CESSA Protocols & Standards Subcommittee Meeting 11/21/2024

CESSA Protocols & Standards Subcommittee Meeting November 21, 2024, 2:30 - 4:30 pm

• Virtual meeting via Zoom

Meeting Minutes - Approved by Members 12/05/2024

Call to Order/Roll Call:

• Meeting called to order by Cindy Barbera-Brelle at 2:32 pm (via Zoom). Cindy Barbera-Brelle reviewed the Open Meetings Act procedures.
• Bobby Van Bebber motioned for approval of meeting minutes from November 7, 2024, seconded by Shelley Dallas.
• Members present and voted to approve: Cindy Barbera-Brelle, Rachael Ahart, Jessica Gimeno (Designee Candace Coleman), Shelley Dallas, Christina Smith (Designee for David Albert), Bobby Van Bebber, Brittany Watson
• Members present and abstain: Brent Reynolds, Justin Houcek
• Members not present at the meeting: Blanca Campos, Drew Hansen
• Motion carried.

State Updates (Christina Smith):

• Thank you for your willingness to have extra meetings to really dig into this work to continue to prepare for the pilots.

Pre-Test Learnings and Recommendations (Dr. Lorrie Jones):

Use of Protocols Recommendations:

• Recommendation 1: Explore possibility of implementing a statutory requirement for PSAPs to utilize law enforcement protocols in addition to EMD protocols
  • Brent Reynolds: I am not in support of #1.
  • Shelley Dallas: I am adamantly opposed to 1, and would need further discussion with #2,3, and 4. PSAPs are being asked to change what they've done well because of boots on the ground responses after the call.
  • Heather Butler: In reference to #1, working closely with the Illinois Sheriff's Association and the Illinois Association of Chiefs of Police, if you try to seek statutory change, you'll receive pushback.
  • Brent Reynolds made a motion to reject Recommendation 1. Shelley Dallas seconded. All favors in favor. No opposed. Motion passed unanimously.
• Recommendation 2: Consider use of a script that directs telecommunicators (TCs) to the Suicide, Mental Health, or Law Enforcement protocols, as appropriate, that were modified by the subject matter expert (SME) workgroup
• Recommendation 3: Explore possibility of asking PSAPs to require TCs to open PowerPhone software when answering calls
• Recommendation 4: Explore the use of a triage question to be used by PSAP telecommunicators when answering calls early in the call answering process
• Discussion on Recommendations 2-4:
  • Brent Reynolds: I am concerned about changing established 911 procedures for such a small percentage of calls. In our center, the most important thing we need is a valid address and telephone number. We're required to use the EMD protocols and we're asking the questions that lead us to EMD protocols so what's broken in this system to change what we want to PSAPs to do?
  • Dr. Mary Smith: The calls don't always come across as mental health. Once you do the rule outs, you get to a question that is about suspicious behavior that could be a person with a mental health issue. Those protocols are under law enforcement, not EMD. We are missing out on identifying people with mental health issues that start out as suspicious person or trespassing.
  • Brent Reynolds: This is something that requires more law enforcement input. Shelley Dallas: This might not be a recommendation that's feasible. The solution is having the resources available to get to these people to respond to the 911 call, to have co-responders and mobile crisis response teams readily available. The third-party calls are not working because we don't have the resources to respond across the state.
  • Rachael Ahart: My understanding is they won't open the protocol initially, they gather information, then open the protocol based on the information gathered. So, we train them to open the specific law enforcement protocols we need.
  • Shelley Dallas: We did that as a pre-tester and those were the results. We were willing to try it but it led to law enforcement response still. When there was a criminal trespass even with the additional questions, it was a law enforcement response.
  • Dr. Lorrie Jones: It was a small sample, so theoretically we could do it in the pilot and see if that experience was validated across the pilot sides.
  • Dr. Mary Smith: Using the protocols that we added questions to was to rule out crimes in progress, medical issues, weapons. We're talking about level 1 of IRLM which is minimal acuity. We would have ruled out any of the criminal involvement or crimes in progress.
  • Brittany Watson: I just wanted to say that I am a mobile crisis responder and I hear the concerns on both sides. I live in a rural area and we have an excellent relationship with law enforcement. We can come up with scenarios but it will change every time. This recommendation might be too involved. My solution is that our law enforcement are very good at contacting us whether it's at a home, the station, the hospital. I think we should train the PSAPs to ask do you want to be connected to 988 or would you like to be connected to a mobile crisis response unit? I'm hearing a training and yearly refreshers might be what we need, because each individual relationship in each PSAP and law enforcement will be different in each area.
