CESSA Statewide Advisory Committee Meeting Minutes 02/13/2024

Approved by Committee Members 03/11/2024

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

Meeting Minutes - Tuesday, February 13, 2024 - 10:00 am-12:00 pm via WebEx
and In-person at Glenview Village Hall, Glenview Illinois

Call to Order/Roll Call

  • David Albert called meeting to order at 10:08am.
  • Stephon Watts' mother, Danelene Powell Dickens, spoke about the passing of her son. Thanked the committee for the work being done to get CESSA implemented.
  • Approval of Minutes (12/11/23 meeting): Lee Ann Reinert asked for a motion to approve minutes, seconded by Drew Hansen.
  • Members Present: Cindy Barbera-Brelle (present and approved), Candace Coleman (present and approved), Curtis Harris (present and approved), Pooja Nagpal (present and approved), Shelley Dallas (present and approved), Brent Reynolds (present and approved), David Albert (present and approved), Ashley Thoele (Bobby Van Beber) (present and approved), Drew Hansen (present and approved), Richard Manthy (present and approved), Blanca Campos (present and approved), Emily Miller(present and approved)
  • Lee Ann reviewed procedures around the Open Meetings Act and meeting logistics. 

State Updates (Lee Ann)

  • A few bills were introduced before the 2/9 filing deadline.
    • Senate Bill 3648 and House Bill 5378 requested by Access Living to extend implementation deadline from July 1, 2024 to July 1, 2025.
    • House Bill 5377: Joint effort between DHS/DMH and Access Living
      • Expanding ability to have a RAC co-chair that is not the EMS medical director because while some are extremely committed, others simply do not have the time. Asked for consideration of a different chair that is a trusted leader in the community.
      • Ability to have subcommittees within the RACs. We've received feedback that the ability to change protocols needs to be at a more local level, rather than regions.
  • David T. Jones, Chief Behavioral Health Officer of Illinois: CESSA Council Strengthening and Transforming Behavioral Health Crisis Care in Illinois Act (STBHCC) Update
    • Goals: Establish a Unified Crisis Continuum (UCC) for all individuals in Illinois that can: accept, triage, response, and support individuals experiencing behavioral health crisis; Ensure parity and equity for the various populations within Illinois by creating a "no wrong" door policy; Centralize publicly funded behavioral health data in a single state data repository; Seek to maximize federal funding opportunities
    • Much work is underway that we conducted through NASHP, the legislation asked that we add the trade association, labor and union, advocacy organizations, and other stakeholders. As we took a deep dive, what became clear was the three pillars. Someone to call, someone to respond, and a place to go. Still much work to do in the third pillar.
    • No later than 12 months after the effective date of this act, DHS/DMH shall submit an action plan to the ILGA
    • In terms of vision where we want to go, what we hope to have is a centralized experience in terms of insurance status (private, commercial, uninsured, Medicaid). The response would result in de-escalation in the crisis they are experiencing. Simplify process.

UIC Crisis Hub Updates (Dr. Lorrie Jones)

  • Communication Plan: We have a list of acronyms and a glossary of terms; both will be posted on our website after review by state partners.
  • Regions: Start moving towards developing pilot sites, PSAPs that are ready to move forward. We are constantly gathering info from pilots to make any necessary changes to IRLM. Think of it as a prototype to structure our work moving forward.
    • Introduced a new hyper local approach: the regions are large sections of the state and very diverse. One may have many counties and others may have a few. The work and the changes happen at a more local level. In other states, these changes have only really been done by cities or a small county, but not statewide. We know that the changes have to be made locally by the PSAP, where the changes and dispatch occur, and the law enforcement agencies and EMS they support in that community.
    • These hyperlocal groups would include PSAPs, EMS/FIRE/EMD, BH, Advocates
    • We want to make sure we have people at the table that want to get this work done, have the time and energy. Let community identify the leader. Regions will convene them to learn and talk and discuss things.
    • Regional chairs are saying it may not work. We have to continue to work through this, whether it be more support needed from the Hub or the State.
    • Richard Manthy: There is a lot of overlap. PSAPs have to understand that they may be reporting to more than one region.
    • Cindy Barbera-Brelle: Based on the resource hospital, they will declare which PSAP belongs to which region. This will create easier deployment and will avoid telecommunicator questioning which region they are in.
    • Brent Reynolds: Any thought of having the RACs and the SAC to meet together?
    • Lorrie Jones: What would be the outcome of meeting?
      • Brent Reynolds: For us to understand their hesitation.
      • Lorrie: The co-chairs are more so worried about the workload.
  • Technical Subcommittees Updates
    • Protocols and Standards: There has been a lot of behind the scenes work to develop the protocol changes for the vendors.
      • We have reviewed protocols and submitted recommended changed to PowerPhone. Next step would be to have EMS medical directors IDPH approve the protocols, then pilot testing.
      • Priority dispatch has the largest number of PSAPs in the state. They are waiting for us to provide some definitions back to them.
      • We will most likely convene APCO in the next 30 days.
    • Technology and Data: We are in the process of trying to understand what data is being collected now, what the ideal data would look like, develop some sample reports, and develop some recommendations for data collection and technical structure for 911 and 988 transfers.
    • Training: The training plans have been approved for 911 telecommunicators, 988 crisis line staff, and 590 MCRT as of Feb. 9, 2024. We are sending the training plans to the regions for the input. RACs have a deadline of end of March to give us feedback on training plans. The next subcommittee meeting is Feb. 20. After the regions review, then the training plans will come to the SAC.

