CESSA Statewide Advisory Committee Meeting Minutes 11/12/2024

Approved by Committee Members 12/09/2024

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

Meeting Minutes - Tuesday, November 12, 2024 - 10:00 am-1:00 pm

Call to Order/Roll Call

Lee Ann Reinert called the meeting to order at 1:02pm.

Lee Ann Reinert reviewed official notices.

Lee Ann Reinert reviewed agenda.

Roll Call and Approval of Minutes from October 15, 2024

Cindy Barbera-Brelle moved to approve the draft minutes from the October 15, 2024 meeting during roll call. Drew Hansen seconded the motion.

Members present and voted to approve:
- Cindy Barbera-Brelle
- Jessica Gimeno (Designee for Candace Coleman)
- Justin Houcek
- Brent Reynolds
- Lee Ann Reinert (Designee for David Albert)
- Blanca Campos
- Shelley Dallas
- Drew Hansen
- Peter Dyer
- Jim Kaitschuk
- Emily Miller
- Bobby Van Bebber
Members present and abstained:
- Rachael Ahart
- Brittany Watson
Members absent:
- Curtis Harris
Note on additional member: Lee Ann Reinart noted James Hennessey is on the roll call list, but he will be a new member effective December 1 and is not present at this meeting.
Quorum confirmed and minutes approved.

State and UIC Crisis Hub Updates

State Updates: Lee Ann Reinert

SAC Membership Changes:
- Shelley Dallas will be resigning effective 11/30/24 and her successor will be joining next month.
  - Lee Ann Reinert acknowledge Shelley's dedication to this work since the beginning as a charter member.
  - Shelley Dallas acknowledged learning through process and intent to be as involved going forward.
- New Members and Introductions:
  - Brittany Watson, representative of advocacy organization (replaced Pooja Nagpal)
  - Peter Dyer, representative of Statewide Organization of Fire Chiefs (replaced Rick Manthy)
Appointment Process Update:
- New contact at DHS, Barbara Hobrock, whose role is to look across all the appointed boards and committees to ensure that DHS is following letter of the law.
- Noted that there is some language in SAC's appointment letter that is not exactly right, so SAC members may expect a new appointment letter to correct these mistakes.
Mandatory Board Training reminder:
- SAC members, as part of a State-appointed committee, are required to take required trainings before the end of the year through OneNet
- DHS does not want anyone to step away from CESSA because of training requirements but there is a mandate. If it's not completed, then your name is on a list that says you are on a committee and haven't completed all of trainings.
- Can reach out to DMH at dhs.dmh.cessa@illinois.gov if you need any assistance.
Public Comment update:
- Background:
  - DHS shared invitation Access Living webinar on 10/28 about mobile crisis response teams.
  - During webinar, Mr. Preston Looper shared some helpful information on how to leverage MCRT in our system, such as detailed strategies, staffing challenges, and ways to increase referrals to MCRTs.
  - DMH and Crisis Hub see this as an opportunity to learn more about each other's systems, and emphasized what a dedicated workforce 911 PSAPs are, both on SAC as well as RACs and subcommittees.
  - Many perspectives and points of views were expressed during the webinar.
- Shelley Dallas: I want to share that I received feedback from colleagues in the 911 profession even though I was unable to attend. I have concerns about the perception of negative connotations around 911. Such as that we don't have time to do things right or do the right thing. I wasn't present for the webinar, but I don't think that was in the best interest for the collaboration for that to be relayed in the webinar. Again, I just want to express concerns I received from 911 about the lack of support.
- Lee Ann Reinert: Thank you and I want to emphasize that Mr. Looper is an independent person who was brought in to provide a perspective, and it's not the view of the DMH or UIC Crisis Hub that 911 is cutting corners or not doing work in a good way.
- Jessica Gimeno: We appreciate the hard work that 911 does. We know it's a challenging job. There was someone who had some questions and concerns, and I read her questions aloud in full during the Q&A at the October 28 event. I thought it was important for her to be heard. I did reach out to that person to ask and invite concerns and opportunities to collaborate, but we didn't hear back. But we did hear her, and we think it's important to respond.
- Lee Ann Reinert: It's important to be candid with each other and recognize different perspectives. Even more important as we head into the pilot is that we keep lines of communication open and if something is said that a member of this group or a member of the public objects to, I really want to recognize that everyone here is mission driven and attempting to achieve a pretty significant change in our systems and is committed to doing that. As we start testing things out, we may find some assumptions are not right and we may have to pivot. I want to reaffirm DMH and the Crisis Hub's commitment to supporting that work and facilitating discussion that remains respective of everyone's perspective and shared goals.
- Brent Reynolds: I contacted the Hub about the webinar. As we try to get 911 involved and engaged through the state, I hope that it's heard loud and clear that the comments that were made about the group of telecommunicators and 911 as an industry did cause some hard feelings. I want us to do our best to vet the folks that are talking to the groups. If you're a first-time attendee from 911 or a 988 representative and that's what you hear, that does not do the great work that's been done over the past three years any good.
- Brent Reynolds: 911 wants this to be successful and we want to be a partner. But we're experiencing things with 988, like over the weekend. A 988 operator who only spoke Spanish called in to Northwest Central Dispatch in Arlington Heights for assistance. They had to get an interpreter on, and they came to find out the call was coming from Puerto Rico. I really hope we can improve on the location information, and we can get the right people to the right location. Very concerning that a misroute from Puerto Rico makes its way to Arlington Heights.
- Lee Ann Reinert: Remember that 988 is adjacent to CESSA but is not the same. There are no Spanish-speaking only people working at LCCs in Illinois. It's an example of how the national 988 system is not fully able to integrate with CESSA because there are times that a 988 call center may google and get one of our Illinois resources and reach out to them. It's completely separate from the processes we're working on with CESSA. We need to be aware of it and share back to national folks, but we can't prevent it from happening with state policy. I'm glad you shared that and if you could send me an email specifically, so I can share it with Vibrant. We don't want misinformation, or something not connected with this process to negatively impact the process.
- Justin Houcek: From Preston's presentation, I was wondering what the positive and negative takeaways were that the Hub and DMH saw. What was good, what was bad, what should we make sure we don't do? I hope that can be answered at some point.
- Lee Ann Reinert: Thanks Justin, and I am going to move us on to Hub updates for time. I did note that there were some things that were helpful in terms of mobile crisis response. And some things we need to acknowledge were damaging to relationships and were not our views.

