Integration of Care Committee Meeting Minutes February 20th, 2019

INTEGRATION OF CARE COMMITTEE
The LGBT Center 208 W 13th St. Rm 301 New York, NY
February 20th, 2019 10:00 pm-12:00pm
MINUTES

Members Present: Dorella Walters(Co-chair), Katrina Balovlenkov, Lauren Benyola, Randall Bruce,

Paul Carr, Bettina Carroll (non-voting), Rose Chestnut, Mary Correa (phone), Dorothy Farley, Billy

Fields,  Ronnie Fortunato (phone), Deborah Greene, Janet Goldberg (phone), Bill Gross, Peter Laqueur, Jan Carl Park, Donald Powell, Saul Reyes (consumer-at-large), Annette Roque, John Schoepp, Claire Simon (phone),  Brenda Starks-Ross, 

Members Absent: Danielle Beiling (Co-chair), Michael Ealy, Graham Harriman, Christopher Joseph, Joel Zive

Other DOHMH Attendees: Jose Colon-Berdecia, X. Pamela Farquhar, Scarlett Macias, Scott Spiegler

Ms. Lawrence opened the meeting, welcoming everyone and leading a round of introductions. Mr. Bruce 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 January minutes were accepted.

Ms. Lawrence explained the graphic illustration, included in the meeting packet, “What happens when PLWH in RWPA are unstably housed or homeless?” (RWPA, Ryan White Part A) Short RWPA and long term HOPWA (Housing Opportunities for People with AIDS) rental assistance target individuals who are not HASA eligible.  Housing placement must be to permanent open market housing. Case finding within the NYC Department of Health (DOHMH) is only available when there is funding through tax city levy dollars. While this funding has been available for the past few years, it is not always available. A linkage is stronger than a referral because it ensures that the referred service is actually accessed. 

Cross referrals across the housing system rarely happen as this would result in loss of a client for the agency, and the lack of DOHMH access to available vacancies in RWPA makes it impossible to require in the same way as HOPWA. HASA places people in emergency SROs immediately. Many people get stuck in these SROs. 

What’s the cut off for HASA? 

HASA has approved rates that they may pay pending apartment approval. These rents are negotiable. Ms. Yvonne Katallage noted that HASA negotiates with landlords all the time because the goal is housing clients and keeping them housed.

Is part of the problem that people don’t know where to go to access services? 

There is not sufficient guidance – whether DOHMH or PHS websites that help people get the services they need. 

Ms. Farquar noted that the graphic illustrates the complexity of the issue of housing for PLWH – the housing landscape is incredibly complicated and directing people to the correct place is not easy, nor is the housing landscape without the additional layers of complexity that are present in clients’ lives.

Are market rates negotiable? Is there an opportunity for TCC programs to have a space in HASA Centers? Housing readiness seems a necessary but missing piece?

Mr. Salnave responded that it is HASA’s goal to do everything on behalf of the client – HASA is required to check each apartment and neighborhood. It’s on a case by case basis.

Ms. Katallage noted that HASA won’t, in some cases, house families next to abandoned housing and the agency has found that it has to teach basic things – like don’t lend your keys to a friend – they may not be your friend.

Will HASA ever have a Consumer Advisory Board (CAB)? What about engaging 80/20s? 

HASA tries the best we can to maintain a high standard for the client – but necessary for the clients to inform us immediately. HASA fights hard to get clients into 80/20s.

HASA has a quarterly CAB, there is an application process – some members are appointed by the Mayor

What is the navigation process for single persons? We always hear about family but how single people should navigate is less known.

It seems to be key that a good social worker is critical to the process. Social workers should ensure that clients are not ashamed of accessing benefits. The social worker must meet the client where they are. 

How can we help support the necessary parts of HASA’s process?

What’s the HASA staff to client ratio? 

1:34, families 1:22, families without supervisors 1:35, individuals without supervisors 1:45

It seems like cases that require translation create great frustration. What issue is HASA currently working on?

Mr. Salnave responded that he started as a case worker because of his passion for people. Due to union restrictions, there are regulations about who we can hire. We do our best to train our workers and give them customer service skills. Used to be able to hire people for language skills – can no longer do that. Union demands we pay people more. Some case workers believe it is unfair to be expected to interpret – we now offer a telephone service that provides interpretation.

We need to learn more about how HASA works with community organizations.