Presentation on Alternative Response Models in City of Chicago (Dr. Eddie Markul, Allie Lichterman, and Tiffany Patton-Burnside)

  • Dr. Eddie Markul: Chicago only has one PSAP for the whole city. I approve the protocols. All calls go to a police call taker, then transferred to EMS/fire side to do a medical screening. Only one PSAP, one police department, one fire department. CARE pilot program started in 2001. Ultimate response team started in 2023.
  • Tiffany Patton-Burnside: CARE Updates
    • Training: When we first started, we had a 3 week training. All new hires have a 3-4 week training period before going out into the field. The team is focused on community-based crisis trainings.
    • Alternate Destinations: Also working on alternative destinations outside of hospitals and jails. Alternative destinations aren't' always equipped to work with individuals at a certain acuity. We work with individuals in the community until they reach that point. When we started, we asked many community organizations if they could serve as a living room. Many of them said they don't have the staff to support crisis.
    • Community Engagement: We are also doing community engagement so everyone knows what's going on in the state, what their local 590 provider is, etc. Within the city of Chicago, there are 77 distinct communities, and each may need a different approach. We did a landscape analysis engaging the community and asking what is missing in this community?
  • Allie Lichterman: Mayor Johnson's Vision and Mission
    • Short term: Creating an implementation plan that will achieve the 2024 expansion goals outlined by Mayor Johnson
    • Long term: Treatment Not Trauma Working Group for beyond 2024
      • Workgroup goal: develop a suggested framework and roadmap in the city to expand mental health and clinical services, non-police response for behavioral and dental health crisis, and community awareness of mental health resources. Report delivered to the Mayor by May 31, 2024
      • Members: Chicago Departments of Public Health; Fire; Assets Information, and Services; Human Resources; Mayors Office; Office of Budget and Management
    • Treatment Not Trauma workgroup recommends the city of Chicago build out permanent alternative response services to meet behavioral health needs.
  • Shelley Dallas: What do you do when resources are too slim to take someone somewhere? And how long do you stay on scene?
    • Tiffany Patton-Burnside: On scene we do crisis de-escalation, psychosocial assessment, and a needs assessment. There may be mitigating factors causing this individual to have or exacerbate a behavioral health crisis. For a medication issue, we may go to the CDPH clinic and see if a prescriber can get you something. 90% of the time individuals are voluntarily committing themselves to a hospital after working with clinicians because they realize they can't keep themselves safe at home. We want people to make informed decisions and choose whatever is the best decision for them. There may be a family issue where a break from the family is helpful so in the past, we've taken individuals to another family member's house.
  • Brent Reynolds: There is not always a team available. Who do you fall back on when you don't have the resources?
    • Dr. Markul: We default back to normal operations as if there was not a CARE team. If it is an EMS issue, it will go to the EMS side. If the police screener thinks it sounds like a police issue, then it goes to police. Follow standard dispatch policies if a CARE team isn't available.
  • Brent Reynolds: How do you communicate with OEMC? Do you have separate radios or phones?
    • Tiffany Patton-Burnside: We have a clinician at OEMC assisting dispatchers with recognizing calls that are behavioral health calls. Call gets screened by police or fire, fire side goes over the radio and dispatches the team, we get our notifications from the police side and some documentation. We operate with police radios because we function in a first responder world, so the clinicians are fighting to get that first responder designation.
  • David Albert: What are the lessons learned so far from the city pilots?
    • Tiffany Patton-Burnside: We need communication and telecommunication. The conversation between 988 and 911 and how to streamline those two entities. Another lesson making sure there is specific crisis staff available at alternate destinations. Another lesson is to figure out who are the stakeholders that hold the community together, and how do we engage them too?

