Community Emergency Services and Support Act (CESSA) Region 11 Advisory Committee
Meeting Minutes- 04/17/2023 - 1:00 PM
Meeting Minutes - Approved by Members 05/15/2023
Meeting began at 1:02 pm.
Dr. Markul: Some house keeping things. Dr. SaafirI see you are on today. Unfortunately, he will no longer be one of the co-chairs but he will still be participating in the meetings. For the time being it will be myself and Dr. Lorrie Jones. Monique we can get started can you complete roll call?"
Monique: Dr. Markul, you are present. Cosette Ayelle: no response, Jennifer Tomke: no response, Jonathan Zaentz: present, Matthew Fishback: present, Joseph Schuler: present, Antoinette Ursitti: no answer, Karrah Kohler: present, Nest Flores: present, Peggy Flaherty: present, Kelsey DiPirro: present, Carla Orlandini: present, Jeff Jamrock: no answer and Matthew Tokarz: no answer. End of roll call.
Dr. Markul: reminder this meeting is subject to the open meetings act and will be recorded. You don't need to be on video. A copy of this recording and minutes provided at the Illinois Department of Human Services/Division of Mental Health in accordance with the open meeting act. We would like to have everyone muted. Please raise your hand if you have a question. Committee members can raise their hand the public will have a chance during the public comment period at the end. Next order of business, I know Monique sent out the minutes from last time. Hopefully, you guys have reviewed them. Can I get a motion for approval please?
Peggy Flaherty: I motion to approve them.
Matt Fishback: I'll second that.
Dr. Markul: Great, we can consider them passed. Today we are going to talk about this toolkit and discuss the business we have at hand today through the toolkit. Quick question, you guys should have received the toolkit. I know it's a pretty dense document. Hopefully, you scrolled through it, it will help with our conversation today. This is a reminder this slide has appeared I believe in just about every meeting we've had. CESSA does not prohibit law enforcement from participating in certain situations, but it really wants to have a continuum response from traditional law enforcement only for some situations to a mobile crisis response for others. Has everyone had a chance to look through the toolkit?
Committee Members: Yes.
Dr. Markul: The interim risk assessment matrix tool. It's really going to help us talk about how we're going to be assigning responses to particular situations. The state committees have already gone through this and fashioned this toolkit to help us be able to work through how to determine what kind of responses we should have for particular situations. It is an interim document and there could be some modifications in the future. Were going to be working through this for our own group. But it really shouldn't be distributed to the public at this time. The Risk matrix has put things into 4 different categories. 4 is an emergent risk and threat to life situations with potential weapons down to the low risk level 1. Really for our group were going to be looking at levels 2 and 3 and determining what resources we have available in our region, region 11 the city of Chicago and determine who is going to be dispatching them and how, And also talking about how there will be some interaction between the two agencies, 911 and 988. These next slides talk about in detail about what the level of the risks are. Level 4 we are not going to be discussing about what kind of response were going to be sending this has already been decided this is going to be immediate law enforcement +/- EMS response. These particular situations is where there is an immediate threat to life, with weapons involved, if there's a history of high level of violence, high level of intoxication, barricaded subjects, physical aggression, psychosis with risk to others or self and unknown risk areas where the caller is not able to provide specific information and/or a well being check. Does anyone have any comments.
Dr. Jones: We've had feedback from other regions about using a diagnosis psychosis here without describing the behaviors. We're still getting information from the regions and there is some consideration about removing the word psychosis and rather describe behaviors.
Dr. Markul: Also, the same with well being checks.
Dr. Jones: Yes, that is the other area. That needs to be defined. It is somewhat known in the PSAP world what that is but we need to be able to define it.
Dr, Markul: I'm glad you guys noticed that, it's something I caught also. I work a lot with our 911 center. The well being check is something our CARE team will be sent out for some of those calls. If there are weapons involved or a situation where violence is highly escalated I think immediate law enforcement +/- EMS responses is warranted in my opinion.
Unknown: For high level of intoxication how would somebody who is taking that information over the phone if there not in a medical setting how would they be able to evaluate that?
Dr. Markul: If somebody is unable to walk, grossly slurred speech. I do agree, high level of intoxication is not as precise as I would want. I know within the city right now the usage of alcohol or marijuana does not disqualify someone for an open ended response. It's a matter of the high level of intoxication.
