CESSA - Region 3 Committee Meeting Approved Minutes 03/21/2023

Community Emergency Services and Support Act (CESSA) Region 3 Advisory Committee

Meeting Minutes - March 21, 2023 - 8:30-10:00 via Teams

Meeting Minutes - Approved by Members 06/20/2023

Call to Order/Introductions

Diana Knaebe called the meeting to order at 8:33am.
Member Attendees: Matthew Johnston, MD, Diana Knaebe, Kristen Chiaro, Chad Dooley, Jessica Douglas, Brenda Hampton, Trenda Hedges, Daniel Hough, Olivia Mefford, Christopher Mueller, Sara Rolando, Mark Schmitz, Andrew Wade, Katrina Moseley
Public Attendees: Taylore Davis, Matthew Fishback, Samuel Jones
Absences: Andrew Dennis, MD, Scott Hough, MD, Raymond Hughes, MD, Devron Ohrn, Scott Pasichow, MD, John Simon, Amy Toberman

Meeting Logistics/Open Meetings Act

Open Meetings Act site at the Office of the Illinois Attorney General
Meetings are recorded. You may choose to turn off your camera.
Minutes will be posted at the Illinois Department of Human Services Division of Mental Health on the Open Meetings page.
Minutes will be posted after they have been approved at the following RAC meeting.
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Only appointed members may contribute to the discussion at any point during the meeting. Members of the public will be able to speak during the "Public Comment" session of the meeting.

Approval of Minutes from February 21st, 2022 Meeting

Motion to approve the minutes by Dan Hough.
Second by Jessica Douglas.
Mark Schmitz emailed that Schuyler County was misspelled. Correction was made prior to the meeting.
Motion carried. No opposed. No abstentions.

Introduction to the Interim Risk Assessment Matric and Toolkit, Part 1 - Diana Knaebe

Last meeting we talked about the continuum of response from police to community.
The state is envisioning a continual response based on conditions and potential lethality of each crisis call. CESSA does not prohibit law enforcement from participating in resolving certain situations and co-responder models and CIT training remained valuable assets in this continuum. A diverse set of innovative law enforcement and behavioral health collective collaborative models are being tested and implemented all across Illinois and nationwide.
The interim risk assessment is a tool that is structured conversation about matching the right dispatch or response to the specific types of mental health crisis. It describes different types of crisis and matches them to different levels of crisis response based on the nature and lethality of the crisis. It is developed based on national best practices, with expert consultant input from Illinois, developed and approved by standards and protocols reviewed by the CESSA Statewide Advisory Committee. It is an interim document and is designed to be used by the members of our Regional Advisory Committee (RAC) as a part of the discussion leading to protocols and standard recommendations. Please note that the Risk Matrices described here and in the Toolkit are for working purposes only. At this point, it is not for public distribution. Please do not submit this to anyone in the public or to your group, thinking that this is the finished document.
Emergent Risk - Level 4 is the highest level and needs a response from law enforcement and/or EMS. Once the scene is secure, they can then determine if they want to bring in mental health professionals. Do not need to have all of the situations that are listed under Level 4, just some combination of the situations.
Urgent Risk - Level 3 & Moderate Risk - Level 2 will be the two areas that we will really spend a lot of time looking at in work groups. We need to look at the distinction between Level 3 and Level 2 and weather this is doable in each of the PSAPs within our region.
Low Risk - Level 1 - The state has determined that as long as the Mobile Crisis Response Team (MCRT) can get to the site within 60 minutes,that should be the preference of the response.
The first part of the risk matrix toolkit is looking at a standardized approach for reviewing and customizing the risk matrix for Levels 2 and 3 response times, dispatch response types for each region or sub areas, taking into consideration current available resources and circumstances to respond to behavioral health and mental health crisis calls.
The toolkit will provide a standardized methodology for reaching a census on customization of Levels 2 and 3 of the interim risk assessment matrix for mental health, behavioral health crisis calls and/or for planning their work. The RAC may elect to perform their work as a committee of the whole or the work may be delegated to a subset of committee members. The final document with recommendations, is subject to the review of the CESSA Statewide Advisory Committee and approval by the EMS Medical Directors and the Illinois Department of Public Health.
The expected deliverable is consensus agreement by each region on response type and response time for Levels 2 and 3 of the interim risk matrix used for assessing risk level and for making dispatch decisions for mental health/behavioral health crisis calls/communications received by PSAPs.
Jessica Douglas - The PSAPs meet monthly with the statewide 911 administrator and they did go through the toolkit in great length. They are still refining the toolkit before they are ready to distribute it, but the PSAPs are aware and will be on the lookout for that document when it is available.
We do want to start having the discussion about how do we want to go about, as a group, setting up how we will determine the work groups for Levels 2 and 3. We may want to split up by PSAPs and the EMS region areas due to our region not being able to have the same response throughout.
- Dr Johnston - We have 4 resource hospitals in the area and have 7 PSAPs. Quincy and Springfield could be similar with their responses, however, when we get out into the other counties, we may be covering 3-5 counties. Meaning that the response time if going to be greater.
- Jessica - The discussion that the PSAPs had with the statewide 911 administrator and the state's representatives, this toolkit will really help us determine what resources we have. The PSAPs are responsible for gathering information from our law enforcement folks and from our EMS folks. Once it is all put together and submitted, we will be able to see what those different resources are. It will help develop that unique response based on the area.
- Dr Johnston - Is there a time period of when this is due?
- Brenda Hampton - The risk matrix toolkit is ready for distribution, the landscape analysis is not. You can start identifying the subcommittees and start to work on the risk assessment matrix. The due date is April 21st.

