CESSA - Region 4 Committee Meeting Approved Minutes 06/20/2023

Community Emergency Services and Support Act (CESSA) Region 4 Advisory Committee

Meeting Minutes- Tuesday, June 20, 2023 - 10:00-11:30 via Zoom

Meeting Minutes - Approved by Members 01/16/2024

• Welcome/Call to Order
• Meeting called to order at 10:01 am by Co-Chair Julie Brugger.
• Attendees:
  • Jeff Shafer, approved
  • Deborah Humphrey, approved
  • Kelly Ann Jefferson, approved
  • Brittany Pinon-Becker, approved
  • James Hengehold, approved.
  • Randy Randolph, approved

All Members attended via Zoom

• Absences: Dana Rosenzweig, Dave Fellows, Amy Foster, Megan Black, Andrew Stein, Layla Simons, Timothy McClain, Dennis Perez, Steven Johnson, Joe Harper, Cindy Wagner
• April 18, 2023 meeting minutes were approved, Kelly Jefferson made first motion, James Hengehold seconded.

• May 15, 2023 minutes were unable to be approved, only eight members in attendance, not able to form Quorum. This will be attempted at July 18, 2023 meeting.

• State Updates
  • Julie- legislative updates include information on House bills 1364 and 3230. For the House Bill 1364, the legislation to extend this as a guideline by one year has passed both houses and is awaiting the Governor's signature at this point; implementation is being extended to July 1, 2024. Also in this bill, they changed the word "Responder" as it's talking about "Crisis Responders" to instead, "Mobile Mental Health Relief Provider". They did this to reduce confusion with CESSA in that it has talked about providers who are responding to these. People were confused about what that meant; not sure if it was the crisis workers on the mobile crisis response teams and/or did it mean law enforcement, did it mean EMS? The Bill 1364 also removes the prohibition in the legislation. The prohibition that has previously been on Mobile Crisis Response Teams or Mobile Mental Health Relief Providers to participate in involuntary hospitalization. Part of CESSA has always been that MCRT cannot participate in the involuntary hospitalization process. With this delay of CESSA, it allows those MCRT to again provide help to those persons who require hospitalization in the community as soon as we get the Governor's signature on this law. House Bill 3230, what this one provides is basically oversight for the crisis system of care. This includes 988, MCRT, Crisis Stabilization and Crisis Receiving Stations. The idea is to oversee and improve crisis services and access to such and create a cost analysis of funding for these services, as well as follow-up Behavioral Health Services. This law also calls for including recommendations for staffing. It includes broadening the definition of lived experience for Engagement Specialists who participate in mobile crisis response and this law talks about broadening that to be not only personal lived experience, but also lived experience like within a family. Example, if someone had a family member who experienced substance use or mental health disorders and had experienced recovery, those people could potentially also qualify as Engagement Specialists for these teams. Additional updates include that for fiscal year 2024, the SAC as well as our RAC meetings can continue remotely.

