CESSA Protocols and Standards Subcommittee Meeting - Approved Minutes 08/14/2025

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 2:31 pm (via Zoom)
Cindy Barbera-Brelle reviewed OMA Official Notices
Cindy Barbera-Brelle reviewed the agenda

Roll Call (Cindy Barbera-Brelle)

Members present: Brian Kieninger (designee for Bobby Van Bebber), Jessica Gimeno (designee for Candace Coleman), Cindy Barbera-Brelle (designee for Alicia Atkinson), Allie Lichterman (designee for David Albert), James Hennessy, Pete Dyer, Rachael Ahart, Blanca Campos (joined at 2:45 pm), Brent Reynolds (joined after roll call)
Members absent: Brent Reynolds, Drew Hansen, Justin Houcek
Quorum is present

Approval of Previous Meeting Minutes (Cindy Barbera-Brelle)

Approval of minutes from August 7, 2025
- James Hennessy made a motion to approve the minutes; Jessica Gimeno seconded the motion
- Members who voted to approve: Jessica Gimeno (designee for Candace Coleman), Cindy Barbera-Brelle (designee for Alicia Atkinson), Brian Kieninger (designee for Bobby Van Bebber), Allie Lichterman (designee for David Albert), James Hennessy, Pete Dyer, Rachael Ahart, Brent Reynolds
- Members not present for the motion: Blanca Campos
- Quroum voted to approve August 7, 2025, minutes

State Updates (Allie Lichterman)

No major updates since last week

Pilot Updates (Cindy Barbera-Brelle)

Total Response and Priority Dispatch
- Evaluation in process
- Weekly and Bi-Weekly Meetings continue
APCO
- Continued planning for pilot

Preliminary Pilot Findings and Illinois Risk Level Matrix Updates (Dr. Mary Smith)

