CESSA Statewide Advisory Committee Meeting Minutes 10/15/2024

Approved by Committee Members 11/12/2024

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

Meeting Minutes - Tuesday, October 15, 2024 - 10:00 am-1:00 pm

Glenview Village Hall (in-person) and WebX (virtual)

Call to Order/Roll Call

Director David Albert called the meeting to order at 10:12 AM.

Dr. Lorrie Rickman Jones took roll call and noted quorum was present.

Approval of Minutes from September 9, 2024

Cindy Barbera-Brelle moved to approve the draft minutes from the September 9, 2024, meeting. Brent Reynolds seconded the motion.

• All members that were present during vote voted in favor to approve the minutes. Minutes approved.
• Members present in-person and voted to approve: Cindy Barbera-Brelle, Jessica Gimeno (Designee for Candace Coleman), Curtis Harris, Justin Houcek, Brent Reynolds, David Albert, Blanca Campos
• Members present virtually and voted to approve: Shelley Dallas, Drew Hansen, Richard Manthy, Darren Gault (Designee for Rachael Ahart), Jim Kaitschuk, Emily Miller
• Members absent during vote: Bobby Van Bebber (joined about 10:20 am, after the voted)

Announcement

Rick Manthy's pending replacement, Pete Dyer, is present. Dyer's appointment is under review. Manthy is still currently a SAC member until the end of the month.

Agenda

The Agenda for the day was reviewed by Director Albert.

State and UIC Crisis Hub Updates

State Updates: Lee Ann Reinert

• Cindy Barbera-Brelle will retire February 28, 2025.
• Geo-routing went into effect by September 17, 2024, in Illinois for Verizon and T-Mobile.
  • AT&T expected by end of the year. This change happens at the national level from Vibrant.
  • Instead of area-code routing, calls in geo-routing are routed by the cell tower that the call is going into. The call is routed into the county that the cell tower is placed in, so it gets it closer to the proximity of the call center that's assigned to serve that area.
  • Cook County now has three call centers that are sharing responsibility for the whole county instead of dividing up areas in Chicago and outer areas of county. We've seen increased efficiency with steadier volume of calls to NAMI and C4. They don't operate 24/7 but they are open some hours of every day. Centerstone receives calls when NAMI and C4 are not open. When they are open, it's a percentage split.
  • 92% answer rate in Cook County with new geo-routing.
  • Will continue to look at resources around 988 and get more calls coming from Illinois answered by call centers located in Illinois. Reminder: Even if no one answers in Illinois, there is a back up national call center.

The Behavioral Health Crisis Hub, UIC Updates: Dr. Lorrie Rickman Jones

• The Hub is hiring. See the postings at https://bhch.uic.edu/job-openings/.
• Dr. Jones did an interview with WBEZ to clarify what CESSA could have done in the Sonya Massey case. There are shortcomings in the system that need to be addressed, but CESSA could not directly impact that. See the article at https://www.wbez.org/criminal-justice/2024/10/09/in-the-wake-of-sonya-masseys-death-springfield-will-test-a-new-way-to-handle-mental-health-calls.

Pre-test and Pilot Updates by Technical Subcommittee

Protocol and Standards: Dr. Mary Smith

• PowerPhone pre-test:
  • The 45 days of the pre-test ends this week then we will review the learnings of the pre-test.
  • We have had weekly check-ins with the three sites.
  • We are working with PowerPhone to generate reports so we can collect data. The reports will be used for pre-tests as well as pilots.
• PowerPhone pilot:
  • We had several meetings with MCRTs and 988, and Cindy updated PSAPs along the way.
  • On 10/24/2024, we will meet with the three groups that are participating in the pilot: Centerstone (988), mobile crisis response teams (MCRTs) and Public Safety Answering Points (PSAPs) to bring them all together.
• Other vendors (Priority Dispatch, APCO, Independents):
  • We have copies of the Priority Dispatch and APCO protocols from previous meetings with them, and we have been working with the subject matter experts to map protocols and indicators to the Interim Risk Level Matrix (IRLM).
  • We will be scheduling a meeting with Priority Dispatch and APCO in November.
  • We hope to move independents along too.

Data and Technology Committee: Dr. Mary Smith

• Indicators for 911 and 988 elements for the pilots were reviewed.
• Reminder: the pre-test is just a test of the protocols. There were no actual referrals to 988 to MCRT, just tracking when PSAPs thought it could be referred.

