CESSA - Region 11 Committee Meeting Approved Minutes 02/20/2023

Community Emergency Services and Support Act (CESSA) Region 11 Advisory Committee

Meeting Minutes- 02/20/2023 - 1:00 PM

Meeting Minutes - Approved by Members 03/20/2023

Attendance: Dr. Rashad Saafir, Dr. Eddie Markul, Kelsey DiPirro, Michelle D'Onofrio, Cosette Ayele, Jennifer Tomke, Matthew Fishback, Nestor Flores, Matthew Tokarz, Samuel Jones,

Meeting began 1:03 pm

• Open Meetings Act. Meeting being recorded, may use your video camera if you like. Minutes will be posted on IDPH open meetings act. Meeting will be on mute, use "raise hand" feature.
• Roll Call - completed by Monique Delgado. Dr. Markul - present, Dr. Saafir - present, Cosette Ayele - present, Jennifer Tomke - present, Jonathan Zaentz - not present, Matthew Fishback - present, Joseph Schuler - not present, Antoinette Ursitti - present, Karah Kohler - not present, Nestor Flores - present, Peggy Flaherty - not present, Kelsey DiPirro - Present, Carla Orlandini - not present, Jeffrey Jamrok - not present, Mathew Tokarz - present. Samuel Jones - public representative.
• Approval of previous minutes - motion for approval. Approved by Matthew , second by Kelsey.
• Approval of charter - not everyone reviewed. Will send again for team to review prior to meeting 3.
• Will be discussing education or each agency roles, oversight, etc.
• IDPH - they look at health policy, promote health equity, prevent/protect against disease and injury. Prepare for health emergencies. There are 12 offices each with distinct area of public health. Dr. Markul: "I operate under office of preparedness and response/division of EMS & Highway Safety." Responsible for EMS Act.
• EMS ACT: state law that governs operations of EMS providers and put into law. Provides minimum standard for EMS services statewide, divides 11 EMS regions. Region 11 - smallest region with highest population (city of Chicago). The advantage of dividing the state into regions is to recognize diversity in each region and allows tailoring for particular communities. EMS act allows for customization. Each region has medical Director to oversee the system.
• EMS system - organization of hospitals, vehicle services providers and personnel. One hospital in each system (Resource hospital, implementing EMS Act and ensuring guidelines are followed). In Chicago, there is one 911 provider (OEMC).
• EMS ACT: Region's EMS Medical Directors Committee. Their roles are to develop protocol for how EMS providers treat people when they arrive, how people are sent to different hospitals and types of hospitals. IDPH EMS division need to approve committee protocol suggestions first.
• Recommend to department licensure and relicense for all EMS system, develop standing medical orders for all EMS personnel to follow, develop and approve EMS dispatch protocols, education & training up to par, etc.
• IDPH Mental Health - Behavioral Health Crisis Continuum designed to provide crisis services to anyone, anywhere and at any time. Consists primarily of 590 Crisis providers. IDPH division of mental health has funded Mobile Crisis Response Teams across the state. 14 providers in region 11. They will receive calls from 911 and have their own crisis lines as well. Operates 24/7. All providers required to have warm hand-off.
• MCR Program - community based, meet people where they are, service available regardless of insurance status, MCR team consists of 2 staff (trained clinician and lived experience). Coordinate with 911 & EMS as needed.
• 590 Crisis Response Teams staff requirements. The purpose is to provide crisis counseling and connect individuals to care, transportation, assist in creating a safety plan/follow up care.
• 988 - designed to be universal and convenient throughout United States. The system was created so counselors received trauma informed training and crisis counseling. Unlike 911, where there is immediate and rapid dispatch, 988 counselors provide a crisis intervention. The call typically takes about 20 + minutes with a response time taking a bit longer than a 911 response time.
• The calls are confidential, if the individual is experiencing a MH crisis, acute psychotic episode or major depressive episode, having suicidal ideation or substance use disorder counselors are trained to respond to those types of situations. Access is available through every landline, cell phone, voice over IP, services are available in Spanish along with interpretation services. Many providers are in the process of onboarding individuals to meet this need. 988 available through call, text, or chat. 988 call centers dispatch calls.
