CESSA Protocols & Standards Denver Star Dispatch Presentation
December 12, 2024, 2:00 - 3:00 pm
Meeting Minutes - Approved by Members 12/19/2024
Protocols & Standards Subcommittee Members Present: Cindy Barbera-Brelle, Jessica Gimeno (Designee for Candace Coleman), Lee Ann Reinert (Designee for David Albert), Rachael Ahart, Pete Dyer, Jim Hennessy
Call to Order and Official Notices:
- Dr. Mary Smith called the meeting to order at 2:05 pm and covered official notices under OMA.
Introduction from the UIC Behavioral Health Crisis Hub (BHCH):
- Dr. Mary Smith from the UIC BHCH discussed the background and goals of the Community Emergency Services and Support Act (CESSA).
- Dr. Mary Smith introduced the three presenters from Denver 9-1-1 and Denver STAR:
- Andrew Dameron, 9-1-1 Director at the Emergency Communications Center in Denver.
- Brian Blick, Denver 9-1-1 Quality Improvement Manager
- Tandis Hashemi, Denver STAR Operations Manager
Denver STAR Overview
- Overview of Denver STAR by Tandis Hashemi
- Design:
- Modeled after the CAHOOTS program (eugne, OR)
- Community-based response
- Meets people where they are
- Team Composition:
- Behavioral Health Specialist (Clinician)
- Paramedic/EMT
- Wraparound Services
- Experience of Team:
- Crisis intervention and management
- Emergency response
- STAR vs. Co-Response Models:
- Police officer is not part of the team
- Expansion
- Developing Policy (presented by Brian Blick)
- Utilizing available experience within the agency to determine natures
- Foundation in existing policy and procedures
- STAR Program Response Criteria (presented by Brian Blick)
- Initially conceived utilizing existing Denver 9-1-1 nature codes
- Focus on codes for which safety concerns are generally low
- Assist
- Disturbance/Disturbance Family (post-pilot
- Indecent Exposrue
- Intoxicated Person
- Narcotics (post-pilot)
- Suicidal Series
- Syringe Disposal
- Trespass
- Welfare Check
- Call Taking Process (presented by Brian Blick)
- Standardized call processing: Weapons? Injuries? Timeframe? Suspect Location?
- Rule-outs happen early in call-taking process. If weapons, it's not eligible, if injury, it goes to EMS, etc. If no rule-outs, then it's STAR eligible.
- 911 Staff Training (Brian Blick)
- Initial Training
- April 2020
- Presentations
- Videos to reinforce
- Utilizing CTOs
- 6 foot 1:1s
- Ongoing Training
- Classroom
- Self-guided CE modules
- STAR Staff Training (presented by Tandis Hameshi)
- Initial Training
- Crisis intervention & management
- Risk assessment/levels of care
- Emergency mental health holds
- Least restrictive intervention
- Motivational interviewing
- Safety planning & means restriction
- Scene safety
- Ongoing Training
- Scene safety
- Cultural responsiveness
- Available resources
- Expanding Nature Codes
- What are we missing?
- /BCOP
- Beyond control of a parent
- Disturbance/Family Disturbance
- The caller reports someone, who appears in crisis, behaving in a non-violent manner which is concerning to the public/caller with no indication of weapons or physical violence
- Star Only
- The caller is requesting a "STAR only response"
- Narcotics
- The caller sees a person using narcotics in a public space
- STAR Responses (presented by Tandis Hashemi)
- Responding to 3rd Party Calls
- Level of comfort of team responding to these calls
- Types of calls: Trespass, welfare checks, indecent exposure
- Other types of issues addressed (e.g. homelessness)
- Calling for backup
- Since STAR started, there has not been a need for emergent back-up
- Train clinicians to have situational awareness
- STAR Stats (presented by Brian Blick)
- View graphs/charts in presentation recording
- Lessons learned
- Dr. Mary Smith requested that each presenter share lessons learned that may be helpful to Illinois PSAPs.
- Brian Blick:
- One of the most important thing in implementation is getting training early on to secure buy-in. Respond to people's fears and concerns early on. In my opinion, that's the key to overall success. You need those people working together, and the more information you can give to people the better result you're going to get.
- Andrew Dameron:
- Know that it'll look very different in each community around the state of Illinois, and the key element is to find what works.
- Also look at other cities around the country that are doing really well: Durham, North Carolina, Seattle, San Francisco, Albuquerque. All have similar programs and they all look different.
