CESSA - Region 11 Committee Meeting Approved Minutes 03/20/2023

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

Meeting Minutes- 03/20/2023 - 1:00 PM

Meeting Minutes - Approved by Members 04/17/2023

Attendance: Dr. Eddie Markul, Dr. Rashad Saafir, Jonathan Zaentz, Carla Orlandini, Cosette Ayelle, Peggy Flaherty, Jen McGowan-Tomke, Matthew Fishback, Joseph Schuler, Kelsey DiPirro, Matthew Tokarz, Dr. Lorrie Jones.

Meeting Began at 1:04 pm

Roll Call Completed by Monique Delgado at 1:06 pm

Dr. Markul: Motion for approval of meeting 2 minutes at 1:07 pm.

Mattew Fishback: motion to approve minutes.

Peggy Flaherty: second motion.

Dr. Markul: I;m Dr Eddie Markul, one of the co-chairs of the Regional CESSA Advisory Committee.

Dr. Saafir: Good Afternoon Everyone I'm Rashad Saffir and I'm the co-chair for the RAC Region 11.

Markul: This meeting is being recorded you do not need to have it on your video. A copy of this recording will be provided to the Illinois Department of Human Services with the open Meetings Act. It will be posted on the DMH open meetings page. All participants will be muted to reduce interference of background noise. If you have a question, please use the "raise hand" feature. Appointed committee members wishing to contribute to the discussion will be unmuted and able to speak. Members of the public will be able to raise their hand during the public comment section to provide input.

Markul: Here is the agenda for today. We will now complete roll call. Monique, can you handle this?

Monique: Dr. Markul- present, Dr. Saafir- present, Cosette Ayelle - no answer, Jenifer Tomke - present, Jonathan zanetz - present, Matthew Fishback - here, Joseph Schuler - here, Antoinette Ursitti - no answer, Karrah Kohler - no answer, Nestor Flores - no answer, Peggy Flaherty - here, Kelsey DiPirro - no answer, Carla Orlandini - here, Jeff Jamrok - no answer. End of roll call.

Markul: Approval of meeting minutes, I know those were sent out and hopefully people reviewed. Can I get a motion for approval please?

Matt: I motion. I sent a slightly edited version of the charter, I'm not sure if that was received by everybody.

Markul: Thanks for that Matt but I don't think the revision went out to the whole group.

Matt: Motion for the minutes.

Flaherty: I second the motion.

Markul: We have the second motion from Peggy Flaherty. If anyone opposes let us know otherwise the minutes will be approved as submitted. As far as the Charter goes, I know Dr. Jones has a 2 pm deadline, we will save that toward the end.

Markul: Today we will talk about the continuum of Law Enforcement to Behavioral Health Crisis Responses. There is a continuum between what is traditional law enforcement only response to a mobile crisis team response and some different responses in the middle. In Chicago were fortunate we have a robust response right now which we will discuss in detail today. As far as the CESSA legislation, it envisions the continuous response based on the conditions and potential lethality of each call. There is going to be a risk matrix that's discussed next month. Hopefully, everyone can attend because we will have a pretty robust discussion about how we do this continuum and who responds. Keep in mind, CESSA does not prohibit law enforcement from participating in certain situations, but the preference is they do not unless there is a threat to public safety or a crime being committed.

  • Chicago has a history of a very robust crisis CIT model. It's been going on for a number of years. We've had a good experience with CIT officers. They form partnerships with other first responder agencies, community providers, advocates, family members and persons with lived experience.
  • There is a 40-hour training to become a CIT officer, refresher courses available in Chicago.
  • In each of these models we will talk about the evidence that's been gathered about them. For CIT the strong evidence that CIT improves officer knowledge, attitudes, and use of force preferences. As an ED provider you can tell when an officer has been CIT trained by their level of awareness of mental health emergencies and what they entail. CIT training program increased linkage to care. As far as evidence related to the use of force the evidence is unclear. Dr. Amy Watson has been pretty involved in the Chicagoland response. There is an indication that training of call takers and dispatchers and call coding is an important component of CIT. We have Lt. Schuler on here, anything you want to mention about Chicago's CIT program.

Lt. Schuler: Good Afternoon, yes you are right everyone must complete the 40-hour training. Every three years they must come back for a 2-day refresher course. It's been going on since 2004. We work with OEMC they do daily training for yearly 8-hour class as a refresher.

Markul: At OEMC they have on the police side of dispatch there's a specific CIT pathway where they identify a situation that could have a mental health component, they do have specific CIT questions they ask and preferentially if a CIT officer is available will dispatch that officer to the scene.

