Integration of Care Committee Meeting Minutes March 20th , 2019

INTEGRATION OF CARE COMMITTEE
God’s Love We Deliver

166 Avenue of the Americas, Boardroom NY. NY 10013New York, NY
March 20th , 2019 10:00 am-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 (phone), Mary Correa, Michael Ealy,

Dorothy Farley, Billy Fields,  Ronnie Fortunato, Deborah Greene, Bill Gross, Graham Harriman,

Christopher Joseph, Jan Carl Park, Saul Reyes (consumer-at-large), Annette Roque (phone), John Schoepp, Claire Simon    

Members Absent: Katrina Balovlenkov, Janet Goldberg, Peter Laqueur, Donald Powell, Brenda StarksRoss, Joel Zive

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

Ms. Walters and Ms. Beiling opened the meeting, welcoming everyone and leading a round of introductions. Mr. Reyes 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 February minutes were accepted. HASA did not attend this meeting. Public comment should be held at the beginning and end of each meeting.

Mr. Fields asked to acknowledge all of the women who are in the struggle, have died in the struggle and continue to do the work.

The grantee developed a side by side comparison of the Non-Medical Case Management (nMCM),

Transitional Care Coordination (TCC), Housing Placement Assistance (HPA) and Short Term Housing (STH) categories and programs. Mr. Speigler led us through the document. The purpose of the document is to give a brief description of the different programs as well as pros and cons and the HRSA definition. Ryan White Part A (RWPA) has standard eligibility requirements, but each service can have additional requirements. 

The committee read through the side by side together. The formatting made it slightly difficult to distinguish between the different categories.

Under STH, for Services Provided Linkage to Care is not listed?

Mr. Speigler noted that it is in there. 

Make sure the services match across categories.

All housing providers have an outreach component. They are all required to maintain waitlists. If those waitlists run down – they must find people who qualify for services.

For TCC outreach – go into SROs and find clients. Programs are not being let into new SROs, and many people are just getting stuck in SROs for 2 and 3 years.

When leaving an SRO how many people do you see go into congregate housing?

Under RWPA a small number of agencies run congregate facilities – looks very different from an SRO. Some have just 4 clients in a house sharing facilities. They are very nice. Folks are moving from shelters or street homelessness into these. They are not considered permanent housing, but serve as transitional housing.

Depending on when client enters congregate housing, they can qualify for TCC. A client in congregate housing according to RWPA is considered stably housed even though it is not permanent.

We are talking about the same issues again and again. What is the end game? 

Helpful to frame the discussion around how we meet the needs of homeless and unstably housed clients. 

So we should think TCC anew? Or revamp?

The side by side includes TCC – which is probably improperly categorized into Medical Case Management (MCM). 

We should be simplifying the flow for these clients. The landscape is incredibly complex – and we have competing interests in our own portfolio. We can either rewrite TCC and encounter some of the same problems that currently exist or we can enhance STH and include the services we know are valuable.

What happens when clients reach the two year limit for STH?

The two year time limit is theoretical. No one is terminated due to the time line. There is a 1% vacancy rate in affordable housing in NYC. We continue to work with clients and help them get ready for independent living. If a client isn’t ready, they continue to work with them. If the client is ready – it’s possible to de-lease an apartment and put it in the clients name. 

Several of my clients are in non-HIV congregate housing and it is not time limited – and its great because staff are there to assist when clients have issues Where are you finding clients if outreach is not working?

Get lots of internal and external referrals.

If you qualify for TCC do they qualify for nMCM?

Yes

Why do you curtail your outreach to a specific area?

Difficult to get into the new SROs. If we outreach too far from the agency, it is more convenient for clients to go to another agency. If they are moved around and away from us, we continue to offer them services – but it may be inconvenient to them. 

80-20s are out there for these clients. 40% should go to emergency housing and people who are homeless. There is no clear cut program to get people in. SROs are frequently substandard and horrible.

The 80-20s are super nice. Congregate housing doesn’t work for all people. DOHMH does have providers who have housed people in 80-20s. 

Planning Council should research the process for accessing 80-20s.

Have to decide if we want TCC – if its working, or if we want to morph the parts that are working into another program. The programs do the same thing but differently – no intense outreach. What parts do we want to get rid of? Recommend we take the parts of TCC that works and put them in a different program.

STH has similar outreach components – programs are competing for the same clients. Need to figure out what is duplicative. 

Additional money into STH has the potential to put more clients in stable housing. The same services TCC provides are available through STH – and they are provided in clients’ homes.

CAMBA has provided over 2000 services to clients just this year. TCC does a lot of the legwork that the other programs don’t do. HPA doesn’t do accompaniments. TCC is frequently an entry to other services. What if we get rid of STH? 

