CESSA Protocols & Standards Subcommittee Meeting 11/16/2023

CESSA Protocols & Standards Subcommittee Meeting November 16, 2023, 2:30 - 4:00 pm via Zoom

Meeting Minutes - Approved by Members 12/07/2023

Call to Order/Roll Call

• Meeting called to order by Cindy at 2:31pm (via Zoom)
• Approval of 10/19 meeting minutes
• Members Present: Rachael Ahart (approved), Blanca Campos (abstained), Brent Reynolds (approved), Jessica (Proxy for Candace Coleman) (approved), Cindy Barbera-Brelle (approved), Christina Smith (Proxy for Lee Ann Reinert) (approved), Drew Hansen (approved), Richard Manthy (approved), Ashley Theole/Leslee Stein Spencer (approved), Shelley Dallas (approved)

Updates on Progress with Protocol Vendors and Timeline (Cindy)

• Crisis Hub has had multiple meetings with PowerPhone staff. They have agreed to review all "identified" incident protocols that may have relevance for persons experiencing a BH crisis.
  • Crisis Hub and state partners will draft additional questions for possible inclusion in protocols. We hope this phase will be complete by January 2024.
  • Question team will include licensed clinicals, expert consultants, and a person with lived experience.
  • Once changes are approved, PSAPs may begin submitting requested changes for approval. It may take 4-5 months for making changes to 50 PSAPs once approvals are obtained.
• One PSAP will serve as test site to beta launch the changes and to provide final feedback to the team prior to implementation across the state.
• Anticipated Timeline
  • November 2023 - Agree on incident protocols requiring change
  • January 2024 - State partners submit suggested changes to PowerPhone
  • January 2024 - PowerPhone accepts changes
  • April 2024 - Changes are submitted to EMD for approval
  • May 2024 - Changes are beta tested at one site and system goes live in test site
  • August 2024 - PowerPhone executes changes in other Total Response PSAPs
  • October 2024 - Other Total Response sites train staff and go live

Discussion on Next Steps with RACs (Lorrie)

• In the October in person meeting, we asked the RACs to develop action plans to advance their work after identifying 1-2 sites in their region to start making these changes.
• We are working to figure out a leadership structure that allows us to focus more hyper-locally. We are having discussions and soliciting feedback and ideas from folks so that we can have recommendations going forward on the best structure to continue this work beyond July 2024.

Discussion of Elements Protocol for Call Transfers from 911 to 988 (Brenda)

• We have been working on a document for a while, but really wanted feedback from National Emergency Number Association (NENA).
  • This document serves as a blueprint incorporating elements of NENA's draft standards for 911/988 interactions.
• The objectives of this document are to:
  • Clarify calling procedures between 911 and 988. 911 can not directly call 988, as 988 does not track by location.
  • Ensure consistency in managing and transferring calls when there's an indication of a mental health/behavioral health crisis. Ensuring we're handling the care of an individual in crisis.
  • Determine appropriate dispatch decisions or referrals, including referral to 988 and ultimately transfer over to 590.
• 988's role is to primarily try to address that crisis on the phone. They're listening to the individual and their situation, they're coming up with a safety plan. They will arrange follow up as necessary.
• 911's role as emergency responders to assess an incident and determine the appropriate response quickly.
• The guidance outline discusses sharing approaches between 911/988.
  • Warm transfer is ideal. If a call comes into 911, there should be a warm transfer to 988. There will be situations where that's not possible, but we want to maximize the probability.
  • It includes information on assistance and call transfers from 911, so that gets a bit more specific. What is the PSAPs name? What is the callback number? Incident number? Goes both ways.
  • There is currently no technology that can automatically transfer information between 988 and 911. Until the exists, a phone call is suggested.
  • If 911 needs to transfer to 988, there needs to be a dedicated phone number. We are brainstorming if there should be one 988 vendor that receives calls or if there should be multiple. We want to ensure 988 answers timely so 911 is not waiting on hold.
  • Currently writing procedures on how to proceed.
• Shelley: Asked if 988 would be the dispatching agency for MCRT or 590.
  • Brenda: Answered yes. We have to start to build this structure and make sure that it's solid.
• Rick: Asked if an area has their own mobile crisis team, like city of Chicago, is that looked into with the vendors as far as dispatching a local crisis response team vs. transferring to 988 and going to the 590 providers.
  • Lorrie: We are working with the city of Chicago, region 11, to figure out how to make use of their teams and how they would relate to the state fund MCRT and how they are dispatched through 988. As other jurisdictions decide to develop their own MCRT, maybe some counties will and we will have to work with them on how that fits in.

Discussion of Proposed "Coalition" Risk Level Matrix (Lorrie)

