INTEGRATION OF CARE COMMITTEE
Veronica Fortunato & Donald Powell, IOC Co-Chairs
Wednesday, March 16th, 2022, 10a-12p
Zoom Meeting
MINUTES
Attendance:
| Veronica Fortunato (co-chair) | Bill Gross | Billy Fields | Brenda Starks-Ross |
| Cassandre Moore | Christopher Joseph | Deborah Greene | Dorothy Farley |
| Francine Cournos | James Walkup | Janet Goldberg | Joel Zive |
| John Schoepp | Karen McKinnon | Michael Ealy | Mitchell Caponi |
| Paul Carr | Press Canady | Rose Chestnut | Tim Frasca |
Guests: Andrea Yaffe, Brian Colon, Mirnelly Fernando, Mrytho Gardiner
DOHMH/PHS Staff:
| Frances Silva | Johanna Acosta | Cullen Hunter | Kimbirly Mack |
| Noelisa Montero | Scott Spiegler (Acting Recipient) | Nadine Alexander | Jacinthe Thomas |
| Johnell Lawrence | Renee James |
Agenda Item #1: Welcome/Introductions w. Pronouns/Moment of Silence/Review of Minutes
In honor of deepening our understanding of trauma informed care with invited guest presenters from Exodus, the icebreaker was simply – how are you feeling today? Many people shared deeply, highlighting our understanding that we frequently do not know what people are bringing into the room. John Schoepp led the moment of silence. The minutes were approved with no corrections.
Link to video of the meeting: https://rb.gy/oxf6y0
Agenda Item #2: Public Comment
None.
Agenda Item #3: Trauma Informed Care and Healing Centered Care
Exodus staff Brian Colon, Director of Training & TA and Mythro Gardiner, LCSW-R Clinical Director with support from Andrea Yaffe presented on trauma informed and healing centered care.
Exodus conducts a 4 question check in from The Sanctuary Model at the beginning of each meeting, using a feeling wheel. “Good” is not an acceptable answer due to its vague nature. Found that raises the understanding of what is in the room and deepens empathy.
85-90% of Exodus staff are justice impacted – former methodology was very prescriptive, very tough love. About 3 years ago realized that organization needed to be retooled – hired consultants from the Sanctuary Institute.
During COVID large number of people released from jails with no resources – Exodus worked to support this population and deepen the orgs understanding of trauma. Wanted to ensure entire organization was on the same page – everyone in org did the training, including the executives.
Exodus gives people multiple chances – no one is ever kicked out of the program.
Founder of Exodus was incarcerated for 12 years – founded the organization to create a place for people to go when they come home – thinking about the social, economic and spiritual needs.
Features several programs, Jail to Jobs, ATI Program – alternatives to prison time, substance use program for support with recover, mental health center and the center for trauma.
A one stop shop for people coming home from incarceration, but the Center for Trauma Innovation (CTI) is for all people. Exodus operates multiple hotels and sites.
Lived experience is a priority for service delivery. Important to understand what people are bringing into the room – and how that is impacting their experience and how to create a universal safe space. Something therapeutic about it – trauma informed approach is an ongoing journey – have to think about it everyday. The DA saw Exodus doing this healing work – needed to create it and adapt approaches to be culturally responsive. Grant for CTI comes from the DA’s office from a fund to prevent recidivism.
CTI is conducting pilots to reconnect people and interrupt cycles of violence.
Care is tailored to the individual. Use best evidence available to tailor the intervention and then adapt it as needed. CTI targets 4 populations, youth 16-24, formerly incarcerated. LGBTQI community and elderly communities.
Model of healing is Direct Service, Training and TA to create a learning community.
Direct Service – people with traditional academic knowledge and people with lived experience. Believe in a non-judgmental approach, allow participants to drive the bus on their healing journey.
Training and TA: Teach and help implement different practices and strategies that move away from traditional deficit based approaches. Facilitated by credible messengers.
A number of participants in Exodus have become staff – try to keep them on as CTI participants while respecting their boundaries as staff members.
Trauma doesn’t just go away – must be considered especially when jobs get stressful. Work hard to maintain confidentiality.
Exodus offers EMDR (Eye Movement Desensitization Reprocessing) but does not train people in it.
Exodus has a 3rd party evaluator from ICAHN that works with Exodus to adapt interventions to fit the communities served.
Trauma lives in our bodies – these are sensations such as heart palpitations, sweating, heavy breathing. Trauma has us constantly thinking about the past or worrying about the future – and not being in the present.
Healing is not linear and this is embraced by Exodus.
To de-stigmatize mental health assessments – done as conversationally and casually as possible.
Implementing TIC across the organization is a continuous process – difficult for people who have been doing something one way for decades. See it working – bring in folks from some of the roughest part of the city and watching them soften and be kind and lift one another up. Constantly providing support for people to embrace change. Research says it takes about 3.5 years to culturally change. People are excited and constantly asking for training.
Agenda Item #4: Ryan White Part A Mental Health and Harm Reduction Services in New York City
Nadine Alexander, ScM, Manager of Equity and Strategic Planning for Care and Treatment presented.
Data is limited to clients enrolled from March 2018- February 2020. Key takeaways follow:
- Enrollment was highest in HRM (2,635)
- Dually enrolled clients made up approx. 10% of all MH clients and 4% of all HRM clients
- A relatively high percentage of clients under the age of 30 were enrolled in MH
- MSM and individuals with heterosexual contact make up a majority of HRM and MH clients (and RWPA clients overall), but HRM had the highest proportion of clients with IDU transmission risk and MH had the highest proportion with perinatal transmission risk
- Problem substance use was generally less common than historical or recent substance use, but problem substance use was more common in HRM than in MH or RWPA overallIn MH a higher percentage of clients were under 30 compared to clients in MH (Mental Health) and RW overall.
- A much higher proportion of HRM clients received a service within 3 months of completing their intake assessment compared to MH clients
- Counseling, coordination with service providers, and assistance with health care, social services, and housing are commonly used services
- Less than half but more than one-third of HRM and MH clients were enrolled after 1 year of completing their intake assessment; the proportions still enrolled after 1 year were higher in both of these service categories than in RWPA overall
- Viral suppression is higher at enrollment compared to the most recent viral load test, in HRM, MH and the overall RWPA population
Discussion:
Is counseling the same service description in HRM and MH?
MH has more options – HRM only has AOD. Person in HRM must be certified but varies from program to program. In MH can be done by a certified peer supervised by a licensed provider.
Services for MH may be paid by Medicaid which is why the number of clients enrolled is so low.
No significance tests were conducted for these slides.
Service utilization can be broken out by race and ethnicity.
Looking at all RWPA versus MH and HRM service utilization – is there significance in difference?
Will need an additional data request.
Agenda Item #5: Fact Sheets on Harm Reduction (HRM), Supportive Counseling (SC) & Mental Health (MH)
Jacinthe Thomas sped through the fact sheets due to other parts of the meeting running over time.
Mental Health Services:
Priority populations – six based on disproportional impact or in need of additional services (i.e. elderly PWH). The fact sheet breaks down the number of clients over a period of 3 years, current demographics, service utilization, geographic location of clients, HIV risk factors (clients can report more than one risk factor) and spending allocation vs actual expenditure.
