CESSA Protocols & Standards Subcommittee Meeting 03/21/2024

CESSA Protocols & Standards Subcommittee Meeting March 21, 2024, 2:30 - 4:00 pm

Virtual meeting via Zoom

Meeting Minutes - Approved by Members 04/04/2024

Call to Order/Roll Call

  • Meeting called to order by Cindy Barbera-Brelle at 2:31pm (via Zoom)
  • Shelley Dallas motioned for approval of 3/7 meeting minutes, seconded by Rick Manthy.
  • Members Present: Rachel Ahart (present and approved), Blanca Campos (present and approved), Candace Coleman (designee Jessica Gimeno) (present and approved), Cindy Barbera-Brelle (present and approved), Lee Ann Reinert (present and approved), Shelley Dallas (present and approved), Rick Manthy (present and approved). Bobby Van Bebber (joined late so not present for vote). Motion approved.
  • Members not present: Brent Reynolds, Drew Hansen

State Updates (Lee Ann Reinert):

  • House Bill 5377 and House Bill 5378, and House Bill 5377, Amendment 1 which would move 5378 into 5377. We anticipate that these will move forward in the House. The companion bill moved forward in the Senate. There is a hearing tomorrow but there are no audio or video links so only in person attendance. They would extend the deadline to July 2025 and offer more flexibility in who can chair RACs and give the opportunity for hyperlocal activity.

Alternative Response Forum Update (Dr. Lorrie Jones):

  • We have been talking about having a one-day meeting in June 2024, probably June 11, for an Alterative Response Forum.
  • We are going to be inviting people from around the country who are doing various types of alternative response model to come and present to folks across Illinois so we can learn from them and allow communities to start imagining what alternative response models could look like in their communities.
  • We are planning to invite members of the SAC and the Expert Consultant Group, and we are giving the Regions a certain number of invitations that they can use to identify leaders across their region.

Update on Work with Protocol Vendors (Cindy Barbera-Brelle):

  • PowerPhone: We did a significant of work with them and we're waiting for a reply.
  • APCO: We did have a call yesterday with APCO. Very positive conversation. They are going to share their protocol guide cards with us. We'll be looking at them in terms of the changes that we proposed with PowerPhone to see if we can make it consistent across the two. They are also going to reach out to Virginia, to see if she can get a copy of their "Marcus" cards to see what kind of changes they made in the appropriate protocol.
  • We have a call with Priority Dispatch Wednesday. We've had some previous conversations but we will be talking to them about making changes to their protocols to make them consistent with the IRLM.
  • In each of these calls, we have subject matter experts that have hands-on experience with that particular protocol.
  • We'll keep you updated on our regular calls and at the SAC meeting as well.
  • For the independents, the 7 or 8 PSAPS that are using hospital provided or created protocols. We are in some early conversations with them for next steps on how to change their protocols. The other piece of the independent group is the police-only. They are not required under the EMS act to provide protocols because they are not dispatching EMS. They transfer calls to the secondary answering point in the 911 system that dispatches those EMS resources. We'll meet with those groups separately because their operating procedures around mental health and suicide calls are different. We're considering doing a survey in advance for that group to see where they're at, and have their resources looked at some co-responder models as part of this project.

Discussion on Clarifying Language on Pilots and IRLM Changes (Dr. Lorrie Jones):

  • Thank you to Access Living who pointed out a discrepancy between the language in the report and the language that was voted on in the motion.
  • The language from the minutes from December 7, 2023 is correct: "SAC will initiate a review and possible changes to the Interim Risk Level Matrix no later than six months after the implementation of two or more pilots by PSAPs utilizing PowerPhone, Priority Dispatch, or APCO/Independents."
  • The salient word there is "or," but the quarterly report said "and." We are going to be issuing a correction in the quarterly report that is due April 1, 2024 to the General Assembly. That was a mistake, and we apologize for any confusion that was created.
  • In Risk level 4, we added co-response team as a dispatch type after, I think Rachael, so we added it here pursuant to the vote. But in the detail, we did not add it to the detailed descriptive part. It was added in December 2023 to the chart but not the detail. We've updated it again today to show that co-responder models is available in risk level 3 and 4.
  • Discussion:
    • Rachael Ahart: I think the intent is to allow for co-responder models and not to restrict them from level 4.
    • Lorrie Jones: Yes, it allows for that, so the PSAP can dispatch that if appropriate or law enforcement.
    • Cindy Barbera-Brelle: Assuming they have a co-responder model.
    • Rachael Ahart: I'm wondering if the recommending co-responder model is different than allowing. Because certain situations, dispath might prefer to do whatever unit is closest. So if they are reading recommending co-responder model, would that be indicating they are attempting to dispatch the unit with a social worker even if a different unit would be closer?
    • Cindy Barbera-Brelle: that would be a mobile decision. Each PSAP will design their CAD different and their recommendations based on the units that are available. They would have to build it in. Today, they might say a domestic is a two-person response, but they'd have to look and see the two closest units. Maybe they have a specific call number and if they're manned for that particular shift, they would be presented in the recommendations. If they aren't a 24/7 unit, then they wouldn't come up as a recommendation because they aren't manned. So they'll be able to manage that with their CAD system.
    • Rachael Ahart: Curios how the local dispatch center would read that language and what that would look like on their end.