Dr. Jones: We can go back to look at the technical pieces. We had people in the PSAPs working on this. Some of the protocols vendors prior to dispatch have questions they ask during the process of collecting information that would possibly lead to that determination. We can go back and find out what questions are typical from the vendors that lead to that designation.
Carla Orlandini: As it relates to intoxication and what level the individual is at really comes into play on whether they are calling themselves or has a third party calling for them. And then they would determine through questioning their actions. In a medical type of situation where they are unable to stand, they are unconscious then we would transfer over to fire. There is always the question of weapons and CIT questions that go along with that. Through all that type of questioning they determine where they are at in their current situation.
Dr. Markul: Litle bit of clarification on the well being check. Lorrie mentioned that has been noted on the state level and needs some teasing out. I agree, it's one of those that aren't clear. There are some times people haven't been seen in days where a well being check is to see if someone is deceased or for someone who has a history of depression and we want someone to go check on them.
Cossette Ayelle: Does that mean the next step in terms of teasing it out goes back to UIC and they reevaluate and reassess? What are the steps in getting more clarification on this?
Dr. Jones: It goes back to UIC only because we organize the meeting. It will go back to the technical subcommittee.
Cossette Ayelle: So the technical subcommittee will make updates and adjustments and bring the toolkit back for us to assess.
Dr. Jones: They will review these comments and decide what they are going to do with them. But I think if there's enough "noise" or concerns then they will likely make some changes.
Cossette Ayelle: Hmm… That's just really arbitrary. I think there should be something that makes that less arbitrary.
Dr. Markul: Monique can you move on to level 3. Level 3 is a risk type where are a region we work together to determine what kind of response we have. These are situation with no immediate threat to life, no one being assaulted, no weapons actively involved; non-lethal weapons present with plans to access them. I'm not sure what that statement means.
Dr. Jones: I can tell you what that means and your PSAPs can comment on this also. Non-lethal weapons for example if you think about Nancy Polossi's husband was seriously injured by a non-lethal weapon. They can be used in a way to cause great harm but they're not guns or knives.
Dr. Markul: Lorrie, the way it's written, "non-lethal weapons with present to access them" so the caller has plan to access the weapon or is that a misprint?
Dr. Jones: No, again I'm speaking from what I think committee members meant by this. For example, I'm going to hit you with this bat. They are threatening with non-lethal weapons.
Dr. Markul: The other statements here are homicidal statements with no plans to act, suicidal statement with no active suicide attempt, implied physical aggression towards other and escalating verbal aggression. Lorrie, are there any other additional questions for the last two implied physical aggression or escalating. I know in Chicago we do punching, kicking or spitting as one level of violence that we consider at a higher level. Then there is pacing and yelling which we consider a lower level.
Dr. Jones: I don't have any more information of that. I can go back to the committee to spell out more of what they are speaking of. I think if you know what it means, you all can establish for the region.
Dr. Markul: I think the questions were currently using at OEMC are pretty good questions that we think will work pretty well. Carla, any comments on that?
Carla Orlandini: Your on point there. I like our questions very much. When we added them it really helped us in determining and learning as 911 call takers. Without any clinical experience that really helped them determine and understand the behavior.
Dr. Markul: Agreed. As a group we do have the authority for that particular category, personally it seems like a law enforcement response. This is a somewhat risky situation, the dispatch types proposed to us by the state all do involve a heavy law enforcement with these types of responses. This is also up for discussion. The dispatching agencies are 911 and 988. Right now we don't have an established process to have 911 transfer to 988. 988 I'm not sure if you guys had a formal policy for when you would transfer calls to 911. I think that's something were going to have to discuss.
Dr. Jones: I can tell you that this one for example. I think the ideal responses would be a co-responder team. That's the ideal response. Remember this is written for the entire state which is why there are different response types listed. Law enforcement with EMS and the mobile crisis response team and law enforcement alone in some parts there wont be any co-response models or anything like that in which case we think law enforcement would be the appropriate response. 988 for this one I don't think it's likely but in some parts of the state again, they co-respond with 911. 911 will call them immediately and if they can get there immediately then they would do that. But again this is probably not likely for Chicago, for Chicago more than likely you would do the co-response teams. The risk matrix was developed for the entire state.