Markul: The next type of response is the co-responder teams. It's pairing a clinician and an officer for a response. I will get to the Chicago CARES pilot. Some of these teams there is also a medical provider, EMT or paramedic can be added to this as well. The goal is to reduce arrests and increase safety, reduce ED transports and hospitalizations, and increase linkage to community care. There's a significant variation in the model that exists. As I mentioned, in Chicago we have the CARE team which has a community trained paramedic on this team. Sometimes the teams arrive together or ride together or telephone support. A lot of the co-responder teams are not 24/7.

  • As far as the evidence for the co-responder teams there have been two systemic reviews and some research on this. Generally, stakeholders are okay with this. There is an improved collaboration between police and mental health. In some communities, there may be less officers time on scene. It may reduce ED transports but the admission rate for those transported is typically increased. May reduce repeat calls for service. May reduce immediate risk of arrest and is typically preferred over police along approach by service providers and family members.
  • It may reduce short term incarceration risk but not long-term EMS demand or risk of justice involvement. Saying there is future research is needed. I think that's something that would be interesting to see how that pans out because I would think that it wouldn't reduce EMS demand.
  • Here's another study showing the findings suggest co-response police mental health response improved the amount of people showing suicide related behaviors. That's something maybe Tiffany can talk about from the CARE team. Sometimes if someone is expressing Suicidal Ideation taking them to the ED is not the best response. This will be a good time to discuss our Chicago CARE model. If we can pull her slides up.

Tiffany Patton: Senior director of crisis sector services with the Chicago department of public health. I supervise the clinicians for the CARE team and some of the day to day operations of the CARE program. CARE stands for Crisis Assistance Response and Engagement. We respond in 3 different ways.