• Month of June meeting to develop our plan for 2024-
  • Julie- developing a plan for the work that's yet to be done, all of the training for all of the different members of these teams who are providing these services. In order to make sure that not only do we know but have realistic expectations for what everybody's role is in all of this and how we can all help each other. Also, what trainings are we expecting everybody to have? Per the calendar of deliverables, there has been much that has been completed and there are a lot of things that are underway currently. Approving training requirements for mobile crisis response, 988 crisis counselors and 911 telecommunicators is underway as well as completing basic assignment codes of dispatch decisions and script approval. Recommendations for data system and call transfer information sharing practices is being considered. Also to that list, is approving performance metrics and figuring out the type of reports we are looking for or looking to have as we continue this work. Also, what kind of reports do we want to have on an ongoing basis to determine whether or not the system is working properly; completing a dispatch recommendation based on mobile crisis response times. The DMH is looking at this month in conducting some beta testing of new protocols and the computer aided dispatch system changes. The SAC is looking to receive reports and training for MCRT; determining exactly what training all MCRT throughout the state should receive and then deliver training for 988 crisis counselors. Looking at exactly what training are we expecting our 988 answerers to receive as well as training for 911 telecommunicators. Additionally, implementing a public communication strategy in terms of explaining to the public about what we're doing in this whole process; so they are aware of when to call 988, when should they call 911. Including approving data collection and reporting procedures, reporting the phase data system and call transfer information and sharing recommendations; how they will interact and communicate or what the expectations will be. Our Statewide Advisory Committee directed the Technical Subcommittee of Protocols and Standards to develop a process to address local alternative responses. They based this four level risk level matrix on national best practices. It was approved by the Technical subcommittee that is the Standards and Protocols Subcommittee through the Statewide Advisory Committee. A single risk level matrix is the idea to be used at each regional advisory committee; this toolkit is based on that four level risk matrix. The flexibility and response decisions is based on local conditions for levels 2 and 3 as it was pretty widely agreed on that at risk level 1 it would be fine for MCRT to respond. At risk level 4 we need 911 and law enforcement to respond. With levels 2 and 3, the moderate and urgent risk levels, that's where we had some room for determining what we would like to see. The interim risk level matrix itself was not to be modified, but instead kind of informed by what resources that we have available in our area; are there co-responder models? We have become aware of two different co-responder models that are becoming available in our area; to add to this information about what the local MCRT can do in conjunction with our Public Safety Answering Points and our law enforcement partners. We have communicated that this is such a complicated process that has so many moving parts, requiring us to understand how decisions are made by each involved entity and what expectations are realistic. Our 590 providers in the region are getting to know each other and we're building relationships between 590 providers and our Public Safety Answering Point providers, which has been enlightening and rewarding. It's great to get to know people and understand how all of these pieces fit into the same system. We've developed and communicated our recommendations for response type and response time for those moderate and urgent risk levels. We passed along concerns about several different things that have happened in our Regional Advisory Committee and some of those have included concerns about the 911 law and transferring calls out of 911 into 988 and whether or not that's illegal or appropriate. We've passed along concerns about the definition of crisis being unclear; that it's hard for our community members to know when is it best to call 911 versus 988. We've expressed concerns about information transfer from 911 to 988 and vice versa. How will our emergency responders know when mobile crisis response is coming? Who's going to close that information loop even once everybody has been dispatched? How are we communicating that and how does anybody know whether or not everything has been responded to In order to help our community members who are reaching out? As we think about this, the first question here is, do we have the right people working on it? Additionally, we want to keep in mind is as we continue to move forward, are we willing to continue this process of meeting once a month to continue discussing this? Are there people who need to rotate off of this committee? Do we need to recruit new members? For example, Dana Rosenzweig from the St Clair County Mental Health Board has just retired. This is absolutely going to be one of the one of the posts that we're going to need to fill. As we think about continuing this work and the upcoming work, who are the other people that we need to recruit in order to make sure that we've got the right people working toward this in order to come up with the answers that we need?
  • Deborah- I think that is an important question. Especially in noticing when you do roll call, how many people can really be committed? I would say in regards to St Clair County we do need representation there. I would like to see someone that would follow Dana there. I am just working on our one and three year's strategic plan. One of our major goals that rises up to top is supporting whatever work our crisis involvement is within the community and what we need to respond to that? So I would say the same thing for St. Clair County, I don't know who would be the best person if it's the person to follow or the program manager. I think that is something in house they could decide, who would be the best representative?
