CESSA Protocols and Standards Subcommittee Meeting - Approved Minutes 09/18/2025

CESSA Protocols and Standards Subcommittee Meeting - Approved Minutes 09/18/2025

Time: 2:30-4:00 pm

via Zoom

Call to Order/Review of Official Notices (Cindy Barbera-Brelle)

• Meeting called to order by Cindy Barbera-Brelle at 2:32 pm (via Zoom)
• Cindy Barbera-Brelle reviewed OMA Official Notices
• Cindy Barbera-Brelle reviewed the agenda

Roll Call (Cindy Barbera-Brelle)

• Members present: Brent Reynolds (arrived late), Jessica Gimeno (as designee for Candace Coleman, Cindy Barbera-Brelle (as designee for Alicia Atkinson), Allie Lichterman (as designee for David Albert), Drew Hansen, Jim Hennessy, Justin Houcek, Pete Dyer, Rachel Ahart
• Members absent: Blanca Campos, Bobby Van Bebber
• Quorum is present

Approval of Previous Meeting Minutes (Cindy Barbera-Brelle)

• Brent Reynolds made a motion to approve the September 4, 2025, minutes; Jim Hennessy seconded the motion
• Members voted to approve: Brent Reynolds (arrived late), Jessica Gimeno (as designee for Candace Coleman, Cindy Barbera-Brelle (as designee for Alicia Atkinson), Allie Lichterman (as designee for David Albert), Drew Hansen, Jim Hennessy, Justin Houcek, Pete Dyer, Rachel Ahart
• Quroum voted to approve September 4, 2025, minutes

State Updates (Allie Lichterman)

• No significant updates

Preamble to the IRLM (Lorrie Jones and Mary Smith)

