Needs Assessment Committee Meeting May 14, 2020

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Meeting of the
NEEDS ASSESSMENT COMMITTEE
Amanda Lugg and Marcy Thompson, Chairs
May 14th, 2020, 10:00AM -12:00PM
By Webex Conference Call

Members Present: Marcy Thompson (co-chair), Maria Diaz, John Schoepp, Leo Ruiz, David Klotz, Randall Bruce, Lisa Best, Rob Walker, Tim Frasca, Jennifer Irwin, Micah Domingo, Claire Simon, Amanda Lugg (co-chair), Billy Fields, Fay Barrett, Finn Schubert, Jamie Walker, Jim Satriano, Jonathan Reveil, Karen Mckinnon, Maiko Yomogido, Peter Durant, Mytri Singh, Press Canady

DOHMH, PHS, NYS and Other Staff: Cristina Rodriguez-Hart, Guadalupe Dominguez Plummer, Ashley Azor, Claire Simon, Graham Harriman, Johanna Acosta, Kimbirly Mack, Nadine Alexander, Roland Torres, Bettina Carroll

Welcome/Introductions/Moment of Silence/Public Comment/

Review of the Meeting Packet/Review of the Minutes:

Ms. Lawrence opened the meeting in partnership with co-chair Marcy Thompson with an icebreaker on foods we are eating or wishing to eat.  Introductions with pronouns were conducted and a moment of silence was held. The April minutes were presented and accepted. 

Review of Current RWPA Mental Health Services

The committee reviewed the guiding document, called the Standard of Care as well as the fact sheet – a compilation of data that reviews the past 3 years of the service. Following is any questions from the committee – copies of the actual documents were sent to the committee.

Standards of Care break down each service offered, how it is offered and who can deliver that service. Across the portfolio, some services, such as assessment, re-assessment, and development of a care plan are relatively standard and unchanged. 

In the standard of care – family refers to anyone the client defines in that way – does not need to be a blood relation. AOD stands for Alcohol and Other Drugs. The duration of sessions is aligned with a logic model from when the program was first rolled out. Groups are longer to ensure people have time to speak.

There is a screening for alcohol and drug use – using a validated screening called PHQ4 and the T-CUDS.

Peers help bridge the experience between clients and clinicians. Service coordination is unique to the RWPA model. 

Psych services are not frequently paid for through RWPA. Patient navigators provide critical coordination for clients and allow therapists to focus on therapy – helps retain and re-engage clients.

All services are required except psych visits and pysch evaluation, family AOD, treatment adherence is not required for group or family, biomedical counseling, wellness and seeking safety are also not required. 

Grantee has partnered with CUCS and with the AIDS Institute – agencies have sent their peers for training. Revised curriculum for seeking safety for peers to support co-facilitation. Patient navigator does not have to be a peers, but incentive program to support a peer getting the appropriate certification.

Mental Health Fact Sheet:

Lists goals of the program, criteria, breakdown of priority populations: Black/Latino, older people with HIV, transgender women, cis women of color and young cis MSM. Breaks down clients by age, gender, borough, risk factor and race/ethnicity.

Biomedical counseling is not common. Not a lot of clients are bringing in their partners for PrEP – clients want to protect the space’s intimacy for themselves.

Expended psych units are low because Medicaid is usually the payer. Not all programs offer Seeking Safety – some do not want to undergo the training. All programs have the ability to bill Medicaid – difficult to say what’s happening on that side. RWPA tries to offer the coordination that help facilitate access to MH services. 

Many programs are co-located with a medical provider – and must have a referral. 

No recent breakdown of who is falling into the psych eval/visit buckets – can do a data request.

Can the fact sheet provide an insurance breakdown – requires a data request.

The people who access RWPA paid psych services are not covered by Medicaid? 

            Possibly – they may have had a lapse of coverage – this is relatively common (Medicaid spend down)

Follow Up HARP Questions with Samantha Repka

Samantha Repka works at the Division of Mental Health – covering Medicaid policy. Last month she spoke about the basics of available coverage and how it is utilized.

Does the lengthy application process for HARP create more burden than it is worth due to the low number of people who are able to access services.

