Received: 16 April 2017 Revised: 13 June 2017 Accepted: 16 June 2017

DOI: 10.1002/bsl.2304

SPECIAL ISSUE ARTICLE

The crisis intervention team (CIT) model: An

evidence‐based policing practice?
Amy C. Watson1 | Michael T. Compton2 | Jeffrey N. Draine3

1
Jane Addams College of Social Work,
University of Illinois at Chicago, Chicago, As academic researchers, we are often asked to opine on whether
Illinois, USA the Crisis Intervention Team model (CIT) is an evidence‐based prac-
2
Columbia University College of Physicians tice (EBP) or evidence‐based policing. Our answer is that it depends
and Surgeons, New York, New York, USA
on how you define evidence‐based practice and what outcome you
3
School of Social Work, College of Public
are interested in. In this commentary, we briefly describe the CIT
Health Temple University, Philadelphia,
Pennsylvania, USA model, examine definitions of evidence‐based practice and evi-
Correspondence dence‐based policing, and then summarize the existing research
Amy C. Watson, Ph.D., Professor, Jane on what is known about the effectiveness of CIT to date. We con-
Addams College of Social Work, University of clude that CIT can be designated an EBP for officer‐level cognitive
Illinois at Chicago, 1040 W Harrison Street,
and attitudinal outcomes, but more research is needed to determine
MC 309, Chicago, Illinois 60607, USA
Email: [email protected] if CIT can be designated an EBP for other outcomes. Using an evi-
dence‐based practice process approach, CIT may also be a justified
strategy for many communities. Future directions to inform the field
are discussed.

1 | I N T RO DU CT I O N

Many law enforcement agencies are adopting strategies to improve officers0 abilities to effectively respond to persons
with mental illnesses or those experiencing a mental health crisis—and for good reason. It is estimated that six to 10
percent of all police contacts with the public in the United States involve persons with serious mental illnesses
(Livingston, 2016), who are also significantly overrepresented in U.S. jails and prisons (Steadman, Robbins, Case,
Osher, & Samuels, 2009). Furthermore, recent Department of Justice pattern and practice investigations in cities
across the country have revealed all too frequent instances of excessive force by police against persons experiencing
a mental health crisis (United States Department of Justice, n.d.). While national data on police‐involved shootings are
not systematically tracked, recent reports by the Washington Post (Lowery et al., 2015) and the Treatment Advocacy
Center (Fuller, Lamb, Biasotti, & Snook, 2015) estimate that at least one in four people fatally shot by police in the
United States has a serious mental illness.
Recognizing these critical policing and public health challenges, the Bureau of Justice Assistance (BJA) has long
promoted both the need for law enforcement agencies to have a specialized police response (SPR) to individuals with
mental illnesses and the need for collaboration between police and mental health agencies (Reuland, Draper, &
Norton, 2012). The most recognized and widely disseminated SPR approach is the Crisis Intervention Team (CIT)
model, sometimes referred to as the Memphis Model by virtue of where it was initially developed. According to
the CIT Memphis website, there are more than 3,000 local and regional CIT programs, most in the United States (Uni-
versity of Memphis CIT Center, n.d.). Supporting the widespread adoption of CIT—though perhaps contrary to one of

Behav Sci Law. 2017;1–11. wileyonlinelibrary.com/journal/bsl Copyright © 2017 John Wiley & Sons, Ltd. 1
2 WATSON ET AL.

the CIT Core Elements that the training and specialization should be reserved for officers who volunteer and then go
through a selection process—the President0 s Task Force on 21st Century Policing (2015) recommended.

that Peace Officer and [sic] Standards Training (POST) boards include mandatory Crisis Intervention
Training (CIT) [sic], which equips officers to deal with individuals in crisis or living with mental disabilities,
as part of both basic recruit and in‐service officer training (p. 4).1