If you take away STH – who houses the clients?

No one gets kicked out of STH – but HRSA has guidance that says RWPA cannot be used for permanent housing. The idea is that 24 months is enough to move people into permanent housing. But it is acknowledged that is challenging.

Transportation is a barrier. If you have a disability you can get housing quicker. Undocumented persons can have success in finding housing through TCC. 

Individuals who are undocumented are not eligible for HASA, but there are housing options for them.  Short Term Rental Assistance targets this population. HPA as well. 

The side by side shows that these programs have a lot of duplication. We shouldn’t talk about which one gets the chop – we should be looking at why we have all these different programs for the one goal of housing people. We should come up with one program and disperse funds appropriately. We are watching HOPWA continuously get chopped. 

Is the end game to look at one housing program or to revamp TCC? 

Should be looking at the allocations for these programs (TCC and Housing). The goal is not to reduce funding. Would bet that a lot of the work happening in nMCM is around getting people housed.  CAMBA- never thought of TCC as a housing program. TCC stabilizes the client. TCC is the entrance to other programs and linkages and ensures acceptance into HPA. Housing is the endgame.

No one should feel defensive about the work they have done with clients. Everything TCC does also happened in STH. No one is discounting the work of TCC – but we must look at housing. The intervention TCC has set up barriers for people – people have a TCC  case manager, a housing specialist, a HASA case manager… How do we align services better to serve the client? Mental health, substance use – these things are happening in STH.

Future of HOPWA is under great jeopardy.  There is value in aligning programming in the portfolio. We can address the weaknesses. There is added value in consolidating the programs. Need to just make a decision. 

No matter what – there will be a re-bid. Even if TCC is maintained.

TCC is not an MCM program. Changing the categorization would change the percentage of core to non-core. 

SROs – so much money poured in. People live in them for decades. People fear going somewhere worse. People will relapse just to stay where they are. Need to unify the whole housing model.

Ms. Greene made a motion to combine STH and TCC and create a new program model. 

It does not need to be defined or named today.

The IOC then will define the nuances of the new program. The motion passed with 14 members voting yes and no members voting no.

Because there are similarities between housing and TCC – does that vote mean the allocation for TCC gets folded into housing? This issue would be taken up in a different committee.     

The co-chairs would bring the issue to the Priority Setting and Resource Allocation committee.

Ms. Macias (project specialist) noted: TCC is not MCM even though its under HRSA’s MCM definition. That’s one of the issues with this program. The services provided are a gateway to other services. Robust case finding, health education and accompaniment are the strongest elements of TCC.

Linkage to care is also important. 

Once a client is placed in STH they receive robust supportive services. 

From Promesa, Ms. Colon disagreed with the idea that TCC is not MCM because she does significant work with clients around health issues, especially substance use issues. You have to account for the need for enhanced health education. Clients are often not ready to be housed. Have clients that are constantly losing their housing because of substance use or severe mental health issues that have not been properly treated.

Need to consider these points as we design the service directive. And if that means strengthening integration of the portfolio, then we need to do that.

Integrated care, and holistic care, means not addressing medical versus social. Must think about all of these issues. If we can think about the clients, we will do a better job.

Mr. Carr noted that he did not have a good experience in TCC – no one linked him into services, but he was expected to meet with a case manager regularly. But they did offer someone to connect to and start figuring out life.

Our focus should be on how do we strengthen our relationship with HASA, as well as clarifying what options are available for people, including non-HIV programs, like 80-20s. Our programs should be thinking about all of these potential linkages.

Upon award, a tool kit with all the information about options would be very useful DOHMH is looking at that for HOPWA as well. 

That toolkit has to be integrated throughout the portfolio – because you’re dealing with these issues in Care Coordination. 

Opportunities for synergies throughout the portfolio are missed because of the siloed nature of the portfolio. 

Where do we go from here?

Name the program – so we can define what should be in it.

We will call it that new program we are working on to help us get to the name. Important to see what is allowable by HRSA.

Can name it anything we want, but it must abide by HRSA rules. 

There is a Policy Clarification Notice that will help us understand how HRSA defines these categories.

We should bring STH providers into the room. 

We should have a draft TCC STH service directive. 

To not bring STH providers into the room, would be a disservice.

This is not the RFP. Or RFP language. 

Want to ensure this directive emphasizes the strengths, addresses the social determinants of health and facilitates working with HASA.

Important to survey STH providers. Can send out 3-4 questions. This allows them to have input.  These are public meetings, STH providers are welcome.

Will likely be going to bi-monthly meetings after April 17th . Meeting adjourned at 11:57pm