- It's helpful to have the crisis response clinicians work closely with dispatchers to share more about what they do, and have been doing for a long time out in the community. Now with this program, Denver 9-1-1 is looking out for them and they are safer than when they were doing this before.
- There is also the issue of liability on the call takers and dispatchers. We've taught in our industry to focus on worst-case scenario and guard against that. To address this we wrote a policy for the STAR-only calls and went to the City's Attorney to take on liability for these calls. This took it off of dispatchers.
- Tandis Hashemi:
- There's a need for continued interactions - training the responder staff, getting that buy-in with the responders. That's a really important relationship to maintain so that you know the program is being utilized effectively.
Q&A (questions received from members of the public in the chat)
- Question from Zachary Gittrich: CESSA was passed unanimously, but it was signed into law as an unfunded mandate. We are working to get permanent funding from the state legislature. We want to be able to fund this beyond grants and medicaid reimbursements. How were you been able to calculate the costs in fully implementing your program: including costs for the MCRTs and PSAPs and any other costs? How much has this cost you? How have you been able to calculate the savings in implementing your program compared to the traditional model of relying on LE? Thank you for all you do.
- Answer from Andrew Dameron: As to cost, the pilot was funded by a grant. In 2018, the City of Denver passed a ballot initiative called Caring for Denver Foundation, which mandated that 25 cents out of every $100 gathered in sales revenue for the city and county had to be set aside in a special fund for use in alternatives to jail, mental health and substance use, and potentially homelessness. We leveraged that and got a $250,000 grant, and only spent $93,000 during the piilot year. That's because Colorado is a Medicare expansion state, and so our social workers can bill Medicaid and Medicare for their services. We have money set aside to pay for that time, but we have funds to offset it. So first year was less than $100,000 in cost. Now budget is increased through general fund dollars and we have $6.6 annually (as of 2024). Still not spending all because of Medicare offsets coming into play.
- This also includes wrap-around services. We partner with community non-profits for follow-up services, and a third to half of the budget goes to those efforts.
- We are still working through a cost-benefit analysis.
- We also received a large donation that we used to supply the vans in the early stages of the pilot.
- Question from Brandon Miller: You talk of the number of calls STAR handled- what was the impact on police call volume?
- Answer from Andrew Dameron: With this beginning in 2020, Denver Police (like many other police departments) suffered some personnel loses and have been working to get back up to fully staffed. We have reduced police call volume by 2.5-3% because we are taking things off their plates that shouldn't have been there in the first place.
- Question from Lorrie Jones: Was most of the budget used supporting the teams to go out?
- Answer from Andrew Dameron: Yes, most of them yes - the vans and the personnel to staff them.
- Question from Jennifer Brown: What about the liability for the dispatcher or for LEO that do not respond and something bad happens
- Answer from Andrew Dameron: We as an industry we have drilled into our dispatchers the importance of potential harm that could occur by not sending police that we didn't think about potential harm if we did send police to the wrong call. Agency took over the liability, so it wasn't on the dispatcher.
- Question from Jim Moldenhauer: 911 calls come into the center and your telecommunicators triage the calls for service and they are not transferred out, correct? They remain with Denver 911 if they are in your jurisdiction and the telecommunicators don't transfer to 9-8-8 or other staff for phone triage of mental health calls?
- Answer from Brian Blick: Correct. The city and county of Denver is one entity, so we have universal call-takers. Our dispatching is broken out by police, fire and EMS and separate dispatchers for each one. Initial triage is done by universal call-takers. We have a small percentage of calls (usually suicidal callers) that we do transfer to 988 and we hope to grow these referrals.
- Questions from Jim Moldenhauer: Are the ETAs known for the STAR units? Do they have radio communication with your telecommunicators or CAD Mobile computers?
- Answer from Brian Blick: To an extent, yes. The STAR units are in the same dispatch channel and dispatched based on location and priority. They have a version, not a true NDT- but they can still see call notes and things like that. Currently STAR is dispatched by police, but we are building out a new dispatch station that is specific to STAR.
- Follow-up question from Jim Moldenhauer: And just to clarify, if your STAR units are available, and you know you're not transferring it to somebody else, maybe waiting an hour to see if they're available? You have an idea of what's available out there correct?
- Answer from Brian Blick: Yes, those units are built into our CAD.
- Question from Zachary Gittrich: Does the STAR program after provide transportation for people to living rooms or other places they may need to go? If so, what do you say to MCRTs in Illinois that are very hesitant for liability reasons to offer transportation?