  • Our first way is the pre-response. We have clinicians embedded in 911 call center. They are currently working with call takers and dispatchers to better understand mental health and how it translates or relates to calls coming through. Often times, we find the individuals who are in a mental health crisis those calls are not coming from that individual in crisis but coming from a third party caller. Having that insight and being next to the call taker and dispatcher is helpful. Especially, the call taker helping them to understand the nature of the calls has been insightful.
  • The next response is in person. Mental health professionals are being dispatched from the 911 call center to respond to behavioral health crisis and require in person response. This means when you call 911 you have an option now that is inclusive of a behavioral health option. Originally, we had police, fire, and paramedics. Now we are working strongly at having this mental health option and putting more effort and emphasis in growing that out, so individuals are being asked the appropriate questions to get an appropriate response.
  • The last way the CARE team interacts is with the Post response. Once we engage with an individual, we link residents to appropriate services so were doing different types of assessments in the time we are engaging with the individual in crisis to determine what their needs are and where would be the best agency, location or service that would meet their needs. That could include an emergency room depending on the acuity of the call or it could be somewhere like a clinic where we have a prescriber, and this is just a matter of getting medication to bridge the gap until they get into their psychiatrist or PCP or wherever they are getting behavioral health services.
  • The CARE teams have 3 different teams responding to crisis calls.
    • Alternate Response (AR) - respond to 911 calls with a mental health component and offer de-escalation, on-site services, transportation to alternate destinations and extensive follow up. This team consists of a community paramedic and a clinician.
    • Multidisciplinary Response (MDRT) - Provide the same services as the AR team. The only difference is they can respond to 911 calls with a greater risk level because they have an officer as part of their team.
    • Opioid Response Team (ORT) - Newest team that follows up with individuals 24 - 72 hours after they have experienced an opioid overdose to offer services.
  • With this team we have 4 Trained Experts in different roles with specific expertise.
    • CFD Community Paramedic - Licensed by the Illinois Department of Public Health that's from the fire department.
    • CDPH Crisis Clinician - Licensed by state of Illinois (LCSW, LCPC).
    • CPD CIT Officers - CIT trained also received training for individuals with behavior health crisis.
    • COIP Peer Recovery Coach - Peer Recovery coaches. Completed Illinois accredited community health certification and have lived experience.
      • Alternative Response team consists of a Paramedic and clinician.
      • MDRT team consists of a Paramedic, Clinician and CPD CIT Officer.
      • Opioid Response team consists of Paramedic and Peer Recovery Coach
    • This is a pilot program to see which methods work. Peers are always welcomed in these models. We are trying to determine what this looks like for the city with the research being completed by Health lab and combining this information to make informed decisions as the pilot moves forward.
    • CARE Program: Pilot program, one month old. Operates in East and West Garfield Park and Humboldt Park and follows up with individuals 24 -72 hours after they have experienced an opioid overdose to offer services and connections to care. The team is a paramedic and a peer recovery specialist. The specialist comes from COIP. They meet in the morning to review a list of individuals who have had an overdose during the last 24 - 72 hours and gather the individual's information and map their day visiting site to site. The goal is to find the individual and get them connected to care. They haven't typically found the people they are looking for but have found more people who are suffering/living with opioid use disorder and offering them resources, harm reduction kits and linking them to services. They are still completing the work of helping people with opioids even if they don't find the exact individuals they set out to find.
    • Alternate response teams function in west Englewood, west Elston, Chicago lawn, west lawn and gage park PD districts 7 & 8. Not directly dispatched throughout the entirety of 7 & 8 we are able to self-dispatch to calls that we hear during that entirety of those two districts. The only thing is trying to get from one side of the district to the other. We have a 15 minute time limit to get to calls we are dispatched to or self-dispatched to. Just because the team doesn't make that 15 minute window doesn't mean that they won't self-dispatch because again the emphasis is on the work and the help the individual may need. We may not get there in that time we still will go because we understand crisis doesn't happen in a vacuum and incidents don't just end with a wave of a magic wand there are still things that need to be in place and this team has the resources to do so. The pair consists of a paramedic and a clinician. The clinician is from CDPH. The eligible call types are disturbance with Mental Illness, Threats of Suicide, Wellbeing check, suspicious person, and criminal trespass. As long as these calls have a mental health element the team is eligible to go. Our response options are primary dispatch from the fire side OEMC, we can self-dispatch because we listen to the radios and we also have a PDT (police communication device to see the pending calls). We also do a police assist this is where a call may not have come in with a behavior health need however when the police arrive on scene they determine the CARE team is a better fit to respond they will go on air to call us.
