CESSA Statewide Advisory Committee Meeting Minutes 12/09/2024

Approved by Committee Members 01/13/2025

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

Meeting Minutes - Monday, December 09, 2024 - 1:00 pm - 3:00 pm

Call to Order/Roll Call

Director David Albert called the meeting to order at 1:02 pm.

Director David Albert reviewed official notices.

Director David Albert reviewed the agenda.

Roll Call and Approval of Minutes from November 12, 2024

  • Cindy Barbera-Brelle moved to approve the draft minutes from the November 12, 2024 meeting during roll call. Drew Hansen seconded the motion. Quorum confirmed and minutes approved.
  • Members present and voted to approve:
    • Cindy Barbera-Brelle
    • Jessica Gimeno (Designee for Candace Coleman)
    • Curtis Harris
    • Brent Reynolds
    • David Albert
    • Drew Hansen
    • Peter Dyer
    • Rachael Ahart
    • Jim Kaitschuk
    • Blanca Campos
    • Emily Miller
  • Members present and abstained:
    • James Hennessy
  • Members absent:
    • Bobby Van Bebber
    • Justin Houcek
    • Brittany Watson
  • Rachael Ahart: "I just wanted to clarify the question I was asking about mobile crisis response and if there's any units currently more engaged in the involuntary process and petition writing, and I shared that our social workers are very involved in that process. I just wanted to clarify that law enforcement is still there in transporting if there's petitions, it's just that our social workers stay engaged throughout the entire process, so assisting with actually writing the petition, filling that information out, they either ride along with to the hospital or follow behind, and then they do that clinical level of exchange with the providers at the hospital. And I just wanted to make sure that that was clear, that it wasn't like our social workers are driving or transporting alone in those situations."

State Updates (Lee Ann Reinert)

  • New Members and Introductions:
    • James Hennessy
  • Barbara Hobrock:
    • Appointment Process Update:
      • According to Lee Ann Reinert, we discovered on [Barbara's] arrival that while we did appointments to the best of our ability/knowledge, we did not follow all the processes correctly for appointments.
      • Accordingly, official appointment letters for this group were not filed.
      • Statute states that the Secretary of Human Services shall appoint members. SAC appointments are being brought to the Secretary this Wednesday, and once Barbara receives approval, then the appointment letter(s) will be filed with the index department. Each individual will receive a copy of their respective appointment letter for their records.
      • 11 regional group appointments will be brought forward to the Secretary in January.
    • Mandatory Board Training reminder: Please complete the trainings by the end of the year. These will also need to be completed in 2025.

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

  • We have a new staff starting on Monday, and we are anticipating/hoping for a few of our other positions pending approval from a SAMHSA grant.

Technical Subcommittee Updates (Dr. Lorrie Rickman Jones)

Training and Education Subcommittee Report

  • 123 people have completed training for pilots
  • Pilot training deadline extended to January 31, 2025
  • All trainings have been posted with the exception of the live training expected to occur on Dec 16, which will be available on-demand by Dec 20.
  • We anticipate a new learning management system to be available in early 2025 which will provide a more seamless, user friendly, training experience

Protocol and Standards

  • PowerPhone
    • Some pre-test recommendations approved by PSTSC on 11/21/2024
    • Added members to Ad Hoc PowerPhone Workgroup to assure representation of all viewpoints
    • Ad Hoc PowerPhone Workgroup meeting scheduled for 12/16. This group will make recommendations to the PSTSC on the types of incident codes to be included in the pilot.
  • Priority Dispatch
    • Held follow-up meeting with Priority Dispatch to further clarify questions with their protocol framework
    • Met with 911 PSAP administrator from Virginia who has implemented Priority Dispatch in accordance with their risk-level matrix and has assessed the similarities with the IL IRLM
    • Will hold follow up meetings to finalize the Priority Dispatch protocol changes and IRLM mapping in January 2025
  • APCO
    • Continued review and finalization of recommendations for modifying protocols

Pre-test Learnings (Dr. Mary Smith)

