Crisis Intervention Team Training Research Articles

The impact of Crisis Intervention Team (CIT) training on police use of force

This study examined the level of force used by Crisis Intervention Team (CIT) and non-CIT officers responding to individuals experiencing a mental health crisis (N = 382). Level of force was coded using National Institute of Justice (2009) strategy, least to most lethal. Analyses examined differences in officers’ use of force by CIT-training status and citizen characteristics. Results indicated CIT-trained officers were less likely to use any level of force and more likely to use the lowest level of force, compared to non-CIT-trained officers. CIT-trained officers were significantly less likely to escalate to higher levels of force, utilizing the lowest level of force more often.

Crisis Intervention Team (CIT) training and impact on mental illness and substance use-related stigma among law enforcement

Limited empirical data and research exists about stigmatizing attitudes and perceptions held by law enforcement officers towards persons with mental illness and substance use issues. Pre- and post-training survey data from 92 law enforcement personnel who attended a 40-hour Crisis Intervention Team (CIT) training was used to investigate training-related changes in mental illness stigma and substance use stigma. Training participant's mean age was 38.35 ± 9.50 years, majority white non-Hispanic race/ethnicity (84.2%), male gender (65.2%), and reported job category as road patrol (86.9%). Pre-training, 76.1% endorsed at least one stigmatizing attitude towards people with mental illness, and 83.7% held a stigmatizing attitude towards those with substance use problems. Poisson regression revealed that working road patrol (RR=0.49, p<0.05), awareness of community resources (RR=0.66, p<0.05), and higher levels of self-efficacy (RR=0.92, p<0.05) were associated with lower mental illness stigma pre-training. Knowledge of communication strategies (RR=0.65, p<0.05) was associated with lower pre-training substance use stigma. Post-training, improvement in knowledge of community resources and increases in self-efficacy were significantly associated with decreases in both mental illness and substance use stigma. These findings highlight the existence of stigma related to both mental illness and substance use pre-training suggesting the need for implicit and explicit bias training prior to the start of active law enforcement duty. These data are consistent with prior reports indicating CIT trainings as a path to address mental illness and substance use stigma. Further research on effects of stigmatizing attitudes and additional stigma-specific training content is warranted.

Modeling the effects of Crisis Intervention Team (CIT) training for police officers: How knowledge, attitudes, and self-efficacy drive de-escalation skills and referral decisions

ObjectivePrior research on Crisis Intervention Team (CIT) training for police officers has demonstrated improvements in knowledge, attitudes, self-efficacy, and stigma, but how these factors work together to influence behavioral outcomes like de-escalation skills and referral decisions remains unstudied. Method251 CIT-trained and 335 non-CIT officers completed in-depth surveys measuring these six constructs. We used structural equation modeling to test fit of the data to our hypothesized model and made indicated changes to improve fit. ResultsAn alternate 8-path model (with three paths originally hypothesized being removed) fit reasonably well, and allowing path coefficients to differ for CIT and non-CIT groups resulted in models with similar fit statistics. ConclusionCIT training enhances knowledge and attitudes, both of which have beneficial effects on stigma. Though an important outcome itself, lower stigma does not have an effect on de-escalation skills and referral decisions, though self-efficacy clearly does.

Evaluation of Ongoing Crisis Intervention Team (CIT) Training for Law Enforcement Using the ECHO Model

