CESSA - Region 4 Committee Meeting Approved Minutes 04/18/2023

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

Meeting Minutes- Tuesday, April 18, 2023 - 10:00-11:30 via Zoom

Meeting Minutes - Approved by Members 06/20/2023

• Welcome/Call to Order
  • Meeting called to order at 10:01 am by Co-Chair Julie Brugger.
  • Attendees:
    • Jeff Shafer, approved minutes
    • Dana Rosenzweig, approved
    • Dave Fellows, approved
    • Deborah Humphrey, abstained
    • Amy Foster, abstained
    • Kelly Ann Jefferson, approved
    • Layla Simons, approved
    • Steven Johnson, approved
    • Brittany Pinon-Becker, approved
    • Joe Harper, approved
    • James Hengehold; approved
      • All Members attended via Zoom
  • Absences:
    • Megan Black, Andrew Stein, Timothy McClain, Dennis Perez, Cindy Wagner and Randy Randolph

• Julie Brugger provided a display of the slides for the Landscape Survey and Risk Matrix toolkits and gave an overview. Julie stated that 7 of the Landscape Analysis were received from the PSAP's. Meetings have been set up with the 590 Providers and the PSAP's that responded who are willing to participate and discuss the recommended response type and response time for the different risk areas in the Risk Level Matrix on levels 2 and 3. These meetings include five-PSAP's as well as three-590 providers at this time. Julie stated she is continuing to follow up with others to work on getting these small groups together to come up with proper recommendations to the state regarding our ability and what we have to offer in regards to response times. The Standards and Protocols committee has created recommendations for each of the risks levels and risk areas regarding what they think is the best response and response time, and we are responding to their recommendations based on what we think is needed in our region or where we think it may need to be handled differently for pieces in our area; this is why it is so important that many of our PSAP's are involved. Concerning the Interim Risk Level Matrix, Level 4, in our small groups most agreed that for this level, the response type would be law enforcement sometimes with/without EMS and response time would be immediate and is based on the high risk level of those specific risk areas. For the most part those that are considered the emergent risk level, the agreement is that law enforcement goes and EMS is to go once the scene is safe. Assessment regarding behavioral health would be later in the response being that safety is at risk in level 4. In level 3 there is slightly less risk and the recommendations varying a bit in terms of the levels of risk, this is where we will inform the state regarding what is possible in our area in terms of response types and response times. We will be determining if each of these require an immediate response time, which can only be achieved by law enforcement and EMS or is there room for potentially having our MCRT respond and if there is time, and safety can be maintained for the period of time the MCRT can arrived, then how quickly can that response be gathered? All of this depends on the hours of the day, where the teams are responding from and where the crisis is, depending on that physical proximity. We are looking at making a recommendation regarding what we can provide in our area.
• Julie displayed the Landscape Analysis Toolkit example and explained the entries/documentation on the form. Explaining that in some areas there is co-response times of 24/7 or Monday - Friday, in terms of what can be offered in the town or city, as well as the variable in the response time, this also includes the information of the vendors the PSAP's use.

• Comments /Questions from committee members:
  • Amy Foster- I may be bringing something new to the table but I feel the occurrences happening with Choate Mental Health Center are under our same umbrella no matter the type of abuse. I would ask as news is coming out from the event with them, that our region is aware. It has been very upsetting to me and I have been requesting that the state please not close this facility, it is the only place that works with BD and mental health. I feel that we need to include this in our description. I ask that we look into what the state is doing as they make changes. I realize that it is in Carbondale but I hope we can look at the changes being made there. Sometimes people with developmental disabilities in psychosis won't be able to explain what they are going through. I am just asking and I hope we can send appropriate resources. I have been told that 60% of people that have developmental disabilities also have a mental health condition. We have to somehow implement this into the matrix.
  • Deborah Humphrey- Who determines the level of risk?
  • Julie Brugger- Initially that is the call taker, it may be 988 or 911. This is where we will develop what is the best crisis response for our area.
  • Peter Eckart- The order of operations for the Interim Risk Level Matrix will form the structure for your conversations, which is going to result in a set of determinations made by all of you about what you want the crisis response to be in your region. Based on the recommendations developed and those that are approved by your EMS Director. These will go into the mechanics/process of what the 911/988 operators use. The 911 operators will be charged with what is working with the EMS Directors to translate the recommendations the RAC has compiled and approved locally; translating these operations with the 911 centers.
  • Chuck Kelley- I am currently an EMT, studying to become an EMT Instructor. Our agencies within Madison, St. Clair, Randolph and Washington all use Medical Priority Dispatch. Per the questions on the matrix, I can give you a perfect process from our Medical Priority Dispatch directly to your co-response model that you are needing. It is already built for you, it is one card. Most of our 911 PSAP's, generally, once they deem a call, they transfer the call with the location of the caller, what is happening with the caller, then we begin the Medical Priority Dispatch. This is where we find out if they are suicidal, suicidal with a plan, if there are weapons; these situations would change our response model. We do make phone calls back to the PSAP's when we need law enforcement to respond with us. We do need to add something additionally to all of this; how does my agency/location call the right group of people, to get that MCRT mobilized? Once I receive the location of the caller based on all of the information from your matrix, we would be making those secondary calls to possibly law enforcement, or MCRT when there is no imminent threat?