• 988 Someone to call - Region 11 is C4 (Community Counseling Centers of Chicago). Also, Statewide Lifeline Center - Bloomington covers all those parts of state currently not covered by regional centers. Region 11 has 14 providers concentrated on a small geographical area in Chicago. Huge gap in services on southside. Due to 590 funding, the agency had to be an existing community behavio9ral health provider which led to some areas of our region not being cover (ie, Englewood, greater grand crossing, etc). Regional map appears to have an overlap in zip codes. Undetermined if zip code and addresses of 590 providers on DHS website actually represent where those services are being provided. Need to continue work with mapping out.
• Antoinette Ursitti: Concentration of the 590 providers limited to one area and creating gaps in other areas. How many in Chicago are SAS providers.
• Dr. Saafir: interesting, I did not look at that specifically but looking at the list now I think there are 3 I can identify from the list I'm looking at now but I can look into that further.
• Nestor: 590 zones are the responders limited to the zone they have been given or are they allowed to go out of those boundaries? Also, who is dispatching the calls now? If a call comes into C4, does C4 directly contact the 590 providers.
• Dr. Saafir: Each 590 provider has a number of zip codes they are covering. Whether they can go beyond that is based on response time, we are trying to keep our response time as short as possible. If a call comes into C4, then C4 will contact the provider based upon the zip codes they are supposed to be serving.
• Cosette: When does the program 590 funding re-open? And who has the ability to change the application requirements so organization who currently don't have that designation can apply for grants so they can create them?
• Dr. Saafir: Great question, particularly given the gaps we are seeing. IDHS Mental Health Division is the entity who is able to change those rules, however, I don't know when the 590 applications will be available. I will take a look and get that information over to you.
• Cosette: Thank you. I think in order to bridge those gaps this committee should consider working on, maybe bring someone to have this conversation from IDHS. Can we put this on our agenda for one of our upcoming meetings to discuss.
• ISP - Emergency Telephone System Act to ensure emergency services are quick and efficient.
• "Public safety answering point" or "PSAP" - set of call-takers authorized by governing body and operate under common management that receive 911 calls and asynchronous event notifications for a defined geographic area and processes those calls and events according to a specified operational protocol. Illinois has 180 PSAPs but only 1 operates for Chicago (CFD).
• PSAPs - need to meet technical & operational standards, receive call from several sources, 911 authorities are responsible for ensuring PSAPs provide continuous 911 services 24/7, 365. They are required to meet National Emergency Standards. Medical service providers have to follow emergency dispatch protocols in accordance with the State's Emergency Medical Services.
• Police/fire/ems dispatchers have protocols to follow and develop a curriculum and certification program with accordance to the minimum guidelines of these organizations.
• Each PSAP work with their Resource Hospital/Medical Directors to get approval for protocols they use which provide a systematic approach to process calls. This ensures the dispatcher connects the caller to the appropriate response resource.
• EMD Protocols - PSAPS use standard software (Priority Dispatch, PowerPhone, APCO)
• OEMC - Police & Fire Call Flow. Matt Tokarz - call originates with 911 and goes to PSAP and will be answered by an available 911 call taker. 3 shifts per day, about 35 call takers per shift. Once the call is received the call taker establishes what type of event to create based on the information gained from the caller. The event is prioritized by CAD (computer aided dispatch system). The CAD system dispatches to the appropriate zone based on the address.
• Chicago has 2 EMS dispatchers, one on south and one on north side of city.
• When call takers suspect a CIT call (crisis intervention) using CAD they employ CIT triage. The CIT CAD triage consists of questions surrounding mental health information, weapons & current behaviors. Once completed the call is dispatched to the according zone. If 911 is needed the call is transferred to them for fire and ems services.
• Crisis Assistance Response & Engagement (CARE) - the program collaborating with the Mayor's office, CFD, CPD, CDPH, EMS Region 11 & OEMC to integrate mental health professionals into the 911 response system. The goal is to have the appropriate help available for individuals experiencing a behavioral health crisis. The CARE program includes 3 different multidisciplinary response models. More than one option is available to fit the variety of calls received.
  • Multidisciplinary Response Team (MDRT): CFD EMS Member, CDPH Crisis Clinician & Crisis Intervention Team (CIT) CPD Officer.
  • Alternate Response Model: CFD, EMS Member and CDPH clinician. Located in 7th & 8th districts. No police in this model.
• MDRT Dispatch Flow: Each call taker for police or fire must use this flow chart to ask questions and navigate the call. CARE teams operate M - F 10:30 - 4 pm (holidays and weekends off). In 6th & 19th district. Once police complete their triage and it's eligible for CARE team dispatch it is transferred to fire side and they complete a mental health triage.
• Alternate Response: Strict guidelines during call to determine level of safety. There is no CPD in this response model.
