MN HIV Services Planning Council
Meeting Minutes for May 10, 2005
Redeemer Missionary Baptist Church

 

 

I.          Welcome and introductions; lighting of the candle

Paul called the meeting to order at 9:00 a.m.  Introductions were made.  Antonio lit the candle saying it represents all of the people who are HIV positive in the world who want to care for themselves in mind, body, and spirit.

 

II.          Review the minutes and proposed agenda

The minutes were approved by unanimous consent with changes – Antonio was present and Nikosi’s name was added to the lighting of the candle section when Dan spoke.

 

III.   Open Forum

No one came forward to speak during the open forum.

         

IV.             Co-chair updates

Paul shared that there are a couple of things looming on the horizon for us.  There will be continuing work with Angela Wasunna who will continue the work she began with the Planning Council on developing a method for ethical decision making during the funding cycle and for policy advocacy, etc.

 

V.          Capacity Building update - Allison Rojas, Community Consulting Group

Community Consulting Group (CCG) is a group of consultants who have recently broken off from the Wilder Foundation. They have done work with Hennepin County for four years.  Allison is here to give an update of the capacity building activities that have taken place during that time.  The CCG has been contracted to work with providers to help build CARE Act provider capacity and evaluate that work.  She described pressures that agencies face in day-to-day operations and the strengths of capacity building activities.  Allison went on to describe the framework that CCG uses which is to: examine the need, develop a response, and then conduct the activity.  They have seen capacity building stop at that point due to a variety of reasons including changes to: external environment, resources, culture, life cycle stage and financial health.  Their goal is to see organizations move beyond that phase so CCG works with groups/orgs to ensure that the activities engaged upon are applied as practice.  Their goal is to improve the organization’s ability to meet their clients’ needs.  They also operate with a number of assumptions in their work (one size doesn’t fit all, there’s more than one answer to each problem, responses must be tailored to the organization, and activities must build capacity and independence). 

 

Allison then gave an overview of the capacity building activities in 2004.  Organizational assessments were done with specific agencies.  CCG also conducted two fundraising workshops based on a survey of providers.  There was also work with collaboratives and strategic planning with certain organizations.  Their evaluation component looks at the impact on the individual, organization, and client.  She then shared the survey tool that they’ve been using via email called Survey Monkey, specifying the personal impact component of the tool (i.e., how capacity development impacted staff personally, impacted their organization as a whole, and impacted the client).  Impact to the client relates directly to the outcomes established for funded providers.  Allison then reviewed the results of those evaluations with the group.  When asked how valuable the capacity building was ratings were:  personally 4.25, organization 4.5, and clients 3.14 (on a five point scale).  The main benefit was knowledge of effective practices identified when asked how it changed a person’s ability to serve those living with HIV/AIDS.  Increased ability of the agency to serve clients was the main benefit identified when asked how capacity development impacted the agencies in their work with people living with HIV/AIDS.  Overall every person said they would encourage others to attend if it were available.  Allison then reviewed some of the feedback that they received from Executive Director’s who had participated in some of the capacity development activities.  Overall the feedback was that the activities would enhance the impact on clients the agencies serve.

 

Folks who have received technical assistance then spoke.  Marie Graham, from Community Fitness Today, said the assistance was very helpful.  She, as a new Executive Director, received information that was priceless – they were able to figure out where the organization was and have done additional work in developing their board. 

 

Beth Zeiler, from Access Works, shared that they did a strategic plan to help figure out changes are occurring in their agency.  It was a great way to find out what other folks within the agency needed in the way of information sharing between programs and administration, as an example.  She added that it helped them get a sense of where the agency wanted programs to be in the next year, next three years, and has stakeholder input. 

Kevin Winge, from Open Arms, then shared his experience.  When he received the initial invitation to participate in capacity building he was a bit reluctant because he’s not a process type of person.  They did take advantage and the opportunity and have continued their working relationship with CCG.  One of the activities they did was to do focus groups with clients, volunteers, and other AIDS service organizations to see if needs were being met.  Kevin said he feels they are at least six months ahead of the process that they laid out and have seen direct client impact as a result of this work.  In the next few months they hope to expand their facility in order to increase the physical capacity for serving clients.

 

Organizational assessments and client level evaluation pieces will be available to service providers.  Contact Jonathan or Diane for more information on future opportunities.