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

Hiring
- Hub Data Manager starting on November 18, 2024.
  - We are excited about this as we move towards the phase where we monitor our progress.
- Hub Program Associate starting on December 16, 2024.
- A few open positions remain-if you know of anyone who may be interested in working in this arena please reach out.
Reminder that this is hard work; there are a lot of views that need to be considered as we move this system forward. Sometimes we have to step back to ensure everyone has their views heard before decisions are made. One of those things is going to happen in the course of today's agenda when we talk about what the role of 988 will be as we transfer calls from 911. Other considerations that we're looking at in terms of the protocols. It's important to get all the views and strive for consensus whenever possible, and if it slows us down then we have to do that. We encourage you to speak up in these meetings and let your view be heard so we can consider them all as we make decisions.

Technical Subcommittee Updates

Protocol and Standards: Dr. Mary Smith

PowerPhone
- The PowerPhone Pre-test has been completed and it spanned about 45 days.
- Protocol and Standards Subcommittee members are meeting to review what was learned from the Pre-test.
- We will also reconvene the small subject matter expert working groups to look at the protocols and learnings.
- The subject matter expert workgroup will discuss recommendations to address the issues that arose as a result of the Pre-test to continue planning for the Pilot.
Priority Dispatch
- Met with Priority Dispatch and a subject matter expert workgroup to clarify the use of protocols.
- Will soon schedule follow-up meeting with Priority Dispatch SME Workgroup and Priority Dispatch to further discuss how protocols comport with the IRLM to meet CESSA goals.
APCO
- Continued review and finalization of recommendations for modifying protocols and will move forward over the next couple of weeks.

Data and Technology Committee: Pete Eckart

October 7 and November 4 monthly meetings:
- Data Systems Development Discussion
  - Shawn Cole from the UIC Office of Medicaid Innovation presented on the development of a larger and more integrated system for centralized dispatch.
- Discussion of metrics associated with the SAC Action Plan

Training and Education Subcommittee Report: Dr. Terry Solomon

All agencies participating in the pilots are expected to complete trainings in topics required by CESSA.
All trainings are on-demand and self-paced.
CEUs will be offered for certain courses. PowerPoint-only courses are not eligible for CEUs.
Exemptions will be considered, upon request, for certain courses if a comparable course was taken in the last 12 months.
Link to training courses are stored on a password-protected page which is linked here: PowerPhone Pilots | JACSW Behavioral Health Crisis Hub | University of Illinois Chicago
Shared with pilot sites on 10/24/24 and as of 11/11/24, 37 training courses have been completed.

