CESSA - Region 4 Committee Meeting Approved Minutes 06/18/2024

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

Meeting Minutes- Tuesday, June 18, 2024 - 10:00-11:30 via Zoom

Meeting Minutes - Approved by Members 09/17/2024

  • Call to Order/Roll Call
    • Julie Brugger called the meeting to order at 10:08 am
    • Attendees: Chair Jeff Shafer, Deborah Humphrey, Jane Nesbit, Brittany Pinon-Becker, Randy Randolph, JoAnn Russell-Baum, Megan Black, Layla Simons, John Nowak, Joe Harper, Erin Hazen, Julie Brugger
    • Approval of Minutes from April and May 2024 meetings. This motion was approved by attending members.
    • Julie Brugger reviewed procedures around the Open Meetings Act and meeting logistics.
  • State Updates (Julie Brugger)
    • The General Assembly has voted to extend the delay in complete implementation of CESSA. The Technical Subcommittee on Training and Education through the State Advisory Committee has designated specific training plans; there is a meeting scheduled with DMH to finalize the core training for the 988 Suicide and Crisis Lifeline as well as the 590 Mobile Crisis Response teams. The Protocols and Standards Committee identified that they are looking at doing pretests before the pilots begin. The chosen three pretest sites are in Lee County, Cumberland County, and Cicero; these are a rural area, a suburban area, and an urban area. The pretest is meant to evaluate the changes to the protocols used by the 911 PSAPs that have been modified to incorporate the interim risk level matrix, risk type and severity or acuity to determine if they are successful in identifying individuals experiencing behavioral health crises. These pretest sites are going to evaluate for about 45 days to see if the changes to PowerPhone would work in terms of adequately identifying people at the risk level that the interim risk level matrix identifies. Additionally, it is to evaluate whether or not these recommended protocol changes and the questions that they've identified, get at the, the core source of the matter, which is are we determining the right risk level and therefore the right response to respond?
  • Overview of the Summit (Julie Brugger)
    • We gathered together with many community stakeholders; it was a community wide meeting, encouraging participation of those in our communities who have influence and much work committed to dealing with our community members who may be experiencing crisis. We discussed the CESSA Law and how it came to be. We shared what is working in our communities now, including different programs that are happening from the behavioral health side, but also, recognizing the amazing work that has been done and continues to be done by our partners in 911 and in law enforcement as well as our partners in hospitals. Discussions also included the progress that the State has made so far in implementing CESSA. We identified that training plans being recommended for 911, for 988 and for the 590 Mobile Crisis Response Team programs. We talked about the recommendations for the computer aided dispatch protocol changes and identifying not only the need for a communication loop, but beginning to identify ways that they can make that communication loop happen. Another discussion was what we need in order to implement the vision of CESSA that the state has and how they have not yet identified; a solid plan for how communication will work between 911 and 988 when calls are transferred, as well as a plan for how communication will work when calls need to be transferred from 988 into 911. With the immediacy of the risk, we identified that there is concern about what resources are being given to the different 988 programs for when they are answering a call that maybe not is local to make sure that they get connected to local 911 resources if that is what's needed. Questions raised included, are 988 systems adequately receiving the information that they need about each of the local areas? 911 dispatchers who were in the room voiced that geolocation data is absolutely needed. When a call is transferred from 988, that information is not available, and we cannot be sure that the person in crisis will adequately be able to tell us where they are with certainty. With that, the question came up, is there a way to pool resources for 911 and 988 so that all calls have geolocation so that there are clinicians available at every call to spend time to listen and de-escalate when the calls don't require an immediate law enforcement or EMS response? Something of this nature would enable our 911 dispatchers to do the steps needed with immediate response, but then also create a system that may allow for something that takes longer. Could perhaps be a 20-to-30-minute conversation that our 911 dispatchers don't have the time to do due to emergent other calls coming in. We also talked about the possibility of a database being created that identifies where community members are receiving or have received treatment services? The IHPA system, which is Illinois Health Providers Association is a system that is run by different managed Medicaid insurance companies that identifies, when a person goes into the hospital, when a person goes into treatment, how often have they been there; how and when are they being seen. This brings up the idea of creating something similar that different members of our community would potentially have access to in order to be to be able to offer the best possible resources in the community for them. This could be accessed by our mobile crisis response teams and 911. However, could it be accessed, or can we share information like that because it would include some amount of protected health information? Would we need