Executive Committee Meeting Minutes July 22&27, 2021

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EXECUTIVE COMMITTEE

Monday, June 22 & 27, 2021,

By Zoom Videoconference

M I N U T E S

Members Present: Graham Harriman (Governmental Co-chair), Dorella Walters (Community Co-chair), Paul Carr (Finance Officer), Saqib Altaf, Lisa Best, Randall Bruce, Maria Diaz, Billy Fields, Ronnie Fortunato, Marya Gilborn, Amanda Lugg, David Martin, Jeff Natt, Guadalupe Dominguez Plummer, Donald Powell, Claire Simon, Marcy Thompson

Members Absent: Joan Edwards

Other Council Members Present: Charmaine Graham


Staff Present: NYC DOHMH: David Klotz, Melanie Lawrence, Cristina Rodriguez-Hart, PhD, Ashley Azor, Jose Colon-Berdecia, Karen Miller; Public Health Solutions: Barbara Silver, Andrea Feduzi, Rosemarie Santos; HRSA: Sera Morgan; J. Corbisiero (Parliamentarian)

Agenda Item #1: Welcome/Introductions/Minutes/Public Comment

Ms. Walters and Mr. Harriman opened the meeting followed by a roll call and a moment of silence.  The minutes from the June 17, 2021 meeting were approved with no changes.  

Agenda Item #2: FY 2022 Application Spending Plan

Ms. Gilborn presented the FY 2022 Application Spending Plans approved by the Priority Setting & Resource Allocation Committee on July 12th.  The EMA must submit separate Base and MAI spending plans in the annual grant application (Base includes Tri-County’s allocation).  HRSA allows EMAs to request up to 5% over the current year’s Base award (max. $95,184,657 for 2022).  The application spending request is a wish list and must be justifiable on the grant application narrative.  In the fall and winter, PSRA plans for a likely reduction in the actual award. 

For the Tri-County portion of the spending request (all Base funds), the plan calls for making the one-time carryover enhancement to Emergency Financial Assistance ($500,000) a permanent part of that category’s allocation.  The enhancement will serve all eligible EMA residents, but program is housed at a TC agency, and so it appears in the TC spending plan.  The PSRA also approved the Tri-County Steering Committee’s plan for a 5% across-the-board proportional increase to all categories, based on ranking scores.

The MAI award is completely driven by a HRSA formula based on the number of non-white PWH living in EMA relative to other EMAs.  As in past years, PSRA requests level funding for FY 2022 ($8,235,205) in four categories (ADAP, Housing, MCM, EIS). 

For the FY 2022 NYC Base Spending Plan, PSRA recommends two targeted increases: 1) an annualized allocation for Psychosocial Support for TINBNC PWH (targeted increase of $493,500) for programs starting on Sept. 1, 2021; 2) Six months of funding for the new service category of Oral Health Services ($250,000) for programs starting on Sept. 1, 2022.  Finally, the balance of the increase is allocated through a 5% across-the-board proportional increase to all categories, based on ranking scores.  PSRA used the Priority Ranking Tool to rank two new service categories from the HIV & Aging directive, using four criteria (payer of last resort, access to/maintenance in care, consumer priority, specific gaps/needs) to assign the categories a rank (Outpatient Medical Care/core: #6; Referrals to Health and Support Services/non-core: #5).  They will be described in the grant application narrative, but the allocation will begin in FY 2023 (amount TBD based on cost analysis).

In response to a question, Mr. Harriman explained the intent of increasing the baseline allocation of EFA is that the carryover enhancement runs out and it would not serve clients if the funding suddenly disappears on March 1, 2022.  If the EFA allocation proves to be insufficient to cover demand over the course of the year, the Council has several options for increasing the allocation (reprogramming and carryover plans).  The PSRA and Council will also be examining possible shifts in the baseline allocations of categories as it continues the review of the portfolio for the scenario planning process for the actual award.

