CESSA - Region 4 Committee Meeting Approved Minutes 11/28/2023

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

Meeting Minutes- November 28, 2023 - 10:00-11:30 via Zoom

Meeting Minutes - Approved by Members 01/16/2024

• The November RAC 4 meeting was called to order by Co-chair Julie Brugger at 10:02 a.m.
• Members Present: Julie, Brugger, Breona Hawkins, Kelly Ann Jefferson, Brittany Pinnon-Becker, Cindy Wagner, and Randy Randolph
• Minutes approved by Members in attendance.

• Members Absent: Jeff Schafer, Deborah Humphrey, Jane Nesbit, Megan Black, Layla Simons, Timothy McClain, Steven Johnson, Dave Fellows, Joe Harper, and James Hengehold

• Tina Saggio conducted the roll call of RAC membership. Simultaneously, committee members indicated their approval or not of the July minutes.
• A quorum was not established with ten of the sixteen RAC members absent. The July minutes were not approved.

• State Updates- Brenda Hampton
  • This is my first meeting with this Regional Advisory Committee. It is a pleasure to meet you all. I have taken over several RAC's and will be working with Julie and the other RAC Co-chairs in order to keep the momentum moving forward and meeting the intent of CESSA. Two important happenings, we are in the process of writing the General Assembly report, which is a quarterly report for CESSA. Likewise, we are working on the 988 report that is due by the end of December.

• October RAC Retreat Meetings- Julie Brugger
  • Recommendations for RAC leadership to consider.
    • How do we apply Level 1 of Risk Matrix to 176 PSAP's (3 categories of PSAP systems/providers) across 11 regions?
    • Assess readiness of each "community" to deflect Level 1 calls made to 911 to 988.
    • What would a plan look like to operationalize this goal in "ready" communities?
    • What would be the corresponding changes in protocols?

