The Multnomah County Board of Commissioners heard updates, Tuesday, Oct. 4, on the Health Department’s recommendations for a transit behavioral health crisis outreach team and TriMet’s plan for implementation.
In spring 2021, the Board approved an intergovernmental agreement for MCSO to provide transit police services for TriMet with an emphasis on TriMet implementing a mobile crisis outreach team under the guidance of the Health Department. At the same time, as requested by Commissioner Lori Stegmann, the Board also requested frequent updates on the new team’s progress, partnerships and timelines.
The concept behind the team, led by the Multnomah County Sheriff’s Office (MCSO), was years in the making and includes partnerships with the Health Department and TriMet. In 2020, the Sheriff’s Office and TriMet began discussions on how to reimagine a different response to public safety and behavioral health concerns on public transit, spurred by TriMet’s Reimagine Safety and Security efforts.
“We have been working together to evaluate the framework and implement such a model,’’ said James Erikson, chief deputy of the Multnomah County Sheriff’s Office Law Enforcement Division.
The Sheriff’s Office’s mission is to support all community members through exemplary public safety service and to create a safe and thriving community for everyone.
“To reach these goals, we are committed to developing creative programs and identifying alternatives to traditional public safety approaches,” said Erikson.
“Our partnership with TriMet and the County Health Department provides a unique opportunity to address some of the root causes of criminal activity by focusing on outreach, prevention, service and interventions.”
Health Department Collaboration
When this process started, the Multnomah County Health Department began exploring models to improve the ridership experience on public transportation while also responding in real-time with support and services to those who may be in a behavioral health crisis, explained Health Department Director Ebony Clarke.
“We were able to step in and partner with TriMet to leverage our expertise specific to the Behavioral Health Crisis and also center our recommendations in our role as the local mental health authority,’’ Clarke said.
The Health Department pulled in many partners, including the Joint Office of Homeless Services; Health department partners from across the tri-county area; Multnomah County’s Racial and Ethnic Approaches to Community Health (REACH) program; the Behavioral Health Division’s Office of Consumer Engagement Unit; and peer advisory groups.
“Because of our commitment to equity and racial equity, we were able to center our work and our values of eliminating structural racism and continue to ensure we are doing our due diligence, amplifying the voice and bringing a public health approach rooted in community and consumer-driven response, while not losing site of (this partnership’s) importance to BIPOC and LGBTQIA+ communities,” said Clarke.
Extensive research and evidence-based practices
Evidence-based practices are the integration of clinical expertise, consumer values and the best research available, explained Leah Drebin, Multnomah County’s new Reimagine Community Coordinator for Public Health and Behavioral Health.
According to Drebin, practices were identified through research, an environmental scan and stakeholder engagement, which included:
- TriMet system and Reimagine Safety and Security background research;
- One-on-one meetings with TriMet staff and attending security, transit police and Reimagine Public Safety Advisory Committee meetings;
- Introducing the work for feedback to the Reimagine Public Safety Advisory Committee, the Transit Equity Advisory Committee and TriMet’s employee town hall;
- Ride-alongs with all safety and security teams and transit police;
- Coordinating with MCSO safety and security data analysts to track incidents that are potentially related to the behavioral health system.
- Observing security systems related trainings and;
- Researching what other transit systems are doing.
“Researching best practices with our local transit and community needs and capabilities was critical because the Substance Abuse and Mental Health Services Administration and others have stressed the importance of building programs tailored to specific communities,'' said Drebin.
The team partnered with Clackamas and Washington counties, the City of Portland Committee for Community Engaged Policing’s Behavioral Health Subcommittee, the National Alliance on Mental Illness, the Native American Rehabilitation Association, the Joint Office of Homeless Services, JOIN, Central City Concern, Portland Street Medicine, the MCSO Homeless Outreach and Programs Engagement (HOPE) Team, Portland Police Bureau’s Behavioral Health Team, crisis response providers and others.
Ultimately, Drebin engaged over 225 local service providers, outreach teams and community members with lived experience to identify evidence-based practices.
“We also knew that we did not need to repeat the research that had already been conducted or was currently in progress,’’ said Drebin.
