A variety of multidisciplinary overdose prevention, response, and diversion and referral pathways, led by law enforcement and other first responders, have emerged in communities throughout the nation. These approaches are referred to as “pathways” because, in contrast to justice system interventions, programs in these pathways enable first responders to offer access, or pathways, to community-based treatment and resources to support individuals in need. These pathways often include first responders working in partnership with case managers, treatment providers, and peer recovery coaches to help individuals access treatment and recovery support services.

Resources

New: The Six Pathways: Frameworks for Implementing Deflection to Treatment, Services, and Recovery—This article describes the difference between “deflection” and “pre-arrest diversion,” explains the term “pathway,” provides descriptions of each pathway and explains how programs in each pathway work. This article provides a good introduction to the publications in the “Pathways to Deflection Case Study Series.” 

Pathways to Deflection Case Study Series

All of the publications in the Pathways to Deflection Case Study Series start with an overview of deflection and pre-arrest diversion, define the term, “pathway,” and describe the six pathways of deflection and pre-arrest diversion. Each publication then provides an in-depth examination of one of the pathways, including its origin story, how programs in that pathway work, and 10 critical elements for planning and implementing programs in that pathway. Finally, each publication features case studies from five sites that are implementing programs in that pathway.

• Pathways to First Responder Diversion Case Studies Series: Self-Referral
• Pathways to First Responder Deflection Case Studies Series: Active Outreach
• Pathways to First Responder Diversion Case Studies Series: Naloxone Plus
• Pathways to First Responder Deflection Case Studies Series: First Responder and Officer Referral
• Pathways to First Responder Diversion Case Studies Series: Officer Intervention

Coming soon!

• Pathways to First Responder Deflection Case Studies Series: Community Response

Articles and other resources

Free Online Training: The Deflection Conversation Framework: A Community Engagement Tool for First Responders - This self-directed, free online training course seeks to provide a comprehensive understanding of effective communication strategies for law enforcement and first responders working in deflection over the course of three interactive educational modules. These modules will examine the science of addiction, treatment, and recovery, and offer practical approaches for building strong community partnerships and effectively engaging individuals struggling with substance use disorders.

New—COSSUP Webinar:  Applying Evidence-based Practices to Obtain Officer Buy-in for Deflection and Pre-Arrest Diversion Initiatives: Police participation is essential for successful implementation of deflection and pre-arrest diversion programs. It can increase the number of referrals to services and enhance community-police engagement. This IACP webinar includes a discussion about the research behind barriers to officer buy-in and presents evidence-based strategies that can be used to obtain officer and agency support for police-led and community-led deflection programs. Representatives from deflection programs in St. Petersburg, Florida, and Montgomery County (Dayton), Ohio, will share highlights about how their programs obtained officer engagement through strategic staffing, policy, training, leadership support, and agency culture change. Participants will have an opportunity to engage with presenters, ask questions, and collectively discuss challenges and successes encountered in implementing practices to increase officer buy-in.

COSSAP Webinar: Critical Elements for Implementing Active Outreach Deflection Programs—The active outreach pathway is a proactive, collaborative, and multi-disciplinary approach being used by law enforcement and other first responder agencies to connect people with SUDs or co-occurring mental health conditions, or who are unsheltered, to community-based treatment and support services. This IACP webinar provides information about the benefits of implementing deflection programs, features leaders of active outreach programs in Story County, Iowa and Morris County, New Jersey, who describe their programs and discuss critical elements needed to plan, implement, and sustain active outreach programs. 

COSSAP Webinar: Critical Elements for Implementing First Responder and Officer Referral Deflection Programs—Every day, law enforcement officers and other first responders encounter individuals suffering from the effects of SUDs, mental health conditions, homelessness, and poverty. These encounters can include disruptive behavior, overdoses, illness, or criminal behavior. The First Responder and Officer Referral Pathway is a preventative approach that can provide alternatives to involvement in the justice system by linking people with unmet behavioral health needs or quality of life issues to treatment and services. In this IACP webinar, representatives from first responder and officer referral programs in Bernalillo County, New Mexico and Longmont, Colorado described their programs and discussed critical elements needed to plan, implement, and sustain first responder and officer referral programs.

