Integration of Care – Minutes – 2/16/22



Veronica Fortunato & Donald Powell, IOC Co-Chairs

Wednesday, February 16th, 2022, 10a-12p

Zoom Meeting


Attendance: Donald Powell (co-chair), Veronica Fortunato (co-chair) John Schoepp, Janet Goldberg, Guadalupe Dominguez-Plummer (Recipient), Deborah Greene, Emma Kaywin, Mitchell Caponi, Bill Gross, Billy Fields, Paul Carr, Graham Harriman (Gov’t Co-chair), Rose Chestnut, Joel Zive, Dorothy Farley, Emma Kaywin, Press Canady, Gregg Bruckno, Claire Simon, Francine Cournos, James Walkup, Karen McKinnon, Adam Thompson

Staff/PHS: Frances Silva, Tye Seabrook, Johnell Lawrence, Cullen Hunter, Bryan Meisel, Aria Shahi (PHS), , Johanna Acosta, Jose Colon-Berdecia, 

Agenda Item #1: Welcome/Introductions w. Pronouns/Moment of Silence/Review of Minutes

Conducted. Minutes were accepted with submitted changes.

Agenda Item #2: NJ Behavioral Health and HIV Integration Project Presentation

Adam Thompson presented on how NJ tried to achieve large scale collaborations among government service systems. Aim of collaborative was to bring develop a system of care in NJ that integrates behavioral health (BH) and HIV primary care to improve system and patient outcomes.

Key highlights of the talk follow. Link to the video of the meeting is here: 

Institute for Collaborative Improvement Model was used-

Every 3 months gather for learning sessions, 8 learnings sessions over 3 years. Went from in-person to virtual due to pandemic.

Introduced conceptual frameworks on coordination, co-location to integration

Movement of the data was more important than physical co-locaiton

Regardless of a person’s substance use patterns – many options for treatment.

Very little tracking of what is happening in community – but community based services are the most widespread and impactful.

Macro, Meso, Micro – BHIP focused on Meso (middle) level. Engaged all Ryan White parts except Part D – focus on improving environment and staff support to better deliver services.

Referral process seemed to make clients wait, or never transpired.

Developed 3 categories of performance measures – a lot of over-screening and improper screening was happening – asked orgs to pick a tool that was evidence based.

How BHIP performed: statistically significant improvement in screenings

Most clients in need of mental health and substance use services are not captured easily unless symptomatic or active in treatment

Important to conduct an environmental screen of funding resources – is this funding being duplicated.

            Need to look at how to align service systems

Critical to support CBOs that do not have health info. Technology

CBOs cannot document and prove that they are providing these services

Fund infrastructure for BH – outreach and home based services

Important to think about how to create a welcoming physical space

Conduct a Big Idea microgrant – supported rapid adoption of interventions including utilization novel treatment modalities


Agenda Item #4: Review of Standards of Care: Health Education Risk Reduction

The same process for review was utilized. 

Grammar corrected for clarity and self-management included in Purpose of Services per Mr. Powell’s suggestion.

Anyone who is a peer facilitator or above in the staffing hierarchy is able to conduct an intake assessment

Unclear what the staffing hierarchies are, brief discussion on this ensued.

Bullets added to service table to facilitate clarity

Minimum number of participants is not noted in the document. Will be clarified. 

Mr. Zive added title of workshop to services table for clarity

Agenda Item #4: Review of Standards of Care: Care Coordination

Inserted behavioral health instead of mental health/substance use.

Mr. Schoepp asked why clients must be enrolled in a specific clinic to access the care coordination program – clients need to be able to access all services under one roof. Issues to refer to mental health was removed, “conditions” viewed as less stigmatizing.Care coordination review will continue in a subsequent meeting