The County’s Office of Consumer Engagement’s research for the Behavioral Health Resource Center and REACH’s community health research regarding transit experiences for Black, African and African immigrant and refugee communities helped inform the Health Department’s recommendations. Drebin also partnered with the Behavioral Health Emergency Coordination Network (BHECN) to learn from their Peer Providers workgroup.
During a meeting between TriMet and the Health Department to further clarify public transit needs, TriMet staff cited a specific example between a Multnomah County behavioral health forensic diversion case manager and a person known to have frequent contact with TriMet’s safety and security team. The case manager provided extensive follow-up and skills training to that person.
And that’s what the agency is seeking, said Drebin: a service outreach referral team model to connect and reconnect people to behavioral health services and resources.
TriMet also cited the St. Louis Metro Behavioral Health Pilot Program, a partnership between the transit agency and a local healthcare provider that assigns behavioral health specialists exclusively to high-volume transit centers.
This type of approach is important because it “can offer prevention and early-intervention strategies, which is a step toward ensuring a person in our community does not have to be experiencing an acute level of crisis when first responders and crisis intervention teams are needed to be called in order to access care and support,” said Drebin.
“We have an opportunity to intervene in more chronic forms of crisis,'' said Drebin. “For example, when people are seeking shelter on the system because of unmet basic needs and work to prevent acute crises from happening.”
Mental health crises and substance use disorders have contributed to an increase in stranger-to-stranger violence, an escalating safety issue.
“We see this program as contributing to the safety of all and maintaining safety through prevention and intervention strategies,” she said.
The evidence-based recommendations were included in the program’s logic model, vetted by TriMet, including clinicians and peer specialists stationed at dedicated transit centers where the data shows the greatest need.
Branded street transit outreach attire is appropriate, as long as it doesn’t resemble that of law enforcement, code enforcement or security, Drebin said.
“This can help individuals feel comfortable and safe, which was stressed by local outreach providers and by those with lived experience,” said Drebin. “But there’s also evidence to support this by research conducted by national transit systems.”
Trained outreach professionals experienced more engagement with individuals when they followed this recommendation.
“As someone who was a former police officer, I can attest that uniforms are a barrier to connection for a variety of reasons,” she said. “It’s also something I observed during every ride-along with safety and security teams on the system. We want to ensure that every rider on the system has someone that they feel safe approaching for help.“
Resources, knowledge and relationships to connect riders to services
Another recommendation was to center equity and trauma-informed practices “that’s based on what we’ve learned of the need and community feedback,” said Christa Jones, a Multnomah County Behavioral Health Senior Manager.
“We learned of a need for mental health and addiction specialists to connect with and support riders and safety and security teams, and a need for outreach teams with resource, knowledge and relationships that can connect and reconnect riders to services; A trauma-informed team that can to follow up with riders, provide skills training and coach people with behavioral health challenges on how to ride the system.”
“And finally, we’ve heard transit police advocate for increasing safety while reducing law enforcement involvement with individuals experiencing these challenges,” said Jones. “We have to have a program focused on prevention and early intervention.”
The team recommended creating a program that is peer driven with clinical support being an effective evidence-based practice for this program. Peer specialists are individuals with experiential behavioral health knowledge, who are in recovery, and who have specific certification to perform specific duties. They provide non-judgmental listening, mentorship and advocacy, and provide a space for others to talk through recovery to share ideas and also build trust, said Jones. They can also provide navigation of the behavioral health system.
In Denver’s transit system, she added, there's less need for crisis response services, because of the proactive work of behavioral health professionals on Denver’s Transit system.
“This is an upstream approach to intervene on an individual and community basis before the crisis happens, while still creating support and opportunities to address the acute situations,” said Jones.
The work is also based on evidence, which led to the peer-driven model at the heart of the County’s upcoming Behavioral Health Resource Center, as well as the Old Town Inreach program.
The team also recommended integrating Qualified Mental Health Professionals (QMHPs), who can provide risk screenings, brief crisis intervention and intensive case management.
“They wouldn’t replace the crisis response team, but supplement them with a focus on early intervention,” said Jones.