Illinois Risk Level Matrix (IRLM): Revised Timeline for Discussion, Feedback and Action
- Overview of IRLM Update Process - August 7, 2025
- Distribution of Updated IRLM to PSTSC - August 13, 2025
- Review of Updated IRLM - August 14, 2025
- IRLM and CESSA Implementation Timeline
- Discussion and Initial Feedback
- IRLM Continued Discussion/Feedback - August 21, 2025
- Discussion and Possible Vote on Updated Risk Level Matrix - August 28, 2025
Why Do We Need to Update and Finalize the IRLM ASAP?
- CESSA legislation states the following: No later than June 30, 2027, implementation of revied protocols by all remaining PSAPs, including any PSAPs that previously cited financial barriers to updating systems that CESSA must be fully implemented by June 30, 2027.
- The following tasks are necessary to meet this timeline:
To meet the CESSA implementation timeline, a minimum of 21 new CESSA implementations must occur every quarter through June 30, 2027.
Changes to the IRLM that impact protocol scripts must be updated in Vendors software as applicable.
Cultural issues with regard to referral of calls for a behavioral health response must be addressed.
CESSA implementation must be expanded to incorporate additional levels of the risk matrix. Heretofore, the focus has only been on level 1 (low risk factors).
All participants in CESSA implementation must complete required training.
Operational issues must be addressed to ensure that appropriate procedures are in place to support CESSA implementation.
CESSA Pilot Preliminary findings - Limitations and Cautions
- Dispatch of third-Party calls for other than LE Response is atypical; thus some calls that may have met the criteria for transfer to 988/MCRT may not have been transferred
- Cold Transfers impeded the collection of some transfer data resulting in missing data
- Callers referred to as familiar callers account for many of the calls transferred from 911 to 988
- Non-standardization in the use protocols resulted in missing data. Calls transferred to 988 do not appear in PSAP reports when protocols are not used.
- Some calls were initially referred to 988 regular call line instead of dedicated 988 call line
- Confusion re: transfer of call types
- Some sites were delayed in implementing the pilot due to operational issues resulting in lesser ability to engage in the pilot process (data collection and reporting impact)
- Very few transfers of calls from 988 to MCRT occurred - The majority of calls transferred from 911 to 988 were resolved by 988 crisis counselors. This may be remedied when additional risk levels are incorporated into CESSA implementation
- There is some reluctance to transfer calls to 988. This may be because of uncertainty about how 988 handles calls, historical patterns of handling calls, concern about the safety of MCRTs responding on-site to some crisis callers
- Refusals by callers to 911 to be transferred to 988. A recent Survey Conducted by NAMI found that 74% of those surveyed (public) are aware of 988, but only 28% are familiar with 988
- Due to lack of familiarity, PSAP concern about safety of MCRTs may have resulted in fewer referrals
- Unable to determine if some calls that could have been referred to 988 or MCRT were not referred
- Medical facilities are contacting 911 regarding BH crises; referral to 988 unclear
- It will take time to see an uptick in the volume of calls transferred from 911 to 988
General Perspective on the Pilots: It's a Win!
- The Pilots are doing what we want them to do. We are seeing transfers from 911 to 988
- The structural changes in the Pilots have become a template for replicable changes that we can build on and improve in other PSAP implementations
- The training that has been developed provides the necessary support for continuing CESSA implementation
- Low risk calls can be addressed by 988 crisis counselors; higher risk calls can be addressed by MCRT
- There are 174 PSAPs and 3500 telecommunicators who need to be trained
Preliminary Findings: Total Response Pilot
- Data Collection Timeframe: January 30th through June 30th 2025*
*The kickoff for the Pilot was held January 29th. All sites were up and running by the end of February, 2025
- Pilot sites
Christian/Shelby Counties
Cicero CERCC 9-1-1
Coles-Moultrie ETSB
Elgin ETSB
Lee County ETSB
Lyons Township Area Communications Center JETSB
Marion County - Salem PD
Ogle County ETSB
Rochelle PD
- Geographic Setting:
Urban: 2
Suburban: 1
Rural: 7
- Number of Telecommunicators: 164; Ranged from 10 to 27 (PT and FTE)
- Call Volume: 1,402 calls to 19,534
- Pilot Agencies Call Volume - FY 2024
Total No. of Calls (Wire, Wireless & VOIP): 262,831
Total No. Administrative Calls: 483,024
- Finding: 705 calls were identified as having a mental/behavioral health component
548 (78%) dispatched to customary responder; 132 (19%) successful transfer to Centerstone; 25 (3%) attempted transfer to Centerstone
- Finding: Call types (N=705)
Psychiatric/behavior: 17 (2%)
Suicidal ideation/attempt: 87 (12%)
Law enforcement calls with MH component: 132 (19%)
Welfare check: 6 (1%)
Missing data: 146 (21%)
Mental health: 219 (31%)
- Finding: Outcome of call transfers to Centerstone 988
86% of Calls were resolved by 988 crisis counselors
Preliminary Pilot Findings - Priority Dispatch Pilot
- Timeline for Evaluation: April 1, 2025 to June 30, 2025*
*The kickoff for the pilot was held April 1, 2025; 3 sites began April 1st; The remainder were phased in at various times in May; One site came on board in July due to operational issues.
