Integration of Care – Minutes – 5/18/22

INTEGRATION OF CARE COMMITTEE

Veronica Fortunato & Donald Powell, IOC Co-Chairs

Wednesday, May 18^th, 2022, 10a-12p

Zoom Meeting

https://health-nyc-gov.zoom.us/j/9831410930

Video link

Attendance:

Guests: Mirnelly Fernando, Sam Cutaia

DOHMH/DOH/PHS Staff: 

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

Introductions  occurred. 

Agenda Item #2: Overdose Prevention Centers (OPC) with Sam Rivera, NY Harm Reduction Educators

Background: Two orgs merging to create On Point NYC. Harm reduction (HR) has transformed the plight of the HIV epidemic. About 4 years ago began discussing OPCs, DeBlasio made an announcement about opening OPCS – which then resulted in the eviction of the Washington Heights Corner Project.

• Signed two 30 year leases.
• Board had to agree to potentially be arrested
• Had to develop a partnership with NYPD – challenging
  • Can’t hang around building
  • Can’t stop clients from accessing services
• Opened both sites Nov 30
• Over 18K unique utilizations
• Over 300 overdose interventions (city hoped for 130/yr)
• Multigenerational community formed in the room
  • People coming out of hiding their use
  • People using less bc want to engage in conversation
  • Mirrors in the room facilitate the intervention (self-examination, safety)

How can RWPA funding help

Funding is key – cannot pay staff with restricted funds. How do we continue to pay our staff? Ensure all the paraphernalia stays in the building. Have seen the 13000 syringes collected by a local park drop to 1000. Need the president to get rid of the crack house statue. Disparity in how cocaine verse crack is treated. Need more OPCs – do not call them SIF (safe injecting facility), because its more drugs than those injected and because the focus should be on the help being provided. 

Only use Narcan 30% of the time. Never use nasal Narcan – use intramuscular, what’s called tip back. Use O2 everytime. If we were to use nasal Narcan – would bring them back and save their life, but unlikely to return to program because it makes them go into withdrawal. If someone is dosed with Narcan, may want to use again – which is very dangerous, because that overdose will kill you.

RWPA requires an assessment to enroll clients – how do you manage that?

We are collecting a lot of data. Ask clients about their substance use. Participants have been very open to sharing. One of our senior staff created a cloud based app that allows us to gather information on the move. Have access to EHRs. 

Is there a mechanism for agencies to do outreach/connect the housing programs to your services?

See a few hundred people a day, hours are 9a-8p. Will expand these hours shortly. We are hiring. Agencies are welcome to come and engage with clients. The OPCs are open to engaging with agencies and services on behalf of the clients.

Do you give clients ID cards?

Give clients a QR code that contains the ID and the QR code is scanned wherever the client goes in the OPC (i.e. coffee, etc). One of the issues we ran into is the community thinking people would come from across the city to use the OPCs. Clients often recall a zip code from their past – makes figuring out their actual address/status difficult. Have to spend more time with them.

What about the legal system?

Have a wonderful relationship with the police precincts. Can ask the captain to have a cruiser move.

What we really need is the crack house statute to be rescinded.

Do you deliver services to people who are undocumented?

Yes. But this is not the place for people to learn to use drugs. 

Sam Rivera led us in the moment of silence.

Agenda Item #3:  Housing Directive Line by Line Editing

Due to COVID and other extenuating factors, this directive has been developed under an incredibly short timeline. There have not been major changes to the services, but the compact timeline has not allowed us to hear from clients and providers.

Started with the strategies section of the document. Highlights from the discussion follow:

• People can access training outside of the RW system. 
• Agencies have waiting list, times vary per client and agency
• Council does not have purview over quality management (QM), thus changing any reference to QM to quality service
• How do we ensure agencies don’t discriminate against clients who use substances or may have mental health disorders ? 
  • It is in the RFP and stands as a requirement.
  • Housing discrimination is complex, hard to identify.
  • Brings up role of legal services in ensuring clients know and have access to legal protections. 
  • If landlords are informed that people with special conditions are the tenants, landlords may not discriminate or evict clients
• Maintaining housing for people with MH disorders is a huge challenge. Takes a good intervention
• Language changed to strengthen client protections
• Important to have HASA at the table
  • Important HASA clients know they have access to legal services
• Housing Support Unit (HSU) will incentive programs providing appropriate support for clients
• Agencies that house clients with MH and SU disorders could ask for additional funding

Agenda Item #4: Public Comment 

Embedding Equity with Dr. Chinazo Cunningham on May 25^th.

^[1] Director and Governmental Co-Chair of the NY Health & Human Services Planning Council

^[2] Represents the Recipient, the Mayor of the City of New York