CESSA - Region 4 Committee Meeting Approved Minutes 03/21/2023

Community Emergency Services and Support Act (CESSA) Region 4 Advisory Committee

Meeting Minutes- Tuesday, March 21, 2023 - 10:00-11:30 via Zoom

Meeting Minutes - Approved by Members 04/18/2023

Call to Order/Introductions
- Meeting called to order at 10:00 am by Co-Chair Julie Brugger.
- Attendees:
  - Dave Fellows, Layla Simons, James Hengehold, Randy Randolph, Julie Brugger; all above attended via Zoom. Kelly Ann Jefferson, attended by phone.
- Absences:
  - Jeff Shafer, Dana Rosenzweig, Deborah Humphrey, Amy Foster, Megan Black, Andrew Stein, Timothy McClain, Dennis Perez, Steven Johnson, Cindy Wagner, Brittany Pinon-Becker, Joe Harper
  - Per Peter Eckart we are not able to have a vote as enough members did not join to form a quorum.
  - Update- Following members approved these minutes at 4/18/23 meeting; Jeff Shafer, Dana Rosenzweig, Brittany Pinon-Becker, Steven Johnson.
Approval of Minutes
- All members in attendance approved meeting minutes for February 21, 2023. However, there were not enough members in attendance to establish quorum. Additional votes for the needed approval will be requested at next meeting, April 18, 2023.
  - Update- Following members approved these minutes at 4/18/23 meeting; Jeff Shafer, Dana Rosenzweig, Brittany Pinon-Becker, Steven Johnson.
- Note: Correction made to of the date of the February RAC meeting agenda emailed; error was typed as January 21, 2023, instead of February 21, 2023. Corrected for Minutes posting.

Julie Brugger provided a display of the slides for the Risk Matrix Tool Kit and gave an overview.
Comments /Questions from committee members:

Q: (James H.) the flow of the toolkit does not seem to make sense. If these MCRT's are not available, example, as it is right now with Centerstone, we are getting calls from Centerstone to deal with calls for people who are in crisis currently, to send police officers or an ambulance to them. Is there something that is going to be in place to make aware that there is no MCRT available, so therefore we will just send the way we always have?
A: (Peter) the Matrix is quite complex. The Matrix is not a decision, it is a tool for you all to have these conversations about how you understand the nature of crisis in your community and match it to the appropriate response. We have two parallel processes happening that were touched upon in your February meeting but have not been delivered yet from the Crisis Hub. It is a process to help you to identify what is the current capacity for an alternative response in your region. This is the work that the PSAP's are doing in terms of reaching out to their local law enforcement to document, if possible, any kind of alternative response and what is available in your community. Additionally, Julie will be presenting the documentation on where the MCRT's are available in your area. Every region is different. In this project, we are going to discover things that we have not necessarily thought of before. A separate meeting is likely needed in addition to your monthly meeting, it just can't be done by July with such little time.
Q: (James) when were the PSAP's notified, I have not received anything from the state yet to collect data?
A :( Peter E.) You will be receiving your own type of toolkit to help with the process.
Q: (James H.) we have a lot of work and you mentioned bringing vendors in to change the MD protocols and such, I do not see that this can be complete by July?
A: (Peter E) I work for the UIC Behavioral Crisis Hub, our job is to try and make as much of this happen as we can in the time that we have. The CESSA subcommittee on technology and data are working on the piece of how to streamline the issues of what kind of reconfiguration has to happen with the PSAP's and the vendors. It may be helpful to have a set of recommendations compiled by July 1 that go to all the EMS Directors who would affirm them and send to their state infrastructure.
Q: (Dave F) has anyone identified the number of disparate vendors there are in region 4?
A: (Peter E.) the states 911 Administrator, Cindy Barbera-Brelle, created a report that lists which PSAP's use which vendor, I will share that.
Q: (James) this will be beneficial in this process, as we need as much data as possible to narrow down the matrices; and have the information of these other levels as we do not have any currently to base our process on.
A: (Peter) Mary Smith will be giving an update from our office to Julie to include the list of all the PSAP's for your region.
Q: (Randy) you mentioned response teams/organization that serve different areas, do we know how many simultaneous responses can occur within a jurisdiction? If we have multiple requests for a crisis team, how many could go at once? Example, I have multiple calls on the east end of St Clair County for a crisis team, how many of those are available to respond?
A: (Julie) example, the most eastern part of St. Clair County, which would primarily be Chestnut. During the week, during the day, Chestnut has three teams that are available all the time and two teams for evening and overnight. Hoyleton responds throughout St Clair County as sort of a backup to Comprehensive and Chestnut. I am not sure if Hoyleton has 24/7 availability for mobile crisis response, I know they do for SASS (for children) and might be available for some of those types of calls, but as far as being available for adults, I am not sure.
Q: (James) just recently we had five suicidal subjects at the same time in various parts of the county and obviously that stretches everyone's resources. My concern is if this is not one of those priority based responses that requires the police and/or EMS going in a crisis team response, how do we handle the subsequent calls that are going to inevitably to come from the people who are requesting assistance, as they already do it today when an officer, fire truck or EMS doesn't respond in their idea of a timely fashion? These are things we are going to have to consider. Will there be a way to inform them that they are on their way? Do we keep sending them back to 988? How do we close the circle?
Q: (Julie) Peter do you know how 988 responds back to 911?
A: (Peter) I cannot speak authoritatively about this; I only know a laypersons knowledge of it. To all of you, these questions are exactly what your conversation is going to be about.
C: (Randy) we understand that it is something that we will have to adapt to. I just want to make sure I empower our people to make the right decisions when those questions come up. Questions are going to come up that we have not even thought of in this process. We want to make sure that our people who answer the phones have the tools to empower them, they have a significant responsibility and want them to make sure they are well equipped.