• • Julie Brugger: How do we assess readiness of each community to deflect Level 1 calls made to 911, deflecting those to 988? What would a plan look like to operationalize this goal in the communities that are already ready? What would be the corresponding changes in protocols that would be necessary to create this? Whose recommendations do we need to move this forward? We need to know who all needs to agree that this is the right way to do this? What confidences need to be built and what relationships need to be strengthened? What other resources do we need to make these changes possible? What changes are possible prior to having those dispatch protocols changed? What are the steps needed to create those changes? As we start our discussion today, what do you think will be necessary to create changes in the existing process so that callers who are at this low risk level specifically can be funneled to 988 instead of going through the 911
  • Cindy Wagner: As we talked in the previous meetings about education, do you feel as well, it will be a really big thing to get out to the communities? I know there are some articles that have come out that it is a real issue on the public side. What are your thoughts about that?
  • Julie Brugger: I think education is a great idea. I think just knowledge that 988 even exists. One of the surveys showed that the awareness of 988 or what it was there for was less than 40%. We need more public information that 988 is out there and that it can offer support and that from that support, if it is needed, they can send out and mobilize our Crisis Response Teams to come out in person if that's what the communities need.
  • Cindy Wagner: It sounds from the meeting that you had in October, the direction of the State, at some point the connectivity between Power Phone and the protocols with the risk matrix, is being worked on. So, on the other side of it for the 988, I feel strongly that the public just needs to really be more aware of what those services really entail, so that they're not fearful to call confidentiality and that's important
  • Julie Brugger: I think that there is a myriad of ways that some of that can happen. 988 had a soft roll out, when it began, we didn't want to overwhelm the system with every single possible call going to it while it was brand new. Now that it's been enacted for over a year, they're up and running, they're ready. They're aware of the resources that exist in the communities like our 590 programs, services that are that are available in different communities for various services, psych services, substance use services, mental health counseling, case management and so on. So, while that system had kind of a soft beginning, I think absolutely it's time to let everybody know far and wide this is this exists, and this is available and is working. What we have come to understand is that with 988, 80% of those phone calls that come from Illinois are being answered here in Illinois now, which is fantastic. Once upon a time only 20% of those were answered locally. This has been a huge increase over just a year and a half that that 988 has been up and running. I think that it's gotten a good start and I think public information is where we need to go from here. We need the public to be onboard, to be willing to talk to 988 in order to receive the services they need. We need interest from our PSAP and law enforcement partners, as we're looking to move some of those calls from 911 into 988. In terms of that, you know some of the things that they will need to recognize in terms of being involved, is that what people are accustomed to when they call 911 is that they will have somebody at their door in like 5 to 7 minutes; that's what they're accustomed to, it's what we're all accustomed to. When we call 911, we expect an immediate response. If this goes out of the 911 system into the 988 system, there are many of those calls that will be dealt with completely over the phone that won't necessarily need an in-person response, which is very different. The other thing is if the person in the community wants that in person response, if that's what they need, then absolutely that will be dispatched to them. However, those crisis response teams aren't going to be able to get there in 7 minutes; maybe once in a great while if somebody's just down the road. As I look at the program that I supervise for 590, our region that that we cover is vast. It's over 90 miles. So, if somebody is 90 miles from where my crisis team is sitting, at that moment, it's going to take at least 90 minutes for them to get there. It is kind of basic reality of it's a different kind of response and it will take a different kind of time frame, so having that expectation is part of it too. As we look at that, what confidences need to build? We are looking at a situation where we need to strengthen relationships and build confidence, kind of build trust as you will in the services that do exist? If we need to build that confidence, how do we begin to go about it? Is there a situation where we need to build some confidence?
  • Brittany Pinnon-Becker: I think there definitely is a need for education and knowledge. I know early on my team were following social media advertisements and initially there were a lot of reports from the community of people waiting on hold for a very long time. I think that even if that's not the case now that people may have had that experience or heard about that experience and now we need to kind of build that confidence back up.
  • Julie Brugger: I think that this is certainly something that we want to look at. Then how do we as a community of stakeholders in creating a system of crisis services that really does serve our community in the way in which it was meant to do? How do we begin to kind of rehab that reputation? How do we begin to mend those fences? I think part of that is getting the word out. Each of us has different platforms from which we approach the world, especially the area of the world in which we live and work and provide service. Some of that is reaching out to other people, members of the community, other stakeholders, other decision makers to get that word out.
  • Brittany Pinnon-Becker: Also taking the approach of hearing people and being very transparent and really focusing on informed consent, making sure that when people call, we do talk through the process, and this is what's going to happen. This is the purpose of this call or this Mobile Crisis Response, so that people do feel more informed. Because I think a lot of the feedback that we saw early on was maybe based on people not being so informed about what to expect when they did call or had an experience with a crisis member.
  • Kelly Ann Jefferson: I think like Brittany stated, early on a lot of people would be transferred to Missouri. They weren't handled here in Illinois. I think a lot of people thought they could call for a family member when they're in crisis. Not understanding that it's the family member who needs to call. I think it's more of a getting the education out now that we've had a year or two to work with it. I do that in Nami, in our support groups providing education, letting them know the calls are now being answered here in Illinois. Also, the client themselves need to call now, and just being patient. I think sometimes a lot of people think it's just for crisis and they don't realize that they can call to talk to somebody, to help give them a minute to talk about what's going on and have a crisis time.
  • Question: Who provides crisis services in St. Clair County?
