CESSA Protocols and Standards Subcommittee Meeting February 2, 2023, 2:30 - 4:00 pm via Zoom
Meeting Minutes - Approved by Members 02/16/2023
Attendees: Cindy Barbera-Brelle, Blanca Campos, Alice Cary, Shelley Dallas, Lee Ann Reinert, Drew Hansen, Alicia Atkinson, Lorrie Jones
- The meeting was called to order by Cindy Barbera-Brelle at 2:32 PM.
- Roll Call and approval of minutes from January 19, 2023.
- There were 2 corrections to the minutes by Ms. Dallas:
- Correction to the spelling of Ms. Dallas' first name: Shelley as opposed to Shelly.
- Second correction to the following statement: Should read, "Where EMS is indicated, there must always be law enforcement to secure the scene in high risk situations".
- With corrections to the minutes, a motion was made and seconded to approve the minutes. Motion carried and minutes were approved.
- Discussion Draft Risk Matrix for Making Dispatch Decisions
Ms. Barbera-Brelle gave an overview regarding the committee's decision in a prior meeting to adopt a 3-level risk matrix. However during the last meeting there was a discussion with regard to revisiting this issue and considering the use of a 4-level risk matrix. The reasoning is that the behaviors described in levels 2 and 3 are so similar that without further distinction it would be difficult for dispatchers to determine what level of risk applies. A small working group led by Ms. Dallas and Ms. Atkinson agreed to develop a four level draft risk matrix for consideration by the committee. Ms. Barbera-Brelle asked Ms. Dallas and Ms. Atkinson to review the changes with the committee.
Ms. Dallas stated that each level of the matrix would be reviewed, and that there are not many changes to levels 1 and 4 because they are pretty clear cut. The bulk of changes relate to levels 2 and 3 and are related to availability of resources.
Ms. Atkinson agreed stating that the outcomes for Levels 1 and 4 are straight forward: Level 1 calls would be dispatched by 911 and Level 4 calls would be dispatched to 988 call centers with further dispatch to mental health/behavioral health centers.
It was further noted that this version of the matrix gives 911 dispatchers information regarding what they need to gather, assess and assign responders. The revised matrix permits 911 dispatchers to triage calls regardless of the availability of resources.
The same factors are used to make assessments in each of the four levels: threat to life, weapons, history of violence, level of intoxication, need for medical care, aggression, and psychosis.
It was also noted that during an assessment by 911, situational factors may impact the assessed risk.
Review of Levels of Risk
Level 4: Emergent Risk
Addresses the following issues: immediate threat to life, active weapon involvement, history of severe violence, high level of intoxication, high need for medical care, physical aggression or verbal aggression, psychosis with risk to self or others, and well-being checks.
Noted that psychotic symptoms are included, but psychotic symptoms are not necessarily dangerous. This will be a training issue for 911 call takers and dispatchers.
Dispatch Level: 911; Response Time: immediate; Dispatch Response: Law Enforcement (LE)/Emergency Medical Services (EMS).
Committee was asked for comments on Risk level 4: Emergent
No comments were offered.
Level 3: Urgent Risk
No immediate threat to life, no active involvement of weapons, situations where homicidal statements may be made with no action or plans, suicidal statements with no active attempt, escalating verbal aggression or implied.
Dispatch Level: 911; Response Time: Immediate. Dispatch Response, LE, LE/co-responder, LE and/or EMS with Mobile Crisis Response Team (MCRT)
Comment:
Curtis Hall: What about people who are suicidal, or in isolation:
Ms. Dallas: If suicidal statements with plans and access, or dangerous to others then this would fall under Level 4: Emergent
Moderate Risk Level 2
No threat to life, no weapons involved, no plans/means suicide, no aggression, and psychosis with intoxication. If psychosis alone could be bumped to level 1
Dispatch: 911/988; Response Time: LE/EMS - Immediate, MCRT: Up to 30 minutes. Dispatch Response: Recommending LE with co-responder or LE with MCRT.
Comments:
Dr. Jones asked the committee to attend to recommendations for MCRT response time and what is appropriate. For example, LE is used to providing an immediate response. MCRTs often require longer to get there. In moderate level, if MCRT is available and can respond in 30 minutes or less then this response would be recommended. If there are comments regarding appropriate response times the committee would like to hear them.
