MN HIV Services Planning Council
Meeting Minutes for December 11, 2001
Division of Indian Work
1001 East Lake Street
Don Anderson Norma Atuesta
David Bergquist Jim Huber
Michael Allen Beyer Sandra Leaver
Linda Brandt Steven Moore
Willie Bridges
Sheila Brunelle
Clarence Charles
Megan Ellingson
Frank Guzman
Efran Tovar Leon
Judi Marshall (co-chair)
Mary May
Nick Metcalf
Jerry Moss (co-chair)
Tim O’Brien – via phone
Bob Olander
Helen Doris Reed
Sarah Rybicki
Michelle Sims
Debra Smith
John Whalen
Community Members Present: Guests:
Bob Tracy Sarah Senseman (2x)
IGA: IGA arriving at 11:00:
Lori Lippert Julia Ashley
Tracy Sides Dave Rompa
Jennifer Thompson
Meg Hargreaves
Julie Hanson
Lucy Slater
Staff: Consultants:
Mary Doyle Becky Kroll
Wardell Thompson Juan Jackson
Mary Dwyer (minutes)
The meeting was called to order at 9:15 by co-chair Judi Marshall.
II. Review of the November 13th minutes
Sheila moved and Linda seconded approval of the minutes.
III. Co-chairs update
Judi Marshall passed out information to help define the role of the Planning Council members – advocate and planner. Members may also have additional roles in the community that are not related to the Planning Council. It is important to keep these roles separate and distinct. Judi then passed out information regarding the challenges of conflict of interest for members. She asked everyone to review these documents on his or her own. At the next Planning Council meeting members will be asked to update and sign their conflict of interest forms.
At Executive Committee meeting there was some discussion about the MDH RFP for the Health Disparities grant. Some had suggested the Planning Council apply for planning money. It was discussed at great length and the decision was made not to apply for any money. The reason cited for not applying were: the deadline was too soon, we couldn’t find great need for the money and other agencies should have that money available to them to expand their capacity in working with those with HIV.
Discussion about the transfer of Title II from MDH to DHS was also briefly shared. Judi wanted to give a little background before the presentation at 11:00. Lori shared that MDH and DHS created a joint response to questions brought by the Executive Committee.
IV. MHSPC staff updates
Mary Doyle shared that IGA staff are doing proposal review so they are not here now but will be over at 11:00.
Mary Doyle announced that the Operations Committee would now be meeting at Powderhorn Park.
Planning Council location
Mary Doyle asked for feedback on the meeting location and shared information about parking available and solicited questions.
Mary Doyle also shared that minutes need to be certified and put on the internet within six weeks of the meeting. Mary Doyle will hand write changes then ask the co-chairs to sign the handwritten changes to signify they’ve been certified. That copy will then be kept in the Planning Council office. The printed changes will be made after the meeting and the amended and certified minutes sent to the website.
We’re continuing to work on speeding up reimbursements. We hope to have more information for the meeting next month. The hope is that we can set it up in an ATM or gift type of card that can be added to. If not, Becky and Juan will reimburse directly with checks. Clarence asked for clarification about the problems that have occurred in the past. Mary Doyle shared that she, as staff, cannot hold a County checking account. The turnaround time has been good for a large organization but is often too long for replacing out of pocket expenses.
V. Working group updates
Jerry provided an update of the linkage group. Members are still being identified.
Bob Tracy provided an update of the statewide group. At the retreat it was identified that there needs to be a connection of HIV services and prevention and that we need to develop a strategy for statewide services. The goal is to act as advisory bodies to the Planning Council and Task Force. Bob T. passed out a discussion draft for how the groups would move forward. There has been discussion in committees about the composition of the groups. Bob T. thought it best to share the concept of the process so everyone could understand where the ideas are coming from. The working groups will act as a steering committee for the statewide plan process. Once the members have been defined, a retreat will be planned. The purpose of the retreat will be to give staff direction in obtaining research information. A second retreat will be held a couple of months after the first to cull information obtained.
Some items on the handout are in italics because the working group needs to sign off on them. Half of the members will be appointed by the Planning Council and half by the Task Force. A group of advisors will also be included – IGAs and statewide organizations are examples of this. A dozen and a half to two dozen advisors will be working with the group. Bob T. presented the list of recommended members of the group – as identified by the joint co-chairs. The ex-officio members will be involved in every step of the process (being notified of meetings, etc.) except voting. Judi asked for clarification on the Planning Council members slated. Bob T. explained they were all appointed members who expressed interest in working on the plan.
Frank asked for clarification of how the process was begun. His idea is that this work should be being done in a committee – like all other Council work. Mary Doyle clarified how the process was developed through the retreat. Judi added that HRSA is also asking us to do a statewide plan. Lori shared that Title II is a responsibility of the CARE Act. Lori further clarified that the Planning Council identified it as a priority at the retreat but the government representatives have been looking at this for a couple of years now. She looks at this as a joint project and a larger partnership. Helen raised the issue that the groups still don’t look racially diverse and that should change. Bob T. said that advisors could be identified to assist in that area. Bill shared that the composition doesn’t reflect many that are positive. Bob T. clarified that the advisors could be added to reflect both the racial diversity and those who are positive.