At its 2016 conference, the International Association of Chiefs of Police (IACP) launched its One Mind Campaign
(One Mind Campaign: Improving Police Response to Persons Affected by Mental Illness, n.d.), which asks agencies to
sign on and agree to adopt four strategies: providing CIT training to a minimum of 20% of sworn officers, establishing
partnerships with mental health agencies, implementing a model mental health crisis response policy, and training
100% of sworn officers in mental health first aid. Additionally, the Department of Justice Community Oriented Polic-
ing Services (COPS) office is soon to release a model curriculum for CIT training. Furthermore, the US Department of
Justice has recently required the implementation of CIT programs based on the Memphis Model as part of consent
decrees and settlement agreements in several cities, including Portland, OR, Cleveland, OH, and Seattle, WA, which
presumably indicates that CIT is viewed as an established gold‐standard model.
At the same time, groups advocating for resources from their state legislatures or local governments to implement
CIT programs are sometimes being asked to show that CIT is “evidence based.” These groups have often approached
us, as researchers, to opine on whether CIT meets criteria to be considered “an evidence‐based practice” or a form of
“evidence‐based policing.” As academic researchers, we have not had a clear and straightforward answer for them.
Our initial response is that it depends on at least two things: (1) What do you mean by “evidence based?” and (2)
Exactly which outcomes are being considered? This is further complicated by the fact that, while CIT is a collaborative
community program, research has generally focused on the training component and police outcomes, as rigorous
research tends to require a limited and controlled focus.
In this commentary, we first describe the elements of the CIT model, as “CIT” is sometimes used to refer to any
number of mental health trainings or programs for police officers. We then discuss what is meant by the term evidence
based in the medical, mental health, and policing fields before reviewing the evidence pertaining to specific compo-
nents of and outcomes relevant to CIT. We conclude with our analysis of the extent to which we can state with con-
fidence that CIT is evidence based, and discuss future directions for research along these lines.

2 | WHAT IS CIT?

The CIT model was developed in Memphis, TN, in the late 1980s following a tragedy in which a Memphis police offi-
cer shot and killed a man with schizophrenia who was wielding a knife and threatening to harm himself. In response to
public outcry, the mayor assembled a task force comprised of representatives from law enforcement, the mental
health system, advocacy organizations, and academic institutions. With the goals of increasing safety in mental health
crisis encounters, diverting individuals in crisis from arrest, and providing linkage to appropriate psychiatric care, the
task force created the CIT or Memphis Model (Compton, Broussard, et al., 2011).
CIT is a collaborative strategy with multiple components to improve police responses to persons with mental ill-
nesses or those experiencing a mental health crisis. The best‐known component of the model is the 40‐hour training
designed to provide select officers with the knowledge, attitudes, and skills to safely and effectively intervene with indi-
viduals in crisis and link them to psychiatric care. See Figure 1 for a standard CIT training‐week matrix. According to the
model, officers should volunteer and be screened for the training, as not all officers are equally suited for or interested in
responding to mental health crisis calls. Enough officers should complete the training to ensure that CIT officers are
available on every shift. Initial estimates were that approximately 20 percent of a patrol force should be CIT trained

1
Of note, the Report conflates “Crisis Intervention Training” and the Crisis Intervention Team model, and misrepresents a key compo-
nent of the model—that officers volunteer to complete the training and take on a specialist role.
WATSON ET AL. 3

FIGURE 1 National CIT curriculum (reprinted with permission from University of Memphis CIT Center)

in order to provide this round‐the‐clock availability. However, adequate coverage is context specific and could require
35 percent or more in urban areas with more mental health crisis calls, or even in rural areas with very small patrol forces.
However, as is stressed heavily by CIT International (a non‐profit membership organization whose primary purpose
is to facilitate understanding, development, and implementation of CIT programs), the CIT model is “more than just
training.” CIT includes significant emphasis on collaboration across agencies and with all community stakeholders to
ensure respectful, efficient, and effective crisis response. This includes coordination and partnerships across
first‐responder agencies, including emergency communications agencies that must identify mental health‐related calls
and dispatch CIT officers. Additionally, collaborations with psychiatric emergency receiving facilities (e.g., hospital
emergency departments, psychiatric emergency rooms, crisis triage centers) and other mental health and social
services agencies are essential so that CIT officers have allies, as well as places to take individuals in crisis (which, in some
cases, diverts them from the criminal justice system). Finally, collaborations with advocacy groups, families, and persons
living with mental illnesses in the community support better and often earlier interventions, and allow officers undergo-
ing CIT training to interact with appreciative families and individuals in recovery rather than in acute crisis (which is key
to increasing understanding and reducing stigma). Ongoing, operational, and sustaining elements of the model are
described in detail in Crisis Intervention Team Core Elements (Dupont, Cochran, & Pillsbury, 2007).
Across the more than 3,000 existing CIT programs, there is wide variation in the extent to which the Core Ele-
ments are being implemented. Some jurisdictions are calling any mental‐health‐related training CIT, others are only
4 WATSON ET AL.