Crisis Intervention Team (CIT) training aims to improve law enforcement officers’ (LEOs) ability to safely intervene in calls for service involving individuals with mental illness, as well as to increase LEOs’ ability to link these individuals to mental health services and divert them from the criminal justice system. However, most CIT training is delivered as a stand-alone class, and continuing education in CIT principles and best practices is limited. To address this problem, the Albuquerque Police Department, in partnership with the Department of Psychiatry and Behavioral Sciences at the University of New Mexico, developed CIT ECHO to provide continuing education in CIT best practices. The authors evaluated 113 weekly CIT ECHO sessions targeting LEOs in New Mexico, offered between 2017 and 2020. LEOs electronically completed a post-session survey after each didactic; additionally, a targeted follow-up survey was distributed to LEOs participating in at least three sessions. Surveys measured impact of CIT ECHO on knowledge, self-efficacy, and attitudes towards individuals with mental illness involved in the criminal justice system. After participating in CIT ECHO, LEOs reported increases in knowledge of didactic content and that they felt comfortable applying didactic content on the job. LEOs also evidenced positive attitudinal shifts towards individuals with mental illness and criminal justice involvement. Continuing education in CIT best practices appears to increase LEOs’ knowledge base and comfort in working with individuals with mental illness and criminal justice involvement, as well as results in positive attitudinal shifts towards this population.

Emergency medical services professional behaviors with violent encounters: A prospective study using standardized simulated scenarios.

IntroductionTo evaluate emergency medical services (EMS) professional response to escalating threats of violence during simulated patient encounters and describe differences in behaviors by characteristics.MethodsEMS professionals of a large county‐based system participated in 1 of 4 standardized patient care scenarios. Each 8‐minute scenario included escalated threats of violence such that EMS personnel should escape the scene for safety. Trained evaluators recorded EMS professionals' performance using standardized data elements. Outcomes included EMS personnel escape and verbal de‐escalation attempts. Descriptive statistics and univariable odds ratios (OR) with 95% confidence intervals (95% CI) are reported.ResultsThere were 270 EMS professionals evaluated as individual members of 2‐person crews. Overall, 54% escaped the unsafe scene and 54% made an adequate de‐escalation attempt; 20% did not make an adequate de‐escalation attempt nor escape the unsafe scene. Paramedics demonstrated lower odds of escaping compared to emergency medical technicians (OR: 0.40; 95% CI: 0.17–0.94), yet greater odds of adequate de‐escalation (OR: 3.17, 95% CI: 1.38–7.31). EMS professionals with more than 20 years of experience (OR: 0.32, 95% CI: 0.13–0.79, ref:2 years or less) and those with military experience (OR: 0.37; 95% CI: 0.17–0.81) demonstrated reduced odds of escaping. Crisis intervention team (CIT) training was associated with reduced odds of escape (OR: 0.38; 95% CI: 0.21–0.69), but increased odds of adequate de‐escalation (OR: 2.19; 95% CI: 1.19–4.04).ConclusionsNearly half of EMS professionals did not remove themselves from a simulated patient care scenario with an escalating threat of physical violence. EMS‐specific training for de‐escalation as a first‐line technique, recognizing imminent violence, and leaving a dangerous environment is needed.

Using the Theory of Planned Behavior to Understand How Crisis Intervention Team (CIT) Training Facilitates Police Officers' Mental Health Referrals.

The Theory of Planned Behavior posits that behaviors are predicted by one's intention to perform them; intention is driven by attitude toward the behavior, subjective norm, and perceived behavioral control. We used this theory to predict Crisis Intervention Team (CIT)-trained and non-CIT officers' intention to facilitate referral of persons with suspected mental illnesses to mental health services. CIT-trained (n = 251) and non-CIT (n = 335) officers from six law enforcement agencies participated. CIT-trained officers had significantly greater scores on all constructs. Theory constructs fit the data well, and fit did not differ meaningfully between the two groups. Direct and indirect predictors together accounted for 28% and 21%, respectively, of variance in behavioral intention. Attitude was the strongest predictor. Intentions to facilitate mental health referrals may be driven by the same factors among CIT-trained and non-CIT officers, but CIT officers, even at a median of 22months after training, have significantly higher scores on those factors.

Cops, Clinicians, or Both? Collaborative Approaches to Responding to Behavioral Health Emergencies.