    • CARE service criteria we assess members between the ages of 12 - 65. We were 18 - 65 until the beginning of March but changed our age range down to 12. This is a pilot; we are building as we go. This new population comes with other things like SAS and schools. How do we interact with teams that are already doing this work so we are not muddying up the playing field but are working together as best as we can. The calls are for alternate response teams that are non-violent and no weapons. For our MDRT we can go to calls where weapons are unknown. Meaning the caller may not know if the individual has a weapon because this team has an officer. We don't go to calls with co-occurring medical crisis. We will get a call where a person has MH also presents with other pressing medical needs and those needs take precedent and those calls are responded to by a paramedic.
    • Our referral mechanisms are from OEMC, this is how we get referrals. The CARE team does have a phone number and does take calls but only from clients they are actively working with. In order to get a CARE response, you will have to call 911. The non-dispatch assist options. We do CPD CIT assist non-emergency follow-ups, post work for 30 days. We don't just drop a call or client at the end of the 30 day marker. We do understand the agencies we are working with do have decreased capacity for new clients so we may hold onto clients longer than 30 days to make sure the linkage is solid linkage and it's not that the individual will cycle through that crisis again. We also have proactive outreach, when the TEAM is not out on calls, they are completing outreach to individuals, priority populations, organizations, or settings in each district. They make rounds to community MH centers, libraries or frequent visiting places people with MI go such as the pharmacy.
    • CARE teams deescalate the person in crisis and conduct a brief assessment. The de-escalation may not just occur with the person in crisis but may also be with the family member. Or the store owner. Individuals who came into contact with the person in crisis may need some conversation to calm the situation down. The CARE van has some resources such as clothing, hygiene items, food gift cards, bus passes and harm reduction kits. The van can transport individuals to a hospital in non-emergency situations based on the individual's acuity level. The CARE team is amalgamation of partnerships DPH, CFD, CPD, Region 11, OEMC, IDPH to create this work we are doing now. The CARE team is not bound for transportation. If we know the individual will have an appointment we will provide bus cards to ensure successful linkage has happened.
    • Pilot Team Implementation - mid 2020 - 2021 the model and development consultation started. We built the protocol and completed QI call and ongoing call center team trainings. The CARE Team has completed 120 hours of training. The training consisted of how to be a team and how to blend the cultures we had in one room to work together as one team. Our dashboard came out last April. Staff training and roll-call trainings for all the districts we are in has occurred and is ongoing. We started our Multidisciplinary response team and went live in Sept 2021. Last year, our alternate response team went live. The opioid response team went live this year.
    • Where are we going: January we launched our opioid response team. March 2023 we will be going live in the Loop in District 1. In the Summer of 2023, we will launch two more teams in Far North & Far Southside in police districts 24 and 4. In late 2023 CDPH will be piloting our Sobering Center and Stabilization Housing as alternate destinations.
    • The Dashboard numbers as of January 2022 show CARE had 559, 911 responses and 483 follow ups with no use of force and no use of arrests. If you are interested in more up to date information chi.gov/CARE is the direct link to our website.
    • CARE Program Activity - Breakdown of how calls went. 29% of CARE services, CARE Services + Transfer. Transfer and Transport numbers are similar because a transfer usually means we had another partner transfer, meaning it could have been a paramedic transfer. We transferred the call to a paramedic because the need was of a medical need. Or there was transport and that was due to the acuity of the individual. 29% there was no contact with the individual in crisis because they were not on scene when we arrived. As you see our average time to the scene is 13 minutes. As mentioned, before we have 15 minutes to get to our calls. Average time spent on an event is 69.94 minutes. We do what is needed for those who are in crisis.
  • Markul: Thanks for that great presentation and for all the great work. Just to reemphasize, the CARE team is still a pilot so it is not something that is written into policy within EMS, CPD, CFD, etc. As she said, your kind of weighing different options for the two teams and see where that goes. This team is not available 24/7, just Monday - Friday at restricted hours. I know Dr. Jones has to get off the call, Monique, can you go to the state updates.
  • Dr. Jones: Great presentation Tiffany. Part of our update is that Tiffany and the city of Chicago did an excellent presentation to the Statewide Committee last Monday that was very well received. I personally want the rest of the state to learn more about the co-responder models that the city is piloting. Particularly, those that involve pairing an EMS with a clinician. So, it would not necessarily have to have law enforcement involvement in that kind of model. Briefly, I wanted to share a couple of things that are coming your way. As Dr. Markul mentioned the risk level matrix has been developed and some of the other regions have actually started meeting and discussing them. I believe it is on the agenda for the next meeting. It's a 4-level matrix. This surveys the protocols and standard subcommittee that worked on this extensively after reviewing several models around the country it does look similar to some of the models we've seen around the country. It has risk levels 1 -4. The low risk level would be most appropriate for the alternative response team. When you see the risk matrix you'll learn more about how it was conceptualized, how events are considered and move forward with your toolkit. UIC has developed a toolkit for you to use to figure out how to integrate this given your existing resources. The city of Chicago will be interesting to see how you grapple with this. The state does have an alternative response model defined somewhat differently from the pilot going on in the city. A co-responder model would provide an interesting variation to law enforcement only response that is already present with these pilots. Figuring out how the pilot and the city is doing will integrate into this risk level matrix and the structure the state has provided with these mobile