CESSA Protocols & Standards Subcommittee Meeting 11/07/2024

CESSA Protocols & Standards Subcommittee Meeting November 07, 2024, 2:30 - 4:00 pm

  • Virtual meeting via Zoom

Meeting Minutes - Approved by Members 11/21/2024

Call to Order/Roll Call:

  • Meeting called to order by Cindy Barbera-Brelle at 2:33 pm (via Zoom)
  • Bobby Van Bebber motioned for approval of meeting minutes from October 3, 2024, seconded by Rachael Ahart.
  • Members present and voted to approve: Rachael Ahart, Blanca Campos, Bobby Van Bebber, Cindy Barbera-Brelle, Jessica Gimeno (Designee Candace Coleman), Shelley Dallas, Lee Ann Reinert (Designee for David Albert)
  • Members present and abstain: Brittany Watson
  • Members not present at the meeting: Brent Reynolds, Drew Hansen
  • Motion carried.

State Updates (Lee Ann Reinert):

* The 988 center for the pilot confirmed today that they will be able to prioritize calls from 911 in their system when we start the pilot. This will help be ensure 988 is responsive to the PSAPs.

Pre-Test Learnings and Recommendations (Dr. Mary Smith):

Pre-test Recap

  • The Subject Matter Expert (SME) Workgroup met with the pre-test sites weekly during the pre-test to understand how it was going and gather data.
  • The SME Workgroup compiled the learnings from the pre-test into five categories with corresponding recommendations:
    • Use of protocols
    • PSAP Operations
    • Training
    • Data Collection and Referrals
    • Organizational Change/Cultural Change Issues

Use of Protocols Recommendations Discussion:

  • Rachael Ahart: When do PSAPs open the PowerPhone protocols?
  • Dr. Mary Smith: They can open it when receiving a call, but its not standardized.
  • Shelley Dallas: There were three of us involved in the pre-test, one of which doesn't use law enforcement scripts. With my PSAP specifically, I asked the telecommunicators to use the protocols that we modified for behavioral health even though we aren't mandated to use the law enforcement. My recommendation is to remove some of the protocols that were put out there during the pre-test. that the mental health question or trigger questions aren't going to be asked if there is a crime taking place regardless of the severity of it, and by statute, that anybody involved in a suspected criminal violation of the law, then law enforcement is applicable. The third PSAP is was varied, it was a smaller PSAP with more diversity in the use of protocols overall. I highly recommend before we get to the pilots taking those out because they weren't successful.
  • Dr. Mary Smith: We agreed to reconvene the workgroup to look at the protocols, but we aren't sure they have been tested enough. The issue here is opening the protocols at the beginning of the call not being standardized.
  • Lee Ann Reinert: I have a question about the statutory requirement about a crime in progress then law enforcement has to be involved. I remember when folks drafted CESSA, they thought they were eliminating that. Can someone who knows about this speak to that? Also, is there a statutory revision that should be pursued around some of these "nuisance crimes" that could allow for a different response (relates to recommendation #4)?
  • Dr. Mary Smith: When we reviewed the criminal damage protocol, if there is a crime in progress, that eliminates referring an individual for mobile crisis response. And for all of these protocols, there are rule outs for medical emergencies, physical aggression, and weapons. If these things exist and a crime is in progress, it's not even going to make it down to a question where a person is going to be referred to 988.
  • Lee Ann Reinert: I'm assuming that there's statutory prohibitions currently that won't even allow us to get through the risk level matrix because there is a crime in progress. I'm trying to pinpoint whether the advocates were expecting something different, and we are realizing what we can and can't do based on the current statute. That's what I want to identify and discuss, that if we had that intention, the way it's written right now we can't do.
  • Shelley Dallas: There is nothing preventing a telecommunicator from sending a co-response or an embedded model if that exists but for the transfer to 988 without law enforcement, that's against the law enforcement and PSAP policies and procedures. CESSA talks about non-violent misdemeanors and PSAPs are coordinating the response to individuals who appear to be in a mental or behavioral health crisis while engaging in conduct alleged to constitute a nonviolent misdemeanor shall promote prioritization of healthcare, and I think that comes post-dispatch once the responders are there. It doesn't specifically state that but once responders get there and realize that a mental health crisis is taking place, or a crisis response team would be a viable better solution than law enforcement, that's where the diversion takes place to get mobile crisis response teams or behavioral health services provided before the law enforcement objectives.
  • Lee Ann Reinert: I don't think that reading the statute many people think it would happen after dispatch. But that may be a reality of the system and other existing criminal statutes.
  • Shelley Dallas: If that is the path that is going to take place, there is a huge financial cost associated with this, and it could cause a huge delay.
    • Dr. Mary Smith: We think that is less of a problem for PowerPhone because they provide all the protocols, but it could be more a problem with Priority Dispatch who sells protocols separately and maybe APCO.
  • Jessica Gimeno: I agree with the first recommendation and adding the triage questions.
  • No additional recommendations suggested.
  • Cindy Barbera-Brelle requested a motion to accept the six recommendations as written for the protocols section. No members made a motion.
  • Shelley Dallas: Can the 1st recommendation one "use of a script that directs telecommunicators to the Protocols" be modified?
  • Cindy Barbera-Brelle: What we are suggesting is that there should be a policy that requires telecommunicators to use a protocols, it should be standardized. I think they may not be following the protocol providers training that requires them to be in protocol-ready mode.
  • Shelley Dallas: I think that one of the biggest issues is we can't even say "911, what is your emergency?" before people start talking to us. You can be 45 seconds into a call before you even know which protocol to pull up. To ask a telecommunicator to go directly to the protocols doesn't seem practical in the real 911 PSAP world. Even on the medical side, the calls are fluid and change rapidly.
  • Dr. Mary Smith: We can't require all the PSAPs in the pilots to open PowerPhone right now. But in lieu of that, Cindy talked about creating some kind of script to direct TC's the protocols recommended by the workgroup. We could use this in the interim unless we can ask all of PSAPs to use the software.
  • Shelley Dallas: Out of 180 calls a day at a small PSAP, maybe 30 or 40 calls are 911 calls. And out of those 30 or 40 911 calls, maybe 50-80% are actually emergency 911 calls. They are ready and there but I think we are opening up a can of works to ask them to open their protocols for every call. Right now, I don't have a recommendation for standardizing. To put a blanket policy for every PSAP in the State of Illinois is unrealistic.
  • Dr. Mary Smith: That's why it's listed as consider and explore. What we are trying to do is figure out a work around to make sure folks are looking at law enforcement scripts because that is the heart of CESSA. Do we want to pause on #1?
  • Blanca Campos: I am always really encouraged working directly with the people being impacted. What are their [PSAPs] recommendations? Have those conversations been had?
  • Dr. Mary Smith: We had three PSAPs working on the pre-test but I think that's what #3 and #4 are. The recommendations don't say "require" or "implement" and we're going to need to work with the people who implement them. But we know there has to be a little more standardization of the process.
  • Blanca Campos: I just encourage further conversation.
    • Cindy Barbera-Brelle: We will in the pilot.
    • Dr. Mary Smith: Yes, the purpose of the pilot is to see what's possible.
  • Shelley Dallas: I agree that a lot of work went into making the protocols. We did use criminal damage to property and domestic disturbance which we all on that call felt should not be a protocol to be tested for a mental health protocol because you are always going to get a law enforcement response and maybe a co-response if available. And once you're on the scene, the law enforcement could recommend mental health response. But I don't know a PSAP in the state that would transfer a domestic disturbance to 988. I recommended pulling some of the protocols like elevator rescue along with the consideration to look at it from a different angle, in the mental health protocol and the welfare check protocol that seem to be the ones prevalent in the pre-test. I recommended to switch it and ask first "is there a possible crime in progress?" I can't fathom trespassing being transferred to 988, but maybe the response could be law enforcement and a co-responder response but that's not available in a rural community. As we move further along and have more resources, maybe. After having tested and been a pre-tester, I don't feel like the protocols tested will suffice for the pilot.
  • Dr. Mary Jones: None of these recommendations relate to these specific protocols. Certainly, in other jurisdictions, folks are looking at protocols other than mental health and suicide. We agreed to reconvene the workgroup and look at the concerns you raised, but no one else are people only using the mental health protocol because then you wouldn't be redirecting a law enforcement response.
  • Shelley Dallas: I recommended to consider #2 through #6 but not #1 at this time.
  • Jessica Gimeno: Could you explain #2 more?
    • Dr. Mary Smith: It won't be the first question, but after the telecommunicators do their initial questions, they would need to ask if it's a mental health issue, law enforcement issue, or medical issue. Some folks have found that useful to get callers to the right person quicker.
  • Blanca Campos: Is this for adoption? Would a vote also be taken by the SAC? Are we voting it out of this group for further discussion at the SAC, or for moving forward with these protocols?
    • Lee Ann Reinert: I think that's a good question because we have in the past through agreement with the SAC given this subcommittee some level of authority to pass recommendations that are reviewed by the SAC but are considered in effect because the protocols and standards subcommittee approved them. Blanca, are you wanting this to be discussed by the full SAC?
    • Blanca Campos: I would be in favor of this moving forward for consideration by the full SAC, but I would be hesitant to vote for full approval.
  • Rachael Ahart: From what I understand from Shelley, the telecommunicators only open the protocols when there is a triggering event. Were there calls coming in that were potential mental health and the protocol wasn't being used? What were the issues that these recommendations might help fix?
    • Dr. Mary Smith: The major change is probably that instead of just staying with medical protocols, we looked at law enforcement protocols that could have a mental health component. The pre-test purpose was to test the protocols to see if they could identify mental health callers in law enforcement protocols. The purpose of the pilot is to test the entire system. It's even difficult to test whether the Protocols work, if there's no standard way that people are accessing the Protocols. So, you have to actually have a full test of the protocols. And we weren't really getting that because there's no standard use of the protocols. That's what we discovered after months of working on the on making, identifying and making changes to the protocols with the work group that we worked with.
    • Rachael Ahart: I think its hard to understand without looking at the protocols. If there are calls that have to be law enforcement response, is there a middle ground where we can identify components without trying to fit protocols into a different process that isn't going to work that way.
    • Dr. Mary Smith: This is our initial foray into this. We are only working with Level 1 of the Interim Risk Level Matrix for the pilots. As you go up, there are different responses based on resources in the area and response time needed. For Level 1, if you don't have a mobile crisis response team that can get to an area within 30 minutes, then right now the PSAP would follow their standard operation.

