Meeting Date: April 22nd, 2002
Meeting Place: City Hall, Room 201
Meeting Time: 4:30pm - 7:30pm
I. Call to Order
4:30pm
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
Membership Committee
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.
Housing Committee
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.
New Business
Eric Whitney passed
out the satisfaction survey for council support.
Adjournment
7:20