Dr. Markul: Yes, agreed. But correct me if I'm wrong, our 988 providers will be using this risk matrix to look at the types of calls they are taking too. That is the intent correct?
Dr. Jones: Well the 988 system will have procedures on how they will transfer calls and how 988 dispatches 590. They also have protocols for which calls should be pushed back to 911 and their protocols should be consistent with the risk level matrix.
Dr. Markul: Yes, we all need to be coming from the same place.
Dr. Jones: The important thing here I think it's differentiating is the response time is immediate. One of the reasons why mobile crisis response is not contemplated for more active involvement and responding is because their response time is not immediate. The mental health system was designed in a different way. Until we evolve different models, particularly out of large urban area there response times can not be immediate. They are not wire like that, like the EMS providers like law enforcement which typical response time is less than 13 minutes. Were actually completing a study on that and will be able to share that information fairly quickly. Even the SAMHSA model allows an hour and a half or more for MCRTs. So different model and different response time is often defining factor in terms of who can be sent.
Dr. Markul: Cossette I saw you had a comment and I think we agree with that, the "escalate verbal aggression" could use more refinement with a clear strong definition with supporting examples. That's why I used the example with how we use in Chicago with punching, kicking and spitting as one level and the yelling as another level. It is a bit vague. Anyone else have any questions.
Dr. Jones: Kevin has his hand up from PATH.
Kevin: I just wanted to speak a little bit more to help clear some stuff up that we see at 988. When were talking about the non-lethal weapons present with plans to access them. It's similar to what Lorrie said. I think of suicide more than I think of homicide, that's much more common. A lot of times you'll get calls where people say they have access to a butter knife and they might use that and it's truly an expression of pain that this person is in. Is it lethal? Probably not. When things like that are going on at 988 we can sometimes deescalate and contact a MCRT if necessary. The way it's working with 988 currently we aren't dispatching MCRT were contacting them and providing a run down of the situation. Then they would make their own assessment as well and be the ones primarily if they decide we need to co-response with 911, they would contact that dispatch. We would contact 911 dispatch if it was "in progress." The rope is around their neck, they've already taken the pills, they are refusing to put the gun down and are not working with us at all. I just wanted to clarify that so you all could have a clear picture of how that looks like on the 988 side for the time being.
Dr. Markul: Thanks for the example. I wanted to clarify one thing you said. If you take a call and determine it needs a MCRT response, you'll then contact that MCRT and they would contact the caller and complete an assessment. Is that the way things are working on your end?
Kevin: Yes, that's correct. We warm transfer if we can. The way the phone systems are currently laid out that's not always possible, So, we do what we call a "hot transfer" we pass along the details and may stay on the phone with the individual until the MCRT can confirm they can call this person back. Just so we can maintain that safety and not just put this person on hold for sometimes potentially 5-10 minutes until we get ahold of a crisis team.
Dr. Jones: Kevin is speaking of what is happening now. But these protocols are actually under review now. There is more discussion around how that happens, how rapidly it happens, who specifically in the 590 program should be taking the call, do they have the capacity to take the calls immediately, and how do we minimize the conveyance of information so they are sharing information. Again, everything that happens in the transfer of calls or information is still being worked on by the state.
Dr. Markul: Level 2. Now we are going down in levels of risk. There is someone calling with no immediate threat to life, no weapons involved, no homicidal statements, some vague suicidal statements with no clear plan or means to complete, no physical aggression, psychosis with possibility of escalation due to intoxication. Less urgent response with these calls with options for MCRT response or co-response team or EMS if appropriate. The dispatching agencies can be 911 or 988. The response time if it's going to be law enforcement EMS will be immediate. If it's a MCRT the response time can be up to 30 minutes. Currently with our CARE team if there is any injury, we're going to go with an EMS response. Minor verbal aggression and unusual behavior is incredibly suggestive. And psychosis I think Lorrie mentioned, clinical diagnosis term with possibility of escalation due to intoxication. It's interesting and specificity.\
Dr. Jones: I think the specificity there is related to the body of evidence that say people who have serious and persistent mental illness the risk for violence increases when there is intoxication.