• State Updates
  • Peter Eckart- in a recent SAC meeting, we had a presentation from Nanette Larson. She shared about how sometimes people with mental illness are perceived as well as misperceived. We at UIC think these issues are very important. When CESSA was originally envisioned, it was written into the statute that people with lived expertise of the system would be a part of the process at every level, because of the issues of the people facing mental illness and the stereotypes that others can perceive about them. One of the things that drove the original design of CESSA is the myth that individuals with mental health conditions are violent and require a law enforcement involvement. In actuality, individuals with mental health issues are actually 10 times more likely to be the victims due to the stereotypes. There are many myths as well about individuals that have developmental disabilities, such as they function best within institutions. When in fact, research has actually shown that when you are able to move people into community settings with proper treatment and supports, they are much more likely to be satisfied, happy and productive. Touching base for April and May, certainly Julie and Dr. Shafer will underscore, that the number one priority for CESSA and your RAC is to really get to the recommendations related to syncing the right crisis response with the right kind of crisis. We know that this work is complicated. One of the things that we are offering to any members of your group that would like to take advantage of this, is office hours with Dr. Mary Smith. As you get into trying to do the work of how to address risk levels 2 and 3, Mary and the rest of us are available to help.

• Committee Questions/Comments:
  • Joe Harper- Thank you Peter for sharing this information. Something that I would like to address to the myths on the slide; by and large the people with mental health illness are not violent. I do think it is important to remember that there is a subset of this population that violence is an issue; specifically people who have personality issues that go along with mental illness. Unfortunately, one of the things that we see a lot with the contacts that we have with crisis are often people who with prior treatments have failed, family members and others trying to get them treatment which they might be resistant to, which might raise the potential of violence. I think it is important that we recognize that.
  • Julie Brugger- Peter, one question asked quite often is how will 911 and 988 communicate? Example, a call comes into 911 dispatch, it is transferred to 988 for de-escalation or MCRT, and then the client from the community calls back to 911 asking when help is arriving? How are the 911 dispatchers going to know from 988 what has happened or when to expect someone?
  • Peter- we do not have an answer for this question at this time. Currently there is not a direct informational interface between 911 centers and 988 centers. I do know DMH is working on guidance related to this. I was in a recent meeting in discussing not only how do you make that contact between 911 and 988 but how do we know what happened afterwards; trying to close that feedback network? No one has ever tried to do this. As you all make your recommendations about how to handle the different kinds of crisis, and so the state is working on interim guidance related to the relationship between 911 and 988. There are so many systems that don't connect with each other or 988 systems at this time, there was never a system designed in the past for the interconnectedness that is going to be required in the future.
  • Joe Harper- 988 only accepts calls from the individual in crisis themselves, not family members or other concerned individuals, how that is going to be handled? Are they directed to call someone else?
  • Julie Brugger- Kevin Richardson responded to me that 988 operators are looking up the local MCRT contact number to give to the caller that is concerned about another adult, so the caller can reach out themselves to the their local MCRT to get the assistance needed.
  • Joe Harper- Law enforcement resources vary widely, especially in our area, it is very limited in their availability and/or training, is there anything that is being developed in all of this work?
  • Peter- Some training has been implemented by law enforcement, such as the CIT training. The toolkit work that Julie was describing is some of the work the PSAP's are doing currently to work with law enforcement to try and document as comprehensively as possible the different models response that are currently available in your region. At the Behavioral Health Crisis Hub at the direction of DMH we are doing a lot of work to understand and survey different parts of the system to find out what kind of training people need as the system grows and changes. There is a survey with 911 operators for what kind of training they feel could be needed and offer training to different elements of the system.
  • James Hengehold- to follow up on some questions, if someone who is not directly involved calls 988 for a family member, then 988 will direct them to community mental health center, and I would assume that 988 will have some sort of screening, that if it is a life threat they will be directed to call 911 and not a community health resource?
  • Julie Brugger- in terms of that, for people reaching out to our MCRT in order to get support de-escalation/crisis response, if we believe law enforcement will be necessary to the situation, we are going to head there and call law enforcement while on our way to join us. The ultimate recommendation for people, the only people who can provide immediate response in any way, is going to have to go through 911. MCRT are scattered throughout areas, therefore, while we may be 15 minutes from one situation, we may be an hour and a half for another due to physical proximity. So as for the person reaching out for help, it becomes a difficult thing. Absolutely, if my team gets that call and we believe it requires immediate response, we will call 911. I think that is what 988 operators tell callers as well; letting them know they can call the local MCRT or if they feel it's necessary to get immediate help, they can call 911.
  • Chuck Kelley- what if the call comes into 911 from a legality purpose, how do we protect the emergency dispatchers who are assigning these calls, and they say we are transferring you to the MCRT/988 line, they actually have a duty to act and send an ambulance because it came in thru 911? I have not seen one amendment to allow that transfer of the call without dispatching EMS through all of the legislative changes this session.
  • Peter- I have no idea and have sent out your question to others that can be of more help in this.
  • Chuck Kelley- Right now they have the perfect mechanism to use it, it's Senate Bill 1672, they can easily add that language in as an amendment, its actually is building the entire framework for the 911 PSAP's to integrate the MCRT but does not take away the duty to act.

• Public Questions/Comment
  • The floor was opened for public comment and there were none brought forth.

• Next Meeting is May 16, 2023, at 10:00 am via Zoom

• Julie Brugger made motion to adjourn, Deborah Humphrey made first motion, Dave Fellows seconded. Meeting dismissed at 11:27 am