    • Julie Brugger: In Saint Clair County, my 590 program responds to the kind of eastern part of Saint Clair County. Brittany's 590 responds to the western part of Saint Clair County. Also, Hoyleton has a 590 program that responds in Saint Clair County. So those are the three 590 programs that respond in Saint Clair County.
    • Brittany Pinnon -Becker-: Hoyleton is covering all that area, Centerstone is not covering any crisis in St Clair County.
  • Breona Hawkins: I wanted to share myself as a social worker for the East Saint Louis Police Department. I am doing crisis response. The issue that I'm having, I'm not always batched when this has happened. I have seen a few times where MedStar has shown up, a lot of times what's helpful is whenever I'm able to write a position to get the individual, to the hospital received it. That doesn't always happen, unfortunately, as a way to make sure that people are getting what they need.
  • Brenda Hampton: Comprehensive in East Saint Louis is also a 590 provider.
  • Julie Brugger- We've got several different 590 programs plus Brianna's program that goes out in Saint Clair County. I completely agree that our EMS and our PSAPs need to be involved in this and to talk about how we can do this in a way that makes sense. I think that in terms of where EMS sometimes must take the same person to several different hospitals just in the same day for them to get the help that they need. Some of the things to look at there are the hospitalization criteria for the inpatient psych units are very, very specific. It's not an insurmountable kind of set of things, but it's a lot. Somebody really must present in a very specific way for the hospital staff once they get there to be able to say yes, we're going to admit you into our program. And I think that you know because we all are invested in the idea of offering treatment at the least restrictive level of care that's likely to be successful, right. So that is something that you know is a difficult thing to get across. I think that sometimes our clients who we see, our community members who are experiencing these crises present differently enough to EMS versus our 590 people versus how they present once they get to the hospital that it's difficult to pin down those criteria sometimes. The other thing that we know about people who experience mental health difficulties is that they don't resolve in the same way physical health difficulties resolve.
  • Cindy Wagner: I mean this is massive project but is the State looking at a building out of centers or a wing of existing centers for observation that could be a hospital or a mental health facility that already exists? That would be a lot of added resources. Are you hearing anything of that or what are your thoughts about such a place?
  • Julie Brugger: I know that the state has put in a lot of money toward developing alternatives to hospitalization. So, things like living room programs where people can go to receive help, behavioral health services for those who are not requiring hospitalization to deal with the symptoms that they're experiencing.
  • Cindy Wagner: I think that's a very important piece here.
  • Julie Brugger: Yes, part of this is that you've got to have places where you can take people.
  • Brenda Hampton: In the onset there were three pillars, someone to call, someone to respond and somewhere to go. The someone to call is clearly 988. The someone to respond is the 590 providers who will respond to the crises wherever the crises are occurring and then somewhere to go is what is being looked at as crisis stabilization units. The state put a mass amount of money into enhancing the living room model. So now the living rooms that have been funded are 24-hour operation, but they're not a crisis stabilization setting. If someone needs a little more intensity of support, the living room is not that because they cannot stay there longer than a 24-hour period. They may need 72 hours. That's not what the living room is for. The crisis stabilization units are still to be developed. There are crisis stabilization units in Illinois, but they're not plentiful. That is to be developed and you're correct, that's the big gap because there needs to be somewhere for people to go who do not need and/or meet the requirements for 24-hour hospitalization.
  • Julie Brugger: One of the things that we've gotten the opportunity to be is very vocal about what the needs are in our communities. Certainly, this is something that the state recognizes is needed throughout Illinois in order for us to provide adequate services to our community members. As we're looking forward to making these changes possible, do we need to further strengthen any relationships? I think in this process we've had the opportunity to really talk to our PSAP partners, to our law enforcement partners and from kind of that 590 perspective that's been great because that's not been opportunities that you know avenues that we've really gone down before. It's great to know people who are part of those systems that are so very important in serving our community. In terms of looking at relationships that that need additional strengthening, what do you think we're looking at there? Are we in a good, pretty good place at this point to be able to move forward with maybe potentially making some of these changes so that we could transfer some of those calls out of 911 into 988 for those low-risk crisis? Or do we need to look at strengthening some relationships while we're in the process of making this occur? And then what other resources do we need to make changes possible. So obviously as we continue to move forward and the state has identified you know this, you know what are, what are all the different steps to creating changes in protocols to those computer aided dispatch systems and those are many and varied. And so those are you know stuff that that is already kind of being dealt with kind of one at a time at this point. What other resources? So obviously public education, getting the communities on board with the services that are available, continuing to make more resources available, right through crisis stabilization programs, hopefully. Are there other resources that we need to make these changes doable and then what changes do you think are possible at this point prior to having those computer aided dispatch protocols changed? Right now, what we can do certainly is educate the communities right on 988 and the fact that they're available and the services that are available in communities. Are there other changes that are possible prior to having those dispatch protocols changed? Because again the goal that we're moving toward is getting those level one, those low-risk callers out of 911 and into 988.
  • John Nowak: From our PSAP, 27% of calls coming in to 911 are for people experiencing a mental health crisis.
  • Kelly Ann Jefferson: Are there enough mobile crisis Teams to respond to the 27% John stated?
  • Julie Brugger: I think it's going to depend on 27% of how many. Because where Comprehensive serves, that northwestern corner of Saint Clair County, so that's Cahokia and East Saint Louis and that area. Also, Breona and the East Saint Louis police serve East Saint Louis. Hoyleton serves all of Saint Clair County, and then Chestnut serves the eastern part of Saint Clair County, so Belleville, O'Fallon, Fairview and then all the way down to Lenzburg, Marissa to the southern most parts of the county. It will depend on where and when and how many of those happen at the same time. I know for Chestnut, there are consistently two teams available. Those are Crisis Response Teams to go out into the community and that includes a Crisis Intervention Specialist which is a mental health professional along with an Engagement Specialist who is a person with lived experience. They go out in teams of two; we've consistently got that. We've got two teams available 24/7, but if we get 5 calls, that's a problem.
