988 Standards Subcommittee Meeting Notes - June 16, 2021

Respectfully submitted by AJ French

1. Dr. Constance Williams opened the meeting with roll call, asking members to introduce themselves. She then solicited volunteers to take notes and co-facilitate the meeting.
   1. Member Roll Call:
      • Constance Williams - [DMH] Executive Director for Region 1 South & Region 1 North
      • Jessena Williams - DMH, Statewide Coordinator for Deaf, Hard of Hearing, Late-Deafened & DeafBlind Individuals
      • Kristine Hermon - absent
      • Kristen Kennedy - Healthcare & Family Services (HFS), Bureau of Behavioral Health
      • Kathy Carey - DuPage County Health Department, Assistant Director of Emergency Services
      • Patrick Dombrowski - C4 Community Counseling Centers of Chicago, Chief Clinical Officer
      • Megghun Redmon - Suicide Prevention Services, Business Manager
      • Kevin Richardson - Path Crisis Center, Call Center Program Manager
      • Sharonne Ward - Grand Prairie Services, President & CEO
      • Paul Phares - Robert Young Center
      • AJ French - Gift of Voice
      • Jim Poole - NAMI Chicago, Chief Integration Officer
      • Dimple Patel - AFSP Illinois, Board & co-Chair DEI Committee
      • Josh Evans - absent
      • Michelle Churchey-Mims - Community Behavioral Healthcare Association (CBHA) of Illinois, Vice-President of Child & Adolescent Policy & Practice
      • Jud Deloss - Illinois Association for Behavioral Health (IABH), CEO
      • Trenda Hedges - Beacon Health Options, Manager of Illinois Warm Line
   2. Notes: AJ French volunteered to take notes for this meeting, provided others would share responsibility and take notes in future meetings. Paul agreed to take notes for next meeting [06/30] and Jim volunteered for meeting after that [07/14].
   3. Facilitation: Sharonne Ward volunteered to co-facilitate discussion.
2. LeeAnn Reinert reviewed the Open Meetings Act reminders (slide 5) and explained that committee members are blind copied in email communication to avoid any committee member "replying all" to an email message and inadvertently violating the Open Meetings Act.
   1. Constance Williams reviewed the online resources available (slide 5).
3. Constance Williams reviewed the statewide charge (slide 6) and then turned facilitation over to Sharonne Ward. The following discussion ensued regarding standards.
4. ADEQUACY GAPS
   • Standard for when to pass off crisis call to crisis intervention team.
     • Huge gaps in what crisis intervention teams can provide from place to place.
   • Standards for how crisis teams respond. Develop expectations for the team.
     • Example: when to go to hospital verses mobile crisis services
   • Standard for recovery or strengths assessment included with risk assessment, provided the call is not assessed as lethal or in-progress.
     • Important that callers hear themselves in a context beyond their problems.
   • Discussion about barriers to people calling resulted in suggestion that this issue also be shared with Marketing Subcommittee.
     • Example: Am I going to be hospitalized if I call?
     • National data suggests 2% of calls result in police getting called
   • Standard for collecting demographic information needed from a statewide service array.
     • Important in better understanding gaps
     • Important to leverage existing systems.
   • Standard for how to incorporate callers with substance use disorders as we explore existing standards.
     • National Suicide Prevention Lifeline provides technical assistance and guidance around standards.
     • Lifeline Network Resource Center is a page that can be accessed by any network provider, with well-developed content about how to have good contact in call.
     • They have a separate training site called Submersion, with role plays.
   • Standard for "warm" transfers as an introduction from 988 line to Warm Line.
     • If the call escalates, we have no identifying information and the number which shows up is the crisis line which transferred the call.
     • Standard already exists, but two subcommittee members expressed they receive unattended transfer calls.
     • 70% of calls in Illinois are not being answered in Illinois.
   • Standard that there be equal opportunity for prosumer organizations to develop 988 call centers and become part of the crisis response system.
