Community Emergency Services and Support Act (CESSA) Region 11 Advisory Committee
Meeting Minutes- 06/26/2023 - 1:00 PM
Meeting Minutes - Approved by Members 12/18/2023
Attendees:
- Cosette Ayelle, Jennifer Tomke, Matthew Fishback: present, Nestor Flores Peggy Flahherty: (Caroline), Kelsey DiPirrot, Carla Orlandini, Lt. Schuler: present (Sgt. Archer) Dr. Saafir, Dr. Markul
- Absent: Jonathan Zaentz, Karrah Kohler, Jeff Jamrok, Dr. Jones
Agenda: Introduction, Roll Call, CESSA Update, Discussion & Public Comment.
Dr. Markul: Monique do you know if anyone from the state will be joining this call?
Monique: I don't believe Dr. Jones will be joining us.
Dr. Markul: Most of this meetings slides are essentially state updates. If there is no one from the state, I won't read their updates. It may be a short meeting. Let's get started. I am the Chair Dr. Markul. I believe we will be having a co-chair joining us soon. Is Eugene Humphrey on the call Monique?
Monique: I don't believe he may be attending this meeting. I sent out the invite.
Dr. Markul: As usual, 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 at the end of the meeting. We will begin with roll call and approval of the last meeting minutes. Monique if you can begin with roll call.
Monique: Cosette Ayelle: present, Jennifer Tomke: present, Jonathan Zaentz: no answer, Matthew Fishback: present, Karrah Kohler: no answer, Nestor Flores: present, Peggy Flahherty: present (Caroline), Kelsey DiPirro: present, Carla Orlandini: present, Jeff Jamrok: no answer, Lt. Schuler: present (Sgt. Archer) Dr. Jones: no answer, Dr. Saafir: present. Dr. Markul you are present. End of roll call.
Dr. Markul: I saw Sgt. Archer. Are you on as a member of the public or representing CPD today?
Sgt. Archer: I am representing Lt. Schuler for CPD, how are you all?
Dr. Markul: I see, great to have you. The meeting minutes were sent out last time if I could get a motion for approval please?
Matthew Fishback: I'll make that motion.
Dr. Markul: Thanks, Matt. Can I get a second motion?
Sgt Archer: I Second, Sgt. Archer.
Dr. Markul: Thank you. So I as said at the beginning of the meeting theres a lot of state updates. I can read through the high points. The legislation is extending the CESSA deadline by one year have passed both houses and is waiting on the governors signature. We were supposed to finish our work right about now which everyone realized was unrealistic so we get another year to keep this work going. Which is a huge win for us and will allow us to get more work done with the extended period. So they will use the month of June to build a new plan to build on the lesson we learned to enable the state and everyone to reach their goals. It looks like we'll continue with remote meetings as well. Sounds like the state advisory committee directed the technical subcommittee to develop a process to address the local alternative response. They are using national best practices and they approved this committee. I think what they are saying the interim risk matirx in itself is not be modified and I wish we had someone from the state was here to help clarify this. We had a workgroup and there was a lot of discussion on the wa things are written in the interim risk level matrix and how we feel it can be approved upon. Monique, keep an eye if anyone from the state jumps on to this meeting they could perhaps address some of these concerns. If there is no one to address them, we will leave them as they are now.
Monique: Okay
Dr. Markul: This is for our group specifically. Some of us were on our 5/30 work group. We had a really good discussion then. We discussed the interim risk level matrix, levels 2 & 3 and started some work on worksheet one which is part of our tasks to complete. In discussing the threats to life and property we all agree as it's written it is too broad in the languge. If anyone has their risk level matrix in front of them. The way threats to life and property is wrtitten it bases as no immediate threats to life active assault of others, minimal ability to cause anyone to get harmed, homicidal statements with no plans or access, suicidal with plans and access but no behaviors, recent damage to property, active minor damage to property. We all felt that was a lot to lump into one description. We thought if we can stratify the threats to life and property we have an opportunity to have responses from law enforcement to 590. I know the 590 providers you mentioned during the workgroup you were going to meet to discuss some of these. And if so, can you guys provide some feedback on that meeting?