  • Julie Brugger: So at least one of the steps that we're looking at to create these changes is really working more toward communication. Communication with the public, communication with each other about what we can do and how we can help, and just being open to the idea of how can we make this work in our communities to get people the services that they truly need? In terms of execution of these plans, monthly meetings with the people who are ambassadors of this, people who believe this is absolutely the right direction to go in to try to move these low-risk individuals out of 911 and into 988 and our PSAP working groups to focus on problem solving, performance review, and improvement opportunities. Because as with everything you know, we will start and then we will tweak the system a million times until we get it to a place where we're, you know, comfortable, where we feel good about it. We want to look at work toward project implementation and performance review. And that will be a standing regional advisory committee item that'll be something that we'll, you know, continue to talk about in this meeting every month. We'll prepare formal communications on the changes to ensure that all departments, partner agencies and key elected officials are aware of and understand the changes. Public education messaging and programs will be reviewed and updated as necessary. We're going to develop a feedback loop for our PSAP telecommunicators in order to encourage confidence in the change and to allow the opportunity to easily identify concerns or additional needs for assistance. We're going to look toward, you know, resource and funding needs. What are the costs associated with reprinting, hardcopy, or backup EMD protocol flip charts? With the newly approved protocols, we're going to determine potential funding needs for the PSAPs in order to you know, create an opportunity for change in looking at data collection and reporting, we want to assess data collection abilities of the reporting entities. We will include PSAPs, the 988 call centers, the 590 providers and get information from everybody on how it's going now, how it goes as we begin to make changes, what kind of responses are we seeing from all of that. And then we'll develop standardized data collection, submission, and reporting protocols so that we will consistently know how we're doing and what needs to be improved. We'll utilize data to assess performance, measure progress, provide for ongoing communication, and identify opportunities for improvement in terms of selecting PSAPs to start with interviewing and recruiting eligible peace apps to participate in the project. To deflect the Level One risk matrix calls from 911 to 988 interviews with law enforcement, EMS 590 providers, and other stakeholders to assess community readiness for this change. And then identify key stakeholders and administrators who will champion these protocol and other process changes. in terms of protocol changes, we'll be working with PCAP administrators and managers on suggested changes to protocols that fall within the Interim Risk Level matrix. We will ill draft recommended changes to the existing EMD protocols based on the Interim Risk Level matrix for all four phases, including EMD questions, scripts, process flow necessary to transfer appropriate calls to 988, reviewing and collaborating with 911 on any changes so that the EMS Medical Director approval can be obtained, and then identifying resources and support required for each involved entity to enact these protocol changes. protocol approvals require identifying steps and necessary people to shepherd approval for changes. Who needs to be on board? This is about making sure that everybody is aware of the changes that are coming, why we're making them, why they're necessary and the steps that we've followed in terms of creating the change that's necessary and then post project review, because this will be a consistent thing. We must consistently review how it's going, checking in with PSAPs on the change that they're seeing. Once we can begin to transfer some of those calls out to evaluate any needed changes in support training, working with and encouraging centers to build 988 and 590 specific calls into their regular quality assurance review processes, determining any specific reporting requirements or metrics which may be necessary to ensure compliance or to identify any potential gaps in implementation. For our next steps, I will reach out to the various 590 providers in our region to make sure that they're reaching out. That each program is reaching out to the different PSAPs with whom we work in order to make sure that everybody is aware of the ways in which 590 can help and then all of us really looking to share information with each other, with other principals who we are aware of, our community partners about 988 and the services that are available that way, making sure that the public recognizes how this can help as well. This is really going to be a lot of communication, it's going to be a lot of working together, it's going to be a lot of partnering because we all have that common goal of serving our community in the very best ways possible.
• Next Meeting Date:
  • December 19, 2023
• Public Comment:
  • John Nowak: I'm not hearing EMS being brought up very much. A member mentioned that a lot of clients are going to Missouri. I've been doing this for 40 years and I have never heard so many requests now from our people that are having some type of crisis. They are preferring to go to Missouri. We are transporting so many patients to Missouri. We'll take them wherever they want because that's what we are asking them, and we are trying to de-escalate everything that's going on. I know 988 is a federal thing, but they're still not getting the support that they need. What we're finding out is that they're back on our side of the river or in our venue calling again. What we end up doing is possibly taking an individual two or three times in a day to different hospitals. There are a lot of patients and of course my venue is Saint Clair County, East Saint Louis and Cahokia Heights. We're running 140 calls a day. I'm looking at my rate right now, 27% of the calls a day are something to do with some type of psych call. Getting EMS involved in this is one of the big things because we're always going to end up on scene. I'm praying for the day when we don't have to respond to those level one calls. How many of those calls in Saint Clair County are coming into 988 now and how many crisis teams do we have responding like the 590's. Educating the public is a big part but I believe educating us within our own committee or within our home structure that we're wanting to do to be able to have that feeling that I can reach out or we do have this going on. You didn't have a quorum today; that's kind of troublesome because you can't get things done unless you can have that quorum and be able to vote and to move forward. Again, thank you for letting me at least speak a little bit from my perspective. These are our brothers and our sisters out there, these are family.
  • Jessica Gimeno: I'm with Access Living. My name is Jessica Gimeno. We were meeting with people in different parts of the country who had instituted a CESSA-like system. The thing that has helped Tucson is they've done embedding, where 988 and 911 people would embed themselves in the call centers so that both sides got to see what the other side does. This helped build some trust as far as transferring those phone calls, that's an idea.
• Meeting ended 11:14 a.m.; no motion to adjourn.