they are at multiple times per week, working to build trust and rapport, developing care plans to address unmet needs, and supporting neighbors in connecting to resources and providers that can address the root causes leading to continued justice involvement.
What's next?
In the coming year, our familiar neighbor's care team will continue to support and work intensively with a small number (likely not to exceed 15) of familiar neighbors. The goal of this pilot is (1) to see if we can reduce the number of public safety interactions for these neighbors by better addressing identified unmet needs, and (2) by so doing, to identify insights, strategies, and system-level process improvements that we might be able to scale to improve outcomes for a larger number of familiar neighbors.
- One significant challenge we have identified in our first few months is the need for more supportive housing as well as a lack of options beyond congregate shelter for providing an initial safe space for working with neighbors who are unsheltered and dealing with mental illness. We are exploring strategies, such as micro communities and pallet shelters, that are being employed by other cities that may hold promise in addressing this need.
- Additionally, we will explore how we might reduce barriers for unsheltered neighbors to receive medication they need for mental illness. Some of the neighbors we are currently working with need regular medication, something that is very difficult to consistently maintain while living outdoors. Some cities provide a more robust street medicine program, and we are interested in learning more about such strategies.
- We will work in the coming months to broaden participation of other departments on our care team, hoping to create a larger multi-disciplinary approach.
To support better care coordination and to help us better understand the size and dimension of the challenge, we plan to continue efforts to develop a platform that integrates data across systems of care. On a recent site visit to Orange County, CA, we saw firsthand how they are using a system like this to offer enhanced care coordination for those who are most vulnerable. Their System of Care Data Integration System (SOCDIS) integrates numerous County databases to crease a consolidated virtual client record that is then used to create client care plans and track progress by a multi-disciplinary team. Durham has nothing approaching this data sharing capacity. We hope to change that.
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