CESSA - Region 3 Committee Meeting Approved Minutes 02/21/2023

Community Emergency Services and Support Act (CESSA) Region 3 Advisory Committee

Meeting Minutes -  February 21, 2023 - 8:30-10:30 via Teams

Meeting Minutes - Approved by Members 03/21/2023

Call to Order/Introductions

  • Diana Knaebe called the meeting to order at 8:32am.
  • Member Attendees: Matthew Johnston, MD, Diana Knaebe, Kristen Chiaro, Chad Dooley, Jessica Douglas, Brenda Hampton, Trenda Hedges, Daniel Hough, Olivia Mefford, Christopher Mueller, Devron Ohrn, Scott Pasichow, MD, Sara Rolando, Mark Schmitz, John Simon, Andrew Wade, Katrina Moseley
  • Public Attendees: Taylore Davis, Phil McCarty, Nathan Shotton, Gabriela Vo
  • Absences: Andrew Dennis, MD, Scott Hough, MD, Raymond Hughes, MD, Amy Toberman

Meeting Logistics/Open Meetings Act

  • Meetings are recorded. You may choose to turn off your camera.
  • Minutes will be posted at the Illinois Department of Human Services Division of Mental Health on the Open Meetings page.
  • Minutes will be posted after they have been approved at the following RAC meeting.
  • Please remain on mute during the meeting unless you want to have some discussion. If you would like to speak, please raise your hand to get the presenters attention.
  • Only appointed members may contribute to the discussion at any point during the meeting. Members of the public will be able to speak during the "Public Comment" session of the meeting.

Approval of Minutes from January 17th, 2022 Meeting

  • Motion to approve the minutes by Dan Hough.
  • Second by Mark Schmitz.
  • No corrections needed.
  • Motion carried. No opposed. No abstentions.

The Continuum of Law Enforcement/Behavioral Health Responses - Diana Knaebe

  • Looking at the continuum of police to community responses. The state is envision a continuum of responses based on the conditions and potential lethality of each crisis call.
  • CESSA does not prohibit Law Enforcement from participating in resolving certain situations and co-responder models and CIT training remain valuable assets in the continuum.
  • A diverse set of innovative law enforcement and behavioral health collaborative models are being tested and implemented across Illinois and nationwide. Range from the traditional law enforcement only response to those in law enforcement that have been trained in the crisis intervention team model.
  • Co-responder model is basically a mental health professional that is embedded in with law enforcement as an actual law enforcement employee or under a contractual or collaborative arrangement.
  • Springfield Police Department just received a Connect and Protect grant and are now rolling out the co-response model in the Springfield area.
  • Crisis Intervention Team (CIT) is a national model. It is a partnership with other first responder agencies, community providers, advocates, family members and persons with lived experience of serious mental illness. Considered to be a single point of entry to the emergency psychiatric care system. It is 40 hours of training for specialist officers.
    • Olivia Mefford - Law Enforcement Training and Advisory Commission) LETC requires officers to have a minimum of two years of service before they begin the 40 hour CIT training. Adopted a policy in September of 2018 that the course is to remain a special specialization and therefore remain distinct from other in-service courses available to officers immediately after certification. CIT training requires communication skills and situational assessments that can only be developed after an officer has field experience exposing him/her to the nature of interpersonal interactions within the public.
    • Dr Johnston - Do any of our municipalities have CIT teams 24/7?
    • Olivia - For Jacksonville, our entire agency was completely CIT certified until they implemented this 2 year requirement. Have had a lot of turnover, but as soon as the officer hits the 2 year mark, we are getting them in the training because we have seen a value in the training. We do usually pair the new officers with an FTO who is CIT trained.
  • There is strong evidence that CIT training improves officer knowledge, attitudes, self-efficacy and use of force preferences. There is good evidence that CIT training and program implementation increases linkages to care. The evidence related to the use of force and arrest in unclear at this point. There is indication that training of call takers/dispatchers and call coding is an important component of CIT.
  • Co-responder teams is the pairing of a clinician and an officer to provide response. The goal is to reduce arrests and increase safety; to reduce emergency department transportations and hospitalizations; to increase linkages to community care. Significant variation exists within the model such as a ride together, arrive together or telephone support; hot calls verses secondary response or follow-up; often not 24/7.
  • Evidence about co-responder teams it that there is two systematic reviews and some quasi experimental and descriptive research that suggests versions of the model are generally acceptable to stakeholders. That improves the collaboration between police and mental health. Some communities may reduce officer time on the scene and it may also reduce ED transportations but increase admission rate for those transported. The intention is if you are sending someone to the emergency room, the group believes that the person is probably a likely candidate or meets criteria for inpatient psychiatric admission. May reduce repeat calls for service and it may reduce immediate risk of arrest.
  • The Alternative Response model, which leverages Mental Health Response Teams, is the model that is reflected in the CESSA legislation, although other models are not prohibited. A key component of the federal SAMSHA Crisis Services Continuum is someone to call, someone to respond and somewhere to go.
  • The committees are charged with coordination of emergency responses of the 911 and the PSAPs with plans for 988 and the Mobile Crisis Response Teams (MCRT) are addressing that. Statewide we are looking at protocols and standards, training, communication, technology and data management. Then at the Region level, we are looking at how do we deal with that, how are we going to have processes to be able to do that and then also looking at how are we going to respond and what are the models that we have in our area?
  • MCRT are teams with clinicians that can be accessed or deployed without any law enforcement involvement. They offer triage screening assessment, deescalate, crisis resolution, peer support, coordination with behavioral health services for follow up and then also crisis planning and follow up. They may respond at the request of a crisis line or law enforcement. The community may also call directly. The team may request law enforcement assistance when safety issues are identified. They are not typically dispatched directly via the 911 system. If law enforcement arrives at the scene and determines that it is more of a behavioral health crisis, they call the Mobile Crisis Response Team and have them come out. There are 66 MCRT providers in Illinois and they are funded by the Division of Mental Health through Program 590.
  • There is limited research on MCRT. The first description in literature was in the 70s. The limited research suggests that Mobile Crisis Team (MCT) intervention may increase connections to services in the community. It is a fairly new piece for all individuals in Illinois. We have has SASS (Screens and Support Services) and outreach for youth in Illinois for many areas. MCT intervention may reduce pressure on the hospital and health care system by a reduction in emergency department visits and hospitalizations and then may provide cost savings by being able to deescalate and not sending individuals that may not need inpatient care to the emergency rooms. The findings are similar for youth MCT. Common findings show that the programs lack of 24/7 availability and long wait times.
  • There is variability across the community response models.
    • How to dispatch/access- 911, 988 and other crisis line, non-emergency line, 311.
    • Who responds - Police, EMS/Fire, Clinicians, Crisis Worker, Medic, Peers
    • Transport Options - Police Car, Ambulance, Van
    • Where is service housed? - Police Agency, Fire/EMS, Mental Health Agency

