Illinois CESSA Statewide Advisory Committee Glossary

Illinois CESSA Statewide Advisory Committee Glossary Contents

• 911 Call Centers

• 988 Suicide and Crisis Lifeline

• 988 Suicide and Crisis Lifeline Call Centers

• Alternatives to Law Enforcement Crisis Response Models

• Community Emergency Services and Support Act (CESSA)

• Co-Response Crisis Models

Emergency Medical Services (EMS) Co-Response Models

Law Enforcement Co-Response Models

Public Safety Answering Point (PSAP) Co-Response Model

Certified Community Behavioral Health Clinics (CCBHCs)

Crisis Intervention (CIT) Team Models

Crisis Service Continuum

Crisis Stabilization Center

Deflection

Diversion

Division of Statewide 9-1-1

Emergency Medical Dispatch (EMD)

Emergency Medical Services (EMS)

Illinois Interim Risk Level Matrix

Living Room

Mobile Crisis Response Team

• Medicaid Mobile Crisis Response (Illinois Department of Healthcare and Family Services)
• Program 590 Mobile Crisis Response Team (Illinois Department of Human Services Division of Mental Health)

Persons with Lived Expertise

• Certified Peer Recovery Specialist (CPRS)
• Certified Recovery Support Specialist (CRSS)
• Engagement Specialist

Public Safety Answering Point (PSAP)

Telecommunicator

References

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911 Call Centers

911 Call Centers are responsible for receiving 911 emergency calls, including voice over internet protocols (VOIP), text and chat messages for first responder assistance 24-hours-a-day, 7-day-a-week, 365 days-a-year. 911 Call Centers utilize caller's answers to standardized protocols to determine the type of emergency, urgency and appropriate dispatch response to address the caller's emergency. (Illinois State Police, https://isp.illinois.gov/Statewide911Division)

988 Suicide and Crisis Lifeline

The national suicide prevention and crisis hotline is accessible 24-hours-a-day, 7-days-a-week, 365 days-a-year for individuals experiencing mental health, substance use and suicide crises and for family members/loved ones of individuals experiencing these crises. 988 suicide and crisis lifelines are staffed by trained crisis counselors who provide real-time crisis intervention.

988 Suicide and Crisis Lifeline Call Centers

988 Suicide and Crisis Centers are call centers that are part of a nationwide network providing crisis intervention and advancing suicide prevention. Illinois currently has seven (7) call centers that operate 988 suicide and crisis lifelines.

Alternatives to Law Enforcement Crisis Response Models

Alternative Crisis Response Team Models are service models that utilize teams comprised of combinations of behavioral health clinicians, various types of community workers, and individuals with lived behavioral health/mental health experience who serve as first responders to individuals experiencing behavioral health/mental health crises and related social determinant issues such as homelessness. These teams do not respond to crises that are life-threatening medical emergencies, criminal acts that are in-progress, or to those situations that involve the use of a weapon. These alternative models may also be referred to as Community Responder models. Alternative crisis response teams do not utilize law enforcement personnel as first responders, although the team may contact law enforcement after they arrive on the scene if warranted. The alternative response model is specifically endorsed by the CESSA legislation as the default model for responding to behavioral health crises, in lieu of law enforcement, with some limited exceptions.

Community Emergency Services and Support Act (CESSA)

On August 25, 2021, Illinois Governor J.B. Pritzker signed into law the Community Emergency Services and Supports Act (CESSA), also known as the Stephon Watts Act. This legislation requires emergency response operators such as those at 911 centers, to refer calls seeking mental and behavioral health support to a new service that can dispatch a team of mental health professionals instead of police. This marks a significant change in policy, and implementation is ongoing as of May 2024.

The implementation details for this law were tasked to the Secretary of the Department of Human Services, who is working in concert with the 911 Administrator at the Illinois State Police, the EMS administrators under the purview of the Illinois Department of Public Health, and Statewide and Regional Advisory Committees established through appointment by the Secretary.

Co-Response Crisis Models

Co-response models vary widely in terms of the makeup of teams with varying combinations of 911 Telecommunicators, law enforcement, emergency medical services personnel (EMS), behavioral/mental health professionals, mental health engagement specialists and peer recovery specialists. Each type of co-response model is described below:

Emergency Medical Services (EMS) Co-Response Models

Mental health professionals and/or peer recovery specialists are embedded in Emergency Medical Service (EMS) Teams. As with the PSAP co-response model, these individuals work side by side with EMS staff in providing crisis intervention services. In other instances, the EMS team may have an agreement with mental health or behavioral health providers to meet the EMS team on site to provide crisis intervention to an individual experiencing a behavioral/mental health crisis. Examples of these co-response teams are described below.

