Our research report published in the Journal of Public Health Management and Practice discusses the methodology, key findings, and policy implications of a national survey on first responder deflection (FRD) programs. Read: Designed to Do Good: Key Findings on the Development and Operation of First Responder Deflection Programs
The authors thank Sophia Juarez for her assistance in preparing this article.
Deflection (also known as first responder deflection [FRD]) arose in large numbers beginning in the mid-2010s, primarily in response to the latest phase of the opioid/overdose crisis, when fentanyl and other synthetic opioids created new challenges for first responders already struggling with the dramatic growth of overdose and overdose-related deaths. Deflection involves the collaboration and alignment of public safety organizations, community-based public health systems, and treatment/services providers to emphasize and facilitate treatment of conditions like substance use disorder (SUD) over arrest and prosecution. Those who are deflected avoid the justice system for offenses committed and have an opportunity, through treatment, services, and recovery, to avoid the justice system altogether. Since deflection is seen as a viable alternative in many communities, the practice has grown quickly and exponentially.
To gauge the scope of deflection initiatives, their partnerships, and the treatment/services they facilitate, the U.S. Department of Justice’s Bureau of Justice Assistance’s Comprehensive Opioid, Stimulant, and Substance Abuse Program (COSSAP) commissioned TASC’s Center for Health and Justice (CHJ) and NORC at the University of Chicago to conduct a survey and report of deflection operations; the coauthors represent the organizations involved in the study. This is the first-ever nationwide, federally funded survey to identify and assess existing deflection initiatives based on the various pathways of deflection. In this article, we summarize important takeaways from the survey and report, a survey of 659 known first responder organizations, to which 321 responded (a full discussion of survey methodology is included in the journal article).
What We Found
- Deflection initiatives launched largely as a response to opioid overdoses and overdose deaths, and are generally created and led by law enforcement organizations. The overwhelming number of initiatives reporting began after 2015, when fentanyl and other synthetic opioids hit the market in large numbers. Further, roughly three-quarters of deflection initiatives are led by police and sheriff’s departments, to be expected, as law enforcement entities typically receive overdose-related calls for service.
- Deflection initiatives involve cross-disciplinary partnerships of public safety, public health, community-based treatment/service providers, and other community leaders. The sustainability of deflection initiatives, as defined by the breadth of treatment/services facilitated, relies on partnerships: Almost half of those responding have at least three treatment/service providers-partners; more than one-quarter have four to six partners across detox/SUD treatment, case management, recovery support, housing, job training, and other services.
- SUD treatment is at the foundation of virtually all initiatives’ services. Medication Assisted Treatment (MAT) is the primary SUD treatment referred by deflection initiatives, with 90 percent linking clients to SUD treatment in general and 73 percent to MAT. Forty-two percent link clients to all three approved MATs, while a little more than one-third link to two MATs. The linkage to MAT is important, as many of these are evidence-based interventions found to be associated with successfully addressing opioid use disorder (OUD).
- Co-responders are prominent partners in deflection initiatives. Most deflection initiatives that responded use co-responders (peer support specialists/recovery coaches, case managers, social workers, etc.) for the initial contact to clients referred for treatment and services. About 80 percent deploy these individuals, whose lived experience in their communities is critical to treatment and recovery, in their operations.
- Personal introductions of referred clients by deflection initiatives to treatment case managers, also known as the “warm handoff,” are common and employed by most deflection operations. A majority of deflection operations, including co-responder models, utilize the “warm handoff,” suggesting that these initiatives have some comprehensive elements. The warm handoff is more than a referral – it is a personal introduction of the client, typically from the first responder to the case manager or care/services coordinator, and serves as a critical linkage to care and services, eliminating some treatment barriers. This often includes transportation to the client’s initial appointment (65 percent provide such services), which addresses another barrier.
- The presence of deflection initiatives seems to align with Medicaid expansion. Almost 90 percent of those initiatives responding to the survey are located in states that expanded Medicaid under the Affordable Care Act (ACA). More than half of those responding report that they bill Medicaid or Medicare for their treatment/services, which helps expand coverage for clients and support the sustainability of deflection initiatives.
Looking Forward
Our study demonstrates how deflection is frequently employed as an alternative for first responders to respond to overdoses and their effects. The community-based foundation of deflection helps reframe the relationship between police and the communities they serve, focus resources on treatment/recovery, keep families/communities together, and, most importantly, keep people who need treatment out of the justice system. As deflection grows, it is gaining support across many areas and from policymakers, including its endorsement by the Office of National Drug Control Policy (ONDCP) and its inclusion in the national drug control policy.*
- *https://www.whitehouse.gov/ondcp/national-drug-control-strategy/
- https://namsdl.org/wp-content/uploads/Model-Deflection-to-Treatment-Act.pdf (2019)
- https://www.whitehouse.gov/ondcp/briefing-room/2022/03/03/white-house-announces-state-model-law-to-expand-programs-that-deflect-people-with-addiction-to-care/ (2022)
- https://legislativeanalysis.org/model-law-enforcement-and-other-first-responder-deflection-act/ (2022)
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