DOHMH maintains a database of folks who are covered by Medicaid and qualify for these services, Approximately 80000 persons qualify for HARPS – but there is a question of how many are PLWH. Possible to do a data match on this. Highest utilized service are peer support services.

RWPB funds some services that are for this population of PLWH and SMI.

People with mental health diagnoses in RWPA overall have higher engagement and lower rates of viral suppression.

Does access/receipt of HARP services result in better outcomes with regard to both HIV and SMI?

People on HARP exhibit higher use of services – which triggers eligibility for HARP.

Lack of data – across this population – makes it difficult to plan for services that could provide support.

How can we plan in a purposeful way?

Difficult to know what to track – or how to track without stigmatizing/ engendering stigma on part of provider, etc.

DOHMH does have a Medicaid warehouse. 

Is it possible to establish a partnership/cooperative agreement with the Division of Mental Hygiene to track outcomes for people who fall into both buckets – HIV and SMI?

DOHMH tracks from a policy perspective – HARP is a state program. City does not run Medicaid benefits – but does provide supplemental funding for behavioral health. Particularly for people who do not qualify for Medicaid. The city tracks data, but does not have a role in Medicaid service delivery.

Bureau of Mental Health does run interventions across the city – such as crisis respite – providers receive funding from Medicaid and from the city to ensure that there is a funder if you do not qualify for Medicaid. 

There are a lot of different funders that provide an array of services – but no coordination or data sharing among these entities such as RWPB, AI, Medicaid, NYS

Summary

All RWPA programs are located throughout the five boroughs.  One is FQHC, three are hospital-based, and the remaining five are CBO. 5 out of the 9 are facilitating the Seeking Safety intervention

Understand that outcomes are an issue – but requires system change. RWPA needs to work with other payers to figure out a plan that would be effective. Really hard time getting state to the table.

OMH and Oasys are part of the larger Department of Health – perhaps that is who we need to be talking to.City has done a lot of work to quantify the work.

Possible to publish a report on the challenges of getting a clear picture of this population.

This needs to be part of the ETE plan – to get the state front and center.

Put into writing a formal letter – that asks for engagement and responses. If we would get Dr. Daskalakis to sign on – would have more teeth. 

Get other partners to sign on as well. 

Office of Medicaid and Office of MH have a closer relationship.

Could CC the commissioner on behalf of the planning body. RWPB does not fund MH services – funds MH education. 

Questions from the chat:

Q: Have we spoken to PWH who have SMI getting Ryan White services to see what the barriers to viral suppression are? 

A: NO – we have not asked clients to come to the table. We have spoken at length with providers.

Q: Using epi, if there are 80k with smi, 4-5k min would be expected to be in need of hiv svcs

A: We matched the DOHMH SMI registries against the entire HIV registry – and came up with 1326 (of which ~344 were deceased). It is entirely possible that more people fit in the “bucket” but it would require Medicaid data to find the population (and still wouldn’t be everyone). It may be possible to conduct another match through the Medicaid warehouse, but it would need to be cleared through legal (I will inquire)

Q: Where and how are people in HARP programs screened and tested for HIV?

A: TBD

Q: Not all people with SMI are in specialized, highly-resourced programs.  Do we know what percentage of those with SMI are in the specialized programs, and their HIV status?

A: Not sure where we would find this information, but will ask BMH

Q: do navigators in RWPA engage clients around readiness for mh/su treatment to support them until they’re ok with accepting needed services?

A: yes, one of the training we encourage patient navigators to receive is motivational interviewing and enhanced patient navigation which addresses engaging clients around readiness.  Also, programs address this during clinical supervision to identify best practices with engaging and retaining clients in care.

Follow up Q: any measurement/gauge of whether folks who get those services ultimately engage in bh care?

A: Will forward q to grantee

Q: For RWPA Biomedical Counseling  – Partners- 1 Insured and the other is Un insured.  What does that look like?

A: Only the client needs to be eligible for RWPA

Q: in RWPA is there routine screening for mental health and substance use disorders? different then psychosocial or psychiatric evaluation

A: Yes, PQH-4 and T-CUDS

Q: Why not making 60min across the board, ( Group / Famil 60 ) – Indv 45min

A: The duration of sessions are aligned with the rates for each service.  But this is something we can consider changing in the future.

Public Comment

None