Dr. Markul: Thanks for that clarification. So, group we are going to be looking at 2s & 3s. We can move onto level 1 if there are no comments. Level 1 these are relatively stable situations that can wait for a more delayed response of up to 60 minutes. Hopefully, 988 will be sending out the times with teams that will be going out there. These situations there is no immediate threat to life, no weapons involved or access, psychosis with no intoxication, no aggression, vague suicidality, unusual behavior, no history of mental health, no history of violence, minimal to moderate intoxication, distress with imminent need of BH support, needs social support. We're not going to discuss this risk level. It's been determined by the state these types of situations are appropriate for a 60 minute response from 988 or MCRT. Any comments?
Jen: I have a quick clarifying question. The 988 dispatch here is immediate or a warm transfer but the mobile crisis response time can be up to 60 minutes because there's some assumption that happens through 988 or directly through 911. I'm thinking about the 988 response time, Is that really assumed to be 60 minutes.
Dr. Jones: No, it's up to 60 minutes. They will get there as quickly as they can. I think the thinking was these kinds of situations do not require an immediate response and some delay in response would be acceptable. And these would be calls transferred from 911 to 988 for MCRT dispatch.
Jen: Oh, I see. I was just thinking the calls where 988 may be the intervention but the point here at level 1 the intervention is the response with a MCRT dispatch.
Dr. Jones & Dr. Markul: That is correct.
Nestor: Is the consensus then that 988 will only deal with low risk there's not a situation where there is a moderate risk as it's been defined, 988 would be first?
Kevin: This is Kevin with PATH. For those who aren't aware I'm designated as an expert consultant of the state. I'm the director of call center operations here at PATH and were the largest provider of 988. It is very much the case that if anything is low or moderate level risk were almost always able to deescalate on the phone alone and safety plan with those individuals alone. It's a very small percentage of calls where we even need to contact a 590 team and especially 911 dispatch. I do just want to clarify that in general. I think there's some fundamental miscommunication or misunderstanding with what might be going on with this risk assessment. Priority one is certainly most of the time were going to be able to deescalate and handle that at 988.
Dr. Jones: The other thing I can respond to is yes there will be times of course in MCRT can be dispatched in moderate situations if they are close enough and able to respond in a timely manner. That's why I said earlier the response time is what is critical. The thinking of the technical subcommittee is that those situations can not really be served well with a 90 minutes response delay. The issue is if the MCRT in the jurisdiction can respond in a timely manner then absolutely that's a choice. The city of Chicago is somewhat different but for may jurisdictions for example, some parts of the regions that have MCRT that are in a pretty circumscribed area and their average response time is lets say 14 minutes then well have all this data to give the regions. Then yes, they may be likely the ones that respond to some of these level 2s. And some jurisdictions that are very rural then the response time is closer to an hour and a half then they are likely not going to be asked to respond.
Nestor: Thank you that makes sense. The reason I ask is because is goes to the sustainability of the programs. If their real estate is only low risk, some moderate risk, but most of the low risk is deflected by the call center then what calls are they actually responding to?
Dr. Jones: Yes, you raise a very good point. I want to say a couple of things to that. One is that, for example, the MCRT, at least in the city of Chicago, it may be across the state, but they are going to be used for other crisis kinds of purposes. For example, they are going to be asked to respond by the office of violence prevention. In some situations that office of violence prevention teams have responded to a violent situation and that there needs to be follow up. Then the MCRT can be involved with that. There are other things they can be involved in. We are clear, we means the UIC Hub and the state, that the intent of the law was to minimize law enforcement response if appropriate whenever appropriate. Because our systems are set up the way they are this is the best we can do now but it doesn't have to stay this way. We are going to encourage the regions as soon as we get through this initial phase where we have to do as much as we can to respond to the requirements of the legislation by June 30. Were aggressively on that path. Were going to pause and ask the regions and state "what's our vision for what we want this to look like?" How do we actually advance this in our state moving us closer to models where there is non police response in many more situations and were not really bound by or MCRT or non law enforcement law is inhibited by the lack of their ability to get there in a timely manner. So what other models can we be looking at? What are the things we should consider? Some jurisdictions pair and have clinicians embedded in EMS systems. Not necessarily law enforcement but their culture and operations allow for a rapid response. There may be some other jurisdiction that expand the workforce in such a way that you can have other community based responders respond in a more timely manner. That's not necessarily the model that the state has now for MCRT. I think the opportunity to think through this with eyes toward innovation is still before us. But this is what the system allows for now.