- 9 Pilot sites
Bloomington (McLean)
IL Regional Valley Dispatch
Joint Central Lake County ETSB (Mundelein)
Northwest Central Dispatch
Richland County ETSB
Sangamon County ETSB
St. Clair County ETSB
West Central JETSB
Winnebago County E9-1-1
- Geographic Setting:
Urban: 4
Suburban: 1
Rural: 4
- Number of Telecommunicators :164
Ranged from 15 to 71 per PSAP (Part-time and full-time)
- Call Volume: 1,078 calls to 33,387**
**Data reported for 4 pilots; Still collecting Data
- Pilot Agencies Call Volume - FY 2024
Total No. of Calls (Wire, Wireless & VOIP): 813,133
Total No. Administrative Calls: 1,300,630
- Finding: 544 calls were identified as having a mental/behavioral health component (between April 1-June 30)
522 (96%) dispatched to customary responder; 18 (3%) successful transfer to Centerstone; 4 (1%) attempted transfer to Centerstone
Note: The start of several pilots were delayed due to IT issues, reporting and staff training
- Finding: Outcome of calls transferred to Centerstone
Caller hung up: 1 (5%)
Referred to 911: 3 (17%)
Call taker initiated transfer to MCRT: 4 (22%)
Resolve by Centerstone call taker: 10 (56%)
- Call suffix for determinant code
The Priority Dispatch protocols are different. We were not able to modify the protocols but the experts we worked with were able to map the determinant codes to response type, which means taking each code and indicating what the response type could be based on what's available in their jurisdiction.
The suffix number gives you additional detail about mental health calls
Preliminary Observations Pertaining to the IRLM
- Provide more guidance re: identifying behavioral health calls that are eligible for transfer to 988
- More specificity regarding defining/determining unusual behavior
- Guidance for determining the difference between highly intoxicated and moderate intoxication
- Guidance for transfer of third-party calls; reluctance to transfer calls when not all information is available
- Distinguishing between lethal and non-lethal weapons; Difference between intent to secure non-lethal weapons for use vs non-lethal weapons that are available, but with no plan to secure or use them
- Guidance for responding to well-being checks
- Some calls answered using law enforcement protocols could be transferred to 988 and/or MCRT, but software programming prevents this from occurring due to the programmed response type
Discussion
- Jessica Gimeno: The data from Total Response showed that 705 calls identified with having a mental/behavioral health component. What was the total number of calls?
Mary Smith: We want to be able to tell you that, but we are in the midst of collecting that. It will be in the evaluation report
Jessica Gimeno: Could you elaborate on the 1,402 listed on the slide?
Mary Smith: If you look at the PSAPs, there are differences in how many calls PSAPs receive. Some are small. Some are larger. The size of the operation determines the number of calls received.
Jessica Gimeno: So is that saying the smallest PSAP got 1,402 calls and the largest PSAP got 19,534?
Mary Smith: That's likely how I would interpret that, but we need to confirm the breakdown when we give you the final report.
Allie Lichterman: So, that's total calls into the PSAP? Not just behavioral health calls?
Cindy Barbera-Brelle: Yes, that's total calls, and including mental health.
- Jim Hennessy: When you say there were about 700 behavioral health calls, how are they flagged to be considered that?
Mary Smith: Some of the work we did with Total Response was to flag calls in reports, so we know they were behavioral health even if they didn't refer to 988. Sometimes there was a suspicious incident protocol with a mental health component, so they could bridge over to mental health to show it also had a mental health component. Then there were other calls that were flagged as mental health that did not meet the low-risk criteria so they couldn't be transferred, or they asked to not be transferred to 988.
Jim Hennessy: I was curious, if you're in the suspicious person protocol, and then you bridge over to mental health, that would be the flag for the behavioral health call? Not just the fact that it was a suspicious person?
Mary Smith: Yes, I can't actually remember if suspicious person was level 1, but what you described was true: if it's a suspicious person, it does have the mental health question so it would be flagged as a mental health call. Just because it's flagged as mental health call does not mean it was appropriate for transfer to 988.
- Pete Dyer: On the Priority Dispatch slide, looks like there were 9 test pilots and several started late. Do we know how many have actually been running the pilots who started late and is there a timeframe for expected data? Are you guys forecasting any changes or are we charting the same across all three PSAPs even with the delay? Could this potential delay impact the IRLM down the road?
- Mary Smith: We know who started in April (3 sites) and who started in May. There is one site that wasn't able to initiate the pilot until July due to operational changes and staff training, so we won't include that data in the pilot data. One of the things we committed to was completing the pilots by June 30 so we are only using the data that we have by June 30. I do not anticipate it will change the outcomes. The plan is to continue looking at and collecting data. We won't stop just because the pilot is over.