  • Process overview
    • The findings and recommendations from the PowerPhone pre-test have been summarized within five categories.
    • The findings and recommendations were presented to Protocols and Standards Technical Subcommittee (PSTSC) on Nov. 7 and Nov. 21, 2024.
    • Findings or learnings were presented to this committee at the previous meeting on Nov. 12, 2024.
    • PSTSC approved most recommendations on Nov. 21, 2024.
  • Recommendations that were approved by PSTSC on Nov. 21, 2024.
    • Use of Protocols
      • PSAPS have questions about the utility of transferring "third party" crisis calls to 988
        • 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
      • PSAPS do find mental health concerns during "Welfare Check" calls
      • To support this, we have scheduled a presentation with folks from Denver Star to be held on Dec. 12 from 2-3 pm.
    • PSAP Operations
      • Emergency Telephone System Boards (ETSBs) may opt not to participate in CESSA although required by statute
      • Recommendation: Include ETSBs (who may not have been involved in the past) in CESSA planning and discussion
    • Training
      • PSAP administrators convene periodic meetings with telecommunicators to update them on operational changes
      • PSAP administrators prefer brief "to the point" training and reported augmenting PowerPoint training with scenarios highlighting types of callers appropriate for transfer to 988 for MCRT response
      • It is unclear how effective the training provided by PSAP administrators was in conveying the intent of CESSA as well as the need to utilize the protocols updated by the P&S workgroup
        • 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
    • Data Collection and Referral
      • During the pre-test period, there were fewer calls related to mental health issues than were anticipated based on national benchmarks/data
      • Most calls identified as mental health related were ruled out as appropriate for transfer to 988 for MCRT response. Law enforcement was subsequently dispatched
      • It is labor intensive for PSAP Administrators to review BH related calls to determine if calls could have been referred to 988 for MCRT response; The PowerPhone vendor has developed a report that has been deployed to the Pre-test PSAP Administrators which should help to address this issue
        • 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
    • Organizational and Cultural Change Issues
      • TCs have decades of experience in dispatching LE, EMS, fire so adding a 4th dispatch option is a technical and cultural change that will take time to implement
      • 911 TCs, 988 crisis counselors and MCRT staff may not be aware of each entity's strengths and experiences in working with individuals experiencing behavioral health crises.
      • CESSA requires major system and organizational changes as well as a change in the "mindset" of line staff with "boots on the ground." This level of change does not occur in a brief period of time such as the 45-day pre-test period.
        • 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
  • Recommendations that were not approved by PSTSC as of Nov. 21, 2024
    • Use of Protocols
      • PSAPS are required by statute to only use EMD protocols, and Law Enforcement Protocols are not required
        • Recommendation 1: Explore possibility of implementing a statutory requirement for PSAPs to utilize law enforcement protocols in addition to EMD protocols
      • If we don't include the law enforcement protocols, we will miss opportunities to determine if calls are appropriate for a mental health response, assuming no rule outs.
      • The Ad Hoc workgroup that's being convened Dec. 16, 2024 will talk about how to address this issue.
      • All PSAPS do not routinely use PowerPhone Protocols at initiation of calls, resulting in no documentation of calls and dispatch decisions into the computer aided dispatch (CAD) systems associated with the protocol changes
        • 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
      • This finding will also be part of the Dec. 16, 2024 workgroup.
    • PSAP Operations
      • Unions may impact changes in PSAP operations including the use of modified protocols
        • Recommendation 1: 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 2: Include union organization(s) in CESSA planning and discussion moving forward
      • PSAP administrators noted that the number and type of calls received varies based upon such factors as time of year, PSAP location (urban vs rural vs suburban and combinations thereof), and population served
  • It is really critical that we resolve the outstanding issues before we can more forward with the pilots.
  • Questions
    • Jim Hennessy: "I know that you said you were going to get some people to present from other jurisdictions that have implemented this or similar things and how they operate. I do want to hear from Denver and how they're operating this, but do we have any smaller departments that are like rural communities or a small PSAP that handles nothing but rural communities that have implemented this, that would be willing to give a presentation on how that works with those regions?"
      • Dr. Mary Smith: That's an important issue to raise. We will be looking for a variety of different initiatives to highlight. We are looking for one like that now to highlight in the future.
    • Curtis Harris: How about recommendations about getting away from contacting law enforcement as it relates to CESSA and what the protocols and data are?
      • Dr. Mary Smith: "Yes, we are still paying attention to the protocols and collecting the data as we move forward. Absolutely. The presentation is intended to show how other jurisdictions handle some of the issues that we're grappling with. So, for example, we chose a range of protocols that fall under law enforcement. It may seem that Illinois is unique, but we're not, so maybe some of the protocols we selected are unique, but by and large many of those protocols are also being used in other jurisdictions with the same goals that we're working on with CESSA. In terms of data collection during the pilots, the idea is still to collect data to see what happens when a call that's appropriate for transfer to 988 or for mobile crisis response happens; we'll be tracking those referrals from 911 to 988 to mobile crisis response. And so, we should have the data to be able to evaluate the process."