How a community responds to behavioral health emergencies is both a public health issue and social justice issue. Individuals experiencing a behavioral health crisis often receive inadequate care in emergency departments (EDs), boarding for hours or days while waiting for treatment. Such crises also account for a quarter of police shootings and >2 million jail bookings per year. Racism and implicit bias magnify these problems for people of color. Growing support for reform provides an unprecedented opportunity for meaningful change, but solutions to this complex issue will require comprehensive systemic approaches. As communities grapple with behavioral health emergencies, the question is not just whether law enforcement should respond to behavioral health emergencies but how to reduce unnecessary law enforcement contact and, if law enforcement is responding, when, how, and with what support. This policy article reviews best practices for law enforcement crisis responses, outlines the components of a comprehensive continuum-of-crisis care model that provides alternatives to law enforcement involvement and ED use, and offers strategies for collaboration and alignment between law enforcement and clinicians toward common goals. Finally, policy considerations regarding stakeholder engagement, financing, data management, legal statutes, and health equity are presented to assist communities interested in taking steps to build these needed solutions.

Costs and Savings Associated With the Police Use of the interRAI Brief Mental Health Screener.

Background: The police response to calls for service identified as being related to mental health continues to be highly controversial. Strategies to improve the police response include Crisis Intervention Team (CIT) training and various forms of co-response models neither of which have been subjected to comprehensive evaluations, particularly as to cost-efficiency. A new approach is the use of the interRAI Brief Mental Health Screener to enhance police officer ability to identify persons with serious mental disorders. The purpose of the current study is to evaluate the costs and cost efficiency of the police response to mental health calls using the interRAI Brief Mental Health Screener.Method: Secondary data was analyzed from the use of the screener from 2018 to 2020 by police officers in a mid-sized Canadian city. Changes were measured in the overall number of interactions police officers had with persons with mental health disorders, the number of incidents where police officers referred the person to hospital, and the time officers remained in the emergency department.Results: A total of 6,727 assessments were completed with involuntary referrals decreasing by 30%, and voluntary referrals by 34%. The overall time police officers were involved in involuntary referrals decreased from 123 min in 2018 to 113 min in 2020. The average emergency department wait time for voluntary referrals dropped from 41 min in 2018 to 27 min in 2020, while involuntary referrals decreased from 61 min in 2018 to 42 min in 2020. Each averted involuntary referral to the emergency department resulted in a savings of $81, on average during the study period.Conclusion: An analysis of the costs and costs savings associated with the use of the screener demonstrate that it is a worthwhile investment for police services. An additional benefit is its ability to collect mental health statistics that may be useful to police leaders to justify budgets. Future studies should attempt to devise some method of collecting pre-implementation data that would reveal the true costs and cost-efficiency of using the BMHS, which have been shown to be significant in the current study however, undoubtedly are under-estimated.

Does the crisis intervention team (CIT) training improve police officers’ knowledge, attitude, and mental health stigma?

IntroductionThe Crisis Intervention Team (CIT) training was developed to educate police officers regarding the complexity of mental health (MHI) issues, and better prepare them for crisis encounters with persons with mental illness (PwMI).ObjectivesTo determine if CIT training improves police officers’ knowledge, attitude, and stigma about mental health issues.MethodsA systematic review followed the PRISMA protocol and was conducted on the PubMed database (Figure 1). Search strings were “crisis intervention team training,” “crisis intervention team,” “CIT,” “effectiveness,” and “police.” Inclusion eligibility required primary studies using surveys that measured the CIT training outcomes (i.e., knowledge, attitude, and stigma). Literature/narrative reviews or opinions were excluded.ResultsThe comprehensive meta-analysis software version 3.0 was utilized during analysis. Randomized odds ratios using a 95% confidence interval (CI) were obtained. Officers’ scores for knowledge, attitude, and stigma about MHI were taken before and after the survey. The Control group consisted of officers without CIT training. The CIT trained officers displayed an improvement in knowledge (OR 2.35, CI: 1.51– 3.67), attitude (OR 2.55, CI: 1.36–4.78), and stigma (OR 3.11, CI: 1.88–5.17). The results were statistically significant, with a p-value of less than 0.001 (Figure 2).ConclusionsCIT trained police officers displayed a significant improvement in their knowledge, attitude, and reduced stigma towards PwMI. Although our study displays CIT training’s positive effects, previous studies reported a nullified effect of CIT in reducing arrests and the use of force during police officers encounters with PwMI. Future researchers must explore this gap, mainly focusing on gender and race bias.