implementing the 40‐hour training (perhaps in part due to barriers or challenging in implementing the full model;
Compton et al., 2010), while still others are fully implementing the model and adding enhancements (e.g., advanced
training, follow‐up linkage teams). Recently, there have been calls to make CIT training mandatory for all police offi-
cers, which represents a misunderstanding of the model. Certainly, all officers should have training in mental health
crisis response; however, according to the CIT model, the specialist CIT officer role has value and should be reserved
for those who self‐select into the role and complete the more advanced training of CIT.
Before reviewing the empirical evidence on CIT to determine if it indeed can be considered evidence based, we
discuss definitions of evidence‐based practice (EBP) from both the medical/mental health and policing fields.

3 | W H A T D O E V I D E N C E‐ B A S E D P R A CT I CE A N D EV I DE N C E‐ B A S E D
POLICING MEAN?

The term evidence‐based practice finds its roots in biomedicine. “Evidence‐based medicine” first appeared in the lit-
erature in 1991 (Guyatt, 1991) as an approach to making medical practice more scientific, as well as guiding clinical
treatment decisions through the use of the best available external clinical evidence from systematic research. This
approach requires an understanding of what constitutes “best evidence” and identifies randomized, controlled trials
(RCTs) and systematic reviews/meta‐analyses as the “gold standard” in the hierarchy of evidence over non‐experi-
mental research (Sur & Dahm, 2011).
The preference for EBP approaches has gained momentum and has now achieved prominence in fields outside of
biomedicine, such as social work, economics, education, and criminal justice. Here, we discuss EBP in mental health
and policing, as these are the fields that the CIT model straddles. Similar to biomedicine, the definition of EBP in men-
tal health originally reflected a process of clinical decision‐making that utilized a combination of clinical experience,
critically reviewed external research evidence, expert opinion, and client preferences to select intervention strategies
(McCabe, 2006). More recently, it has also been used to describe specific treatments—whether they be psychophar-
macological or psychosocial—that have acceptable empirical evidence for effectiveness (Surface, 2009). The Sub-
stance Abuse and Mental Health Services Administration maintains the National Registry of Evidence‐based
Programs and Practices (NREPP) for behavioral health disorders (Substance Abuse and Mental Health Services
Administration (SAMHSA), n.d.). To be included in NREPP, a program or practice must meet three criteria: (1) research
has examined behavioral health outcomes of the program or practice, (2) evidence of these outcomes has been
demonstrated in at least one study using an experimental (RCT) or strong quasi‐experimental design with pre‐ and
post‐tests and comparison or control groups, and (3) results of these studies have been published in a peer‐reviewed
journal or other professional publication, or documented in a comprehensive evaluation report. Here, as in biomedi-
cine, the RCT is the gold standard; systematic reviews in the absence of experimental or quasi‐experimental trials
are not considered sufficient. As of February 2017, there are 424 interventions registered in NREPP, spanning topics
from Adlerian Play Therapy for children in first through third grades to the Wellness Initiative for Senior Education for
older adults.
In writing about evidence‐based policing, Sherman (2015) points to the movement beginning with the first ran-
domized trial of police decision‐making launched in Liverpool, United Kingdom, in 1963. In 1998, he proposed merg-
ing the evidence from that and subsequent tests of police practice onto the model emerging in medicine to create
“totally evidenced policing” or evidence‐based policing (Sherman, 1998) which he defined as follows:

Evidence‐based policing is the use of the best available research on the outcomes of police work to
implement guidelines and evaluate agencies, units, and officers. Put more simply… It uses the best
evidence to shape the best practice (Sherman, 1998, pp. 3–4).