Bob T. responded to the questions. To Frank’s point re: committee work – we wanted to connect services and planning activities to look at these issues, which we seldom consider. The other is recognizing that this is an unusual level of work, which will go back to both the Planning Council and the Task Force. Debra said that we shouldn’t put the structure in place and then try to include those we’re trying to serve (i.e., people of color and those living with HIV/AIDS). Bob T. addressed the issue of people of color. What is represented are Native American communities, Efran was thought to be included because of his work with the migrant population outstate. We have had conversations discussing the issue of racial representativeness. He thinks it’s important that people continue to forward names of those who may fit these areas.
Bob T. summed up that this is about providing services in greater Minnesota. Since there are only twelve spots the focus was put on selecting those who provide services to those represented in outstate Minnesota – making sure we don’t lose sight of Native Americans, migrants and those who live in outstate Minnesota. He suggested that if this doesn’t meet the goal, the group could be enlarged to 15 to try and address these concerns. Lori said numbers might not be key but names of those who know someone that knows the needs of those in greater Minnesota is important. She reiterated, finding the right people is the goal, not increasing the number just to get more people. Tim suggested we not impede the process by stalling at this point. He suggests moving forward, being mindful of the ultimate goal, so as not to stall the process.
Judi shared that approving those slated is the goal for this meeting. She and Jerry both approve of those slated. She clarified that more HIV+ need to be represented. PROPOSAL: To authorize appointment of up to sixteen members to this working group – coordinating with members of the task force, specifically to include members who are HIV+ and/or racially diverse. Helen moved to make the proposal a MOTION, Linda seconded – approved unanimously.
VI. SAR presentation and discussion
Becky began by sharing information about SAR presentation and the information being reported. Home Health Care information has only been captured two times so we have limited information to date. Becky shared that the first page is used to identify over or under utilization of services. Bob Olander suggested that this does not accurately represent those who receive these services in other areas. Lori clarified that this is more of a supplement wrap around. More of an access – eligibility status. There are groups of people receiving these services that are not included in these numbers. Bob O. asked who would have that data – on those not receiving Ryan White funding. Lori suggested that no one may be capturing that information in aggregate form. It does exist in private systems.
The outcomes identified here are basic living support – not nursing care. Emotional support or reduced isolation was the second outcome. Data was collected on 19 people the first time, 26 the second time – so we have very small numbers to work with. The target groups identified are hospitalized in the last thirty days, see a physician twice a month or more, homebound, lack of support and mental illness diagnosis. One place where there is a positive movement in the intended direction is in identifying other services. Bob O. asked if the responses are factored by the state of health. John clarified that yes; the severity is a factor. The other thing that happens is that whenever a new service is involved, there is an upsurge – which is uncomfortable until they get used to it. He likened these responses to those that many of us experience with changes in day to day life. He also suggested that when looking at home health care (whether HIV related or not) there have been many problems in the industry such as staffing that might have a large impact as well. Bob O. asked for clarification about whether this is an issue of quality of care. Juan shared that those who he’s spoken with in the past year who have since passed away have shared this type of service is difficult. Tracy reminded the group that this discussion is very appropriate but because the numbers are so small it’s hard to find significance. Linda shared that the data is available by the payer so we should be able to get more information about how many are receiving these services.
Sarah shared her thought that good presentation stimulates good conversation. All the points she was planning to cover were brought up. Mary May shared that having experience in this area for the last twenty years, she knows that the degree of skill funded would make a big difference on outcomes. Having more skilled nursing would provide better outcomes.
VII. Committee reports
Sheila provided an update from the meeting. Only one SAR was reviewed – Home Health Care. Because of the extensive discussion on the Consumer Satisfaction Survey, another meeting was scheduled and further discussion was tabled to that meeting. The issue of evaluating services that are no longer funded was also discussed, as was the issue of asking those who are no longer funded to participate in fielding the Consumer Satisfaction Survey.
B. HIV+ Committee
Bill Seed provided an update of the HIV+ committee. The committee would like to propose a change in the meeting times of the committee and flip with the Planning Council meeting so those driving in from outstate would be able to drive during daylight as much as possible. HIV+ will discuss it again this afternoon and take it to the Operations Committee. Mary Doyle suggested it might be useful to get a sense of how Planning Council members feel. Don said lunch should be included if meetings will be held all day long. Helen concurred.
C. Community Participation Committee
Clarence provided an update – no members have come forward to participate in the committee. Clarence has recommended that this committee be disbanded. Judi recommended that Bob Tracy and Clarence discuss this and bring it back to the Executive Committee.
D. Operations Committee
Helen shared that we are in the process of finalizing the recruitment plan for the next round. We are also finalizing the attendance policy and will be bringing it back to the Executive committee then on to the full Council. Jerry asked if we have any new applications for membership – we are solidifying the attendance policy before soliciting new members.
E. Planning and Priorities Committee
Linda provided the report. Mary Doyle has been leading us through many planning exercises. This has led us to gaining more information about testing and counseling provided. This has also been helpful in learning more about reporting. The format of how we collect qualitative information has come up – we’re trying to find a way to present the information we gain in a more uniform and useful way.
