The police-based crisis intervention team (CIT) model: I. Effects on officers' knowledge, attitudes, and skills.

OBJECTIVE: Individuals with serious mental illnesses are very likely to interact with police officers. The crisis intervention team (CIT) model is being widely implemented by police departments across the United States to improve officers' responses. However, little research exists on officer-level outcomes. The authors compared officers with or without CIT training on six key constructs related to the CIT model: knowledge about mental illnesses, attitudes about serious mental illnesses and treatments, self-efficacy for deescalating crisis situations and making referrals to mental health services, stigmatizing attitudes, deescalation skills, and referral decisions. METHODS: The sample included 586 officers, 251 of whom had received the 40-hour CIT training (median of 22 months before the study), from six police departments in Georgia. In-depth, in-person assessments of officers' knowledge, attitudes, and skills were administered. Many measures were linked to two vignettes, in written and video formats, depicting typical police encounters with individuals with psychosis or with suicidality. RESULTS: CIT-trained officers had consistently better scores on knowledge, diverse attitudes about mental illnesses and their treatments, self-efficacy for interacting with someone with psychosis or suicidality, social distance stigma, deescalation skills, and referral decisions. Effect sizes for some measures, including deescalation skills and referral decisions pertaining to psychosis, were substantial (d=.71 and .57, respectively, p<.001). CONCLUSIONS: CIT training of police officers resulted in sizable and persisting improvements in diverse aspects of knowledge, attitudes, and skills. Research should now address potential outcomes at the system level and for individuals with whom officers interact.

The police-based crisis intervention team (CIT) model: II. Effects on level of force and resolution, referral, and arrest.

OBJECTIVE: The crisis intervention team (CIT) model is a widely implemented police-based program to improve officers' responses to individuals with behavioral disorders. The authors examined levels of force used by officers with or without CIT training and disposition decisions in a large sample of encounters with individuals whom they suspected of having a serious mental illness, a drug or an alcohol problem, or a developmental disability. METHODS: A total of 180 officers (91 with CIT training and 89 without) in six departments reported on 1,063 encounters, including level of force and disposition (resolution at the scene, referral or transport to services, or arrest). RESULTS: CIT training status was generally not predictive of level of force, although CIT-trained officers were significantly more likely to report verbal engagement or negotiation as the highest level of force used (odds ratio [OR]=2.00, p=.016). For CIT-trained officers, referral or transport was a more likely outcome (OR=1.70, p=.026) and arrest was less likely (OR=.47, p=.007) than for officers without CIT training; these findings were most pronounced when physical force was necessary. Analyses of disposition differences by officers' perceptions of subjects' primary problem (for example, mental illness only versus a drug or an alcohol problem) found some effects of CIT training status. CONCLUSIONS: CIT training appears to increase the likelihood of referral or transport to mental health services and decrease the likelihood of arrest during encounters with individuals thought to have a behavioral disorder. Research should address subject- and system-level outcomes that complement this early evidence of successful prebooking jail diversion.

Use of force preferences and perceived effectiveness of actions among Crisis Intervention Team (CIT) police officers and non-CIT officers in an escalating psychiatric crisis involving a subject with schizophrenia.

BACKGROUND: Few studies have examined police officers' use of force toward individuals with schizophrenia, despite the widely disseminated Crisis Intervention Team (CIT) model of partnership between mental health and law enforcement that seeks to reduce use of force and enhance safety of officers and individuals with mental illnesses. This study tested the hypotheses that CIT-trained officers would select a lower level of force, identify nonphysical actions as more effective, and perceive physical force as less effective in an escalating psychiatric crisis, compared with non-CIT-trained officers. METHODS: Police officers (n = 135)-48 CIT trained and 87 non-CIT trained-completed a survey containing 3 scenario-based vignettes depicting an escalating situation involving a subject with psychosis. Data were analyzed using repeated-measures analyses of variance. RESULTS: Officers escalated their preferred actions across the scenarios. A significant scenario by group interaction indicated that CIT-trained officers chose less escalation (ie, opting for less force at the third scenario) than non-CIT-trained officers. Officers reported decreasing perceived effectiveness of nonphysical action across the 3 scenarios. A significant scenario by group interaction indicated that CIT-trained officers reported a lesser decline in perceived effectiveness of nonphysical actions at the third scenario. CIT-trained officers consistently endorsed lower perceived effectiveness of physical force. CONCLUSIONS: Efforts are needed to reduce use of force toward individuals with psychotic disorders. These findings suggest that CIT may be an effective approach. In addition to clinical and programmatic implications, such findings demonstrate a role for clinicians, advocates, and schizophrenia researchers in promoting social justice through partnerships with diverse social sectors.

