CESSA Statewide Advisory Committee Meeting Minutes 03/13/2023

Approved by Committee Members 04/10/2023

Community Emergency Services and Support Act (CESSA) Statewide Advisory Committee

Meeting Minutes - Monday, March 13, 2023 - 1:00 pm-3:00 pm via WebEx

This meeting was recorded. 

  • The March meeting was called to order by DHS Secretary Grace Hou at 1:08 p.m.
    • Members present via WebEx: Jim Kaitschuk, Richard Manthy, Shelley Dallas, David Albert, Curtis Harris, Cindy Barbera-Brelle, Christopher Huff, Drew Hansen, Brent Reynolds, Alice Cary, Ashley Thoele, Emily Miller, Blanca Campos, Pooja Nagpal (joined 1:17pm)
  • Lee Ann Reinert read the Open Meetings Act and reviewed meeting logistics.
  • Secretary Hou called for a motion to approve the February 6, 2023, minutes. A motion was made to approve the minutes by Member Brent Reynolds and seconded by Member Blanca Compos.

Q: (Chris Huff) - What does S & P mean?

A: (Cindy Barbara-Brelle) - Standards and Protocols

  • State Updates (Lee Ann R):
    • 988
      1. February's report was received from Vibrant. Illinois' 988 vendors are up to 80% response rate. Illinois is making adjustments with its routing of calls. These are positive changes. Illinois is also working with SAMHSA on workforce challenges.
      2. SAMHSA has started to focus on abandonment rates - the number of callers to 988 who hang up without talking with a 988-crisis counselor. When a person calls 988, they are placed in a queue. The national level of abandonments is a concern. SAMHSA has been in conversation with Vibrant about ways to make the system more tangible. One approach is to identify counties, nationally, for transfer to a backup system. Illinois is a target for this pilot. Illinois is in discussion with SAMHSA and Vibrant to work in a manner that is least disruptive to both Illinois' 988 vendors and 590 providers based on a specific location. Illinois does not want to damage existing progress made in working with 988 transfers to Program 590. This is not something that Illinois requested, but rather a change that is being imposed on the state. This change is being shared in transparency. Illinois does not control Vibrant's routing.
      3. The Unified Platform is being piloted with two sites. There are some positive reports of experiences. SAMHSA and Vibrant have preferences to utilize the Unified Platform. SAMHSA and Vibrant have stated that all 988 LCCs that do text and chat will be required to use this platform.
    • Note: Erica Freeman has announced her resignation from SAC. She was nominated by Gift of Voice to serve on the SAC. Gift of Voice has indicated that they will nominate a replacement. This vacancy is also open to other advocacy organizations to submit a nomination. Send names to dhs.dmh.cessa@illinois.gov.
    • Public Comments:  One comment came in from three different sources - Letter dated February 5, 2023, was sent from a coalition of community organizations located in Central Illinois. Their ask was that before finalization, the Risk Level Matrix needed considerable changes. The concern is that there is still too much police involvement in responding to emergency calls from person's experiencing mental health or behavioral health crises, in violation of CESSA. The ask is for the Risk Matrix to be reworked. Alternative responders need to assume the lead on CESSA related calls.

Committee Discussion:

Comment: (Shelley Dallas) - in relationship to the letter, it is the intention to comply with the language of CESSA. However, this must be done in recognition of the resources available in the respective jurisdictions. When calls come into 911 there will be an emergency response.

Comment: (Blanca Compos) - Agrees with the letter, in the spirit of CESSA, but also acknowledges that the existing infrastructure does not have sufficient resources. However, there is an opportunity to look at the 3rd level and possibly make a switch between law enforcement and MCRT, whereas MCRT is the lead.

Comment: (Christopher Huff) - The issue of limited current resources is understood. The letter addresses future planning for resources to be in place assuring that the state does not sway away from the intent.

Response: (Lee Ann Reinert) - This is an "Interim Matrix". It was very intentional to call it 'Interim'. As resources are built, the Matrix will be adjusted. The Matrix is guidance for Regions to do their work.

Comment: (C. Huff) - The Matrix will complicate matters when CESSA goes into effect in four months.

