CESSA Protocols and Standards Subcommittee Meeting - Approved Minutes 02/16/2023

CESSA Protocols and Standards Subcommittee Meeting February 16, 2023, 2:30 - 4:00 pm via Zoom

Meeting Minutes - Approved by Members 03/02/2023

This Meeting was Recorded

Cindy Barbera-Brelle called the meeting to order at 2:31 p.m.

Attendees: Chief Alice Carey, Blanca Campos, Brent Reynolds, Christopher Huff, Lee Ann Reinert, Drew Hansen, Richard Manthy, Shelly Dallas, Kathleen McNamara, Cindy Barbera-Brelle

A motion was made to approve minutes from the February 2, 2023. This motion was seconded.

Cindy B-B provided an overview of the Risk Matrix and Next Steps:

• Update on Risk Matrix and Next Steps
  • Risk Assessment Matrix and Mental Health/Behavioral Health Incident Code Mapping for Use by Public Safety Answering Points
    • This toolkit has been developed to assist regional advisory committees in reaching a consensus regarding the risk assessment matrix to be used in their region, and mapping mental health and behavioral health incident codes to risk assessment level and dispatch decision.

Dr. Mary Smith (UIC Crisis Hub) walked through the design of the Toolkit:

Goal 1:

• To provide opportunities for each Region to review the Risk Matrix developed by S & P.
• To determine the fit based on current resources within the Region.
• To determine, If necessary, modifications to the assessment matrix within risk stratification level may be recommended or adopted.
• To look at the different resources across the state - there may be a need to provide different responders based on what is available.

Goal 2: 

• To provide a standardize methodology for RACs to work with PSAPs, to map incident codes to the risk matrix in the respective jurisdictions.
• To update PSAPs protocols for assessing behavioral and mental health crisis related calls.

Goal 3:

* To provide a standardized methodology to be used by RACS to work with PSAPs within each region and map the risk level and incident codes to call dispatch decisions.

Note: There has to be a certain level of consistency across the state

• Next Steps: (Lorrie Jones)
  1. Finalized the above steps and obtain approval.
  2. Conduct meetings with the vendors to discuss Illinois Matrix.
  3. Present Toolkit and Matrix to RAC co-chairs at the March 1st meeting.
• Comments/Questions from committee members:

Q: (Blanca Campos) - Will RACs have options to amend the Matrix?

A: (Lorrie J.) - Of the 4 Levels, Levels 1 and 3 will remain intact with descriptors. Levels 2 and 3 have a range of possible responses based on resources in the respective RACS.

Q: (Chris H.) - How are RACs considering year 1 expectations vs year 5?

A: (Lorrie J.) - RAC (regions) will be encouraged to think about moving forward to advance opportunities, over time. UIC Crisis Hub will support this planning, if the regions do not currently have the resources. This can be part of the Toolkit - resource needs for future planning.

Q: (Chris H.) - Standardization - how will this be coordinated across regions?

A: (Lorrie J.) - RAC co-chairs have monthly meetings on best practices, to share and collaborate with each other.

Q: (Chris H.) - As there are differences across regions, how will the Toolkit account for these differences to get to the point of consistency?

A: (Mary S.) - I am not sure that we can ever say that it will be the same way across the state. We are not looking for 100% consistency across the regions.

A: (Lorrie J.) - There is only one other state (Virginia) that has a statewide mandate. Other system changes are county based or city based. Understandably, the regions across the state are different. There will be encouragement for regions to develop resources that they do not have and to do so using best practices. Most of the change models are from larger urban areas and not rural areas.

Comment: (Kathleen M.) - This is incredible work. One worry is that the meaning of CESSA is to minimize police as first responders. However, to be very transparent, in an emergency it means that police will be sent, as well.

A: (Lorrie J.) - When police do not need to be dispatched, that is the optimal. There can be guidelines that even in co-responder models, the clinicians take the lead. This can be highlighted even more. We want to be able to monitor approaches.

Comment: (Kathleen M.) - This will necessitate buy-in from law enforcement.

A: (Lorrie J.) - that is exactly what I am saying.

Q: Will the Toolkit provided to the RAC have information on the Program 590 agencies, PSAPs, and 988 LCCs?

A: (Lorrie J.) - Yes, maps were provided early on to all RAC co-chairs.

Q: (Chris H.) - Is DMH going to work to get resources for those regions that do not have resources? Am I the only one who remembers the conversation about the 5-year plan?

A: (Lorrie J.) - We agree that to grow system change it will take time. We continue to monitor the 590 programs; we want to build out the continuum; encourage other models to come from the planning of the regions.

Q: (Chris H.) - Launch is different from full implementation. Is DMH going to help regions develop more resources?

Comment: (Lee Ann Reinert.) - Something in this discussion is being conflated. SAMSHA believes that it will take 5 years to meet the full pillars of implementation. By the end of 2023, 90% of all calls to 988 are to be answered; by the end of 2025, 80% of individuals living in the state will have access to mobile crisis response services; and by 2027, 80% of the state will have access to crisis stabilization centers.

All states are doing an analysis of what resources they have available, and all states are starting at different points. These are the 5-year goals of SAMSHA.

Q: (Chris H.) -Thanks for the clarification. Is DMH going to assist to build out resources in regions where they do not exist?

A: (Lee Ann R.) - That is what the 590 dollars are doing. But it is not an even playing field across the state. This is going to take time. Not all regions are going to do so at the same pace, because they are starting at different places.

• Landscape Analysis: of local BH/LE/EMS models (Lorrie J.)
  • Purpose of the Toolkit
    1. To provide a standard methodology to conduct the survey.
    2. To organize the information so that within the region know what alternative resources exist.
  • Still flushing out the method.
  • Will pilot the Toolkit next week.
  • Finalize results by March 24th.
  • Information to go back to the RACs for local planning.
  • UIC crisis hub will develop a statewide inventory.

Q: (Chris H.) - How are the crisis centers factored in the planning processes for the regions?

A: (Lee Ann R.) - Are you talking about 988 LCCs (sometimes referred to as crisis centers) or are you talking about Crisis Stabilization Units (CSU)? CSU are part of SAMHSA's 3 pillars. Illinois does not have them, yet. We cannot plan for the future because they need to be built. There will be discussions to inform what currently exist. DMH does acknowledge what needs to be developed. There may be a need in the future, but funding cannot be discussed as it violates contractual rules/requirements under GOTA. SAMSHA knows that building CSUs are expensive and that will take time.

Q: (Chris H.) - This is confusing since it offers another piece to the puzzle. Why it is not being done?

A: (Lee Ann R.) - There is no way to create all that is needed for a robust crisis system within the time frame of CESSA (July 1).

Public Comment:

Zach G. - SAC should take on responsibility of advising RACs on possible funding opportunities to assist with expanding resources. Also, inform how private insurances, Medicaid and Medicare can cover costs.

Regarding police training, all officers in McLean County are CIT trained. The 40 hours of training is negligible - it assumes an overreliance on what these officers know and how to apply.

Matt F. - How will data collection be done and what kind of data is needed and can the Cook County Sheriff's office assist?

Cindy B-B adjourned the meeting at 3:32 p.m.