Questions/Discussion on the pilots:

• Blanca Campos: I've been hearing concerns regarding the pilots about the workflow; decisions made in isolation and not in a collaborative manner. Concerns that when it's piloted in real world it won't work, and about the decision-making taken from the mental health providers. We want to work collaboratively and make sure that these pilots are rolled out in a way that they will be functional. What has the dialogue been like? It was recently expressed in the Protocols and Standards meetings.
• Dr. Mary Smith: We have had multiple conversations with MCRTs for months. We're doing the best we can to ensure the people understand the pilots and provide training.
• Brenda Hampton: Mary is correct. We hold monthly cluster meetings with the MCRT project directors. We have been talking about pre-test/pilots for the past 4-5 months. We had a meeting in August where we shared the draft guidance which will be the step-by-step process for the pilot.
• Dr. Lorrie Jones: I think the concern is about whether the MCRT always responds or if 988 will have an opportunity to resolve.
• Brenda Hampton: The way it's set up now, 988 would be the pass through. 988 Centerstone would do warm-transfer from 911 and share that information with the MCRT. In the pilot, Centerstone won't be doing their own 988 crisis assessment. We want to indirectly connect 911 with the MCRT. This is, without the technology, the best way we can make that connection.
• Blanca Campos: That process that you outlined is where there are concerns.
• Lee Ann Reinert: The technology doesn't yet exist in the state to do what we really want to do. You're right, if 988 can resolve a call over the phone, they should. But right now, we're dealing with calls that start with 911 and we need to be respectful that those telecommunicators need to transfer on if they determine that they need someone to go out. At the state we are working hard over the next couple of months to develop the technology. Vision for the future is a seamless process from 911 to 988 to MCRT. CESSA is parallel and it's not going at the same speed. It's going to be clunky until everything is aligned.

Training and Education Subcommittee Report: Cindy Barbera-Brelle

• The subcommittee approved the training plans for 911, 988, and MCRT on 10/08/2024.
  • Based on feedback, we're going to modify the 911 and 988 plans again to have the training in more manageable sizes for call handlers. We will work on this over the next week or so, bring it back to the subcommittee and seek their approval for the modified plans
• Pilot training: There will be a call with the pilots tomorrow where we will lay the groundwork.
  • PSAP pilot telecommunicators will training via PowerPoint which is an expanded version of the training that the pre-test PSAPs received.
• Each training is organized by core, additional best practice, and optional trainings.
  • Telecommunicators will have 60 days to complete their core trainings
  • Similar requirements for the other two (988 and MCRT) - they will have 45 days
  • CESSA training courses will be on-demand and self-paced (asynchronous)
• Cindy Barbera-Brelle also reviewed the requirements in the CESSA legislation and summarized the core courses.
  • Core courses for all (911, 988, and MCRT):
    • Illinois Emergency Crisis System
    • The Power and Importance of Language
    • Respectful Interactions and Working With Individuals having Developmental Disabilities or Autism Spectrum Disorders Experiencing a Behavioral Health Crisis
    • Respectful Interactions and Working With Individuals Experiencing a Behavioral Health Crisis: Mental Health, Substance Use, and Suicide Prevention
  • Core courses for 911 telecommunicators:
• De-Escalation
  • Core courses for 988:
• National Standards for Culturally and Linguistically Appropriate Services (CLAS) Cultural Awareness
• De-Escalation
• Developing Community Relationships
  • Core courses for MCRT:
    • National Standards for Culturally and Linguistically Appropriate Services (CLAS) Cultural Awareness
    • Developing Community Relationships
    • HFS-required courses

Questions/Discussion:

