CESSA Statewide Advisory Committee Meeting Minutes 10/16/23

Approved by Committee Members 11/13/2023

Community Emergency Services and Support Act (CESSA) Statewide Advisory Committee

Meeting Minutes - Monday, October 16, 2023 - 1:00 pm-4:00 pm via WebEx

Call to Order/Roll Call  

  • Meeting called to order by Director David Albert at 1:13 pm. 
  • Approval of September Minutes:  A motion was presented by Shelley Dallas to approve minutes, seconded by Cindy Barbera-Brelle. Minutes approved by all present members.
  • Members Present: David Albert, Bobby Van Bebber (Designee for Ashley Thoele), Cindy Barbera-Brelle, Brent Reynolds, Shelley Dallas, Drew Hansen, Jim Kaitschuk, Blanca Campos, Emily Miller, Pooja Nagpal, Candace Coleman, Curtis Harris, Rick Manthy, Rachel Ahart
  • Members Absent: N/A
  • Lee Ann Reinert reviewed procedures around the Open Meetings Act and meeting logistics.   

Illinois' Unified Crisis Continuum - David T. Jones

  • NASHP - National Academy for State Health Policy
  • IL is one of five states that received a grant.
  • Behavioral Health Modernization State Learning Collaborative
    • Increasing access to integrated care
    • Cross-sector alignment and braided funding
    • Assessing and building the crisis response continuum and community services
  • Collaborative Participants included - DMH, Office of Illinois Governor, HFS, DCFS, Department of Insurance, Office of Medicaid Innovation, Children's Behavioral Health Transformation Initiative
  • Unified Crisis Continuum (UCC) Initiative
    • Establish a unified crisis continuum for all individuals in Illinois that can: accept, triage, respond, and support individuals experiencing mental health crisis.
    • Ensure parity and equity for the various populations within creating a "no wrong door" policy.
    • Centralize publicly funded behavioral health data in a single repository.
    • Seek to maximize federal funding available through Medicaid.

State-level Initiatives Under Way - Lee Ann Reinert

  • 988 Working Group
  • Deflection and Pre-Arrest Diversion Initiative
  • Program 590
  • Certified Community Behavioral Health Clinic (CCBHC)
  • Pathways to Success
  • Community Emergency Services Support Act (CESSA)
  • NASHP Multi-State BH Modernization Learning Collaborative
  • Opioid Action Plan / opioid Remediation Plan
  • Assessment of Mental Health System Landscape

Candace Coleman: What is your timeline for hitting your goals?

  • David T. Jones: Probably February or March of this coming year
  • Candace: How will that information be shared once you are complete?
  • David: At the moment we do not have a finalized plan. We are open to hearing from others to find out best strategies for making sure the information is complete.

Brent Reynolds - As we progress, there is more money moving into this project. Whatever model we decide on we need to think about what it will look like moving forward if money is not there.

  • David Albert - We are required to engage an outside consultant to make sure we are moving forward with fiscal responsibility.

Kathleen MacNamara - You mentioned in the unified crisis continuum that they are consulting with stakeholders from the community. Is this the slide you showed with all of the various entities or is there another group of stakeholders? And if so, how could one apply to be part of that?

  • David Jones - The real purpose of NASHP is to bring people together across the continuum. There are several different work groups where we have liaisons with our NASHP team. If there are any groups you are interested in, reach out to the workgroup.
  • Lee Ann Reinert - House Bill 3230 does specifically require some stakeholder engagement in a couple different ways. It does not require appointments, so I think what we are trying to do is figure out how to get as broad a representation as possible. We haven't quite settled on exactly how yet. I would say that it will come out through our various channels of communication with participation information shared broadly.

Emily Miller: The communications plan is early on in its inception. One point that shouldn't be overlooked is that even small bits of progress reports that can be communicated broadly go a long way with some people. If there was a little more communication from the State side, it could work positively.

Lorrie Jones: Now that the group understands all these different tables where work is occurring across the continuum, as we move forward, we need to remember that other groups are working on some aspects, so we can table some of the issues for the other teams to work on. Respecting that these are different bodies and the work we each do may affect each other.

Pooja Nagpal: Is there a listing of all of these acronyms? I think it would be helpful for everyone education wise to have all of this information.

Candace Coleman: We could use statistics around mental health in Illinois. There's a stigma around mental health and people may think it's far out of their reach. It would be good to give people examples so they would know how close it is.

Blanca Campos: Please involve us in any sort of programming. There is a lot of nuance across the state. As I'm looking at all the programs there is some engagement, but it would be good for it to be early on in the process. It's not always what is going to fit into their community. Community based providers.

Lorrie Jones: We have developed an Interim Risk Level Matrix, and I think it's reasonable that some of the PSAPs that we have worked with to develop these levels, will be able to refer these level 1 calls to Mobil Crisis Response. There is a lot to get done for this, but I think we can do it. I think there is a lot of opportunity with levels 2 and 3. There's opportunities for local communities to advance their alternative response models. We should think about what it's going to take to support these local initiatives as we think about moving forward.

Lee Ann Reinert: Is that one of those local things? Or is that something that's going to happen across the state?

  • Jim Kaitschuk: If you want to promote a process, there's not going to be one diversion process that works for the entire state.
  • Lee Ann: Are there places that are doing any of this yet?
  • Jim: I think something like this can be done on a pilot level, it's just not called this. They're not going to be the same county to county though.

Candace Coleman: Is there any adjustment available to the Risk Level Matrix? Do we have to use that because there is a lot of opportunity for police involvement where they shouldn't necessarily have to be.

