Meeting Date: April 22nd, 2002
Meeting Place: City Hall, Room 201
Meeting Time: 4:30pm - 7:30pm
I. Call to Order
II. Roll Call
See Attachment A. 26 of 31 members present; a quorum was reached.
III. Review and Approval of Agenda
The Agenda was approved.
IV. Review and Approval of Minutes, March 25th, 2002
Mjay Sanders has made some changes to the minutes; he will email them to Robert Owens. The minutes were approved, with changes.
Brad Hume spent the day with Karen Wuopio at the Marin County Department of Health and Human Services. Brad thanked Karen for a great day. Brad Hume stated that he wants proposals from Providers about how cuts are going to impact their services and how they are going to handle it.
Toni Butler handed out monthly reports about STD’s and syphilis. See Handouts San Francisco Monthly STD Report and Epidemiological Characteristics of Early Syphilis Cases 2001-2002.
Catherine Geanuracos stated that the deadline for the Provider Survey portion of the Needs Assessment is extended to Friday.
Mark Dunlop requested that more council members need to attend the PWA Caucus.
Ken Pearce inquired how many providers are represented by the Provider Network. Jim Illig responded with 50 to 55 providers.
Catherine Geanuracos conducted a Straw Poll concerning who would like to speak for public comment; 19 people responded. Catherine indicated that only one person from each agency speak, each person gets one minute, and public comment has been extended for 20 minutes.
Jim Illig announced that the Provider Network would continue to discuss ideas and gather information about the Targeted vs. Proportional cuts position from other agencies.
Naomi from Lyon Martin stated that she is in favor of targeted cuts, and is concerned about cuts to primary care.
Virgin Lazarus, an HIV+ woman, announced that across the board cuts will reduce women getting services.
Miriam Johnson, a HIV+ woman who uses Lyon Martin stated that Lyon Martin has helped her out a lot; she got medical attention, mental health services, and housing services. She feels that across the board cuts will hurt primary care.
Henry Johnson, an HIV+ heterosexual male who uses the Continuum Program stated that there are not a lot of programs for heterosexual men and he has found there services to be great. He is in favor of targeted cuts.
Tim Goldstone from Tom Waddell, is in favor of target cuts. If proportional cuts are used he feels that the medication adherence program will be cut; this program has helped him a great deal.
A HIV+ client from API Wellness Center has received a lot of support from their programs. If the funding is cut, he doesn’t know where else to get help.
John Walsh, a client at Saint Mary’s, TARC, Quan Yin has found these agencies to be helpful and that they do a lot of good work,.
Tina, a nurse at General Hospital, is the primary health care for TARC and API clients. Across the board cuts will affect the hard-to-reach people.
Zack Cook, a HIV+ and HEP C consumer at Quan Yin, stated that he would like the council to look at proportional cuts for different agencies.
Rachel at API Wellness Center thinks that proportional cuts are bad for small agencies.
Ruth, Women’s Specialty Program Director at UCSF, is in favor targeted cuts. With the current cuts they will lose provider time and social work time.
John Stansell, MD, HIV+, Medical Director at UCSF Hospital, is in favor of targeted cuts. Primary care encompasses many things, substance use treatment, mental health treatment, pharmacy, and social work.
Jane Gelfand, Senior Benefits Counselor at Positive Resource Center stated that PRC serves 1,400 client annual, focusing on the underserved populations; benefits counseling helps support other services. She is in favor of targeted cuts.
VII. Presentations – Standards of CARE, Dara Coan, Harder & Company
Dara Coan handed out and reviewed her PowerPoint presentation, Title I Standards of Care. See handouts, Title I Standards of Care, Dental Care, San Francisco EMA Standards of Care, Primary Care, Mental Health, and Substance Abuse.
The Title I inconsistencies issues were reviewed, addressing the development of standards of care, representing minimal expectable levels for each service category; noting that these standards are not clinical.
Dara Coan reviewed the process of developing Standards of Care, with the working groups of dental, primary care, substance use, and mental health. These working groups met over 7 months. In addition, she discussed the client feedback from the focus groups on quality and standards and the public comment period.