• With the new CARE program have you changed the risk matrix in OEMC? How do you go about screening calls since they cover narrow sections of the city?
• All the questions for fireside are governed and created by IDPH and are in the middle of training with a new protocol. It will allow for new questions to be asked and it will allow the team to respond to more requests for help. Since implemented in September 2021 we realized there are options for progressing and moving forward. We will have training in March and hope to have it rolled out very soon.
• Cosette: Who's delivering the training that will begin in March?
• Tokarz: Police and fire operations will both be delivering the training for the protocol.
• Cosette: I want to know more about how those trainings are being created. If they are under any kind of certification program?
• Tokarz: For fire training Dr. Markul will be assisting with the beginning of our training. We will be completing small training courses at a time and discussing the importance of the team, important questions and protocol we have to follow. For the police operations they have a specialized training division and will be training all their members at roll call.
• Cosette: My critique of that, folks are asking for certain types of calls to be answered by the CARE team and others community based organization under the 590. I think if those are the only two entities that are providing training internally to internally then we will have some bias in the guidance in regards to who is capable of answering what type of call. I'm wondering around the flexibility for there to be more diverse trainers in the assessment of the risk matrix and who is eligible to arrive and be dispatched.
• Tokarz: I understand that. I know CDPH clinicians are in the building as well and assist in the training as well.
• Cosette: Who can we talk to to dig more into that problem.
• Tokarz: Sure, it would be Carla Orlandini. She is the deputy director of 911 and should be on this email list.
• Cosette: The availability of the CARE team is not enough, they are only answering less than 1% of calls right now. How the PSAP dispatch process leverages the 590 programs so they can receive some of these calls to increase that percentage. Is that anything being thought of for PSAP dispatch process or are those organizations ineligible to receive any of those calls.
• Markul: some of the work we are doing in this committee is to determine what calls that come into the PSAP can be eligible for 590 dispatch right now there is no process in place. The hope is when we are finished with this work in July we will have a process in place to your point. We understand that the CARE team is limited and we'd love to be able to get the right resources to people with mental health needs.
• Cosette: Right now, the only program I know that provides training is college of DuPage. I'm wondering because there are some barriers to more people being trained as 911 telecommunicators. I'm wondering what other resources are available outside of that. When I spoke to OEMC about training for 911 telecommunicators the only location available was in DuPage. That contributes to the capacity gap in having 911 telecommunicators if the only program is out in DuPage.
• Tokarz:? City colleges of Chicago are hosting OEMC sponsored training in classes. There is one on March 9 that goes into specifics about CPD/CFD 911 operators with presentations by both sides. That information is available online. As for fire dispatchers they are all EMTs and EMDs licensed by the state of Illinois.
• I know you guys started embedding mental health clinicians, just wondering how your process works for that? Are they physically in OEMC or are they in a separate area? How was that set up?
• Tokarz: Before the pilot program, in the beginning we had clinicians at OEMC. We had them listen to 911 calls and sit with fire and police call takers so they can get a better understanding of the city and the types of calls coming in. Currently, the clinicians visit the 911 center to discuss calls to discuss opportunities with our call takers but physically they are in the vehicles with the fire department paramedic or CIT officer.
• Markul: State updates. Monique, did Lorrie join the meeting?
• Dr. Saafir: no, I have not received a response.
• Markul: We were expecting Dr. Jones on the call for this part.
• Dr. Saafir: Were somewhat behind the curve in meeting the deadline for all the recommendations due by the end of June. These are scheduled out so hopefully we will be on pace. We're trying to gather all the information not only from this regional advisory committee but from the other 10 advisory committees as well so the state advisory committee can approve and make the recommendations to IDPH. This slide is basically showing us where we are and where we should be with regard to meeting those deliverables.
• Markul: Hopefully Lorrie will be with us next month. They are supposed to be feeding us some information that the state advisory committee and the subgroups and the best practice is it should be coming down to us to consider.
• Kelsey: Senior Clinical Director C4 - the 988-call center for Chicago. Crisis continuum: C4 has programs in each of these 4 places on that crisis continuum. These are the zip codes we take call from 988. They are based on the caller's area code and prefix of their number rather than the caller's location. Dispatch protocols are to dispatch 590 or MCRT response teams. 95% of calls can be deescalated over the phone per the guidelines from SAMSA on how to operate national suicide prevention lifelines. In the last few months only 4 calls that we've taken required 911 dispatch. 3 of those calls were requested by the callers to facilitate a warm hand off to 911. 6 of those calls were dispatched to MCRT. At this point were taking between 150-300 calls per month.