  • Lorrie Jones: I think the IRLM allows that the flexibility is given to the resources in that community. Different areas can look at their co-response models and deploy that. It allows for communities to think about doing something differently. It was written recognizing the system as it is now. As we continue to evolve this can too. We have to have something stable to start with.
  • Candace: I think there needs to be regional involvement rather than standardizing it here. If it's standardized here, it will be very difficult to change.
  • Shelley Dallas: Our protocols and our CAD system can be based on the IRLM. This can change as the system evolves. You just replace that with the protocol vendors. It's off the shelf software, but you can update them with specifics.

Kathleen MacNamara: In terms of how flexible the model is. My understanding is that the law is written the CESSA applies to all units of local government that provide or coordinate ambulance or similar emergency medical transportation services for individuals. Is that still the way the statue is written? Because that does add a little bit of complexity. There are municipalities that have fire and police, but there's many others that have separate fire. The way that it's written it seems as though it is for only municipalities with fire and police.

* The language was updated to reflect that first responders include more than just EMS or police. It applies to all localities.

How do we get from where we are now to there?

Drew Hansen: One thing that would be beneficial is plugging in the Risk Matrix to how a specific area would apply it. It's different between rural and urban areas. The RACs really need to see what that looks like to see realistically how different scenarios work in their specific Region. Some practical implementations work. The region has to see what resources are available and how the IRLM can best be implemented.

Peter Eckart: I think we have to differentiate what is happening at the RAC level versus what is happening at the State level.

Each vendor in each region has different systems as well.

Bobby Van Bebber: Additionally, each EMS system is made up of different hospitals with individual in house policies.

The RACs should tell us what is feasible for each of them.

Candace Coleman: I think there are still people missing from this conversation. I think we need to seek them out and include them.

  • Lee Ann: Are you suggesting legislative review because they are not listed?
  • Candace: Yes

Next Steps:

  • Development of a communications outline
  • Feedback from the RACS, proposed updated timeline, roadmap, etc
  • Other kinds of potential changes we want to put on the table for CESSA:
    • Blanca: 590 providers are not able to assist in the involuntary commitment process. That completely turned our system around. It's not in effect yet, but there was a lot of confusion for a while. It's not in effect until July 2024, but we do not have a plan in place yet.
    • Candace: In involuntary commitment, if you are dealing with a low acuity crisis you won't even need involuntary. Industry wide we need to look at changing policy and procedure or legislation that isn't CESSA.
    • Lorrie: We need money for the Regions. We need to reevaluate leadership within the RAC people that are fully available to do the work. What the structure should be going forward to support innovation at the local level.
    • Realistic timelines. If there aren't timelines, you're less likely to have the urgency to do the work. We have to be thoughtful and use appropriate timelines.
    • Peter: The legislation is very specific as to what constitutes an 'alternative response.' There are some interesting and effective models across the state. There's not just one model that can satisfy the spirit of CESSA.
    • Shelley Dallas: Misdemeanor crimes in progress. CESSA was very specific to the types of issues and responses for this. The 911 operator is not going to know the level of 'crime' going on at the time of the call. It may be the secondary responder that finds this out.
    • Candace Coleman: Who should be added into the SAC? Group composition?
    • Lorrie: In terms of process, the recommendations go to the Director, and ultimately DHS, and they make any decisions on legislation recommendations or changes.

Public Comment:

Jim Moldenhauer: Do you have any idea as to when the se RACS are supposed to reconvene to start discussing some of these things? There have been a lot of points brought up, but if we are looking to do this at a regional level, why are we not meeting?

 Peter: Some of the RACs have cancelled meetings recently in part to await the outcome of this meeting. The RAC co-chairs have their own meeting tomorrow here in Springfield where we will be talking at great length and detail about how to translate the discussion from today and turn it into actions plans for the Regional Advisory Committees.

 Jim: I've been a 911 professional for the last 15 years. I've received calls from people saying 'I'm thinking about harming myself." Okay, where are you? 'Well I'm not going to tell you.' So what am I supposed to do with that? Am I supposed to transfer it to 988? Am I supposed to try and get a dispatch location? We don't kick that call to somebody else in another center. Even if I do blind transfer that call to 988, what exactly are they going to do without a location? They may be able to talk to the person on the phone, but if that call escalates what are they going to do? There has to be a better way for us to dump these calls to 988. It's going to make more work for us all if we do not have a location. Let alone the lack of closure. In 60 - 90 seconds we are supposed to get a location and send someone and I don't know if that will be possible under this. So I have major reservations about that.

Kevin Richardson: From my experience in a 988 center, (I'm with PATH) if someone is calling in to 911 saying they are going to or already have harmed themselves, that's not a call that would end up going to 988. I do want to echo one thing, as this conversation is going on the similarities vastly outweigh the differences between 911 and 988. We have familiar callers as well, we have specific ways we do things for Vibrant as well. We have to build the confidence in both ways. Not argumentative, but the issues that 911s are expressing that they're experiencing, we are experiencing but the opposite way. It depends on who you get. I also want to advocate for some legislation around information sharing. We do not often get closure when we contact 911, but we have a protocol to follow up until we have something. There's issues in the system going both ways. Having a legislative bump to share some information to assist with that and make sure we are legally on the same page would be excellent.


Brent Reynolds made a motion to adjourn the meeting, seconded by Candace Coleman. Meeting adjourned by Director Albert at 4:00 pm.