  • Dr. Lorrie Jones: Maybe we try these questions with a larger sample? Which means we would start with asking a few questions at the beginning which is what Shelley said she did.
  • Brent Reynolds: I agree with Brittany. Law enforcement want to work with their partners and prefer not to go on calls where they're law enforcement skills aren't required. We're basically going to question every call that occurs to see if mental health is associated.
  • Dr. Lorrie Jones: It's not every call, it's specific calls where there is a possibility that could be responded to.
  • Brent Reynolds: When it's third party, its different. But the telecommunicators are asking the normal questions, they should be able to identify when they need to open up PowerPhone.
  • Shelley Dallas: The domestic disturbance ones I'm still opposed to. When you say open the protocol right away, we can't because we get non-emergency calls and we need to figure out the jurisdiction. When they describe what's happening, we put in the complaint type, that would launch the protocol. When the protocol is launched, it's already a crime in progress. Then part of the protocol is whether they are behaving in an unusual manner. We are a small portion you could see the results with more people using that. Once law enforcement is on scene, we have a good relationship, and they can initiate the mobile crisis response.
  • Rachael Ahart: Knowing that these were used in the pre-test, I would agree that we move forward so long as the locations testing this are also using the same protocols with an in-house training.
  • Shelley Dallas: We never got as far as is there a reason to believe the person is having a mental health crisis, because we are coding it as criminal damage, just like trespass, the question is so far down there, that we never got that deep into the protocol.
  • Jessica Gimeno: I just wanted to say something that Brent said earlier about knowing what we are voting on in advance would help me as well.
  • Rachael Ahart: What instructions were given to the pre-test? Is there a reason to move forward as is or to change something now?
  • Shelley Dallas: We went over several examples of what a legitimate transfer to 988 would look like, and I brought a couple of call samples for all of the telecommunicators to Review. We had shift meetings. There was a PowerPoint presentation, with instructions and the basics of what we are looking at in the pretest, the recommendations to send it to 988 and to review the protocols to see if any changes need to be made. I'm not opposed to moving forward with these but I'm trying to express that with my specific county in the pre-test process, had questions about ones obviously not going to be a transfer to 988.
  • Dr. Mary Smith: We did expect the protocols would be uniformly used by all the telecommunicators, but we found they weren't. Also, we never thought there would be an overwhelming number. I'm not actually sure we gave the protocols a chance.
  • Lorrie Jones: We will reconvene the work group.
    • Jessica Gimeno, Jim Hennessy (replacement for Shelley Dallas) and Rachael Ahart volunteered to join.
  • Rachael Ahart: Would that work group be able to remove criminal ones because CESSA doesn't allow transfer for 988 if there is a crime in progress? I don't see how it makes sense to include protocols that we know are going to require law enforcement dispatch.
    • Lorrie Jones: That would be fine
  • Lorrie Jones: Can we get a motion to not adopt any of these recommendations at this time, agree to reconstitute PowerPhone work group on changes to the PowerPhone protocols, and review the process and training once again, prior to implementing the pilot?
    • Brent made the motion. Jessica second. Shelley Dallas third. All in favor. No opposed. Motion passed.

Use of Protocols Recommendations (Continued):

• Recommendation 1: Provide PSAP administrators with real-life examples of referral of third-party calls to MCRT/community responders and outcomes.
• Recommendation 2: Consider presentation(s) by PSAPs from other jurisdictions who successfully use modified protocols for alternatives to law enforcement responses to callers experiencing BH/MH crises
• Discussion:
  • Shelley Dallas: I have a little bit of resistance or concerns transferring a third-party person to report a suspicious person or welfare check to 988.
  • Brent Reynolds: Its hard to describe suspicious person. it would be better to hear some examples.
  • Justin Houcek: Is there concern for red flag laws for firearms?
• Rachael Ahart: If someone calls in about a potential firearm, that would not qualify for a transfer.
• Brent motioned to approve the recommendations. Jessica seconded. All in favor. No opposed. No abstention. Motion carries.

