Integration of Care Minutes – 4/19/2023

Minutes of the Meeting of the

Integration of Care Committee

Veronica Fortunato & Steve Hemraj, IOC Co-Chairs

Wednesday, April 19^th, 2023

10:00am-12:00pm

Watch the Zoom Meeting Here

Minutes

Attendance

Committee

Bill Gross

Billy Fields

Brenda Starks-Ross

Charmaine Graham

Deborah J. Greene

Dorothy Farley

Emma Kaywin

 Graham Harriman

Gretchen Ty

Hondo Martinez

Janet Goldberg

Joel Zive

John Schoepp

Karen McKinnon

Kimbirly Mack

Marcelo Maia Soares

Mitchell Caponi

Raffi Babakhanian

Ronnie Fortunato

Rose Chestnut

Staff

Bryan Meisel

Claire Simon

Cristina Rodriguez-Hart

Grace Mackson

Ilana Newman

Scott Spiegler

Guests

Angela Aidala

Logane Brazile

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

The meeting was opened with quick introductions (name, pronouns) and one word about spring. John Schoepp led the moment of silence at the end of the meeting.

Agenda Item 2: CHAIN Behavioral Health Follow Up

Highlights from the discussion around the presentation are:

• How are you capturing childhood trauma
• Study is limited – cannot capture highly unstably housed individuals
  • Have that question, but it is not part of this analysis
• How are ACEs represented in the survey?
• Need n’s to better understand the data
• Follow people over time
• CHAIN does not actively connect people to services – can’t provide or recommend specific services
• Offer help with finding information but do not make specific referrals
• Can the indicators be broken down by demographic
• Is there a report back to agencies when gaps are identified in services?
• Numbers of people not getting the services they need is ~30%
  • Confidentiality issues prevent sharing back with agencies
  • Break it down by borough
• Have a clinical psychologist on call at CHAIN to assist any situation that arises
• Currently preparing a report on service needs and utilization
• High demand and high utilization is seen in mental health
• See lower rates of adherence among people with MH and harm reduction needs
• What predicts people getting services?
• People who receive other supportive services are more likely to receive MH services
• People of trans experience make up less than 1% of study participants
• White males tend to do better – hence they are the reference standard
• If people feel they need treatment – that’s the biggest indicator they will access the service
• People are not getting the services they need.

Really important to think about how we frame the data analyses and frame client experiences as they touch the system and attempt to access services.

Agenda Item 3: Line-by-Line Editing of the Behavioral Health Directive

Set an additional meeting for May 3^rd and May 31^st to support completing the directive. Highlights from the conversation around line-by-line editing:

• Convey that clients should not be re-traumatized by sharing traumatic experiences
• Providers sometimes lack the appropriate training, whether due to turnover or a lack of experience
• Big issue is the larger question of whether people providing these services are properly trained to do so.
• Coping is very important – most people are resilient and bounce back after traumatic events – some strategies are helpful, some are damaging – like substance use – important to screen for coping strategies and embed that info into a treatment plan
• Lit review currently being sent to HRSA
• Trauma treatment in RW now
  • Seeking Safety
  • Stage 1 treatment – people not ready to talk thru their trauma
  • Stage 2 – high level – people must be highly trained – agencies do not have staff on this level, e.g., EMDR Eye Movement Desensitization & Reprocessing
  • A lot of clients will want to come in and disclose their trauma, thinking this will be therapeutic – address this in a frequently offered DOHMH training. Pulled this into directive
  • CHN offers EMDR
• Corrected language to more clearly convey concepts around delivering services and trauma
• Guidance should be separate from capacity with regard to tracking completion of referrals
• Desire to remove word pariah from directive

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