  • Julie- does anyone else have thoughts regarding having the right people working on this? Do you think we need to devote extra time or resources toward the risk level matrix? We met with 590 providers and PSAP providers who all serve the same areas to come up with what we feel like our realistic responses and by and large we absolutely agreed with the standards and protocols recommendations or the recommendations that came to us from the Standards and protocols committee. With that said, we do have two new co-responder models in our region that we didn't have before; one in East Saint Louis and one in Alton. They have co-responder models now, crisis response personnel, mental health professionals, that are co-responding with police in both of those areas to respond to crisis in the community. With the advent of those two new programs, does that change in any way what we feel like are our realities in our area? With this additional information are these people that we want to hear from and invite them to a meeting and have them tell us how that's going? They can tell us about their programs and tell us about what the thoughts are behind beginning a new service.
  • Deborah- absolutely, is my response to that. They're going to be beat on the street. They will be able to share, identifying individuals in their mental health, substance use disorders that they see and hopefully providing earlier intervention. We may see them again in the system, but if we know who those individuals are and are able to connect with those individuals on the street, or those that they have that built relationship before, it will help make us aware of what they're doing to respond before the crisis and then us being aware of being connected to them when the crisis does occur. These co-responders are going to hold a lot of information about these individuals and should be providing support for them, so they're part of the system. So if you look at the continuum of services, I would say they definitely need to be at the table and better now when they're starting out. I think it would be a win-win, a help to them as well as a help to the committee, both ways agree absolutely.
  • Julie- I can definitely reach out to them. What help do we need from the UIC crisis hub? What additional support do you feel like we need or guidance or anything of that nature? If you come up with any ideas about any of these questions, just let me know.
  • Peter- I just want to say one of the things that it occurs to me as I'm reflecting on the earlier comment about making sure that we have the right people in the room so that we can have the Quorum that you need to do the work. Julie, maybe it would make sense before the next meeting to sit with you and your and your medical director and just go through the roster and talk about who needs to be replaced and figuring out how to make sure that we get the right people. We will continue to provide the base slides and try to be an effective go between the activities that are happening statewide and what you want to do and are asked to do as a part of the CESSA process. It's nice they've got a whole year, but there's still so much to do and so we want to be as supportive as possible. I think part of it is being honest with ourselves and that includes you and all the members of your RAC about what's working and what's not. We can all pretend everything's fine and having another year makes that easier, but I don't imagine there's going to be another extension. We've got 12 months to get all this done. I'd much rather you deal with anything that's a true barrier, because each region is different. If there's a great opportunity that we need to leverage and support, we want to know about that. What I really want to do is just to commit, and for you to know I will, we will, continue to be as supportive as we can.
  • Julie- I definitely welcome a meeting where we talk about people that we really do need to replace. As abilities change and needs change, we've got to look at who can join, who wants to continue to participate in this and who is available to do so in a real way. Considering those things, absolutely one of the barriers I see is not having a quorum. We're not able to make specific decisions or recommendations and a lot of times we're spending time going back over information from the previous meeting because we didn't have a quorum. We need to keep everybody on the same page and keep everybody caught up, so that does become difficult for sure.
  • James- the EMS system agencies, those have named people that are supposed to be at these meetings or is it they send somebody?
  • Julie- I think it's just that they send somebody. I know you and Randy are actual members of the committee by name, but I know that at the bottom of our membership roster it has different PSAPs identified but it doesn't have a person necessarily identified from them.
  • James- I'm referring to EMS system agencies i.e. like all Memorial Hospital, it just says that each System Agency will have a representative present during the meetings, which that doesn't have a named person. I don't know if that was a position that someone had to be selected for. For example, I was at a meeting for our Madison County 911; we have a medical director that's in charge of us. I asked him "what his involvement was in CESSA" and he said "he was never selected but his name was in for something relative to this RAC". So I didn't know if that was a named sort of situation or it's just randomly whoever they want to send?
