Beginning in 2010, the Illinois Criminal Justice Information Authority awarded several grants to the National Alliance on Mental Illness of Chicago (NAMI-C) to fund Crisis Intervention Training For Youth courses to officers at the Chicago Police Department (CPD). The program was the first 40-hour, five-day law enforcement youth crisis intervention training offered in the country. NAMI-C and CPD developed the course to answer requests for additional training from officers responding to calls for service involving youth with mental, emotional, or behavioral disorders.
Nationally, it is estimated that as many as 70 percent of the 2 million youth and young adults arrested each year suffer from mental health disorders which the justice system is not equipped to handle.1 These youth could be diverted to community-based treatment services rather than the juvenile justice system. Law enforcement, under the doctrine of parens patriae, have the authority to intervene in mental health-related incidents and determine the juvenile’s trajectory - resolution on scene, arrest, or psychiatric hospitalization transport. However, law enforcement officers called to intervene in crisis situations may not have the skills to safely interact with youth in crisis. Too often, officers resort to excess or even deadly force,2 although many individuals with mental disorders pose little risk of harm to others and are much more likely to harm themselves or be victims of violence.3
The Crisis Intervention Team (CIT) model was developed in response to the need for alternative law enforcement response to crisis calls. The team is designed to be a collaboration between police and appropriate community service systems to ensure that individuals with mental health needs are referred for services rather than brought into the criminal justice system.4 Extending this model to youth crisis calls required additional training to prepare officers to identify youth in crisis, assess their risk of harm, and apply de-escalation techniques to reduce trauma to themselves, youth and their families and avoid criminalization of juvenile behaviors related to unmet needs.5
This study was part of a multi-year evaluation conducted by Authority researchers on the implementation of 12 Crisis Intervention Training for Youth (CIT-Y) courses for CPD officers funded by the Authority. It focused on the second year of training implementation in 2012. It was designed to assess CIT-Y core training components and measure the curriculum’s effect on officer knowledge of and attitudes toward appropriate responses to youth crisis calls. The evaluation also sought to assess progress on recommended diversification of training participation among the various levels of CPD staff, especially those responsible for supervising trained officers. Authority researchers designed evaluation tools to measure training effectiveness, including a pre-/post-curriculum test, 18 training module evaluation surveys, and follow-up focus group questions. Data was collected from 144 officers attending CIT-Y training courses from January 2012 through May 2013 after completing adult CIT training, and a comparison group of 137 officers volunteering for adult CIT training classes but not yet trained in crisis intervention techniques.
CIT-Y training participation
Only officers who had completed an adult crisis intervention course (offered by CPD since 2004) were eligible for CIT-Y training. Both the adult and youth CIT courses are offered on a voluntary basis. Research suggests that officers often self-select CIT training because they have family members with mental illness or have failed to help individuals in previous crisis situations and want to avoid such failures in the future.6 However, as documented in the initial CIT-Y evaluation report,7 the voluntary nature of the program can lead to lack of program awareness and department support for implementation of CIT-Y techniques in the field. It was then recommended that training participation be expanded to more diverse levels of staff to overcome barriers to training implementation. Findings indicated that Year 2 CIT-Y training participants did not significantly differ in characteristics from those receiving training in Year 1 - the majority were older officers with close to two decades of CPD experience, and there were virtually no participants of higher rank beyond sergeant. Further, training participants did not differ in composition from a comparison group of officers seeking initial CIT training. Since the pool of eligible CIT-Y training participants was not attracting supervisory and command staff, departmental diversity in CIT-Y training was not likely to be achieved.
Training effect: Increased knowledge and more favorable attitudes toward handling youth crisis service calls
Some material taught in the basic adult course carried over into the advanced youth course, including how to gauge risk levels of harm during a crisis call, corresponding crisis de-escalation techniques and information on department mental health-related directives.
At the start of the CIT-Y training course, participating officers (n=144) averaged 2.55 years of law enforcement experience with CPD as a CIT officer, and had higher baseline knowledge for two of the three training objectives—Risk & de-escalation and Service call disposition—than untrained officers (n=137). They also differed with respect to their confidence in successfully responding to youth in crisis, their role as first responders, and their opinion of the mental health system as an effective solution to police referrals. These findings indicated that the prerequisite adult course provided a foundation of knowledge for more advanced CIT-Y training. This is consistent with past research.8
Figure 1 shows the changes in knowledge regarding CIT-Y objectives measured in officers at pre-test, after training, and at six months after training. Officers had more correct responses to test questions on two of the three training objectives Risk & crisis de-escalation and Service call disposition immediately following the week-long training session and six months later than on the pre-test. However, there was no statistically significant training effect for the Identification of youth mental health signs and symptoms objective over time. Responses to items measuring attitude change also showed the training positively influenced officers’ confidence in their ability to handle youth crisis calls and the mental health system’s capacity to provide effective solutions.