• Proposed preamble
  • The Illinois Risk Level Matrix is a policy document developed to inform necessary changes in the dispatch of emergency services by 911 Public Safety Answering Points (PSAPs) in response to persons experiencing a behavioral health emergency. These changes are required in Illinois pursuant to the Community Emergency Services and Supports Act (CESSA) passed into law in August 2021. CESSA requires 911 PSAPs to connect callers facing a behavioral health challenge, who are not at risk of violence or criminal activity, to an appropriate mental health response that does not include law enforcement. In effect, this adds a new response option to our crisis response ecosystem, without removing any existing options.
  • The Illinois Risk Level Matrix is the successor document to the Interim Risk Level Matrix, developed in 2023. Both documents were developed with wide stakeholder involvement and review, including representatives from 911 PSAPs, law enforcement, public health, fire, mental health providers, advocates, and payors across the Illinois landscape. The final Illinois Risk Level Matrix, updated following the completion and review of multiple pilot implementation sites, was approved in September 2025 by the Protocols and Standards Technical Subcommittee of the Statewide Advisory Committee, authorized by the 2021 statute.
  • The Matrix was also guided by principles embedded in the vision statement adopted by the same body in May 2024: "Individuals experiencing mental health or substance use-related emergencies are deflected from unnecessary hospitalizations or incarceration when appropriate and are linked with available, appropriate community services that enable the individual to recover, heal and thrive."
  • The PSAPs across Illinois will be required to assure that their protocols and dispatch software are fully aligned with the recommended decisional guidelines offered in the Risk Level Matrix. While these changes are a statutory requirement, it is recognized that telecommunicators have the discretion to conduct situational assessments for any incident that may result in a reassignment of risk level and ultimately the dispatch decision. This is recognized as standard practice. The Matrix itself will never be used directly by any telecommunicator or crisis counselor for decision making.
  • Finally, although this document is considered "final," it is always subject to modification as a result of new statutory requirements or quality reviews of incidents. It will be used, in this form, to advance the system to full implementation of CESSA.
• Discussion
  • Allie Lichterman: Is it possible to put up a version that shows it all on the same slide?
• Mary Smith: Pulling it up now.
  • Jim Hennessy: I appreciate the last part about it being a constantly evolving document. As this gets distributed, we will likely receive lots of constituent/stakeholder feedback across police, fire, EMS and 911. Hopefully we can revisit concerns once we get that feedback.
• Lorrie Jones: We don't mean to have an iterative rolling document but anticipate there may be some statutory changes or sentinel events that require a second look. We can collect feedback along the way, but if we make changes all along, we will never get through implementation.
• Jim Hennessy: When our group was passing the IRLM back and forth, I wasn't sharing it with the whole 911 community, so that community might have a different perspective than just me. They may provide valuable feedback that our group didn't think of.
• Lorrie Jones: We should absolutely catalog that. And open the IRLM at an agreed upon time in the future.
  • Brent Reynolds: This is my first time seeing the preamble; I can't comment today. Might be able to send by the end of the call. Is this something that can be sent to the Subcommittee?
• Lorrie Jones: Changes were made earlier today, so we were not able to get it out before the meeting. But we are happy to send it out.
• Drew Hansen: I'm in the same boat as Brent. Takes a minute to digest and come up with a response.
  • Lorrie Jones: When we decided to have a preamble, it was requested to include: 1) references to show that the IRLM is grounded in legislation; 2) references to show that IRLM is grounded in vision statement, and 3) clarification about IRLM not being used directly by telecommunicators. Not meant to be long, extensive document; just to cover three things and be readable. Are we missing anything?
• Allie Lichterman: I was looking to see the purpose of this document and highlight that it won't ever be on the screen of a telecommunicator. This helps inform scripting and protocols; reminds folks of the guardrails set by statute; reminds folks of the vision statement. CESSA is not removing any options but providing training to expand options.
• Drew Hansen: My only comment from 911/EMS/fire/police is that we've been battling wrong information. The first paragraph says "an appropriate mental health response that does not include law enforcement." It should just end at "an appropriate mental health response." While we understand nuances of legislation, people may think calls involving crisis can never include law enforcement response.
• Brent Reynolds: I understand there were last minute changes to the preamble, but I feel rushed to provide feedback without the opportunity to soak it in and make sure wording doesn't put any of us at a disadvantage.
  • Lorrie Jones: We will not rush you and we will consider your thoughtful comments. But please note there are many requests for the document, so trying to balance the need to get it released with the need to collect thoughtful feedback from Subcommittee. But we will hold people off until we get the preamble done.
  • Brent Reynolds: I appreciate that, and I respect that folks want to see this document. On the same day it was approved, there was an unfortunate incident in Champaign-Urbana area that could have been much worse. Kind of went against where we were with the risk level matrix. It's given me some pause.
  • Lorrie Jones: Brent, can you brief people on the incident?
  • Brent Reynolds: I won't get into specifics because it wasn't my agency, but it was in public safety. There was a call to 911; fire department and ambulance services were dispatched. Nothing in the call led call-taker to believe there was any threat; law enforcement not dispatched. Multiple public safety/ambulance crew were stabbed but thankfully survived. Drew, do you have more details? A lot of call-takers are worried about not doing the right thing based on how the protocol is designed.
  • Drew Hansen: This has been on the forefront of our minds throughout the process. Those are two of our members - a fire lieutenant and firefighter that were critically stabbed during an incident. Not shocking to us, unfortunately. That's why we have historically advocated for the presence of law enforcement to accompany us. Dr. Jones has always been supportive of making sure scene is safe. It hits home and unfortunately, the violence faced by EMS and fire is nothing new, and something to always be cautious about.
  • Lorrie Jones: This was not a jurisdiction implementing CESSA; this was "business-as-usual" situation. We don't have details about the call or the telecommunicator's decision not to send law enforcement. We would like to hear the call and compare it to the IRLM to see if it would have made a difference. IRLM could have indicated that co-response is necessary, so IRLM could have been helpful in that situation.
  • Brent Reynolds: This call was concerning enough to me that I wanted to make a comment on it, especially as we read the matrix. When I read the paragraph that starts - "The PSAPs across Illinois will be required to assure that their protocols and dispatch software are fully aligned with the recommended decisional guidelines offered in the IRLM" - I don't agree with that. We are participating in EMD and will continue to participate in EMD because it's the rules and it's appropriate. I have had experience with the police protocols, and I'm not comfortable or ready to make my agency or other PSAP agencies use those protocols. This one paragraph causes me concern.