crisis response teams that have been put into the city. Dr. Saafir and I were looking at those earlier and there were probably around 8 or 9 providers that are funded to do alternative response by the state funds. That becomes the work that you do going forward. There is also a landscape analysis. The purpose is for the state and regions to understand what resources are available. Yours will be easy but some of the other jurisdictions will have multiple. You have one PSAP. The PSAPs will be asked to complete the landscape analysis so we'll have an understanding of what different models are available across the state. When we look at CIT officers and different co-responder models. I think we studied able 9 different variations of co-responder models. So, what is available in the region. The landscape analysis will be sent out later this week. The co-chairs will get more information about the expectation of getting that information completed at the regional level. This is the season for legislation to be pushed through. There are 3 bills we are tracking closely in Springfield. One is Senate bill 1672 which has to do with amendments to the CESSA statute. There's another bill, house bill 3230, which recommends a cost analysis so the state could understand what the total cost would be, infrastructure cost to be considered as we build out the crisis continuum. Another one, Senate bill 818 which specifically regards creating a work group for 988 to learn more about how it's functioning and fitting into the crisis continuum and what the data looks like coming from 988. That's it in terms of updates. Any questions, if any?
  • Markul: The deadline to have all our recommendations is June or July?
  • Dr. Jones: It's July 1st.
  • Cosette: It seems as though at the next meeting we should be prepared to bring feedback about the risk matrices pending us receiving them at the end of this week. And if so, what will be on the agenda at the next meeting. How will our feedback in this group inform the finalization of those risk matrices.
  • Dr. Jones: The risk matrix has been adopted by the regional advisory committee and reviewed by the statewide advisory committee. It is what it is. We're calling it an interim risk matrix because we expect as the system evolves over time there will be opportunities to amend the matrix. The region will consider the matrix and will figure out how to best implement the matrix within your specific region with greater understanding of what your resources are.
  • Cosette: You said risk matrix was adopted by the regional?
  • Dr Jones: No, I said it was adopted by the protocol and standard committee.
  • Dr. Markul: Hi Dr. Jones, I think she's right. I think it is the first time you may have said that accidentally.
  • Dr. Jones: It was adopted by the protocol and standards subcommittee of the statewide advisory committee. It's given us guidance through the entire state. With the understanding that regions have different resources and will adjust in its implementation based on the resources available in the state in their specific regions.
  • Dr. Saafir: Just to be clear, I want to be sure our committee members are clear about this. There is not an opportunity at this point to make any recommendations or changes to the risk matrix itself were simply looking at how to implement what has already been approved.
  • Dr. Jones: That's basically correct. Now if the region has some adjustments it wants to make that is certainly acceptable. The notion was that the entire state would adopt a risk level matrix that will guide how decisions are generally thought of across the state. We didn't want a patchwork of risk level matrices across the state, and you go from one region to the next and all of a sudden you're dealing with something completely different. So that was the recommendation of the statewide committee and so that is how they moved forward.
  • Matt Fishback: You said a couple things. 1 everyone in the regional committee is going to receive the risk matrix. Are we also receiving the toolkits?
  • Dr. Jones: Yes, all that information has been released to your co-chairs. Your co-chairs will decide how to distribute it to the region.
  • Matt Fishback: Also, you said this interim risk matrix has opportunities to change in the future. How is that going to come about?
  • Dr. Jones: Well, I think that as the state begins to implement things as we find out the regions have different resources that are available, we get data on experience across the state. At that point, I think we should consider changing the risk level matrix. This is something that will happen over a number of years. The system cannot change on a dime just because a piece of legislation was passed that said we need to implement something by 7/1. This level system change is going to take some period of time. I think your region, 11, is farther along than a lot of the regions because of the work you completed in your pilots. Particularly, since you're working with transform 911. You'll have data that is available for you, the region and state to look at. As we get data from across the state in different regions we'll be able to assess everything and see if it makes sense to make any changes.
  • Matthew Fishback: I understand completely. My question is more along the method of how it will be changed. For example, is the state committee going to continue meeting after 7/1?
  • Dr Jones: That's a good question. The expectation is that we'll have to see what happens when legislation passes. There is some, in the current legislation, vague language around monitoring. I think the committee is supposed to meet a couple of times of year. But very limited kinds of oversight. We're thinking that might change with the passage of any new legislation but we don't know. The bottom line is it all remains to be seen but it's certainly our hope and expectation with this level of systems reform that there is some ability to track and monitor and review going forward.
  • Dr. Markul: Dr. Jones just to make sure I'm clear. Essentially, the risk matrix is defined and it's the work of the RAC to figure out what resources we have available and what resources we want to send to specific tiers of the risk matrix. Is that correct?
