Clear Pathways, an initiative of Peg’s Foundation—Ohio’s largest philanthropic mental health funder—has joined a three-state collaboration designed to develop transformational, sustainable approaches to community crisis response. The Behavioral Health Emergency Response Initiative (BHERi) brings together Ohio, Michigan, and Texas to improve how communities respond to the estimated 48 million annual 911 calls that involve someone experiencing a mental health or substance use crisis.
BHERi is 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 joins the Center for Behavioral Health and Justice at Wayne State University (Michigan) and Meadows Mental Health Policy Institute (Texas) as implementing partners, working to transform crisis response systems at local, state, and national levels.
The Challenge in Ohio
In recent years, Ohio has made important progress in building a comprehensive crisis response system. In conjunction with the launch of 988—the National Suicide and Crisis Lifeline—in 2022, communities across Ohio have expanded mobile crisis teams and other alternatives to traditional crisis response.
Yet significant gaps remain. When someone calls 911 during a behavioral health crisis, dispatchers often have limited ability to connect that person to 988 or mobile crisis services, even when those would be the most appropriate response. Meanwhile, mobile crisis teams—though effective at diverting people from emergency departments and jails—struggle with financial sustainability, relying heavily on time-limited funding rather than stable Medicaid reimbursement and other health insurance payers.
Clear Pathways is working to close these critical gaps by strengthening the connections between 911 and 988 systems and developing sustainable funding models for mobile crisis services.
Building on a Strong Foundation
Clear Pathways’ strong track record of system transformation and its active role in leading and scaling crisis response reform efforts across Ohio were key drivers in its selection as a BHERi implementing partner. Clear Pathways’ participation reflects the strength and sustainability of our existing work, while providing additional resources to expand our reach and accelerate progress alongside partners in Michigan and Texas.
Since its launch in 2020, Clear Pathways has worked with communities throughout Ohio to pilot innovations, build capacity, improve policies, and generate knowledge. This work has been done in close partnership with state agencies, including the Ohio Department of Behavioral Health (DBH), as well as community partners, including Alcohol, Drug, and Mental Health (ADAMH) Boards; Public Safety Answering Points (PSAPs); 988 call centers; behavioral health providers; law enforcement; and people with lived experience.
Clear Pathways brings critical assets to this national collaboration, including:
- Deep relationships across often-siloed systems, including PSAPs, behavioral health providers, and private health plans.
- Expertise in 911-988 interoperability, having developed evidence-informed strategies in partnership with Ohio communities since 2022.
- Experience convening diverse stakeholders to solve complex, cross-system challenges.
- Strong state partnerships that enable local innovation to inform state-level policy change.
Stronger Together
The multi-state structure of BHERi creates unique opportunities for learning and acceleration that would not be possible working in isolation. Each state brings different strengths and is tackling different aspects of the same fundamental challenge. By working together, the three implementing partners can learn from each other’s successes, troubleshoot common challenges, and avoid duplication. NYU’s SCALE + Lab facilitates this collaboration, creating opportunities for Clear Pathways and its partner organizations to coordinate efforts, share insights, and leverage their distinct strengths.
This collaborative approach ensures that innovations developed in Ohio can inform work in Michigan and Texas, and vice versa, accelerating progress across all three states and building a roadmap for national impact.
“This work requires extensive coordination among first responders, behavioral health providers, state agencies, and the complex web of organizations that fund and regulate these systems,” said Alicia D. Smith, Executive Director of Clear Pathways and Vice President of Policy at Peg’s Foundation. “Clear Pathways serves as a crucial convener, bringing these partners together to solve challenges that no single agency or organization can address alone.”
Our Focus: 911-988 Interoperability and Sustainable Funding
Through BHERi, Clear Pathways will deepen and expand its work on two critical elements of effective crisis response: 911-988 interoperability and sustainable funding for adult mobile crisis services.
Both workstreams build on Clear Pathways’ ongoing work and will involve intensive collaboration with communities across urban, suburban, and rural Ohio to demonstrate what success looks like locally, while also using data to inform policy improvements that facilitate statewide scaling.