Questions from the Committee

Dan Hough - How many PSAPs are in our region
- Dr Johnston - There are a lot of PSAPs in our region.
- Jessica - There are 15 911 PSAPs in our region.
Andy Wade - Are 988 centers considered PSAPs?
- Brenda - No, they are two different functionalities.
Trenda Hedges - Is this eliminating all other forms of dispatching? For example, the Illinois Warm Line has traditionally reached out to support callers and connect them with emergency services if they are at either an urgent or emergent risk. Is this being designed to where it would eliminate the general public from being able to reach out or would we have to go through 988 or 911? I am trying to understand because it says dispatching entity is either 911 or 988.
- Diana - I think that is when the call comes through directly to one of those areas.
- Brenda - 988 is not a dispatching center. 988 will refer a call to one of the 590 programs and make the warm handoff. They will make an assessment if they need to dispatch a team out to respond to that individual in the community.
Andy - Are there plans for 988 to become a dispatching center?
- Brenda - Not at this point. The function of 988 is different than the function of 911. 988 is a crisis resolution entities. They will work with that individual caller in order to address what the situation is and about 90% of the calls are resolved at that level. The intent is not for them to dispatch directly to 590 because 590 is a clinical component that may be able to address or deescalate the situation before a team formally has to go out into the community.
Andy - An example is we had received a phone call from someone that was in the midst of a psychotic break and fit into Level 3 criteria. Should we call 988, 911 or MCRT directly? I think that there is a lot of organizations where that level of guidance would be really helpful.
Trenda - I agree with that. I think that what I am hearing is multiple layers to get the person to the help that they need. For example, if someone calls the warm line or NAMI and we have already done our assessments and support, then we transfer to 988, who is going to do their assessments and support, and then they are going to do a warm hand off to the MCRT who is also going to do their assessment. It sounds like it is just creating multiple layers of barriers verses actual support and help to that individual that is experiencing a crisis situation. It is very confusing for all of us that are involved in this. Especially when looking at the risk level because even the urgent level 3 is no immediate threats to life they are not even making a threat to harm to themselves or others. Can somebody explain why that is an urgent risk level if there is no immediate threats to life? A risk level 3 where you have implied physical aggression, suicidal statements with no active suicide attempt, then the dispatching entity that is listed here is 911. Why do we have MCRT if we are going to dispatch through 911, that seems absolutely opposite of the goals and desired outcomes of creating 590 providers to respond to behavioral health crisis.
- Brenda - The response time is assumed by the PSAPs tele-communicator. It may be considered as immediate. Remember, the MCRT's response times could be up to 60 minutes. They may be different based upon the geographic area, but it may be up to 60 minutes. If the PSAPs tele-communicator is hearing more of an emergency situation based upon what is being conveyed to them by that caller, they may consider that there needs to be more of an emergency dispatch. The MCRT cannot get there fast enough, so they are sending out law enforcement.
Andy - Are there plans for the risk assessment matrix to be used by 988? I want to reduce the overload on the 911 system, but also make use of the MCRT. I do understand what is being said about dispatch time or response time being a critical factor because that could be a difference maker.
Mark Schmitz - Response times are a real concern when the geographies that we are trying to cover as the MCRT, it takes longer to get to some of the lower counties than 30 minutes. That is a concern. I think part of the issue is when folks are talking about there are layers, when you look at the resources the MCRT are covering multiple geographies of 911. The two are not exactly matched up to have the same type of response and I think that is kind of what Brenda is talking about. The MCRT may be able to resolve issues on the phone but it is trying to modulate the fast that the resources are probably not there to have as robust of a response from MCRT as you might have from EMS.
Chris Mueller - Nobody cares about all our different silos. They do not care what each of our expertise are, all they want is help. We can talk about handoffs and everyone doing their own assessments, but that sounds like government to me and is incredibly inefficient. People want to help. I would love to see some sort of technological fix where we have a seamless handoff. We get the call at 911, get the information and start going through some questions. Once we realize is not a proper 911 response, we computerize the information and then transfer what we have to the next entity who is able to pick up where we are at and nothing is dropped. If someone is going through assessment after assessment, that is not good for the citizen.