  • Dr. Jones: Kind of. As I think of what you all are doing. I don't know enough of the details of how the dispatch decision are made out of 911. But that's essentially where the work has to take place. I think you all do not have a private vendor and have created your own scripts and protocol. You would take that and look at how your dispatch decisions currently fall and see if there is any opportunity to change. So, for example, in the state definition of alternative response teams. You have to figure out how to integrate these other providers that are doing alternative response as defined by the state. They are funded with mobile crisis response teams that have clinicians and peers. Those low risk level situations can be dispatched to these low-risk calls. Now you have this pilot and must figure out how the pilot fits in with all of this.
  • Cosette Ayelle: So essentially, the own is then on the CARE to change and I just don't see where the change would be. It would be like us making a suggestion to the CARE team to implement something that they currently don't have as part of their system.
  • Dr. Jones: Well, I don't really see it that way. I see there is a way to integrate everything that's happening with what the CESSA requirements are. I think it's an opportunity frankly because you would be adding more resources by using the alternative response teams funded by the state as another resource in your systemic response approach.
  • Cosette: For example, the presenters chair that already have a system by which they at the 911 center determine what constitutes being able to send out an alternative team versus another team. We would essentially need them to submit that list, that flow chart to compare and contrast with the risk matrix and then if we see things that seem more applicable in the risk matrix then we would be making a suggestion to the CARE team that they should change their dispatch flow to accommodate this best practice. It still kind of requires the team in question to have a person present who would be there to receive this feedback that a certain aspect of their dispatch flow needs to adjust to be in compliance with the matrix. But not just the CARE team, but also every other 590 program that has a MCRT and is using a certain type of risk matrix. It's just more so for CARE because outside the other groups they have a particular connection with 911.
  • Dr. Jones: I think your co-chairs understand the work before them.
  • Cosette: Okay, well can the co-chairs speak to that.
  • Dr. Saafir: Looking at it hypothetically, there may be some possible misalignments or gaps that need to be addressed however I think the main work that were looking at trying to complete is to make sure there is good alignment with the resources that do exist and the risk level matrix. So it's not so much to try and reshape something that already exists, as much as understanding where it fits within the risk matrix and how we implement that at the local level.
  • Cosette Ayelle: My question is how can an alignment be generated without the programs comparing their dispatch flow. They have their own dispatch flow set up so what does building alignment look like to you.
  • Dr. Markul: I think you're right on the money with your assessment. One thing I would say is the CARE team is a pilot. It is not something that's a feature. It might be with the new mayor, I'm not sure both candidates seem supportive of this project. But it might be with the mayor change the CARE team may not exist anymore. I think we need to focus on our 590 teams out there and not necessarily the CARE team. We can do that analysis with the landscape to figure out what resources are available in a non-pilot status and figure out how we're going to plug them into a risk matrix. If the CARE team does become a part of the city's response and not a pilot, then it will need to fit within that risk matrix.
  • Cosette Ayelle: That makes sense. Well in that case I think this group needs to do some work to get some of those program 590 providers in this space so they can be aware and abreast of the collaboration we are trying to do.
  • Dr. Jones: You have two 590 providers on the call. Dr. Saafir and Peggy from Thresholds.
  • Dr. Markul: Also, Kelsey DiPirro is on the call as well as a representative.
  • Dr. Jones: Good questions team.
  • Dr. Saafir: Cosette I see where you're going with your thinking, and I think your spot on. We're just not in a place at this particular point because we have not gone through the risk level matrix and the toolkit to really be able to speak more concretely to what you're concerned about.
  • Cosette Ayelle: Yea, I mean I think the set up of these meetings in general needs to shift from a presentation model to a work meeting model. And also, I was on the call on Monday and there's no way she should have had to give that presentation here after having given that presentation at the statewide committee meeting. I feel we are wasting our time when work needs to be completed and we only have a short runway to do that. I'm more curious what work can be done now and the next meeting so folks that need to be in the room are there. From what I understand there are hundreds or almost a hundred 590 providers under the program especially in region 11.
  • Dr. Jones: There are sixty-eight 590 providers.
  • Dr. Saafir: That's across the state not just region 11. That number is much smaller when you are only looking at region 11.
  • Cosette Ayelle: That's from the closure of 2021 so I asked a question last time about when that program would re-open but we were not sure.
  • Dr. Jones: I'm sorry what closure are you talking about?
  • Cosette Ayelle: That's when the last application closed was in July 2021 for previous program 590.
  • Dr. Jones: There are sixty-eight providers that procurement is not open anymore right now. And I believe there are around 8 - 10 in cook county.
  • Dr. Markul: I think it's seventeen in Cook County.
  • Dr. Jones: Is it seventeen?
  • Dr. Markul: Yes, across all five regions.
  • Dr. Saafir: Yes, across all the five regions, but if only talking about region 11 there's only about 9.
  • Cosette Ayelle: Well then to me that looks like being aware of their systems so we can kind of draw some comparisons between them.
  • Dr. Jones: If there are no other questions I can answer I have to hop off to get to another region's meeting. Dr. Saafir, Dr. Markul?
  • Dr. Markul: I think we're good for now.
  • Dr. Saafir: Yes, thank you Dr. Jones.