Dr. Markul: CFD does about 23,000 runs a year that are labeled a psychiatric emergency and there's definitely lots of opportunities for some of those calls to be handled by MCRT as opposed to an EMS provider. MCRT bring the proper tools to those situations to be able to provide the right resources. EMS where were currently at if an ambulance arrives your either going to be a refusal or you're going to an ED. Just to Lorrie's point where we are now and where we want to evolve to we have a lot of opportunities for the future. There's definitely a lot of situation out there available for everybody it's just making sure we get the right resources to the right situation.
Jonathan Z: One area being touched on here too is the subsequent response and turn out. Part of that comes in in the CFD analysis the number one leading disposition is actually a behavioral health disposition meaning there are many opportunities where the ambulance is going to an event that isn't initially flagged or wouldn't be captured by any of our PSAP protocols as being appropriate. That then grabs if there was any where down the road to be able to do a transfer or a hand off to the appropriate agency. You have a lot of area where 988 grantees can help it would really work out to help the overall system and change the outcomes and destinies of these individuals.
Dr. Markul: What were doing now, well in my mind and I think for many of my colleagues at the state and university. This is our starting point not our finishing point. We don't want it to be our finishing point and we don't want it to be. We want to continue to evolve the system in unique ways that really can advance the concept behind the work we are doing and the desired outcome of the legislation ultimately.
Cosette: I feel like one the main issues with that is that were not building in, at least not with this matrix, what is prohibiting us. What I'm hearing you say Lorrie mostly is about the response times being the main thing prohibiting us from building more MCRT and response to moderate risk level. If that's really the case then I think we should have as a part of this process an evaluation of what the amount of teams or providers we need in order for us to feel comfortable in our region. How many do we need in order to feel comfortable as having law enforcement be removed as being the very first name in each levels 2 and 3 of those sections. I think that is a major problem especially towards a bit of what Kelsey is saying in the chat. Some people may be at level 2 and also requesting police not be sent out. But if they are already here in this risk matrix as a major responder then that doesn't allow a person a lot of autonomy over who responds to them and who they want to see which could escalate the situation even more.
Dr. Jones: I hear you and I think it's a very good point. I think most of them say co-responder first. Again, this is written for the entire state, so, in jurisdictions where they don't have co-responder models then law enforcement is the response.
Cosette: It said law enforcement/,,,
Dr. Jones: Yes, co-responder.
Cosette: If you asked CIT, CI International about that they don't think co-responder models shouldn't be the primary models for these responses. Especially level 2 is in direct conflict with CI Internationals guidance on mental health crisis response. But I think the research here is missing. If it's really due to not having enough then that needs to be said here and it needs to state how many do we need.
Dr. Jones: I don't think how many we need is the answer. I think new models are the answer. That is why I said what I said earlier. Were looking forward to the opportunity to use this information and figure out what new models rather than building more of the same. We can build more of the same but is that the right model that were looking at. And what is the model? I think that's part of the discussion we should be having in the very near future. Law enforcement/ co-responder is really co-responder and CIT is law enforcement.
Cosette: I'm talking about CI International who created the CIT training program. They stated for level 2 that law enforcement should not be a part of these responses even years ago.
Dr. Jones: But the co-responder is the first on the list. If there is a co-responder model in the jurisdiction then that should be the response based on the fact that they could respond rapidly. But again, looking forward to more discussion around this. Looking forward for this your group for coming up with ideas about what the system should look like.
Cosette: Well I don't know about that Lorrie. There are only 11 program 590 providers that were sent to our email. In one minute your saying the key issue why it has to be law enforcement or co-responders is because of response time. Well the response time of MCRT and program 590 is much longer because there is fewer of them so they have more volume they have to get to. However, if we increase the number of program 590 available then we could decrease the response time. I think that is the key aspect of research so we could know. Actually only now where your saying only co-response teams can respond up to 30 minutes or below. Actually that's not true. Now mental health crisis teams and other community programs can respond at that rate as well. I think that's something the state and UIC is making a lot of assumptions about without a lot of research to see what their actual response time right now. Because we just had somebody at the last meeting who said they don't get a lot of calls. Which means they probably could have a much quicker response time. But that's something we don't have a lot of research on. Were just making an assumption using this risk matrix that it's going to be longer than 30 minutes or 90 minutes.
