Clear Pathways, an initiative of Peg’s Foundation—the largest philanthropic mental health funder in Ohio—has selected five Ohio sites to join in its 911-988 Interoperability Technical Assistance (TA) Project. The announcement marks a milestone in Clear Pathways’ efforts to operationalize warm transfers from 911 to 988 (the Suicide and Crisis Lifeline) across Ohio and the nation. By enabling warm call transfers, adults experiencing a behavioral health crisis can be connected to appropriate care in the least restrictive setting possible.
The cohort of five selected sites was identified through an application process and discussions that centered community interest and preparedness. The selected counties and cities represent a cross-section of Ohio, spanning rural and urban geographies, varying population sizes, and service contexts. The diversity of the selected sites allows Clear Pathways’ Interoperability Strategy to be tested and refined, furthering its applicability across communities. Clear Pathways plans to work with a total of 4 cohorts consisting of 20 diverse sites throughout this project.
Selected Sites
The five sites selected to participate in this cohort of the 911-988 Interoperability TA Project are the following:
- City of Cincinnati
- Delaware County
- Geauga County
- Hardin County
- Miami County
Building From a Proven Foundation
Since 2022, Clear Pathways has developed and continuously refined an Interoperability Strategy to facilitate warm transfers between 911 and 988. In 2023, the initiative launched a 12-month Crisis Response Pilot across five different Ohio sites. Each site was composed of a 911 public safety answering point (PSAP), a 988 call center, and a local Alcohol, Drug Addiction, and Mental Health Services (ADAMH) board. Using the SAFECOM Interoperability Continuum, Clear Pathways identified governance and standard operating procedures as the essential starting points for 911 and 988 coordination in Ohio.
Mathematica, Clear Pathways’ research and evaluation partner, conducted an independent evaluation of the pilot and found that sites made meaningful progress in strengthening 911-988 interoperability. Through Clear Pathways’ structured pilot process, sites were able to build trust among 911 and 988 partners, establish work groups, and develop the early frameworks to facilitate shared call-transfer procedures. The evaluation also highlighted clear lessons for strengthening 911-988 interoperability efforts, such as conducting call center site visits, engaging in peer learning opportunities, and sharing call data. These learnings have enhanced Clear Pathways’ approach to supporting the next phase of work with communities.
A Phased Approach to Enhance Interoperability
This next iteration of the project moves beyond the foundational governance and protocol-development work of the original pilot toward implementation support. Over the next 12 to 18 months, Clear Pathways will guide selected sites through a four-phase approach designed to formalize and operationalize interoperability procedures. With Clear Pathways’ support, sites will:
- Build consensus internally to form a cross-agency workgroup and a shared vision.
- Understand systems by learning about the call flows of each agency, conducting site visits, and analyzing call data.
- Develop protocols to facilitate call transfers.
- Plan, implement, and monitor the site-developed protocols.
“This next phase incorporates valuable lessons from our Crisis Response Pilot and Evaluation. Our structured, evidence-informed process gives communities the tools they need to start connecting 911 behavioral health crisis calls to 988 and other resources—and our next cohort is energized to get started,” says Cal Jenkins, MS, Assistant Director of Research and Systems Innovation at Clear Pathways.
Using Technical Assistance to Guide Implementation
Each selected site in this cohort is receiving 12 months of no-cost technical assistance from Clear Pathways, which includes the following:
- Expert guidance to apply Clear Pathways’ evidence-informed 911-988 Interoperability Strategy
- Facilitation and project management support
- Tools, templates, and resources for protocol development
- Subject-matter expert consultation and peer-to-peer learning opportunities with other participating sites
- Data analysis and continuous quality improvement support
- Implementation planning support
A National Network and Plans for Expansion
This cohort of communities represents Clear Pathways’ next phase in a multi-year plan to scale the Interoperability Project. Clear Pathways will engage 15 additional communities through 2027, with technical assistance and data collection continuing through 2028. As this work expands, Ohio’s experience continues to inform how 911-988 interoperability strategies are implemented and scaled in communities across the country.
The 911-988 Interoperability Technical Assistance Project is a component of the Behavioral Health Emergency Response Initiative (BHERi), a multi-state effort coordinated by NYU’s SCALE + Lab at The Marron Institute of Urban Management and funded by Blue Meridian Partners, with additional support from The Pew Charitable Trusts. Clear Pathways serves as Ohio’s implementing partner for BHERi, with other implementing partners in Michigan and Texas. This involvement gives Ohio communities the opportunity to learn from and contribute to a growing body of national evidence on effective crisis response, while bringing national expertise and resources back to the state.
Findings from the pilot and the current cohort work are adding to the national evidence base on 911-988 interoperability, offering insight into how other communities might achieve their own interoperability goals.
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About Clear Pathways
Clear Pathways is an initiative of Peg’s Foundation, the largest philanthropic mental health funder in Ohio, investing in scalable systems change efforts that improve behavioral health crisis response across Ohio and beyond. Clear Pathways assists local, state, and national partners with accelerating the implementation of best-practice crisis response to reduce reliance on jails and hospitals, ensuring adults experiencing a behavioral health crisis have a clear path to getting person-centered help. Learn more at https://clearpathwayscollaborative.org.
