Integration of Care – Jan. 7, 2023 Minutes

MEETING of the

INTEGRATION OF CARE COMMITTEE

Veronica Fortunato & Steve Hemraj, IOC Co-Chairs

Wednesday, January 7^th, 2022

10:00am-12:00pm

Watch the Zoom Meeting Here

Minutes

Attendance

Committee:

Bill Gross

Billy Fields 

Chris Joseph 

Deborah J. Greene

Dorothy Farley

Graham Harriman

Gregg Bruckno

Gretchen Ty 

Hondo Martinez 

Janet Goldberg 

John Schoepp 

Karen McKinnon 

Marcelo Maia

Mitchell Caponi

Raffi Babakhanian

Ronnie Fortunato

Steve Hemraj  

Staff:

Adrianna Eppinger-Meiering 

Bryan Meisel

Cristina Rodriguez-Hart

Doienne Saab

Grace Mackson 

Ilana Newman

Kimbirly Mack

Scott Spiegler

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

The meeting was opened with introductions (name, agency, title). Co-Chair Hemraj led the moment of silence. The minutes were accepted. There was an issue with the wrong link on the agenda – noted and will be double checked in the future.

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

Co-Chair Fortunato volunteered to read first. Following is a summary of the changes made to the document, and highlights of the corresponding discussion.

• Language changed to clarify who delivers what services
• Grammatical changes were made
• Detailed language added to ensure all external referrals to RWPA also qualify for navigation
• Can only direct RW providers on how to deliver services – which means we provide navigation for all services that another funder does not.
• After the health home brings them to a mental health clinic, and the clinic processes an intake, the health home no longer provides navigation – this is where RW can provide the support the client needs until they are able to engage on their own
• Navigation by RW acts as a complement to any other funders
• Question of what safety means in the context of the directive?
  • Trying to consider how to support the client’s perception of safety – where the space might be safe but does not feel that way to the client
  • Safety is a core principle of trauma informed care
  • Important to think about training that providers will need – and if smaller agencies can deliver services in these ways.
  • Sentence edited to make it actionable – prioritize is not a clear action
  • Tied an assessment of client’s perception to safety with the use of a trauma informed lens
• Included client choice to refuse a service
• Discussion of how flexible client choice is in a program of services – but if a program has requirements that the client cannot meet – the program is not for the client. Such as, only in person when the client prefers remote, etc.
• Case conferencing requires a meeting of client’s case managers with medical providers
• Modified DOT should be offered virtually through telehealth – this is already happening
  • Should be called out as its often not considered as part of telehealth
  • Is telehealth the appropriate word for remotely delivered services – a lot of disagreement about this meaning
  • Virtual DOT leaves uncertainty about whether pt took meds 
  • Important to re-examine penalty driven measures in services – supportive vs punitive
  • There are several other medication adherence assistance apps – doesn’t have to be observed to be helpful – text reminders, etc.
  • Important to name other ways to support client adherence
  • Previously there was a limit on number of times you could bill for DOT – how has that changed – does it change the reimbursement model to do mDOT?
  • [can we do a data request on how many DOT services are provided since mDOT has been made available]
• No hard and fast separation between MH and medical – can use clinical a broad way to include all services
• Tobacco cessation is specifically called out because of the severe impact it has on clients’ health
• Language changed to indicate that agencies must offer services – such as accompaniment – instead of by request.
• Impossible to evaluate clients “living their best lives” – language changed to make the strategy measurable
• Psychosocial rehab should be a funded RW service
  • Should happen in community
  • Helps keep people out of clinics and hospitals
  • Credentialed peers can deliver these services
• Question of where harm reduction is defined (is defined in Framing Directive) – Melanie will find a definition
• Question of whether high intensity case management exists in NY (with lower client caseloads) 
  • Directive is trying to build that service – important to keep in mind
  • Required delivery of this service, and couched service into mental health portion of the directive
  • Can require all MH programs to have at least one case manager with a lower client load to support clients with complex needs
  • Don’t want to create a whole different program – need to ensure language reflects exactly what we want agencies to do
  • Important to define a proper patient to staff ratio to support this strategy working appropriately – in health homes, the ratio is 30-35 pts to a case manager

Questions to Consider:

1. Members should interrogate the document now, so that they can be in full support when it goes up for approval
2. Add a definition of psychosocial rehab (endnote?) Psychosocial Rehabilitation (PSR) Assists individuals in improving their functional abilities to the greatest degree possible in settings where they live, work, learn, and socialize. Rehabilitation counseling, skill building, and psychoeducational interventions.
3. Consider difference between services and service delivery and how strategies have been parsed
4. Service delivery section remains only 3 points, maybe it makes sense to integrate it into the above section as was done with trauma informed care earlier in the call
5. Need to cite harm reduction references: two primary locations that have supported definitions are https://hri.global/ & https://harmreduction.org/, since harm reduction can be a philosophy, practical strategy, political movement, etc.

Agenda Item 3: New Business & Public Comment

No public comment.