It includes step-by-step instructions for a community-led alternative emergency team that evidence suggests will improve care and reduce costs in the Downtown Eastside.
For years, advocates and community members have been raising awareness of alternative emergency responses that could improve care while lowering costs for traditional responders like police, firefighters, and paramedics.
With support from the UBC Learning Exchange and a number of Downtown Eastside organizations, a community-based working group has put together a toolkit that describes how a community-led alternative might look in Vancouver’s Downtown Eastside and includes a step-by-step guide to potentially implementing a pilot
Based on consultations with people living and working in the Downtown Eastside and evidence from promising programs in other cities, it suggests that a fourth level of emergency response could be a better way to handle many low-acuity emergencies.
The toolkit is called the “Implementation Report: Alternative Emergency Response (AER) Initiative.”
And they want people to steal it.
Nurses & community, together
The report suggests that for lower-acuity situations, a well-equipped, trained, and trauma-informed team of nurses and community members can respond more quickly and resolve situations more effectively, in many cases, than traditional responders. Such a team could also help with follow-up care, connecting people with the services they may need to resolve underlying issues and prevent repeat calls.
“The AER initiative is the result of years of organizing, research, and consultation led by people from the Downtown Eastside,” said Tara Taylor, the executive director of the SpencerCreo Foundation and a contributor to the report. The SpencerCreo Foundation is a Vancouver-based foundation that supports grassroots change, harm reduction, and inclusive employment.
“The approach centres those most impacted by systemic inequities—including Indigenous peoples, as well as people who use drugs, engage in sex work, or are unhoused—as experts, leaders, and responders, and addresses the urgent need for alternatives to police response.”
And it’s that community connection that is key, she said, because it translates into culturally sensitive responses.
‘Do all calls need cops?’
The AER report is based on community feedback that suggests traditional responders struggle with low-acuity situations by “over responding” and potentially escalating non-violent situations, or by “under responding,” which means longer wait times for these urgent but non-life-threatening situations.
“What we heard from the people we talked to was that not all calls need cops,” said Scott Maxwell, an alternative emergency response consultant, community-based researcher, and contributor to the report. “Or firefighters. Or ambulances. These are highly specialized and expensive services that are critical for certain situations. But many situations could be resolved by people who know the community context better, and who can also take a lead connecting people with the community services that might resolve the issue in the long term.”
The community feedback was collected through street surveys with 174 community members who reported diverse identities and experience with many of the issues people in the Downtown Eastside face.
In recent years, Vancouver Coastal Health (VCH) has independently been developing some of the directions highlighted in the report, including a mobile non-police de-escalation team with a focus on mental health issues.
“Ramping up non-police responses is a great start, as is focusing more on mental health,” said Tara. “But the community feedback and the evidence from successful programs in other cities tells us that it’s critical to have teams with community and cultural experience—it’s the blend of services that is key.
The AER report also notes that it is important to have two ways to contact an AER team—a direct line for people who fear triggering a police response through the 911 system, and the 911 system itself so that it is accessible to everyone in the community.
Promising results in other cities
The AER report cites a number of similar programs in other cities that are having success with this approach.
For example, a program in Portland reported one arrest in 7,238 calls traditionally responded to by the Portland Police Bureau, and an 11.5% reduction in arrests on calls they refer to as “welfare checks” and “unwanted person” calls. That program also reported only 2.5 per cent of clients were transported to hospital, which suggests similar relief for hospital and emergency rooms.
In Chicago, a similar program reported increased trust between community members and emergency services, particularly in marginalized communities. The Portland program reported high satisfaction rates between both clients (92 per cent) and staff (96 per cent).
Community training by community partners
A unique aspect of the AER toolkit is the training model.
Informed by conversations with local partner organizations, the report advocates for those existing organizations to provide training in areas where they have particular expertise, such as non-violent crisis intervention, gender-based violence prevention, de-escalation, overdose response, Indigenous cultural safety, anti-racism, and sanctuary principles for newcomers to Canada.
“The community-driven training programs can help teach the important lessons our partners have already learned as they’ve had to respond to and prepare for emergency scenarios in the Downtown Eastside,” said Kathleen Leahy, director of the UBC Learning Exchange and another contributor to the report.
‘We don’t want it to sit on a shelf’
Many community organizations in the Downtown Eastside provided feedback for the report, including Aboriginal Front Door Society, Overdoes Prevention Society, Sanctuary Health, PACE Society, and the Downtown Eastside Women’s Centre.
“This project demonstrates the power of action-oriented research when academic institutions genuinely partner with communities,” said Tara. “The project moves beyond theory to implementation, offering a real example of what respectful, accountable collaboration can look like when grounded in community priorities and leadership.”
Why ask people to steal it? Because, the contributors say, they don’t have the authority, capacity, or funding to make it happen given the different systems that need to align and work together to make it a reality.
“But there is so much useful information here,” said Caithlin Scarpelli, a senior non-profit consultant who also contributed to the report. “It is a full roadmap—from stakeholder engagement and governance to training frameworks and follow-up care—that can be adapted and implemented by other communities, as well. This isn’t just a report—it’s a practical, community-built toolkit designed to inspire replication and adaptation across jurisdictions facing similar challenges. We don’t want it to just sit on a shelf.”
“So, please, steal it!” added Scott. “We promise not to call the cops!”
The Implementation Report: Alternative Emergency Response (AER) Initiative was prepared by Changemark Research + Evaluation with funding from Social Planning and Research Council of B.C. (SPARC BC). It builds on Scott Maxwell’s research on community-based responses in the “Decriminalizing Poverty Research and Engagement Project (DPREP) which was supported by Central City Foundation. Caithlin Scarpelli, Tara Taylor, and Kathleen Leahy joined Maxwell’s efforts alongside key contributors from the University of British Columbia (UBC) Learning Exchange to move the research into action.