Dr. Markul: I think one of the things we have to do is get input from all of our 590 providers to figure out what their response time can be. That's going to be part of the work we have to do.
Dr. Jones: Yea, we have the data on what they recorded as their response times. That report is in the process of being written right now. So we'll have that available for folks. And again if the response time of your MCRT is appropriate for the incident then obviously they can be deployed. But you have to remember this was written for the entire state.
Dr. Markul: But Lorrie, correct me if I'm wrong. It's risk level 2 & 3. So if we decide as a region that law enforcement is not appropriate and we have enough resources who could provide adequate response time then that is our recommendation for the region.
Dr. Jones: Yes, absolutely. Monique can you open all the points on the slide. We already kind of talked about this we know what the toolkits are. We have this nice little work sheet were going to have a standardized way for reaching a consensus and then customize the level of 2s and 3s of risks. The deliverables will be completed and submitted to the larger state committee. We spent a lot of time talking about what's on this slide. Levels 4 & 1 we talked about some tweaks maybe that needs some clarification. However, we will primarily be working with levels 2s and 3s.So we've been having a lot of conversations talking about what we want to accomplish in this region with the resources we have. One of the things I put on my own here but we need to come up with how 911 and 988 are going to interact. That dialogue between both agencies. Lorrie is there anything you want to specifically point out on this slide. Were talking about the concepts. I think one of the things were going to need to do. I don't think were going to be able to accomplish everything we need to in this group so well talk more about the concepts in the sub groups to talk about some of the specifics on there.
Dr. Jones: Yes, that is the point of this. It's kind of giving the regions some guidance. Which is what we did today. We talked about the general concepts. I think the next step is figuring out how your going to. Forutnately, you have one PSAP. Some regions have 15 or 18 PSAPS. Think about how complicated that can be.
Dr. Markul: Were fortunate, we just have one.
Dr. Jones: The deliverables of course is the work sheet.
Dr. Markul: So we'll do the worksheets. After we complete them we will meet. Part 2is the PSAP which is just OEMC working with the EMS medical directors. And I happen to be the EMS Director who already partners with OEMC to talk about how our recommendations can be worked into protocols at the OEMC. Just for everyone's reminder our OEMC. I know Lorrie, referenced some of the software providers. Right now the system at our 911 center. Myself and my co medical directors, we write the protocols for the fire dispatch not the police dispatch. But for the EMS/Fire dispatch and we submit those to the IDPH for approval. If we need to change protocols, it is somewhat easier than working with some of these national vendors. We can make the changes here to reflect what our desires are. One we start working on our PSAPS we'll work with our CAD. OEMC is going to be changing their CAD in the next year or two. We'll make sure all the changes are reflected on there. In preparation, Carla Orlandini has submitted the landscape analysis for our region to the state. We can discuss that briefly if we could. Right now the way things work. We have CIT. OEMC has specific questions to give a CIT response. If there's any kind of medical issue with a MH call it will be transferred over to the EMS side and will usually be a co-response with EMS and police. We talked in our last meeting about our CARE team. I would cautious to the group we have a new mayor elect in the city of Chicago and is supportive of the CARE team and may want to expand the CARE teams. Were all excited about that but right now were still in that pilot status. And well see where things go. We are hopeful they will continue and go from pilot status to something that is currently entrenched into the standard operations with increased hours. Right now the CARES teams are M- F 10:30 -4 , no holidays. Our hope is that in the future that there will be a large expansion. That was reflected in Carla's landscape analysis. The CARE team is operating on limited hours. A lot of information we talked about today. Does anyone have questions or comments from the group?
Unknown: So for this interim risk assessment this is separate from the overall protocols well develop in the end. This is what we are using to come up with the framework for those protocols. Is that right?
Dr. Markul: Yes.
