CESSA Technology, Systems Integration & Data Management Subcommittee Meeting - Approved Minutes 10/07/2024

CESSA Subcommittee for Technology, Systems Integration & Data Management (TSIDM)

October 07, 2024, 2:00 - 3:30 pm via Zoom

Subcommittee members: Brent Reynolds, Cindy Barbera-Brelle, David Albert (Designee-Lee Ann Reinert), Richard Manthy, Jim Kaitschuk, Robert Van Bebber, Candace Coleman (Designee-Jessica Gimeno)

  1. Welcome and Call to Order (Roll Call)
  2. Open Meetings Act
  3. Approval of the Minutes from previous meeting
  4. State updates
  5. Hub updates
  6. CESSA Pre-tests and Pilots Updates
  7. Data Systems Development
  8. Public comment
  9. Adjournment

The meeting was called to order by Brent Reynolds at 2:03pm.

Brent Reynolds reviewed procedures around the Open Meetings Act and meeting logistics.

Roll call and previous meeting minutes:

  • Motion to approve meeting minutes from September 3, 2024, from Cindy Barbera-Brelle, seconded by Robert Van Bebber. Motion carried.
  • Present: Brent Reynolds (approve), Robert Van Bebber (approve), Lee Ann Reinert (approve), Jessica Gimeno (approve), Rick Manthy (abstain), Cindy Barbera-Brelle (approve)
  • Absent: Jim Kaitschuk

State updates (Craig Williams):

  • On September 17, 2024, 988 geo-routing went live in Illinois with two of the three main cellular phone carriers. Geo-routing is off to a good start, and we expect a Vibrant report soon for September.
  • Prior to geo-routing, calls were routed based on area code, which would often send calls to the wrong general location. Geo-routing is attempting to fix this.
  • Vibrant completed a traffic study from July 27-August 23 and determined that Illinois would see 4% reduction of call volume based on this period's data. Different factors, including seasonality, impact traffic-so this study is limited.
  • Brent Reynolds: Thank you for this, this is a huge improvement over where we were.
  • Craig Williams: It's a federal approach, but it's something that DMH really has had their arms around.
  • Rick Manthy: So the plan is when someone calls 988, they'll have a better idea of where someone is calling from, and then it will make it easier to transfer to a 911 center or deploy a 590 agency as needed?
  • Lee Ann Reinert: It's not geo-location, it's geo-routing. The cell tower that's being used for the call is identified as being within a county, and then it goes to the call center that has responsibility for that county. Doesn't include GPS mapping but general location so they can have the best handle of resources and will be more knowledgeable about their area. At this time, FCC doesn't allow for geo-location due to protections for anonymity.
  • Rick Manthy: If someone is calling from 312 area code, but they live downstate, they'll now get routed downstate and not downtown Chicago. That's a huge leap forward.

Hub updates (Mary Smith):

  • The Hub posted June 11th BH Forum resources: https://bhch.uic.edu/forum/
  • Introductory and breakout sessions posted - not all available due to technical issue.
  • PowerPoints for all presentations are posted and bios of presenters.
  • Brent Reynolds: I will share with the Illinois NENA and get this shared out to membership.

CESSA Pre-test and Pilots (Dr. Mary Smith):

Pre-Test Updates

  • The PowerPhone pre-tests started September 3 and set to run 45 days
  • PSAPs administrators have worked the Hub, DMH staff with lived expertise, and PowerPhone to modify the protocols to incorporate the risk factors and acuity levels.
  • Cindy and Mary have weekly check-ins with the pre-test PSAPs covering implementation issues, training needs, review of identified issues.
  • Example of issues include:
    • PSAPs using PowerPhone and protocol in different ways
    • One or two of the PSAPs don't open PowerPhone right away with a call
    • Some use only EMD protocol, some also look at the law enforcement protocols