• Crisis Clinicians. On each of our calls we have a varied staff LPHA, licensed professionals with degree in counseling, social work, family therapy and QMHP, master's degree in human service field. We also have MHP and RSA (people with lived experience). All are receiving the same level of training. Similar to 911, we are trying to obtain demographic and safety informati0on. Completing the calls in a dialectic way to have a conversation with the caller and gather this information throughout the call rather than gather all that information upfront. Sometimes we may not get demographic information on the call because the 988-call system is designed to be low barrier. If people don't want to disclose their legal name or address, we prioritize providing crisis intervention without that information.
• Emergent calls - have the highest risk. Present with suicidal ideation and intent. A very small portion of the calls have been received. These calls are considered high risk for lethality or community safety issues. These callers may have psychosis including paranoid delusions, active withdrawal from alcohol or benzodiazepines. We evaluate gross impairment in hygiene and medication management. We coordinate with 911 when necessary.
• Urgent calls - small portion of calls received. Present with SI/HI but have no intent. Their plans may not be feasible or no access to means. Maybe with withdrawal from SA. They can get escalated during the call. They often experience some complex emotional responses. In these calls we may dispatch a MCRT if the caller can't deescalate and safety plan effectively and if they are open to warm hand off to MCRT and willing to give access to their personal location. We will prioritize with internal or external service providers within C4 or the partners we have. Peer engagement specialist will follow up in 24 hours.
• Routine Calls: The vast majority of calls received. Individuals whose daily activities have been impacted. Decreased quality of life may be emotionally dysregulated. They may be distressed because of their decrease in quality of life. They are typically able to demonstrate insight with therapy, coaching and de-escalation techniques and are able to safety plan effectively. Internal and externals are provided and included in the safety planning process. 988 call takers follow up in 24 hours with consent of the caller.
• Two other types of calls: 1 warm line calls individuals that are missing a social connection in their life or have limited social support network these individuals will be handled off to appropriate resources. MH professionals call 988 and community members to see what 988 is about and what the process looks like. We screen calls for opioid use disorders so we can conduct a warm hand off with the Illinois helpline so they can be enrolled in services with opioid use.
• The duration of the call we complete a risk assessment using the SAFE-T with CSSRS tool an evidence based practice modality to assess for suicide risk and complete a safety plan with client. We also engage them with consent for follow up to review the CSSRS tool and connect to warm hand off in their geographic area. Will continue follow up as caller deems appropriate or interested in that service.
• Markul: Is this system you developed for taking calls developed by C4 or are you working in accordance with a national committee on standards.
• Kelsey: I can't say C4 specifically has had access to a national committee standards. All our process has been developed in concert with evidence-based practice through SAMSA and other crisis organizations and suicide hotlines in the country and we compiled them and insured they were relevant to the citizens of Chicago and specific cultural elements we see here that might be different. All our protocol is informed and approved through SAMSAs criteria.
• Markul: For emergency calls, a person who is suicidal with a plan and means to commit it, is that a definite 911 call and transferred over there or do you have time to transfer the call to a 590 provider.
• Kelsey: It depends on the caller and the way the engage with the crisis clinician and their preference is to have a mental health provider respond as opposed to 911 and they are able to continue engaging with the crisis clinician and MCRT in getting that need met then we will proceed with that attempt first. However, if the call escalates then we will change gears and call 911.
• Markul: You'll stay on the call until the resource arrives?
• Kelsey: We'll stay on the call until 911 arrives or until the MCRT is able to connect and provide an ETA.
• Cosette: I see most zip codes are above the Stevenson. Do you know how those were selected? Or if there is another call center for the zip codes below interstate 55?
• Kelsey: Great question. Those zip codes were self-selected by C4 when we pursed funding through the 401 grants. We have been a national suicide hotline provider since 2017 and it was a natural transition for us. We self-selected those zip codes based on office locations familiarity with community providers and also transparently with the amount of funding provided and the size of the team we could develop based on funding we were given access to. The funding was smaller than anticipated. There is not another call center that covers the zip codes for Chicago. Those calls would go immediately to PATH which is the statewide back up system.
• Cosette: How many call takers do you have currently? Do you think that is enough?
