Needs Assessment Committee Meeting November 14, 2024

Members Present: Rasheed Ford (Co-Chair), Raffi Babakhanian, Fay Barrett, Reginald Brown, Vanessa Decamps, Billy Fields, Steve Hemraj, Jennifer Irwin, Susan Mellender, Marcy Sedlacek, John Schoepp, Shavonn Stallings

DOHMH, PHS, NYS, CHAIN, and Other Staff Present: Doienne Saab, David Klotz, Michael Navejas, Kimbirly Mack, Adrianna Eppinger-Meiering, Sara Kramer, Cristina Rodriguez-Hart, Karen McKinnon, Alyssa Prince, Lilian Ha, Maiko Yomogida, Angela Aidala, Alex Furuya

Agenda Item #1/2:

Introductions/Moment of Silence/Minutes/Announcements:

Rasheed F. opened the meeting with new and existing attendee introductions. A moment of silence was held. The October meeting minutes were approved with no changes.   

Agenda Item #3:

Presentation – CHAIN 101

Maiko Yomogida (Community Health Advisory & Information – CHAIN) provided an overview of the research project’s goals, objectives, data collection methods, recruitment strategies, and types of analysis. She explained that CHAIN was established in 1993 as a general-purpose evaluation resource for the Ryan White Title I (Part A) Program of the New York Eligible Metropolitan Area (EMA). Its purpose is to address the needs of people with HIV (PWH), understand where they seek care, identify service gaps, and determine which populations are underserved. The project also examines which services are effective, which barriers or access issues exist, and which resources should be provided.

Maiko noted that the CHAIN project provides a quantitative profile of PWH in New York City and the Tri-County region, focusing on their health and social service utilization through comprehensive in-person interviews. Study participants are randomly selected at service sites serving individuals with HIV and receive a $50 transit/gift card for completing each interview. CHAIN emphasizes the inclusion of voices often excluded from research—such as individuals experiencing homelessness, transient living situations, or those with multiple competing challenges to accessing healthcare and social services. Data collected by CHAIN includes, but is not limited to:

• Current health status,

• Socio-demographic information,

• Housing,

• Mental and emotional health,

• Social service utilization, and

• Barriers to care.

The current cohort consists of 3,365 individuals with 12,529 interviews completed.

CHAIN is a critical resource for informing the following: Ryan White funding applications, needs assessment and priority setting, service planning, and advocacy efforts. Its findings also inform recommendations for the New York State Ending the Epidemic (ETE) Blueprint and other local plans to address the HIV epidemic.

The CHAIN team collaborates with Council committees to define topics, draft reports, and disseminate final reports. More than 20 CHAIN reports are publicly accessible, via the NY HIV Planning council website (CHAIN Reports (Template 12) – NY HIV Planning Council).

Some members raised concerns about ensuring CHAIN reports are written in a manner that is understandable to a lay audience. Maiko Y. replied that consumers are invited to participate in CHAIN’s Technical Review Team and NYC Department of Health meetings to provide feedback on reports. Angela A. emphasized that CHAIN tailors its reports to meet the audience’s needs, whether for HRSA applications or as brief reports.

In response to a question regarding the youngest cohort interviewed, Maiko clarified that CHAIN includes a small subset of participants aged 18-28. One member shared that feel that CHAIN’s sample population does not completely reflect a person’s life and challenges through the HIV care continuum.

Presentation – HIV & SMI Workgroup: Fostering a Cooperative Approach to Addressing Unmet Needs

Karen McKinnon, representing the Northeast Caribbean AIDS Education and Training Center – NECA AETC shared updates on the major milestones that have occurred since the establishment of the HIV and Serious Mental Illness (SMI) workgroup. This workgroup was initiated following a presentation to the NAC highlighting HIV-related services provided by the New York State Office of Mental Health.

Karen highlighted and emphasized the importance of the HIV & SMI workgroup’s quarterly meetings, which served as a platform for collaboration, problem-solving, and fostering innovation across siloed healthcare systems. These meetings focused on developing recommendations to improve the delivery of HIV services for people with HIV who also experience serious mental illness. It also aimed to build cross-agency consensus about the high priority activities identified during 2021 NAC-hosted forums addressing this population and topic.

Karen M. outlined the nine key priority activities and identified the agencies responsible for their implementation. As of July 2024, the workgroup’s priorities and main activities include:  