• Crisis Hub received an email from a Protocols member requesting that a coalition of advocates have proposed changes to the IRLM. Displayed the approved IRLM with highlighted changes. Opened up the floor to Access Living to discuss.
• Jessica: Proposed we use data collected to re-assess the IRLM in the future to inform decision making. Some members of the coalition have concerns with the IRLM: trying to standardize the response across the state of Illinois might unintentionally allow for law enforcement presence in situations that aren't necessary. Looking at level 3, it says no immediate threats to life with active assault on others and we have suggestions. Compromise could be to have law enforcement nearby in case the situation escalates to a level 4.
  • Shelley: Discussed how 911 centers are dispatch entities, but they do not dictate law enforcement protocols. Thinks that if we put this in a dispatch matrix, it goes above and beyond the 911 call center dispatching responders. We can't dictate how they respond. They have their own policies for each code and how they respond to calls. Suggests that this is overstepping boundaries of 911 centers, our dispatch policies and procedures, and even the risk matrix can handle.
  • Jessica: Clarifies asking if question was about the dispatch response type co-response?
  • Shelley: Asked what the 911 authorities to do when there is no co-response model available?
  • Zack: The difference in level 3 dispatch response time between the interim and what the coalition is proposing isn't much different, just simplified the language. Currently, co-response is dispatching law enforcement and MCRT at the same time, not that they're working together as a correspondence team. Not expecting PSAPs to be demanding law enforcement do something, just trying to give them as much information as possible. Re: symptoms of mental illness such as delusion, etc. Recommended back in June to replace florid psychosis.
  • Shelley: Suggests that MCRT shouldn't be listed on a 911 dispatchers card if they are not going to be dispatching. It becomes somewhat problematic. Suggests that it instead of MCRT, it should read transfer to 988 for MCRT.
  • Zack: Suggested committee reconsider whether 911 can dispatch MCRT, because in some places they already are.
  • Shelley: Asked who they recommend they send in areas where MCRT is not available. 911?
  • Zack: The way CESSA is written, if you don't have MCRT then you would send LE and EMS.
  • Drew: Though IRLM was developed as a base foundation, just a starting point for RACs. The state is very diverse, the RACs will have a better understanding of their areas. Adding more complexity, more language to it at a state level doesn't make sense. Would rather is be more generic and flexible at state level so RACs can tailor it to the people they serve.
  • Zack: Agrees with comment, but states that the RACs are not able to make these changes.
  • Lorrie: The IRLM is a tool to start with at baseline. There's a lot of flexibility on who can respond based on resources that are available in that community. That's why it can be region specific. If a region has a co-response model, it can be activated in level 3 emergency. If they don't have co-response or a MCRT that can get there immediately, then it goes to law enforcement. It was developed to afford region's flexibility based on the resources available.
  • Rick: We added 4 levels, instead of just 3, in case an agency or a PSAP has got another alternative between sending LE and sending LE/EMS and transferring to 988. The firm part of the IRLM is determining what is a level 1-4. Asked once determined, do PSAPs have the ability/flexibility to say that yes, the 911 vendors are going to determine what those levels are. For level 2, you may send LE and in another area/PSAP, you might be sending MCRT. Is there some flexibility in that side of it or is it pretty much the criteria that sets the level and the response?
  • Lorrie: The response types give you a number of different types that you can choose from. If you go to level 1, its 988 or MCRT. In 2 or 3, there's gradations where they can rely on co-response or other models, if available and can meet response time requirements.
  • Jessica: Asked if we can set up a time to look at IRLM in future once we have data?
  • Lorrie: Suggested that this makes sense. We can collect data all along and start to look at it and then start making recommendations for changes. But, making changes in the middle of this extensive work would stop the work - we would have to start and go backwards.
  • Bobby: Echoed Lorrie's point. Thinks its important to remember that the IRLM that this group voted on is the starting point. We're collecting data, and will see evidence of what's working and what's not and opportunities for improvement. Looking at quality assurance and quality improvement processes. Any changes will delay he implantation of CESSA. Very pleased to see coalition interest in this.
  • Rachel: Noticed that there's not currently a co-response team as dispatch for level 4. Suggested it would be a good idea to include it. Her police department currently utilizes co-responders. They have mental health workers ride in the cars with officers and don't restrict calls that they're able to go to. Would like to see this as an option, especially as co-response is becoming more popular. There are situations described that have successfully utilized their co-response team and she would hate to see that as a limiting factor with not having that as an available option in level 4. Agrees that it becomes more confusing when you add in more information. If 911 gets a call and it's a LE response, most likely LE is going to get to the scene and based on information gathered on scene, theyre going to request back to dispatch to send a mental health provider, a co-response to the MCRT, whatever is available. The decision isn't based on the 911 dispatcher, but EMS or LE that is on scene.

Next Meeting Dates and Next Meeting Agenda

• Next meeting is Thursday December 7, 2023.

Public Comment

• Zack: This version of the risk level has not trickled down to the regional level. The first section of the bullet that's how you explicitly know which one it's going to be in and based on PSAPs that he's talked to and the CAD systems, feels it would be more effective way of allowing those protocols to be developed so that they can quickly assess situations. Heard general confusions on florid psychosis and it seems like there was some agreement that it would be changed. Even though regions were told they could make recommendations, they are now not allowed to. There's a disconnect between what the SAC says they're able to do and what they've been able to do. Heard from many members that IRLM is a good first step, but very confusing. Goals for level 2 was more of an alternative response. But at any point, MCRT may call LE and it's not in violation of CESSA.
• Matt: Cook Co. Sheriff's Office has offered virtual co-response to all LE agencies. Currently 28 municipalities have signed on and 9 are in the onboarding process. Relationship between 911 and 590s have come up often. If 911 gets a call and they will transfer to 988, doesn't think 988 is capable of saying they'll have a MCRT there in 40 minutes. If 911 was able to transfer to 590, they can say "I'm in the area, be there in 30 minutes." Suggests a direct line drawn within these protocols as they're developed would be useful.
• Motion proposed by Jessica: Re-evaluate the interim risk level matrix in August 2024, in light of forthcoming data and other future developments. Seconded by Rachel.
  • Nays: Blanca, Cindy, Christina, Drew, Bobby, Shelley
  • Yays: Jessica
  • This motion did not carry.
• Blanca: Suggests that it is important to reassess. But in terms of available data, not sure we will have enough data in seven months. Suggests we should have more data before we consider changing the matrix.
• Motion proposed by Rachel: Add language to the level 4 dispatch response type that reads law enforcement/co-response team. Seconded by Jessica.
  • Nays: Drew, Bobby
  • Yays: Rachel, Blanca, Jessica, Christina, Cindy, Shelley
  • This motion passed.

Adjournment

• Meeting adjourned by Cindy Barbera-Brelle at 4:16pm.