Officer satisfaction with training
Participating officers (n=144) were very satisfied with the CIT-Y training curriculum. They found it be relevant to their law enforcement role, engaging, and easy to understand. They were also very satisfied with expert presenters, finding them knowledgeable, professional, and prepared. Presenter satisfaction ratings correlated positively with knowledge of CIT-Y objectives. Thus, as trained officers’ satisfaction with presenters increased so did their post-curriculum test scores.
Of 43 officers providing responses about training limitations, the most commonly mentioned was lack of role-playing opportunities. A majority of trained officers (61 percent, n=88) anticipated barriers implementing newly learned techniques in the field; one-third (n=30) stated that the department’s culture could present a barrier, and 23 percent (n=20) credited lack of CIT training among supervisors as a potential barrier.
Focus group discussion with CIT-Y officers
A subgroup of trained officers (n=26) attended focus groups six months post-training. Officers in all focus groups reported the CIT-Y training prepared them with appropriate responses to youth crisis calls. Some requested more guidance for handling repeat incidents involving the same youth and their families. Participants reported using crisis de-escalation techniques daily and added that there were safety concerns for officers and youth when they were not applied.
Focus group participants identified barriers to implementing CIT-Y training information on their jobs, including lack of program awareness among the department and public, lack of department support, difficulties with dispatcher linkage to calls, lack of availability of non-emergency community-based treatment providers besides psychiatric hospital admission, and difficulty in accessing department paperwork to document the incident.
Focus group discussion included ways to enhance the application of training information in the field. One suggestion was to improve record sharing across systems, including the police department, detention, courts, hospitals, youth protective agencies, and behavioral health providers. Another recommendation was to offer refresher courses.
Implications for policy and practice
Based on the evaluation findings, the following recommendations were offered:
Improve the CIT-Y training curriculum and departmental reporting processes to help officers better identify youth in crisis
The CIT-Y training curriculum used in Year 2 was focused on three training objectives — the identification of youth mental illness signs and symptoms, awareness of levels of risk of harm and appropriate de-escalation techniques, and knowledge of CDP protocols for responding to youth crisis calls.
For two of the three core CIT objectives—Risk & crisis de-escalation and Service call dispositions - trained officers’ knowledge was statistically higher at six months post-training than before the course, suggesting that these training objectives were being met in the course. However, there was no statistical evidence of knowledge gains for the Identification training objective over time. On the contrary, findings revealed that the training barely caused participants’ scores to increase on this domain to the levels of the untrained officers — participants’ average knowledge scores after the training was 1.83 correct answers (out of three items), compared to 1.89 average scores for the group of untrained officers. While some research suggests that differentiating between youth crisis calls and other calls involving youth may be difficult simply because they “reflect those of the adolescents living in the community,”9 this is a founding concept of the youth crisis intervention team program.
The core training component of youth-in-crisis identification can be bolstered in several ways. Future trainings should present real-world youth crisis call data captured by the Mental Health/CIT incident report in the Youth mental illness—Signs & symptoms module for better instruction on recognizing youth in crisis. Training participants may better retain scenario-based information that they have experienced on the job. Curriculum developers can also incorporate this material into such modules as Q&A with CIT-Y officers, as well as the Department Procedures for Mental Health Crisis module, for further reinforcement of the information. If such changes are made, the curriculum test should be revised to reflect this new material, and the number of questions increased to equal those testing knowledge of the other two core components (which averaged nine questions, not just three).
At the departmental level, problems with this core component of CIT-Y training may reflect the fragmented nature of youth crisis call tracking. Training participants identified problems with the reliance on paper-based documents to record information about these calls, which severely limit the ability to track the frequency, characteristics, and outcomes of mental health calls, as well as dispatcher success in assigning calls to CIT-Y officers. The CIT-Y curriculum cannot be expected to accurately impart information on these calls if the department does not generally know their characteristics. At the very least, this evaluation pointed to a disconnect between course content and officer knowledge, which may improve as departmental record tracking is improved and the resulting knowledge about youth crisis calls is incorporated into the training curriculum.
Expand CIT-Y training to more officers and partnering agencies and develop refresher courses
Recommendations made by training participants in both Year 1 and this Year 2 evaluation stressed the importance of wider adoption of CIT-Y training within the department for greater impact in the field. This evaluation found that there was little or no change in the composition of training participants between the first and second year, and the predominance of patrol officers with many years of service was evident even in the untrained group of officers volunteering for basic CIT training. Reliance on this volunteer pool of CIT trained officers as a departmental training policy for further CIT-Y training will not achieve more diversity in trained staff, particularly in reaching supervisory-level staff that can reinforce the use of CIT-Y training techniques in the field. This evaluation found that prior knowledge of core CIT-Y concepts was higher than for untrained officers, but that even the most informed participants (who were already trained as adult CIT officers) started out with low pre-test scores (an average of 8 out of 21 questions correctly answered). Therefore, the departmental policy of requiring adult CIT training as a prerequisite for CIT-Y training should be re-evaluated as to its effect on reaching a wider training audience.