 

VI.     Title II and ADAP update - Dave Rompa

Dave shared that an email has gone out explaining the compromise that MAP and DHS have come to on the HH bill that was proposed to the legislature.  He thinks it is a very good bill that will be helpful to the process.  MAP introduced a bill that was based on the Institute of Medicine (IOM) report.  When it became clear that there was no way a bill of that magnitude would pass, discussion began on how to compromise.  The final bill was sent on to Senator Berglin and it is currently in the legislative process.

 

NASTAD has proposed, and DHS is supporting, a $60 million increase to the CARE Act over the next four years.  It also suggests changing the formula used to determine funding.

 

They still do not know what will come out of the MN legislature’s conference committee regarding other changes to Minnesota Health Care programs.

 

Medicare Part D – they are still struggling through it.  They have received more guidance from HRSA and other federal agencies.  They will be meeting with the Health Care division at DHS tomorrow to discuss Medicare Part D in more depth.  There is a contract person coming through the aging department that will be able to help them get a handle on the changes and how they will be implemented.

 

Redwan and Howard, who helped with the audit and is with the disability division, are working with the consumer advisory committees.  Information and applications were handed out for folks who are interested.  There are two advisory committees – one for those in the metro and one for those in greater MN.  Redwan said they are looking for new members, specifically in the metro, and encouraged anyone on Program HH to participate.  The committee meets two to three times a year and serves as an opportunity to hear feedback from consumers and/or share information gained from the community and other trainings. 

 

Howard will also be heading up a new program in the next few months for which he will be the new physician/clinic liaison.  Delays in MCHA are due in part to forms not being returned to DHS to allow completion of applications.

 

A letter of intent was submitted to Blue Cross/Blue Shield of Minnesota to assist with the transition of African born individuals who are entering in to care for HIV treatment.  The grant would create one stationary case manager, one mobile care advocate, and one community organizer who would work with agencies to build capacity.

 

The policy position posts today at DHS.  They have to go through two rounds internally and if no candidate is found it will be posted externally.

 

Sam Soriano, a key member of Save ADAP, from Washington State passed away about two weeks ago.  He exemplifies advocates working on a community level.

 

Aaron Keith, Redwan and Dave are leaving next week for a national ADAP conference.  If there is any information that anyone would like Aaron Keith to bring back or questions that you’d like to ask please let Aaron Keith know.

 

BREAK

 

VII.   Title I update and contract process - Jonathan Hanft

Jonathan said he’d like to spend most of his time today talking about the contracting process because the allocation process has been completed, and the contracts are based on the allocations of the Planning Council.  He has handouts including his PowerPoint presentation, a new provider directory of all Ryan White Title funded providers (I, II, III, and IV), and a list of contracted providers for each service area/activity.

 

Training update – the grantee staff is continuing some of the cultural competency work done last year.  Intercultural Development Inventory (IDI), a method used to assess where each agency is on a continuum as far as cultural competency is scheduled for May.  There will be follow up as to how to move an agency forward based on aggregate results for each agency.  Contact Diane for more information.

 

Discussion moved to the contracting process.  Jonathan shared the overview of the whole Planning Council process from Lennie Green’s PowerPoint presentation used during the HIV Positive Committee’s technical assistance.  His focus today is on the procurement (contracting) process that follows priority setting and allocation.  Once contracting has occurred it is the responsibility of the grantee and the Planning Council to monitor and evaluate the process as well as reviewing the outcomes.

 

Provider selection happens in two ways, either by requests for proposals (RFP) or sole sourcing.  When deciding to offer sole source contracts, several considerations are involved.  They are: services for which a provider was selected through the RFP process in the past; a record of quality Ryan White service delivery, demonstrated HIV competency, an established infrastructure, is cost effective, and ensures the continuity of client care. 

 

The other mechanism for contracting for services is the RFP process.  When the RFP is issued providers submit proposals for consideration.  A community review committee rates the contracts on a consistent set of issues, i.e. program plan, agency capability, etc.  A proposal selection process is initiated, providers are selected, negotiations are completed with the providers and contracts are executed.

 

The timeline used for the RFP was then described.  Notification of funds available was sent out to agencies and information sessions were held with interested providers.  Agencies then submit letters of intent.  Proposals were due on November 19 and the review committee was trained on the process.  Members of the review team then reviewed each proposal and scored each one.  After meeting and discussing all proposals review committee members selected those agencies that would be funded and notices of award were sent to the agencies chosen. 