Lum, Telep, Koper, and Grieco (2012) added three distinctions to this definition, as summarized by Lum and
Koper (2015):
WATSON ET AL. 5

Evidence‐based policing is a decision‐making perspective, not a panacea.It is grounded in the idea that
policies and practices should be supported by research evidence and analytics, not blindly determined by
them.It suggests that research is not ignored and that it at least becomes a part of the conversation on
what to do about reducing crime, increasing legitimacy, or addressing internal problems (p. 5).

As in the mental health field, while evidence‐based policing (EBP) is described as a process of using the best avail-
able evidence to guide policy and practice, there are efforts to designate specific interventions as evidence based. For
example, Lum, Koper, and Telep (2011) at the George Mason University Center for Evidence‐based Crime Policy have
developed the Evidence‐based Policing Matrix, a research‐to‐practice translation tool that organizes experimental and
quasi‐experimental research on policing and crime reduction along three dimensions of crime prevention—the nature
of the target, the extent to which the strategy is proactive or reactive, and the specificity or generality of the strategy.
To be included in the matrix, research on the intervention must include either randomized, controlled experiments or
quasi‐experiments using matched comparison groups or multivariate controls and include crime or disorder as a mea-
sured outcome (Center for Evidence‐based Crime Policy, n.d.) Given that CIT outcomes are not generally conceptual-
ized as reductions in crime or disorder, regardless of one0 s assessment of the rigor of CIT research, it is not surprising
that CIT is not included in the matrix.
Across fields, the idea of EBP as a process of using the best available evidence to inform practice is generally
accepted. When considering EBP as a designation, the supremacy of the RCT (or, at minimum, rigorously designed
quasi‐experiments) is also generally accepted, though not without criticism. In a reflection on the implications of
the experimental turn in criminology, Sampson (2010) refutes the idea of RCTs as the “gold standard,” as well as
the idea that there should be a single “gold standard” at all. He argues that “criminological randomistas,” a term he uses
to describe criminologists who argue the only valid evidence is from randomized experiments, have oversold RCTs to
the extent that “evidence‐based” policy is now widely understood to mean “experimental based.” Further, he details
several myths that “randomistas” have fallen prey to (and convinced policy‐makers of), and suggests that both exper-
imental and observational studies have value for informing policy and practice, with the choice of method determined
by the question and phenomena under study rather than being based on a hierarchy of methods. Thus, it can be
argued that the question of whether CIT can be considered evidence based requires careful consideration and assess-
ment of all available evidence, as well as clear articulation of how we are defining “evidence based.” Additionally, the
question and outcome(s) of interest must be specified.
The current body of research on CIT includes both qualitative and quantitative studies of varied designs and rigor.
Qualitative studies provide rich description of the subjective experiences of officers and the operation of CIT pro-
grams, and are critical to our understanding of CIT. However, those most commonly asking the question “Is CIT evi-
dence based?” are generally more interested in numbers that can tell them if, and to what extent, CIT impacts
quantitatively measurable outcomes. While we are not aware of any RCTs of CIT, a number of studies do exist, having
examined CIT training outcomes using pre‐ and post‐training designs, some with comparison groups; outcomes of
mental health crisis calls handled by CIT‐trained officers compared with non‐CIT officers; call outcomes pre‐ and
post‐CIT implementation in a single jurisdiction; and cross‐sectional examinations of use of force in CIT calls.
Additionally, one systematic review (Taheri, 2016) examining the impact of CIT on arrests and officer safety has been
published. Data for the existing studies have come from surveys and interviews of officers, and researcher‐designed
data‐capture tools, as well as existing police and emergency communications databases.

4 | W H A T E V I D E N C E I S T H E RE T O D A T E ?

In this section, we summarize, though not intending to be exhaustive, available quantitative research on CIT. We
group outcomes as officer‐level cognitive and attitudinal outcomes (e.g., knowledge, self‐efficacy, attitudes, stigma),
officer‐level behavioral outcomes (skills and decision‐making, based on both self‐report and more objective measures),
subject‐level outcomes, agency‐level outcomes, and community/society‐level outcomes, and describe the methods
6 WATSON ET AL.

and evidence at each level. We then discuss how this evidence fits within the prevailing definitions of “evidence
based,” as well as implications for moving the field forward.

