Integration of Care Committee Meeting Minutes May 2 nd , 2019

INTEGRATION OF CARE COMMITTEE
Gotham 42-09 28th St, Room 12-38 Queens, NY 11101
May 2 nd , 2019 10:00am-12:00pm
MINUTES

Members Present: Danielle Beiling (Co-chair), Dorella Walters (Co-chair), Lauren Benyola, Randall

Bruce, Paul Carr, Bettina Carroll (non-voting), Rose Chestnut, Billy Fields,  Deborah Greene, Graham

Harriman, Christopher Joseph, Peter Laqueur   Jan Carl Park, Donald Powell (phone), Annette Roque,

John Schoepp, Claire Simon, Brenda Starks-Ross (phpone)

Members Absent: Katrina Balovlenkov, Mary Correa, Michael Ealy, Dorothy Farley, Ronnie

Fortunato, Janet Goldberg, Bill Gross, Saul Reyes (consumer-at-large), Joel Zive Other DOHMH Attendees: Scarlett Macias, Kimbirly Mack, Scott Spiegler

Ms. Beiling opened the meeting, welcoming everyone and leading a round of introductions and an icebreaker about favorite ice cream. Mr. Schoepp led the committee in a moment of silence.

Ms. Lawrence introduced the meeting packet and asked if there were any changes to the minutes. The March minutes were accepted.

Mr. Spiegler invited everyone to attend the long term survivor event on June 5^th.

The presentation is summated here:

• Housing need, assistance and engagement in care
• Community Health Advisory and Information Network project – an initiative of the Council, began in 1994
• Housing has always been an issue. Lack of housing including quality housing
• Today will look at more recent data, including patterns of need, association between unstable housing and engagement in care, and clinical health outcomes, the role of housing assistance.
• Try for our service categories to relate to the Council’s but does not always happen.
• Rent continues to go up, as people live longer – creates additional pressure on an already tight market. 
• Recruit cohorts, cross section of PLWH follow them forward – conduct about 5-6 interviews with people over time. Currently recruiting now.
• Eligibility – persons who have had at least 1 service contact in the past 12 months. People have had contact with services but may not be engaged in care.
• High percentage of homeless among the cohort. 
• Persons who are doubled up are sometimes doing worse in managing their care than folks in shelters. Only 45% of people interviewed (who are unstable) can be found in the same place.
• Interviewers visit places where people are living. 
• People are living in terrible conditions. Rats, bedbugs, etc. Places people who are immunocompromised especially shouldn’t be living.
• People may need help because where they are living is not accessible, or partner passed away and cannot pay rent on their own. 
• 70% of people need and are receiving assistance. 18% are in need but not receiving housing services.
• Severely rent burdened – rent is more than 50% of their income. 
• Retention in care indicates no missed appointments. For the odds ratio, any number less than 1 means it is unlikely. 
• What facilitates engagement in care? Many factors contribute to connection in care.
• When you factor in mental health and substance use – housing is less likely to be associated with engagement in care
• Medical case management is associated with entry into appropriate care.
• Housing need is one of the most consistent barriers to care – this includes homeless, unstable and rent burdened.
• We have done better at getting people housing but food and transportation are still yawning gaps that complicate adherence.
• Housing assistance is associated with a number of positive outcomes, not always statistically significant, but in a positive direction.
• Linkages to other services, such as case management, makes a big difference.
• All CHAIN data is self –reported, but occasionally do validation against surveillance and Ryan White data
• Younger people have higher need than the continuing cohort.
• The HIV world needs to be at the table when conversations about affordable housing are happening.
• If housing needs are not met, we will not hit larger goals for ending the epidemic. 
• The value of HOPWA dollars has decreased.

Mr. Joseph noted that the Council should be thinking about policy. Ms. Walters noted that the Council must work in an integrated fashion because changes are happening across the board – and the RW population is not considered in those arenas. Ms. Beiling asked if the co-occurring issues like substance use, mean that the housing impact is diminished. Housing is necessary but not sufficient – all of the needs must be addressed. Main issues are food, transportation, substance use and mental health.  Ms. Roque noted that kids are injecting meth and other drugs – potentially exacerbating transmission – but this has not been seen yet.

Mr. Walker noted that much of the housing stock available to PLWH is substandard. A lot of new housing is going up and is supposed to go to people with special needs. 80-20s are turning over because they are losing their tax abatements. We have to go to community meetings. 

Ms. Aidela has seen that very seldom is senior housing utilized – lack of referrals and welcoming of seniors in these spaces.

• Difficult patients may not be getting the help that they need – possibly due to lack of diagnosis and misdiagnosis
• Co-morbidities are increasingly an issue.
• Having clinicians (LSWs CASACs) on staff really helps. More personnel.
• Transferring the lease to tenants is ideal, as clients get comfortable in their homes.
  • It can happen, but not always. Would be good to know the pathway
• Additional support is needed – food, clothes, etc
• RIO alerts (that tell agencies when the client is in the hospital) are invaluable
• HASA will stop funding a clients rent if they go into short term and long term treatment. This is protected under Ryan White
• Clients are not being classified appropriately so cannot get into permanent housing and other programs like NYNY3
• Are partners allowed to sleep over?
  • Sleep overs are allowed (program dependent) and are time and frequency restricted
• Sometimes guests who have criminal intentions come into the building late night – hence a curfew can be beneficial
• Methods of data collection does not reflect effort 
• Credit scores are a huge barrier, and cost clients money
• Clients are selling their meds
• Should be collecting qualitative data in this category to better understand trends
• Outreach should be conducted in a similar fashion to TCC

Ms. Carroll asks how IOC can avoid writing a new service directive. Many of the issues that have been discussed are things we do not have purview over. Mr. Joseph – important to develop a way to view the RWPA inventory. Mr. Laqueur suggested a better integrated portfolio would better serve clients. Big hurdles to housing exist for many people, even those who don’t have co-morbidities or substance use and mental health issues.

Mr. Bruce noted that it seems like just having HIV is not enough to get the services. Need a program that is closer to one stop shopping – doesn’t make sense to pull a substance use program into a housing program, but there is validity in having a clinician on site. Peers can also help with accompaniment.

Mr. Harriman pushed back against writing a service directive. Wants to enhance the current service directive and avoid an RFP. Can we get a service directive done by July?

Mr. Park asked if it is unethical for us to advantage the current STH providers without giving additional providers an opportunity to compete. The current service directive does not necessarily address credit score improvement as well as funding to pay for agencies to constantly pull those credit scores.

Mr. Harriman does not believe that issuing a new service directive obliges the issuance of a new RFP.

Mr. Laqueur requested a longer meeting on May 15^th. Dr. Aidela will provide more recent housing data.

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