SAC Goals and Action Plan (Pete Eckart)

  • Overview
    • We started this process back in September asking the SAC what are your priorities for FY25?
    • We turned those suggestions into a road map and then goals and action items.
    • Then we did a survey where we asked you to say how you and your colleagues can contribute.
    • We received 100% response on the survey.
    • We will follow up on your offers to contribute.
  • Regional/Subregional Goal #1: Phased implementation of the revised, approved PowerPhone protocols by end of FY25 including the ability to transfer from 911 to 988 to MCRT [Protocols]
    • Discussed in pre-tests and pilot planning update.
  • Regional/Subregional Goal #2: Complete pilots for APCO, Priority Dispatch and Independents by end of FY25 [Pilots]
    • Discussed in pre-tests and pilot planning update.
  • Regional/Subregional Goal #3: Stakeholder groups understand the purpose of CESSA, what crisis response services will be available, and how to access them [Communications]
  • Statewide Goal #1: Reduce the reliance of people in a behavioral health crisis on the 911 system (System)
  • Statewide Goal #2: Develop and implement a Quality Assurance plan for CESSA implementation (QA Plan)
  • Statewide Goal #3: Increase collaboration between different parts of the crisis response system (Collaboration)
    • Seven of the 15 of you offered to contribute to this.
  • Statewide Goal #4: Have an actionable and sustainable plan for FY26 and beyond (Sustainability)

Regional and Subregional Updates (Brenda Hampton)

  • High-level overview of the guidance documents that we have written on the flow of the PSAPs from 988 to the mobile crisis response teams (MCRT)
    • Connection between 988 and MCRT
    • Transfer to MCRT will be on a no-decline basis
  • Subregional planning is moving along. We provided them with information about the structure and toolkits to support that work.
  • We will have a presenter, Brandon Miller, from Illinois Regional Valley PSAP will present at the RAC co-chair meeting on Wednesday
  • We have 10 PSAPs suggested for Priority Dispatch pilots and three PSAPs suggested for APCO, collected from the RAC Co-Chairs and from Cindy Barbera-Brelle.