Blanca Campos: The ideal would be for LE to be available for backup if/as needed. Ideally the lead would be MCRT with LE available or nearby.
Dr. Jones: Agreed. If MCRT could get there quickly they could take the lead. If not LE would take the lead and keep the situation stable until MCRT arrived.
Ms. Dallas: In these instances, LE would be dispatched to ensure that situation doesn't escalate. Once MCRT gets there and if situation is still safe, LE could leave scene.
LRJ: This is all evolving. When localities figure out what they want to do, different models may emerge. In some areas like Chicago, behavioral health may be able to get to scene faster, but this may be different for other jurisdictions. Localities may develop different models. Each region will have to decide the best approach for their local area. It will be important to collect the appropriate data for monitoring and to determine the efficacy of the approach.
No other comments were offered.
Level 1: Low Risk
Ms. Atkinson: These are calls that could be transferred from 911 to 988 or MH team/counselor could be dispatched. A response time of up to 60 minutes is recommended.
Ms. Dallas: As people become familiar with 988, 911 won't receive a lot of these calls.
Ms. Dallas asked that the committee pay particular attention to the second bullet point on the following slide: "Proposed Risk Matrix Incident type, Response Type and Response Time"
Specifically, the risk matrix and recommendations should be viewed with the understanding that when answering a 911 call, triage/dispatch decisions are impacted by situational assessments. These assessments may lead to a change in the risk level that is determined.
Ms. Barbera-Brelle: The proposed matrix looks at all levels and breaks down typical or frequent risk areas that we come across on a daily basis. It provides further guidance to bring more to light what 911 call takers and dispatchers see day to day.
Comments or Concerns:
Chief Cary: When MCRT is dispatched for low-risk situations, if the situation escalates will LE be called?
Dr. Jones: Yes, it is anticipated that if MCRT feels they need backup of LE or EMS, they will call immediately.
Request for Action:
Ms. Barbera-Brelle posed the following question to the committee: Should the risk matrix be approved and presented to the Statewide Advisory Committee (SAC)?
Dr. Jones: We are asking for approval on all documents that you received. If approved, all information will be sent to the SAC for review and approval. If SAC approves, it would then go to the Regional Advisory Committees (RACs).
Ms. Dallas made a motion to approve the risk matrix and all materials and to move it to the SAC. Seconded by Ms. Campos. The motion passed. The risk matrix and related materials will be discussed with the SAC on Monday for input before being disseminated to the RACs.
Dr. Jones recognized Ms. Atkinson and Ms. Dallas and other workgroup members for their work on creating the 4-level matrix.
Public Comments:
Zach:
- No recordings of the Standards and Protocols committee are posted on the public website.
- The overwhelming majority of cases that don't fall into level 4 should result in alternative co-responses. Zach noted that the goal of CESSA is to separate public health from public safety.
- At every risk level, LE can be out of sight or around the corner with the exception of Level 4. Police are an escalation to situation. Alt responders need to decide if there is a threat to public safety and need for LE
- Alternative response needs to be connected to 1st responder network independent of 988, so 911 knows they are going out to scene.
Amber Smock - Access Living:
Concerns re: risk matrix.
- Echoes a lot Zach's concerns re: LE and levels 1, 2 and 3.
- If a person requests that LE not respond, will that be honored? Hope that it is added to the protocol.
Blanca Campos: Moderate risk decisions are dependent on if co-responder teams are available at a particular time. The point is that MCRT or co-responders would be 1st responders with LE as needed.
Zach: If someone calls for a co-responder that should be honored and added to level 1. If LE is out of sight or around corner, that is still an appropriate response.
Shelley Dallas: When someone calls 911, they are contacting a public safety access point. When they call, they are requesting help and this must be addressed. Resource availability is important. 988 will be helpful and MCRT or co-responders will be used as much as possible, but if not available a rapid response is needed.
Alicia Atkinson: It is the responsibility of 911 to gather, assess and assign responders. The right resources must be available for response as requested by the caller to 911.
No other comments were offered.
Ms. Barbera-Brelle called for a motion to adjourn the meeting. Ms. Dallas made the motion which was seconded by Ms. Campos.
The Meeting was adjourned at 3:20 PM