4.1 | Officer‐level cognitive and attitudinal outcomes

Pre‐training/post‐training surveys have demonstrated improvements in knowledge, attitudes, and stigma with regard
to schizophrenia (Compton, Esterberg, McGee, Kotwicki, & Oliva, 2006; Ellis, 2014); enhanced self‐efficacy and
reduced social distance stigma with regard to schizophrenia, depression, alcohol dependence, and cocaine depen-
dence (Bahora, Hanafi, Chien, & Compton, 2008); and psychiatry‐congruent beliefs about the causes of schizophrenia
(Demir, Broussard, Goulding, & Compton, 2009). The largest and most rigorous study to date (Compton et al., 2014a)
compared 251 CIT‐trained officers (at a median of 22 months post‐training) with 335 non‐CIT officers, in terms of
knowledge, diverse attitudes, and skills; many measures were linked to two vignettes, in written and video formats,
depicting typical police encounters with individuals with psychosis or suicidality. 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, and social distance stigma.

4.2 | Officer‐level behavioral outcomes

In terms of research based on officers0 self‐report, Compton, Demir Neubert, et al. (2011) demonstrated reductions in
use of force preferences and reductions in perceived effectiveness of physical force when comparing CIT‐trained and
non‐CIT officers in a vignette‐based study. The aforementioned large study comparing 251 CIT‐trained officers with
335 non‐CIT officers (Compton et al., 2014a) also found significant and substantial differences between the two
groups in terms of behavioral intentions (what they would do) and their endorsement of the effectiveness of de‐esca-
lation skills and referral decisions based on vignettes showing typical police encounters pertaining to psychosis and
suicidality (effect sizes d = .71 and .57, respectively, p < .001).
Other research has examined officers0 actual encounters. Compton et al. (2014b) collected officers0 reports (using
a researcher developed data capture tool) on 1,063 encounters with individuals suspected to have a mental illness
and/or substance use disorder, and found that CIT‐trained officers were significantly more likely to report verbal
engagement or negotiation as the highest level of “force” used (medium effect size, OR = 2.00, p = .016). Furthermore,
for CIT‐trained officers, referral or transport to mental health services was a more likely outcome (weak effect,
OR = 1.70, p = .026), and arrest less likely (medium effect OR = .47, p = .026), than for officers without CIT training;
these findings were most pronounced when physical force was necessary (strong effects, OR = 3.38, p < .01, and .28,
p < .01, respectively).
Using data from researcher‐administered surveys of Chicago police officers about mental‐health‐related calls
they had responded to in the prior month, Watson and colleagues (2010, 2011) found that CIT officers linked a
greater proportion (effect size d = .49) of individuals to psychiatric care (transport to a hospital or other referral)
and were less likely to provide no intervention than their non‐CIT peers (d = .25). There was no difference found in
arrests. Additionally, CIT officers used less force with more resistant individuals than their non‐CIT peers (Morabito,
Kerr, Watson, Draine, & Angell, 2012).
Several additional studies have examined officer‐level behavioral outcomes using dispatch or police call data.
Teller, Munetz, Gil, and Ritter (2006) analyzed police dispatch data for two years prior to and four years after CIT
implementation in Akron, OH. They found significant increases in identified mental health calls, transports to emer-
gency treatment, and the proportion of transports that were voluntary in the period following CIT implementation.
They did not find a difference in rates of arrest. In a study comparing arrest rates of persons with mental illnesses
in three jurisdictions with different mental health crisis response models, Steadman, Deane, Borum, and Morrissey
(2000) found the lowest arrest rate in the jurisdiction using the CIT model (Memphis, TN). The one published
WATSON ET AL. 7

meta‐analysis (Taheri, 2016) examining findings from seven CIT studies did not find an impact on arrests or officer
safety; however, that study did not examine linkage to mental health services or other outcomes.

