Needs Assessment Committee Meeting January 13th, 2022

Needs Assessment Committee

Finn Schubert and Marcy Thompson, Chairs

January 13^th, 2022, 1:00PM -3:00PM

Zoom Video Call: https://zoom.us/j/4708943670

Members Present: Fay Barrett, Paul Carr, Billy Fields, Graham Harriman (Gov’t Co-chair), Jennifer Irwin, Amanda Lugg, Finn Schubert (Co-chair), John Schoepp, Marcy Thompson (Co-chair), Angela Aidala, Freddy Molano, Erin Harned, Karen McKinnon, David Martin  

DOHMH, PHS, NYS and Other Staff: Cristina Rodriguez-Hart, Johnell Lawrence, Kimbirly Mack, Noelisa Montero, Roland Torres, Nadine Alexander, Scott Spiegler, Arly Pelaez, Melanie Lawrence

Welcome/Introductions/Moment of Silence/Public Comment/

Review of the Meeting Packet/Review of the Minutes:

Marcy led introductions of people present. There was no public comment. No corrections to the December minutes and they were approved.

Needs assessment (NA) workgroups

A facilitator from each NAC workgroup gave a brief report out on what their workgroup would be discussing in their breakouts that day. NAC split up into 4 simultaneous breakout rooms, each discussing a different component of the HRSA-required NA. Noelisa and Nadine facilitated the epi profile workgroup, Graham the resource inventory workgroup, Johnell and Scott the provider capacity workgroup, and CHAIN staff (Angela, Maiko, and Erin) the service needs and gaps workgroup. Below is a summary for each workgroup in terms of their progress.

Epi Profile

Summary of what was discussed:

• Select Stages of the Care Continuum and Unmet Need Framework among Priority Populations in the NY EMA by Race/Ethnicity, 2019
  • Unmet need defined as the percentage of clients with diagnosed HIV with no CD4 or viral load test in 2019
  • Priority populations: Young MSM, Cisgender women, Older people with HIV

• Data request to send to NYS DOH to be able to include Transgender women as a priority population
• Results of a data request submitted to DOHMH HIV surveillance: Estimated proportion of persons living with undiagnosed HIV in New York City by sociodemographic characteristics, 2020
• Data requests to be sent to NYS DOH:
  • The most recent year of demographic information for People with HIV (PWH) in New York Eligible Metropolitan Area (NY EMA) using HIV Surveillance data
  • Comparison of sociodemographic characteristics by suppression status: consistently unsuppressed, inconsistently suppressed, consistently suppressed (to be decided if needed)
• Discussion questions

Next steps:

• Go over the document: Select Stages of the Care Continuum and Unmet Need Framework among priority populations in the NY EMA by Race/Ethnicity, 2019 to answer some additional questions
• Mental Health: Explore results on Prevalence and Correlates of Mental Health Diagnoses among People with HIV Receiving RWPA Services in NYC

Resource Inventory

Provider Capacity

• Stigma Article- C. Rodriguez-Hart
  • Do we want to add questions around staff attitudes; staff norms; staff efficacy
    • Could do through role-play question with scenario to work from. 
• • Add questions re. self efficacy and norms
    • Perhaps: I feel competent and readily able to respond 
  • Insert question re. staff attitudes and competency after Q22
    • “When I see stigmatizing behaviors occurring in my workplace, I feel competent in responding… etc. “ 
  • Need to meet with AETC to discuss wording of stigma questions and if they can be changed 
    • “If I witness stigma happening in my setting, I feel capable of taking action to address it.”
  • Change Questions asking about addressing stigma as a priority 
    • Is it a priority in your workplace to address stigma? (page 10). 
      • Change to active language 
  • May need to include examples of bread definitions in certain questions
    • I.e. giving definition of health equity 
  • Need to confirm who this is going to (is it 1 individual per org, or does it go to a rep from the org to be disseminated to other team members). 
  • Make sure instructions are clear
    • Survey is going to individuals from org, NOT just 1 representative from orgs. 
  • Participant vs. client vs. person enrolled in program 
  • Q47- unmet need
    • What should be included in the question 
      • Keep it qualitative 
  • Q30- 
    • Add specific offerings (Johnell has list) 
  • Ranking questions
    • Ask for top 3 in bulleted list (do not rank all)
  • New additions/changes
    • “If I witness stigma happening in my setting, I feel capable of taking action to address it.”
    • “Is it a priority in your workplace to address HIV stigma?”
    • “Is it a priority in your workplace to address racial equity?”

Next steps: Finalize survey questions, develop an outreach/recruitment strategy in February, and review other data sources (e.g., fact sheets) and literature on provider capacity in March

Service Needs & Gaps

Discussion Summary:

Reviewed three separate housing need indicators. Need for permanent housing placement (PHP) and need for rental assistance are exclusive (those who are homeless or in an unstable or temporary housing situation and thus need PHP are not categorized as included in the need rental assistance category). The third indicator is need for any housing assistance which is inclusive and includes needing permanent housing placement, needing rental assistance, as well as those facing eviction or housing loss for any reason and housing quality/ habitability issues (e.g., no heat, mold). Tables and graphs showed rates of service need and ‘gaps’ defined as needing the service but not receiving the service. Short descriptive text to be added to results write up to explain definitions and highlight key findings to answer the following questions. What’s the prevalence of service need and gaps? Are there differences in needs and service gaps among subpopulations? How do these needs and gaps change over time? These findings and a final question, what are actionable steps that can be taken to address these needs and/or gaps, to be discussed during workgroup meetings. 

Reviewed housing results (see Key Takeaways below) and graph. All figures calculated using the whole sample (or whole subsample population) to highlight prevalence. The graphs show the proportion of persons with need who are not receiving the service – i.e. the service ‘gap’ among those who need the service. Additional labelling to be added to graphs to clarify. 

Fay and Amanda confirmed housing results are in line with their observations: even PWH who have jobs cannot afford housing. Cost of housing is pushing people farther out of the city or increasing the number of occupants per residence. Funding for housing assistance is available via RW, but limited since they are the payer of last resort (e.g., if eligible for HASA, will receive via HASA). Reviewed subpopulation results (see Key Takeaways below). Subpopulation graphs by service area to be added. After reviewing more services areas, needs and gaps by subpopulation will be examined for patterns. 

Reviewed behavioral health indicator definitions. There are two indicators for need mental health services. Need for professional mental health services is indicated by a score on a mental health measure comparable to inpatient populations or receiving psychiatric inpatient or other professional mental health care. This indicator is more focused on severity than the “any” indicator. A more comprehensive indicator, Any need for mental or emotional health services, is indicated by a score on a mental health measure at or below a cut-point indicating experiencing clinically relevant symptoms or self-report needing assistance with emotional or psychological difficulties (i.e., would include those with more serious mental health treatment needs). Regarding need for alcohol or drug (AOD) treatment or services, Need for professional AOD treatment is indicated by current hard drug use or problem drinking or report that receiving AOD treatment is important or currently receiving AOD treatment. A separate indicator of Any AOD treatment or service need includes persons who may not currently be in AOD treatment but self-report that substance use treatment or further treatment is important to them and includes persons needing supportive services to avoid use or relapse. Indicator labels to be adjusted to improve clarity and footnotes to be added to tables. 

Next Steps

1. February workgroup discussion: Review updated housing and behavioral health results and new case management, employment, and food and nutrition results.

Public Comment

There was no public comments period. The workgroups met until adjournment at 3pm.