     • Diversity, Equity, Accessibility and Inclusion (DEAI) is not limited to racial justice.
     • Currently only 17 counties are covered, while 87 counties remain uncovered.
   • Standard regarding text and chat.
     • None of current call centers have these accessible features.
   • Standard regarding monitoring [recording] calls for supervision, training and coaching.
     • Lifeline highly recommends, but currently does not require monitoring.
     • Important because not being able to monitor calls doesn't provide comprehensive training.
     • One committee member believes national call center announces call will be recorded for quality assurance purposes.
     • One call center that doesn't record addresses quality assurance through annual training sessions, accreditation, confidentiality and code of conduct.
     • Another call center reports monitoring calls, having a process and following AASS (?) guidelines for accreditation.
   • Standard for dispatch regarding release of information when connecting people to post-crisis and ongoing services or providing warm handoffs.
     • Example was given of dispatching when there's no access to a community crisis center or crisis team and we've had to call 911. If there's no location for person, we have to call the police and sometimes get a subpoena so a cell phone company can release phone records to disclose caller location.
   • Standard for hiring percentage of staff member who have earned or are working toward Certified Recovery Support Specialist (CRSS) and Certified Recovery Peer Specialist (CPRS) credentials.
     • Clarification was requested regarding difference between prosumer agencies and CRSS/CPRS professionals. Prosumer agencies are entities operated entirely by persons in mental health recovery. CRSS and CPRS are credentials earned by people with lived mental health recovery experiences.
     • Research proves individuals with these kinds of lived experience credentials are better at engaging people in conversation. Research also proves that substance use and psychiatric hospitalization are both reduced when professionals with lived experience credentials are involved.
     • One crisis center estimated 50% of volunteer staff have themselves or a loved one who has been affected. That's why they want to do this work, but they are not credentialed.
     • From an administrative perspective, how do we go about that? A scenario was offered of someone who has just gone through a suicidal crisis and wants to go through training and help, but they're not at a place where this is helpful. Should we include this as a standard, be careful about how precisely.
     • Suggestion was made to have a separate orientation to CRSS credential. Interest was expressed and willingness to share with current volunteer base.
     • Suggested that other subcommittees might also find this helpful.
     • Warm Line is staffed 100% by employees who have CRSS or CPRS credentials - or are in the process of obtaining them - and staff is quite capable of handling calls.
     • Effective supervision is key.
     • To establish an environment conducive to hiring CRSS professionals, supervision and training need to be embedded in writing.
   • Standard/s for accessibility.
     • Do people have bandwidth, supplies and tools needed to access services?
     • What technology platforms are currently used by different centers?
     • Would there be a preferred or required system, database or call platform technology that everyone fielding calls would want to be using?
     • Technology needs to be a certain minimum coverage verses a certain carrier.
     • What costs are associated for another agency that may want to become 988?
     • Is this [minimum coverage, without one system] a barrier to why we currently have statewide coverage?
     • Accessibility standards go beyond technology.
   • How we provide services [method of technology]
   • How text and chat is being executed [delivery of service
5. LEGISLATION, RULES, POLICY NEEDED TO ACHIEVE THIS OBJECTIVE
   1. Tabled until we have identified standards.
      • Coverage changes due to state plan amendments or rules under JCAR?
6. COST PROJECTIONS TO ACHIEVE OBJECTIVES
   • Standard that state cover costs of call distributer, database and technology needed when adding call centers and increase capacity of current call centers.
   • Standard for technology
   • Standard for training
   • Standard for making sure we bring everyone up to same standard (once we have examined service gaps).
   • Standard about number of anticipated calls verses number of workers
   • Keep budget in mind while planning. Legislation and costs go hand in hand.
     • It's hard to project cost until we know some of the standards.
   • Tabled until we have identified standards.
7. DIVERSITY, EQUITY & INCLUSION
   • Standard for practicing diverse racial representation and inclusion on this sub-committee.