Jen: We were able to meet.Nestor, Caroline and I to talk about this piece here. Eddie, did I send those notes over to you.
Dr. Markul: No, you did not.
Jen: I apologize for that, I will leave some notes on the chat here and please Nestor and Caroline please chime in if you want to. We talked about stratifying the threat in this level. We broke into scenarios. Scenario 1 where risk level 3 required a primary law enforcement response a secondary mobile crisis response. And scenario 2 trying to explore where level 3 can necessitate just an inperson mobile crisis response. We broke out some of the language in scenario 1. No immediate threat to life with a strong possibility for escalation creating a need for an in person co-response as a primary response and then potentially a secondary response from mobile crisis once the situation is deemed safe. We talked about some indicators that can cause escalation including potential for physical aggression, verbal threats, active significant damage to property, or active assault on others with minimal ability to cause significant harm. That was the language in the matrix. For those possibilities for escalation, again being an indicator that co-response might be necessary first with a potential with mobile crisis response after. We talked about the distinction where just a mobile crisis response may be warranted as the initial response by further defining to include no aggression or current escalation, active minor damage to property or verbal aggression without touching or threats to others. We talked about the definition of threats related to homicidal ideation. The distinction being homicidal ideation with no plan or intent with access to weapons with aggression requiring a co-response. Homicidal ideation with no plan, intent or access to weapons without aggression being a mobile crisis reponse. Suicidal ideation with plan, action but no intent to be a mobile crisis response. In regard to response times. That co-response will look to be immediate and the mobile crisis response time to be within 30 minutes. Another note on level 3, the section around no lethal weapons with plans to access them. We talked about the definition needed here to clarify that objects are being currently used as weaponized intent. In our last subcommittee meeting we had a lot of discussion on what could be a weapon and when. But providing more language that the object is currently being used with a weaponized intent may be clarifying for the call taker. I can send the document to you Dr. Markul and Monique and can share it in the chat as well. Caroline, Nestor anything you wanted to add?
Caroline: No, I think you did a great job summarizing.
Nestor: Yea, I think a visual aspect will be helpful and should be shared.
Jen: I'll add it to the chat now and will send that out.
Dr. Markul: Thanks for that. One thing you pointed out that is important to consider. Although, we may have a primary initial response I think the opportunity to call out the CARE team or a 590 provider. Then for secondary responses, it's a really important concept for us to think about as we move forward. As Carla Orlandini can tell you from the OEMC perspective. A lot of information they are getting on the calls is inaccurate or incomplete or not able to get all the information you need. Once you have resources on the scene who then have an awareness of what's going on and what needs are met then you can get that secondary response that is more appropriate for what is going on.
Carla: A lot of the time it is actually third-party information that is not known by the caller.