Interim Risk Level Matrix Updates (Dr. Lorrie Rickman Jones)

Approach to Amending the Illinois Risk Level Matrix (IRLM)
- Reviewed other risk level matrices nationally
- Reviewed previous commentary on the IRLM
- Reviewed information garnered from the pilot
- Created an 'internally consistent' document (all factors addressed across all levels)
Summary of Improvements: Updated Factors
- Current Factors > Proposed New Factors
  - History > Violence (formerly aggression)
  - Intoxication > Criminal Activity (new category)
  - Aggression > Mental State and History (merged psychosis and history)
  - Unknown Status > Intoxication
  - Psychosis > Unknown current status/well-being check
Additional Significant Changes
- Defined co-responder models (non-law enforcement, law-enforcement)
- Introduced diversion into language on Criminal activity
- Changed response times to expand use of 'up to 60 minutes response times'
- Defined when MCRT should respond to Unknown status/well-being check
- Removed use of 'psychosis' term and replaced it with symptom description
- Removed verbal aggression in Level 4 and moved to Level 3
- Offered examples of non-lethal weapons
- Classified domestic violence calls as requiring law enforcement response
A draft version of Detailed Interim Risk Level Matrix was presented by Dr. Lorrie Rickman Jones and Dr. Mary Smith.
- Risk level 4: Emergent Risk
  - This level is high risk, so the response is law enforcement and/or law enforcement and EMS immediate response, or co-response if immediately available.
  - "Verbal aggression" moved to Level 3
- Language about Risk Levels 2, 3, and 4 hasn't changed much; if the telecommunicator detects a safety issue after initial assessment, they can override the initial thought to transfer to 988 for behavioral health response
- Provides Co-Response Model Definitions for "Non-Law Enforcement" and "Law Enforcement Co-Response Models"
- Risk level 3: urgent risk
  - There weren't many changes to this level other than the new risk types (including violence)
  - The response type is co-response if available and immediate, otherwise law enforcement
- Risk level 2: Moderate risk
  - Level 2 is where we are really pushing MCRT so we hope this drives more mental health calls to MCRT
  - There is still need for rapid, if not immediate response, in many of these cases. We want to support communities to develop other kinds of non-law enforcement models they can respond immediately. One model we've seen nationally is clinicians embedded in fire departments, which respond immediately. Thats's not how our system is designed using state-funded mobile crisis response teams, and the SAMHSA model gives an hour and a half which we've shortened. Those are not immediate, but we envision a system in the future where more of these types of responses are developed.
  - 988 and MCRT as response
  - Further differentiating self-injurious behavior
  - Regarding intoxication levels, Hub is having a dedicated call with substance use disorder colleagues at the Department of Behavioral Health on Monday so the language may be further clarified.
- Risk level 1: Low risk
  - No significant changes; new category for Criminal Activity
  - All 988 and MCRT responses as appropriate
Discussion
- Brent Reynolds: Is there a chance you will send this out to the committee?
  - Lorrie: We sent this yesterday.
- Allie Lichterman: Can you go back to the summary slide that lists the differences? It will be helpful for our discussion.
- Blanca Campos: When are these changes taking effect? Regarding co-responders, in terms of workflow, is 911 dispatching or will 988 have access?
  - Lorrie Jones: The IRLM informs 911 dispatch decisions. PSAPs work in tandem with local law enforcement. If their law enforcement agency has a co-response, that's what the PSAP can deploy. Not all communities have co-responder models. We did a survey which we are updating to ask PSAPs if their LE agencies have co-responder models and what type it is. If the LE has a co-responder, that's what the PSAP will deploy. Once this subcommittee votes to approve these changes, we will take them to the vendors and negotiate with them to add the changes to their systems, hopefully in September.
  - Allie Lichterman: Blanca, the goal is to roll out to new PSAPs starting in October because we need to roll out to 21 a quarter to get 175 done by 2027.
- Jim Hennessy: The issue I see is criminal activity. I thought the statute said law enforcement was not supposed to respond unless there was violation of criminal law. If there is a crime, LE is allowed to respond. So why in the IRLM are we putting MCRT response for non-aggressive crimes, when the legislation says we can send law enforcement to these things? The statute determines when law enforcement can't go. They can't go to mental health crisis when there is no threat of injury or unless they are involved in a suspected violation of the criminal laws of the state. So, for trespassing, law enforcement has the ability to go.
  - Lorrie Jones: You may be right, we may need to change that but also we will make a note to see exact language.
  - Jim Hennessy: The statue only says when they can't respond. This is saying 988 or MCRT, but regions could decide they want law enforcement to go to criminal trespass calls and that wouldn't be against the spirit of the legislation. My stakeholders are going to want law enforcement to respond if someone is trespassing.
  - Jodie Bargeron: CESSA also has language about diversion. It seems like trespass with mental health would be trying to divert.
  - Lorrie Jones: We have to balance the diversion requirement in the law with the law enforcement involvement that may or may not be exercised.
  - Mary: We will go back and look at this. Where appropriate, we do want a behavioral health response. That doesn't mean law enforcement can't go, but other factors fold into that.
- Allie Lichterman requested for people to provide comments in writing.