Update on Call Transfer Strategy (Brenda Hampton):

  • This is a draft. Because it is a draft, it is confidential. I shared it with the 988 call centers to get their feedback yesterday. There is a written document that accompanies the PowerPoint presentation.
  • This is PSAP to 988 call transfers. The mirror document is 988 to 911. We want to make sure that folks who are having mental and behavioral health crisis are being transferred with consistency and sensitivity of the population we're working with. Transfer protocols are informed by the IRLM.
  • Clarifying roles of 911 and 988 and 590 Mobile crisis response teams.
    • 988 does not operate like 911. There are some functional technology deficits in how we have to operate in lieu of a system that will allow transfers from 911 to 988. All of this is grounded in making sure we have warm transfers from 988 to 590 and 911 to 988.
  • Types of Call Transfers from 911 to 988 (Appendix A)
    • It's important to recognize that 988 is not emergency dispatch so there's certain calls that won't be transferred.
  • Warm Transfers from 911 to 988 allow for both the caller and the receiving 988 crisis counselor to be better prepared for the conversation.
    • Share with the caller that they are going to transfer with 988 so its not a surprise.
    • They want to ask the callers permission. Caller has the chance to decline. If a caller should decline a transfer, then the 911 telecommunicator will follow whatever protocols they have, but if callers agrees, then they will link caller with 988.
  • Pilot 911 transfer to a dedicated 988 phone line
    • 988 does not have the technology to receive a transfer from 911 so in lieu of that, we are going to have to resort to the resources we have, which is a dedicate phone line.
    • We are going to pilot this to see how it will work. We will have 2 or 3 lifeline call centers to serve as pilots.
    • These are the procedures that 911 will go through to initiate what we're calling a warm transfer.
    • Telecommunicator will provide: The PSAP name, telecommunicator identifier, and call back number; The incident number; Caller's name and phone number; Caller's location, address, or any identifying markers; A secondary contact person's name and phone number, if available; A description of the reported situation (what is occurring); [If a 3rd party caller] - attempt to gather that individual's name, phone number and relationship to the person in crisis
  • Procedures
    • We are expecting the 988 crisis counselor to answer the call within 3 consecutive rings. We don't want to leave the caller on hold or interfere with 911 ability to answer other emergency calls.
    • Once the relationship between 911 and 988 has been made, information has been shared, caller has agreed, then the 911 telecommunicator will say "information has been conveyed." That will signal that the warm transfer is complete and the telecommunicator can disconnect.
    • Should the caller disconnects before the warm transfer is complete, and calls back within 10 minutes, the 911 telecommunicator can call the 988 crisis counselor again. If the time exceeds 10 minutes, then 911 telecommunicator should collect information again.
  • Translation services
    • This will be difficult based on the lack of technology.
    • If 911 receives a call from a person via TTY or related system, then 911 accesses whatever interpreter service they have available in order to communicate with the individual. So then the 911 telecommunicator would reach out to the 988 dedicated phone number, indicate that they have translation services on the line. 988 will access their translation services, but there may be a disconnect, because there is not way for the two translation services to talk to each other right now.
  • Text and Chat
    • There is no functionality for 988 to receive a text or chat from 911. They will have to contact the 988 crisis counselor using the dedicated phone number, and the crisis counselor would have to reach out to the person who is texting or chatting 911.
    • It's not ideal. We know these are discussion questions we have to figure out.
  • Documentation
    • PSAPs should create a record of call transfers to 988 (in the computer-aided dispatch (CAD) or other recording system): Name and/or identifier number of calls transferred to 988; Name and/or identifier number of text/chat transferred to 988; Name and/or identifier number of calls dropped before transfer to 988; Name and/or identifier number of text/chat discontinued before transfer to 988; Date and time of transfers/dropped or disconnection; Name of receiving 988 LCC (transfers/chat/text).
    • Since they have to identify themselves to the 988 call centers, we want to be able to identify the patterns where these are going.
  • Discussion Issues:
    • If a person calls 911, speaks with a telecommunicator then disconnects and calls back, is this logged somewhere so that the second telecommunicator has a record of the previous call?
    • If a person calls 911, speaks with a telecommunicator whose decision it was to transfer to 988, then the person disconnects - should the person call back within 10 minutes is it feasible for 911 to immediately transfer to 988 if that was the original decision?
    • How can we best streamline translation services from 911 to 988 when there are two different contracted vendors? Is the process described in the guidance feasible, fluid and sensitive to one in crisis?
    • How to best handle text and chat in lieu of existing that technology is not conducive to transfer this information. Is the guidance, as written, feasible.
    • Feedback loop from 988 & MCRT to PSAP/911 - What is needed? How to convey?
    • How can we make this process as fluid as possible when we have people on the line in crisis?
    • Same thing with text and chat? How do we make this feasible?
  • Charles Petrof: I am a member of the public. Should I hold my question?
    • Cindy Barbera-Brelle: Yes, please hold it until the end.
  • Rick Manthy: Are the standards fairly similar for when it's transferred from 911 to 988 to the IRLM?
    • Brenda Hampton: It's almost a mirror document in reverse. Very similar information in reverse.
    • Add more to Rick's question.
    • Lorrie Jones: The calls centers have their own protocols informed by Vibrant. I don't think we ever did a crosswalk. But they call 911 now, when they have an issue they can't handle. We'll be looking into that as we develop those policies and procedures down the line.
  • Shelley Dallas: Some of this looks similar to what PSAP currently have incorporated. This is a great start. We have call transfer procedures from PSAP to PSAP, so streamlining this is an awesome start.
  • Brenda Hampton: This is not the last version, but we wanted to get something written, particularly as we are starting the pilot projects.
  • Shelley Dallas: Yes, it will be fluid, and it won't be the same for every PSAP.
  • Lorrie Jones: I'd like to invite the committee to send suggestions for speakers for the forum to me at jonesl@uic.edu or the CESSA inbox.