Law Enforcement and Persons with Mental Illness: Responding Responsibly

According to a Washington Post database, in the USA, police-involved shootings have killed over 5680 people since January 1, 2015, with 1359 (23%) of those deaths involving a person with a mental illness. It has been asserted by Fuller et al. that people with an untreated mental illness are approximately 16 times more likely to be killed in a police-involved shooting than other community members. In response to this issue, several practices have been implemented to help prevent negative outcomes in police and person with mental illness interactions and promote safety for all involved parties. Three practices have developed into models for police departments which include the following: Community Oriented Policing, Crisis Intervention Team (CIT) programs and training, and co-responder mental health teams. In addition to the foregoing three practices, other individual-level approaches and techniques can be implemented that are evidence-informed, such as increased utilization of stress-reduction training techniques and implicit bias training. Based on an additional examination of the existing literature, this problem can be addressed at the macro level, through amending policies and procedures (e.g., use-of-force guidelines, use of community-review board) as well as increased access to non-lethal weapons, presence of civilians on the police staff roster, and utilization of special consideration response registries. This review aims to incorporate existing literature in an effort to synthesize best practice responses for law enforcement in improving outcomes related to interactions with persons with mental illness.

Policing persons in behavioral crises: an experimental test of bystander perceptions of procedural justice

Policing is in the midst of a legitimacy crisis. Procedural justice is a primary avenue for police reform, including when police officers interact with vulnerable populations. The purpose of the current study was to evaluate the nuanced circumstances in which the public may endorse police interactions with persons in crisis as more or less procedurally just. We recruited a nationally representative sample of 569 Americans and a diverse sample of 809 undergraduates. Using factorial survey vignettes, we assessed bystander perceptions of procedural justice to encounters between officers and a person suffering a behavioral crisis, which varied in officer tactics, use of force, and the cause of crisis. Officers were perceived as more procedurally just when they employed tactics consistent with Crisis Intervention Team (CIT) training. Use of force reduced perceptions of procedural justice, but use of force by CIT officers was perceived as more procedurally just than conventional officers’ actions, regardless of use of force. Conventional treatment and use of force were considered less procedurally just when the person’s crisis was due to mental illness compared with substance use. The current findings suggest bystanders did not uniformly endorse use of force by police but were more tolerant of force when officers used CIT-informed tactics and when a person’s crisis was due to substance use. Use of force against persons with mental illness was viewed as procedurally unjust, perhaps reflecting the public’s increasing sensitivity to this population and a growing dissatisfaction with police involvement as the often standard response to persons in crises.

An Examination of Crisis Intervention Teams in Rural Jurisdictions.

A disproportionate number of people with mental illness are involved in critical police encounters resulting in arrest and/or excessive use of force. In response, many jurisdictions have implemented Crisis Intervention Team training. This mixed method study used survey and focus group interview data to investigate Crisis Intervention Teams in rural communities in a Northeastern state in the U.S. Findings indicate that unique situational realities prevent optimal effectiveness of Crisis Intervention Teams in rural jurisdictions. Three themes emerged as clear barriers to effectiveness: (a) time and money; (b) buy-in and support for Crisis Intervention Teams; and (c) systemic barriers to adequate care. Rural-specific impediments affect each aspect and member of Crisis Intervention Teams in rural jurisdictions. Efforts to develop a specialized police response training program for rural jurisdictions should be developed and examined.