Ms. Gilborn, on behalf of the PSRA Committee, moved to approve the FY 2022 Base, MAI and Tri-County Application Spending Plans as presented.  The motion was adopted 15Y-0N

Agenda Item #3: Service Directive: Aging & HIV

Mr. Bruce and Ms. Best introduced the new Aging & HIV service directive, noting that this was the first time that the Consumers Committee has undertaken the task of developing a service directive.  The need to address aging with HIV has long been a high priority for consumers.  The Committee underwent a seven-month development process for the Directive.  They received presentations from a number of subject matter experts (Jules Levin on the state of HIV and Aging research, Moises Agosto-Rosario on Health inequities for Aging PWH, Dr. Anjali Sharma on issues for Women with HIV, and Dr. Eugenia Seigler on considerations for the Healthcare system.  The Committee conducted an HIV and Aging Community Forum on June 4 where community members provided feedback and edits on the Directive.  The Directive seeks to address gaps in a service system that needs to transform to meet the changing needs of Aging PWH.  The Directive includes Outpatient Medical Care, Referral for Healthcare and Supportive Services, leveraging existing services to include prevention and wellness activities to support aging PWH, and additional training resources for funded provided to support them to acquire new expertise in addressing the needs of this population.

The Consumers Committee is proud to present this work, the first Directive in the new format using a logic model based on the Consolidated Framework for Implementation Research (CFIR).  The Directive includes two additions from the version sent to the Executive Committee concerning the need to specify assistance from benefits navigators and language that sets an expectation that the grantee will report back to the Council on the outcomes in the Directive on an annual basis.  The Committee believes that this will be a national model for addressing the needs of aging PWH.

Dr. Rodriguez-Hart described the Implementation Science Logic Model used for this directive.  Evidence-based practices (EBPs) are the convergence of the best scientific evidence with clinical experience and patient values, but EBPs are often not used in the real world.  Implementation Science (IS) is the study of methods to promote the uptake or integration of research findings into healthcare practice.  Traditional HIV research is usually focused on health outcomes at the level of the patient or individual coming in for services, like HIV status, timely linkage to care, and viral load.  In contrast, IS focuses on strategies that target health systems and providers so that we can get the best evidence to the patient or community.  The field of implementation science, which focuses on studying how we can get interventions we know to work adopted, used, and sustained over time.  The IS Logic Model was described, showing Determinants (What can influence effective implementation of your intervention), Implementation Strategies (How will you get systems, programs, and/or staff to use the intervention?) Mechanisms (Why do the strategies you picked create your implementation outcomes?), Interventions and Outcomes (What changes will happen in your setting that will tell you if implementation of a new intervention occurred?).  

Mr. Harriman presented the new Aging & HIV service directive approved by the Consumers Committee.  PWH over 50 represent a majority of the total PWH population (59% of PWH in NYC in 2019) and yet their intersectional needs are often unaddressed by HIV service organizations.  PWH over 50 have achieved the highest proportions of sustained viral suppression of any age group and yet care for their comorbid health conditions remains suboptimal and they have shorter life expectancies than those not living with HIV with two thirds of deaths among PWH due to non-HIV-related causes.  Much data shows the need for improved resources for PWH over 50, including services to address social isolation, coordination between programs, benefits navigation, services offered in Spanish, and to address medical conditions of women with HIV over 50.  The services included in the Outpatient Medical Care (OMC) component include: 1) Increase capacity to treat the complex needs of PWH over 50 mirroring  aspects of the Golden Compass model  through use of clinical staff(MD, RN, Pharmacist, Medical Assistant) to address comorbidities and to provide health education; 2) Geriatric, Psychiatric, and Cardiology consultation, and referrals to ongoing specialty care; 3) Resources provided by RWPA to address gaps in current care provided at clinical sites; and 4) support improved self-advocacy/ self-management so that PWH over 50 can talk to their medical providers about broader health concerns.