Dan - I think there needs to be some clarity on 988. Is the purpose to relive the stress from 911 or is it to secure societal groups that do not want law enforcement?
- Diana - 988 is a national line. It was originally the National Suicide Prevention Lifeline and was an 800 number. The wanted to set up a number that was easy to remember like 211 or 311. 988 also expanded beyond just being a suicide crisis line to a menta health crisis line. 988 was not set up to relieve 911, it was to give people who had a mental health crisis a place to call and speak to a trained crisis counselor who might be able to help that person on the phone. There are also other lines out there that are available based on specific populations and all kinds of other things.
Jessica - It takes my 911 center on average 1.6 minutes to process an emergency call for service, whatever the emergency might be. The 988 call center's average call in about 20 minutes. The counselors for 988 are specifically, intensively trained to deescalate those things on the phone whereas in the 911 world, we receive mental health crisis training, but we are processing calls very quickly, very rapidly.
Diana - I don't believe that we are trying to lose sight of what the original law is. I think the complexities are around the 988 system. We are wanting to make sure that if people are needing an immediate response because the MCRT is still being built and in the rural areas we are unable to respond quickly, we want to make sure that a rapid response is being obtained. Is what is being presented in Level 3 as risky? That is something that needs to be discussed at the regional and the local levels. Is the right response to Level 3 be to dispatch EMS response with MCRT getting there as quickly as possible or MCRT responding virtually?
- Trenda - In the real world, that is not happening. We are getting calls where people are in a crisis situation and we are trying to transfer to a MCRT and are unable to get through. Had a call yesterday where it took me 5 calls to different phone numbers to connect to a MCRT. I would love to contribute to the solution and brainstorm how that could be different because it is just not happening right now.
Mark - One of the challenges for the mental health providers is if you recreate 988 at every MCRT Center, essentially you are tasking the MCRT agency to do what 988 is designed to do, which is handle lower level responses. We are trying to figure out how to modulate being open enough that we are accessible, but not so open that ultimately we are recreating 988 at every location. MCRT do not have the same bandwidth as 988 because someone needs to be available to answer the phone, but they may be out in the field. If someone is in imminent risk, I think 911 is a solution, if they are not in imminent risk, 988 is the best design.
Dr Johnston - I agree with that. What we need to understand is that this is a work in progress and will continue to be a work in progress even after our July 1 date. I would love to send a MCRT to everyone in the first 3 risk levels, but unfortunately our resources are not there yet.
Brenda - The interim risk matrix is part of the ongoing process of the standard and protocol committee under CESSA and was developed specifically for the PSAPs. They did not have a document before to help them make decision points on individuals who have behavior, health or mental health crisis. Just want everyone to understand that this is a working document and is not a final form. Feedback from the RACs will be very instrumental for their specific region.
Diana - The task at hand is how do we want to split up the process of looking at the risk assessment matrix. Do we want to split up by PSAPs? Are there any similarities in the 911 systems?
- Jessica - 3 of the 911 systems use Power Phone as their protocol vendor, the other 12 use Priority Dispatch.
- There are 4 EMS directors in our region. Does it make sense to split up on how the EMS directors look at things
- Dr Johnston - Might work well to have the Power Phone and Priority Dispatch users work together, especially because of the education to the dispatchers themselves. Overall risk matrix be talked about with everyone. The medical directors will have to sign off on Level 2 & 3, but I think that working with individual users from each system would work.
- Looking at the levels of response for mental health, it may vary depending on if it is an urban or rural area. Does that figure into how we want to talk about the dispatch response possibilities for Level 2 & 3 based on where someone is located?
- Chris - That is a good question. In Sangamon County, we serve both the city and the county. I do think that it would be good to get the Power Phone & Priority Dispatch users together to see what we can do, what we can't do and what their expectations will be.
- Jessica - Agree with Chris that we are going to have to meet and determine what the status is of those new protocols coming out for those mental health transfers. I do think that as a group that we take the approach of how our areas are set up.
- Will separate the work groups based on the 2 protocols.