Continuation of Visioning Work (Mike Thompson):

  • Recap interviews conducted:
    • Everyone had extensive familiarity with behavioral health crisis care. There is shared commonality among big picture goals and with challenges that must be addressed. There are different barriers to progress, which vary by locality.
  • Components of a vision:
    • What constitutes long-term success? As we talk about CESSA implementation, what do you want to achieve as a member of the SAC?
    • What are the values that inform our efforts? Do you feel everyone is coming from a similar place in terms of values?
    • What practices must be employed in every community? What does success look like in every community?
    • Who is responsible in each locality for closing the gap between the status quo and desired outcomes?
  • What constitutes long term success? Taken from the CESSA legislation: Individuals experiencing mental or behavioral health crises are diverted from hospitalization or incarceration and are instead linked with available appropriate community services"
  • What values undergird our efforts? This is a summary from interviews:
    • Demonstrate that behavioral health emergencies require responses consistent with emergency physical health care
    • Ensure the safety and well being of all people present
    • Provide responses that are timely, welcoming, coordinated, and informed by latest research
    • Minimize the use of law enforcement
    • Use the insight and perspective of people with lived experiences
    • Tailor strategies to the uniqueness of each community
    • Ground all efforts in equity, and an understanding that care must be responsive to a person's age, gender, culture, sexual orientation, disabilities, and other needs
  • Feedback from SAC Members on recap of interviews and information presented so far:
    • David Albert: There are times when the hospital is the place for people in crisis to go. Only when absolutely necessary, but don't want to suggest there is not role for psychiatric hospitalization.
    • Candace Coleman: Self-directed care is missing from the mission. We want to make sure that people have choice between the hospital other options.
    • Lee Ann Reinert: Right now, it's only about where the service ends up (the outcome) so we need something more process orientated because this is about making sure the response is appropriate and safe. For example, individuals experiencing mental health crises receive an appropriate and safe response consistent with their needs.
    • Drew Hansen: The fact that this is available independent of time of day or date of the week is missing. We need to make sure it is available like 911, no matter what county you live and no matter the time. Anytime. Anywhere.
    • Cindy Barbera-Brelle: And timely.
    • Drew Hansen: Talk more about resource you're trying to provide instead of talking about what you're trying to divert them away. We are trying to expand the resources available to everyone.
    • Drew Hansen: Instead of "minimizing law enforcement," we may want to say minimize 911 involvement altogether.
    • Drew Hansen: When we say unnecessary involvement of law enforcement, it puts them on the defensive. The overall goal is minimizing involvement of the 911 system. But we are trying to expand the service we are providing and minimizing law enforcement response when it's not the most appropriate. Is there a benefit to being more inclusive and positive? This is the only one that was a negative statement.
    • David Albert: What about minimize the use of unnecessary and inappropriate law enforcement response?
    • Lee Ann Reinert: Minimize the reliance on law enforcement? Because we didn't have anything else until now so we relied on them.
    • Stephanie Frank: In deflection, we talk about providing that bridge. Law enforcement is good at one thing, social services are good at another thing. How do we link those two? The 988 and crisis teams are not necessarily minimizing law enforcement, but how we link law enforcement with the community and social services? How do we create that bridge?
  • Outline of Visioning exercises:
    • SAC members were asked to put color-coded stickers on flip chart paper.
    • Each color corresponded with their level of alignment for each perspective. Green is "clear and aligned". Yellow is "it's complicated". Red is "not clear or not aligned". Blue is "I don't know".
    • Perspectives: You personally; the stakeholders you represent; State Advisory Committee as a group; Regional Advisory Committees as a group
  • Visioning exercise #1: Reflect and assess how clear/aligned we are about the vision and the values we discussed
  • Takeaways from visioning exercise #1:
    • Brent Reynolds: The stickers reflect that we are all pretty much aligned. The biggest concern is understanding where the Regional Advisory Committees are in this process. I mentioned it earlier, I think it would help us tremendously to hear in their own words where they are at.
    • David Albert: agreement, impressed with the alignment and would also like to know more about the RACs
    • Drew Hansen: I view this as a communication hurdle about sharing what we know externally and passing it down.
    • Blanca Campos: I agree we are in alignment but we are still in the weeds figuring out how this will happen so that's why I teetered closer to yellow.
    • Emily Miller: The overall belief in the why is apparent. But there is still a misunderstanding of those outside of the process. We as the SAC would benefit directly from the regional groups to know what's happening.
  • Visioning exercise #2:
    • What practices must be employed in every "locality"?
    • To what extent each locality has adopted these desired practices today?
    • Who is responsible in each locality for closing the fap between the status quo and desired practices?
  • Takeaways from visioning exercise #2:
    • Pooja Nagpal: It looks like there's opportunity for better communication between each of these levels. Here it looks like we think the RACs don't understand the practices or the status quo. We are clear on ourselves understanding but we don't have an understanding of the local level.
    • Mike Thompson: There is a high degree of clarity among best practices, but where do I find that in writing?
    • Lee Ann Reinert: if you went out and did a survey what tool would we use to ask if we have this or this? I think we would use the SAMHSA checklist but the challenge is few people locally are familiar with it.
    • Blanca Campos: 590 programs have contracts saying all the mandated requirements of what's expected of them, but the SAMHSA guidance is the framework.
    • Pooja Nagpal: I would love for the SAMHSA guidelines to be available for everyone, at every level of government, so we work from the same place.
    • Lee Ann Reinert: I agree. Part of it is the CESSA design, it's statewide. So this committee is focused on how to do it at a state level but in IL we have the challenge that we aren't a county based system so we don't have the established structure to funnel things down to the counties.
  • Takeaways and next steps from the visioning exercises:
    • Lorrie Jones: The regions need some help and I love that idea. Perhaps we even consider dedicating a meeting to a joint meeting with the regions. To Drew's point, there are education and communication opportunities. There is alignment among this table but have to make sure the information is passed down and outside of this room. To Mike's point about a checklist, we may want to look at the SAMHSA checklist and spend time personalizing it for IL.