 

Jonathan then reviewed the required content that each proposal was required to address.  In the 2004 RFP there were a few new pieces including the combining of emotional support and health education, joint care and prevention/testing outreach, and fostering of collaboration.  He then reviewed information about the maximum number of contracts that could be granted, number of proposals received, amount available for funding, and the amount requested.  There were 56 proposals submitted for consideration. 

 

Discussion moved to selection of the proposal review committee.  Expertise is sought in specific areas, as well as, diversity of members and conflict of interest management including biases against specific providers.  When members are selected care is taken to ensure that the committee is as representative as possible, including HIV positive status, which is based on member self report. 

 

Jonathan then described the scoring mechanism used when reviewing proposals.  The grantee shared information about currently funded providers including spending for last two years and how many clients were served.  In deliberations the committee begins discussion by considering the rank of each proposal in order of the proposal score.  Other considerations are: strengths and weaknesses of proposals, number of proposals in the category, etc.

 

VIII.          Geographic Analysis (from the 2003 Needs Assessment) - Becky Kroll, CLEAR

Every three years CLEAR conducts a Comprehensive Needs Assessment.  In alternate years the Planning Council asks CLEAR to conduct analysis of this info focusing on various populations or issues. This year the Needs Assessment and Evaluation Committee, the Community Voice committee and the Planning Council asked CLEAR to analyze the Needs Assessment information from a geographical perspective – what are the differences between need in the metro, non-metro EMA and Greater MN areas?   Becky found while doing the geographic analysis that the results turned out differently than what she had expected based on “conventional wisdom.”

 

Becky began this analysis by using zip codes to identify a “Metro” group (Mpls-St. Paul – 155 people), a “Non-Metro EMA” group (non Mpls-St. Paul EMA – 54 people) and a “Greater MN” group (non-EMA – 32 people).  Becky presented a quiz to allow members to explore their knowledge and preconceptions versus the actual findings.  The methodology for finding people to interview for the Needs Assessment is a snowball sample, which is when one respondent recruits others who then become respondents.  Findings cannot be generalized to the entire HIV+ population in MN and is based on self-reported information.  There is probably a bias towards those who are in care/services.

 

Becky then shared the key points that she’s identified from this data analysis.  She talked about the HIV status indicators by geography. As a point of reference ten percent of those in the metro area have had an AIDS diagnosis.

 

Those interviewed were then asked to self-rate physical health, mental health, and diet and nutrition.  For mental health there was a higher percentage in greater Minnesota who said their mental health was good.  Needs being met included medical needs, mental health, diet, and need to pay for medical care.

 

In looking at the differences between the three geographical areas Becky pointed out similarities.  Those are:  self reported viral load, percentage of those with AIDS, and proportion of people with AIDS at first diagnosis.  Other key points identified were:

 

Metro area:

Largest number surveyed

More diversity

More racial/ethnic diversity

Younger

Higher average CD4 count

Less likely to have an AIDS diagnosis

 

Higher percentage working for pay

Income slightly higher (metro cost of living higher)

Housing is a major issue (lower rating for meeting needs, more barriers to affordable housing)

More domestic violence

Greater amount of current drug use

 

Higher average number of barriers to services

More likely to cite provider issues

More likely to cite cost/access issues

Travel fewer miles and use less time to get to physician

Less likely to cite barriers

More likely to cite provider issues as barriers

Less awareness and use of dental services

Greater use of food shelf

 

Non-metro EMA

Greater challenge to describe as a group

More women, more people with children, more Latinos and blacks

 

Higher percentage of people with AIDS diagnosis and AIDS at first diagnosis

Highest percentage of people with detectable load

Lowest percentage of those with CD4 count >200

Lowest percentage with current health insurance

 

Report better “environmental” conditions

Rate housing needs better met

Rate diet and nutrition better

Less tobacco use

Less current drug use and history of use

 

Highest percent of people reporting barriers to service but the number of barriers is lowest

Report higher percentage of cultural barriers to service

Transportation is a barrier

More likely to get WIC

More likely to have home delivered meals

Appear to be less connected (less knowledge of primary care services)

 

Greater MN

For people in greater MN there is the greatest number of statistically significant differences.  Those interviewed in greater MN are older than others surveyed in other parts of the state.  There are also more folks who are chronologically older and have been living with HIV/AIDS for a longer time.  They are more likely to report past drug/alcohol use and more likely to have been in treatment in the last five years also more likely to have been HIV+ at time of substance treatment.  They are more likely to have used injection drugs.  Of concern is the number of people who reported trying to get into treatment in the prior two years that were not able to.  But, there are a greater proportion of those with past problems who say they are now clean and sober. 