legislation in order to support this kind of collaboration? We discussed needing a pilot site to try out the recommended protocols, changes in priority dispatch. We found people by and large are saying, "not interested in doing this until I know it is actually going to work because I don't want to be part of something that's going to fail". In terms of looking at this, until we know that 988 can adequately respond, until we know the plan for communication between 911 and 988, we've got some understandable hesitation. I think that participation in this pilot site idea will give us more say in how things are created to make sure that it is exactly what we need. We discussed that there is some trepidation regarding the upcoming publicity for 988 regarding our concern that the community that this information going out statewide to the various communities telling our community members to call 988 for a behavioral health crisis when our 988 answerer is changing as of July 1. As of July 1, Path Crisis did lose that contract and Centerstone won it. Centerstone will be the new 988 call center provider for Central and Southern Illinois as well as being a backup for the entire state. There is concern about how they are going to get up to speed on all of the different community resources that need to be contacted and how they will know all of the pieces of information that they need to know in order to be able to operate fully and operate in a way that makes sense to be our 988 provider. There is the additional need that we identified of when transportation is needed by our community members to non-hospital resources; we need to figure out how that transportation's going to be available because our ambulance system can't be expected to provide that. As we look at that, we've got to identify how that transportation is going to be made available and what's going to make that possible. In our small area we don't have 24/7 resources for that So identifying how that is going to happen was another concern.
  • Comments/Questions from committee members:
    • Q: (Deborah Humphrey)- Are they still with the same plan to roll out the marketing in July ?
      • A: (Julie Brugger) -Yes. I voiced our concerns about that because it is our area that is changing. They are saying to let people know about 988 but there is trepidation; how this is going to work and whether or not it's going to be effective.
    • Comment: (Deborah Humphrey) - I understand when you're developing initiatives and efforts that we have to go through the process. It's just when you talk about this subject, these are life and death matters; that is what is so concerning to me about all of it. When phone calls are going to a voicemail, we have no control over that. If they call the mental health board, we're going to give them information as we know it. I think us being knowledgeable, making those within the community more aware and share about the system changes and maybe some media coverage representing what's happening here. Perhaps with law enforcement like the Wellness officers and entities like that; whoever we can get information dispersed to, it seems really important.
    • Comment: (John N.)- I had an incident where someone shared that he was having trouble with a teenager at home threatening to kill himself with a gun. I offered that we get an ambulance and police officers there. The man relayed that the individual stated that he "would complete his intentions before help would walk through the door". I suggest we try the new service, 988. He called 988 twice and got a voice recording to leave a message and they would get back with him. I called 988; initially it rang about four or five times, and then it just stopped. I called again, it rang twice, somebody answered, and they were actually from Missouri. We weren't able to get information for the Illinois side. I ended up trying another route to get him help with Chestnut. The point is, there were four attempts to call 988 and on the 4th attempt somebody finally answered, but they knew nothing about us in southern Illinois. This has to be fixed. Even though this phone was from a different area code, they were from Illinois and have been for a few years. My phone is the 618-area code and I'm not sure if that's why it went to Missouri or if it should have gone to Illinois. I'm hoping I heard you say there is a different agency that's going to take this over for Central Illinois.
    • Comment: (Julie B.)- we are counting on having Centerstone in charge of that. I know that Centerstone does have that contract in other states; they do have experience with this already. They will be a powerful addition to our community services.
    • Comment: (Jeff Shafer) with CESSA, if you have someone threatening suicide, holding a gun, this is not a CESSA situation; that is traditional 911. You don't have any choice there. This type of situation does point out the inconsistencies that are still present in the system that need to be worked out. These issues are very much unfortunately a little broader than what our mandate implies
    • Q: (John N.) - Are they strictly picking these counties for their pilot and collection data collection for this 45 days under the assumption just because those areas are using PowerPhone? I feel they are not getting the data from some of the areas that they that truly need to be analyzed.
      • A: (Julie B.) it is starting with PowerPhone; it was initially the most amenable of the different computer aided dispatch systems that exist in Illinois. Priority Dispatch will be next and will likely happen at some point during the six months that PowerPhone is in its pilot. Priority Dispatch pilots will likely begin sometime during that.