Next Meeting Dates

Meetings are held virtually 2:30-4:00 PM on the first and third Thursdays of each month starting in August, unless otherwise noted.
- August 21, 2025, 2:30 - 4:00 pm, via Zoom
- August 28, 2025, 2:30 - 4:00 pm, via Zoom
- September 04, 2025, 2:30 - 4:00 pm, via Zoom
Note: There may be requests to schedule additional meetings over the summer as discussed at the last State Advisory Council Meeting

Public Comment

Justyna Czerny [chat]: When we say medically cleared, does this mean they are in an emergency room?
- Lorrie Jones: We will respond next week to public comments.
Alyssa Marrero [chat]: I'm looking for some clarification on the sections that identify MCRT as an option for co response. Would 911 be dispatching MCRT with police in those situations? Or only if they already have an existing relationship?
- Cindy Barbera-Brelle: Will respond next week.
Jim Poole: I am a Senior Director of Policy for NAMI Chicago. We're proud to serve as a 988 call center for Cook County, and we have been supporting people living with a mental health condition and their families since 1979. Whenever we engage in conversations about risk assessment, it's important to establish some shared agreements, that we will use the least restrictive intervention when responding to people who need help. This value is central and really needs to be clearly stated within the risk matrix. We also think it's important to recognize that people without a mental illness can experience a mental health crisis, and those risk factors must be included in these matrices. As currently written, the matrix seems to use mental illness as an indicator of risk. I know that the original version named psychosis instead of serious mental illness, and this has been adjusted to be more inclusive than that single symptom. However, the matrix still falls short of evidence-based practice and risk assessment. It does not consider the context of a situation or speak to other factors that may impact the risk of any given situation, like whether or not a person is alone. In some cases, the matrix seems to use symptoms of a mental health condition or intoxication as the sole reason for indicating higher levels of risk. While that can be true in certain cases, it is generally not true that people with mental illness are riskier or more prone to violence. Basing a risk determination solely on the fact that someone is living with a mental health condition or using substances is stigmatizing and risks leading to more unnecessary, overly restrictive, and harmful interventions. Further, the content of the detail matrix includes pejorative or subjective terms like belligerence, hysterical, and implied aggression. These terms should be replaced with neutral and descriptive language to reduce bias and improve consistency. Lastly, I just want to say that we're generally concerned that we are putting the 988 continuum itself over to the side, and making it sort of a secondary responder. We think that it must be possible for 911 to dispatch mobile crisis itself. It shouldn't have to go to 988 to do that. We also need to think about when 911 will transfer to 988. In levels 2 and 3, there are opportunities for de-escalation that we're never going to get if we can't get the calls over to 988. Generally, we would just ask that there is a greater role for transfers or conferences from 911 to 988 in levels 2 and 3, that would do more direct dispatch, and really building this integration in, even as we're still building the behavioral health side of the system, will help us realize the successful implementation of CESSA. Thank you.
- Cindy Barbera-Brelle: Thank you Jim. Putting that in writing would be helpful if you could do that for us, then we have the clear content of the information you provided us today.
Matt Fishback: From my read of the statute, non-violent misdemeanors are supposed to prioritize healthcare, so you have the MCR response before doing the police objectives. I don't know if that's inaccurate. But going through the data, it looked like most of the calls that were transferred to 988 were in the missing data/undefined category, and I'm wondering if it just didn't have any call code associated with it. And how those calls were transferred to begin with, I'm curious.
Heather Butler [chat]: Are the pilot preliminary findings/data slides that were presented available for RAC chairs to review as well?

Adjournment

Pete Dyer made a motion to adjourn the meeting; Jim Hennessy seconded the motion.
Voted to adjourn: Blanca Campos, Brent Reynolds, Cindy Barbera-Brelle, Allie Lichterman, James Hennessy, Pete Dyer, and Rachael Ahart
Motion passed. Cindy Barbera-Brelle adjourned the meeting at 3:58 pm.