• Kelsey: We have 2 call takers on every shift. The shifts are 12 hours. Tuesday - Monday morning. No calls are taken from 8 am Monday - 8 am Tuesday. We were funded in a way to provide 2 call takers, a supervisor and a team lead. Supervisor during the day and TL at night. At this point, our call acceptance rate is 40 % primarily due to receiving calls at the same time. Those calls bounce out to other call centers. We initially proposed having 14 people and we have 7.
• Cosette: First through third party callers. Receiving calls from a hand off versus a person directly involved or a bystander/witness. What is the split with these calls?
• Kelsey: I don't have specific data now, I can give that to you at a later time. When I was looking at the data last month, our third-party callers were just around 25 - 30% of our call volume.
• Cosette: Do you know about the first party, the people directly involved?
• Kelsey: Were only measuring third party or first party. I'm not sure how many calls are first party involved.
• Cosette: You also follow SAMSAs direction on data collection. I'm wondering if that's something you all would like to look at. I'm assuming there are different trainings and ways to to talk to folks who have been receiving a warm hand versus the person who is on the phone receiving the intervention.
• Kelsey: The interventions can be different. It depends on how much coaching we can do. Keep in mind individuals have a right to consent to services. That becomes difficult with third party callers, when the third party caller is somebody in law enforcement or in a medical system versus a bystander on the street or a sibling or family member. I do have the data available by types of callers. DMH doesn't ask us to separate that information for third party callers.
• Cosette: For the training, who do you receive training from and how long does it take?
• Kelsey: The call takers are in training for about 60 days. While we engage in interagency training and access to other trainings like uic and path. The vast majority of our training comes from Vibrant which include specific training on third party, on veterans, on text and chat and include simulations.
• Dr. Saafir: You mentioned 40% of the calls received are actually answered and the rest are diverted to call centers. Do you have any way of knowing whether the calls that were rerouted were connected at all?
• Kelsey: I don't
• Dr. Saafir: So, it's possible some of those calls are being dropped.
• Kelsey: We do have information on how many calls are abandoned. Some of which are abandoned before they get to us, and some are abandoned after. The caller doesn't know the call is being rerouted. We have less than 20 seconds to pick up a call before it is rerouted.
• Dr. Saafir: Id' be curious to know what the rate of dropped calls are because I think this represents another gap in the service system we need to take a look at.
• Kelsey: I think Vibrant has maybe more specific details on that since they cover the entire state.
• Nestor: You said you're collecting a number of statists, how is that broken down? What are you looking for? And how would that affect how were going to set things up in this region?
• Kelsey: Were looking at the reason for the call. Were trying to gather demographic information as much as we can. Looking at regions, whether it's in Chicago or somewhere in Illinois and outside of the state. Were gathering data on the purpose of the call, currently have mental health providers, whether they want to be connected, referrals made, do they want follow ups, was someone dispatched or connected to 911.
• Nestor: Is your answering system the same as CAD where it has prompted questions to ask or is there a different method?
• Kelsey: We have a form page in our software that drives the clinician through each of the questions so they can select the appropriate response. And they submit the data, and it is evaluated on an ongoing basis.
• Nestor: For 911 transfers, do you have a direct connection or method?
• Kelsey: No, we do not. It's a little complicated because you can't relay calls with 911. Often times we have to use two call systems to connect to 911 for the warm hand off.
• Next meeting March 20, 2023 at 1:00 pm.
• Review Charter before next meeting and will vote at the next meeting.
• Antoinette: Great idea, send it out again and announce we will vote at the next meeting.
• Matt: I have some state 988 statistics, I put a PDF in the chat. You can look at the abandoned call rates. You can look at the basic metric Vibrant collects. None are very specific but thought you all might want to look at it. I know from the statewide meeting they are creating a tool kit to be sent to the regions which will include the risk matrix approved by the protocols and standards subcommittee. Also, starting to collect information from each region. Each region's PSAPS will gather what resources are available in the region, co-response and alternate response.
• Public comment: No one.
• Markul: Any other comments? We had a great meeting with great discussions and great questions were asked. Dr. Saafir what do you say, we close out at 3:27.
• Dr. Saafir: Thank you all again, this has been a very robust discussion and we really appreciate all the questions. Our hope is were going to get to a bit more granular with regard to the data we are looking at. I think it's important this process is being driven by data. It's a lot we need to know. Also, fyi we submit a monthly report along with our minutes to the local CESSA hub which is at U of I. Those go up to the state advisory committee. So many of the questions you raised will be included in that document. So you can expect there will be some follow-up. Thank you all very much.
• Markul: Thanks for the meeting, everyone, take care.
• Meeting adjourned 3:28 pm.