4.3 | Subject‐level outcomes

Outcomes in this domain include reduced injuries, reduced criminal justice involvement, and improved mental health
treatment linkage and engagement, among others. While we are in the process of completing data collection on a
study of CIT and non‐CIT officer interactions, which examines the experiences of persons with mental illnesses
involved in police encounters and their outcomes over a 12‐month follow‐up period, there is currently very little infor-
mation available on subject‐level outcomes. The only study that we are aware of that sheds any light on this is the
SAMHSA Diversion study, a large quasi‐experimental, non‐equivalent comparison group study of eight criminal justice
diversion programs for persons with co‐occurring mental health and substance use disorders that included three
police‐based pre‐booking jail diversion programs, two of which were using the full Crisis Intervention Team model:
Portland, OR, and Memphis, TN (Broner, Lattimore, Cowell, & Schlenger, 2004). At these sites, pre‐booking diversion
simply involved the officer transporting the person to the hospital or linking him/her to services instead of arrest. The
study found that jail diversion by police increased the odds of receiving mental health services (counseling, medica-
tion, hospitalization) at three‐ and 12‐month follow‐up, compared with usual processing through the criminal justice
system. Additionally, diverted individuals at one of the CIT sites experienced reductions in mental health symptoms at
the three‐month follow‐up. Across all eight sites, diverted individuals had fewer jail days in the three‐month follow‐up
period, but exhibited no differences in overall criminal recidivism, except for increased odds of arrest at 12 months for
one of the CIT sites. It is important to note that not all linkages to care by police (including CIT officers) represent
diversions from jail. Clearly, additional research specific to CIT and subject‐level outcomes is needed.

4.4 | Agency‐level outcomes

Such outcomes span a range of concerns, including morale of personnel, overall agency efficiency and effectiveness,
community relations, resource allocations, and cost. There is limited evidence addressing a few of these outcomes. For
example, an early survey of departments implementing different models of mental health response found greater con-
fidence in their department0 s response among officers in departments implementing the CIT model (Borum, Williams
Deane, Steadman, & Morrissey, 1998). In terms of police resources and efficiency, Dupont and Cochran (2000)
reported reduced time per call following CIT implementation.

4.5 | Community/society‐level outcomes

At the very broadest level, potential outcomes of CIT might include overall costs (i.e., including mental health and
criminal justice costs), reduced incarceration of persons with mental illnesses, community safety and health, and com-
munity confidence in police and other service systems. Here, we have very little evidence other than a couple of stud-
ies that have estimated costs and savings related to CIT. An analysis of the CIT program in Louisville, KY, reported
modest savings (El‐Mallakh, Kiran, & El‐Mallakh, 2014), estimating that CIT saved $3,455,025 annually in deferred
hospital and jail costs, with net savings of $1,024,897 annually after accounting for program costs. The authors noted
that the study was not able to consider potential cost savings related to reductions in injuries due to lack of adequate
data on the prevalence of injuries among officers and subjects. In contrast, using data from the Memphis site of the
SAMHSA Diversion study, Cowell, Broner, and Dupont (2004) found that, while CIT‐associated jail diversion was
associated with improvements in mental health symptoms at three‐month follow‐up, it was also associated with
increased costs of $6,576 per person over the 12‐month follow‐up, as the increased hospital costs exceeded the
savings from reduced jail costs.
8 WATSON ET AL.

5 | D O E S T H E E V I D E N C E SU P P O R T C I T A S A N E B P ?