Data Collection Elements and Reports

  • Worked with PowerPhone to create report that can be used for pre-tests and pilots
  • Reports allow us to collect the kind of information that we need to evaluate the data, with data elements helping us to know if the protocols are working and if the transfers from 911 to 988 to MCRT are successful.
  • Report can be set up to gather data from different reporting time frames.
  • The reason we have two different incident IDs is because not all CAD systems will contain incident IDs at the point that we need them for each person that calls 911.
  • We will have the Total Response ID number, generated for each call that comes in, and we will connect that to PSAP IDs so we will have unique IDs for everyone.
  • We have been working with Centerstone on 988 data collection elements, because we need to be able to track people when people are transferred from 911 to 988 to MCRT
  • Pilot Preparation:
    • Convened a meeting with the MCRT Project Directors and Executive Directors, Centerstone, and we'll be meeting with the PSAPs
    • Created and reviewing guidance for transferring calls from 911 to 988 to MCRT
    • Creating some on-demand training modules for 911, 988 and MCRT response- will be posted on the BHCH website.
  • Shelley Dallas: Some of the data elements displayed don't exist, Total Response Incident ID number for example, and they aren't feasible. I'm finding some of the PowerPhone requirements from Total Response are not available, even with the new report.
    • Dr. Mary Smith: The Total Response Incident ID field does exist, but you can't see it. PowerPhone software creates a Total Response ID, and then there will be a 3-digit code that is assigned to each PSAP, and then that is concatenated onto the Total Response ID. We had to take that approach because the CAD incident ID is not there for each person. When you run the report PowerPhone gives you for Total Response, you'll see it.
  • Brent Reynolds: Will this report be the same for all providers, or is that something unique to PowerPhone?
    • Dr. Mary Smith: We are only working with PowerPhone right now and haven't gotten as far with the other vendors. We will have to figure out how to get the ID for everyone.
  • Lee Ann Reinert: What are the mechanics of collecting the data? Is it automated?
    • Dr. Mary Smith: PowerPhone will create report and will give the report along with instructions to the PSAPs, and each PSAP will be able to run the report and export the data into an Excel file. They will send the excel files to the Hub and we will run the data and do analysis. We have also met with Centerstone to discuss these elements and talk about their ability to generate the report and excel file. When the pilots are over, hopefully there will be something much better in place to collect the data.
  • Jessica Gimeno: How are you collecting data on the type of mental health crisis - is there a way to differentiate between someone being suicidal, someone having autism?
    • Dr. Mary Smith: We will have the chief complaints and call nature codes. We don't have a diagnosis. Right now, we're using the categories that are used by 911.
  • Susan Schafer: Will the chief complaints and nature codes be standardized across all PSAPs, whether they have Priority Dispatch or PowerPhone?
    • Dr. Mary Smith: That would be nice, but each are propriety. Powerphone and APCO looks pretty similar, but Priority Dispatch is different.
    • Cindy Barbera-Brella: We'll have to have some translation table to align everything.
  • Jessica Gimeno: In the indicators, when the report comes out, will we be able to see what number or % could have been sent to MCRTs? For the pre-test.
    • Dr. Mary Smith: For the pre-test, there was a code that was created called 988pre. We would at least be able to look at the number of calls that could have possibly been sent to 988 for MCRT if that would have been in place.
  • Lee Ann Reinert: Just confirming, for the pre-test, no transfer is happening. And for the pilot, it's only happening where a transfer can occur.
    • Dr. Mary Smith: That's right. The right teams have to be in place, people have to respond at the right time, etc. And we're trying to take that into account.
  • Jessica Gimeno: For the pre-test, within the calls that are identified that are mental health, then we are identifying calls that would be transferred to 988.
    • Dr. Mary Smith: Yes, the idea is to identify this, but the mechanism isn't in place. We want to get an idea of what would be appropriate to transfer to 988.
  • Mary Smith: We are excited about this, and we look forward to giving you all updates.

Data Systems Development (Shawn Nelson Cole)

Introduction (Pete Eckert)

  • We're turning it over to Shawn Cole from the UIC Office of Medicaid Innovation (OMI), to give an update on the State's plans for a centralized dispatch system.
  • We have been tracking this for quite awhile, looking at states and looking at what it would take to have a multi-agency, multi-provider in place. Shawn will talk more about what is inside and outside their purview.