1. The development and maintenance of a ETE Dashboard to routinely update data depicting the full HIV care continuum on PWH with SMI in NYS. The data would include regional breakdowns, such as NYC boroughs and Tri-County/NYS information
   1. Update: Including individuals with both HIV and SMI in the ETE Dashboard is feasible but determining the frequency of routine updates remains under review.
2. The inclusion of PWH with SMI as a priority population in the NY ETE Dashboard.
   1. Update: Designating people with both HIV and SMI as a priority population on the ETE Dashboard is now implementable.
3. The implementation of a comprehensive HIV testing, treatment, prevention policythroughout OMH licensed and operated programs.
   1. Update: No direct progress has been made toward implementation.
4. The assessment and capacity building of care centers for people with SMI, including psychiatric hospitals, to administer, support & measure HIV testing, HIV treatment access, PrEP/PEP support – Update:
   1. Areas where improvement is needed: The provision of PrEP, condoms, HIV testing, and treatment monitoring does not align wit the current needs. Programs licensed/operated by OMH with high-volume HIV caseloads have tripled but on-site HIV testing is only available in about one-third of these programs. The percentage of programs not offering condoms to clients has increased.
   1. A NIDA-funded revealed that 96.8% of psychiatry residents were aware of PrEP, and 92%- 98% believed that PrEP was appropriate for all patients with psychiatric conditions. However, the likelihood of psychiatric residents prescribing PrEP to individuals with varied psychiatric diagnoses was significantly lower than that of family medicine residents. This disparity is partly attributed to the belief that prescribing PrEP falls outside the scope of psychiatric practice, highlighting the  need for more training, despite the overlap in serving this patient population.
   1. The scope of care centers for individuals with Serious Mental Illness (SMI) has not yet been clearly defined. However, the Medicaid algorithm holds the potential to identify areas where attention is most urgently needed.
5. The assessment of cost and clients benefits for developing a state- and city-wide integrated electronic medical record system or explore leveraging existing systems such Regional Health Information Organizations (RHIOs) or the Statewide Health Information Network (SHINY) to enhance service coordination of care for PWH who receive funded services.
   1. Update: Not currently possible since the restructuring of electronic medical records to enable cross-healthcare system collaboration and coordination is not feasible is presents significant challenges. Recently published federal Ending the HIV Epidemic (EHE) findings, including insights from DOHMH leadership, suggest a need for incremental improvements in the absence of a fully integrated care system.
6. The expansion of an HIV status neutral approach to prevention and treatment – Update: A recent review of peer-reviewed literature highlights the importance of focusing on interventions consistently associated with improved HIV-related medical outcomes and healthcare utilization. These include sustained case management and outreach efforts, which can be applied across the HIV status neutral continuum. Effective interventions for behavioral health outcomes in HIV settings involve task-shifting, peer support, and collaborative care. All the above require staff training, organizational support, provider and institutional buy-in, and sufficient investment to prioritize integration processes, create opportunities/incentives to leverage the existing workforce to create better integration of services. The NECA AETC can provide training to staff for improving awareness and building skills to address the gaps identified in ongoing needs assessments.
7. To build strategic partnerships to enhance capacity and establish routine HIV testing at sites where people with SMI regularly access care
   1. Update: Supported by Department of Health (DOH) data match, this effort is implementable. EHE jurisdictional partners, including DOHMH leadership, are committed to training staff and advocating for routine HIV testing at local program sites. These efforts are further supported by NECA AETC, which is conducting two separate needs assessments with providers in different service systems: i. outpatient mental health providers regarding HIV services offered and ii. RWPA-funded sites focusing on mental health services. Results will be appended to the final HIV & SMI report as soon as they are available.
8. Facilitating HIV testing at all OMH facilities. Adapt the STIRR (screen, test, immunize, reduce risk, and refer) model to routinize opt-out HIV testing during annual medical assessments for all clients that access outpatient mental health programs.
   1. Update: Currently HIV testing occurs in inpatient settings only; licensed OMH outpatient programs are not required to provide laboratory testing. Efforts to address “threshold issues” are ongoing at OMH, with a target date of October 2024 target for updated guidance. All agencies (DOH, OASAS, OMH) need to be aligned for progress. As of now, ono updates have been made to the June 18, 2019 policy directive (PC-1412) (https://omh.ny.gov/omhweb/policymanual/pc_1412.pdf). This directive outlines guidance for state-operated inpatient psychiatric facilities to ensure that all its affiliated programs comply with this directive. Outpatient program compliance is the responsibility of the recipient’s health care provider. A pilot program is reportedly offering PrEP to young ACT based on HIV testing outcomes. Follow-up from OMH is needed.
9. Designating PWH and SMI with unsuppressed viral loads as a priority population for outreach services that re-connect clients to care based on missed/high viral loads and missed prescription refills.
   1. Update – This effort supported by DOH Medicaid data is implementable with more detailed data pinpointing service organizations with low viral suppression rates and offering additional resources for (re)engagement and retention services as well as prescription refill supports.

In summary, Karen M. reported that the HIV and SMI workgroup had made significant progress in addressing service gaps for a highly vulnerable population – progress that surpassed what had been achieved through decades of research. The workgroup successfully developed local data to outline the challenges faced by PWH and serious mental illness. However, some obstacles remain unresolved, particularly those linked to siloed healthcare systems unable to adapt their operations to meet the complex needs of this population.

Karen M. highlighted several high-priority activities that the workgroup had to navigate successfully, given the 2024 configuration of the workgroup. She emphasized the need to nominate new members with decision-making authority to facilitate meaningful change and to keep the momentum of progress. Karen M. urged the NY HIV Planning Council to continue these efforts to overcome critical and life-shortening gaps in services for people with these co-occurring and chronic conditions. She recommended initiating another multi-year cycle of the HIV & SMI Workgroup to tackle the persistent barriers and gaps. She believed that the HIV Planning Council is well-positioned to lead these efforts, to organize and advocate for the unmet needs of people with SMI to ensure better access to HIV prevention and care.

Adjournment