The services in the Referrals component are: 1) Increase the knowledge of resources available to support PWH over 50 among RWPA funded providers; 2) Improve referral tracking to ensure PWH over 50 are engaged in needed services; 3) Adapt referral practices from the ARTAS model (i.e. the development of referral partnerships),  communication/outreach/education, navigation and transportation if neededThe programs will strengthen PWH networksand fund organizations that provide social support services for older people living with HIV, fund social support for exercise (e.g., set up buddy systems, making contracts with others to complete specified levels of physical activity, orset up walking groupsand other groups to facilitate  friendship and support), fund navigation,  structured health education and practical and emotional peer support services  to increase engagement in care and promote self-care; and identify how toleverage technology for social support and overcome barriers that older people living with HIV face.  There will also be funds for provider training to ensure that they are able to effectively support PWH over 50 through increased ability toidentify comorbidities, and link PWH over 50 to needed resources.

A summary of the discussion on the Aging and HIV Service Directive follows:

  • The layout of the directive makes it difficult to map to the logic model, including seeing how determinants map to outcomes. 
  • The fact that the directive is complex and text-heavy means it can’t fit neatly into the horizontal flow chart format of the logic model.  Recommendations for making it more readable are welcome.
  • There are several further edits that are needed to refine the document, which can be done at this meeting, but might take too long to wordsmith now.
  • Case managers and other front-line workers need training on aging and HIV issues to ensure effective delivery of services.  Even billing and administrative staff need training to improve services (e.g., dealing with insurance companies).
  • Behavioral Health encompasses both mental health and substance use, as both are often intertwined.  The directive also seeks to improve general mental well-being beyond clinical mental health issues.
  • The recommendation for 12 months of exercise in the directive is too specific and should be edited to refer to general increase in exercise.
  • The referral map can use existing resources (e.g., NYC Unite) to prevent duplication of effort.

Ms. Corbisiero, responding to a request for clarification, explained that if the Committee votes to approve the Directive, they are voting to approve its entire contents as written.

Mr. Klotz recommended that the Committee approve the concept of the service model described in the directive so that this groundbreaking work can be highlighted in the three-year grant application.  Further refinements of the language can be done by the Consumers Committee over the summer for final approval by the Executive Committee and Council in October.

Ms. Best, on behalf of the Consumers Committee, moved to approve the concept of a service model to address Aging and HIV, with the final directive to be presented to the Executive Committee and Council in October after additional review by the Consumers Committee.  The motion was adopted 17Y-0N

Agenda Item #4: Assessment of the Administrative Mechanism

Mr. Carr explained that the Ryan White legislation requires that the Council assess whether the Grantee used Part A funds as determined by the Council’s priorities and allocations.  The Council also evaluates how quickly and efficiently the Grantee contracts with service providers and how long they take to pay them. Using fiscal reports and the quarterly spending reports that the Council receives, the Executive Committee assesses the Grantee on four measures: 1) How quickly funding has been committed and contracts executed. 2) How well the Grantee did in timely procurement (this measure is moot for this assessment as there were no RFPs in 2020); 3) Were sub-contractors paid in a timely manner; and 4) How well did the Grantee do in spending the grant over the course of the year. 

In most years, the findings are that the Grantee was effective in committing and allocating funds and in paying sub-contractors in a timely manner.  FY 2020 was a very different year, as the pandemic caused disruption to the Grantee’s work.  Also, the master contract with Public Health Solutions (PHS) was rebid and negotiations delayed by 4 months, which caused major backups. The findings of the assessment are different from recent years, and the intent of the assessment is to have the Grantee address these issues so that there are no negative findings next year.  A summary of the findings follows:

Contract Renewals: During FY 2020, while no new contracts were executed, a portion of the portfolio required renewals to be executed (47).  These contracts faced delayed execution due to challenges posed by the COVID-19. Additionally, during FY 2020, we rebid our master contract which involved a lengthy process of negotiation and resulted in a 4-month contract delay, with a new contract registered on December 31, 2020.  During this time, there was no contract mechanism for authorizations to be carried out which contributed to the delay.