State Updates
- Peter - per the slides, we are very clear on what needs to be accomplished before July 1. As you all are working at the regional level, there is a statewide advisory committee as well, that really doesn't have any decision-making power, but they are monitoring the process. There are four technical subcommittee's, which exist to get information to you, as well as protocols and standards, tech & data, communications, and training. Protocols & Standards is always the important process you will be working on. We are on target for the timeline, there is a good amount of work about to happen now.
Committee Questions/Comments:

Q: (Julie) who would be willing to meet again before the next meeting to discuss more in depth our task; who do we dispatch, how do we get them there, how to we know that they are coming? What is a realistic timeframe for different teams to respond for different situations?
A: (Randy) I am open to that barring any other scheduling conflict. I do want to ask from the leadership team is that we have someone(s) or answers to these questions prior to that meeting. We don't need to discuss the hypothetical, if we are going to move forward, we need clear, distinctive answers.
A: (James) I agree with Randy. I am also in support of helping. Ideally if they get the questionnaire out to the PSAP's, we will have we some sort of answers. We cannot support pushing forth a matrix without knowing what have to start with, otherwise our dispatchers/988 employees don't know what they can send.
A: (Dave F) I agree with both Randy and James. I feel there is so much disparity in how the PSAP'S are run. If James and Randy cannot have an informative opinion, I think we are going to have a hard time in convincing everyone else. I think if James and Randy can produce a good plan with our help, I think it will make it sellable and palatable.
C: (Randy R) unfortunately, I feel the matrices at this point, draw more questions than answers. In looking through it, it lists a deadly weapon, but there is no definition of a deadly weapon. These things can be very open and interpreted differently. My staff would be concerned about liability at this point. Yesterday I worked the desk and took a call for a man that wanted to report clearly a CIT related issue. When the officers arrived, he came out with a knife. If we would have sent a mobile crisis team, we would have had a larger situation.
C: (James) that is why it is going to be critical to have some type of EMD protocol for this; the decision based yes or no answers just like we do with EMD. I do not see it working any other way.
C: (Randy) I 100% agree. It will have to be something through the EMD process that streamlines it and gives some shield that you did the best you could with the information provided. If we can get that, we already have similar processes in place now for anyone that uses IED, EMD's in particular. There are tools out there that already address this, although, not to this level of detail. This is a system that our staff knows how to use already. They know how to work through it, how to ask the questions to ask to drive the determinant code, to determine who would be sent to the situation. There is no other way to implement this that is going to be smooth.
C: (James) 100% agree.
C: (Julie) in our small meeting, in addition to Randy, James and Dave, some of the MCRT from different areas of our region are going to need to be there to give realistic response times, who is available, when, what is available 2/47 and what isn't.
C: (Randy) from a PSAP standpoint, my CAD system tells me I have four ambulances in town but three are in use. So obviously there will not be anything in place for the MCRT's to know what is available; these are the other stumbling blocks that are going to occur.
C: (Julie) I think we will also need someone with information from 988 in terms of how they confer in situations like this.
C: (Peter) I just want to affirm as that is an issue, and to say that we know that from the perspective of supporting the state as they build the capacity for 988 and the 590 MCRT programs we've been working a lot with them on how they interact with each other, but no one has put in the time yet to develop these specific guidelines about how 911 and 988's work together. We do know that is important.
C: (Julie) I have contact information for Kevin Richardson, to see if he is available or someone else to help us out in our smaller meeting, to get some questions answered and in making recommendations for our region to the state.
C: (Randy) even operationally, being able to notify us, what phone number to call us on as we have special lines specifically for those types of situations that get prioritized. These could be operational situations that we can work out together to try and get the best result and make sure staff knows that the line ringing is 988 and a priority, telling us that someone is on the way.