Unknown: I was thinking about what Chief Zaentz said at some point can we add in if EMS or FIRE or police are dispatched. They can turn that situation over to a 590 program. Due to like not having enough time to respond. This was an immediate response, this is a level 3 but really it doesn't need a medical or law enforcement conclusion. Can we add in that kind of warm hard off to do for MCRT.
Dr. Markul: Yes, I think that is something we should do. Because there are a lot of EMS or police calls that really need a MCRT response and for whatever reason they get dispatched but when they get there they understand there are other resources available. But Lorrie that's more of a future oriented goal as opposed to what our immediate work is correct?
Dr. Jones: I would say it could be included but not priority. I think we would go to very rapidly after we get this work done. What were in the process of doing now as regions do this the next step is to actually cross match your incident codes. Again, you've got 3 vendors in 11 jurisdictions that are not using the vendors so they will have to do their own. Is mapping the incident codes using the matrix to the new dispatch decision. So when that PSAP telecommunicator is doing their work collecting their information. Right now the CAD systems kick out a final dispatch decision then they base it on the information in the final coding of the incident code. So what the regions have to do after they work through the matrix is to map their incident codes to the new dispatch decisions and that's what smaller workgroups in the regions are tackling. And again, were working with the vendors. The vendors are helping us match their dispatch codes to the new dispatch decisions and the regions who use those vendors will be tackling that and making the changes. I think that's the work before you now is to look at the incident codes in Chicago and start re-mapping them to the new dispatch decisions. The landscape span which your PSAP should have done is the other piece of information that should be informing your dispatch decisions. Has that been done?
Dr. Markul: Yes, we submitted that too.
Dr. Jones: Good. So that's tied up to the mapping exercise that has to happen next. I don't know if you created work groups to start working on that.
Dr. Markul: I have that as an action item at the end.
Dr. Jones: The 6 moth spread plan. Basically we are in April and as far the work that's been done. Were pretty much on target with protocols and standards which is in purple. Again the work of the smaller groups is to start matching these dispatch decisions and getting things approved. You have your person who's approving right here on the meeting. We have the MCRT time and were about to push out so everybody knows what the average MCRT response times are in their region. And the one thing we have to put on the agenda fairly quickly is best practices for diversion of non-violent misdemeanors. That was a specific requirement of the statue. There have been at least 3 or 4 trainings that have been occurring they are well attended. They are available through university. But the training subcommittee will be convening to approve the training requirements and credential requirements for all crisis workers and the data group is continuing to develop sample reports and kinds of things we should be tracking in terms of data monitoring the system implementation. Were in conversation with a vendor university based group that will help us develop a data system which will allow us to look at data across 988, 590 and 911. Were excited about that. It's going to be a pretty complicated process but I think in the end having the ability to look at the data across three systems will really help us monitor and track what we need to in terms of implementation looks like with a degree of specificity based on the data we can draw from the field. I think we still have a lot of work to do. Were hopeful that we can get at least a significant percentage of this done. We don't know if we'll have all the trainings completed by the end of June. But we'll be able to report exactly where we are by the end of June. The other thing that we are understanding that the piece of legislation that was supposed to actually improve, make some editions make some changes to the existing statute has been stalled. We don't know whether or not that will move forward. There are only a couple of months left of this legislative session and not everyone's at the table wanting to discuss things. One of the thing the legislation did not do, it dropped things on June 30th. It expected everything to be done. It didn't really have any if it's not done what should happen. Other than the groups meet once or twice a year. It wasn't really a lot. And what the state put in there was a lot more detail around continuing the effort, developing some monitoring tools to monitor and track implementation so the system will know how things are progressing and so forth. Whether the legislation is updated or not it's the secretary's intent to keep this work moving. We don't know what that entails. If i''s going to be asking for new appointments or asking people to stay around the table until you know at least what you started is completed. It is the intent of the state and secretary to continue this work regardless of what happens with the legislation. And you can stay tune to more information on that in the next meeting. Any questions about any of this that I covered? Next slide please. These are some of the February and March deliverables we already talked about we know what's before us. Okay, that's it. Any questions about state updates. Okay back to you Dr. Markul.