Subcontractor Payments: During FY 2020, subcontractors were not paid in a timely manner. This was due to a variety of reasons: the challenges posed by the COVID-19 pandemic, Governor Cuomo’s NYS on Pause Executive Order (from March to July 2020), and the need to comply with NYC policy changes to reimbursement for non-for-profit organizations. Additionally, during FY 2020, we rebid our master contract which involved a lengthy process of negotiation and resulted in a 4-month contract delay, with a new contract registered on December 31, 2020. During this time, there was no contractual mechanism for DOHMH to pay PHS.

Spending: The Recipient reported spending for the 2020-2021 Ryan White Part A grant year for the 2nd and 3rd quarters, and through a final report.  The report for the 2nd quarter showed 31% of the funds expended at that point in time.   The Recipient’s Master Contractor assured the Council that expenditures were at less than 50% because a number of expenses were not yet accounted for, but they expected full expenditure by year’s end.  The 3rd quarter showed 72% spending with another assurance that the grant would be fully spent. The Final closeout report, however showed 94% of the funds were expended with $4,911,567 in unspent funding.   This amount was reported to the Planning Council at the June meeting which necessitated the development of a carryover plan in the same month. While the plan is sufficient, assembling a plan in a short amount of time is not optimal.

In summary, for the proposed 2020-2021 Assessment of the Administrative Mechanism, the Council will find that the Grantee was unable to present accurate expenditure reports which hindered the Council’s ability to conduct its planning responsibilities for services for people with HIV. The Council understands that this year was unprecedented due to the global pandemic, the temporary transition to cost-based reimbursement, the transition to work from home and the rebid of the master contract. Regardless of these circumstances, we ask that this finding be used for quality improvement to support the subcontractors’ receipt of timely payment and the Council’s timely receipt of accurate fiscal reports to conduct its planning responsibilities.

Mr. Harriman stressed that if the Council had known in the third quarter that there was going to be higher than usual underspending, they could have had more time to plan for the carryover.  The Recipient knew the challenges of paying providers in the midst of the pandemic and needs to improve its performance.

Ms. Silver introduced herself as the new Director of Contract Management Services at PHS and pledged more consistent participation from the master contractor at Council and committee meetings.  Ms. Plummer added that all official documents should consistently use the HRSA terminology of “recipient” (formerly “grantee”) as the entity responsible for overall grant administration.  (HRSA refers to the service providers as “sub-recipients”.)

Mr. Carr moved that the Committee approve the Assessment of the Administrative Mechanism as presented.  The motion was seconded and approved 17Y-0N.

Agenda Item #5: FY 2020 Revised Framing Directive

Mr. Powell and Ms. Fortunato presented the revised Framing Directive approved by the Integration of Care Committee, which worked most of the year to revise the document in a considered and well thought out process.  Formerly known as the Master Directive, this document guides all services in the Ryan White Part A portfolio.  The Directive utilizes an implementation science framework to clearly establish the context of the portfolio and align implementation strategies with that context.  In this directive, the entire Ryan White Part A portfolio is considered as the intervention.

The Integration of Care Committee received presentations  on: Stigma & HIV Care (Dr. Rodriguez-Hart); CHAIN and Consumer Needs & Service Utilization (Angela Aidala, PhD); The Consumer-led QI Project: Integrating the Lived Experiences of People Living with HIV into Recommendations for HIV Care Quality Improvement (Dr. Rodriguez-Hart, PhD, Ms. Best, Ms. Diaz, Mr. Martin, Mr. Fields); Gender Affirmation & Intersectionality (Octavia Lewis, MPA); and Ensuring the RWPA Portfolio Embeds Equity in Planning (Tracie Gardner, JD).  Multiple service category directives were reviewed to identify the following critical areas for inclusion: Patient Centered Care; Trauma Informed Care; Data Burden; Implementation Science; Health Equity; Anti-Racism; Race Equity; and Anti-Stigma. 