Campus Police Response to Mental Illness: Training, Collaboration, and Perceived Effectiveness

Most research on police response to mental illness has not included officers who work in college settings. This study examined the frequency with which campus police are asked to respond to mental health crises, their preparedness to do so, and their perceived effectiveness. Additionally, this study gathered information about campus and community partners and examined differences between mental health-focused calls involving students versus community members. Seventy-six campus police departments participated in the study and reported that 10% of calls involve a mental health issue, with wellness checks and suicidality being common student issues and homelessness, violence toward others, and substance abuse being common issues for calls involving community members. Over half of officers have Crisis Intervention Team (CIT) training, and the number of CIT-trained officers was related to perceived effectiveness at managing student mental health calls. Implications for mental health resources on college campuses and the need for additional research in this area are discussed.

Evaluation of CIT Components of Guardian Law Enforcement Training

In 2014, the Washington State Criminal Justice Training Commission (WSCJTC) shifted from a paramilitary “warrior”-style training to a guardian model focused on community participation, social justice, procedural justice, and de-escalation and crisis intervention skills. The current study examines the effects of crisis intervention team (CIT) training components in the WSCJTC guardian curricula. A quasi-experimental pre-/post-survey design was employed comparing responses from a sample of 139 WSCJTC Basic Law Enforcement Academy (BLEA) recruits who completed BLEA in 2015 with two comparison groups—(1) 296 BLEA graduates who completed training prior to implementation of the guardian training who had no prior CIT training and (2) 851 BLEA graduates who completed training prior to implementation of the guardian training who had prior CIT training. Additionally, the study examined the effects of a WSCJTC’s 40-hour CIT training through a pre-/post-survey of 78 law enforcement personnel who completed the voluntary 40-hour CIT in-service training. Significant training effects were observed for the 8-hour and 40-hour CIT training programs. Results offer support for continued implementation of the 8-hour CIT training component in BLEA and the 40-hour CIT training. Implications for continued improvements to law enforcement training are discussed.

Crisis Intervention Team Training in a Correctional Setting: Examining Compliance, Mental Health Referrals, and Use of Force

The Crisis Intervention Team (CIT) model was developed as a specialized police-based program in which officers are trained to safely interact with individuals with mental illnesses. In 2011, the Minnesota Department of Corrections adapted this program for corrections. This study compares prison incidents involving CIT officers to a comparison sample of non-CIT incidents on a number of outcomes, including gaining compliance from people in custody (either immediately or as an incident unfolds), making mental health referrals, and using force against people in custody. We conducted a content analysis of reports describing 500 incidents in an all-male, maximum security prison and estimated multivariate binary logistic models to control for characteristics of situations, incarcerated people, and employees. The findings provide some support for implementing CIT training in a correctional setting, but some less encouraging results show that improvements to the program are still needed.

The impact of Crisis Intervention Team Training for police

Policing persons with mental illness and/or emotional/behavioral issues is complex and difficult. Police interactions and encounters of this nature are expected to increase due to dwindling budgets and the resulting deficiencies of local mental health systems. Police departments are responding to this growing need by requiring officers to attend Crisis Intervention Team (CIT) Training. CIT Training is designed to teach officers about mental illness and effective strategies and techniques for engaging and de-escalating potentially volatile interactions and encounters. This study was conducted in a large, Midwestern, municipal police department. The data were triangulated and included: (a) CIT Training pre- and post-tests administered to officers ( N=323) prior to and upon completion of the required 40-hour CIT Training held during the months of October through December 2016 and February through May 2017; (b) participant observation with police patrol officers in three of the seven police districts ( N=127 hours; April 2017 through May 2017); (c) semi-structured interviews with police patrol officers assigned to three of the seven police districts who had completed the CIT Training ( N=32 patrol officers; intensive interviews were conducted during participant observation); (d) in-person semi-structured interviews with service providers/practitioners who interact with officers in the context of their working roles and responsibilities ( N=27; July 2017 through January 2018); and (e) interviews with Urbantown Police Department (UPD) executive command staff, CIT coordinators and UPD telecommunications personnel ( N=10; September 2017 through January 2018). The assessment finds that the CIT Training administered in a large, municipal police department changed officers’ perceptions, as well as their street-level practices with persons with mental illness and/or emotional/behavioral issues. This assessment also finds that police officers are taking fewer persons into custody for involuntary treatment, and are instead transporting more persons for voluntary treatment.

