Community Emergency Services and Support Act (CESSA) Region 11 Advisory Committee
Meeting Minutes- 05/15/2023 - 1:00 PM
Meeting Minutes - Approved by Members 06/26/2023
Meeting began @ 1:10 pm.
Dr. Markul: Open Meetings act, this meeting is being recorded and will be posted to EMH open meetings page. Please make sure everyone is on mute during the presentation. If you want to comment just raise your hand and we can discuss whatever point you have. Appointed committee members wishing to contribute will raise their hand and be unmuted to speak. Members of the public will raise their hand during the public comment period. We will begin with roll call and approval of the last meeting minutes. Monique if you can begin with roll call.
Monique: Dr. Markul you are present. Cosette Ayelle: present, Jenifer Tomke: present, Jonathan Zaentz: present, Matthew Fishback: present, Joseph Schuler: present, Karrah Kohler: present, Nestor Flores: present, Peggy Flahherty: present, Kelsey DiPirro: present, Carla Orlandini: present, Jeff Jamrok: present, Matthew Tokarz: no response. End ofroll call.
Dr. Markul: The meeting minutes were sent out last time if I could get a motion for approval please?
Peggy??: I motion to approve.
Kelsey: I second.
Dr. Markul: Thanks guys those meeting minutes are approved and we will now move forward. Where were at right now. Unfortunately, we tried to orgaanize a sub group last time but no one responded but we'll get to that in a second. Last meeting, we talked about the risk level matrix and the landscape analysis. The co-chairs or chair in this case, I have a plan to try and get through the tasks we need in a pretty short order. As far as deliverables and what we need to get done and back to the state is the completed landscape survery analysis. This was done, thank you Cara Orlandini for getting this done, probably about 6 weeks ago. That is already completed. That informs us what resources are available at least at the 911 center that are avialable for behavioral health responses. We also need to complete the risk level matrices and what kind of response and response time for these. Were going to get data from the landscape analysis and the resources we have and data from DMH on the average response times for MCRTs in our region as well. We need that information to be able to help inform us on how were going to incorporate them in our responses. As I mentioned, the working groups for this work that we have here. As Lorrie mentioned, we do have to comply with the open meetings act anytime we have a group of people that meets a certain criteria. Working groups can only meet with less than majority of the quaram. We only have about 13/14 people in our body. A quaram would be slighlty more than half of that and has to be less than majority of the quaram. If we have 4 people we qualify for the open meetings act and have to post this with an agenda 10 days prior to the meeting. That does put a lot of restirctions. I was able to have a meeting with Carla from OEMC but that's just the two of us so it doesn't qualify for the open meetings act. Non- members in the group can participate in the groups but will not have a vote on the RAC. The open meetings act scheduling makes things difficult for a lot of reasons. 10 days in advance, getting an agenda and getting a scheduling tool out there is what we'll have to do because we do have a fair amount of work to get done. Monique will get a doodle poll out after this meeting. Just please make sure to reply promptly. The RAC is basically a place to record outside of a working group to talk about our status. This meeting right here is not going to be the primary driver behind a lot of the work we have to do. Working groups need to get started soon. With upcoming holidays things can get pushed back. As I was saying the working groups are basically going to be doing reports out us an the interim level matrix completing these work sheets and is the important work that needs to be done. Let me talk a little bit about the landscape analysis was already complete. We can talk about the current resources we have available from Chicago's 911 system for behavioral health situations. We have CIT that is available 24 hours a day for behavioral health responses and so is CFD. The CARES team is still in pilot status, were working with IDPH since it's not a formal response. The availability of this response is limited M-F, excludes weekends and holidays and in certain PD districts as well. It can be incorporated into a response. Our resources are discpatched through OEMC. A lot of agencies have specific proprietary software that use dispatch codes based on questions and responses. The code will determinse what type of response will be dispatched. OEMC does not use this. We have our own dispatch system developed over 20 years ago. They dispatch based on event types. The call comes into police side and the call taker will gather information and classify the event type and will send out CPD or CFD. CIT can be dispatched to any event type through the OEMC that is deemed to have a mental health component on there. CPD takes all initial calls, if it is a