The first sections of the directive, Determinants, Intervention Characteristics, and Inner Setting, Outer Setting, Characteristics of Individuals Implementing the Intervention and Process establish the context in which the Ryan White Part A portfolio operates. The Implementation Strategies and Mechanisms are evidence-based responses to this context that seek to achieve optimal service delivery and health outcomes for PWH.  The Outcomes (Implementation and Clinical/Patient) are the identified metrics to track the portfolio’s progress (or lack thereof) in improving health outcomes.  Two relevant inner settings (Care and Treatment Program (CTP)/Department of Health & Mental Hygiene (DOHMH), and RWPA Funded Organizations) describe expertise, organizational structure and bureaucracy and the stigma and equity characteristics of both.  Outer Setting Characteristics are drawn from the DOHMH EHE Situational Analysis (e.g., generally high but inequitable achievement of outcomes along the HIV care continuum). 

The Directive describes implementation strategies to be initiated within one year of contract award.  To prevent redundancy, organizations may substitute other work, with CTP approval, for the following strategies: 1) pay equity & racial equity analysis; 2) organizational stigma assessment and plan that must be conducted by all contracted & monitoring bodies; 3) prepare consumers to be active participants in the implementation of client centered care; 4) facilitate the development of client crisis plans grounded in research; 5) train staff to deploy non-police alternatives, where police are called as a last resort; and 6) develop mechanisms to enhance or modify programs mid-contract to reflect emerging evaluation.  

Quality Management-related strategies include: 1) recruit, identify, train, and prepare organizational champions to ensure participation in quality improvement processes; 2) collect new and updated client assistance resources to create a searchable live site/resource map that facilitates the completion of comprehensive and appropriate referrals and linkages; 3) provide technical assistance to enhance uptake of current and emerging technologies that reduce client and staff burden train staff to deploy non-police alternatives, where police are called as a last resort; and 4) support tools and activities (technical assistance on organizational development, grant writing, development of mutually beneficial collaborative funding opportunities) that support the development of a multi-organizational initiative that facilitates leveraging supplemental public/private funding sources to build economies of scale. 

The Directive requires training and education of stakeholders (e.g., hard reduction, trauma-informed care, outreach protocols, health equity, anti-racism/anti-oppression, gender affirmation).  Training calendars and resources should be coordinated throughout DOHMH, DOHMH will incentivize inclusion of disproportionately impacted populations of PWH, and DOHMH will support modifications to existing spaces, resources, and materials to ensure reasonable accommodations to persons with any type of disability.  DOHMH will also modernize and streamline data collection to minimize data burden and improve identification of unmet needs, set up an anonymous suggestion box to field questions/comments from program staff, and funded sites will set up mechanisms for clients to provide each other with social support to reduce stigma and isolation.   

The Recipient (CTP) will report on the following measures (by percentage) to the Planning Council on an annual basis, with a comprehensive, cumulative report on these measures every 3 years: RWPA programs that have completed a stigma assessment within 12 months of the award; RWPA programs that have a written stigma reduction plan within 12 months of completing the stigma assessment %% of organizations that identify a quality management champion; reduction in staff turnover over a period of 12 months; increase in referral completion over 12 months; consumers providing feedback to inform best practices over 12 months; increase in client perception of self-management skills; clients that rate services as satisfactory or better; increase in provider awareness of gender affirmation; increase in staff with lived experience and who identify as Black, Latinx, youth, TIGNBNC; organizations that have a system for identifying and supporting clients who request accommodations for their disability; organizations that conduct case conferencing and navigation for all clients as appropriate to service delivery (care coordination, harm reduction, and mental health services); organizations that implement best practices for centering client care through accessible hours, follow-up for missed appointments, etc.; organizations that utilize the live resource & site map for clients, as needed; organizations that develop and implement crisis plans for clients that include non-police alternatives; decrease in clients lost to care; organizations that delivered services in the language spoken by clients served; organizations that have/launch a social space for peer-to-peer engagement/support among clients; and clients that rate that social space as satisfactory or better.