• Shelley Dallas: I wanted to go back to the pre-test and pilot update in support to Blanca's comments. There is resistance with 590 MCRTs and PSAPs in my region. Taking the decision-making away from 988 where 911 will automatically send out the MCRT doesn't feel like a real-life scenario. Leading up to this, the message is that 988 can resolve issues 80% of the time, and there are areas when we have limited or less than 24/7 coverage by MCRT. I don't want to set up MCRT up for failure. This was just recently presented to MCRT and then the subcommittee and now to the SAC as already presented, thereby making the discussion and decision-making a moot point. The way its being presented or discussed behind closed doors is setting the system up for failure. If we aren't ready for it, if the technology isn't ready for it, maybe CESSA needs to take a step back.
• Director Albert: Thank you. I want to make sure there is appropriate follow-up. Brenda, can you make sure there is a follow-up conversation with people that want to be heard on this? We want to make sure this specific concern is addressed.
• Jim Kaitschuk: I heard a lot of conversation, I didn't hear about any training going out to law enforcement agencies for the pilots. Is there a plan to also update police officers? Calls don't just get called into dispatch, I might get flagged on the side of the road. A citizen might say I noticed this person is having some issues, and we then stop and talk with them.
• Dr. Lorrie Jones: You raise a great point, this is part of the agenda later today. Communication plan and strategies-we consider this a gap and an opportunity. How we communicate with law enforcement and the public. We will be following up with more specific ways to address this.
• Chief Darren Gault: Clarify to Jim, I don't believe this situation applies, it doesn't go through 911 or 988, but to piggyback on Jim's comment, I don't think anything is being addressed with non-law enforcement, particularly hospital and healthcare systems. It's created a situation where law enforcement and EMS are now at odds when they both arrive at a low-level call and law enforcement are just standing by. Medical directors are confused and making orders that are probably unlawful for law enforcement to even carry out.
• Dr. Lorrie Jones: We need a comprehensive communication strategy. We are relying on you to help with the strategy for law enforcement. Our goal is a detailed strategy which we'll discuss today.
• Brent Reynolds: Did you say 60 days to complete training?
• Cindy Barbera-Brelle: Yes, but that's core.
• Dr. Lorrie Jones: It's a cultural thing, we know that they move quickly and they need the cliff notes. We're going to condense some of the trainings and report back to the expert that developed the training. They have a choice to do the whole training or the cliff notes.
• Chief Darren Gault: If Illinois Police Chiefs and Illinois Sheriffs were to provide feedback, what's the best method?
• Dr. Lorrie Jones: We will use this meeting and probably pull together separate meetings around this as we develop what a communication plan. We will work behind the scenes to figure out what, who, when should be communicated, and put that to you to help us strategize how we get this information out.

Regional and Subregional Updates: Dr. Lorrie Rickman Jones

• New model better aligns with the legislation. The implementation work centers around the 179 PSAPs. They have partnerships with their local fire, EMS, and law enforcement departments. So we have 179 bodies that need to change.
• We also want to bring together vendor learning collaboratives around vendor type.
• The subregional committees are subject to the Open Meetings Act and require membership from stakeholder groups in CESSA legislation.
• Purpose is to leverage communities' strengths, assets, and limitations in response variability.
• We will provide technical resources to the RACs in the upcoming weeks to launch this.

Questions/Discussion:

• Jessica Gimeno: Is there overlap with the STBHCC task force headed by Chief Jones? That task force came to similar conclusions, with training and could we streamline? Some of the suggestions were a hub to do trainings in real-time.
  • Lee Ann Reinert: Yes, there is some overlap. There are challenges with implementing CESSA because it's parallel to but not the same as the other things in the state. One thing we did with Dr. Solomon is we met with the Office of Medicaid Innovation, we tried to look at the feedback and what's required of providers on the mobile crisis side of things. We tried to cross-walk wherever we could with what CESSA requires to what already exists. Also did surveying of people with boots on the ground on what they need to be trained on. This has significant overlap with what is being done with STBHCC. We tried to develop two things: 1) What is required by law that we need to do and 2) what is best practice that we will make available to everyone who is working in the system and make it free, but not mandate so it's not overly burdensome.
• Question from Justin: I've heard the word "interim" risk level matrix. What does interim mean? When's the new one come along?
  • Dr. Lorrie Jones: It was designed to get us started. A lot of concerns that we should probably go farther, in terms of what MCRT could respond to. We agreed that we would keep the IRLM for now and we would collect data as soon as pilot is operational, learn from that data, and then we would make changes to the matrix in relatively short order.

