Tri-County Steering Committee Minutes November 10, 2021



November 10, 2021, 10:05-11:35am

By Zoom Videoconference


Members Present:       S. Altaf (Co-chair), J. Palmer (Co-chair), D. Ahmed, V. Alvarez, L. Beal, J. Gago, M. G. Ferone, G. Harriman, B. Malloy, K. Mandel, C. Oldi, M. Piazza, G. Plummer, S. Richmond, L. Reid, V. Schneider, K. Scott, S. Thomas

Members Absent:        M. Acevedo, L. Best, L. Bucknor, A. Contreras, M. Diaz, D. Dominguez, L. Hakim, A. Hardman, P. Laqueur, A. Pizarro, A. Ruggiero, D. Scholar, T. Seabrook, A. Simmons

Staff Present:              NYC DOHMH: D. Klotz, M. Lawrence, S. Spiegler, J. Acosta, D. Ferdinand, G. Navoa, R. Torres, W. Riley; Public Health Solutions: D. Ortiz; CHAIN: D. Norman

Agenda Item 1: Opening/Moment of Silence/Minutes/Announcements/Public Comment

Mr. Altaf and Mr. Palmer opened the meeting followed by introductions and a moment of silence.  The minutes of the October 13, 2021 meeting were approved with no changes. 

Ms. Schneider announced that there are still funds available in the Emergency Financial Assistance (EFA) program.  Mr. Oldi announced that Legal Services of the Hudson Valley is holding a “Know Your Rights” and community needs assessment on December 2nd

Agenda Item #2: Updates

Consumer Update

Mr. Alvarez reported that recent discussions by consumers about difficulties with services provided by Westchester Department of Social Services are meant to help find solutions and improve services.  Just recently a client was not able to get needed transportation.  These kinds of issues need to be resolved.  Also, everyone should promote the EFA program, which is a vital lifeline for many consumers.

Recipient Update

Ms. Plummer reported that the NYC Board of Health issued a resolution declaring racism a public health crisis.  This supports DOHMH’s focus on health and racial equity and incorporating anti-racism into DOHMH policies.  She congratulated Hudson Valley Community Services for receiving a World AIDS Day award for their EFA program extending the service to reach the entire EMA during the COVID-19 crisis.  A new HRSA policy eliminates the need for 6-month recertification.  The Recipient will soon issue a communication about new requirements to all Ryan White Part A (RWPA) contractors. 

On December 14th, DOHMH will issue a request for proposals (RFP) for RWPA Housing programs in Tri-County.  Proposals will be due on January 24, 2022, awards announced March 15, 2022 and programs will start June 1, 2022.

Planning Council Update

Mr. Klotz reported that the Council’s Needs Assessment Committee has started work on a new comprehensive needs assessment.  The Integration of Care Committee is working on Standards of Care for NYC programs, and will incorporate feedback into the draft Framing Directive.  The Consumers Committee is developing a workshop on the newly Council-approved HIV & Aging Service Directive for the December 14th Power of Quality Improvement Conference.  The PSRA Committee reviewed data on NYC-based Non-Medical Case Management and Early Intervention Services. 

Mr. Harriman reported that there will be a presentation at the November 18th Planning Council meeting on Project PROSPER, which is the plan for federal Ending the HIV Epidemic funds in four counties designated by HRSA and CDC (Bronx, Manhattan, Brooklyn, Queens).  There will also be a presentation on CHAIN data concerning PWH and COVID-19.  In response to a question from Ms. Beal, Mr. Harriman and Ms. Plummer reported that incentives for remaining undetectable are given through the NYC-based “Undetectables” program, as well as a pilot project with RWPA NYC Care Coordination programs.

Agenda Item #3: Follow-up on Tri-County Housing Services

Mr. Ferdinand presented a follow-up to questions that arose from last month’s presentation on HIV housing services in the Tri-County region concerning the disparity between NYC and Tri-County housing resources.  NYC has a huge investment in HIV housing through the HASA program, which provides emergency, supportive and permanent housing, in addition to RWPA and HOPWA services and services provided by the NYC Department of Homeless Services (shelters, placement, eviction prevention).  NYC Housing Authority also provides public housing and vouchers.  Advocates in Tri-County can provide data showing that the region is underserved and advocate for additional funding and resources.  VOCAL has been advocating for years for HASA in all of NY State.