Overview (Shawn Cole)

  • Thanks for the invitation. I'm happy to talk about where the unified crisis continuum (UCC) and centralized dispatch discussions are at.
  • The reality is that I represent a large effort between Lee Ann, DHS, HFS, parts of SUPR that sit around the table with Chief Jones, to think about what the UCC really means.
  • We want crisis response to look very consistent for anyone in Illinois.
  • It's going from a heavily Medicaid, behavioral health focus to a larger focus, which is a challenge. Lots of state agencies are thinking hard about how we can do this.
  • 988 has to become the front door for crisis whenever possible. In the crisis continuum, there are call centers in the State that exist and function very similar to what 988 has envisioned, but they don't have the ubiquitous nature of 988, don't have a 3-dgiit number, no name recognition.
  • Since 2005, we have been working to administer the SASS and CARES hotline. CARES is the primary front door to the children's health screening program. They do almost 40,000 screens a year, funded by state funds and all of the managed care programs and state fees for service, covering essentially anyone who presents as long as they don't have private insurance.
  • We have this infrastructure, and schools are comfortable with it, but 988 is still probably the best front door. Instead of telling schools not to use CARES, can we have a 988 platform that can plug into existing infrastructure and bring the CARES technology into the platform?
  • Since 2005, the CARES vendor is a single statewide location that has direct access into the HFS Care system. For any customer that presents in a crisis, they can identify whether they are enrolled in Medicaid. If they're not, they have the ability to generate a recipient ID number for that individual. They have all the artifacts needed to have a claim process through the state system. This gives inventory tracking control for customers in crisis, in a way that lets you actually make a transaction or a payment for something done for that individual.
  • Since 2005, CARES has been able to identify the physical location of the child who has been referred, figure out who exactly is responsible and will respond no matter what -- "crisis accountability"
  • How do we take the best parts of all the systems and get to the point we need to get? You could attempt to tool an entire 988 network and tool each to uniquely respond to everything that we need, or we could take those 988 centers that exist today and plug them into this logistical operation that already exists in a centralized location.
  • We need to think about centralized dispatch, we think about customers, how do we tag them in terms of eligibility in order to make sure they are claimable.
  • And then we think closely about crisis accountability, can we connect this to looking at crisis providers in the area and then look forward how to outfit functionality with proximity based, real time who is available crisis response.

Discussion:

  • Lee Ann Reinert: I want to make sure everyone understands that all the work Shawn is talking about is related to the UCC, which is parallel to but separate from CESSA. It's a large set of work that has been going on even before CESSA legislation, and it's bigger than CESSA. We are designing this to ensure a comprehensive crisis continuum of care for anyone experiencing a behavioral health crisis anywhere, anytime across Illinois. Some of it doesn't align precisely with what CESSA is trying to do, which is - a call goes to 911, what happens?
  • Pete Eckart: Will mobile crisis responders be able to access or use the unified platform?
    • Shawn Cole: Providers come to the table with mixed bags of technology and resources. Some providers have a call center, some use answering services, everyone uses cell phones. We are struggling to have the providers find consistency in EHRs to streamline data collection, treatment planning, etc. The state needs to play a role in the conversation and the infrastructure needs to come with portability.
  • Lee Ann Reinert in the chat: we need to be clear on language here - I believe when Pete asks about a "unified platform" it's not THE Unified Platform that is a Vibrant development for 988.
  • Pete Eckart in chat: Right. I'm speaking about a centralized dispatch, referral and tracking system that would enable providers to accept assignments / referrals of persons in crisis.
  • Shawn Cole: We currently have a location-based structure and we are moving into a structure of "Who is the closest mobile crisis responder to us?" It's important that the department gets efficient in design and it's modular to make sure things are building upon each other.
  • Pete Eckart: Where does this sit administratively? You're at OMI, a partnership with HFS. What is the timeline for this project and what pieces will be available first and when?
    • Shawn Cole: I do sit in the University system office, we report into the Medicaid line, so Director Whitehorn, Kelly Cunningham, as well as the Governer's office chief Behavioral Health Officer. So we report in the two directions (CBHO and HFS) and it's the line to the CBHO that puts us at the table with DHS and have visibility into the CESSA conversation.
    • Shawn Cole: Timeline is a mixed conversation. We know that HFS is in the process of trying to procure a CARES vendor pretty soon. There are NOFOs in your space. I think the reality is that within the next 12-24 months, how to pull together UCC infrastructure that makes the most sense for the State. And how does private insurance come to the party. I can't speak to the full timeline of UCC because there are many pieces of policy that have to come together for this to work.
    • Lee Ann Reinert: Anytime there is active procurement, we can't talk about it in a public meeting, it's ex parte.
  • Jessica Gimeno: You said CARES is good at identifying where the customer is and that either tool 988 with this information or plug the CARES entity into the 988 centers. Can you elaborate on that?
    • Shawn Cole: 988 high success rates with de-escalations. Somewhere from 1-5% will end up needing a mobile crisis dispatch. Maybe we pay for crisis services differently or fund services in a unique nature, or more consistently. For example, in SASS, all are paid from one source. If you want state dollars to stretch as far as possible, it's a good idea to ensure that we structure service delivery, so it matches Medicaid, because people fall in and out of eligibility.
  • Shawn Cole: Does it make sense to tool every one of those 988 centers in such a way that they could plug into, like the State's recipient databases and access all of the State's technology systems and maintain a certain level of quality control across all the sites? Or does it make more sense to route that call or that individual. It's about finding the right way to do that within the technology system. It probably takes a little bit more sophistication than what some of the 988 centers might have the tools at their disposal.
  • Lee Ann Reinert in the chat: it's also important to note that 988 and CARES have traditionally served different audiences. more than 92% of individuals calling 988 are calling for themselves; they are the person experiencing the crisis and requesting intervention. CARES was built around the child-serving crisis system and it is usually a 3rd party calling on behalf of a child/family so they are not generally talking directly to a person in crisis themselves.
  • Shawn Cole: When 911 determines someone needs to go, we don't need multiple entities making that same determination, we just need to make the pass from identifying that someone should go to actually getting someone to the person. We need to route them to the actual dispatching process and get them plugged in.
  • Lorrie Jones: In terms of the work the UCC is doing, we are contemplating 988 as entry point, but sometimes its 911. We have to think about: What is the best way for these behavioral health calls to be managed by a 911 telecommunicators so they get triaged to the right system appropriately? Do we develop a system where they are trained to know which calls go to 988 or a centralized system for resolution? As UCC grapples with designing that part of the system, the 911 system needs to be considered.
    • Shawn Cole: There's a desire to not add administrative layers in that process. At the same time, some information gathering needs to happen. Bottom line is we need to identify pathways to service, pathway for 911 to route to dispatch. Things move from social service to a more medical service, and we've got to figure out what's financially viable. We need to figure out a standardized pathway to service. There are a lot of 911 centers, and we have to get everyone on the same page because there are a lot of moving parts.
  • Lorrie Jones: We need to agree on what is an acceptable interim approach as we work on longer-term plan. We are happy to come talk to anyone at any time and will bring this up at UCC.
  • Brent Reynolds: We can't lose sight of the fact that 911 has many PSAPS and not all are created equal. We should have a more in-depth conversation, and I can take it upon myself to get more 911 PSAPs represented. I'm concerned it's a bit of an afterthought about how it will integrate with 911. We need to make sure that we are setting up to the lowest common denominators in terms of their abilities, staffing, and administration. I think we need to get focused on this sooner rather than later.
  • Rick Manthy: Seems like things are being put together and moving in the right direction.

Next Meeting Dates

  • Monday, November 4, 2024, from 2-3:30 pm
  • Monday, December 2, 2024, from 2-3:30 pm

Public Comment:

  • No public comments
  • Brent Reynolds provided reminder that there will be an in-person Statewide Advisory Committee (SAC) meeting next week

Adjournment: Meeting adjourned by Brent Reynolds at 3:18pm. No opposition.