COSSAP Webinar: Critical Elements for Implementing the Officer Intervention Pathway of Pre-Arrest Diversion—Of the five pathways of first responder deflection and diversion programs, Officer Intervention is the only pathway that is a true pre-arrest diversion program, in that it is offered in lieu of arrest and can only be implemented with the participation and support of law enforcement agencies. The goal of Officer Intervention programs is to connect eligible individuals to treatment and services to address the underlying reason for their alleged offense while still holding them accountable. In this IACP webinar, representatives from officer intervention programs in Blue Earth County, Minnesota, and Orange County, North Carolina, describe their programs and discuss critical elements needed to plan, implement, and sustain officer intervention programs.

Critical Elements of Successful First Responder Diversion Programs— The opioid crisis has generated an increase in calls for service by individuals with substance use and co-occurring disorders. In response, new law enforcement-led diversion and fire/emergency medical services-led initiatives are helping to reduce overdoses and overdose-related deaths by connecting individuals to community-based treatment and services.

COSSAP Webinar: Arlington County Public Safety Response to the Opioid Crisis—Arlington County (Virginia) leaders will provide an overview of their Operation Safe Station program, a multidisciplinary effort designed to reduce the dangerous impacts of opioids and other drugs in the community and promote treatment options. The prosecutor, police department, sheriff's office, and department of human services collaborated to develop a process by which individuals who seek help with their drug use can self-report and receive services without fear of prosecution and incarceration.

Program Documentation: First Responder Deflection Resource Library—This is a repository of foundational documents that were submitted by existing first responder deflection (FRD) programs from across the United States. These documents comprise some core elements of FRD programs, such as release of information forms, policies and procedures, program brochures, intake forms, and memoranda of understanding. The library also houses a growing collection of process and outcome evaluations of existing FRD programs. If you are interested in contributing documents from your pre-arrest diversion or deflection program, please contact [email protected].

Implementing Law Enforcement and First Responder Diversion Programs

Treatment Capacity: Divert to What?—Law enforcement and first responder diversion offers a connection to treatment and recovery for individuals with SUDs.  But before a referral system is implemented within a community, local availability and treatment options must be assessed to establish capacity.  Put another way, treatment capacity answers the question, “Divert to what?"

Building an Organizational Culture That Values Law Enforcement Diversion—Police leaders across the country have recognized the need to connect individuals with substance use disorders to treatment services through diversion programs. Critical to this effort is the necessity to build a culture within their own departments that embraces the mission and goals of front-end/pre-arrest diversion.

COSSAP Webinar: Building an Organizational Culture That Values Law Enforcement Diversion—The success of law enforcement and first responder-led diversion programs relies on the willingness of frontline officers, firefighters, and emergency medical service (EMS) technicians to participate in their implementation. This IACP webinar addresses how law enforcement leaders can successfully advance change within their agencies. Whether introducing new policies, procedures, or programs, it is important to build an organizational culture where change is readily accepted. The presenter discussed how challenges driven by organizational culture were overcome when the new Pre-Arrest Deflection Program was introduced at the Tucson, Arizona, Police Department, and provided steps for working within agency cultures to build support for front-end diversion.

Panel Session—2021 National COSSAP Forum: One Key to Program Success: How to Obtain Officer Buy-In for Your First Responder Diversion Program— How can the leaders of deflection programs secure the buy-in and participation of first responders—especially law enforcement officers who have the discretion to deflect or arrest? The presenters in this IACP workshop shared their experiences and perspectives on obtaining officer buy-in. A leader from the Tucson Police Department provided detailed steps and guidance on working with officers to obtain the support needed to implement Tucson’s Deflection Program, and a community-based clinician who partners with the Charlotte-Mecklenburg Police Department explained how officers can become more connected to the communities they serve, as well as the benefits to law enforcement and the community when frontline officers serve as liaisons between the justice system and community-based treatment and service providers. As reported in the newsletter, Catching up with COSSAP, “This session should be required viewing for any local stakeholder interested in responding effectively to substance use in their community.” 