VIII.DHS and MDH re: possible Title II transfer
Julia Ashley and David Rompa
The discussion began with introductions of guests to the Council. Julia passed out information about how the Title II process currently works and explained the flow to the Council. She also provided information about the history of funding prior to Title I funding being added. Based on the fact that DHS has a longer history of providing services throughout the state, they made the transition of having them do case management. MDH doesn’t do direct services and have very few people who have that experience – Julia and Julie Hanson are the only ones with that experience. DHS has a long history of providing services and the idea is that MDH and DHS would continue to work together.
Julia then shared the proposed plan for after the transition. The main piece that would change would be grant administration. She then solicited questions from members. Juan asked about continuing data collection at MDH and if there has been discussion of moving that. Julia shared that they have quite an extensive history, with changes and growth – there’s no need to change that at this point.
David asked why case management money comes out of Title II. Julia clarified that it’s a combination of Title II and State funds. It is then contracted out.
Megan shared that MDH has had a public health/assurance function. DHS has not always had that piece. Lori added that public health isn’t the only service that does gap analysis. Megan qualified that this is more of a philosophical or operational place. This is a separate function that MDH staff has brought to the table that will continue.
Bob Tracy shared that we’ve combined Title I and Title II planning – has that been discussed. Dave said that would remain status quo. Much additional information, including responses to the Executive Committee’s questions were passed out. Bob Tracy then shared that DHS has been a significant service provider, with a lot of funding. How will this work if the grantee has a primary role in setting the budget proposals? Now we’ll have a situation where the grantee will also have significant funding – where will the checks and balances be? Dave referred to question 8 and it’s response. Bob Tracy said this is not an adequate response because of ADAP and other funding that the Planning Council is not included in. Further consideration needs to be taken in this issue.
Becky went back to the data collection piece, suggesting that consideration be taken when developing the transition. Multiple reporting has been a barrier in the past in collecting data – the thought is to consolidate these processes a bit. Becky shared that from a provider perspective – layers of evaluations and forms have been a barrier. Lori suggested that during a transition is a good time to look at these issues and examine the way we want to keep the system going. This is an opportunity for us to look at these issues.
Bob Olander asked about the capacity issue to make this happen – the way dollars move, the economy – would it require additional people? Is there a comfort zone that the transition could happen without more administrative dollars (more money or staff)? Dave said they’re not adding staff to cause this to happen, we’re approaching this as a management team of existing staff to see this happening. Bob Olander then asked if the service provision is required by the State, like ADAP. Lori shared that State insurance is but not Title II funding. Bob Olander mentioned that some states are contracting welfare services out rather than providing them. Bob Olander then asked how Julia and Dave see the Planning Council being involved in the accountability – how can we make government accountable. Judi said we do have indicators of how Grantees perform. Lori shared that the Planning Council’s responsibilities are needs assessment, priority setting and evaluating grantees. Dave shared that DHS has introduced a whole new department addressing this issue.
Linda asked if the RFP process to rural Counties would move to DHS. It’s already at Hennepin County and will stay there. The public health system will stay as it is. Bob O. echoed Linda’s concerns about keeping our allies in local public health.
Bob O. then asked about the opportunity to create a stronger link between HIV, chemical and mental health. Dave shared that they are looking at developing access training to see that this has begun. Those discussions and links are already being worked on. Obviously, that needs to improve and we’re working on that. Julia acknowledged the great role rural providers of public health in both prevention and services and the desire to continue that. Bob O. suggested that sometimes those involved outside the unit (i.e., chemical dependency) are often better suited to evaluate this because it’s out of their “turf”.
Dave stated that the three agencies have worked very well together and that should continue. He then passed out a flow chart of staffing at DHS so people could see the structure. (Note that Lori should have a dotted line below here – she does not directly supervise those staff.)
Bob O. reiterated that we will have an agency that is involved in planning, providing services, and to get the rest of the pieces – and feels that it’s crucial that this group (the Planning Council) be involved in all of the steps and is a big provider of services. Bob Olander asked if this is an attempt to merge two different entities (check which ones with Mary Doyle). Lori shared that this Governor may be looking at balancing services. Bob O. said he’s proposing that this be looked in to. He’s hopeful that merging this may be a good thing – and that it acts as a catalyst for positive change. Dave shared that the models that come out of this can serve as an example to other areas.
Jerry shared that Title II is charged with holding forums - will the outreach workers be looking at this? Dave said they would look at setting these up. Judi asked about DHS’ continuing role in the Planning Council. Dave shared who sits where and how that might change. Judi then asked for clarification - we’ve been talking about if, reality is – is it going to happening? DHS and MDH have approval, the Governor has to make a legislative change and HRSA will have input. It should be effective April 1st when the new contract begins. We won’t know definitively until prior to April 1.
Discussion moved to an update on the hiring process. Lucy shared that they’ve interviewed many, made a decision but she hasn’t made an offer yet. The hope is that someone will be in place on January 1.
MOTION: Clarence moved and Linda seconded adjournment of the meeting. Passed.
Adjourned 11:55