System- and Policy-Level Challenges to Full Implementation of the Crisis Intervention Team (CIT) Model.

The Crisis Intervention Team (CIT) model of collaboration between law enforcement and mental health is widely recognized as being "more than just training" for police officers; the core elements of CIT include a number of other components. However, several system- and policy-level obstacles can make successful implementation of CIT difficult in many communities. Three such challenges are addressed in this article: insufficient training and policies for dispatchers, poor availability of psychiatric emergency receiving facilities, and complexities related to implementation of CIT in rural settings. Collaboratively addressing these and other challenges will undoubtedly advance the goals of CIT.

Crisis intervention team training and special weapons and tactics callouts in an urban police department.

OBJECTIVE: This study tested a hypothesized inverse correlation between the number of crisis intervention team (CIT) officers and the number of Special Weapons and Tactics (SWAT) callouts in an urban police department. METHODS: Data for the number of accrued CIT-trained officers were combined with administrative data on the number of SWAT callouts during 27 four-month intervals. RESULTS: There were no significant correlations for the relationships examined, and implementation of CIT training was not associated with a decrease in SWAT callouts. CONCLUSIONS: Although the CIT model may yield important benefits in other domains, this study found no evidence of declining SWAT utilization as the number of CIT-trained officers accrued. The absence of association is likely due to the relatively low prevalence of SWAT use and the very different nature of CIT versus SWAT responses.

A statewide Crisis Intervention Team (CIT) initiative: evolution of the Georgia CIT program.

In late 2004, Georgia began implementation of a statewide Crisis Intervention Team (CIT) program to train a portion of its law enforcement officers to respond safely and effectively to individuals with mental illnesses who are in crisis. This overview provides a description of the evolution of the Georgia CIT, including discussions of the historical context in which the program developed; the program's vision, mission, and objectives; the importance of the multidisciplinary Georgia CIT Advisory Board; the training curriculum; the role played by state and local coordinators; the value of stakeholders' meetings; practical operations of the program; the importance of considering the adequacy of community-based and hospital-based psychiatric services; costs and funding; the program's expansion plan; and evaluation, research, and academic collaborations. These detailed descriptions of the Georgia CIT program may be useful for professionals involved in local, regional, or state CIT program planning and may provide a practical synopsis of one example of this collaborative model that is being rapidly disseminated across the U.S.

A comprehensive review of extant research on Crisis Intervention Team (CIT) programs.

The Memphis model of the Crisis Intervention Team (CIT) program has established itself as a prototype of law enforcement-mental health collaboration for a large number of municipalities across the country, and several states are implementing statewide training programs that seek to train approximately 20 percent of their police forces. Given the enthusiasm of advocates, law enforcement/public safety personnel, and mental health professionals for the CIT program, and in light of the increasing pace of implementation of this complex collaboration in a multitude of localities across the country, we seek in this review to provide a systematic summary of the very limited available research that has been conducted on CIT to date and to comment on future avenues for research.

Brief reports: crisis intervention team training: changes in knowledge, attitudes, and stigma related to schizophrenia.

OBJECTIVE: Crisis intervention team (CIT) training provides police officers with knowledge and skills to improve their responses to individuals with mental illnesses. This study determined changes in knowledge, attitudes, and social distance related to schizophrenia among police officers after CIT training. METHODS: A survey was administered to 159 officers immediately before and after a 40-hour CIT training program in Georgia. Pre- and posttest data were gathered from surveys taken between December 2004 and July 2005. RESULTS: After the training, officers reported improved attitudes regarding aggressiveness among individuals with schizophrenia, became more supportive of treatment programs for schizophrenia, evidenced greater knowledge about schizophrenia, and reported less social distance toward individuals with schizophrenia. CONCLUSIONS: This study supports the hypothesis that an educational program for law enforcement officers may reduce stigmatizing attitudes toward persons with schizophrenia.