Expansion of CIT-Y training should be considered in two other aspects. Participants in this evaluation commented that it could be difficult to apply CIT-Y techniques in tandem with untrained officers who may misinterpret de-escalation techniques as outside of normal protocols. It was recommended that CIT-Y training video presentations be made available to untrained officers through roll-call presentations or on CPD’s website. Increased awareness of CIT-Y training concepts will promote more coordinated responses by all officers responding to youth crisis calls and dispel misconceptions. Training participants also recommended expansion of CIT-Y training to partnering entities, particularly school personnel and youth probation officers. While this may be beyond the scope of departmental training capacity, making the training video material available to other entities could fill this perceived training need. Exposure to CIT-Y training concepts developed from a law enforcement perspective can also inform partnering entities of that perspective, which may differ from the viewpoint of their profession.
Finally, CIT-Y training is limited to the one 5-day course. Participants in this evaluation recommended the opportunity for yearly refresher courses to support CIT-Y officer knowledge of training information and address implementation barriers and any questions/concerns.
Develop protocols and training to help officers more effectively deal with repeat youth crisis calls
Partnerships with mental health service providers are fundamental to successful law enforcement responses to youth crisis calls. The CIT-Y program model calls for diversion from the juvenile justice system and linkage to appropriate treatment services to reduce subsequent law enforcement contact, arrests, and jail and hospital admissions.10 This model assumes that diverted youth do not re-enter the juvenile justice system because of successful treatment of their underlying mental health issues. However, training participants identified that one barrier to successful CIT-Y training implementation is the lack of information on how to deal with other agencies when dealing with repeat crisis calls involving the same youth and their families. They identified the lack of non-emergency, but urgent, linkage options as one barrier to successful youth diversion. In particular, they expressed a need for more cross-system information sharing and streamlined follow-up processes with child protective services, especially when dealing with service calls involving child abuse and neglect. It is recommended that department CIT-Y directives be enhanced to address these inter-agency collaborations.
Conduct additional evaluations of the impact of CIT-Y training
Future evaluation efforts should explore implementation and impact of CIT-Y training in the field. There are many avenues for future investigation: the outcomes for youth handled by CIT-Y officers, an assessment of adherence to CIT department directives and cross-system collaborations, and the diffusion of CIT-Y concepts and techniques through informal peer training on the job. The key to future evaluation efforts is better data collection on mental health calls within the department. Toward that end, researchers developed a proposed information system map to assist in data exchange development (see full report). The recommended automation of the Mental Health/CIT incident report form and record linkage among collaborating partners will allow for more research on the prevalence, characteristics, and dispositions of youth crisis calls which will result in a better understanding crisis call characteristics, officer responses, and the progression of violence.
- Hammond, S. (2007). Mental health needs of juvenile offenders. Denver, CO: National Council of State Legislatures. Retrieved from https://www.ncsl.org/print/cj/mentaljjneeds.pdf ↩
- Wexler, C. (2016). Guiding principles on use of force: Why we need to challenge conventional thinking on police use of force. Washington, D.C. Police Executive Research Forum. Retrieved from http://www.policeforum.org/assets/30%20guiding%20principles.pdf ↩
- Teplin, L.A., McClelland, G.M., Abram, K.M., & Weiner, D.A. (2005). Crime victimization in adults with severe mental illness: Comparison with the National Crime Victimization Survey. Archives of General Psychiatry, 62, 911-921. ↩
- National Alliance for the Mentally Ill. (2001). Families on the Brink: The Impact of Ignoring Children with Serious Mental Illness. Arlington, VA: National Alliance for the Mentally Ill. Retrieved from http://www.ncmhjj.com/resource_kit/pdfs/Overview/References/FamsOnBrink.pdf ↩
- National Federation of Families for Children’s Mental Health (2008). How to work effectively with police when youth are in mental health crisis: A guide for families of children and youth with mental, emotional, or behavioral health problems. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services. Retrieved from https://goo.gl/x4DARj ↩
- Doulas, A. V., Lurigio, A. J. (2014). Juvenile crisis intervention teams (CITs): A qualitative description of current programmes. Police Journal: Theory, Practice and Principles, 87(2), 114-125. ↩
- Skorek, R. (2014). Influence of court-ordered forensic evaluations on juvenile justice system-involved youth: Evaluation of River Valley Detention Center’s Detention to Probation Continuum of Care program. Chicago, IL: Illinois Criminal Justice Information Authority. ↩
- Compton, M. T., Bahora, M., Watson, A. C., & Oliva, J. R. (2008). A comprehensive review of extant research on crisis intervention team (CIT) programs. Journal of the American Academy of Psychiatry and the Law, 36 (1), 47- 55. Retrieved from http://cit.memphis.edu/Publications_files/Compton-_Review_of_CIT_Literature.pdf ↩
- Doulas, A. V., Lurigio, A. J. (2014). Juvenile crisis intervention teams (CITs): A qualitative description of current programmes. Police Journal: Theory, Practice and Principles, 87(2), 114-125. ↩
- National Alliance for the Mentally Ill. (2001). Families on the Brink: The Impact of Ignoring Children with Serious Mental Illness. Arlington, VA: National Alliance for the Mentally
Ill. Retrieved from http://www.ncmhjj.com/resource_kit/pdfs/Overview/References/FamsOnBrink.pdf ↩