    • Comment: (John N.) - When I hear mandates and conversation of funding, funding which effects MedStar huge is, it is a big issue for us. We certainly don't mind doing our part and helping out, but we want funding as well.
    • Comment; (Julie B.) - I have asked that we be sent some of that information because there are so many other states that are already so far ahead, which are supporting this and funding this and receiving federal funds. I just keep getting the information that it is federal money.
  • Next Meeting Date: September 17, 2024
  • Public Comment
    • Q: (Charles K.) - I just had some questions as to who you are working with at Priority Dispatch; we are in ACE accredited center? We are in the middle of our ACE accreditation, and I sit on my 911 ETSB and manage all the medical calls that come from MedStar throughout Region 4. Do you know who are they talking to at Priority Dispatch? If you were to find that out, I could probably speed that process along, as I am an instructor for the Academy.
      • Comment: (Julie B.)- I don't have that answer but I can find out from the Crisis Hub.
    • Comment: (Randy R.) Notification came out on the 13th from Priority Dispatch in the Academy regarding the Protocol 41 caller in crisis has been released in the pro QA maintenance release. I think that is the protocol that they are looking to utilize for this type of scenario. We have not yet upgraded our Pro QA to that maintenance release. If I'm correct, prior to using it, there is a mandatory online training that the telecommunicators have to take before they can use it.
    • Comment: (Charles K.)- We had an incident where we received the 988 call and were given a valid, reliable address. We responded, to find there was no one at that residence. We attempted to call 988 back, only to end up talking to another call center. We explained to them what was happening, an hour and a half of bouncing back and forth between 988 and our dispatch center, they found out that it was the wrong state. The caller had an Illinois area code, and it still went out of state, and they didn't know who to call. It is important to recognize for 988 contractors that the FCC has a database of every PSAP in the country and how to contact them and where they are located. Being in region four, we are heavily reliant on Missouri resources. How are we going to get the information back out of Missouri? I have had this discussion with Christina McCutcheon at HFS. We have no pediatric services in the southern half of the state. There are resources in Missouri when we transport over there, HFS and these Medicaid Managed Care organizations are not paying the provider. They will pay them for the emergency room stabilization, but they are not paying for the hospitalization, and they are forcing them to transfer that patient back into Illinois unnecessarily when the resource is right there. This is just a small sampling, not a complete year. We averaged 240 behavioral health calls a month and in just a 10-month period we have responded to 2409 behavioral health emergencies on the EMS side. We need to be part of the conversation because we are getting these calls once my PSAP receives them, once it hits a medical provider, we have to respond per state statute, unless they have some change happening. I've been watching it very closely and seeing nothing to change the language that says we're not going to send an ambulance. I've seen the conversation about squad cars and law enforcement, things like that. ComWell should be in on these meetings as well. I collaborate directly with them almost daily and they are fabulous to work with when it comes to this. They cover Randolph and Washington and they've already got a call center that's been operating for years, but they are not part of this conversation. With the numbers I have every month versus how can we get them to the right services that they need when they need them?
    • Comment: (Julie B)- there is no doubt that there is still growth to be done in this system. Just in terms of meeting our community members, those basic needs for services. We still have to grow our processes and create systems that work more seamlessly, less siloed than what we are now. In looking at being able to share information about treatment or where people have received treatment, it likely would require legislation allowing that. I think that one of the things we've got to do is get together and come up with what we want the plan to be and what we're willing to live with., because at some point, everything's going to be a negotiation to some extent.
    • Comment: (Jessica G.)-I go to all the CESSA subcommittees and have observed all of the RAC's. I spoke at the RAC 1 Summit. I'm a member of Rack 11. Julie that was the best explanation I've ever heard anybody give of the pretest and the pilots; that was amazing, the best explanation. I appreciate people sharing their stories. It's very sobering hearing the work we have to do. One idea for people who want another way to give input on the things you mentioned, the indicators, the data being collected, the pretests and the pilots would be, is to attend the Technology Subcommittee. They meet once a month, on the first Monday; their next meeting is September 3rd. The Chair of the Technology Subcommittee welcome public comment, so that is another way to give critical feedback about your, communities' concerns and what is going on.
  • John Nowak. made first motion to adjourn, Deborah Humphrey seconded. Meeting ended at 11:10