CTP will also measure the following client outcomes: increase in PWH aware of their status, retained in care, and virally suppressed; increase in PWH quality of life; increase PWH satisfaction with HIV services; and decrease in anticipated and internalized stigma reported by clients.

A summary of the discussion on the Framing Directive follows:

  • Outcomes should be streamlined to align with Ending the HIV Epidemic (EHE) indicators, as well as what will be included in the forthcoming NYS Integrated HIV Prevention and Care Plan.
  • The directive allows for providers to self-critique, as well as to capture the consumer voice in service delivery to improve services and outcomes.
  • There needs to be a mutual understanding of the outcomes and allowance for flexibility to capture the needed data.
  • Small, grass-roots organizations will find the reporting burden significantly worse than larger organizations.  Also, it should be clarified if organizations with more than one RWPA contract will need to capture data for each program separately, which could also be onerous.
  • Other options are to identify higher priority outcomes and allow for self-assessment for select outcomes.
  • The outcomes in the directive are not meant to be punitive, but to help providers improve the quality of services.
  • The 12-mionth timeline for implementation of the stigma recommendations is too short.
  • Formerly, Recipient and master contractor staff was intimately involved at the committee level, offering insights into feasibility and other issues.  CTP and PHS staff have been heavily burdened this past year with short staffing, staff transitions and other priorities and thus have not been able to weigh in throughout the process as much but will be more closely involved going forward.
  • Measuring outcomes will be the responsibility of CTP’s quality management staff, including director Jennifer Carmona.  They should be involved in determining what outcomes can be measured and what data collection is feasible.

Ms. Fortunato, on behalf of the Integration of Care Committee, moved to approve the Framing Directive as presented, with the addition of language that adjusts the stigma timeline to ensure implementation at 24 months, and in the Outcomes section establishes a working group with the authority to examine and amend the outcomes, and determine the methods and a timeline of outcome data collection that is feasible to RWPA providers, the Council and the Recipient.  The motion was adopted 16Y-0N.

Agenda Item #6: Recommendations for Serving PWH with Serious Mental Illness (SMI)

There was a consensus that the presentation of the recommendations for addressing unmet needs of PWH with SMI be deferred due to the late hour so that the Executive Committee can give it appropriate consideration. 

Ms. Thompson, on behalf of the Needs Assessment Committee, moved to postpone review of the SMI Recommendations until a time to be determined next week prior to the July 29 Planning Council meeting.  The motion was adopted 15Y-0N.

Due to the late hour, the meeting was adjourned at 5:20 to meet at a future time to be determined by the Planning Council Co-chairs before the July 29, 2021 full Planning Council meeting for the consideration of the final item on the Executive Committee Agenda.

The Executive Committee reconvened on July 27, 2021 at 4:05pm.

Members Present: Graham Harriman (Governmental Co-chair), Dorella Walters (Community Co-chair), Saqib Altaf, Randall Bruce, Maria Diaz, Billy Fields, Ronnie Fortunato, Marya Gilborn, Amanda Lugg, David Martin, Jeff Natt, Guadalupe Dominguez Plummer, Claire Simon, Marcy Thompson

Members Absent: Lisa Best, Paul Carr, Joan Edwards, Donald Powell

Staff Present: NYC DOHMH: David Klotz, Melanie Lawrence, Ashley Azor, Scott Spiegler, Jennifer Carmona; Public Health Solutions: Rosemarie Santos; J. Corbisiero (Parliamentarian)

Ms. Thompson and Ms. Lugg explained that the Needs Assessment Committee spent over a year to develop recommendations to address SMI-related years.  Members of the SMI sub-committee, including Council member Tim Frasca, as well as partners from many agencies and Ms. Lawrence were thanked for their work.