PSAP Operations Recommendations Discussion:

• Recommendation 1: Include ETSBs (who may not have been involved in the past) in CESSA planning and discussion
• Recommendation 2: Determine impact of TC unions on implementation and use of protocol modifications; If this is a factor, develop recommendation for how to address issues (note: it was determined that some TCs are union members and others are not)
• Recommendation 3: Include union organization(s) in CESSA planning and discussion moving forward
• Discussion:
  • Shelley Dallas: how do you want to include ETSBs who may not want to participate?
  • Lorrie Jones: I think the most important thing we could do at our level is to educate folks and invite them into the process. Beyond that, we'd go up the chain of command, but we aren't there yet.
  • Cindy Barbera-Brelle: I can't think it's in their contracts to define operational processes.
• Brent Reynolds motioned to approve #1 and to reject #2 and 3 to be struck. Brittany Watson seconded. All in favor. No oppose. No abstain. Motion carries.

Training Recommendations Discussion:

• Recommendation 1: Prepare brief, concise, and interactive training, including scenario-based training (actual scenarios experienced by PSAPs), as a module in PSAPs' current (in-service) training
• Recommendation 2: Consider train the trainer model and explore whether some of the larger PSAPs can send subset of TCs to attend on-site or live training
• Recommendation 3: Measure impact of TC training
• Discussion:
  • Brent Reynolds: How would we measure the impact of training?
  • Lorrie Jones: Usually, you start by a knowledge check at the end to make sure they understood. In addition, maybe satisfaction with the training, what was missing, what they might want to add.
  • Rachael Ahart: Is this training for pilot participants?
  • Lorrie Jones: We have already developed trainings for the pilots due January 31, 2025. We would need to develop additional scenario-based training.
  • Mary Smith: I would add that we also have expanded the PowerPoint to include information about the pilots.
  • Shelley Dallas: It was mentioned in a different meeting that we could have the training while the pilot starts. It's my recommendation to make sure the administrators and telecommunicators are trained prior to launching the pilots.
    • Lorrie Jones: We said the 31st before there was discussion about getting the trainings done. But Cindy with your agreement, we could change the date for the telecommuncators if we change the date
    • Cindy Barbera-Brelle: Yes
  • Jessica Gimeno: I was thinking about the training on de-escalation. One metric could be rates of referrals to mobile crisis or rates of calls labeled as mental health.
    • Lorrie Jones: Great idea but there won't be a before, but we will improve the training to include scenario base.
  • Rachael Ahart: How would you envision a train-the-trainer process on-demand?
    • Mary Smith: It would be moving forward. Right now, the modules are on-demand. This would be down the road during the pilot and into the future to improve the training.
    • Rachael Ahart: So if these are things that we are trying to vote on for the pilot, maybe that wouldn't be applicable here?
    • Lorrie Jones: No, this isn't just for the pilot, it's things from the pre-test to consider as we move into implementation.
  • Rachael Ahart: Can we include real-life scenarios in the training?
• Lorrie Jones: It won't be happening before the pilot training, but after we improve the training and move toward implementation, we can improve it for beyond the pilot sites.
  • Justin Houcek: Is there some way they can be introduced to real-life scenarios prior to the training?
    • Lorrie Jones: We can look into it.
  • Brittany Watson: Is it practical or feasible to have a pre-test and post-test design?
    • Lorrie Jones: I don't know if we will have the opportunity to make the changes now, but moving forward for the next round of trainings we can do something like that.
    • Mary Smith: We are collecting other indicators as well beyond training, that came out of the data committee, like the kinds of calls that come in, the calls that will be transferred to 988 and MCRT and the outcomes there. So, there will be other evaluation to measure the impact we are making.
• Shelley Dallas motion to accept recommendation with the addition of the feedback from this discussion. Second by Justin Houcek. All in favor. No opposed. No abstain. Motion carried.