C: (James) we also built a 988 line, the information was sent to Cindy Barbera-Brelle and she is to distribute it to the 988 centers, as it will go above all of our other lines.
C: (Julie) I will reach out with some potential dates and see if I can get some of the other MCRT as well as 988 to see if they can join us. We can get some discussions going on about who should respond when and what we are recommending that is going to work for our group.
C: (James) hopefully the state gets the questionnaires out to the PSAP's so some data can come back so we have some better understanding in our region.
Q: (Julie) Peter do you know a timeline regarding the PSAP's to return the questionnaires?
A: (Peter) the hope is that PSAP's turn this around in two to three weeks from their receipts of the instructions.
Q: (Megan B) Julie regarding the different MCRT you were speaking of and their availability, are they centralized to one location? I work for a busy municipality, Madison County. I think we would run more of the psychiatric calls near Troy and Highland. If they had someone call, I know the response time would be long versus if they were centralized in Edwardsville and coming down to Granite City, Madison or Venice. I did not know what that would be like logistically, because at some point if we were on scene waiting for them to come, I can see our trucks just choosing to take them to the hospital. It might not be the appropriate place for them to go but also, we cannot stay out of service for hours waiting for someone to come from across the county.
A: (Julie) during the weekdays, we operate out of Granite City as well as Collinsville. Evenings, overnight and weekends, our staff is on call, so they operate from home. Wherever staff live, which could be an hour away. As we serve eastern half of St Clair County; for example, if we were to get a call from Lenzburg or Marissa, then getting back to a call in Troy, that is going to take a good amount of time because of the physical location of where the person is starting from and going to. It is such a large response area; it could absolutely take an hour in that scenario; generally, it doesn't, but it has. This is definitely something we need to discuss in terms of what is going to help people get help faster. Honestly, an hour away is too long for someone to wait.

Public Questions/Comment

Q; (Rachel L.) What is currently in place as far as MCRT? How many are there? Where are they located? How are they dispatched?
A: (Julie B.) There are 5-590 Medical Crisis Response Teams in Region 4. These teams are Centerstone, Chestnut Health Systems, Prairie Counseling, Comprehensive and Comwell. Each team has its own contact number but can be dispatched by 988 call centers as well, dispatching the team nearest the situation.
Q: (Steve) I wanted to share with the group that the Regional EMS Advisory Council Committee did create a subcommittee to specially start working on the CESSA challenges that we are going to be faced within the region. The meeting is with EMS professionals, incorporating medical directors that oversee all the EMD protocols. We do capture certain portions of the group but that leaves still law enforcement out and our crisis responders. What we would like to do is move forward to at least get a vision on what we believe is EMS role is in this, but it is certainly an open invitation to anybody that sits on the Regional Committee. We just must be cognizant that we would not have enough members to technically create a quorum to say that you were having a meeting but to get some participation from the membership here on that EMS subcommittee so we can just have a more unstructured dialog, to discuss our challenges and talk about resources available, limitations. I think if we are going to be anywhere close to hitting that July deadline, I think we need to have it in an environment that is a little less structured but kind of a work group environment and more easily discuss things as we bring forth our different knowledge bases that each one of us can bring forth to the team. I just wanted to put that out there. Julie if you would like to gather names from the people here you can send them to us, and we can send out the invites.
A: (Julie) I do think the more voices the better as we determine how we can all work together it will help in providing the best services we can. Being able to talk about the progress and discussion into that meeting as well. I think that will be beneficial too.

Next Meeting is April 18, 2023, at 10:00 am via Zoom
Adjournment
- Not enough Members present to vote on adjournment. Meeting dismissed at 11:32 by Julie Brugger.