     • DEI was minimally addressed with planning committee, don't know conclusion.
     • Stigma and shame associated in some cultures Example: having anxiety when talking about lived experience as a Therapist.
     • Having people look like you is important, as well.
   • Standard for DEI training curriculum.
     • Education component about supportive vrs. shameful
   • Standard regarding data and statistics.
     • Making sure equity is across board in assessment process, that one particular group is not being deemed high risk more than other people groups.
   • Standard to be inclusive to providers across Illinois and to community groups that have not been involved before.
     • This is important because it drives people with lived experience into the field.
     • This is important because it drives organizations into this work and we're not excluding based on technicalities or things that may be barriers to inclusion
   • Standard about language barriers
     • Example about asking south-Asian individuals "Do you feel like things would be better off if you weren't here?" and eventually working up to the word "suicide."
     • Standards currently exist when asking "suicide" question, but not sure how specific it is to diversity, equity and racial inclusion.
   • Standard about addressing cultural aspects in assessment tools by asking questions which would consider the risk level of a person based on what's culturally appropriate.
     • Protective and risk factors vary from culture to culture
     • Events in some cultures may cause more shame. Example: Losing a job in a Hispanic Machismo culture where this is a harmful identify experience. Another example: A diagnosis is considered more shameful in some cultures than others.
     • NSPL centers have three standard questions (desire, intent, capability), but the rest of the call is conversational and a short-term duration intervention.
     • Standards should guide productive conversations. If standards become too stringent, it reduces our capacity to do the best work that we can.
     • One committee member shared they were recently interviewed on a podcast and shared the Warm Line number instead of the Lifeline number because the Warm Line is so intentional about cultural competence.
     • There seems to be a gap in this discussion about getting DEI training and practicing DEI. How are we continue to implement in our service delivery?
     • Everyone on this line is trying to support people in their moment of need and trying to figure out what's the best way we go about it.
     • It's not a scripted conversation, but there are principles to keep in mind while having the conversation.
8. OTHER SIGNIFICANT ISSUES
   • Standard for accreditation to become call center (which would come into cost projects).
     • National Suicide Prevention has a minimum requirement of certification or accreditation with specific agencies.
     • This is important because it helps keep policies and procedures up to date.
     • Accreditation helps meet minimum standards
     • Various accreditations exist. National Suicide Prevention Lifeline has nine different accrediting bodies which meet their standards.
     • IMPORTANT: The aforementioned standards were discussed, not determined. Further discussion is needed to determine which standards will be recommended.
9. Question: Is Lifeline seeking for each state to develop their own standards or is there an expectation that Centers will be going by Lifeline standards with State adding to those?
   1. Answer: We will be looking at Vibrant's Lifeline Clinical Standards, SAMHSA's National Guidelines for Behavioral Health Crisis Care and other resources. Confirmed that State's are being given some authority in influencing standards for existing centers and potential new centers interested in becoming an NSPL provider.
10. Question: Is there anything else we need access to in order to make informed decisions?
    1. Answers:
       • Vibrant has Lifeline Clinical Standards
       • SAMHSA's National Guidelines for Behavioral Health Crisis Care, Best Practice Toolkit
       • It would be helpful to see where 911 call centers are based and how they can possibly link into this system.
       • It would be nice to have a list of 911 centers with capability of tracking location, as many do not and cannot ping a cell phone to determine caller location.
       • Local law enforcement? EMS? Anything else?
11. Future Meetings: will be 1:00-2:30, every other week. Next meeting is June 30th at 1:00pm. Need co-facilitator. Sharonne will not be available on the 30th and has requested the group share the responsibility.
12. Agenda items to be brought to full coalition:
    1. CRSS, how individuals can obtain and how organizations can maintain workforce
    2. Prosumer organizations - AJ, would you want to do that? I would be honored.
13. Public comment:
    1. None expressed.