CESSA - Region 2 Committee Meeting Approved Minutes 05/10/2023

Community Emergency Services and Support Act (CESSA) Region 2 Advisory Committee

Meeting Minutes- May 10, 2023 - 1:00 pm via Teams

Meeting Minutes - Approved by Members 06/14/2023

• Call to Order/Introductions
  • Call meeting to Order by Dennis Duke at 1:01 PM
  • Attendees:
    • Via MS Teams: Dennis Duke, Michael Barr, Brian Murphy, Zachary Gittrich, Ryan Beck, Latricia Seye, Darren Gault, Jamal Simington, Sarah Scruggs, Julie Lewis, Brandon Miller-Gus
  • Absences
    • Sarah Stasik, Sheila Stokowski, Travis Noyd, Todd Noe, Rhonda Flegel, Anthony Walraven, Donald Miskowiec, Christopher Watkins, Jake Herbert, Imad Khan, Chris Rogers, Meghan Moser, Jodi Mahoney, Wayne Gallops, Michael Daley, Luke Tomsha, Allen Haeffner, Matthew Jackson, Steve Delis
  • Guests:
    • Gabriela Vo, Mike Epping, Bobby Leebold, Nathan Shotten, Brittany Bauman, Samuel Jones, Brenda Hampton, Deborah Laveau, Susan Schafer, Stacy Brown
• Chair Update: Dr. Barr shared information from a call held with Dispatch last week regarding some issues to take back with this larger meeting. To be discussed later in the meeting.
• Open Meetings Act - Read and notified meeting is being recorded.
• Approval of Minutes
  • Correction/addition noted to the April 12, 2023 Minutes - No corrections noted - Minutes approved as submitted.
    • Motion by Member Zachary Gittrich, second by Member Darren Gault
    • Motion Approved by all members present
  • Next RAC Region 2 meeting will be June 14, 2023 at 1:00 PM
• Progress on Developing RAC Recommendations for the Interim Risk Level Matrix
  • Dennis Duke reminded members of 590 providers and PSAPs meeting were to be held to complete Landscape Analysis Surveys. To date we've received 14 back out of 26 for region 2. Encouraging PSAPs to work with 590 providers to please complete the Landscape Surveys and turn them in.
  • Dennis inquired if able to identify progress being made or any barriers and called the members attention to the questions provided from the state to address:

• • • Brian Woodford responded from experience across his law enforcement agencies noting there is not consistency as far as co-responders or CIT training.
    • Bobby Leebold responded from their 590 provider & PSAPs meeting a good attendance and robust conversation regarding the risk matrix. Further noted Chief Gault provided recommendations and feedback and was able to complete in one session.
    • Members were in consensus the right people are working on it and regarding extra resources needed, funding was noted.
    • Zachary Gittrich requested to hear from the 590 groups if the funding was to be made up from Medicare and Medicaid reimbursement.
    • Darren Gault shared concern of putting these protocols in place with the inconsistencies. Suggestion provided by Chief Gault were to provide additional funding and provide licenses for people to run the program.
    • Brenda Hampton shared there is work being done to extend the July 1st deadline. Further indicated this has not yet passed in Legislation, but a lot of agreement/expectation it will pass to extend the deadline to 2024. Virginia has a six-year plan to do it. Therefore, not all pieces will be in place due to infrastructure and technology systems which are unable to predict a time frame.
    • Dennis Duke inquired about possibility of UIC Crisis Hub funding.
    • Brenda Hampton shared to help move the process forward with landscape analysis or RAC formulation of recommendations for the risk level matrix, the subcommittees would need to work on these issues. If you do not have committee members to work on this, then that is the assistance that can be provided. It should not fall to the Co-Chairs to aggregate the data.
  • Dennis Duke asked Zachary Gittrich to provide an update from the Protocols and Standards Subcommittee.
    • Zachary Gittrich provided an update noting: The subcommittee met May 2nd and noted the RACS cannot reduce levels 2 and 3. Also when needing to dispatch, 988 is unable to dispatch 590 teams in region 2. However 988 will eventually be able to dispatch, 590's issues are technical in nature. Next item discussed was terms clarification like fluid Psychosis means hallucinations, delusional beliefs, psychosis where someone appears intoxicated but aren't and are not dangerous. Discussed the term emergent as if there's aggression, weapons, danger to self or others those individuals are more emergent than just needing to talk (example knife out to hurt someone verses in their pocket). Discussed EMS only allowed to transport people to the hospital not CSU unless located at the hospital. Also EMS time management waiting on mobile crisis arrival. Discussed need clarifications on expectation and symptoms for autistic related crises. Next meeting is May 23rd, 2023 at 1:00pm.
  • Dennis Duke encouraged members to participate in the RAC 2 Subcommittees as that is where the work can be done to provide recommendations for our RAC to consider. Also noted a couple of the items addressed were noted in the Statewide Advisory Committee meeting regarding medical terminology and funding.
  • Dennis Duke focused on the question raised regarding who is responsible for the scene and for region 2, and this would be a discussion point today.
    • Ryan Beck shared regarding EMS being unseen, the struggle is if dispatched and arrive at the scene, EMS has a duty to stay with the patient unless we can obtain approval from our medical direction to allow that patient to stay on scene without us. That would mean we would have to establish competency to make that decision and then we would have to be able to show that they're not going to be a harm to themselves or others. Furthermore, shared the concern of EMS unit tied up at the scene and cannot leave that patient or they're considered abandoning that patient.
    • Darren Gault responded it's going to need some significant examination because law enforcement may not be the next in line either because there have been many changes over the years. If our presence is an agitation, this is going to need significant discussion.
  • Dennis Duke inquired what is happening now in our regions and sub regions in these situations.
    • Ryan Beck responded what's happening today is the patient are transported to the emergency department. To fix the issue, we would need more resources, funding and providers. Also, if we get the funding would we have the mental health clinicians to hire.
    • Brenda Hampton shared this question has been brought forth to the Planning Committee internal group several times as this group has addressed the need. It will necessitate legal counsels from DMH, Public Health, our state police, and all different forces to discuss. We need time to process and figure out how these components fit together.
    • Zachary Gittrich shared when it comes to hospitals not having enough beds to treat these situations when it happens, just reminding everyone that is an explicit choice for profit institutions not to make sure that they have the necessary requirements because they don't make as much money currently. Also noted McLean County has 70% of our 590 calls are going to their local hospitals to deal with these situations cause the hospitals not putting the funding towards taking care of this. With regards to community, I think that's something that needs to be taken in consideration by all the different groups that these hospitals need to be stepping up in this area so the 590s can be out in the community.
    • Brenda Hampton responded the 3 pillars under the SAMHSA is designed for behavioral, health care is someone to respond, someone to call which is 590 or someone to call 988 and 590 respond. Somewhere to go, which is a crisis stabilization resource that has not yet been built by the state. Considerable discussion regarding funding needs for alternatives to inpatient psychiatric hospitalization or hospital presentation to the ER for someone who may be in crisis.
    • Dennis Duke shared there is a majority of cases that oftentimes have medical comorbidities or addiction issues going on the require screenings that only the ER can do.
    • Dr. Michael Barr concurred the majority of mental health evaluations are done in Rock Island and would not be served at a facility other than the ER due to their equity and the presentations.
    • Dennis Duke shared there has been issues or concerns related to the messaging or scripting from PSAPs perspective. The state is working with 3 major vendors to craft the messaging and scripting to create that in our risk level matrices. It is my understanding this is active work going on now.
    • Brenda Hampton responded yes but there is no timeline.
  • Dennis Duke addressed the question regarding involvement of the mobile crisis response teams in the involuntary commitment process.
    • Zachary Gittrich responded one of the reasons the CESSA coalition wanted it included in the CESSA Law is they were worried if people saw the 590 team show up, if they knew there was a process/possibility they might be involuntarily committed, they would be less likely to reach out. Zachary Gittrich asked for an informal roll call of what members opinion on this.
    • Brenda Hampton shared its part of the discussion, but uncertain if appropriate.
    • Gabriela Vo commented the matter of involuntary commitment is a nuanced and complex matter and questioned how much justice can be done or benefit of taking a vote.
    • Consensus was to revisit this after a future presentation as this was not included in the meeting agenda for action item.
    • Ryan Beck shared concern to be careful that there might be some breach of trust for those providers. Furthermore, shared the intention of them not being involved in that process was so individuals felt safer with those providers and they weren't going to get forced to do something they didn't want to do. Uncertain if should leave it separate or just place stringent parameters on when it would be followed through on.
    • Brian Murphy shared looking at how the legislation is written: responder involvement with involuntary commitment to maintain the appropriate care relationship; responders shall not in any way assist in the involuntary commitment of an individual. Further noted if the intent of CESSA is to divert people away from incarceration and hospitalization, then the legislation as written should be handled accordingly. Further noted he did not want to put 590 responders in a position where they are stepping outside of the appropriate care relationship but utilize the existing resources in place.
    • Darren Gault inquired who then is appropriate to initiate then. If its coming back to law enforcement, he will not do it. If there is a medical health provider with training and is more appropriate to evaluate the individual that they should be involuntary committed, that is where the responsibility should lie.
    • Gabriela Vo responded about the risk relating to involuntary commitment noting the dangers it can exacerbate helplessness and the lack of control and the symptoms related to that, and the stress level and in some case traumatize them.
    • Zachary Gittrich would like to have a presentation to discuss further.
    • Dennis Duke agreed this issue will require further discussion and training. Dennis Duke can arrange an involuntary commitment training/overview from Robert Young Center. Dennis Duke provided an overview of the process for the Quad Cities as follows: should the police or EMS bring an individual to emergency room a licensed mental health professional, along with attending physician or psychiatrist on call make the decision to do an involuntary commitment - may require somebody transported against their will and the certificate is completed in the emergency room.
• State Update
  • 988 Someone to Call slide reviewed. Reminder that 988 technology cannot decern where the call is originating from. Hopefully we will have that dispatchability in the future.
  • Dennis Duke shared Brenda Hampton had already provided an update of the work being done to extend the July 1st deadline until July 2024. All indications that this extension will go through.
• Committee members open discussion - Questions/Answers
  • Dennis Duke inquired of feedback regarding having meetings with 590 providers and PSAPs within their areas for workgroups to complete the deliverables.
• Schedule Remaining RAC Meeting
  • Next RAC 2 Meeting Date: June 14th
• Open for Public Comment - none noted.
• Meeting was Adjourned at 2:00 PM by Zachary Gittrich, seconded by Ryan Beck.