Comment: (Brent Reynolds) - What seems to be lost is that the Interim Risk Level Matrix is for the 911/PSAP telecommunicators, because there is nothing currently in place. The Matrix is to help 911/PSAP understand how to handle and route calls. Folks, please take a breath. This feels like a rush because of an unrealistic timeline. Let us work through the process and not get too caught up that law enforcement is mentioned in the three top levels.

Comment: (C. Huff) - I feel that the Risk Level Matrix is not intentional enough. People do not know 988. People know 911. How will this be changed or adjusted overtime. This is unclear.

Response: (LAR) - When CESSA became law, 988 did not exist. Part of what has happened is a messaging campaign issue. 988 is to resolve calls with limited dispatch. The state is working on getting the word out about 988. 988's data is promising - help via phone vs help via dispatch of a MCRT. Right now, we are focused on the July 1 deadline, to continue to work forward and evaluate the system and its effectiveness while the state is developing its crisis continuum.

Comment: (BR) - That was stated well - we are moving fast and sometimes lost sight of realistic timelines.

Comment: (Grace Hou) - We are trying to honor the intent of the legislation, but not to prohibit where we want to go. As a statewide body, we can provide parameters, but hard conversations are regional. We must balance all factors in an imperfect situation.

Presentations - co-responder models:

  • Tiffany Patton-Burnside, Chicago Department of Public Health
    • Crisis Assistance Response & Engagement (CARE) Program
  • Dr. Amy Watson, University of Wisconsin/Milwaukee
    • Stockholm Sweden
    • Portland Street Response
    • Denver Support Team Assisted Response (STAR)
    • Chandler Arizona

Questions from the Committee:

Q: (Richard Manthy) - How does Chicago plan to incorporate 988 and 590 MCRT into the CARES model?

A: (Tiffany P-B) - CDPH has monthly meetings with some of the Program 590 grantees in the area. CARES also uses HRDI and BEW as alternate response agencies. CARES also works collaboratively with other 590 agencies.

Q: (C. Huff) - Is there a divergent process used by PSAPs/911 - how is it decided who responds, one of the CARES teams or EMS/law enforcement?

A: (Tiffany P-B) - There is no deterrent factor on what team is sent to respond or where. This is still in a pilot phase to determine what is the best model for the city or by area. There is no Risk Level Matrix for use by PSAP to determine the best model to respond to a caller.

Q: (C. Huff) - Has there been any situations when a CARES alternative model has responded to a crisis call, then the crisis escalated resulting in hospitalization? How do you help a person come to a decision of self-determination?

A: (Tiffany P-B) - It is a team decision about course of action if the acuity is great, thus requiring transportation. The use of the van has no restrictions and can freely move cross the city to transport.

Secretary Grace Hou announced Wrap Up - Next Meeting is April 10, 2023, at 1:00 p.m. - 3:00 p.m.

Q: (Chris H) - question for Dr. Watson - Do you have any knowledge on data? Any data on increases/decreases in involuntary admission?

A: (Dr. Watson) - I have not seen any information yet. This is something that can be tracked.

Q: (BR) - question for Tiffany - what reporting do you do? Is data collected using a tool that is a home-grown system or a pre-designed system.

A: (Tiffany P-B) - we use a department software.

Comment (BR) - we know there are different models. Instead of eliminating law enforcement, we should look at models that are co-responders.

Public Comments:

Zach G: I liked the presentations. I have several comments:

  1. Vibrant and 988 must focus on pinging calls the same way that 911 operates. I am demanding that this should be considered a priority.
  2. There are actions underway to repeal the CESSA prohibition on involuntary commitments. We do not want people in crisis to be worried about hospitalization. This must cease.
  3. I am not clear on the difference between Risk Matrix Levels 2 and 3. There must be clear articulation on what the differences are.
  4. The timeline for completion of this process under the umbrella of CESSA is not unrealistic. DMH had plenty of time. If DMH needs help, then ask for assistance.

Mark Schmitt: Thanks to presenters for sharing the models. However, I would like to see examples of models implemented in less populated areas.

Dana Craig: I am curious to know if you have had any crisis encounters with individuals who are deaf or hard of hearing? Is there a plan on how to serve this population should the need arise?

John Nowack: In EMS Region 4, there were 46,000 calls of which 18,000 have been behavioral health. The biggest concern is understanding funding. What is the funding source(s) for CARES?

Grace Hou adjourned the meeting at 2:47 p.m.