New— COSSUP Webinar: Reducing Crime and Recidivism Through Sheriff-led Deflection: A Spotlight on Law Enforcement Assisted Diversion in Marion County, Oregon— Law Enforcement Assisted Diversion (LEAD) is a pre-arrest program aimed at redirecting individuals engaged in low-level criminal activities—often linked to substance use, mental health issues, or quality-of-life concerns—toward community-based services instead of arrest. What sets the Marion County Sheriff’s Officer (MCSO) program apart is its treatment-based model focusing on accountability to achieve behavioral change. With an immediate, street-based, case management services approach that prioritizes public safety and quality of life and focuses on treatment instead of incarceration, the MCSO targets the root of the problem instead of the symptoms.

New—COSSUP Webinar: Insights From the Front Line—Police-led Deflection Programs—Evidence from studies on police led-deflection indicates that police-led programs that deflect people with SUDs from the justice system can prevent criminal offending and show promise for improving participants’ health and reducing justice system costs. This IACP webinar featured presenters from Rice County, Minnesota and the New Jersey Transit Police Department, who explained the benefits of addressing substance use disorders (SUDs) through deflection to treatment and services, discussed the work of their initiatives, and share best practices for collaborating with community partners. These programs were featured in the January 2024 issue of Police Chief magazine, and the articles are available with the webinar.

New—Using Deflection as a Public Health and Public Safety Collaboration to Address Homelessness — Widespread homelessness poses significant challenges for communities across the nation. Deflection offers a way to address these challenges by connecting public safety and public health systems to create community-based methods of response.

COSSAP Webinar: Innovative EMS Response to Overdoses: Beyond Naloxone— Four panelists described how their EMS systems have piloted/implemented creative responses that go a step beyond reversing overdoses. While lifesaving interventions are critical, some EMS agencies have been able to implement additional measures to help break the cycle of addiction.

COSSAP Webinar: How Police and Other First Responders Can Create Recovery Pathways for People with Substance Use Disorders—This IACP webinar explains how many people begin to misuse both legal and illegal drugs including the impact of childhood trauma, the effects of substances on brain chemistry and how changes to brain chemistry can impact an individual’s behavior, and barriers to treatment for people with SUD. Presenters demonstrate how police officers, other first responders, and medical, behavioral health, and human services staff can contribute to, and more effectively support, long-term recovery and other positive outcomes for individual’s affected by opioids, stimulants, and other substances.

COSSAP Webinar: Engaging Your Community—First Responder Strategies—A representative from the Charlotte-Mecklenburg Police Department (CMPD) discussed programs CMPD created to educate young people in their community on how to make better decisions, provide life-changing experiences, and create positive interactions with law enforcement resulting in reductions in adolescent arrest rates and racial and ethnic disparities, as well as the "school-to-prison pipeline." In addition, a licensed clinical therapist specializing in substance use disorder (SUD) discussed how police officers can support people with SUD in their communities by serving as linkages to SUD treatment and support services, and describes the benefits of doing so to both the community and to the officers. Both panelists explained strategies for engaging the community and ways that treatment alternatives can be identified and utilized to create safer communities.