1. EMS and Peer Recovery Specialist - Substance Use Overdose: The co-responder team is comprised of EMS personnel and a peer recovery specialist trained in substance use issues who are dispatched and arrive together for emergency response.
2. EMS and Embedded Mental Health Clinician: The team is comprised of EMS personnel and an embedded mental health clinician trained in crisis intervention who travel together and arrive on site together.
3. EMS and MH Clinician Meet on Site: EMS are dispatched by PSAP and meet MH clinician or Mobile Crisis Response Team and caller on site.

Law Enforcement Co-Response Models

In this model, behavioral/mental health professionals respond to crises situations with law enforcement. Behavioral/mental health professionals may be embedded with law enforcement so they travel together to a site, they may meet law enforcement on site, or they may arrive on site after law enforcement has arrived. Some examples are described below:

1. Law Enforcement with Embedded Mental Health Clinician/Mental Health Professional: A mental health (MH) clinician is embedded in the law enforcement office/agency accompanying law enforcement officers for emergency response. The team may travel together or separately, but they arrive together on site to meet the caller.
2. Law Enforcement and Contracted Mental Health Clinician/Professional Ride Together (Not embedded): A law enforcement officer and MH clinician ride together to a crisis site responding as a team. Law Enforcement may have a contract or an agreement with the mental health professional or agency regarding crisis response.
3. Law Enforcement Meets Mental Health Clinician/Mental Health Professional on Site: A law enforcement Officer is dispatched with a planned meeting with a MH clinician or MCRT who arrives separately at the crisis site. Law Enforcement may have a contract or an agreement with the mental health professional or agency regarding crisis response.
4. Law Enforcement with Post MH Contact: A Law Enforcement Officer responds to the crisis call site, makes an assessment and contacts a MH clinician to provide crisis intervention services. Law Enforcement may have a contract or an agreement with the mental health professional or agency regarding crisis response.
5. Law Enforcement Officer and Mental Health Clinician Virtual Team: A law enforcement officer utilizes telehealth via an IPAD, telephone, or other technology on site to link the individual in crisis to a trained clinician.
6. Law Enforcement Officer, EMS and Mental Health Clinician: A multidisciplinary team comprised of Law Enforcement, EMS personnel, and a mental health clinician are dispatched and arrive together at the crisis site for emergency response.
7. Other: Co-response models not included above may include Law Enforcement and Social Services Staff that address issues such as housing or other social service needs; Law Enforcement and Mental Health Advocates, and Law Enforcement and Community Health Worker models among other possible combinations.

Public Safety Answering Point (PSAP) Co-Response Model

Mental health or other clinicians skilled in crisis intervention techniques are embedded in 911 Public Safety Answering Points (PSAPs) Dispatch Centers. These individuals have been hired or contracted to work side by side with PSAP staff on site. These individuals serve as part of the PSAP team. Mental health and behavioral health related crisis calls may be routed to this individual when received through 911.

Certified Community Behavioral Health Clinics (CCBHCs)

Certified Community Behavioral Health Clinics (CCBHCs) provide services to anyone who requests care for substance use or mental health services, regardless of their ability to pay, place of residence, or age. CCBHCs are required to provide the following services: crisis services that are available 24 hours a day, 7 days a week, outpatient mental health and substance use services, person and family centered treatment planning, community based care for veterans, peer family support and counselor services, targeted care management, outpatient primary care screening and monitoring, psychiatric rehabilitation services and screening, diagnosis and risk assessment. CCBHCs must offer comprehensive behavioral health care services and care coordination across providers to help people navigate behavioral health care, physical health care, social services, and other systems in which they may be involved. (Substance Abuse and Mental Health Services Administration), https://www.samhsa.gov/sites/default/files/national-guidelines-for-behavioral-health-crisis-care-02242020.pdf; Illinois Department of Healthcare and Family Services,https://hfs.illinois.gov/medicalproviders/certifiedcommunitybasedhealthcenterinitiative.html).

Crisis Intervention Team (CIT) Models

Crisis Intervention Team Training models have been developed for 911 Telecommunicators, law enforcement officers and other interested parties. CIT International has developed an 8-hour in-service training designed specifically for telecommunicators as well as an in-depth 40-hour course specifically designed for law enforcement officers with at least two years of experience. Telecommunicators and law enforcement officers can also complete a Mental Health First Aid course that consists of 8 hours of training. Law enforcement officers completing the intensive 40-hour CIT course may also enroll in one day refresher courses, advanced CIT training focusing on juveniles, and specialized CIT training for Corrections and Emergency Dispatch.