Understanding Local Resources for Alternative Response - Diana Knaebe

  • The state is going to be conducting a landscape analysis of new or existing law enforcement using local law enforcement, and then looking at behavioral health crisis responses.
  • The CESSA legislation calls for regions to develop plans to coordinate emergency responses among PSAPs, 911, 988, law enforcement, EMS and mobile crisis response. The intention is to provide options for response to mental health crisis incidents beyond a law enforcement only response. In order to provide an alternative response, PSAPs and other dispatchers in the crisis system must know where the alternative are, where they operate, and when they are available. To date, there is no standard or accessible data about alternative response in Illinois. That data needs to be collected and organized for access by system operators and providers.
  • What are the current examples in your area of programs where community mental health professionals and law enforcement agencies are working together to respond to mental health crisis incidents? Consider 3 types of responder models that we have discussed: CIT, Co-responders, and alternative response with MCRT. Are there any other models or way that police and community providers are responding together? Who in the region would know more about this subject? How can we get that information?
  • In the Springfield area, we have MCRT. Sometimes it is the MCRT that calls law enforcement and asks them to meet us on site. Other times, law enforcement will arrive first and then call MCRT. In some cases, 988 has received the call and then they reach out to the MCRT. It is the intention that 988 providers call when a MCRT is needed. They do have the listing and are able to call the MCRT that is in the area where the person is located.
  • Mark Schmitz - I am the Executive Director with Transitions of Western Illinois in Quincy. We have MCRT funded through DHS that covers Adams, Hancock and Pike counties. We have served those areas for 20 years. Prior to the 590 grant, we covered them for SASS. In November we added SASS only for Schuyler and Brown counties but are in conversation about expanding 590 to those counties.
  • Olivia - Morgan County Jacksonville Police Department has implemented LEARN (Law Enforcement and Resource Network) and MBH is part of that group. It is group that pools community resources on a monthly basis to where it you have an individual that was in crisis that still needs some services provided. It is addressed as a group discussion to determine what are all the components of this? Housing is a huge issue. We sit down as a group with the multiple community partners at the table and have that discussion and try to come up with a long term solution. We have had a lot of success. It does require consent from the individual.
    • Diana - Sangamon county also has a LEARN program.
  • Dan Hough - Montgomery County has a MCRT that is run through the Montgomery County Health Department. Through Local Emergency Planning Committee, we have formed a Community Risk Reduction Committee where we have identified our issues within our county and have tried to implement some conversations with the Sheriff's Office, the local law enforcement and Montgomery County Health Department.
  • Who are point people going to be? If you know someone that is not involved in our region meetings, that would be a good contact person, please share their information with the group.
    • Kristen Chiaro - Think that we should have local police departments as well as the sheriff's association.
    • Olivia - IACP (International Associations of Chiefs of Police)
    • Chris Muller - There is a Central Illinois Association of Law Enforcement Executives, a Sangamon County Association of Law Enforcement Executive.
  • The UIC Crisis Hub is developing a toolkit to help us and the PSAPs to do a quick survey of the different responses available in our region. Instructions for conducting this survey will include definitions and background material regarding the purpose of the survey. A standard methodology for identifying alternative response models currently in use and their availability within each region and worksheets to assist us in organizing the information collected so that it can be used by the PSAPs for dispatch decisions as well as by 988 lifeline centers. We will be looking at the material as it comes and we believe that it is coming fairly soon. We will be figuring out who in this region can be assistance in helping us to gather all this information.
    • Brenda Hampton - I believe that the due date is March 24th.