SAC Next Steps

  • Next virtual meeting dates:
    • March 11, 2024
    • April 8, 2024
  • Next in-person meeting date:
    • May 13, 2024 in Springfield hosted by Emily Miller from IARF

Public Comment

  • Charles Petrof, JD (Access Living; Author of CESSA legislation): 1) Are the 590s and MCRT regulated by CESSA, are they the same thing or are there differences? If there are differences, can we describe the differences for the public? For example if there is a 590 doing involuntary commitment work, can they continue that work from pre-CESSA as long as they are not doing it as a CESSA regulated MCRT? And in that case, would that area also need a CESSA regulated MCRT? 2) In the uniform crisis continuum vision, there's a clear vision for centralized MCRT dispatch function, but in our discussions there's an appropriate focus on regionalism and hyper-local activities. Have the RACs and hyper-local entities been consulted about uniformed crisis continuum vision of centralized call lines and dispatch, in terms of getting their input? 3) Whether or not the population served, when calls come into PSAPs for mental health care, are those populations the same populations or are there significant differences? If so, how does that inform our work?
    • Blanca Campos: CESSA speaks to MCRT, but we also have MCRT outside of 590 because it's a Medicaid billable service. This goes back to the glossary being developed, we should be aligned in terms of definitions.
  • Danelene Powell-Dickens (Stephon Watt's mother): I'm under the impression that these aren't going well with the regions implementation. Are the regional committees not committed to carrying out their duties?
    • Lorrie Jones: The regions are very committed. In the legislation, the EMS director is supposed to chair the RAC. These are ER doctors and they are very busy. We paired them with Behavioral Health leaders in the community to co-chair. There are 11 different regions with varying levels of time availability. They are all committed to this but they all have other jobs. We have to better support regions. They are committed to the vision, it's just a matter of them finding time to implement it.


  • Meeting adjourned by David Albert 12:28pm.