PSAP Operations Recommendations Discussion:

  • Lee Ann Reinert: For unions, there is a representative on the SAC but I don't think it's PSAPs. I think it's fire. I think that there are unions on some RACs but I don't know if it's PSAPs and it's not across the board.
  • Blanca Campos: I think these are reasonable.
  • Heather Butler [in chat]: Will public comment only be at the end? Or are RAC Co-chairs able to speak up before then?
    • Lee Ann Reinert: RAC co chairs are considered part of the expert consultant group and welcome to participate throughout.

Training Recommendations Discussion:

  • Shelley Dallas: The pre-test training was well-received. It was slimmed down from the original to show the point of CESSA and the expectations for the telecommunicators.
  • Shelley Dallas: I also want to make sure that it's really clear that law enforcement protocols are not always being used by PSAPs. Every PSAP has local policies and procedures but they may not be using the set from a vendor.

Data Collection and Referrals Recommendations

* Postponed due to time.

Organizational Change/Cultural Change Issues Recommendations

* Postponed due to time.

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

* Postponed due to time.

Public Comment:

  • Jason Kern: I think if we want to get a good idea of the testing, we should look at the EMD which is the only thing by statute. The cost to the other vendors is significant, it's upwards of $200,000 to move to that, and that's just one center. There are costs to implement, train, and for quality assurance.
  • Pete Dyer: I am the representative on the SAC committee to replace Rick Manthy. In our area the dispatch centers have cards through ProQA that are addressing these issues. I do believe that the 911 that are using EMD protocols are having this built in to the triage of calls that are going to go to 988.
  • Jim Moldenhauer: I am with a pilot center and I want to echo what Shelley Dallas has said. Abandoned found person, we had five calls in eight years, two of which were errors. We don't utilize that, and it seems like a medical one. Criminal damage, domestic disturbance, elevator rescue (still don't know why that's on there), public disturbance, public indecency, suspicious person trespass. They all fall under crimes and to ask us to screen these for mental health will tie up telecommunicators. To be me attempted suicide means a Level 4, not a Level 1. If crime in progress is the limiting factor, we are limited to first person callers in crisis and those calls are few and far between. Also, there was a comment earlier that mobile crisis response is within 30 minutes but it's actually 60 minutes. And when exactly is that determination being made? I've got concerns about why these protocols are being changed and put on the PSA and about the individual trainings for telecommunicators.
  • Heather Butler: As someone who came in 14 years of dispatch, opening the protocol at the start of the 911 call is almost impossible. Dispatchers will ask universal questions to understand what's going on, so asking to open protocol right away is impossible, how will they know which one to open? On a second note, it was reported that ETSB's are reluctant to be in CESSA. I'm employed by an ETSB and very involved. Also, there was a statement that many ETSB's are saying they won't participate in a pilot even though the statute says they need to. Does it say in the statute that someone has to participate in a pilot?
    • Cindy Barbera-Brelle: There is nothing in the legislation that says that.

Next Meeting Date:

Meetings are held virtually 2:30-4:00 PM on the first and third Thursdays of each month, unless otherwise noted.

  • November 21, 2024
  • December 5, 2024
  • December 19, 2024
  • January 2, 2025
  • January 16, 2025

Adjournment: Cindy Barbera-Brelle adjourned the meeting at 3:58 pm.