Crisis Service Continuum

The three pillars of a crisis response continuum are someone to call, someone to respond, and somewhere to go. The crisis continuum is comprised of crisis call centers to receive crisis calls, mobile crisis response teams to respond as necessary, and crisis stabilization centers, including living room programs.

Crisis Stabilization Center

Observation units that provide brief, medically monitored, or supervised care to individuals experiencing a mental health crisis. Crisis Stabilization Centers are considered to be less restrictive than traditional inpatient psychiatric units. (Pinals, 2020).

Deflection

Deflection is a collaborative intervention connecting public safety and public health systems to create community-based pathways to treatment and other service to address social determinants of health without entry into the legal system. There are six deflection pathways:

•  Self Referral: Individual initiates contact with law enforcement for a treatment referral (without fear of arrest); preferably a warm handoff to treatment.
•  Active Outreach: Deflection team intentionally identifies or seeks out individuals; a warm hand off is made to a treatment center, which engages the individual in treatment.
• Naloxone Plus: Engagement with treatment and Naloxone as part of an overdose response or with someone with opioid use disorder,
• Officer/First Responder: Law enforcement/First responder initiates treatment engagement from a call for service. No charges are filed.
• Officer Intervention Referral: Law enforcement initiates treatment engagement from a call for service, charges or citations are held in abeyance with requirement to complete treatment.
• Community Response: In response to a call for service, a team comprised of a community based behavioral health professionals which may include a combination of clinician, person with lived expertise, engagement specialist, etc, engages an individual to help de-escalate a crisis, mediate low-level conflicts, address quality of life issues by providing a referral to treatment, recovery support services or case management.

Diversion

Diversion, according to the CESSA legislation, is the practice where PSAPs and emergency services dispatched through PSAPS promote, to the greatest extent practicable, the practice that "individuals should be referred to health care services with the potential to reduce the likelihood of further law enforcement engagement and referral to a pre-arrest or pre-booking case management unit should be prioritized in any areas served by pre-arrest or pre-booking case management." (Community Emergency Services and Support Act)

Division of Statewide 9-1-1

"The Illinois State Police (ISP) Division of Statewide 911 is responsible for developing, implementing, and overseeing a uniform statewide 911 system for all areas of the State outside of municipalities having a population over 500,000. The ISP has oversight authority of 911 systems providing central coordination and supervision". (Illinois State Police Website, https://isp.illinois.gov/Statewide911Division)

Emergency Medical Dispatch (EMD)

Refers to a system that enhances services provided by Public Safety Answering Point (emergency) telecommunicators. It does so by allowing the telecommunicator to quickly narrow down the caller's type of medical or trauma situation, so as to better dispatch emergency services, and provide quality instruction to the caller before help arrives.

Based on specific question-and-answer logic trees ("systematized interrogation"), the telecommunicator is able to determine a problem type and priority for the call, and use that information to provide systematized Pre-Arrival Instructions, which gives phone instruction to aid the patient until help arrives, provide other information to the caller, activate appropriate protocols and dispatches the call to the appropriate resources.

Emergency Medical Services (EMS)

Emergency Medical Services System means an organization of hospitals, vehicle service providers and personnel approved by the Illinois Department of Public Health (IDPH) in a specific geographic area, which coordinates and provides pre-hospital and inter-hospital emergency care and non-medical transport. EMS providers are licensed by IDPH.

Illinois Interim Risk Level Matrix

The Illinois Interim Risk Level Matrix (IRLM) was developed by the CESSA Standards and Protocol Technical Subcommittee for incorporation into protocols used by 911 telecommunicators to identify individuals experiencing behavioral health/mental health crises and to serve as a basis for making decisions regarding emergency response type and urgency. The IRLM is comprised of four risk levels ranging from low (level 1) to emergent (level 4), with each level containing descriptions of risk factors and risk acuity or severity. The IRLM is described as an interim matrix because the type of response as well as the response time described reflect what is currently available in the Illinois crisis system. As the crisis system evolves and expands adopting more and varied alternative response models and co-response models, the risk matrix will be updated to reflect these innovations.