medical event then it is transferred over to the fire department dispatch center. CFD call taker stays on the call in case CPD is needed. CFD also dispatches based on event types; for behavioral health situations, it is tyipically psych dispatch event. They have specific questions they ask to make sure it is a psychatric situation and no other resources needed. CFD will always send an ambulance if it is a medical situation. Please let me know if you have any questions. So onto the CARE team and how that is dispatched. The call comes in a CPD district where the CARE team is available. Certain CPD event types can be CARE eligible. They comfirm it's a mental health situation and screen to see if there are any weapons or high level violence. If there are no concerns it will be transferred to CFD. The call takers ask questions to make sure there are no health concerns, injury or overdose. If they answer all the questions then the CARE team can be dispatched through CFD dispatch. IDPH requires that all licensed EMS provider are dispatched through EMS dispatch, not by police dispatch. Other resources we have in Region 11 is our 590 providers. Some of them are not 24/7, some have limited response times. Right now there are no 911 calls being transferred over to the 590 side that I'm aware of. Well take this information and include it in the risk level matrix. Everyone should have received a copy of the toolkit. We will only be customizing levels 2 and 3 of the risk matrix. Level 1 is fine for 988 situation and level 4 requires an immediate response with law enforcement. You can look at what we have to fill out with our final recommendations and send in to DMH. We already have this information from our PSAP which in this region is OEMC. Level 4 needs an immediate law enforcement response +/- EMS. Level 3 is less urgent but still requires a timely response. Depending on whether the CARE team is formalized as a response, we can potentially use this resource for these callsThe hope would be we have the CARE team as part of a response for Chicago. We need to determine what is an appropriate level of response for levels 2 and 3 and a response time. Here's what I've come up with what we here as a group need to work on.We need to formalize our OEMC dispatch process for behavioral health situations using the risk level matrix. We need to go through them and match up critierias and resources and how quickly the resources need to be sent out. We have significant work to complete. As I said, the work groups is where a lot this work has to get done. This group will have to report out on the work that's been done over the previous month. Any comments or questions. As far as these work groups well definitely need to have someone from 911 on the call and someone who represents 590 and anyone else who wants to participate to make sure we are getting the right resources to the right calls at the right time. Lorrie, are you prepared to give the state updates.
Dr. Jones: Yes, sure. Can you hear me? The major state update is the advocates and state parties have agreed to language changes to the statute. One change would extend the deadline to July 2024 which will give another year to work on these efforts. There was another proposed language that could not be agreed to around co-response models, involuntary commitment and so forth will continued to be discussed over the summer months in hopes we can have a complete update to the statute. There were some minimal changes as well. The legislation is moving and should continue to move through the leglistlative process in Springfield. We are planning to pause in many of the regions after the 1st of the year. The work will continue to go on through the background, your work groups will continue. But we wanted to give the region and leadership an opportunity to step back and have some visioning work for what you think the crisis system should look like in your jurisdiction. The CESSA legislation gives us a direction we should move in, but creating a vision for what the crisis system looks like and what is should look like in our region. We want our co-chairs with someone from the behavioral health crisis hub we are going to bring in to help guide those conversations. To make sure everyone has an opportunity to think through how you want the system to go work in your specific area. We will try to get that done over the summer as we continue the backgroud work of changing the systems, the CAD systems and dispatch systems. We always talked about this as an interim risk level matrix. This is based on where the system is now. It's not where we think the systme should end up. We think that visioning exercise should help with that work and were looking forward to giving you all time to discuss where you think the system should be. I think that is all for state updates. There are a couple of other bills we are tracking closely. One is for a 988 work group which would track more closely with reports to the general assembly progress with the 988 system. Another one has to do with the cost analyisis for the entire behavioral health crisis in Illinois. I think that was it Eddie.