Next Meeting Date

  • April 4, 2024

Public Comment

  • Charles Petrof: with the call transfer strategy, what is the thinking in terms of dispatching the mobile crisis teams? Is that the strategy to get a call to 988 and have 988 dispatch the team? If so, what is the committee thinking for places like City of Chicago's CARES program, where 911 is already dispatching mobile crisis response teams. What does this mean in terms of employment of mobile crisis teams? Some advocates are interested in members of the mobile crisis teams being members of municipal entity so how does that impact that?
  • Lorrie Jones: You are right that CARES teams are dispatched directly from 911. Mobile crisis response teams funded by the state are not dispatched that way. So that's the work of region 11 to figure out how to put these services together based on the different services that have been developed. As far as the future, are you saying municipalities want to create something like Chicago?
  • Charles Petrof: Yes, Evanston is doing something similar to Chicago and CESSA. So it opens up the question.
  • Lorrie Jones: Yes, they are thinking about a situation where you'll be able to call 911 and get law enforcement, fire, or behavioral health. That's one of the models we'd be presenting in the alternative response all-day meeting. This is the way we started this system, but it doesn't mean it will stay that way. If we move to central dispatch, then all these resources can be connected through a central dispatch line and 911 would communicate directly with them. The system is evolving and we want it to evolve in a way that the evidence takes us and as municipalities evolve. We don't want to be rigid. We should make room under the tent for anything that makes sense that's getting the job done.
  • Lee Ann Reinert: I think what you're talking about could be other dispositions on other levels of the IRLM. The IRLM isn't telling them to contact 988 on every call, only when certain conditions are met, so it may be part of the IRLM.
  • Cindy Barbere-Brelle: As we mentioned earlier, if local communities are developing co-responder models, those are local resources that would be included in the CAD system and they'd be dispatched locally just like a fire or law enforcement would be. They'd be included as a resource to be dispatched based on the nature of the call. So local resources would be dispatched locally.
  • Lorrie Jones: That's very reminiscent of the Albuquerque model, where you can call 911 and ask if you want law enforcement, fire, EMS, or Albuquerque Community Safety (ACS). ACS has different types of teams. We're hoping to get somebody from Al here at our meeting in June.
  • Jessica Gimeno: When are the pilots starting? RAC 7 said third quarter but do you have anything specific?
    • Cindy Barbere-Brelle: We don't have a specific date yet. Once we get APCO it's going to be dependent on the protocol providers to incorporate the changes we've asked for.

Adjournment

  • Meeting adjourned by Cindy Barbera-Brelle at 3:30pm.