The positions would provide TriMet and transit police with a team that has the knowledge, training, certifications and pathways to resources to address behavioral health and addiction challenges. Follow-up services would also be an important feature, noted Jones.
Peer specialists and clinicians would also provide case management, referrals, skill training and system navigation training.
And lastly, the team would establish regular locations at dedicated transit centers to build relationships and as a connection point to resources between TriMet safety and security teams and riders, said Jones.
“Having teams staffed at dedicated platforms where data consistently shows need, such as the Gateway Transit Center, provides prevention and early intervention strategies,” she said.
Multnomah County Sheriff’s Office HOPE Team
The Sheriff’s Office is committed to providing quality prevention, intervention and rehabilitation services to the communities of Multnomah County, said Captain Brent Leisure.
“We seek to improve the quality of life by reducing crime through innovation, partnerships and teamwork with the communities we serve.”
In addition to the Homeless Outreach Programs Engagement (HOPE) Team and TriMet’s already-existing Safety Response Team, “our hope is that in following the Health Department’s recommendations, we’ll have long-term positive impacts for transit police and the community by reducing police involvement with people experiencing behavioral health, addiction and housing challenges,” said Leisure.
This will reduce strain on transit police staffing and free up staff to process criminal cases, conducting thorough investigations and overall allowing for more sustainable staffing practices.
The Sheriff’s Office’s HOPE Team is an outreach-first group that connects community members experiencing houselessness with resources while also providing law enforcement services. And since MCSO provides services to the transit system, Leisure said, “this is an opportunity to provide outreach services to houseless community members while also having a positive impact for transit riders.”
TriMet safety, security and vulnerable communities
“We have a great partnership between TriMet and Multnomah County, both in the Sheriff’s Office and the behavioral health side,” said Andrew Wilson, TriMet’s Executive Director of Safety and Security.
“We have been going through a reimagining process, which has been underway for a couple of years and has brought forward excellent recommendations.”
The partnership has led to more enhanced training and de-escalation techniques, as well as more ways to approach safety on our system.
“The program and logic model is well-done and helps understand gaps in the system,” Wilson said.
“TriMet’s Safety Response Team has been in operation for a year,” said Marissa Clarke, TriMet’s first-ever Vulnerable Communities Coordinator.
There are currently 46 members, with 48 projected by the end of the year. On average, the team performs 500 welfare checks monthly — calls that would have traditionally been routed to law enforcement, said Clarke.
“The team increases the ability to proactively address low-level livability issues and the basic needs of the most vulnerable riders throughout the tri-county area,’’ said Clarke.
Other efforts include connecting to transit agencies across the country who are also reimagining their approaches to enhancing transit security, as well as garnering wider regional support for this ongoing work.
Clarke will work closely with the City of Portland and contracted providers on the implementation of the Menlo Park Safe Rest Village.
“I appreciate the thoroughness of the report and thoughtfulness,” said Commissioner Susheela Jayapal. “As I understand, the team you’re describing is more of an affirmative preventative care response.”
“Really, the need we have most acutely is that preventative element,’’ replied Wilson.
“The statistic about the Safety Response Team doing 500 welfare checks a month is a really incredible number,” said Commissioner Jessica Vega Pederson.
“You can tell in all the work the thoroughness and thoughtfulness and robust opportunity to how this helps the system.”
“Could one of you speak to the impact of methamphetamine on TriMet?” asked Commissioner Sharon Meieran.
“Yes, particularly fentanyl, we have seen the impact,” Wilson answered.
“There’s an impact of drug use and other lawless behavior that’s out there. We’re working on a multi-pronged approach, connecting teams and services for prevention, then a Safety Response Team to address acute basic needs, and then code-enforcement or ultimately the Sheriff’s Office.”
Chair Deborah Kafoury shared that she was curious about next steps as this work transitions “from concept to implementation,” recalling that this commitment to create the Public Safety Transit Behavioral Health Response Team began with the Board’s vote “to have the Sheriff’s Office be the ‘mothership’ — for lack of a better phrase — of TriMet transit police.”
Watch the board briefing here.