Dr. Markul: Okay, thanks. There were these other slides on the importance of people with lived experience. I know this was included in the slide deck and I didn't want to exclude it.
Dr. Jones: Oh right, I didn't know if those slides were there.
Dr. Markul: There's a few; stereotypes, myth busters, mental health.
Dr. Jones: Let me go through those quickly. We always want to ground ourselves and remind ourselves as we do this work and who we do this work for. Were committing our time and energy for whom. Which is people with mental illness. They should be at the table in every conversation we have. They should also be our north star in the work we are doing. Some of the regions and some conversations we have had some other folks around the table that don't really know the system as well as behavioral health folks. Those of us who are mental health providers who've been working in the system for years have perhaps a different level of understanding of strengths and opportunities for those with lived experience. Those that we have brought around this virtual table from other disciplines may not. So we want to make sure we are taking every opportunity to eliminate any stereotypes that we have of persons with mental illness. One of the big ones is that they are more violent than the average population. The reality is people with mental illness are more likely to be victims than perpetrators of a crime. There are some mitigators around that. Persons with mental illness who are not medicated or are using substances than their risk for violence goes up. There are other stereotypes that they can't learn, they aren't intelligent. There are lots of things. I think we need to work hard to recognize those stereotypes and educate ourselves about what living with mental illness is actually like. Particularly, since we know the general data suggested it was 1 out of 5 and now I think it's 1 out 4 persons in our communities experiencing mental health not well being. Mental health myth busters: mental health problemare rare again, 1 in 4 Americans are affected. People with mental illness are violent but we talked about that; only 3 - 5% of violent acts can be attributed to persons with mental illness. We have to really be careful now particularly since we know there are people in our country who are quick to attribute all gun violence to person with mental illness. You know when we have these mass shootings it's always a person with mental illness and we have to do more to address mental illness. Now of course there are other reasons why there is violence in our communities but that helps to advance and further these stereotypes so we have to be careful not to let that happen and correct people with this kind of information whenever we can. Another major one we hear a lot, people with mental health never recover. And research shows that people with even the most serious mental illness can and do get better. Particularly, if they have supports, medication they need many recover completely and go on to live productive lives as members of our communities.Developmental disabilities and mental illness are life long conditions and can affect the mental health and well being of an individual but there not mental illnesses and there's no treatment for mental illness but of course there is treatment. Again, take a look at these and arm yourself with information to fight these stereotypes and myths when you hear them. This is basically our work at a glance. We tried to complete this work by 6/30 which we thought was super ambitious and not very likely. And of course as we get into the work we now know that is not going to happen but we've been hopefully given a different runway to try to advance this work. This slidedepicts a lot of the work that has been done and work that is remaining. This one in particular, shows different committee standards and protocols and data communication and training what the deliverables are and I think by and large were probably by many areas were at abou mid march. Were still behind in work that needs to be done in April. We have made progress but there is still a lot of work to be done to make these system changes. Just as a note, many of us or contingent of us folks, state staff and behavioral health staff are going to Virginia in July. It is the only other state that is doing a statewide implementation very similar to CESSA they call it the markus alert system based on similar kind of incident that happened to an individual in the state of virginia. Were going to do more collaboration and sharing in terms of process and best practice and findings as we kind of go through the process of doing this work in large urban areas, suburban and rurual areas across our respective states. Were looking forward to sharing what learn from Viriginia as well as Viriginia is looking forward to what they learn from Illinois and will happen in July. So we may come up with some new ideas. CESSA from the statewide perspective, does it make sense for us to structure different kinds of opportunities for folks around the state to get together. As you work on these dispatch decisions and challenges related to that and start collecting data. Does it make sense for us to bring the urban communities across the state together and the rural communities, their issues are different than Chicago. Give them an opportunity to get together and brainstorm best practices for how implementation will work in their communities. Were looking forward to having those discussions and advancing our implementation in a way that we can continue to learn and support everyone across the state as they do this work.
