Crisis Assistance Helping Out On The Streets (CAHOOTS)

Crisis Assistance Helping Out On The Streets (CAHOOTS)
Name	Crisis Assistance Helping Out On The Streets
Abbreviation	CAHOOTS
Formation	1989
Founder	White Bird Clinic
Location	Eugene, Oregon, United States
Services	Mobile crisis intervention, mental health outreach, substance use support
Staff	Crisis workers, medics, peer counselors

Crisis Assistance Helping Out On The Streets (CAHOOTS) is a mobile crisis intervention program based in Eugene, Oregon, that provides mental health, substance use, and nonviolent conflict de‑escalation services. Originating as a community health initiative, the program operates teams composed of clinicians, medics, and peer counselors who respond to low‑acuity calls. CAHOOTS has been cited in discussions about alternatives to traditional law enforcement, drawing attention from municipal leaders, public health officials, and media outlets.

Overview

CAHOOTS functions as a dispatchable alternative to police response for behavioral health and social service needs, working alongside municipal emergency systems such as the City of Eugene, Oregon 911 network and regional dispatch centers. The model emphasizes harm reduction, trauma‑informed care, and peer support, borrowing practices from organizations like Planned Parenthood Federation of America and National Alliance on Mental Illness affiliates. Teams typically include a medic with qualifications comparable to standards from the National Registry of Emergency Medical Technicians and a crisis worker trained in approaches used by programs such as Homeless Outreach Team (HOT) and Street Medicine initiatives. CAHOOTS interfaces with institutions including Lane County, Oregon hospitals, the University of Oregon, and community clinics such as the White Bird Clinic.

History and Development

CAHOOTS was launched in 1989 by the White Bird Clinic amid a wave of community health reforms influenced by models from Harm Reduction Coalition advocates and the deinstitutionalization trends associated with the Community Mental Health Act. Early funding and sustainability drew on partnerships with local agencies like Lane County, Oregon health services and philanthropic organizations connected to the Robert Wood Johnson Foundation. During the 1990s and 2000s CAHOOTS expanded practices in parallel with projects such as Project ASSERT and outreach efforts by Shelter Partnership, Inc., while adapting protocols referenced in manuals from Substance Abuse and Mental Health Services Administration and workforce development frameworks from American Psychiatric Association guidance. High‑profile municipal conversations in the 2010s, including debates in the Portland, Oregon City Council, increased interest in replicating CAHOOTS in other jurisdictions such as Denver, New York City, and San Francisco.

Operations and Services

CAHOOTS teams operate mobile units that respond to low‑acuity calls including wellness checks, behavioral disturbances without weapons, substance use crises, and noncoercive transport to facilities like PeaceHealth Sacred Heart Medical Center and community shelters. Services include crisis stabilization, suicide prevention strategies aligned with American Foundation for Suicide Prevention recommendations, brief problem‑solving, and referrals to resources like Oregon Health & Science University outpatient programs and Lane County Behavioral Health. Operational protocols draw on training paradigms used by American Red Cross disaster mental health teams and peer support models promoted by Veterans Health Administration peer specialists. CAHOOTS collaborates with local institutions such as the Eugene Mission and St. Vincent de Paul (society) to address homelessness and coordinate with regional responders like Lane County Sheriff when safety risks require law enforcement backup.

Funding and Organization

Originally funded by the White Bird Clinic and local grants, CAHOOTS receives a mix of municipal contracts from the City of Eugene, Oregon, reimbursements through Medicaid programs administered by Oregon Health Authority, and private philanthropy from foundations similar to the Kaiser Permanente Community Benefit Program. Organizational structure includes a program director, clinical supervisors licensed under standards of the Oregon Board of Psychology and Oregon Health Authority, and frontline staff comprising licensed clinicians, emergency medical technicians credentialed per National Registry of Emergency Medical Technicians guidelines, and peer counselors with certifications aligned with Peer Support Specialists standards. Budgetary planning references models used by other nonprofit providers such as National Health Care for the Homeless Council and incorporates best practices from United Way funding collaborations.

Impact and Outcomes

CAHOOTS reports redirecting thousands of calls annually away from police response, with metrics tracked in partnership with agencies like the City of Eugene Police Department and Lane County Public Health. Evaluations have compared outcomes to crisis systems discussed in literature from Centers for Disease Control and Prevention and Substance Abuse and Mental Health Services Administration, noting reductions in police encounters for mental health crises and potential cost savings relative to Emergency Medical Services (United States). Case studies highlighting collaborations with hospitals such as PeaceHealth Sacred Heart Medical Center and academic analyses from faculty at the University of Oregon and public health researchers cite improved linkage to community services and decreased reliance on arrest or involuntary hospitalization. The model has inspired pilot programs and policy proposals in municipalities including Chicago, Minneapolis, and Seattle seeking alternatives to traditional policing.

Criticism and Controversies

Critics have raised concerns about scalability, sustainability, and scope of practice, citing incidents requiring law enforcement intervention and debates within bodies such as the Eugene City Council and county health boards. Questions about funding adequacy, liability, and coordination with agencies like Lane County Sheriff's Office and state criminal justice systems echo analyses from think tanks such as the Brookings Institution and policy briefs from the Urban Institute. Civil liberties advocates and mental health organizations including American Civil Liberties Union and National Alliance on Mental Illness have both lauded and critiqued aspects of the model, prompting discussions about replication in larger jurisdictions like Los Angeles, New York City, and Washington, D.C.. Scholarly critiques reference emergency response literature from the Johns Hopkins Bloomberg School of Public Health and legal analyses involving statutes administered by the Oregon Judicial Department.

Category:Mental health organizations in the United States