  • Lorrie Jones: When we wrote this, we thought this paragraph and this sentence reflected the law. Is your issue that it doesn't reflect the law? Or is your issue with the law?
  • Brent Reynolds: Having only seen this in the last 40 minutes, I can't tell you.
  • Lorrie Jones: Please take your time to review it, and we can send the updated statute for your reference.
  • Pete Dyer: I want to piggyback; we've done a lot of great work, and I think this will work out. I wanted to echo what Drew and Brent said. The IL Fire Chiefs, my constituents, are very concerned about any behavioral health call with fire responding without police. We need to look down the road, with 988 providers and MCRTs: what are we going to do when MCRTs need to have an individual seen by a hospital or behavioral health facility? We need to address who will do that transport. Would like to make a motion to table this preamble until Subcommittee members can independently review.
  • Lorrie Jones: No motion necessary. We will send preamble to folks.
  • Subcommittee members agreed to review the preamble and provide feedback by close of business Wednesday, September 24.
  • Lorrie Jones: Cindy and Alicia, I wanted you to weigh in on the Champaign incident if you choose to do so.
  • Alicia Atkinson: I spoke with their operations manager yesterday and it was obviously a terrible situation for not only the responders but the telecommunicators who handled the call. I want to highlight that we don't know what kind of risk assessment they did, what questions they asked, what policies they had in place ahead of CESSA implementation. We don't know what response our IRLM would have dictated. I have asked for the audio so we can learn from a quality improvement lens, what would have happened if CESSA was implemented. But right now, we don't know.
  • Cindy Barbera-Brelle: As part of that review, we'll want to know what their procedure was. They use Priority Dispatch, but we need to know their policy for sending EMS units, if law enforcement is responding automatically with all calls, or just certain calls. We will see what the policy was, whether it was followed, and what the protocols recommend. Those are the other pieces that we will be looking at.
• Reminder to provide feedback on the preamble by close of business Wednesday, September 24; acknowledging Champaign incident, the importance of protecting all stakeholder groups, and doing no harm
  • Brent Reynolds: I want to be clear, and I do not want to diminish the impact on firefighters and ambulance attendants by any means. But this isn't just about those firefighters. My concern has been that, in our approach to remove law enforcement from the process of assisting crises, we are also taking on a high risk of someone calls, and we respond to someone who says they need help, and something like this happens to a mental health expert. Then, we're back at square 1, where we have telecommunicators and folks in 988 sending people into situations where they can't assure safety. It's not just 911 looking out for police or fire; it's 911 looking out for whoever is responding.
  • Lorrie Jones: We have started to reach out to other jurisdictions, and the city of Chicago CARES line, to find out how many adverse incidents have actually occurred in the mental health response world, when mental health is responding to those incidents. We can see what data is available, and if that informs the picture. We want to understand better where there are risks, with the goal of making sure people experiencing a behavioral health crisis have the opportunity for an appropriate mental health response when there is no risk of health and safety. That's the law. There are over 150 response models around the country that are operating, collecting data, and sending mental health teams to calls. There are not many highly publicized incidents, but we are going to actually collect the data and see what is actually reported. Allie may have some information about the city of Chicago, but I believe there have been no adverse events, and they respond to higher acuity of calls than our IRLM allows.
  • Allie Lichterman: I came from the city of Chicago, working closely with the CARE team. They started in 2021 and first it was co-response only, then it was co-response and true alternative response, and now it's fully alternative response. They have been dispatched through 911 that whole time and no police use of force incidents nor harm to first responders. They also get training about calling for backup, which is an important part of the picture. How do we make sure our first responders are able to get additional safety support if needed very quickly? As Dr. Jones said, this is giving our telecommunicators additional training to get the right response, whether that's a community or law enforcement response. Make sure our MCRTs are going to lower acuity calls so law enforcement and EMS can handle high acuity calls that they should be going to. This is something to learn from and we are grateful that first responders are physically healing.
  • Drew Hansen: The name of the IRLM itself indicates that there will always be some level of risk. It's just something to keep at the forefront of our minds as we navigate IRLM decisions, training and implementation, and working with partners across the field. It's ingrained in our line of work, to have situational awareness. We don't have a good understanding of our cohorts that work in the mental health crisis response field, and what their experience is like out in the field. No matter what the situation is, there is always varying levels of inherent risk. I appreciate the group's attention to this.
  • Alicia Atkinson: Drew hit the nail on the head. In public safety, there's always risk. We don't know what we don't know. We have processes in place for debriefing and to turn things into learning opportunities. If and when we can listen to that call through a CESSA lens, and see what the IRLM would have done, then we can have a conversation. That's what we do in public safety, because things happen all the time. You learn from it and adapt.
  • Lorrie Jones: How much training do EMDs have on de-escalating and dealing with behavioral health crises? Is there a need to look at additional training for them?
  • Alicia Atkinson: Their training is going to depend on who their EMD provider is. The three protocol providers typically provide that training, and there are standards that IDPH puts in place, and they have to approve them. Would need to look more closely at approved topics.
  • Lorrie Jones: That might be something we want to consider providing. We currently provide de-escalation training to MCRTs and to the 988 counselors, and to a lesser extent to 911.
  • Allie Lichterman: I appreciate Drew's point, about the risk of first response, and that telecommunicators, fire, EMS, and police are all very familiar with each other, how you operate in the field, what level or risk you are prepared for, the situational awareness and the training that you get, That doesn't exist yet with crisis clinicians. I have spent a lot of time with crisis clinicians, and it helped me understand their situational awareness, what kind of calls they can go to, and that takes time. We need to have conversations about operational understanding - who goes first at a scene? It's also helpful to hear what folks want to know about crisis clinicians, and the future communications plan can capture what a crisis clinician does and how they can work with other first responders. However, we saw in Chicago, it took people working together and building trust on the ground. It takes a lot to learn and shift that.
  • Lorrie Jones: The state partners are getting together to see if there can be some information or response about this incident. Stay tuned for those discussions.
  • Allie Lichterman: Regarding implementation, we have talked about interactions between telecommunicators and MCRTs; how do you get people meeting face to face, building trust, and understanding each other? Will be important for rollout.