Dr. Markul: Thanks Lorrie, I appreciate it.
Dr. Jones: Any questions.
Monique: There is a hand up from Jen Tomke and a queston in the chat box from Cosette.. Cosette asked how do we sign up for the working groups.
Dr. Markul: Hopefully, last time you received a doodle poll for the availability of when we were trying to schedule the working groups so everyone on this committee is invited but as I mentioned given the complexity of everyone's schedule were going to give options to what days and times and pick the date that is most aggreed upon. And I know the next meeting is June 19th so if it is a federal and state holiday then I guess we should reschedule the meeting. Are people able to do the 12th or 26th of June?
Monique: I think we will have to push the meeting back to June 26th to make sure we are meeting the deadline to submit the meeting time.
Dr. Markul: I think your right I'm checkin my work schedule.
Dr. Jones: Are you talking about the 26th Monique?
Monique: Yes
Dr. Jones: That's great, Eugene Humphrey from HRDI will be the new provider partner for this effort. He will be able to join for the June meeting. Dr. Saafir will hopefully be able to join the meeting as a consultant to the behavioral health crisis hub to orient Eugene on the roll of the provider partner as the co-chair and provide administrative support.
Dr. Markul: That's great. Unless anyone opposes I suggest we move the next meeting date to June 26th.
Monique: There are a few responses in the chat box saying they are available either day. I will go ahead and change the invite date.
Dr. Markul: Yes, a new doodle will be sent out. Any other questions.
Jen: I have a question on the points you were discussing on the visioning of the crisis system and planned discussions this summer. Lorrie, can you clarify if your talking about broader system visioning or still speaking within the perview that CESSA oversees how the mobile crisis and 911 system work together.
Dr. Jones: The latter, specific about behavioral health crisis response in Region 1.
Jen: Thank you for clarifying.
Dr. Jones: Any other questions Monique that you can see.
Dr. Markul: Any comments or questions from anyone? Next meeting date will be changed to the 26th. Anyone from the public, now is your time? I'm hearing no comments from the public. I think that is the last slide. Guys I will coordinate with Monique and we will get another doodle out. What I envision the first work group is talking about what were currently doing with the city as far as how the CARE team is dispatched and using that as a start of a conversation as to how were sending out. What were currently doing for screening for behavioral health calls and how we currently are using a risk assessment on there and hopefully be able to apply some of that with the risk level matrix and start getting some of that work done as well. The second part of the conversation is to figure out what opportunities we have to get 590 involved in this because regardless of how aggressive the new mayor is seeing chicago having a 24/7 CARE team type of response is probably not going to be a reality so there will be opportunites for our 590 providers to go out and respond to go out and respond to specific situations we deem as safe. I think it's important that we start doing the groundwork to see how were going to get you guys involved and when were going to get you involved. Those are a lot of important conversations so please respond promptly to the doodle poll and well get our first workgroup going here. We have to wait 10 days so hopefully within the next two weeks well be able to get that first work group. Any final questions before we officially adjourn?
Nestor: Quick questions what happened with the last time with the doodle. I responded and I saw it on my calendar. So what do we need to do differently.
Monique: Yes, I received Nestor's right after I sent the email to you. After I cancelled the meeting I started receiving accepted invites but we missed the deadline.
Peggy: Yes, see I also responded to the doodle.
Monique: Yes, not sure what happened. We will send out another invite.
Nestor: So were going to try again, got it thank you.
Dr. Markul: Yes, sorry about that. My understanding no one responded yes and we waited pretty close to the deadline.
Monique: Yes, it was the day we had to cancel. Dr. Jones informed us we surpassed the deadline so we had to cancel it.
Dr. Markul: Well make sure we get that out. It sounds like we have a lot interest so if we don't get a response we'll make sure we are making this happen. Any other questions or comments? Alright guys expect a doodle and enjoy the rest of your day.
Meeting ended 2:02 pm