Jail diversion: the Miami model.

The Eleventh Judicial Circuit Criminal Mental Health Project (CMHP), located in Miami-Dade County, FL, was established in 2000 to divert individuals with serious mental illnesses (SMI; eg, schizophrenia, bipolar disorder, and major depression) or co-occurring SMI and substance use disorders away from the criminal justice system and into comprehensive community-based treatment and support services. The program operates two primary components: prebooking jail diversion consisting of Crisis Intervention Team (CIT) training for law enforcement officers and postbooking jail diversion serving individuals booked into the county jail and awaiting adjudication. In addition, the CMHP offers a variety of overlay services intended to: streamline screening and identification of program participants; develop evidence-based community reentry plans to ensure appropriate linkages to community-based treatment and support services; improve outcomes among individuals with histories of noncompliance with treatment; and expedite access to federal and state entitlement benefits. The CMHP provides an effective, cost-efficient solution to a community problem and works by eliminating gaps in services, and by forging productive and innovative relationships among all stakeholders who have an interest in the welfare and safety of one of our community's most vulnerable populations.

Law enforcement and mental health clinician partnerships in global mental health: outcomes for the Crisis Intervention Team (CIT) model adaptation in Liberia, West Africa.

The Crisis Intervention Team (CIT) model is a law enforcement strategy that aims to build alliances between the law enforcement and mental health communities. Despite its success in the United States, CIT has not been used in low- and middle-income countries. This study assesses the immediate and 9-month outcomes of CIT training on trainee knowledge and attitudes. Twenty-two CIT trainees (14 law enforcement officers and eight mental health clinicians) were evaluated using pre-developed measures assessing knowledge and attitudes related to mental illness. Evaluations were conducted prior to, immediately after, and 9 months post training. The CIT training produced improvements both immediately and 9 months post training in knowledge and attitudes, suggesting that CIT can benefit law enforcement officers even in extremely low-resource settings with limited specialized mental health service infrastructure. These findings support further exploration of the benefits of CIT in highly under-resourced settings.

Juxtapoetics: Aesthetic Uncovering of Racist Logics Within a Crisis Intervention Team Training’s Instructional Arc

Through Educational Criticism, I composed narratives and poems around a Crisis Intervention Team (CIT) Training for police officers through its intended, enacted, and received curriculum. Within analyzing CIT’s instructional arc, I juxtaposed voices: ideas left solitary were incomplete, simplistic, or, at times, naïve. Thus, I weaved voices and scholarship together or against each other for depth of meaning, nuance, and contestation. Juxtapoetics exposed the complexity of well-intended individuals and localized interventions situated within institutions reifying the White supremacist milieu and disrupted linear rationality and universality of Whiteness.

Mental Health Crisis Location and Police Transportation Decisions: The Impact of Crisis Intervention Team Training on Crisis Center Utilization

Crisis Intervention Team (CIT) research has shown increases in officer transports of individuals with serious mental illness to emergency departments (ED) which, while more appropriate than incarceration, can be expensive and lack linkage to long-term mental health services. Mental health crisis centers offer a promising alternative, but impact may be limited by proximal distance and lack of officer awareness. To address this concern, this study asked, “Does CIT training affect officer transport decisions to a crisis center over a nearby ED?” Researchers analyzed crisis call reports in a Midwestern county and found increased use of the crisis center and decreased use of EDs by officers after CIT was implemented. The crisis location affected officer transport decisions, yet CIT officers were more likely than non-CIT officers to travel farther for appropriate linkage. Findings suggest CIT changes officer behavior, which could potentially lead to long-term, low-cost treatment for individuals with serious mental illnesses when there is a mental health crisis center.