911-988 Interoperability Strategy
Clear Pathways will build on its interoperability strategy, working with PSAPs and community partners to develop protocols that enable seamless coordination between 911 and 988. This includes:
- Building consensus among partners on goals and priorities
- Analyzing call data to identify which calls could be transferred or coordinated between systems
- Developing decision trees and call transfer protocols
- Creating standard operating procedures and interagency agreements
- Supporting implementation and continuous quality improvement
Sustainable Funding for Adult Mobile Crisis Services
Funding is the single greatest barrier to effectively implementing mobile crisis in Ohio. Most providers operate adult mobile crisis services at a financial loss, with Medicaid and commercial insurance reimbursements covering only a small fraction of expenses while ADAMH Boards provide the bulk of funding through time-limited funding (Clear Pathways, 2025).
Clear Pathways will partner with Medicaid managed care organizations, commercial health plans, mobile crisis providers, and other system partners to develop alternative payment models that support financial sustainability and improve service quality. This includes:
- Aligning mobile crisis services with Ohio’s practice standards to ensure consistent, high-quality delivery
- Developing value-based payment models that cover allowable provider expenses and reduce reliance on local Board funding
- Supporting providers to optimize staffing models and operational efficiency
- Creating standardized data collection and reporting to track outcomes and demonstrate value
- Testing and refining payment approaches through a multi-year demonstration with selected providers
- Building the evidence base to inform state policy and expand sustainable payment statewide
What to Expect in the Coming Months
In the coming months, Clear Pathways will be:
- Recruiting community partners to participate in cohorts focused on 911/988 interoperability and alternative payment model development.
- Launching intensive technical assistance with selected sites to implement evidence-informed strategies.
- Convening vested partners across systems to align efforts and share learning.
- Working with state partners to identify policy barriers and opportunities.
- Sharing progress and insights with the field.
Join Us in Transforming Crisis Response
Clear Pathways is committed to transparency and engagement throughout this work. Over the coming years, we will be sharing resources, lessons learned, and opportunities to engage with this initiative.
If you have questions about the BHERi Initiative or would like to learn more about Clear Pathways’ work, email us at clearpathways@pegsfoundation.org.
Stay Connected
- Follow us on LinkedIn for updates, resources, and opportunities
- Sign up for our email list to receive news and announcements
About Clear Pathways
Clear Pathways is an initiative of Peg’s Foundation, Ohio’s largest philanthropic mental health funder, designed to sustainably align systems to improve care for individuals experiencing a behavioral health emergency.
About the Behavioral Health Emergency Response Initiative (BHERi)
The Behavioral Health Emergency Response Initiative (BHERi) is a national effort working to improve responses to behavioral health-related 911 calls, concentrating initially on Ohio, Michigan, and Texas. BHERi aims to reduce unnecessary arrests and emergency department visits while connecting people in crisis to effective community-based care.
BHERi is coordinated by NYU’s SCALE + Lab and funded by Blue Meridian Partners, with additional support from Pew Charitable Trusts. More information can be found on the NYU website.
This partnership enhances Clear Pathways’ capacity to support more communities in strengthening local crisis response while contributing to national learning on effective, sustainable, and scalable crisis response systems.
References
- Clear Pathways. (2025, October). Clear Pathways Mobile Crisis Project: Phase I closeout session [presentation].
- Lindquist-Grantz, R., Porter, N., & Hancock, K. (2025). Advancing 911/988 interoperability: Findings from the Clear Pathways Crisis Response Pilot evaluation. Mathematica. https://www.clearpathwayscollaborative.org/wp-content/uploads/2025/12/Clear-Pathways-Crisis-Response-Pilot_Evaluation-Report_July-2025.pdf
- Ohio Department of Mental Health and Addiction Services. (2024). Mobile response and stabilization services (MRSS) annual report (SFY 2024) executive summary. https://dam.assets.ohio.gov/image/upload/mha.ohio.gov/GetHelpNow/MRSS/MRSS-Data.pdf
- Ohio Department of Mental Health and Addiction Services. (2025). 2025 annual report. https://dam.assets.ohio.gov/image/upload/mha.ohio.gov/AboutUs/MediaCenter/Annual-Reports/OhioMHAS-AnnualReport-2025.pdf