Discussion on Defining Success for Fiscal Year 2025 (Part 2 Roadmap): Pete Eckart

Overview of the Roadmap Exercise

• In the September meeting, we asked you the different ways we could define success and reviewed our drivers. We put this in a 5-year plan, as this is the minimum that we've seen this being implemented in other states.
• The suggestions from last meeting became our roadmap. A roadmap has lanes, and the lanes are the goals that will drive the conversation today.
  • 3 local lanes/goals (regional/subregional work)
  • 4 express lanes/goals (statewide work)

Local Lanes

Dr. Mary Smith reviewed the strategies and metrics for Local Lanes #1 and #2 which relate to the pre-test and pilot, and prompted group to jot down what they plan to contribute as an individual or organization.

The SAC members and consultants were divided into small groups to discuss Local Lane #3: Stakeholder groups understand the purpose of CESSA, what crisis response services will be available, and how to access them (communication). Recap of small groups for Local Lane #3:

• Group 4:
  • Group members: SAC members Cindy Barbera-Brelle, Brent Reynolds, Blanca Campos and Jessica Gimeno (designee for Candance Coleman)
  • Who should we communicate with? Law enforcement, fire, EMS, resource hospitals, county boards, municipal leadership, 708 boards, health departments, legislators, 911 PSAPS, behavioral health providers (public and private).
  • What to communicate? Our vision statement, elements of the statute that should be everyone should be aware of, how the system functions now and how CESSA will change the function of that system in the future, what CESSA is and is not.
  • How? Targeted messaging, a primer for each group, including print media, websites, social media, community meetings, public radio professional presentations at conferences and so forth.
  • Progress? Have One or more communications with those the "who list" and then take the list and have them contact in the regions at a local level two to three contacts on the list that are not represented
  • Contribute? The organizations around our table would push the information out.
• Group 2:
  • Group members: SAC Member Justin Houcek, Expert Consultant Stephanie Frank, and Incoming SAC member Pete Dyer
  • We tried to focus on the difference between the communication strategies for 988 and CESSA, and that the public needs to know about 988 as a resource.
  • The public needs to know about CESSA a little bit in the sense that when they call 911, the dispatch could change, but really CESA is a process and the folks who need to know the most about CESSA right now are the people involved in that change process and getting them on board.
  • One of the strategies we came up with was working with Cindy's office to make sure that all the PSAPs are on the same page, they know where we are with the pilots, and what's coming down the pipe.
  • Also make sure we use the DMH website where there's already FAQs and updating that regularly.
  • Metrics: Gather data from PSAPs to see what types of calls each area is dealing with and what types of resources each PSAP has, because there are different resources for each region (targeted communications by geographic area).
• Group 1:
  • Group members: SAC member Curtis Harris, RAC chair Heather Butler, DMH staff Lee Ann Reinert, and Nate Sanders
  • We talked about media campaigns, from radio, TV, billboard, paper materials, digital materials.
  • We thought that texting out with information could be helpful.
  • Making sure that the depiction of CESSA in the media is accurate
  • Participating in the local news cycle.
  • Using the power of personal testimonies.
  • Getting the word out to students in schools.
  • Metrics: call volume, number of transfers in pilots, decrease in hospitalization, increase in living room usage, increase in the use of police social workers, and possibly follow-ups and outcomes, but that can get a bit complicated with PHI and confidentiality.
  • Contributions: it's important at the local level to push out materials and information.
  • It would be helpful to have a template and even support from the state with printing materials.
• Group 3 (Virtual):
  • SAC Members Emily Miller, Rick Manthy, Bobby Van Bebber, Shelley Dallas, Drew Hansen, Jim Kaitschuk, Darren Gault (designee for Rachael Ahart), and Expert Consultant Amanda Lake
  • We talked about communication in terms of the broader general public and within the smaller realm of those organizations or stakeholders who are more intimately involved in general.
  • The importance of unified communication
  • The use of state websites is a great idea to ensure the general public knows where to find information.
  • Explaining how 988, 590, PSAPs, fire, police, EMS interact in CESSA
  • The language can be different with the stakeholders involved in CESSA than it can in the general public.
  • Tap into shared interactions now that CESSA has brought different groups together, figure out how to share resources and better communicate across the spectrum. Perhaps a joint message could be released.
  • Metrics: fewer questions coming back to us after information is released, get feedback from the RACs on a Q & A document

Statewide Lanes

Lanes #1-4 were each discussed in a small groups. Each group discussed a different lane/goal. Recap of small groups below:

• Lane #3 (virtual group): Increase collaboration between different parts of the system
  • SAC Members Emily Miller, Rick Manthy, Bobby Van Bebber, Shelley Dallas, Drew Hansen, Jim Kaitschuk, Darren Gault (designee for Rachael Ahart), and Expert Consultant Amanda Lake
  • Big takeaway is making sure PSAPs understand the matrix and the role of 988, and understand the collaboration of 911 and 988.
  • This is a small percentage of the calls coming into the 911 centers and it will be a learning curve for the PSAPs.
  • Have a safe space for conversations at the state advisory and the regional levels and try to remain positive and have as much collaboration as possible between the different entities.
  • Send out information at the appropriate level, for example to regions where it's not being implemented yet.
  • Disseminating the difference between behavioral health and substance abuse
  • Work with embedded co-responder programs that already exist
• Lane #1: Reduce the reliance of people in behavioral health crisis on the 911 system.
  • Group members: SAC member Curtis Harris, RAC chair Heather Butler, DMH staff Lee Ann Reinert, and Nate Sanders
  • Education needed to be done on all our phone numbers (911, 988, 211, 311, Safe to Help line) on what each of these entities are use for, what scenarios necessitate each resource
  • Get this educational campaign out through families, schools, MCRTs, community events, etc.
  • Integrate information into required mental health curriculums in schools
  • Utilize 708 boards to go out and have conversations
  • Attend county fairs, festivals (MCRTs, DMH, 708 boards) and introduce these resources to communities
• Lane #2: Develop and implement a Quality Assurance Plan for CESSA
  • Group members: SAC Member Justin Houcek, Expert Consultant Stephanie Frank, and Incoming SAC member Pete Dyer
  • Should measure the process of implementation and evaluation of the implementation.
  • Ask the PSAPs to report out and decide on a cadence for reporting
  • Metrics include call transfers, time, transportation time, response time
  • College towns have large communities-factors like this might skew the numbers and make sure to consider these factors
  • Key question: Are appropriate resources sent to the appropriate place (eg public safety response only when appropriate)?
  • Use the QAP to revise the IRLM and protocols
  • Communicate how the changes are taking place
  • SUPR can provide data about OD hotspots. Do we have a metric for type of MH call involving substance use being transferred during the pilots? Could map that with data where OD is happening and see where more calls are, where more resources are need
  • Incarceration and hospitalizations could go down if CESSA is a success
• Lane #4: Have an actionable and sustainable plan for FY 26 and beyond
  • Group members: SAC members Cindy Barbera-Brelle, Brent Reynolds, Blanca Campos and Jessica Gimeno (designee for Candance Coleman)
  • Obstacles: resources and participation
  • Funding: State legislation, working with 708 boards and municipalities
  • Communications: when we stumble, we should say what we did wrong and what we plan to do to remedy the situation
  • Transparency and managing the workload
  • Visual celebrations of success
  • Sharing with the public what we're doing and what we will do next
  • Share success stories: ask MCRT to share stories, which will motivate communities to keep going
  • Use YouTube videos
  • Success story: Stark county now has a 911 presence, thanks to Cindy

SAC Next Steps

Announcements:

• Lee Ann Reinert:
  • Official thank you to Rick Manthy for his work on the committee.
  • Reminder that training requirements for SAC members need to be completed by end of the calendar year on OneNet.
• Jessica Gimeno:
  • Upcoming training, all encouraged to attend: Preston Looper, MCRT consultant, 10/28 from 11am-1pm.

Meeting Dates:

• November 12, 2024, 1-3 pm virtual
• December 9, 2024, 1-3 pm virtual

Public Comment

• Justin: Will there be a legislative revision every year as part of CESSA's ongoing planning?
  • Lee Ann: We would have to discuss if a legislative revision would need to occur.
• Angelica Tobias: I'm part of Supporting Illinois Brothers and Sisters (SIBS network). I'm wondering if once CESSA is implemented, can we also include dialogue with people with IDD that have more comprehensive needs? I'm thinking of my brother who has been through crisis, and I know we don't talk about disability this way anymore, but he's 36 and "functions at a one-and-a-half-year-old level." so I'd like to put that on the table at some point.
  • Lee Ann Reinert: Thank you Angelica

Adjournment

The meeting was adjourned by Lee Ann Reinert at 1:05 pm.