COSSAP Webinar: How EMS is Impacting the Lives of Overdose Patients in North Carolina - In this webinar, Dr. James Winslow, State Medical Director for North Carolina's Office of Emergency Medical Services (EMS), describes the EMS medication-assisted "bridge" programs developed in several counties in NC. These EMS agencies have developed community paramedic programs that immediately follow up with patients who have overdosed to encourage them to begin medication-assisted treatment (MAT) to keep them safe from overdosing before starting a treatment program. In addition, Dr. Winslow will discuss initiating MAT administration to patients with substance use disorders whom he sees in the emergency department. Interventions by EMS in NC that are discussed include: state opioid dashboard, increased naloxone access, leave behind naloxone, EMS based needle exchange, pop up testing sites for HIV/Hepatitis, and EMS Medication Assisted Bridge Programs. 

Collaboration, Treatment, and Recovery

COSSAP Webinar: Opioid Response Strategy: Public Health and Public Safety Partnerships to Prevent Opioid Overdose— The Overdose Response Strategy (ORS) is an unprecedented and unique collaboration between public health and public safety, created to help local communities reduce drug overdoses and save lives by sharing timely data, pertinent intelligence, and evidence-based and innovative strategies. Funded by the Office of National Drug Control Policy and the Centers for Disease Control, the mission of the ORS is to help communities reduce fatal and nonfatal drug overdoses by connecting public health and public safety agencies, sharing information, and supporting evidence-based interventions. This webinar highlighted how local jurisdictions can collaborate with their states' ORS drug intelligence officers and public health analysts to help communities and individuals make healthier, safer choices through evidence-based interventions and programs.

COSSAP Webinar: Closing the Gap: A Case Study on Collaborative Work Between First Responders and Recovery Support Services—First responders are facing increased burdens related to the rise of opioid-involved overdoses, contributing to stress and burnout. Frequently they are left with limited information about resources and time to connect people to care; however, this connection is often crucial for people who use drugs. Instructing first responders about “bridge programming” from first responder to treatment services, and their part within a larger collaboration, is a critical piece in the continuum of care. This webinar covers how to identify gaps in service accessibility for people with SUDs and provides information on strategies to implement collaborative responses between first responders and recovery agencies in the community.

COSSAP Webinar: Peer Support in Law Enforcement-Led Diversion Programs—To achieve positive outcomes, peer recovery support services (PRSS) are increasingly offered across diverse criminal justice settings, including within law enforcement-based programs, to address opioid and other substance misuse. A panelist from the Tucson Police Department will describe two police-led diversion programs and how they integrate peer specialists, identify changes to organizational practices and procedures necessary for the successful integration of peer work, discuss training for peer specialists and departmental staff to prepare for peer services, and describe the outcomes of Tucson's program.

COSSAP Webinar: A Path to Recovery—The Story of a Peer Support Specialist—A peer support specialist shared her experiences of addiction, the trials of an overdose, and how she ultimately found the path to recovery. Throughout the story, the webinar pauses to discuss the effects of addiction on the brain and demonstrate that substance use disorder is a disease rather than a choice. It also highlights how educating first responders and treatment providers about addiction and stigma can help people with SUD by reducing barriers to entering treatment and sustaining recovery. Finally, it discusses evidence-based programs shown to help build relationships between certified peer specialists and first responders.

Peer Support in First Responder-Led Diversion and Deflection Programs: Necessary Tools in the Fight Against COVID-19—During the COVID-19 pandemic, more than 40 states have reported increases in opioid-related deaths and ongoing concerns about individuals with mental illness or substance use disorder. Linking people who are struggling with an opioid use disorder with treatment has been particularly challenging. First responder-led diversion and deflection programs that incorporate peer supports into their work have found them to be an invaluable addition. Peer supports provide connection and hope during this challenging time, offering innovative approaches to saving lives.

First-Responder Trauma and the Opioid Crisis—The opioid crisis has placed increasing demands on first responders, compounding already high levels of job-related stress. To reduce its impact and prevent burnout, TASC’s Center for Health and Justice and Advocates for Human Potential, Inc. (AHP) interviewed personnel from first-responder agencies working on the front lines of the crisis. Among their findings: Compassion fatigue and a sense that their efforts are failing to make a difference are hampering first responders’ work, as is the stigma many attach to requesting help, all of which underscore the need for career-long self-care.

