Consumers Committee Minutes, April 19, 2022

CONSUMERS COMMITTEE

Tuesday, April 19, 2022, 2:00PM – 4:00PM

By Zoom Video Conference

Committee Members:

NYCDOHMH/NYSDOH:  Melanie Lawrence, David Klotz, Cristina Rodriguez-Hart, Kimbirly Mack, Claire Simon

Agenda Item #1: Welcome/Intros/Moment of Silence/Review of the Meeting Packet

Co-chairs Leo Ruiz and Charmaine Graham opened the meeting with a welcome and a kickoff icebreaker for the agenda item on inclusion in discussions. Committee members shared their styles of communication when resolving conflict. Styles shared included taking a break from the conversation, listening openly, trying to find compromise, be honest and self-effacing. The minutes were accepted – some members did not receive the minutes. A moment of silence was conducted.          

                                            Agenda Item #2: Public Comment

Public comment was moved to the end of the meeting to accommodate the presentation.

Agenda Item #3: Communication and Inclusivity with Dr. Rodriguez-Hart

Why inclusivity and communication?

To increase equitable participation among all consumers, improve feelings of belonging and foster buy-in for group decisions.

Key Highlights:

• Kindness is important in any type of communication. Improve feedback for Integrated Plan
• To Build and Inclusive Culture, Start with Inclusive Meeting (book)
• Customs: Structural behaviors can make people more comfortable, i.e., pre-meeting emails that prepare people to share
• Conduct: Adhere to ground rules to lift up people’s voices and ensure dominant voices don’t dominate. Ensure to actively bring all voices into the conversation.
• Commitment: leadership should explicitly define inclusivity and model the behavior.

Mr.  Francis asked whose job it is to ensure conduct, customs and commitment. Everyone needs to take accountability – not just the co-chairs.

• The group should determine who should and should not intervene when these issues arise.
• Psychological safety is the number one fact in an inclusive team.
• Micro-inclusions – subtle signals to others they are respected and valued
• Facilitators- keep meetings on track, invite those not speaking in
• Virtual accessibility – using accessible platforms and accommodations
• Data – reviewing the data on who is participating and who is not
• Diverse meeting agendas that utilize different technologies to bring voices into the conversation

Key Highlights from Crucial Conversations (book):

• In a discussion where the stakes are high, opinions vary and emotions run high. Human bodies go into fight or flight – blood leaves the high reasoning sections of our brains, lowering out capacity to engage.
• The most influential people are good at expressing risky or controversial opinions.
• In the best orgs everyone holds each other accountable.
• People who fail at crucial conversations have poorer health.
• Dialogue is critical to this process. Important to make it safe for everyone to share their opinions. As people are exposed to more accurate info, they make better choices.
• Important to start with yourself. Know what you want, stick with it, have the right motives. Pause and ask what you really want here – recognize that it’s not a physical threat, allowing blood to return to your brain.
• Dialogue killers – wanting to win, hurting the other person, becoming silent. Avoid thinking in either/or ways. Find the compromise within the choices. Remove the binary
• Watch for conditions – look for when the conversation becomes crucial, i.e. stomach gets tight, look for safety issues i.e., avoidance, understand your style under stress.
• How to restore safety –
  • establish a mutual purpose
  • ensurethat others perceive convo is working toward a common outcome.
  • Can ask – does the other person believe I care about their goals.
  • Ensure mutual respect. Conversations become unsafe without mutual respect.
• When things break down, an authentic apology can work. As can contrasting – make don’t & do statements, i.e., the last thing I wanted to do was disrespect your work [don’t], I think your work is spectacular [do]
• Different purposes – use C.R.I.B. Commit to staying in the conversation. Recognize the purpose behind the strategy. Invent a mutual purpose. Brainstorm new strategies
• Inclusivity requires safety

Discussion Hhighlights

• A lot of times people listen to respond and not to hear
• Avoid the sucker’s choice (Can you explain what this is?) – can instead empower people.

Sucker’s Choice:

• thinking in either/or ways, as if there are only 2 options (I can be honest or respectful vs. what if there is a way to be both honest and respectful?)
  • Suckers Choices are simplistic tradeoffs that keep us from thinking creatively
  • We remain stuck in ineffective strategies by justifying our attacking or retreating behaviors
  • Clarify what you want, don’t want, and ask how you can achieve both goals (the “and”)
• Words are very important, can empower or disempower.
• Treat everyone the same
• Sometimes the choice to say something is difficult because we have limited time, there are many opinions, some may tend to not speak up because the conversation may be combative. Can be hard to be kind when offended. Important to sit with things for a moment. We should all take on the leadership of holding ourselves accountable.
• Creating safety opens freedom in the conversation
• Sometimes pointing out how you are in agreement with others can transform the tone
• Affirming others can improve the conversation
• What about when alcohol or drugs are involved?
  • Leave the conversation on good terms/de-escalate until you can engage
• Have to be mindful of the unseen trauma people might be bringing into the conversation
• The issues are at the root  – hard to dig into to that
• Don’t discount people who are under the influence. Is the substance use harming the person? Interventions are about people being ready.
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Agenda Item #4: NY HIV Integrated Plan

Graham Harriman presented on the NY State Integrated Plan in partnership with Claire Simon. Second 5-year plan. This plan builds on the last plan. Idea is to develop new goals and objectives and address health inequities.

