Needs Assessment Committee Meeting May 13th, 2021

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Meeting of the
Needs Assessment Committee
Amanda Lugg and Marcy Thompson, Chairs
May 13th, 2021, 10:00AM -12:00 PM

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

Members Present: James Satriano, Leonardo Ruiz, James Walkup, , Tim Frasca, John Schoepp, Francine Cournos, Karen McKinnon, Matthew Lesieur, Norine Di Giulio, Charmaine Graham, Randall Bruce, Fay Barrett, Amanda Lugg (Co-chair) 

DOHMH, PHS, NYS and Other Staff: Ashley Azor, Bryan Meisel. Roland Torres, Andrea Feduzzi, Graham Harriman, Cristina Rodriguez-Hart

Welcome/Introductions/Moment of Silence/Public Comment/

Review of the Meeting Packet/Review of the Minutes:

Ms. Lawrence opened the meeting with introductions and an icebreaker.  Introductions with pronouns were conducted and a moment of silence was held. The minutes were accepted

SMI & HIV RWPA Recommendation Drafting

Ms. Lawrence presented the draft of recommendations specific to the Ryan White Part A portfolio and live edited during the meeting. 

Highlights of the discussion include:

Slide 2: Who are PWH with Serious Mental Illness (SMI)?

  • How to best identify people with SMI in the portfolio
    • Is self-report enough?
  • How do we help clients get an appropriate evaluation?
    • What’s the process? Is it systematic? Does it apply to all clients? Where is the information recorded?
  • Because this applies to a broad range of people, including people doing food pantry – who should ask these questions and provide these referrals.
    • Goal is to have the portfolio providers facilitate referrals with warm hand-offs to a provider who can appropriately conduct the evaluation
  • This will further stigmatize the person if they do not believe they have a diagnosis, and the provider does.
    • Will require training of whoever is asking these questions/making this offer
  • Idea is to de-stigmatize the process of getting a psych eval
  • Separate out clinical v non-clinical settings
  • Need to figure out what kind of path will capture as many people as possible, and we should return to this after some reflection (slide 1)
  • Develop a decision tree

Slide 3 Mental Health Stigma

  • Appropriate cite Dr. Rodriguez-Hart’s work

Slide 4 Designate Additional Client & Program Support

  • Inclusion of consumer as part of the team as a peer
  • Where would the team be housed? In an agency? At the DOHMH?
  • Peers are members of the community, HIV+, usually not a regular staff member
  • All behavioral health providers should be linguistically competent and culturally safe
  • Don’t want to require that every program has late or weekend hours – makes programs more expensive, may not be useful
    • Need should track to population served, i.e. youth
    • Maybe we should say ensure a network of accessibility across the portfolio
  • Want to expand availability of low threshold services – changed availability to access

Slide 5 Designate Additional Client & Program Support (cont)

  • Important to give resources to clients but recognize that that is not sufficient.
  • Live resource map is a tool that can be updated by providers, i.e. Transatlas. 
    • A live referral site map would look a lot like the Transatlas site, where providers and clients can submit resources that are then verified and uploaded permanently to the site.

Slide 6 Designate Additional Client & Program Support (cont)

  • Current modified DOT does include other medicines clients take, but is limited to the care coordination service category

These recommendations, upon approval by the Needs Assessment Committee will go to the Executive then Planning Council Committees. The Integration of Care Committee will include these recommendations in the development of a revised behavioral health service model.

  • Clients will self-disclose not self-report
  • Obtaining the diagnosis, if the evaluation is conducted outside of the portfolio – which is very likely, since Medicaid funds this service, would be challenging.
    • Even if the clients are evaluated in the same site, if Medicaid pays for the services – challenging to get that information
  • Need an active referral and a way to track completion. Once the referral is complete, Ryan White is done with that piece
  • Can try to use PSYCKES and other sources to check on patients, but Ryan White cannot provide all of the services due to allocation and legislation
  • State needs to address these barriers
  • Need to identify a work around to ensure that Ryan White can identify those who would benefit from additional services
  • Could hire a psychiatrist to facilitate the transfer of information to eShare to ensure clients are able to receive care
    • Why does it need to be eShare? Why not use PSYCKES and RHIOs
  • How do we know if the service system is providing adequate services if we don’t know who the targeted clients are?
  • We already know Ryan White is failing these clients
  • How do we do chart reviews?
  • The imperative is to move the larger system of care.
  • Development of a decision tree will help us understand the flow/how people are triaged through services
  • Need to think about how we leverage Ryan White resources
    • That’s the goal of the program – to leverage other resources
  • Real need to have a team who can focus on  

Slide 7 Designate Additional Client & Program Support (cont)

  • Added PSYCKES

Slide 8 Follow the Data

  • Modified sentence to clarify goal for the evaluation of all clients
  • Currently referrals are not tracked in Ryan White
    • Can currently happen in Care Coordination, but optional
  • Dashboards are currently utilized but do not have the level of data highlighted on the slide
  • ART access isn’t the problem other then people need to be connected to funders
  • We constantly hear that no one feels responsible for a patient – when they are in a psych hospital or other site. 
  • Can’t control the entire system, but Ryan White can document these issues.
  • No one takes responsibility for PWH with SMI
  • Can Ryan White pay for inpatient psych care? Once the original funder won’t.
  • Need to think about what it means that if a client goes into a hospital, their viral load will not be addressed

Need to pick up at slide 8…

Public Comment

None