Regional and Subregional Updates: Brenda Hampton

RAC Summit/Townhall meetings
- 3 scheduled in November, for a total of 7 that will have taken place this year.
RAC Challenges
- Mandatory training requirements for RACs and Subregional Committees (SRCs)
  - Concerned about the time commitment
- Role of the RACs preceding the pilots
  - What they do prior to the pilots being implemented
  - Majority are Priority Dispatch, APCO or independents, so they have a wait period
- Recruitment of SRCs
  - It's necessary to reach out to people who have not been involved before
  - RACs are concerned about finding people who can pass the message forward, to work with PSAPs, and be champions in the community
- We will continue to work with RACs to continue to overcome barriers

Pre-test Learnings: Dr. Mary Smith

Reviewed the learning results which been summarized within five categories:
- Use of Protocols
- PSAP Operations
  - Committee questions related to this category of learnings:
    - Lee Ann Reinert: What do we think the recourse is if we encounter a system that says that may be the law, but we're not doing it?
    - Cindy Barbera-Brelle: Would we take that to the Attorney General's office to enforce?
    - Lee Ann Reinert: Maybe. Who would take it to the AG's office to enforce? DHS has to do certain things, but I don't know who has authority over these ETSBs.
    - Cindy Barbera-Brella: Yes, the Emergency Telephone System Act defines my authority and the 911 systems authority.
    - Lorrie Jones: That's something we should discuss. I think we need to be prepared for that happening and know how to deal with it. It's in the parking lot so that when we get to those who are more resistant to the change, and DHS legal council, Cindy's legal council, attorney general - we'd have discussions at that point. What's more urgent and pressing is that we get the ones who are interested in doing this up and running.
- Training
- Data Collection and Referral
- Organizational Change/Culture Change Issues
Will come back to this group after discussing these recommendations with the subject matter expert workgroup and Protocols & Standards subcommittee. It will be critical to discuss these issues before we move into the pilot.

Role of 988 in the pilots: Dr. Lorrie Jones

Discussion and vote on the following question: During the pilot, should 988 call centers be instructed to attempt to resolve a crisis situation referred by 911 in lieu of transferring all calls automatically to MCRT (pass-through)?
Background:
- When we designed the pilot, the thinking was that the calls coming into 911 that could and would be transferred to 988, would be, but then 988 would automatically activate mobile crisis response.
- In speaking to people, there were lots of pros and cons to this approach. So we decided to pause and vet this with SAC and have some discussion and hopefully arrive at a consensus.
Reviewed the pros and cons presented by various stakeholders:
- Pros:
  - 988 should have the opportunity to attempt to de-escalate a crisis and only transfer to MCRT if they cannot resolve or if a community response is required.
  - It is best practice care to first have 988 use their crisis counseling skills to attempt to resolve a crisis.
  - 988 is required to provide follow-up and referral resources after the call.
  - Having 988 resolve crisis without dispatch keeps MCRT available for other callers when this response is necessary.
  - This reflects how the system will operate when CESSA is fully implemented.
- Cons:
  - MCRT will not be utilized (988 resolved 80% of calls) frequently enough to develop skill sets desired to be enhanced during the pilot.
  - The pilot would need to be redesigned to collect additional data elements to evaluate this component of data.
  - Callers to 911 are generally expecting an in-person response.
  - The community does not know about 988 and this will create unnecessary frustrations for the person in crisis.
  - Multiple assessments by 988 and then MCRT may be frustrating to the person in crisis.
Comments from Committee:
- Rachael Arhart: Looking at the list of pros and cons, I think it would be more advantageous to reflect what will happen when it's actually implemented. If the MCRTs are engaged on calls where they wouldn't normally be called, and then they're needed for a different call, I wonder if it's taking a significantly longer length of response that we should be giving people. The data wouldn't be that that important to CESSA because mobile crisis response is responding to calls they normally wouldn't respond to. If we're looking at benefits to CESSA and the person. I think it's best to have 988 resolve over phone when able and MCRT respond when necessary.
- Blanca Campos: I would echo what was just shared and I think you did a good job of capturing the pros and the discussion we've had about the various concerns that we've had about not piloting how it will be operationalized when fully live. In terms of that timely access to connecting individuals with mental health professionals, and that expectation of a 60-minute response. Whereas if they're able to provide that response over the phone, it could be immediate. I agree 100% with the pros in the slide.
- Shelley Dallas: I agree with Rachael and Blanca with their comments. Thank you for laying out both sides, both sides have merit. I think we want to move forward with the way it's going to be when it goes into full operation. To Blanca's point, about in-person response when they call 911, some of it is educating callers that 988 is available. Callers referred to 988 are low-acuity, not a harm to themselves, and typically those callers are looking for someone to talk to and asking for crisis intervention. 988 could be very successful in de-escalation without having to utilize or over-utilize MCRT.
- Lee Ann Reinert: I do want to pause because I do know some folks had concerns about moving forward this way, that's why the pilot wasn't designed this other way. So I want to make sure I'm not facilitating any group think and give space for comments.
- Jessica Gimeno: If the calls are not transferred, we could still have a separate metric by which we see if the call qualifies as mental health?
  - Lorrie Jones: We will be getting metrics from 911 call centers about the nature of the calls, calls they designate that is mental health related, regardless of how it's managed. We will also get data on which calls were transferred to 988, and which ones were transferred from 988 to MCRT. So there are three metrics.
  - Lee Ann Reinert: We're not saying that 911 won't transfer to 988, it's what 988 will do with the call once they get it.
  - Jessica Gimeno: Can you state those three metrics again?
  - Lorrie Jones: Right, so we'll be getting metrics from the 911 call center about the nature of the call, so calls they designate as something mental health related. It'll be challenging, but we'll get that information. And we'll get which calls they are transferring to 988. Remember for the higher-acuity calls 911 will manage through their own system. And then we'll have that report and validate that 988 has a record of these calls in their system. 988 will also report which calls are sent to mobile crisis response. Jessica, we can spend time offline showing you what the data collection looks like.