 

Housing may be part of the upside of living in greater MN and rate their housing more positively; also rate housing needs as better met.  They pay less for total housing payments but it is often more of a problem to make those payments compared to EMA and non-metro EMA respondents.

 

Those interviewed in greater MN also cited a number of barriers to medical care and services: 53% cite distance; 47% report transportation as barriers to medical care.  They report less access to congregate dining and food shelf than those in EMA and non-metro EMA.

 

Despite the environmental challenges those in greater MN report doing better clinically, based on self-report.  This group has the highest percentage of those with both CD4 counts above 200 and undetectable viral load.  Even though they may face a large number of barriers they seem to have overcome them and have become well connected to medical care. 

 

They also appear to be well connected in other ways: highest percentage of participation in clinical trials, highest percentage have talked with dietician or nutritionist about their diet, highest percentage in prevention for positives programs.

 

Conclusions and recommendations that were drawn from this analysis were to do further investigation with folks in the non-metro EMA.  Becky suggested convening two focus groups of consumers – one of more recently diagnosed people and one with those how have been living with HIV for ten years or more. 

 

In thinking about greater MN it might be useful to work with existing providers and networks to share these findings and identify issues, which are not adequately captured in this data.  This data is not necessarily representative all who live in greater MN.

 

A participant asked how people were recruited for the survey.  Becky shared that she found many people at conferences and events; many of these people further recruited others to do the survey.  The western part of the state was not covered well in the survey.  Because of ethical standards, Becky is not able to directly contact potential respondents and must rely on others to circulate her cards and wait for potential respondents to contact her, meaning they are self-selected.  Becky asks Planning Council members for help in developing other methods for gathering information. 

 

Question – how does sample distribution compare to epidemiological data?  Becky said that the sample compares closely to the epidemiological information.

 

IX.          Committee written reports;time for questions, discussion    

 

Planning and Priorities Committee

Request for ideas for Carryover – please submit ideas through Mary Doyle, Dan Capouch, or Bob Hansen in the next two weeks. 

 

HIV Positive Committee – Lenny Green, HRSA Technical Assistance provider, worked with the committee to develop a game plan and identified four priorities: Needs Assessment, Comprehensive Plan, Priority Setting & Allocation and Member Recruitment.  To reduce stigma around the name of the committee, it was renamed the Community Voice Committee.  Also, in order to reduce potential stigma issues the committee will meet at the Tubman Family Alliance rather than The Aliveness Project.  Meeting dates/times were also changed to the Tuesday prior to Planning Council from 10am-12n.  The committee was disappointed that the incentive program had to be discontinued due to a HRSA policy to reimburse members only for incurred expenses. 

 

Needs Assessment and Evaluation Committee

Community Participation Committee

Operations Committee

ADAP Ad Hoc Committee

Next meeting date and location – will be held on Wednesday, May 18 from 12:30-2:30pm at Hennepin Powderhorn Partners (1201 East Lake Street).  Due to a resignation, Francis is currently the only co-chair and encourages others to self nominate if they are interested in serving in this role.

 

X.                Announcements, evaluation, next agenda

 

Mary Dwyer – there are now bus tokens and taxi vouchers available for members.

 

Paul and his partner Bill are getting married on May 26.  A reception will be held on June 4 from 1:00-5:00pm.  No gifts please. Mary Doyle will forward the specifics of the invitation.

 

Documents distributed at or before the meeting:

·        Agenda and minutes from April 12^th meeting

·        Written committee reports

·        Geographic Analysis of 2003 Needs Assessment Quiz and Answers with supporting documentation

·        Geographical Analysis of 2003 Needs Assessment PowerPoint presentation

·        Services information from the Geographical Analysis

·        DHS HIV/AIDS Program Consumer Advisory Group Information and Application

·        Ryan White Contracting PowerPoint

·        2005 Title I and Title II funded provider list

·        Ethical Considerations in the Allocation of HIV/AIDS Treatment Using Title I and Title II Base Funds PowerPoint presentation prepared by Angela Wasunna

·        Implementation Model for Ethical Decision Making in HIV/AIDS Treatment Rationing handout

·        Carryover criteria and budget principles for 2005

 

MOTION: Gary moved Andy seconded to adjourn.

Adjourned at 11:25 a.m.