Living Room

"Living rooms provide 24/7 alternatives for less acute needs and often accept police-drop-offs for individuals who meet their admission criteria. They are typically unlocked and serve individuals who are voluntary, non-violent and motivated for help. Living rooms offer a home-like environment with couches and artwork and are staffed predominately by peer specialists with limited coverage by a psychiatrist or other provider" (Balfour, Hahn Stephenson, Winsky and Goldman, 2020). In Illinois, the Living Room Program is staffed by Recovery Support Specialists. Individuals voluntarily seek support from a living room may self-refer or be referred by police, fire, emergency departments or other organizations with which an individual experiencing such a crisis may come into contact. (Illinois Department of Human Services, Living Room, https://www.dhs.state.il.us/page.aspx?item=126349)

Mobile Crisis Response Team

Mobile Crisis Response Teams (MCRT) "provide 24-hour-a-day, 7-day-a-week, 365 day-a-year rapid response to assess an individual in a crisis, situation offering community-based interventions and stabilization by meeting them wherever they are including, at home, work, school, or anywhere else in the community where the person is experiencing a crisis". Per SAMSHA, "To fully align with best practice guidelines, teams must meet the minimum expectations and: 1.Incorporate peers within the mobile crisis team; 2. Respond without law enforcement accompaniment unless special circumstances warrant inclusion in order to support true justice system diversion; 3. Implement real-time GPS technology in partnership with the region's crisis call center hub to support efficient connection to needed resources and tracking of engagement; and 4. Schedule outpatient follow-up appointments in a manner synonymous with a warm handoff in order to support connection to ongoing care. (Substance Abuse and Mental Health Services Administration, https://www.samhsa.gov/sites/default/files/national-guidelines-for-behavioral-health-crisis-care-02242020.pdf).

Medicaid Mobile Crisis Response (Illinois Department of Healthcare and Family Services)

"A mobile, focused, and time-limited service designed to achieve crisis symptom reduction, stabilization, and restoration of the client to the previous level of functioning" (Illinois Department of Healthcare and Family Services, 2018, https://www.cbha.net/resources/Documents/Homepage/MCR%20Webinar.pdf). Mobile crisis response services, which are funded by the Illinois Department of Healthcare and Family Services (IDHFS), may be provided by an individual and does not require a team approach or require mental health peer engagement staff to be part of a service delivery team. IDHFS Funds mobile crisis response services for children under 21 who are enrolled in Medicaid Managed Care Plans.

Program 590 Mobile Crisis Response Team (Illinois Department of Human Services Division of Mental Health)

Program 590 is a grant program funded by the Illinois Department of Human Services Division of Mental Health (DHS/DMH) to provide mobile crisis response team services (MCRT) to individuals experiencing behavioral/mental health crises. MCRT services are delivered by a team consisting of a clinician and an engagement specialist who provide crisis intervention services to individuals experiencing a behavioral/mental health crisis wherever they are located including home, work, school, and community settings. These 590 programs are housed in community behavioral health/mental health agencies certified by IDHS.

Persons with Lived Expertise

An individual with personal lived experience of a mental health condition or substance use disorder or a developmental disability or intellectual disability. (Illinois Department of Human Services Q&A, https://www.dhs.state.il.us/page.aspx?item=131578). Lived Expertise is a person's knowledge based on their own perspective, personal identity, and history beyond their professional or educational experience. Descriptions of qualifications of persons with lived experience who are certified to provide mental health and substance abuse services are displayed below.

Certified Peer Recovery Specialist (CPRS)

CPRS are certified by the Illinois Certification Board. CPRS professionals are individuals trained to incorporate their unique personal experience in their own recovery with a distinct knowledge base and human service skills. They utilize unique insights gained through one's personal experience in recovery from substance use disorder, mental illness or dual diagnosis of mental illness and substance use disorder, and provided to support other individuals with such conditions and/or family members/significant others.

This combination of experience and training allows the CPRS professional to facilitate recovery and build the resilience of persons in recovery. The knowledge and skill base may be acquired through a combination of specialized training, education and supervised work experiences. CPRS professionals help consumers to address their physical, intellectual, emotional, social and spiritual needs to facilitate and maintain wellness throughout the behavioral health recovery process. Persons served by a CPRS include persons with substance use disorders, mental illnesses, persons dually diagnosed with mental illness and substance use disorder, family members/significant others and/or staff of organizations seeking consultation on the behavioral health recovery model.

CPRS professionals assist consumers in becoming involved in their own recovery process so they might develop personalized action plans for their own mental, emotional, physical and social health. They provide experience, education and professional services to assist and support individuals in developing and/or maintaining recovery-oriented, wellness-focused lifestyles. In addition, CPRS professionals recognize problems beyond their training, skill or competence, and are carefully trained to refer to appropriate professional services.

Certified Recovery Support Specialist (CRSS)

CRSS are certified by the Illinois Certification Board. CRSS professionals are individuals trained to incorporate their unique personal experience in their own recovery with a distinct knowledge base and human service skills. They utilize unique insights gained through one's personal experience in recovery from mental illness or from dual diagnosis of mental illness and substance use disorder, and provided to support other individuals with such conditions.