Data Collection and Referrals Recommendations

• Recommendation 1: Research factors that impact identification of mental health crisis calls received by 911 PSAPs to determine if seasonal, PSAP location etc. account for variation in number of MH/BH calls received
• Recommendation 2: Research/review MCRT and civilian responder referral data from other jurisdictions (Note: preliminary research reveals that the number of callers with BH crises to 911 who are referred to MCRT/civilian responders is initially minimal
• Recommendation 3: Design a quality assurance process for use during the pilots and beyond
• Recommendation 4: Use reports developed by PowerPhone to generate data required for monitoring and evaluation of Pilot process
• Discussion:
  • Rachael Ahart: What was being looked at in the pre-test? Is this including criminal calls?
    • Lorrie Jones: It measured how many calls were mental health calls and how many calls could have been referred to 988 based on new protocols. All calls. And then what percentage were mental health. And of those, what percentage would have been referred to 988
    • Shelley Dallas: We gave a total of every one of the CAD incidents for that week and ran a percentage of ones strictly coded as mental health plus the other protocols that were being pre-tested in comparison to the total call volume for the week from our CAD reports.
  • Justin Houcek: Do college towns skew the numbers?
    • Rachael Ahart: It would depend on how you're asking about skewing. From our perspective, there's a lot of criminal calls we go to that also have mental health components. If we're talking about call volume specifically coded as mental health calls, they are greater when students are present than during the summer month. There are still a lot of mental health calls but the data changes to an older population.
    • Heather Butler: We have discussed this in De Kalb because we have NIU. We discovered that they have their own crisis unit on campus so we aren't really getting calls from students because they have that resource.
• Brent Reynolds motioned to accept the recommendations. Brittany Watson seconded. All in favor. No opposed. No abstain. Motion carried.

Organizational Change/Cultural Change Issues Recommendations

• Recommendation 1: Develop strategies to help change the way in which various CESSA participants think about how to handle BH/MH callers
  • Recommendation 1A: Provide information regarding training and experience of 911 TCs, 988 crisis counselors and MCRT staff so that each are aware of each others' strengths and abilities to respond to callers experiencing BH/MH crises
  • Recommendation 1B: Provide continuing education about examples from other jurisdictions advancing alternative response models
• Recommendation 2: Consider staff exchange or visitor programs so that 911 TCs, 988 crisis counselors and MCRT staff understand how each operates
• Recommendation 3: Survey of attitudes toward alternative crisis response; repeat over time and compare
• Recommendation 4: Provide information across system partners and public education on the crisis continuum, including 988 Lifeline Crisis Call Centers, MCRT, and other crisis services
• Discussion:
  • Justin Houcek: For the training and site visits, do they do the site visit on their work time? It's taking time out of their day, they need to be compensated to make it easier to go do this training.
  • Brent Reynolds: I really want it to be right and that we don't force this out to everyone in the state of Illinois and we cause failure. Other programs took six, seven, eight years to do this. I want to make sure we aren't rushing just to meet the legislation timeline.
  • Jessica Gimeno: Dr. Joseph Troiani talks about CIT training as not just for law enforcement. They have clinicians, 911 and 988 participate to cultivate relationships.
  • Rachael Ahart: What would #2 look like? Much of this is at the local level.
• Lorrie Jones: The recommendations that come out of here are speaking for SAC. So the SAC would be informed and then the RACs would be informed. Then the RACs would institute that at the subregional level. Once its known that Protocols and Standards and SAC together are strongly advising that these programs take place, some of it is happening organically, that's how the ball gets rolling. Justin raises some good points about how to endorse this at the PSAP level.
  • Rachael Ahart: How would #3 look?
    • Lorrie Jones: The Hub would administer a survey across the entire system including 911, 988 and MCRT staff to develop a baseline and see if that changes over time.
• Brent Reynolds motioned to accept the recommendations. Jessica second. Justin third. All in favor. No opposition. No abstentions. Motion carries.

Update on Work with Protocol Vendors (Mary Smith):

• The subject matter expert workgroup is scheduled for 11/25 from 12:30-1:30 pm.

Next Meeting Dates:

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

• November 25, 2024 - cancelled
• December 5, 2024
• December 19, 2024
• January 2, 2025
• January 16, 2025

Public Comment:

• Matt Fishback, Cook County Sheriff: You said the stats from the pre-test were low. What is that number?
  • Mary Smith: I would prefer to review the data and make sure I give you the right number. I would be able to share that at the next meeting.

Adjournment: Lorrie Jones adjourned the meeting at 4:35 pm.