As a Planning Council member, I should know who has a TCC grant. Public Health Solutions and the Planning Council need to do better about sharing info. As a social worker, you may want to hoard your resources. When salaries are low – cannot attract social workers or even high quality workers – there are other ways to raise the standard and training of who is working with our portfolio.

How does HASA work with TCC and other community based organizations (CBOs)? 

HASA offers several resources – what works best with CBOs is open dialogue. Point people do wonders – we have point people for CBOs and for city agencies. Need to improve trust between agencies – willingness to be open and hear what doesn’t work and change it. Teamwork makes a huge difference in changing people’s lives.

Ms. Jules noted that she her agency has developed a better relationship with HASA because of the consistency of one case worker for all clients.

Mr. Salnave noted that union reps may view CBOs as threats to employee’s jobs. HASA’s goal is to incorporate CBOs as much as possible.

Five agencies are funded for TCC – these five agencies serve 700 clients – would it be possible to have a special unit to work with TCC agencies in order to streamline communication – reduce client’s repeating histories of trauma. Could there be a group of point persons?

This is difficult legally – but it is a good idea. We can appoint a point person for each TCC provider to better align the work.

Find that some HASA clients are housed with slumlords. 

Different HASA centers work differently – some are wonderful – some do not work well at all. Quality improvement seems like a critical aspect. Sometimes it’s the client who is not compliant. But there has to be a way to bring it all together. Having a point person seems like a great idea.

TCC agencies may develop informal relationships, but there is no formal coordination even though HASA is critical to getting folks housed.

HASA is working on a pilot for case management – and looking at best practices for the most unstable clients. Looking at integrated care planning. 

Could we do video accompaniment? HASA will investigate this.

Clients need to understand the true nature of HASA. It is an inflexible institution and so TCC will have to help clients maneuver through that process. Clients don’t understand the limitations – necessary for those expectations to be managed. 

HASA commits to attending March IOC meeting. 

Would be great to have assigned point people. There is very little follow up and a lot of sanctions A lot of sites don’t do anything until the end of the month when they need to get their paperwork in order.

Congregate facilities are not clean – to the point that stoves catch fire. Lots of back and forth with HASA but no follow up. 

We cannot undo a contract based on performance – have to wait for the contract to end. We have 4-5 inspectors whose job it is to address issues immediately. 20 bad employees make it bad for everyone else- same with clients. Cannot just eject people from buildings – must have due process. We are constantly working on how to address these issues holistically. It is difficult for people who don’t know how to live on their alone. Or have experienced intense trauma.

Need for training for clients and the CBOs whose case managers are handling the clients. I have seen where case managers in the same unit have completely different levels of information and knowledge about how to handle issues. My friend went through an intense back and forth and almost lost the apartment because no one knew who was to pay the brokers fee. These things are not explained to the client. Clients need more info on what they are and aren’t allowed to do – causes a lot of frustration.

Need a program where everyone is on the same page – will manage expectations.

HASA does not issue vouchers. Many people refer to HASA as a housing program. We have no voucher like section 8- we work with clients to find the best housing, including type of housing, for that client. Clients would benefit from a certification program that agencies would execute that could then be shared with the landlord to improve the kind of housing that clients have access to – certificate would ensure client knows how to maintain an apartment and live respectfully in community. 

Collaboration, training and corrective action. I had a client who was told his rent couldn’t be paid. I called John and Jackie Dudley – they corrected the issue within 3 days. Case worker did not have the knowledge on what could be done. 

Want to reiterate the training problem – very hard to get younger people housed. Landlords are weary of young people. Remember when CBOs could table at HASA centers – this should be rekindled. Can you tell us more about the HASA resource list? How is it updated?

80/20s legislation requires that when building has a certain number of units – they must be used for emergency housing – HASA needs to get their hand in the pot because no one is taking advantage of this. Talking to people about safe sex practices – should be about PrEP. And inspections should be a surprise.

Should be a single point of contact – everything needs to be more streamlined. 

I’ve had several clients not pay their rent due to substance use. Needs to be more consistent monitoring so that 1-2 years down the line, clients are not in arrears several thousand dollars. 

Join the Oral Health Subcommittee! Contact Melanie (mlawrence1@health.nyc.gov or 347-396-7356) if you are interested. Upcoming meetings to be held Friday, March 15^th and April 5^th from 2-4pm at Cicatelli.

Meeting adjourned at 12:00pm