This combination of experience and training allows the CRSS professional to facilitate the recovery and build the resilience of persons with mental illnesses or those dually diagnosed with mental illness and substance use disorder. The knowledge and skill base may be acquired through a combination of specialized training, education and supervised work experiences. CRSS professionals help individuals to address their physical, intellectual, emotional, social and spiritual needs to facilitate and maintain wellness throughout the mental health recovery process. Persons served by a CRSS include persons with mental illnesses, persons dually diagnosed with mental illness and substance use disorder, family members/significant others and/or staff of organizations seeking consultation on the mental health recovery model.

CRSS professionals assist individuals in becoming involved in their own mental health recovery process so they might develop personalized action plans for their own mental, emotional, physical and social health. They provide experience, education and professional services to assist and support individuals, in developing and/or maintaining recovery-oriented, wellness-focused lifestyles. In addition, CRSS professionals recognize problems beyond their training, skill or competence, and are carefully trained to refer to appropriate professional service(s).

Engagement Specialist

An individual with personal lived expertise in recovery from mental health, substance use, or co-occurring mental health and substance use disorder who earns the Certified Recovery Support Specialist (CRSS) or Certified Peer Recovery Specialist (CPRS) credential within one year of date of hire. Engagement specialists are a key staffing component of DHS/DMH funded mobile crisis response teams (MCRTs). (Illinois Department of Human Services, Living Room, https://www.dhs.state.il.us/page.aspx?item=148653)

Public Safety Answering Point (PSAP)

Public safety answering point (PSAP) means the primary answering location of an emergency call that meets the appropriate standards of service and is responsible for receiving and processing those calls and events according to a specified operational policy.

Telecommunicator

A telecommunicator is an emergency response coordination professional trained to receive, assess, and prioritize emergency requests for assistance, including, but not limited to: determining the location of the emergency being reported, determining the appropriate law enforcement, fire, emergency medical, or combination of those emergency services to respond to the emergency, coordinating the implementation of that emergency response to the location of the emergency, and processing requests for assistance from emergency responders.

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References

9-8-8 Suicide and Crisis Lifeline Workgroup Act. § 405 ILCS 150.

  https://www.ilga.gov/legislation/publicacts/103/PDF/103-0105.pdf

Balfour, M.E., Hahn Stephenson, Winsky, J., and Goldman, M.L. (2020). Cops, Clinicians, or Both: Collaborative Approaches to Responding to Behavioral Health Emergencies. Alexandria, VA: National Association of State Mental Health Program Directors.

  https://www.nasmhpd.org/sites/default/files/2020paper11.pdf

Community Emergency Services and Support Act (CESSA). § 50 ILCS 754.

  https://www.ilga.gov/legislation/publicacts/102/PDF/102-0580.pdf

Health Facilities and Regulations (210 ILCS 50/) Emergency Medical Services (EMS) Systems Act,

   102-0623 (ilga.gov)

Illinois Department of Healthcare and Family Services. Certified Community Behavioral Health Clinic (CCBHC) Initiative. 

  https://hfs.illinois.gov/medicalproviders/certifiedcommunitybasedhealthcenterinitiative.html

Illinois Department of Healthcare and Family Services. (2018). Mobile Crisis Response (MCR) and Crisis Stabilization: Updating Illinois' Medicaid-funded Crisis  Continuum. [PDF]

  https://www.cbha.net/resources/Documents/Homepage/MCR%20Webinar.pdf

Illinois Department of Human Services. 2539 Q&A - Crisis Care System (590).

  https://www.dhs.state.il.us/page.aspx?item=131578

Illinois Department of Human Services. 590 Crisis Care System (24-444-22-2539).

  https://www.dhs.state.il.us/page.aspx?item=148653

Illinois Department of Human Services. Living Room Program.

  https://www.dhs.state.il.us/page.aspx?item=126349

Illinois State Police. Division of Statewide 9-1-1.

  https://isp.illinois.gov/Statewide911Division

Jones, David, T. CESSA Statewide Advisory Council STBHCC Update, Presentation to the CESSA Statewide Advisory Council, February, 2024.

Pinals, D. A. (2020). Crisis Services: Meeting Needs, Saving Lives. Alexandria, VA: National Association of State Mental Health Program Directors.

  https://store.samhsa.gov/sites/default/files/pep20-08-01-001.pdf

Substance Abuse and Mental Health Services Administration (2020). National Guidelines for Behavioral Health Crisis Care.

 https://www.samhsa.gov/sites/default/files/national-guidelines-for-behavioral-health-crisis-care-02242020.pdf