RWPA Housing programs in Tri-County consistently spend their entire allocation and above, even though the allocation has more than doubled in the last five years (from $572K in 2017 to $1.2M in 2021).  This increase was done despite consistent reductions in the overall grant award.

Agenda Item #4: Draft Framing Directive

Ms. Lawrence presented the draft Framing Directive approved by the Integration of Care (IOC) and Executive Committees and voted down by the full Council.  The Directive is being presented to the Council’s committees and the public for additional feedback and revision.  Formerly known as the Master Directive, this document guides all services in the Ryan White Part A portfolio.  The Directive utilizes an implementation science framework to clearly establish the context of the portfolio and align implementation strategies with that context.  In this directive, the entire Ryan White Part A portfolio is considered as the intervention.

The first sections of the directive, Determinants, Intervention Characteristics, and Inner Setting, Outer Setting, Characteristics of Individuals Implementing the Intervention and Process establish the context in which the Ryan White Part A portfolio operates. The Implementation Strategies and Mechanisms are evidence-based responses to this context that seek to achieve optimal service delivery and health outcomes for PWH.  The Outcomes (Implementation and Clinical/Patient) are the identified metrics to track the portfolio’s progress (or lack thereof) in improving health outcomes.  Two relevant inner settings (Care and Treatment Program (CTP)/Department of Health & Mental Hygiene (DOHMH), and RWPA Funded Organizations) describe expertise, organizational structure and bureaucracy and the stigma and equity characteristics of both.  Outer Setting Characteristics are drawn from the DOHMH EHE Situational Analysis (e.g., generally high but inequitable achievement of outcomes along the HIV care continuum). 

The Directive describes implementation strategies to be initiated over time.  To prevent redundancy, organizations may substitute other work, with CTP approval, for the following strategies: 1) pay equity & racial equity analysis; 2) organizational stigma assessment and plan that must be conducted by all contracted & monitoring bodies; 3) prepare consumers to be active participants in the implementation of client centered care; 4) facilitate the development of client crisis plans grounded in research; 5) train staff to deploy non-police alternatives, where police are called as a last resort; and 6) develop mechanisms to enhance or modify programs mid-contract to reflect emerging evaluation. 

Quality Management-related strategies include: 1) recruit, identify, train, and prepare organizational champions to ensure participation in quality improvement processes; 2) collect new and updated client assistance resources to create a searchable live site/resource map that facilitates the completion of comprehensive and appropriate referrals and linkages; 3) provide technical assistance to enhance uptake of current and emerging technologies that reduce client and staff burden train staff to deploy non-police alternatives, where police are called as a last resort; and 4) support tools and activities (technical assistance on organizational development, grant writing, development of mutually beneficial collaborative funding opportunities) that support the development of a multi-organizational initiative that facilitates leveraging supplemental public/private funding sources to build economies of scale. 

The Directive requires training and education of stakeholders (e.g., hard reduction, trauma-informed care, outreach protocols, health equity, anti-racism/anti-oppression, gender affirmation).  Training calendars and resources should be coordinated throughout DOHMH, DOHMH will incentivize inclusion of disproportionately impacted populations of PWH, and DOHMH will support modifications to existing spaces, resources, and materials to ensure reasonable accommodations to persons with any type of disability.  DOHMH will also modernize and streamline data collection to minimize data burden and improve identification of unmet needs, set up an anonymous suggestion box to field questions/comments from program staff, and funded sites will set up mechanisms for clients to provide each other with social support to reduce stigma and isolation.  

The Recipient (CTP) will report on the outcome measures to the Planning Council to be reviewed by a workgroup, made up of the recipient, the Council and agency representatives who have the authority to examine and amend the outcomes, and determine the methods and a timeline of outcome data collection that is feasible to RWPA providers, the Council and the Recipient. 

A summary of the discussion follows:

  • Some requirements can be implemented quickly, but some will take several years.  Some can only be implemented when a service is re-bid.
  • The intention is to not overburden providers, who already have a large data and reporting burden.  Adequate time and resources need to be preserved for direct client services.
  • The Recipient will be mindful to not require programs to duplicate efforts already underway.
  • Implementing these requirements will be very different for a small CBO compared to a large hospital.  The Recipient will work to tailor initiatives to organizational needs.

Committee members were encouraged to send any additional feedback to the Council staff.

The next Committee meeting will be held on December 8th, 10am.

There being no further business, the meeting was adjourned.