State Updates - Brenda Hampton

  • We are still working through the state Standards and Protocol Committee to finalize that document. There is a controversy around it, but we want to have it into a format where we can share it with the RAC Co-Chairs at their upcoming meetings.
  • Still working on the 6 month sprint to July.
    • Diana - For figuring out with DMH on the credentials of staff answering calls, do you know more about that?
    • The training department is just starting to kick off in March and that is a work in progress that they will have to go through. We want to make sure that the 988 call centers really have staff who have credentials to answer those phones and also 911. This is some of the training that will start to occur.
  • Andy Wade - NAMI IL is working to launch or re-launch NAMI in central IL communities and would love to have representation from this group, since building awareness and support communities for crisis response is part of what a NAMI affiliate would do. We have start up efforts underway in Quincy area, and will be visiting with folks in Sangamon and the Decatur area next month. If you'd like to be involved or hear more, please reach out to me or Taylor Davis at andywade@namiillinois.org or taylore@namiillinois.org.  Thanks in advance. We will help on public communications - please let us know how we can help. The purpose of a NAMI organization would definitely be to support building public awareness and understanding, specifically on how it works. I think we have gotten beyond the point of exists, so I would be interested in how we could be helpful on the public communications piece.
  • The DRAFT Risk Matrix will be coming out in March. It has not been approved yet. Once it has been shared, we will get that out to the group.

Next Meeting on March 21st, 2023 at 8:30am.

Public Comment

  • Dan Hough - Earlier in the month, I had an individual reach out to me and said that they attempted to contact 988 several times on January 30th between 6:15-6:45pm and no one answered the call. I was also told about a call where someone called and were told that they do not meet the criteria of 988 and that they would have to seek out other means. Both calls occurred in the Montgomery County area.
    • Mark - If the call has a different area code than that of Montgomery County, it is routed to that area code.
    • Brenda - I will bring this to the 988 group. We do recognize that this is a big problem and it is a national problem.
    • Mark - If something like that happens is DMH able to reach out to the Illinois Call Centers to identify which call center that might have gone to?
    • Brenda - Yes, that is why we ask for very specific information. So if we have the date, the time, if we have a name of the person who called, if we have a name of the person who answered the phone, if we can hone in on where this call is coming from, we do try to problem solve it and resolve it with 988. There are ongoing meetings with the 6 Illinois vendors weekly and then monthly learning collaborative. We have constant training.
    • Mark - Is this a common thing that DMH is getting reports about or is it that the call centers have capacity issues since the system is so new?
    • Brenda - This is not common. I do know that in January, the Vibrant internet was down for some time and so all the call centers nationally were impacted
    • Gabriela Vo - I am a Quality Assurance Supervisor for 988 Department from PAT Corporate and I would like to address the second incident. The crisis interventions councilor will handle any call, including emotional support. Other resources are only provided after the intervention has reached its conclusion. It is part of my job to review those interactions and address it with the crisis intervention counselor who was involved with the interaction. That is how our system addresses and remediate those situations if/or when they occur.
    • Diana - 988 system is anonymous, so the individual does not need to give their information. Depending on the circumstances, the crisis interventionist may ask if the individual is wanting resources and if they are willing to follow-up. In that case, they would be asked their information, but that is up to the individual that is calling.
  • Mark - If we are trying to troubleshoot a dropped call situation, would we reach out to PATH or DMH?
    • Brenda - You can reach out to anyone at the UIC Crisis Hub.

Dismissal

  • Motion to adjourn by Kristen Chiaro.
  • Second by Olivia Mefford.
  • Motion carried, adjourned at 9:46am.