New: Trauma and the Opioid Crisis: Perceived Impacts on First Responders—This publication explores the mental and emotional impact of the opioid and other drug crises on first responders who address these issues daily, as well as tools and strategies to help support them. 

Considerations for First Responder Deflection in Rural Communities—First responder diversion (FRD) programs help connect individuals with SUDs and mental health concerns to treatment and services and provide pivotal opportunities to redirect them away from the justice system or emergency departments. This 2022 brief explores challenges to implementing FRD programs faced by rural jurisdictions and examples of innovative responses that have been developed by six rural sites around the nation.

Mobile Treatment of Opioid Use Disorder: Examples from the Field—This article profiles two mobile treatment initiatives and provides some general takeaways and suggestions for law enforcement and public safety professionals who are interested in collaborating with a mobile treatment program in their community.  

Data, Research, and Evaluation

Report of the National Survey to Assess First Responder Deflection Programs in Response to the Opioid Crisis—This report provides the results of the first national survey of first responder deflection (FRD) and pre-arrest diversion (PAD) programs in the United States. It represents the most comprehensive overview of the practice of deflection and its role in responding to the opioid crisis, as well as insights on how FRD and PAD offer alternative means to law enforcement and other first responders in how they address people with substance abuse disorder. 

Report of the National Survey to Assess First Responder Deflection Programs in Response to the Opioid Crisis (Infographic)—This infographic illustrates the key findings from the report of the national survey.

Data-Driven Responses to the Opioid Crisis (and Beyond)—Timely information sharing between law enforcement and public health agencies is one way to facilitate implementation of strategies to curb substance abuse.  Using analysis results obtained in drug seizures, DEA’s NFLIS-Drug program illustrates changes in indicators of drug patterns; provides information about the diversion of prescription drugs; and identifies emerging drugs of abuse.

COSSAP Webinar: Making Data-Driven Decisions to Enhance Your Diversion or Deflection Program—Data are critical to understanding the individual- and community-level impacts of pre-arrest diversion and deflection programs over time. This IACP webinar highlights how administrators of these programs can apply evaluation recommendations to adjust program implementation for improved outcomes. Click on the links for Information about the two programs that are discussed in this webinar: Hero Help in New Castle County, Delaware and Longmont, Colorado's diversion programs.

Stimulants: Recent Trends and Prevention Resources—The use of illicit stimulants and the misuse of prescription stimulants present a daunting public health challenge across the United States. This article presents recent trends in the misuse of stimulants, and information on selecting appropriate prevention strategies that focus on stimulant drugs.

Children and Families

Considerations for Deflection and First Responder Diversion Programs: Taking a Trauma-Informed Approach—Substance use disorder not only affects individuals but also their families and communities. The opioid crisis, particularly in its effect on children, presents an ongoing challenge that deflection programs have begun to address. For first responders, minimizing repeated trauma in children through a trauma-informed approach is critical. Deflection offers first responders a way to connect children with treatment and services to help interrupt the impacts of trauma and produce positive outcomes for children.

The Opioid Crisis: The Critical Role of Law Enforcement—Law enforcement agencies can play an important role in mitigating the effects of the nation’s opioid crisis on its youngest victims by leveraging deflection strategies to identify and protect drug-endangered children and to connect them to community-based treatment, which is critical to reducing their exposure to substance use at home.

Law Enforcement Collaborations to Support Children Affected by the Opioid Epidemic—The 2020 Comprehensive Opioid Abuse Program National Forum highlighted the importance of law enforcement collaboration across systems to support children exposed to adverse childhood experiences (ACEs). This report describes how programs leverage cross-system collaborations, discusses ACEs and their connection to substance misuse, and details initial considerations and helpful resources for communities interested in replicating successful programs.