Vote on role of 988 in the Pilot

Blanca Campos made a motion to vote on the following decision. Shelley Dallas seconded the motion.
- "During the pilot, should 988 call centers be instructed to attempt to solve a crisis situation referred by 911 in lieu of transferring all calls automatically to MCRT (pass-through)?
Members who voted "yay" or "yes" to this question:
- Cindy Barbera-Brelle
- Justin Houcek
- Blanca Campos
- Shelley Dallas
- Drew Hansen
- Peter Dyer
- Jim Kaitschuk
- Emily Miller
- Bobby Van Bebber
- Rachael Ahart
- Brittany Watson
Members who abstained:
- Jessica Gimeno
Members who were absent:
- Brent Reynolds (left the call at 2pm)
- Curtis Harris
Lee Ann Reinert was leading the voting discussion and did not vote.
Motion carries with 11 who voted yes, 1 who abstained, and 2 who were absent.
As a result of the vote, during the pilot, 988 call centers should be instructed to attempt to solve a crisis situation referred by 911 in lieu of transferring all calls automatically to MCRT.

SAC Goals and Action Plan: Pete Eckart

Report back on SAC's recommendations to the Hub based on goals and actions identified for FY 2025.
Two requests for SAC members:
- Respond in the chat about any commitments you want to make for you or your colleagues for any action steps.
- After the meeting, complete short survey with roadmap goals and action items underneath so you can identify where you'd like to contribute.
Goal is to be sure it's driven by the identified stakeholders for CESSA, SAC members' participation really matters.
Regional/Subregional Goals #1 and #2:
- Phased implementation of the revised, approved PowerPhone protocols by end of FY25 including the ability to transfer from 911 to 988 to MCRT [Protocols]
- Complete pilots for APCO, Priority Dispatch and Independents by end of FY25 [Pilots]
- Committee input:
  - Jessica Gimeno via chat: I would like to be involved in goals #1 and #2.
Regional/Subregional Goal #3: Stakeholder groups understand the purpose of CESSA, what crisis response services will be available, and how to access them [Communications]
- We don't have a communication subcommittee, so we need support and expertise, and need to look at our resources in SAC, DMH, the Hub, etc.
Statewide Goal #1: Reduce the reliance of people in a behavioral health crisis on the 911 system (System)
- Paused on the action step to "create and promote educational campaigns for families, schools, and MCRTs; interested in two things here, (1) is anyone interested in contributing to the development of these educational campaigns about CESSA for these groups and (2) does anyone have networks that connect these three specific groups (families, schools, and MCRTs)?
- Committee input:
  - Blanca Campos: Through CBHA, we have a School Mental Health Provider Group that meets regularly. As you know we do have a SASS program for crisis services for children and adolescents. If there will be nuances around this piece for schools we should make sure it includes all the pieces they are already familiar with. We have a Child and Adolescent lead at CBHA and if we are all able to participate that would be very helpful.
  - Pete Eckart: We all know how busy Blanca is, and she mentioned that there's someone on her team that may be able to participate in this. As we talk about how much work there is to do, we want to try to expand the group of people who are doing it so that we aren't depending on people who are already stretched fairly thin.
Statewide Goal #2: Develop and implement a Quality Assurance plan for CESSA implementation (QA Plan)
- This activity is already fully staffed by the UIC Crisis Hub based on a co-occurring request from DMH due to a requirement from SAMSHA, but we would still welcome feedback from those who have evaluation and assessment experience.
Statewide Goal #3: Increase collaboration between different parts of the crisis response system (Collaboration)
- This goal is at the heart of CESSA, and there are many things that are similar or adjacent to CESSA. We want you to continue to inform us of anything new that you're aware of.
Statewide Goal #4: Have an actionable and sustainable plan for FY26 and beyond (Sustainability)
- We want to ensure CESSA meetings are focused on strategic decision-making, communications, and action, and we want to hear your ideas and critiques about the meeting structure that supports CESSA.