Dr. Markul: Yea, absolutely. Once we get a response out there we can get accurate information and the appropriate response. Any other comments? Further on this too. Talking about what was discussed in the workgroup. Identifying what when you say damage to property. Which damage to property that is occurring has a mental health component is difficult for a call taking agency. Right now damage to property will default to a law enforcement response. OEMC does not risk stratify damage to property. That is important for us to consider how that looks. In our workgroup, we did say that people who are decompensated can be damaging property and the more appropriate response is someone with mental health resources but it's just hard to tell at the call taker level. Weapons are the next slide. Jen, it sounds like you guys talked about this too. The assessment of non-lethal weapons is difficult. There were some examples brought up during the workgroup on how a pencil can be a lethal weapon used in the right context. Having worked in a trauma center for 16 years I can attest to that. One thing we mention, is that the non-lethal weapons, really it's best to pair this with the current intent and level of aggression occurring on the scene. Questions? Currently, were doing on aggression right now. OEMC is stratifying violence in two categories. There's the yelling, cursing, pacing category which is considered less. And the punching, kicking or spitting category which is considered more violent. We can potentially refine this more. We discussed level 3 which is more acute. Now for Level 2 which is less acute. Level 2 also has the threats to life and property. Additionally, there is minor self-injurious behaviors without suicide attempt. When you mention injury it becomes an automatic EMS response and very unrealistic to expect a call taker to determine how bad an injury is over the phone. We really need to have medical providers assess that first. As I mentioned, having a secondary response from 590 could be once EMS gets on scene and realizes it's a minor injury then we can perhaps get a 590 response there but initially I don't think it's realistic to expect call takers to stratify a level of injury. For aggression 2 similar comments to level 3. There is opportunity to refine. And for psychosis we all agreed florid psychosis is not a functional concept for a call center. They need specific behaviors they could identify and base their response on that but the word psychosis doesn't mean anything. Also, for the psychosis category in level 2, again there is a lot in this box. They also put evidence of intoxication of drugs or alcohol. I think we all agree this needs to split off from psychosis. Intoxication is really not a precise term at all. Really we should be looking for evidence of impairment rather than a phrase like intoxication. Use of drugs or alcohol should not exclude a 590 response. Several people who could most benefit will have a history of using drugs or alcohol. Rather it really needs to be if they are impaired at the time. If they are impaired they should get an EMS response. But use should not remove the ability for 590 to respond. Any comments or questions? We're going to have a short meeting today unless we have some discussion. As I mentioned, the RAC should really be a report on what the work groups are doing. We had the first work group begin talking about this. We're going to have to ask the state how they feel about our comments. If the risk level matrix is truly a set-in stone document that we can't modify then our work will be short because a lot of what we have here is based on refining and improving what's in the risk level matrix.
Nestor: You don't know for sure if we can modify the risk level matrix.
Dr. Markul: I don't know at this time. My expectation is there would always be someone from the state on all these meetings to sit and participate in all these discussions. If they are ultimately the authority, then we need their input or feedback. It doesn't make for a functional meeting if they don't attend.
Nestor: Well for the record, even a quick overview of the risk level matrix, in my opinion and my colleagues' opinions, does require some tweaking some modifications. In the hour that we spent with the three of us we were able to identify a lot of things we should re-think. I guess getting an answer to whether some modifications will be allowed and whether the state will participate seems important.
Dr. Markul: I agree with that Nestor. I think we all agree with that. I think the original thought was each region was going to be able to tailor these. I understand the concept they are trying to make. The goal of every regional committee is to tailor their intent to something that works for our specific region.
Matthew: I have some questions on how all this is going to work but I think it's things we can get to down the line. Just because of the way of contacting and mobile crisis response. How will that actually happen, is that from 911 if someone is out in the field how would that work. I think that's minutia at this point. But from the last meeting. I think there was some time they said they were going to be taking off for the summer. I don't know if you heard anything about that.
Dr. Markul: That is our next order of business. I am not going to be able to meet in July. I'm not sure if the other co-chair is going to be officially started by then. I would prefer to take July off. Workgroups are able to meet as you wish please report back out to the larger group. Send any comments or summary of the meetings to me. I don't anticipate we will meet in July.
Matthew: Makes sense to me. Other statewide meetings. It seems like they are reviewing what they've done last year and deciding how they want to approach everything these next 12 months. As they settle their method I don't know how much work we can progress next month.
Dr. Markul: Agreed. It is important for us to operationalize some of the things were talking about here. How do law enforcement and ems arrive on scene, and it's determined that a 590 is a more appropriate response how that is going to work. It's important for us to start thinking about. Having worked in a large system for a while things take time to operationalize and see how things are going to work. Anyone any comments or questions. Okay as I said we're going to take July off. If the third Monday still works, we'll keep that to start our August meetings. We don't need to vote right now. If anyone has any comments you can email Monique or I. Public Comment. I think I saw one person from the public. If you would like to comment, the floor is yours. Alright no public comment. That's it. A short meeting today. I'm going to work with IDPH to make sure we always have representation at each meeting. No meeting in July and reconvening in August. If no comments have a great summer and I will see you in August.
Meeting Ended at 1:38 pm.