  • Dr. Jones: No problem, I'll see you next month. Wait a minute before I go, I wanted to introduce our new staff person who be my colleague in attending these meetings. Asanta Adargwa will be available to you, she just joined us last week. She's a doctoral student at Georgia State University and were pleased to have her on board. She will be a liaison to Regions 8, 9 & 10 and will assist me with Region 11. And with that we're going to hop off.
  • Dr. Markul: Cosette, I think your point were good as far as the format of these meetings being given a slide deck from the state. I was learning a little right there as far as the expectation of this group is. I actually thought there was going to be some input from the RAC about the risk matrix, specifically two tiers of it. But is sounds like were being given a risk matrix and will have to try and figure out what resources we have in this region and plug them into the risk matrix and figure out how were going to have both our 911 agency as well as the 988 organizations and how they are going to dispatch these resources within the context of this risk matrix.
  • Cosette Ayelle: I appreciate you naming that and what the expectations are. I think this is really crucial to me because when you talked to the 988 center I noticed the only places they were receiving calls from where all the wards above I 290 and that means if there are no 988 centers receiving calls below I 290 are not connected to that call center. So, I wonder where that puts the mobile crisis teams. There are 8 - 10 of them, where that puts them in terms of receiving calls via 988. Not only the calls they receive direct to their hotline, but also any calls they might have otherwise had the opportunity to receive if we had a 988 center that supported the south and southwest parts of Chicago.
  • Dr. Markul: Can you bring back up the slide deck? These slides talk about the alternate response which basically talks about a non-law enforcement type of response. This is what I think the CESSA legislation is trying to get at here. I think the alternate response in our region to the context of this is talking about the 590 providers we have available. As I mentioned, right now how resources are dispatched we have our 911 center in Chicago (only 1 call center). As mentioned by Dr. Jones, we do write our own protocols in that center. We do not have a proprietary call algorithm system that we need approval for. I'm not sure if there are other crisis lines that do any dispatch. 311, I don't know if any of our OEMC colleagues can comment. Does 311 do any dispatching of any kind of mental health response at all.
  • Carla Orlandini: 311 would not, the call would be transferred to NAMI directly or to 211 which has now come into the system can give resources in a non-emergent way. They would not specifically leave the hub.
  • Dr. Markul: Hi Carla, so 311 can transfer calls to NAMI.
  • Carla Orlandini: We can, yes.
  • Dr. Markul: We must make sure we know all the ways a response can be dispatched. As far as who responds we talked about police. We know there's a preference for CIT officers. We also know EMS/FIRE can respond. For example, if someone calls and says they want an ambulance that call will be transferred. If it's a behavioral health situation typically an ambulance will be sent out. As far as the other responders as well, we talked about our 590 groups. Transport options we have available as far as 590 responders, are you guys doing any transport or do you call a city agency for transportation.
  • Peggy Flaherty: No we transport ourselves.
  • Dr. Saafir: That's right, that is correct.
  • Dr. Markul: As far as those services are housed EMS and Fire come under city but the Mental Health agencies are a bunch of independent providers. I think we had some great discussion on this and have a lot of work to be done. Does anyone have any comments currently before we move on with trying to develop an action item list before the next meeting.
  • Matthew Fishback: There is a 988 center that responds to calls for cook county beside C4, it's PATH that covers a majority of the state. There is a 988 center that takes calls to the city. Kevin Richardson is the director of operations for PATH. They usually have representatives at these regional meetings. At the next meeting he will probably be there. Besides that, going on the risk matrix. My understanding we get the suggested risk matrix but as we set up the protocols for response that we can do ourselves and then get submitted to the state for approval. So if we chose to have a different response mechanism than what is listed, that should be fine because that's what for our region specifically.
  • Dr. Markul: Yes, I saw a draft. I didn't realize the risk matrix was completely finalized until Dr. Jones mentioned that on the call. Basically, I last saw it there were 4 basic tiers that tell you the type of situation. One of them is clearly a violent situation that needs a police response and the other side is a situation where somebody is expressing they need some help such as a tele support or perhaps if they were going to send somebody probably a 590 provider, a mental health clinician is what they really need. In between, there's a lot of variability in the different types of risks. I think once we get that out to the group that will answer a lot of the questions you all have.
  • Dr. Markul: Conducting this landscape analysis of what we currently have available. Dr. Jones implied that we're going to get some resources to be able to send up to the group to be able to conduct this analysis. We've had a lot of these discussions already about what resources are available. What kind of responses do we have. We have CIT. We have 590 responders. As far as the co-responders, that's a pilot program in the form of the CARE team, at least one part of the team. I'm not sure what the future of the CARE team holds. I think that depends on the result of the election and a number of different things. It is a pilot but can become part of the framework of Chicago's response or it can be scrapped. We need to get the information about the landscape analysis about what's available here in Chicago and need to get the risk matrix out to the group before the next meeting for discussion. Dr. Saafir, any information you have been given that I'm not aware of right now?
  • Dr. Saafir: Just to clarify though, the landscape survey needs to be completed with the PSAP and law enforcement. That's not something that's already completed and available to send out. We do have the risk matrix and the toolkit which we will send out to members of this committee prior to the next meeting.