State Updates - Brenda Hampton

Do want to talk about the difference between 911 & 988. 911 pings off cell phone towers, so wherever you are in the county, 911 operators can identify your location. 988 does not have that functionality and that is not unique to Illinois. The FCC Commission will not allow 988 vendors to use geolocation so we identify callers based on their area code. The other important thing to know is that when a call goes to 988, it goes into a queue. If a person hangs up and calls back, it appears as if they are abandoning the call. So the message for our clientele population is that if you are calling 988 in a crisis, stay on the line, do not disconnect. The 988 vendors have 2 minutes to pick up a call.
The landscape analysis should be out, hopefully within the next week or so. It is going through the final review process and we are working on guidance now in terms of the communication flow between 911 and 988.
We are still sprinting to July. The deliverables that we wanted to have to the RACs in February are just now getting to the RAC committees. We did anticipate that was going to happen because the work production is very difficult, but we are still sprinting to July 1st.
The training component is having their first training on March 28th and information has gone out to the 590 providers.
Dr Johnston - Do we have anyone working at the state and national levels to work with the FCC on their ability for 988 to use the geolocation? We may have significant issues in the future if we need to locate a caller.
- If there are resources or means to advocate with the FCC to change that, by all means we encourage that. One of the reasons is there has been so much controversy around 988 with the rumors that 988 was going to track people and was going to do all these things that 988 never intended to do. Because of the concerns that were raised, the FCC made a decision not to allow 988 to use geocodes.
- Dr Johnston - I think that it might be good for our 988 areas to track how many times we don't know where people are and how it affects their care so that when we would get a national call for this, we have some information on that.
- That is something that we encourage our RACs to do So not only do you have that information from Region 3, we can collect that information from Illinois.