- Answer from Tandis Hashemi: Our STAR teams do offer voluntary transportation. But at the point where the person has been de-escalated and going someplace else is the best option for them, such as a hospital, shelter, somewhere else in the community. Andrew, do you want to touch on the liability piece?
- Answer from Andrew Dameron: I don't know enough about the secured transport and and that side of thing, and and particularly what concerns may exist in Illinois. What I can say is that from the beginning the the STAR program I was fortunate to get to do a ride-along during the pilot phase, and had a good experience transporting someone in a STAR van.
- Question from Tonya Beasley: Andrew, when you say 'we" take on the responsibility to reassure 911 professionals that they wont be liable, who is "we" and do you agree to cover any legal costs?
- Answer from Andrew Dameron: It's the City and County of Denver, and then the City Attorney is the legal representation should anything happen. It helps to have a lot of hard stops in the intake process, so that if there are any major risks then it disqualifies for them. That shows that we've done our due diligence to mitigate any potential risks. We have not had any liability issues to date.
- Question from Tiffany Patton-Burnside: Can your EMT's be dispatched by police or do they require an EMD to dispatch them?Answer from Brian Blick: So our our police dispatchers are civilian that work for the city and county of Denver. Our EMS dispatchers work for Denver paramedics, which is part of the local hospital authority that is contracted to be sort of a county hospital for the city, and then the dispatchers for Denver Fire are firefighters. So we do use EMD within that initial call triage. But it's our police dispatchers doing the dispatching just because the calls are primarily calls that would have historically gone to the police.
- Answer from Andrew Dameron: I've spoken with other ECCs around the country who are trying to do this from an EMS/paramedic perspective. They (at least using ProQA/Priority Dispatch) have the same problem that we identified, that the Protocols are just too strict to fit an alternative response program like this. They are actively working on it. I've had conversations with their kind of clinical director that's working on some of the new protocols around this. But it's still hard to have much gray area, which is ultimately what STAR is. The difference between a medical call and a police call, there's not a lot of overlap in that Venn diagram, whereas the way at least we're implementing it,STAR versus police has a tremendous amount of overlap. One little detail could change it from one side to the other. So that's why we don't use any of the standardized protocols. It's all the the policy and procedure we've developed in House.
- Answer from Tandis Hameshi: I want to add that Police, Fire and EMS can also request STAR Unit to help out over the radio.
- Question Sarah B. Scruggs: Does STAR cover any rural areas? Logistical considerations for rural? We (Arukah) are a mobile crisis provider in a rural area, and we have found that "Living Rooms," which are brick and mortar crisis stabilization units, can augment the impact of mobile crisis response, measured by reduction in police contacts. We observed 67% reduction in police contacts in 2 years with combination of the two.
- Answer from Andrew Dameron: No, because we don't have really any rural areas. However, I've worked with Clear Creek County and Summit County, both up in the mountains. If you'd like to visit I'm happy to make introductions. Clear Creek has a 10,000 population and they pair clinicians within ambulances because it's a more readily resource and there was a lot of buy-in from the health system. There are other models in rural areas to look at. I would point you to the Council of State Governments; they are actively compiling examples of alternative response programs thorughout the country. Denver is one of the learning sites.
- Question from MJ Martin: You mentioned that your highest response is for welfare checks - are you sending your MCRTs to welfares instead of police response?
- Answer from Brian Blick: Yes, as long as they are STAR-eligible. This means no premise history, violence is taking place, they are known to have weapons, etc. They don't go to all of them due to the volume.
- Question from dtousignant: Maybe I missed this, but did the State of Colorado mandate all cities to use STARS? or is the decision made at a local level?
- Answer from Andrew Dameron: It was at a local level. There has been no State mandate along these lines. The co-responder program began in 2016, and two things happened after that. One, a group of community activists felt that there should be a completely non-law enforcement model. And then the clinicians who were riding on the Co-Responder teams were saying they could handle a call by themselves. So it was a very grassroots development in Denver.
- Question from Jessica Gimeno: (Andrew) you mentioned tweaking the nature codes that your department determined had a mental health component to them. What kinds of tweaks did you make? Did you add questions -- are you able to share examples of questions you added?
- Answer from Brian Blick: We added something at the end giving them criteria and examples, then STAR is appropriate for these instances. Tried to identify as many examples as possible, reinforce the whole safety aspect of it, including the STAR-only part of it We tried to keep processes normal for as long as possible and then add that small tweak at the end to get the STAR eligibility determined.
- Adjournment:
Dr. Mary Smith adjourned the meeting at 3pm.