Implementation Challenges

  • Introduction (Brenda Hampton)
    • Chief Gault has been a tremendous partner and champion in Region 2. He has spoken throughout the state in partnerships between law enforcement and mental health. He has raised concerns that have been brought to his attention and we thought it was important to share with the SAC some of the challenges that he and his counterparts have encountered in working through implementing CESSA.
  • Presentation (Chief Darren Gault, Chief of Police, Moline Police Department, on behalf of the Illinois Association of Chiefs of Police)
    • From a law enforcement perspective, I support the CESSA legislation, at least the concept of it, and I want to see it succeed. For many years, we have asked "why are we responding to these calls" and we know that we're really handling a healthcare crisis at the law enforcement level, partly because of the lack of resources throughout the state.
    • I commend the approach to take it slow and tackle the challenges now to make sure we do it right. The practicality of actually implementing is becoming quite daunting.
    • The health care system is largely controlled by private hospitals. The medical director at each of these hospitals controls the license of an ambulance paramedic. EMS ambulance by law can only go to an emergency room. These are two examples of significant barriers to implementing the statewide goals. Without changes to the law or some of the regulations, it's going to be impossible to divert individuals from incarceration and/or hospitalization.
    • CESSA will prohibit law enforcement responding to mental health calls unless there's two factors: crime or threat of physical injury issue. Under the mental health code, though, a police officer may take a person into custody and transport them for involuntary hospitalization to protect them from harm.
    • For the purpose of this conversation, let's just exclude the obvious homicidal or suicidal patient. We think those high-level calls that we're all engaged in, the risk level fours, we're kind of on the same page.
    • Let's consider something where there isn't a crime and there isn't an active threat, but the individual is experiencing psychosis or suffering from SMI. Many times an ER doctor will order paramedics to bring the patient into the hospital. Historically, where law enforcement was there helping health care professionals or ambulance drivers take care of these patients, an officer would use force to help the paramedics get the patient to the hospital.
    • But modern best practices say the officer should walk away, such as in the Sonya Massey case, but paramedics once they have face-to-face contact, can't walk away.
    • In Armstrong v. The Village of Pinehurst, that says when the purpose of taking custody by a law enforcement is to protect a person from harm, any force that causes harm, is contrary to the mission of protecting that person.
    • I hear regularly that medical directors and ER directors are ordering patient to be brought in to "play medical defense" to protect themselves from liability, but it shifts liability to the first responders if we violate the law but I am not willing to take on this liability from a medical doctor because an MD orders a police officer to take a patient. This goes against the goal of CESSA which is to avoid hospitals, and we don't take orders from hospitals, but it leaves paramedics at risk of losing their license.
    • Another issue here is law enforcement transportation. The Mental health code says for an involuntary commitment in custody can be transported by police but I think CESSA says if you wouldn't normally go on another case, you shouldn't go on these cases. There's some conflict in the laws that need to be cleaned up. If we're diverting them from hospitals, currently an EMS first responder can't go anywhere else except an emergency room.
    • I had written a letter about a case that happened here in Moline that kicked off grievances from the fire union and concerns about what will be common practice once CESSA is implemented.
    • I encourage the committee to dive deep with what's going on in the private hospital sectors. It's a unique situation when a private hospital has control over a municipal employee.
    • The CESSA work is focused on alternative response, the call taking, and the resources. But the next step is looking at the practicality of what's happening in the field. One of the problems I have about using force, is to take them to the hospital to evaluate, kick them out of ER in 30 minutes and sent to community-based care.
    • One of the things that gets, lost the criminal justice system is a "must-do" system. Conversely, the health-care system is optional, the person can refuse, until its mental health court. Mental health court is very effective.
    • We are putting the first responders and the administrators that oversee these agencies into some difficult positions.
  • Director Albert: Thank you for this presentation. It's given us a lot to think about. The more we implement CESSA, the more we see it's complicated.
  • Curtis Harris: With CESSA and 988 in place, and criminal liability, I know CESSA was designed to shift away with law enforcement for non-life-threatening ailments that that person will oppose to police, but what if the person's in a mental health crisis? And you talked about the great point that you hit on about that if a person is a firefighter, is that person in danger or is that person having a mental health crisis? I think that person is having mental health issues.
    • Chief Gault: In that case I gave you, now we have added a crime to the call if that's aggravated battery to a paramedic. I don't know what the right answer is, but I understand the doctor is playing it safe and saying bring them in.
  • Chief Gault: Many of the counties around the state are not using court orders, they are circumventing that using the mental health code involuntary commitment petitions. So, you get down to central and southern Illinois where its less frequent. There's even less resources and beds in the rural hospitals.

SAC Next Steps (Lee Ann Reinert)

Meeting Dates:

  • January 13, 2025, 1-3 pm virtual
  • Monday, February 10, 2025, 1-3 pm virtual
  • Monday, March 10, 2025, 1-3 pm currently virtual but will change to in-person
    • Time will be extended to three hours for in-person meeting. Location TBD.
    • Previous meetings have rotated between Chicago and Springfield.
    • Jessica Gimeno, Emily Miller, Brent Reynolds and Jim Hennessy offered to host.
    • Members will receive another survey for location with the options of Chicago, Springfield, or Will County.

Public Comment

  • Alyssa Marrero had her hand raised but the committee could not hear her. It appears there are tech issues. Lee Ann Reinert put the email address in the chat. To make public comment, please send to DHS.DMH.CESSA@Illinois.gov at least one week before the next meeting.

Adjournment

The meeting was adjourned by Director David Albert at 2:35 pm.