COSSAP Webinar: The Youngest Victims of the Opioid Epidemic: Law Enforcement's Role in the Response—The opioid crisis and its effect on children present a range of challenges for individuals, their children, and their families. First responders, particularly law enforcement, are in a unique position to help identify and divert children to community-based treatment and other services, thus diverting them away from the consequences of exposure to drug use. Such steps can have significant effects in identifying and addressing the needs of children exposed to and endangered by the presence of illegal drugs in their lives and homes. Panelists in this webinar defined “drug endangered children” and associated risk factors and identified three ways law enforcement and community-based organizations can collaborate in their response to drug endangered children.

Juvenile Deflection: Meeting Youth Where They Are - Experts consider youth in America to be in the middle of a mental health crisis. But there is light at the end of the tunnel: law enforcement and juvenile justice systems have started to focus their attention and resources on the underlying factors impacting youth mental health, substance use, and co-occuring behavioral health disorders. This article is about the use of deflection programs as an upstream preventative or interventive approach to addressing issues related to addiction and mental health that preempt the need to wait for an overdose, crisis, or arrest.

The COSSUP TTA Program offers learning opportunities and assistance to support BJA COSSUP grantees and other local, tribal, and state stakeholders to build and sustain multidisciplinary collaborative responses to address illicit substance use and misuse.

Training and technical assistance is provided in a variety of formats, including virtual and in-person training events, workshop and meeting presentations, and online resources.

Law Enforcement/First Responder Diversion and Referral Mentoring Initiative

This initiative provides communities interested in starting diversion and/or referral programs the opportunity to learn from established or innovative programs that have shown success in meeting the treatment needs of individuals with substance use disorders, some of whom may have experienced an overdose.

The ten mentor sites listed below represent a diverse cross-section of model strategies and examples of successful collaborations between law enforcement and first responders, behavioral health providers, and other community partners to connect individuals with substance use disorders to treatment and resources. As host agencies, these mentor sites will offer their experience and expertise to visiting mentees.

Information on the mentor sites and an application to apply for mentoring are available here.

The scope of this effort is limited to programs that have been created to serve individuals with opioid use disorder and other substance use disorders that have substantial law enforcement, fire services, or EMS engagement. [Note: Diversion or referral programs operated by prosecutors or the courts are not within the scope of this effort. Likewise, programs with a primary focus on addressing homelessness, untreated mental health disorders, and/or public nuisance offenses are not within the scope of this effort.]

Mentor Sites

• Huntington QRT, West Virginia
• Colerain Township QRT, Ohio
• Seattle LEAD, Washington
• Pima County’s U-Matter, Arizona
• Philadelphia PAD, Pennsylvania
• Plymouth County Outreach, Massachusetts
• Lake County’s “A Way Out,” Illinois
• New Castle County's Hero Help, Delaware
• Newark's Community Street Team (NCST) Overdose Response Program, New Jersey
• Stanly County's Paramedic Division, North Carolina

Program Documentation 

First Responder Deflection Resource Library: This is a repository of foundational documents that were submitted by existing first responder deflection (FRD) programs from across the United States. These documents comprise some core elements of FRD programs, such as release of information forms, policies and procedures, program brochures, intake forms, and memoranda of understanding. The library also houses a growing collection of process and outcome evaluations of existing FRD programs. If you are interested in contributing documents from your pre-arrest diversion or deflection program, please contact [email protected].

Articles and other Resources

Opportunities for Peer-to-Peer Connections: Commonalities Among FY2019 Statewide COAP Grantees: One of the goals of COSSAP (and its predecessor, the Comprehensive Opioid Abuse Program (COAP)) is sharing information about effective strategies to combat substance abuse. While each grantee’s activities are tailored to specific circumstances, there are commonalities in approaches that grantees may wish to explore through peer-to-peer connections. This article provides a snapshot of activities being prioritized by 13 fiscal year 2019 statewide COAP grantees and suggestions for how grantees can connect with their peers.