Dr. Markul: This is a good opportunity to talk about our action items that we need to do. So we talked about developing work groups. I would like to propose we do that to discuss the level 2 & 3s and the matrix and discuss what resource we think should be sent to those calls and what time frame. Lorrie mentioned too we should get some response times from our MCRT will help inform that conversation. With that in mind though, there are some rules on the open meetings act as it applies to work groups. Work groups can only meet with less than majority of a quorum. If we have more than two people then we need to make this part of the open meetings act. I think it would be great if we could meet sometime in the last week of April. Whoever might be interested in discussing the specific types of response. But we need to get that on the books fairly soon in order to comply with the open meeting act.
Dr. Jones: Just to clarify Dr. Markul I think Peter sent you how many people could be in a work group in region 11.
Dr. Markul: I did. I'm looking at it right now. I didn't do the math because I think it was saying about a 9th person.
Dr. Jones: He actually sent you the number for region 11.
Dr. Markul: No I did not see that Lorrie.
Dr. Jones: I'll find out what it is. Because I think…Do you know off hand how many members there are?
Monique: I think it's closer to 15 but give me a minute and I will count them for you.
Dr. Jones: Yea I think it's going to be around 3-4 people.
Dr. Markul: Yes, it is a small group.
Dr. Jones: Youre right. If you want to have more than the 3-4 meeting together then you have to do everything your doing for this meeting. You will have to send a meeting date, it would have to be posted, your agenda would have to be posted, you'll have to take minutes and so forth and post them.
Dr. Markul: That's why I was warning the group that if we want to do that. At the very least I would have to be there. We need a representative from the 911 center, we need a representative from the 590 community and 988 as well. So were talking at least 4-5 people already. Were already going to need to do that. What would be the best format to do that with people. Do people like the online polls like doodle? Do people like those things?
Members: Yes
Dr. Markul: Carla, is there any issue with sending the landscape analysis to the group.
Carla: No not at all.
Dr. Markul: Whoever decides who wants to be in the group. Monique in the next day or two well talk and get a doodle poll out to the group. With the open meetings act we do need to do 10 day I believe. Your timely response will be appreciated. Once we decide that we'll send out the landscape analysis. Lorrie, if it's possible to get those response times for our 590 providers within the region that would be amazing for that group.
Dr. Jones: I'll see what I can do. I think one of the problems we were having is that we did not have a 100% response rate so there going back and trying to contact the agencies that did not respond. But I will check for your region and see. I'll make a note to try and get that to you.
Dr. Markul: It's just understanding what resources we have, how fast they can be to a particular scene and looking at those level 2s and 3s and deciding.
Dr. Jones: Do you have your incident codes?
Dr. Markul: For our dispatch center?
Dr. Jones: Yes.
Dr. Markul: Carla, I'll let you answer that question.
Carla: When you say incident code do you mean what type of event it is? Yes, we have those that are sent by the police department.
Dr Jones: Again, another action item would be to take those incident descriptions or codes and map them into the risk matrix. You might want to do that with one or two people and take that back to the larger group for discussion.
Carla: Yes, because in Chicago when we use an event type or incident code sometimes it has different meanings. So, it might not always fit into risk 2 or 3. It may depend on how it is typed with the information on that event.
Dr. Markul: Carla, I'll contact you offline and we can discuss.
Carla: Sounds great!
Dr. Markul: That's it guys be on the look out for a doodle from Monique and we can decide a date hopefully late next week maybe early the first week of May to get our subgroup going.
Dr. Jones: I just want to make another comment. We are the university is planning to contract with Dr. Saafir so he can come back and continue to co-chair this until we find another behavioral health led provider to be your co-chair Dr. Markul. So, for the next meetings Dr. Saafir will be able to.
Dr. Markul: You've been very valuable to our conversation today we appreciate your attendance.
Dr. Jones: My pleasure.
Dr. Markul: Anyone have any comments. I think the next slide is public comments. If not, we will open it up for public comment. Monique was anyone from the public on this meeting.
Monique: Not that I saw Dr. Markul.
Dr. Markul: The next official meeting will be on May 15. There will be a doodle poll coming out to discuss options for a subcommittee to talk about what we already mentioned. Does anyone have any closing comments they would like to make. If not, we can adjourn. Thanks for some good discussion today guys looking forward to keeping this momentum going with our subgroup and our next meeting.
Dr. Jones: Thanks everybody.
Dr. Markul: Have a great day everyone.
Meeting adjourned at 2: 20 pm.