Dara Coan reviewed different issues concerning admission standards, policy, debates around minimum standards, and measures to indicate if standards are being met.
Dara Coan then reviewed the themes and issues concerning dental care, primary care, mental health, and substance use.
The next steps are to activate the 2003 contractors for providers and to update the case management standards.
VIII. Presentation - San Mateo County
Jonathan Mesinger, Edison Clinic Manager, San Mateo County Health Services, reviewed the San Mateo County Health Services AIDS program’s demographic and service utilization information. (See handout, San Mateo County AIDS Program Client Demographics by Provider compared to Cumulative and Living AIDS Cases.) Current San Mateo trends include an increase in the number of clients who are more than 45 years of age (as persons with HIV are living longer), an increase in the number of women infected with HIV, and an increasing number of clients who are monolingual Spanish speakers. Other issues that San Mateo is addressing include health maintenance concerns, mental health care for long-term clients, and support for medications adherence. Transportation can be a barrier to receiving services, due to the County’s area and geographic features.
The HIV/AIDS death rate in San Mateo has declined each year since 1995. In 2000, nine clients died directly from HIV/AIDS, down from 119 in 1995. Recently, Quality Assurance research has allowed the AIDS Program to track individual health outcomes by changes in treatment regimens. 147 out of 420 clients were surveyed in January 2002. In that survey, 97.8% of respondents rated the County’s HIV/AIDS services as “good” or “excellent”.
Comparing San Mateo, San Francisco, and the State of California shows that San Mateo’s HIV epidemic is more like California’s than San Francisco’s, with women, African-Americans, Latinos, and injection drug users accounting for a larger percentage of the total HIV/AIDS population than in San Francisco. John Conley commented that HIV/AIDS issues are not as visible in San Mateo as they are in San Francisco, and there are only a small number of community-based HIV/AIDS service providers in San Mateo. There is significant competition for local funding. Like San Francisco, San Mateo has very expensive and limited housing. Stabilizing clients in housing is even more difficult than in San Francisco, as there is no rent control in San Mateo, and no housing specifically designated for persons with HIV/AIDS.
Susan Shea asked if San Mateo has a central database like REGGIE and what is the total HIV/AIDS population? John Conley stated that estimates of the total number of people living with HIV/AIDS in San Mateo County range from 1,500 (the State’s estimate) to 3,000 (a figure extrapolated using methods similar to those used by San Francisco to estimate its own HIV population). During the past year, the San Mateo County AIDS Program served 566 unduplicated HIV/AIDS clients. There is currently no central database which is shared by the County AIDS Program and its contractors.
IX. Presentation from DPH – Michele Long Dixon
See handout: What is Quality of Care for HIV Health Services. Michele Long Dixon reviewed the purpose of program, legislation language, and HRSA purpose in conducting this work. The objective for the San Francisco EMA is to enhance existing services. Currently the components are to develop standards of care, trainings, evaluations, and defining what quality means. Michele Long Dixon reviewed how focus groups were used, what has been developed and what will be developed. Michele Long Dixon then discussed the process of Standards of Care (SOC) development, reviewed training on dental care, case management, and other SOC integrated services programs. Next, Michele Long Dixon reviewed the monitoring process, moving to more client-centered outcomes, conducting client satisfaction surveys, and review of grievances. Data systems were then reviewed concerning information gathered, REGGIE, adherence to SOC, and areas of insufficient data. Michele Long Dixon then reviewed the sources of information, accomplishments to date, and what has been developed. Next Steps were then reviewed on how the council can participate, trainings, and updating REGGIE information.
Mjay Sanders inquired if there are ways to increase participation, in contracting with providers concerning REGGIE. Michele Long Dixon stated that yes, there is way, the language in all CARE contracts mandates participate.
Susan Shea reviewed the past council activity regarding REGGIE; stating that the council mandated Reggie participation for all CARE-funded agencies should be enforced only when enough support was given to agencies; the council needs to have discussion about this issue.
Catherine Geanuracos stated that REGGIE will be discussed at the next Steering Committee meeting
X. Committee Reports
Kevin Johnson reviewed the last membership meeting, nominations, current council demographics and available open seats. Membership interviewed four candidates and has recommended all four. Only two candidates were presented for membership at this time.