If we are asking whether or not CIT should receive a designation as an EBP (and what group or organization would give
such a designation remains debatable), at present, the answer to this question is, “Yes and no, depending on the
outcome of interest.” With regard to officer‐level cognitive and attitudinal outcomes (e.g., knowledge, self‐efficacy,
attitudes, stigma) and officer‐level behavioral outcomes (skills and decision‐making, based on both self‐report and
more objective measures), there is substantial evidence—not from randomized experimental research (RCTs) per se,
but from studies with comparable control (non‐CIT officer) groups—of positive effects, even after many months, if
not years, since training. With regard to these outcomes, we believe that CIT can be deemed “evidence based”; i.e.,
there is published, compelling evidence that CIT benefits officer‐level outcomes. Regarding subject‐level, agency‐
level, and community/society‐level outcomes, although research is underway and gradually accumulating, there is
not yet enough research to deem CIT “evidence based” with regard to these outcomes.
If, on the other hand, we are thinking more in terms of EBP as a process of using the best available evidence
combined with professional expertise/client preferences, many (but perhaps not all) communities would justified in
selecting the CIT model, tailored to some extent based on local needs, as the most evidence‐based approach to
collaboration between law enforcement and mental health in order to achieve shared outcomes.
Regardless of the definition of EBP that is used, there is a clear need for additional research on CIT to inform the
field. While improvements in officer knowledge, attitudes and self‐efficacy are important, they are important because
we believe they impact behavioral outcomes and subsequently, subject, agency‐ and community‐level outcomes.
Future research must continue to examine these outcomes with the most rigorous methods (appropriate to the
question) possible.
Several characteristics of the CIT model complicate this endeavor. CIT is an organizational and systems interven-
tion. Conducting an RCT on the full model would be very difficult, as the unit to be randomized would be organiza-
tions or communities. This would require cooperation of a sizable number or sites and significant resources to
conduct. Further complicating this approach is the lack of uniform collection of data on mental‐health‐related calls
across agencies (if the data is systematically collected at all), making comparison of outcomes difficult. Additionally,
the model is intended to be flexible so it can be tailored to local needs—thus there is great variation in implementation
of the model. Given the current lack of a fidelity measure for CIT implementation, it is difficult to tease out the effect
of CIT training versus implementation of the other elements of the model or compare findings across studies. The
development of such a measure, which includes some flexibility to allow for (and measure) local variation, will facilitate
future research on the model and increase confidence research findings.
We can also continue to test components of the CIT model using the most rigorous approaches feasible/available
to build our understanding of CIT0 s impact on specific outcomes and to answer questions that help agencies and com-
munities make decisions about how improve their system of response to individuals with mental illnesses. Such
research could include a variety of methods, from qualitative case studies to experimental studies that randomize vol-
unteer officers to CIT training or wait list control.

6 | C O N CL U S I O N

We are confident in our conclusion that CIT training can be designated an EBP for improving officer‐level cognitive
and attitudinal outcomes. More research is needed to determine if CIT can be designated an EBP for other outcomes.
However, considering CIT from an evidence‐based practice process perspective, we are also confident that many juris-
dictions would be justified in adopting the model based on the best available evidence. It should be noted that the
majority of existing research on the model originates from a handful of research groups (authors of this commentary
included) working in a limited number of jurisdictions. Moving forward, we encourage researchers to take this
endeavor across communities to address the many unanswered or only partially answered questions about the model.
WATSON ET AL. 9

Some relate to effectiveness for specific outcomes and will be best answered by experimental or quasi‐experimental
approaches. Other questions may be better answered by observational, non‐experimental or qualitative approaches.
Given the limitations of the data used to examine CIT to date, additional approaches to measuring CIT processes and
outcomes are needed. The development and use of a fidelity measure in future research will also help determine what
components and variations of CIT are related to specific outcomes.
As there is mounting pressure on law enforcement officials to improve mental health crisis response, many juris-
dictions are moving to a train all officers model. This is not consistent with the Memphis model, which maintains the
value of the self‐selected specialist CIT officer. However, we have no research to inform this discussion. Furthermore,
the CIT model was originally developed for a large urban setting. Research is needed to examine how to best to adapt
the model or smaller and rural settings. Likewise, there are other promising models emerging that have little or no
research to date. There is a need to rigorously test those approaches as well, so that the best available evidence pro-
vides good guidance to decision‐makers in varied community contexts. What we have learned from studying CIT so
far can inform strategies for studying these models. Thus, while they may seek a simple and definitive yes or no
answer about CIT, policy‐makers, funders, and agencies will need to consider all available evidence when making
decisions.

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Borum, R., Williams Deane, M., Steadman, H. J., & Morrissey, J. (1998). Police perspectives on responding to mentally ill peo-
ple in crisis: Perceptions of program effectiveness. Behavioral Sciences and the Law, 16(4), 393–405. https://doi.org/
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Broner, N., Lattimore, P. K., Cowell, A. J., & Schlenger, W. E. (2004). Effects of diversion on adults with co‐occurring mental
illness and substance use: Outcomes from a national multi‐site study. Behavioral Sciences and the Law, 22(4), 519–541.
https://doi.org/10.1002/bsl.605
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How to cite this article: Watson AC, Compton MT, Draine JN. The crisis intervention team (CIT) model: An
evidence‐based policing practice?. Behav Sci Law. 2017;1–11. https://doi.org/10.1002/bsl.2304