  • Dr. Markul: Yes, we'll try to get that out to you guys as soon as possible. Dr. Saafir, you said the last piece of the analysis is going to be completed by the police and PSAP?
  • Dr. Saafir: Yes, to collect data regarding the response types and times of levels 2 and 3 of the risk matrices.
  • Dr. Markul: So, they won't need the risk matrix before they can do the landscape analysis?
  • Dr. Saafir: Yes, that's correct.
  • Dr. Markul: Dr. Saafir already mentioned getting this worksheet out so we can have the landscape analyzed. There are no changes in the deliverables. Dr. Saafir and I will make sure we get out the risk matrix to the group and from there we'll have that landscape analysis completed as well and will have that information before the next meeting so we can have a discussion on how were going to take the resources available and apply them into our risk matrix. Any questions or comments? Did everyone get a chance to review the charter? I know Matt had a few edits specifically about the timing of the CESSA legislation. Thanks for correcting that Matt. Would anyone like to motion for approval of the charter?
  • Matt Fishback: I'll motion that at 2:24 pm
  • Peggy Flaherty: I'll second that at 2:24 pm
  • Dr. Markul: Okay, if nobody opposes well go ahead and consider the charter approved for our RAC. I believe we still have public comment left. Anyone from the public on this call, this is your opportunity to discuss any concerns or issues you have. Next meeting is going to be on 4/17/23 at the same time. I think we'd like to scrap any formalized presentation to try and get down to accomplishing what work this group is intended to do. Any other final questions or comments.
  • Cosette Ayelle: I think the only other useful presentations that I could see coming up are from some of those 590 responder programs. If they want to share about their programs so we can build consensus around recommendations so some of them can be streamlined.
  • Dr. Markul: That's a good point. I know we have two 590 providers on here. We can discuss resources 590 providers have available to them. Peggy mentioned there is a van they can transport it. I know some 590 providers are not off the ground yet. I think it would be interesting to know. We say we have X amount of 590 providers in region 11 but how many are up and running. What resources do they have and where are they at with implementation.
  • Jonathan Zaentz: In regards to that, if we had a capacity hours model accreditation and such from the 590 since we talk about it. We can stop talking about it in the abstract and perhaps move a little bit more towards how we can get a consensus and streamline and actually compliance with any of the CESSA regulations. I'm not sure if that is something that can be matrixed together.
  • Dr. Markul: Great point, I'm not sure we'll have to look into that.
  • Peggy Flaherty: Certainly, we could present our program. And I know CDPH organized the city many providers just to get more information about who is covering what area and their resources. I really want to second Cosette's request for information about the calls. Just because we're not getting that many. I don't know if it's with marketing or learning to move calls to the providers so we can respond. Because we're ready.
  • Dr. Markul: That is something I have heard with the small set of people I have talked to. People have done the work of setting up a response setting. Chief Zaentz what is the response for behavioral health calls. Something like 32,000 calls for behavioral health calls
  • Jonathan Zaentz: Yes, there are 35,000 behavioral health calls responded to by the fire department alone.
  • Dr. Markul: There are calls out there Peggy. It's just a matter of making sure the right call is sent to the right resources.
  • Peggy Flaherty: I appreciate that and I think there is a learning curve as far as what calls they want to dispatch the crisis response teams. The more experience the teams have with it we can circle back and get feedback about certain calls.
  • Dr. Markul: Hey Cosette, I saw your comment, can you speak to that a little bit please.
  • Cosette Ayelle: Yes, I just looked at what Jen shared in the chat about the new call center. The application closes on Wednesday for a new call center in Chicago. From the last meeting, Kelsey talked about C4 and talked about the calls that are under I 290 from 988 are going to the statewide system. If that's the case, then they don't have a strong understanding of the specific skills of the 590 programs in those zip codes that could potentially receive calls routed from 988. That's a big problem for the state's 988 center. But if this new call center is going to open up then ideally we should have some sort of review over ensuring that it weighs all the zip codes C4 doesn't touch. I think for those program 590 that are on the southside, which is where I'm going to assume more volume of calls are coming from, they would end up being connected to some of those 590 programs that aren't getting those calls right now. I think ahead of even that program being selected we should become aware how those 590 programs can be integrated with them and who is even submitting an application.
  • Jen: No Pho is for 39 zip codes in Chicago which are primarily south and west side zip codes. It doesn't overlap where C4 takes call from. It's for overnight hours 4 pm - 8 am.
  • Cosette Ayelle: That's good then we should be able to receive some more calls to those southside 590 providers. There must be some integration process set in place.
  • Jen: agreed, totally.
  • Dr. Markul: Thanks for sending that Jen I was unaware there was a proposal for this call center.
  • Jen: Yea, it stems back from initial conversations with the state. There were stakeholder meetings before 988 rolled out and there was a lot of discussion about the 988 call centers needing to be regional. And of course the direction of the state initially was the statewide back up but this seems to be following through on that strategy that local call centers will understand the resources like 590s and others to be better able to connect callers directly there.
  • Dr. Markul: Got it. Anything else from anyone. Alright guys thanks for a good meeting. We will get out that information that was mentioned hopefully soon. And then we'll have a great discussion next month. Enjoy the rest of your day.
  • The meeting adjourned by 2:40 pm.