Integration of Care – Nov. 16, 2022 Minutes

November 16^th, 2022

MEETING of the

INTEGRATION OF CARE COMMITTEE

Veronica Fortunato & Steve Hemraj, IOC Co-Chairs

Wednesday, November 16^th, 2022

10:00am-12:00pm

Zoom Meeting Recording

Minutes

Attendance:

Committee:

Bill Gross

Billy Fields

Brenda Starks-Ross

Christopher Joseph

Claire Simon

Deborah Greene

Francine Cournos

Graham Harriman

Gregory Bruckno

Gretchen Ty

Janet Goldberg

John Schoepp

Karen McKinnon

Marcelo Maia

Michael Ealy

Mitchell Caponi

Press Canady

Raffi Babakhanian

Recipient: Nadine Alexander

Ronnie Fortunato

Rose Chestnut

Steve Hemraj

Tim Frasca

Staff:

Bryan Meisel 

Cristina Rodriguez-Hart

Grace Mackson 

Jose A. Colon-Berdecia

Renee James 

Shomari M. Harris

Guests:

Marcy Sedlacek

Uju Berry

Agenda Item 1: Welcome, Roll Call & Moment of Silence

Co-chair Ronnie Fortunato opened the meeting with introductions and a moment of silence.

Agenda Item 2: Intimate Partner Violence & Mental Health

Dr. Berry briefly introduced herself before beginning the presentation, noting that she currently sits at NYU as a clinical associate professor, seeing patients and conducting research. Most of her time is spent in central office at Health and Hospitals, the city’s public hospital system where she oversees a domestic and gender violence grant. This includes the city’s response to mental health and domestic violence. She had no financial disclosures and explained her current grant funding and its focuses. Key points from her presentation follow:

• Huge correlation between HIV and violence
• Family Justice Center Mental Health Collaboration ensures that survivors of IPV are connected to medical care and connected to social services
• IPV or domestic violence is larger than physical violence
• According to the CDC: The definition is, it includes fiscal violence is most people aware of, but also sexual violence, stocking, and psychological aggression. It’s about power and control by any means necessary.
• Serious, preventable public health problem that affects millions of Americans
• Clients think its fiscal grabbing and pulling, punching, or kicking, choking. But there’s also emotional violence, gas lighting, a lot of isolation. Financial restriction, sexual restrictions, intimidation and threats. Use HIV against them (no one wants you, denies access to meds); use children against them. Power and control.
• Harm is more predominated by males against women, the severity of abuse and frequency tends to be more predominant on women
• LGBTQ individuals experience IPV at rates at equal to or higher than non-LGBTQ individuals.
• About 18k IPV domestic reports, responded to by the NYPD. Went down during pandemic, slowly creeping back up
• People with HIV experience higher lifetimes of violence and trauma. So, more risk for more experience in violence and trauma. Conversely, survivors of IPV are an increase in risk of acquiring HIV.
• Not uncommon for people who have a history of a recent IPV history to stop going to seeing their HIV provider and no longer taking medication
• We should also think about those who cause harm, and providing support for them as well
• Integrated approach provides needed supports
• Incredibly hard for people to leave situations – high threat of homicide or injury
• 10-15% of patients came back into services during pandemic. 
• Police feed legal systems that already traumatize communities
• Systems are there to help, but can be barriers, or arbiters of brutality, particularly for disproportionately impacted communities, consider the legal system – not trauma-informed 
• Research shows that the effects of IPV and mental health can be seen as early as infancy
• Screening is the most effective tool, but most be connected to appropriate referrals
• Treatment is multiphase, acute stabilization and physical safety, mental health safety, and then movement into processing, reconnecting, finding support, getting back into care….
  • Needs an individualized approach
  • Histories of familial abuse require rethinking the social connections
• First principle of recovery is empowerment of the survivor
• No intervention that takes power away from survivor can possibly foster her recovery
• The silos we work in do not serve our clients
• Real need to think about relationship of the system of incarceration to the system of healthcare
• Suicide among people with SMI is very high
• Really innovative program run by the city – no billing – no documentation status needed – provides acute crisis treatment, medication and therapy
• Majority of clients are Latino, but this is who reports, not who is victimized – this abuse is present in all cultures.
• Gap in access for children who need services – the system is not always set up to protect their access 
• Strong association with shame and stigma; important to consider how criminalization of specific communities plays a part

Agenda Item 3: PTSD Refresher with Shomari Harris

• Trauma commonly refers to severe physical injuries, but in one applies to trauma, informed care. It encompasses a range of physical, emotional and psychological events and effects across all domains of human functioning. There are typically two different types of traumas that we think about.
• Trauma is what tends to happen when we think about like childhood sexual abuse. Childhood, physical or emotional trauma. Think about ACES.
• It’s estimated that one in 11 people will be diagnosed with PTSD in their lifetime, and women are twice as likely as men to experience it. And if you are Black American, Latino, or Native American, then you are probably disproportionately affected
• Different clusters of symptoms:

• intrusive memories -unwanted, distressing memories, flashbacks, drinking with nightmares. Avoidance symptoms- where you try to avoid thinking about or talking about the event and the places, activities or people that remind you of the traumatic event.
• easily startled
• Difference between PTSD and complex PTSD
  • more issues with identity integration and with feelings of safety and impulse, control, identity and self-perception, issues with the body, and how one views their bodies problems with meaning, making, and managing interpersonal relationships.
• outcomes for people who experience significant trauma, whether it is ACES, adverse childhood experiences, or trauma that they’ve experienced as adult – for each new traumatic experience, people become more susceptible to many of the negative

consequences of their social assignments

Discussion

• Trauma can be intersectional: multi-generational, cultural and historical
• Multi-layered approach needed
• moving from what’s wrong with you to what happened to you
• can be retraumatized – by witnessing an event
• issues of sexual violence against children
  • the more marginalized you are as a result of the intersections of all the identities that you have, the more likely you might be to experience some sort of sexual abuse as a child, particularly if you identify as black, male and LGBTQ
  • in terms of grooming children, the adult attempts to find a child that they can groom into silence, and ensure that the child is isolated, especially children already on fringes 
  • Important for care to be trauma informed in all ways
  • Noises can be triggering especially if someone is having an episode
  • Need systems that identify when people need help even when they are not ready to asl for it

Agenda Item 4: Behavioral Health Directive, New Business & Public Comment

Committee will read through behavioral health directive in advance of line-by-line editing at the next meeting. Only the Strategies, Outcomes and Mechanisms sections will be line by line edited

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