The Hub will be sending out a survey to SAC members to gather interest for specific contributions. Members of the public can also send messages directly to dhs.dmh.cessa@illinois.gov and/or Pete Eckert at peckart@uic.edu.
Additional committee comments:
- Rachael Ahart: I'm wondering if any others have experience with MCRT teams in their area and if they're involved in involuntary commitment or petition writing. I'm asking because looking at the transfer to 988 and MCRT, and then situations where MCRT feel that they need someone to be transported, and they contact law enforcement to do that-I'm wondering if that's typical, how MCRT is currently operating? Or is that something new coming under CESSA?
- Lee Ann Reinert: That's not new, and it's not CESSA. That is actually the mental health code, which talks about who has legal authority to take control or custody of someone.
- Rachael Ahart: I understand that. In our area, if a social worker evaluates someone and identifies someone is in need of mental health hospitalization, they will fill out the petition. If the person is willing to go to the hospital with them, they will turn that into the hospital. And then the hospital will evaluate and if that person voluntarily signs into the hospital for admission, they can get treatment that way. Law enforcement is utilized if the person is unwilling to go to the hospital and we have to take custody and transport them. I'm curious if there is anyone doing more engagement with the individual on the scene. Like if they are willing to go to the hospital and wants care, would they engage and either go to the hospital with that person or drive with them and then stay engaged throughout the admission process. My concern is that it would be strict, so every time this needs to be completed it's going back to law enforcement, it could potentially be causing more issues and damaging the relationships.
- Lee Ann Reinert: I would like to request that we revisit this and maybe put it on a future agenda. A few reasons:
  - First of all, getting someone to the hospital is not the overall expectation of mobile crisis response. It's a service itself and not a means to an end of getting someone hospitalized. What we would hope to see is that someone who is needing to go to higher level of care is more the exception than the rule. I think we need that baseline expectation that mobile crisis response teams are going out and getting people to the hospital, involuntary or otherwise.
  - Second, this is more of a legal ethical thing. If a mobile crisis response team is completing a petition and then taking someone under the guise of a voluntary admission because they're willing, but they're taking the petition along just in case, then there is legal gray area around whether the person is actually voluntarily going.
  - More discussion is needed here and it's something that people need a good understanding of as we move the system forward.
- Rachael Ahart: It would be great to put it on a future agenda and talk through it more to make sure the best care for the person does continues.

SAC Next Steps

Meeting Dates:

December 9, 2024, 1-3 pm virtual
January 13, 2025, 1-3 pm virtual
Will discuss in December meeting if there will be an in-person meeting next quarter

Public Comment

Nate Sanders: You are doing awesome work, thanks for the hard work and if it gets implemented it could be very good for a lot of people, so thank you. I was at the in-person meeting in October, and it was mentioned that the state was looking into technology that could help with receiving or dispatching calls. I didn't hear anything about that today and was wondering if there's an update on this.
- Lee Ann: We don't have an update yet, as anything related to technology has to go through procurement and we're not allowed to discuss any details. There will be more to come once procurement comes. We can't discuss anything in advance of that.
Alyssa Morrero: How can someone get involved with SAC initiatives who is not a member?
- Lee Ann: For non-SAC members, you can email dhs.dmh.cessa@illinois.gov and send in your name and anything you're interested in, and someone will get in touch.
Matt Fishback: When will the statistics on the pre-tests be available? I have two RAC meetings in the next week and it'd be real informative to how we move forward, especially with the pilots starting up.
- We will be getting back to you on that soon.

Adjournment

The meeting was adjourned by Lee Ann Reinert at 2:57 pm.