Integration of Care Minutes – 3/15/2023

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Minutes of the Meeting of the

Integration of Care Committee

Veronica Fortunato & Steve Hemraj, IOC Co-Chairs

Wednesday, March 15th, 2023

10:00am-12:00pm

Watch the Zoom Meeting Here

Minutes

Attendance

Committee:

Billy Fields

Brenda Starks-Ross

Chris Joseph

Deborah J. Greene

Dorothy Farley

Graham Harriman

Gregg Bruckno

Gretchen Ty

Hondo Martinez

John Schoepp

Karen McKinnon

Marcelo Maia

Michael J. Ealy

Mitchell Caponi

Raffi Babakhanian

Ronnie Fortunato

Rose Chestnut

Steve Hemraj

Staff:

Adrianna Eppinger-Meiering

Bryan Meisel

Doienne Saab

Frances Silva

Grace Mackson

Ilana Newman

Isidra Grant

Kimbirly Mack

Renee James

Scott Spiegler

Guests:

Alison Maling

Angela Aidala

Deborah

Delilah Gavilanes

Lucie Toussaint

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

The meeting was opened with introductions (name, agency, title) and what you learned about yourself during the pandemic. Rose Chestnut led the moment of silence. The minutes were accepted without changes.

Note: Several issues with calendar invites have been occurring – issue is systemic. Please check the calendar on nyhiv.org if you do not have an invite.

Agenda Item 2: Line-by-Line Editing of the Behavioral Health Directive

Highlights from the conversation around line-by-line editing:

  • Committee agreed to allow times for sections to be re-worked
  • Payer of Last Resort and SEPs – require agencies to have MOUs with SEPs since becoming a SEP may be unnecessarily burdensome – and will not help those programs access Medicaid dollars. Important to be able to transfer clients.
    • Language will be brought back at a subsequent meeting
    • Concern for reducing stigma around access – NYS created the second tier to support lower threshold distribution
  • Recipient submitted comments mid review. Working draft of directive now reflects these.
    • Will continue to move forward then go back and review previous unresolved comments
    • Staff are asked to speak to their comments
  • Question about peer certification
    • Small certified staff pool – high demand
    • How would peers be integrated into BH work
    • Language in portfolio supports peers without certification but with appropriate training
    • Peers are meant to provide support – not clinical services
    • To deliver some services, certification is necessary – Certified peers, for special populations, are key to providing support
    • Don’t want to see peers retraumatized – what kinds of interventions can peers support  – can cause a rupture if not ready
    • Really also speaks to supervision that peers are receiving – if peers are receiving robust support can perform at high levels
    • Only OMH peer services are Medicaid reimbursed – AIDS Institute has not gotten there.
    • Some, but not all, orgs support peers in getting certification – makes a big difference to have that support in navigating a confusing process
      • Process considered onerous and overly extensive to get certified
    • When peers are hired into the RWPA system – should have some training and experience to serve in those roles. Believe it works well.
    • Peers are part of the healing process
    • Title is not key – lived experience is
    • Push back on word peer,
    • Certification can be preferred and not required
    • Patients are being engaged on the street – clients don’t think about what people’s titles are – their priorities are not ours.
      • Want to feel like they share something in common with the peer. Don’t care about title – care about reliability and capacity to help.
    • Negative associations with the term have more to do with the poor treatment some people experience in these roles.
    • Important to consider language with regards to affirming staff
    • It does make a difference to staff in these roles- where the title reflects the actual role and services delivered
    • Depends on program needs – people who are connected to client cultural experience and background is also important
    • Clarified language around client safety plans
  • Language around movement will be informed by the lit review Mr. Harriman is developing for HRSA
    • Meditation and mindfulness is happening in the portfolio but no movement – big component of the Seeking Safety intervention
    • Stretching is important, why was it removed – vigorous exercise is important. Like idea of exercise being prescribed and supervised
    • Concerns about liability if exercising on site.
      • Not sure how much this would cost, would need t
    • Doesn’t make sense they don’t pay gym memberships
  • LCAT – Licensed Creative Arts Therapist – can bill Medicaid
  • Why can’t physical movement be pushed through physical therapy?
    • Must be a justification
  • Want to promote safe spaces, and use of available funds to support changes that create affirming environments with recognition of the limited funding associated with RW and other grants in this space
    • Very hard to do this in large institutions as well.
    •  

Agenda Items 3: Public Comment

Really important to think about triggers clients experience. Currently impossible to access a mental health appointment sooner than 3 months.

There is such high demand.

Elmhurst currently only taking people without insurance

Recommend everyone read, “The Subtle Art of Not Giving a @#%”

 NameConflict
Brenda Starks-RossFood & Nutrition Services, Short-Term Housing, Health Education/Risk Reduction, Family Stabilization and Supportive Counseling, Harm Reduction
Deborah GreeneHarm Reduction
Janet GoldbergMedical Case Management, Harm Reduction, Food & Nutrition Services
Ronnie FortunatoFood & Nutrition Services