Integrated Plan Highlights:

• Allows for use of already developed plans, such as the EHE plan.
• The ETE Blueprint highlighted strategies and goals based on a 3 point plan under Governor Cuomo. In 2020, NYS held ETE listening sessions to inform the work. Focus on health disparities, health inequities (or health equity), trauma informed care and Covid-19.
• Currently gathering documents and information from across the state. Will hold community convenings in the near future. Timeline is moving toward a December deadline. Each step of the process is iterative.
• The EHE plan does not include Staten Island or Tri-County.
• The federal plan has 4 pillars: Diagnose, Treat, Prevent and Respond. NYC added cross cutting issues: health inequities and the HIV service delivery system.
• The list of priority populations was incorrect (included duplications) and will be corrected for future viewing.
• The EHE Plan includes 9 key activities that focus on improving service delivery, such as bias free, accessible services, enhanced sexual health services in the NYC clinics, increased peer worker opportunities. Some of these activities are underway.
•  

Testimony Highlights

• At La Nueva, clients that walk in with a peer or a provider, get service immediately. Clients who walk in alone, are often ignored mistreated. This happens across the system – people without any advocacy have a lower chance of success, even if it is a friend or family member.
• People of trans experience don’t have easy access to services. People who are stigmatized are less likely to have a successful outcome when accessing services. Maybe stigma should be a measure – groups who experience the highest levels of stigma, i.e., foreigner, have an accent, etc., people experiencing or at risk for IPV, people who are aging, patients new to health care provider, people with high ACEs scores, same gender loving women who are bisexual.

Highlights -HIV service delivery:

• There are many services, but they are not adequate or delivered in a professional manner. Housing is available, but people don’t know how to deal with HASA.
• Better education and navigation for services. Increased empowerment to navigate services.
• High number of case managers per client to coordinate different services is a barrier to care.
• Peer led advocacy can address these issues.
• Improved access to interpretation – often insufficient for clients’ needs.
• A lot of advocates used to accompany clients to access services – helped educate clients.
• Health homes, some are especially helpful, and take care a lot of needs. Some health homes are not as effective at navigating HIV care.
• Each agency has a different case manager for you – unless you know who to call for help, can be lost.
  • Need coordination of case management, especially for new case managers. They are not pro-active either – must seek them out.

From the polls:

• HIV doesn’t operate in a bubble – need for comprehensive care
• A comprehensive approach to health must include all the issues that may influence people to remain in treatment and avoid treatment failure
• Better coordination needed between governmental systems that are stakeholders;
• Need for improvement. Learn from the systems that are working.
• Housing is the pillar to healthcare

From David Martin – Recommended Inclusions to Integrated Plan:

·         Priority Populations

• Persons perinatally exposed to HIV
  • Persons Aging at-risk for HIV
  • PWHA seeking treatment from New Providers (prioritize and assess urgency when referred)
  • PWHA with Comorbidities
  • PWHA with inaccessibility to MH Services (add to: Serious Mental Illness)
  • PWHA with high ratio of Adverse Childhood Experiences (ACEs)
  • PWHA experienced with or at-risk for Domestic Violence (add to: Intimate Partner Violence)
  • Women Who Have Sex with Women (WSW) who Identify as Bisexual

·         HIV Delivery Systems

• Baseline Assessment of Adverse Childhood Experiences (ACEs) for PWHA
  • Communication Barriers in Healthcare (Limitations due to excessive phone prompts and no options to access to live person)
  • Integrate Lived Experience of HIV Diagnosed Population in Quality Management and Decision-making for All City, State and Federal Funded Entities
  • Men’s Focused Health Programs & Awareness addressing Specific Needs and Concerns
  • Need to Increase Availability of Providers that Culturally Align with the percentage of Patient Population of Community Served especially in Mental Health and Primary Care
  • Oral Healthcare has minimal provisions that address needs. More focus on accountability and the limitations in dental care, as it is a serious health need and critical to good health. (Excessive tooth loss/extractions, inaccessibility to major dental procedures, i.e., tooth implants, etc., and time limits on dental services.)

·         Social & Structural Determinants

• All Insurance Carrier’s Authorized Provider Rosters should receive regulatory assessments for inequalities with DEI lens to find discrimination, bias practices, and inequities in reimbursement rates, etc. that limit and create barriers to accessing providers that culturally align the population needing services.
  • Appointment Duration Too Short to Meet Need for Quality Care
  • Communication Strategies to Rebuild Trust and Perceptions of Healthcare System
  • Congregant Housing (Shared-Living Communities) – An outlier where PWHA experience often-ignored inequities by residential and case management
  • Defined Policy for Provider-initiated Appointment Cancellations (Onus should be on Provider to follow-up and initiate rescheduling appointments)
  • Intra & Inter Agency/Facility Access to Patient’s Data to Reduce Data Burden
  • New Patient Barriers seen in Accessing Providers
  • Provider Referral Patient’s Insurance Coordination
  • Provider Referrals Tracking & Follow-Up

Agenda Item #5: Lapel Pin Update

There is a small subcommittee for the lapel pins, which will meet every other Friday of the month. Please let Charmaine or Melanie or Leo know if you would like to join the subcommittee

Agenda Item #6: New Business/Public Comment

The Consumer Committee will host the Planning Council’s picnic on July 19^th. Feel free to join in on the planning. Looking for somewhere that is accessible and near transportation.

Billy Fields, Chair of Rules and Membership, invited everyone to apply to be on the Council, and to share the application widely. The application is on the nyhiv.org website (scroll to the bottom of the page for the link)