  • Peter- thanks for that question. It does identify the fact that I don't think that we communicated clearly upfront. The intention when we were designing the process was that the named Regional Medical Director and I know that that changes according to a schedule and that is also different for each region. However, the named director at that time, was the official chair of this committee; then each medical director for the other systems in the region are all intended to be named and a part of the official quorum. We also recognize that among all of the busy people in this group, EMS medical directors are as busy as anybody else and I think we identified the fact that coordinators, which if I understand correctly, is kind of an official role and that coordinators could also represent the system EMS directors at the meeting. Because the EMS medical directors are such an important part of this process, we need to do better in communicating to each of those directors to ask that they please participate as fully as they are able, and please invite your coordinator to attend in your stead so that we can continue to both have your contributions and your voice, but also make sure that we don't lose the quorum because we don't have your specific constituency. Of all of the different member types of the RAC, the largest one on every RAC is the Medical Directors. I am happy to answer any follow-up questions, but I wanted to be really as specific as I could about that question because it's an important one.
  • James- I think it's very important that they get involved because of staffing levels and EMS. Rigs, the number of wheels on the street that are going to be affected by this directly. How are we going to get these people help? The help is going to occur at all these hospitals where they are going to be discharged without further treatment. I think it's very important that they're part of this conversation.
  • Peter- I think a third reason is because the CESSA Act correctly named EMS directors as kind of the final say because EMS directors by other legislation, approve the protocols and standards, they approve, I think as you just said, the staffing. They approved the training across the system. It's not that they're more important than other members of this group, but they are the final authority. I don't think any EMS Medical director wants to be given the results of their community, multi-agency, crisis advisory committee recommendations without having participated in them. That is another thing for us to talk about, is an engagement process and I think it's probably really important to have your chair as part of that conversation.
  • Julie- Absolutely. I know Jeff knows many more of those individuals than I'm going to know.
  • Greg- this is Greg Attebury. I'm the regional EMS coordinator from the Illinois Department of Public Health. I am from for region 4 and the state liaison to EMS. We have 5 systems, each one has an EMS medical director and all five of them have an EMS coordinator who is either an RN or a paramedic. I don't know that they were individually invited to participate on this; they certainly know about it, but I'm just wondering if you need me to send you those contacts? I know you have some concern about having a quorum, if you add them all maybe they could be invited as subject matter experts and it wouldn't require an attendance from them to meet the quorum. Also, as you talked about the EMS medical director being a kind of end all that is related to state law in licensing for EMS. All EMS licensing personnel from paramedics down to dispatchers and not function independently under their license. They all must function under an EMS medical director. That is the law, that is why it's so important, as if the doctor literally signs off those protocols as a standing medical order from them; just so that's clear to everybody how that works. I can get in touch with them if you wanted to reach out to me or I could give you their contact and you guys can work it any way you want to.
  • Peter- if you could share the emails for the coordinators that would be really great. By statute, I believe that the, those medical directors or their coordinators in their in their stead have to be voting members because of the significance of their roles. Hopefully by being clearer in our communication to them and by allowing their coordinators to attend in their place, we can count on having them participate. Julie, I think we can add this to our agenda when we get together and talk about how to strengthen the advisory committee for year two.
  • Julie- right. Thank you. Thanks, Greg. I really appreciate your input and I really appreciate you sending us the information. Does anyone else have thoughts about making sure we've got the right people working on this? Is there anyone in this group at this point who feels like they are not going to be able to continue this; that the time commitment isn't going to work? Just let us know so that we can make sure that we can continue this work as we continue to move forward.
  • Jeff- as you reach out to these people, if I can have a proxy attend and maybe they can too that may help you with the out having to make any significant roster changes if the people are still interested.
  • Julie- that would be great. I think it makes perfect sense to be able to have a proxy person come for any member who can't make it to a meeting because there are so many things going on in the world today that we have to know that just because we've chosen the third Tuesday of the month doesn't mean that it stops anything else from happening, that's important.
  • Julie- we've gone over some of our concerns and it does seem like a lot of those concerns are being heard and addressed, which I really appreciate on a statewide level. I think that that those will continue to happen. I just think that we have to be really vocal about what we need and what concerns us and what questions we have which leads us to questions from the committee.
• Next Meeting Date: July 18, 2023
  • Gabriela V- was quorum met now at the end of the meeting?
    • Julie- no we did not have enough committee members in attendance to approve the prior meeting minutes. I think that is certainly something that we can talk about if that's something that you're interested in, in terms of becoming a voting member.
    • Gabriela V- yes, I will think about it.
  • Julie- thank you all for joining and participating. We really appreciate your presence here today and your participation and your thoughts. You know, we all need each other to, to do this work and to get it done right.

Adjournment:

Julie- We don't have a quorum so we don't have to have a motion to end this meeting at 10:58. Thank you all. Have a great day.