UChicago Health Lab Evaluation Results: The Chicago CARE Pilot Program Reduced Client Distress, Showcased Importance of City Agency Culture in Effective Mental Health Crisis Response

Research conducted by the University of Chicago Health Lab found promising results through effective emergency mental health response in reducing client distress. The University of Chicago Health Lab released its findings today in a report evaluating the implementation of the City of Chicago’s ambitious Crisis Assistance Response and Engagement (CARE) Program, a two-year pilot program which tested several promising interventions for mental health and substance use-related crisis response.

“We hope that our findings provide practical insights for Chicago, and for other communities across America that seek to improve mental health crisis response,” reports Harold Pollack, Faculty co-director of the University of Chicago Health Lab.

“Multidisciplinary response programs, like CARE, seek to better respond to the needs of community members experiencing crises,” said Rebecca Neusteter, executive director of the Health Lab. “Despite their rapid proliferation, much remains unknown about these kinds of efforts locally or nationally. Our evaluation sheds light on critical considerations regarding operational practices, program comparability, and effectiveness.”

The pilot program represented a partnership of the Chicago Mayor’s Office, the Chicago Department of Public Health (CDPH), the Office of Emergency Management and Communication (OEMC), the Chicago Fire Department (CFD), and the Chicago Police Department (CPD). The agencies worked together to test three healthcare-based alternate response team models.

“Our research revealed some important fundamental outcomes, demonstrating that this model – even in early iterations – shows promise in delivering effective care,” added Jason Lerner, director of programs at the Health Lab, “but for future versions to reach their full potential, they must overcome many practical barriers that confront first-response agencies that seek to collaborate in meeting the needs of persons who experience mental health crises.”

Pilot program findings included:

• Clients reported feeling significantly less distress after interacting with CARE clinicians.
• The number of calls that CARE teams successfully responded to increased by 37% over the pilot period.
• 40% of clients presented symptoms of schizophrenia, depression, anxiety, ideations of self-harm, or misuse of alcohol or other drugs, crisis calls best served by mental and behavioral health professionals
• CARE team staff provided clients with important supports and resources designed to meet their therapeutic and material needs.

Key programmatic challenges included: 

• The creation of new policies and procedures in a cross-agency partnership – at the agency, local, and state level – impacted the timing of the launch, day-to-day logistics, and, quite likely, the number of calls reporting during the period, with limited data collection and infrastructure creating difficulties in capturing or evaluating operational information and programmatic impacts;
• Preexisting differences in partner agencies’ cultures and assumptions required close collaboration and strong commitment from leadership and staff to navigate clear departures from preexisting agency norms; and
• Optimal staffing decisions – including dedicated and stable agency funding as well as commensurate pay, hiring, and retention for staff – are key considerations for localities that seek to provide sustainable and scalable interventions.

CARE initially included three teams: the Multidisciplinary Response Teams (MDRT), which were designed to respond to 911 calls involving somewhat higher levels of risk; the Alternate Response Teams (ART), which were designed to respond to 911 calls involving a range of mental- and behavioral-health issues with slightly lower levels of risk; and the Opioid Response Teams (ORT), which were not dispatched via 911, but instead deployed to address opioid overdose and substance use-related issues by offering follow-up services to people who experienced an overdose in the previous 24 to 72 hours.

Operating between 10:30 a.m. and 4:30 p.m., Monday to Friday, CARE teams actively responded to calls in pilot districts in several Chicago communities. CARE team staff provided clients with important services, supports, and resources, including face-to-face engagement, de-escalation, medical and psychosocial assessment, snacks, water, transit cards, clothing, community service referrals, non-emergent transport, and care coordination with other agencies and organizations.

“CARE is critical to fulfilling Mayor Johnson’s vision for a robust continuum of care and ensuring that all Chicagoans experiencing behavioral health crises receive a behavioral health response,” said Deputy Mayor of Community Safety Garien Gatewood from the City of Chicago. “The University of Chicago Health Lab’s evaluation is a source of guidance for our City departments and a critical validator as we work to expand CARE and permanently solidify it as part of our first responder ecosystem.” 

“CARE represents an important step forward toward ensuring that Chicagoans receive the right care, at the right times, thanks to the dedication of the city agency partners,” said Dr. Quintin Williams, Senior Program Officer at the Joyce Foundation, which funded the study in partnership with Chicago CRED, the Pritzker Pucker Family Foundation, and the Charles and Lynn Schusterman Family Philanthropies, among others. “The University of Chicago’s Health Lab implementation evaluation report provides important insights in how to successfully field practical interventions to ensure that individuals in distress get the support they need.”