The council unanimously endorsed Curtis Baker and Skye Ambrose as new Council nominees to be forwarded to the Mayor for appointment.
The other two candidates will be presented in future meeting. The Membership Committee feels that a discussion and vote regarding the Council’s Bylaws needs to occur prior to forwarding names of candidates that would place the Council in opposition to its Bylaws. Currently, the By-laws State that the Council membership must be 67% HIV-positive, and 40% unaffiliated HIV-positive consumers of CARE-funded services..
Ken Pearce reviewed the history of the ”67% rule” in the bylaws and HRSA’s mandates. Ken Pearce stated that the 67% HIV+ rule and the 40% unaffiliated consumers rule needs to be reviewed; it’s an unrealistic rule and needs to be lowered. The council has yet to ever reach the 67% rule.
Susan Shea asked what happens if we don’t follow the bylaws? Catherine Geanuracos stated that HRSA guidelines should be followed.
Targeted vs. proportional cuts
Catherine Geanuracos reviewed the Steering committee’s thinking around the issues of targeted vs. proportional cuts. John Conley suggested a combination approach might work well. Catherine Geanuracos conducted a straw poll of the council: proportional cuts had 3 yeas and targeted cuts had 21 yeas.
Cecilia Chung announced that it was great to see providers show up at meetings; more information is needed from providers for them to get involved with the planning process. Catherine Geanuracos is in favor of targeted cuts in looking at services on a sub-category level, focusing on target populations, types of programs, units of service, number of clients projected and served, other funding sources, and other demographics; some information will come from REGGIE, AIDS office and providers.
Susan Shea gave a brief historical review of the I & E committee, concerning core vs. non-core services, and “hold harmless” categories.
Catherine Geanuracos stated at the next meeting in May will be the Needs Assessment presentation. This information will assist with which sub-category and categories need to be focused on more. Larry Cruz stated that it is important to get as much information as possible.
Brad Hume stated that the council needs to look at the definitions of core services. Catherine Geanuracos stated that the council should be much more specific in ranking by sub-category, from important needed services to less needed services.
The council then discussed the information that would be gathered from the Needs Assessment and how to use that information in prioritization and the 3-Year Plan. The council agreed that the cuts would be targeted.
Laura Thomas stated that the Needs Assessment has been helpful in past prioritizations; and the council should look at having two council meetings a month. Catherine Geanuracos stated that the two council meetings a month idea will be discussed at the next Steering Committee.
3-Year Plan Work Group
Catherine Geanuracos stated that the committee has begun to plan and review what needs to done and has been done. In addition the committee will review the 5-Year Plan, timelines, needed tasks, and past Grantee Assessments.
PWA Caucus Committee
Brad Hume stated that the council should read the minutes of last meeting. Brad Hume announced that the committee will discuss the 67%/40% bylaws rule and Mission Statement at next meeting. The committee has received the draft Policy and Practices from Jeff Morey, the consultant.
Mjay Sanders would like to thank clients and providers that have attended the meeting and was very pleased with the Derek Silva report.
Brad Hume stated that the committee reviewed the 5-Year plan, its goals and objectives, and had a discussion concerning targeted vs. proportional cuts. Brad Hume announced that the request to obtain a seat on the SRO task force was received well by the task force; currently the Housing Committee is waiting for the board of supervisor to approve the seat; hopefully in the next 6 months the seat will be approved.
I & E Committee
Sam Kaplan reviewed the discussion on the Grantee Assessment. At the next meeting the committee members will bring their ideas about conducting the Grantee Assessment.
Substance Abuse Work Group
Charlene Pugh stated that she will start attending meetings. Donald Frazier stated that he had attended two meetings; the next meeting will be scheduled soon. The committee might possibly combine the groups of mental health and substance abuse into one work group.
Community Action Committee
Eric Whitney stated that the committee discussed it’s structure, goals, and purpose. Next meeting the committee will focus on the mission statement.
Eric Whitney passed out the satisfaction survey for council support.