Co-Responder Case Management: Assessing Needs and 911 Utilization

Co-Responder and Case Management Program Structure

Co-responder teams consist of a mental health worker and a law enforcement officer who work side by side to handle behavioral health crisis calls. With co-responder case management, existing programs typically follow one of three structures: the ride along, where the mental health worker rides with an officer for their shift, together they travel and manage calls; some have a meetup structure where the mental health worker travels to meet with officers at appropriate calls, and others have a set location where the mental health workers are stationed and officers transport individuals in need to them. 

Adding co-responder case management to the team layers another level of support. The case manager doesn’t respond to emergency calls, and it isn’t necessary to have advanced degrees in mental health to succeed. These individuals may be graduates of bachelor’s level social work, psychology, or similar programs. A case manager’s primary role is to be the liaison between individuals helped by the co-responder team and community mental health programs and services as needed.

Case management is a proactive team approach that integrates mental health professionals and law enforcement. Everyone works together to keep individuals connected to mental health services and resources, to help them abide by treatment plans, and meet responsibilities such as work, school, and training. In addition, since everyone works together to create solutions, this significantly decreases repeat interactions with emergency services.

The Case Manager’s Role in Co-Responding

While the co-responder team responds to emergencies in the field, the case manager connects law enforcement referrals and community partners.

With a case manager to be the program’s liaison between law enforcement and community services, the emergency responder team can focus on crisis calls and maintain the most updated referral information possible. In addition, the case manager works with local mental health resources, providers, and community partners to provide the community and individuals served with as many options for success as possible.

Having a case manager on the team also allows them to take over individuals’ follow-up and service care coordination, an essential part of decreasing repeat emergency calls from high utilizers of emergency services.

An essential part of the case manager’s role is also to help maintain the data on services. The case manager can take the time to complete assessments, maintain a database of information, and analyze that information to help the program determine where to best send resources.

Case Manager and Assessments

Data on the usage of services and the community’s needs is vital to developing and maintaining the best program possible. This assessment and data collection can help ensure funding is directed where it is most needed; programs can be designed to fill unmet needs, and the data can be used to show where more resources and funding are required. In addition, such data is typically helpful when applying for federal or private grants to help the community.

It can be difficult for the co-responder teams to maintain a thorough database of information, though the cloud-based platform Julota can significantly help with that.

Julota is compliant with HIPAA-/mental health (42 CFR part 2)-/Criminal Justice Information System(CJIS). Additionally, Julota can interface with any law enforcement CAD system.  It perfectly complements any community attempting to build a well-connected and successful program.

With the involvement of case managers and a well-connected system, more assessments and data can be compiled to help the individual and the community utilizing co-responder case management

Assessing Needs

Assessing needs is to mental health care, what goal setting is to any business. Just as having your strengths and needs identified in any aspect of life is essential, mental health is no different, especially when there is a history of emergency service usage.

Emergency services usage is a sign that something is significantly wrong; being proactive about maintaining mental health is substantially easier than correcting something major in an emergency.

When considering clients’ needs creating or using an assessment that looks at the client’s whole system is essential. For example, an individual with strong extended family support and other community support already needs a far different plan than one with no support system.

It is also essential to assess what the client thinks and feels. The best way to ensure that someone will follow through on a plan is to ensure you have their buy-in by having them heavily involved in developing it.

Finding out things like:

How do they feel they are doing?  

What do they say they need?

What have they done up until now for mental health


Do they even think they have a problem?

Do they want to pursue mental health treatment?

If so, What are some barriers to care?

Are they open to resources? If so, what?

Working together instead of working for the individual gives them a more significant role in their care, and is more likely to follow through with any plans made. This is important for long-term success.

It is also essential that the co-responder team in the field has access to this information to bring up and follow any plan that has been made if another emergency situation arises.

High Utilizer Assessments

High Utilizer assessments are created to help determine how acute a case is and how active case management may need to be.  This helps case managers and co-responder teams decide the level of care required to ensure the use of emergency services decreases over time.

This level of assessment requires access to call history, Emergency Department history, and clinical history. For example, a case manager would need access to this to decide

if the individual is improving or if they are just paying verbal tribute when the case manager is present and then continuing to require emergency services after hours. The only way to be confident of this is to access calls received from that individual.

When accessing mental health history, the case manager can see if there are any red flags for a high level of care needed.  These red flags may be: seeing multiple providers, multiple inpatient hospitalizations, and events occurring for six months or more.

This requires an understanding of all systems involved and a basic understanding of mental health diagnosis. Individuals with specific diagnoses may struggle with regulation more and utilize emergency services frequently until they learn how to manage their emotions in a healthier manner.

Repeat Risk Assessments

These are created with high-utilizer screening to provide more clinical insight into the client’s call history. For example, an individual managing post-traumatic stress disorder and utilizing emergency services likely differs significantly from an individual learning to cope with substance use disorder or other differential diagnoses.

To assess the likelihood of someone calling 9-1-1 repeatedly, the case manager would first complete the High Utilizer Screening. Then armed with this information, they would have to make some clinical judgments.

A high utilizer score is relevant because if the individual is already a high utilizer, they are likely to call again. They may need help solving their problems independently, which may lead to a reliance on law enforcement and other emergency services. This may be anything from the parent that can’t get their child to go to school and calls police officers for ‘backup’ to individuals with severe anxiety who end up in the hospital ER for every panic attack.

Any individual scoring high on the chance of repeat risk should have someone talk to them about other places to ask for help and what supports they have to rely on

If the individual has additional resources for use, they are

less likely to call 9-1-1. Resources may include mental health services, family members,  and calling a crisis line.

It is important to note if the individual feels they are continually in crisis because

If they are continually in crisis, they will likely call 9-1-1 again. This problem would need to be addressed by teaching coping and problem-solving skills and connecting to resources.

Considerations for Co-Responder Programs Adding Case Managers

It is important to note that a co-responder case management assessment is not designed to obtain a full mental health history or to provide a diagnosis. Instead, it is intended to determine the level of care and resources needed to allow the client the best chances of success.

Additionally, since much of it is based on the client’s responses, they can choose not to disclose parts of their history that may impact clinical decision-making. Clients can also decline any resources offered.  A case manager can do everything possible, and the client may refuse to engage for several reasons.

It is also vital that case managers have access to a wide variety of data from multiple community sources. For example, the case manager needs access to mental health and medical records and 9-1-1 call history to best assist everyone.

This is a large amount of data to work with and analyze and requires cooperation from multiple agencies and a significant amount of time. Earlier, Julota was mentioned as an excellent way to connect this data; this program allows all systems to communicate needed information while maintaining privacy to comply with regulations and federal privacy laws. It is well worth your time to look into if you are looking to add case management to your current responder program or if you are looking to start a co-responder program.