Next Meeting Dates (Cindy Barbera-Brelle)

• Meetings are held virtually 2:30-4:00 PM on the first and third Thursdays of each month starting in August 2025, unless otherwise noted.
  • Thursday, October 2
  • Thursday, October 16
  • Thursday, November 6

Public Comment

• Shelley Dallas: I appreciated this talk. When we talk about risk level matrix, want to share call from Lake County from September 15. I will share recording later, but I am in the process of redacting it. I have a strong concern regarding what happened. We had an 11-year-old girl call indicating she just needed someone to talk to. She said that she had gotten into an argument with her parents, and she was having suicidal thoughts. We are a pilot site, and our dispatcher went through Total Response questions, and dispatcher asked for appropriate permission to transfer to 988. 11-year-old girl indicated they tried to call 988 first, but they didn't answer. Dispatcher gained permission to transfer, and the automated 988 machine said, "please hold, someone will be with you shortly." There was loud on-hold music, so no chance for dispatcher to continue to communicate with the caller. If anyone can reach out to 988 about not having that when it's a 911 transfer from a PSAP, that would be great. We were on hold with the caller, for a surplus of 10 minutes, to no answer. At this time, the girl was upset. Not sure if she disconnected or if the line disconnected, but well over 10 minutes. Law enforcement did respond in this process. This just can't happen. We are trying to conform to the pilots and Total Response protocols, and we did, and we had someone on hold. This was just a low-acuity call, and we could have had law enforcement there in two minutes engaging with her. I raise a concern that if we reach out to more PSAPs and transfer volume increases, we need to look into why transfers are being put on hold or not answered.
  • Lorrie Jones: Quick question. Do you know if 911 filled out an incident form?
  • Mary Smith: 911 doesn't have an incident form, but we have tried to make clear that you can send an email to us and we will respond immediately. Shelley, if you can get that information to us, we will respond immediately.
  • Shelley Dallas: Will do, just need to redact some information from the call.
  • Lorrie Jones: Thanks Shelley, we can raise this on our regular calls with Centerstone.

Adjournment

• Brent Reynolds motioned to adjourn the meeting; Drew Hansen seconded the motion.
• Voted to adjourn: Brent Reynolds, Jessica Gimeno (as designee for Candace Coleman, Cindy Barbera-Brelle (as designee for Alicia Atkinson), Allie Lichterman (as designee for David Albert), Drew Hansen, Jim Hennessy, Justin Houcek, Pete Dyer, Rachel Ahart
• Motion passed. Cindy Barbera-Brelle adjourned the meeting at 3:52 pm.