Integration of Care Committee Meeting November 18th, 2020

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INTEGRATION OF CARE COMMITTEE

Danielle Beiling & Donald Powell, IOC Co-Chairs

Wednesday, November 18th, 2020, 10a-11:45a

Zoom Meeting

https://zoom.us/j/4708943670

MINUTES

Attendance: Danielle Beiling (co-chair), Donald Powell (co-chair), Janet Goldberg, Leo Ruiz, John Schoepp, Deborah Green, Bill Gross, Mitchell Caponi, Stephanie Serafino, Paul Carr, Ronnie Fortunato, Rob Walker, Billy Fields, Brenda Starks-Ross, Greg Bruckno, Christopher Joseph, Rose Chestnut, Janet Goldberg, Michael Ealy, Dorothy Farley, Randall Bruce, Matt Lesieur, Joel Zive

Staff/PHS: Jose Colon Berdecia, David Klotz, Guadalupe Dominguez Plummer, Graham Harriman (Governmental Chair), Bettina Carroll, Kimbirly Mack, Ashley Azor, Cristina Rodrigues-Hart, Bettina Carrol, Rachel Crowley, Joan Edwards

Agenda Item #1: Welcome/Introductions/Moment of Silence

Conducted.

Agenda Item #2: Stigma & HIV Care

Dr. Cristina Rodriguez-Hart presented on stigma and HIV care. Highlights from the discussion are below.

  • Thinking about stigma as a mark of disgrace is actually stigmatizing. 
  • Solutions to stigma must be multi-level. 
  • Providers and consumers surveyed agree that stigma is common in NYC
    • Concept of intersectionality not well understood
  • Strong need for more staff with lived experience and representative of the community served
  • Integrated services are optimal
  • A learning culture is needed to transform stigma
  • Minimize staff burnout
  • Abstinence based programs are associated with enacted stigma – idea of substance use as “dirty” and associated with shame
  • Importance on non-violent communication – examining our language within ourselves and with others
  • Synergy exists between multiple types of stigma/oppressions – cannot separate them out.`
  • Words matter – how we speak to ourselves and others is very important
  • Coping is an individual level stigma strategy – 
    • Not always effective
    • Seeking out support as a form of coping is useful
    • Educating self is helpful
    • Avoidance and vigilance – can create a lot of stress in the long term
    • Important to help people with positive coping – but must recognize this is an invidial strategy that doesn’t address the larger structural issues 
    • Need to assess coping 
    • Media communications guide during COVID – has been helpful
    • A number of resources are mentioned in the slide set – lengthy references are included
    • Identify how to support Ryan White providers to do this work
    • Hoping the results of the mapping project will provide guidance on best practices:
      • Core things that are very effective:
        • Integrated services
        • Continuous training
        • Representative staff
    • T-Tap has a stigma training and an online accompaniment that looks really good

Mr. Joseph shared a tool that was useful to audit charts and start conversations about the use of stigmatizing language

  • Necessary to recognize that many people in the committee have experienced stigma
  • People who have good coping strategies fare the best
    • Important to have your own way to manage
  • Need to evaluate the Council as an organization
  • The Health Policy Project developed a stigma survey and a checklist for facilities – could possibly adapt that to the NYC process
    • Other organizations have developed organizational assessment tools 
  • Instead of calling people out – can now educate people – moving beyond being impacted by stigma – 
    • Ask GMHC about training where providers have to examine use of language

Agenda Item #3: Review Master Directive & Recent Directives

Guidance for the new NYS plan to end the epidemic has not been released.

Committee read through master directive.

Language from Care Coordination not included in master:

  • Culturally appropriate
  • Accommodations for people with disabilities

Food and Nutrition:

  • Leveraging public private partnerships
  • Utilizing economies of scale
  • CLAS standards
  • Age appropriate
  • Sensitive to physical and sensory impairments

Should be thinking about who our most vulnerable clients are and how services should be delivered

TIGNBNC:

  • Need to use different technology to meet clients where they are
  • Gender affirming
  • Builds self-management skills

Participant vs client vs consumer vs patient

How are technological inequities to be addressed in the master directive?

No public comment.

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