SMI is defined as a mental, behavioral, or emotional disorder resulting in serious functional impairment that substantially interferes with or limits one or more major life activities.  All clients across RWPA services should be offered a clinical diagnosis/evaluation (by referral if necessary) to appropriately identify clients who qualify for additional MH services.  A two-stage screening process is recommended to facilitate appropriate triaging: differentiate between PWH with SMI from PWH without SMI, then confirm an SMI diagnosis, if appropriate.  Appropriate services should be delivered to all clients, including those without SMI, and providers should identify all clients that have SMI with a confirmed diagnosis conducted by an appropriately licensed provider.  Client identification can occur through self-report, confirmed by psychiatric evaluation or chart review.

To address mental health-related stigma, NAC recommends embedding evidence-based stigma-dismantling practices into service delivery, require agencies to conduct organizational stigma assessments to inform responsive plans, support the development and implementation of policies that address and dismantle stigma, and support implementation of the NYS-NYC organizational stigma assessment and application of best practices. 

The intersection of mental health and HIV is well documented but a full picture of PWH with SMI is unclear, even within Ryan White Part A, where mental health assessments are not conducted across all service categories.  NAC recommends to improve capacity of CBOs to identify people with HIV who may have SMI; ensure all clients are offered a referral for a psych evaluation across all service categories; use mental health opportunity presented by pandemic to offer everyone an evaluation; modify data systems to accurately track referral completion, especially for mental health and support services; develop internal care report card dashboards that highlight clients’ care status through medication prescriptions, ART access/adherence, and viral load measures across all appropriate service categories.

Clients with a mental health diagnosis in RWPA have higher rates of engagement but lower rates of viral suppression.  NAC recommends Designate an ombudsperson team for the Ryan White Part A portfolio to support agency management of clients in crisis, identify additional resources and facilitate support for PWH with SMI (a combination of providers from legal services to social work may be most effective; ideally through an initial consultancy to be incorporated into BH service model).  Clients who either self-disclose or receive a mental health diagnosis should qualify for additional support services that facilitate viral suppression.  Provide modified Directly Observed Therapy for all medications.  Ensure provision of appropriate navigation services to all clients discharged from any and all mental health inpatient services. 

NAC recommends to integrate and coordinate care for behavioral health, substance use and HIV care through the development of single site access for all services; facilitate case conferencing, and more staff training on Motivational Interviewing, SMI and referral; improve capacity of CBOs (Community Based Organizations) to manage people with HIV who may have SMI; collaboratively develop best practices to inform agency specific crisis action plans; streamline & accelerate access through strengthened and formalized partnerships; and implement client specific plans to maximize the likelihood that PWH with SMI achieve viral load suppression through Collaborative Care and Focus on resources for psycho-social rehab.

Data shows the need to diagnose HIV earlier, as later stages of HIV disease progression are associated with poorer health outcomes.  NAC recommends developing strategic partnerships to enhance capacity and establish routine HIV testing at sites where people with SMI regularly access care; bolstering HIV testing access to increase the identification of PWH with SMI at all available sites; and building capacity among behavioral health and psychiatric care providers to support HIV testing, prevention and navigation.

A summary of the discussion on the SMI recommendations follows:

  • Confidentiality needs to be insured, especially if there is data sharing across agencies. 
  • The NAC identified a strong need for data sharing to ensure effective coordination of services, but confidentiality and consent will have to be ensured by those providers.
  • Providers need training on mental health first aid.  The Care & Treatment Program already strongly promotes mental health first aid training for all RWPA providers so that they are better able to address someone having a mental health crisis.
  • The recommendations will be incorporated into the new Behavioral Health service directive that the Integration of Care Committee will develop.   
  • This work has already led to many people in the field thinking about this issue.

Ms. Lugg, on behalf of the Needs Assessment Committee, moved that the Executive Committee approve the SMI recommendations as presented.  The motion was seconded and approved 14Y-0N.

There being no further comment, the meeting was adjourned at 4:40pm.