I. Call to Order
Co-Chair Siron called the meeting to order at 10:05 a.m.
II. Roll Call
Council Support called roll. [See Attachment A, Column 1]
III. Review and Approval of Agenda
Council Members reviewed the agenda. There were no objections to the agenda
and it was approved by consensus.
IV. Review and Approval of Minutes- July 25, 2005
Council Members reviewed the minutes from the July 25, 2005 Council Meeting.
There were no objections or changes to the minutes, and they were approved.
V. General Announcements
No announcements.
VI. Public Comment
Tim Patriarca, E.D. of Maitri Hospice provided a point of clarification on
the summary sheets on pages 82 and 83 regarding facility based home care.
He indicated that the RCFCIs in this category do not receive private insurance.
The majority of the work of Maitri provides hospice care, he asked Council
Members to keep in mind that CARE funds and private donations and HOPWA provide
funding, and if there is a significant decrease in Ryan White funding it
would be detrimental to their program.
No other public comments.
VII. Introductions
Co-Chairs will introduce Susan Strong – Facilitator. Overview of activities
of two day meeting, ground rules and logistics. Will also include a review
of Prioritization and Allocations by the Facilitator. Council Members will
introduce themselves.
Co-chair Allgaier indicated that the co-chairs would be turning over the meeting to Susan Strong to facilitate the meetings today and tomorrow. He provided background information on her qualifications.
Susan began the meeting by having people use the paper and crayons provided to either draw a picture or write a statement regarding their expectations of this summit meeting. On a second piece of paper, she requested Council Members to draw a picture or write a phrase regarding how they hope to feel at the end of meeting.
Susan next asked for Council Members to introduce themselves, and how many Prioritization and Allocation processes they have participated in, and to take the paper the created about expectations and provide a 15-second explanation. The paper depicting their “hope for outcome” is to be put in the binder for use at a later time.
Council Member Expecations:
Oropeza – 1st -- happy
Kleffner – 1st – small changes
Thomas – 16th – progress
Soto – 3rd – work well together and get done by end of day
Antonetty – 5th or 6th – many more as non-voting – some in
circles but end up in a pattern that will work out for everyone
Ortiz – 2nd – walk without expectations, because with expectations
you are disappointed
Callandrillo – 1st – start somewhere and end somewhere, but not
sure how to get there and will break through stopping points
Simmons – 3rd as voting member, 10th as community member – expectation
is for everyone to be calm
Hicks – 4th – fear from last year’s process and has anxiety.
Anderson – 1st – working for same goal
Pearce – 5th or 7th P/A- a cloud of uncertainty with the sun breaking
through
Kanios – 1st (several as a community leader)- deliver compassionate service
to communites we serve and the community
Sweetin – 1st – engagement and struggle (give and take)
Smelcer - clarity and accomplishment
Booker – 3rd – group of people getting up a mountain all connected,
and at the top is the sunshine and a hooray we made it.
Allgaier -- expectation is to have a day of thoughtful data-driven dialogue,
with the best interests of people with HIV in their heart, and positively impact
those clients with HIV
Siron – optimistic, open-minded, willing to trust (sun with hope, birds,
trees)
Pugh – 4th or 5th – lots of good ideas, fruitful discussions, golden
rule used and be at peace
Benham – 2nd year - tree by a stream of water and hope there are some
good ideas flowing, and fruitful ideas
Miller – 2nd – two pictures, one is a happy expectation but may
be pissed off.
DiCrocco – 2nd year- thinking about his idea and everyone else getting
his idea
Graham – 4th year – come out of last year’s crisis and get
some good ideas
Spaeth --1st year here, but several in Marin Co. – hope this is a learning
experience to take back to Marin.
Flood – 3rd, 1st voting – hearts to make proper decisions
Molnar – 1st year, several as community participant – expectation
to remain focused
Blum – 3rd year – expectation is “empassioned” – emphasizing
the compassion when they disagree
Banks – 1st – victory or defeat is his expectation
Byers – 10 years or more on multiple councils (has been between 50-70
priority processes); expectations are frustration leading to resolution.
Susan reviewed the comments and indicated that there is lots of experience around the table, pointing to CM Byers and CM Thomas as examples of people who could be drawn on for utilizing their information and experience. She encouraged people to get around different points of view and at the end have good choices for consumers.
Susan provided information on her background, and how the process will work. She indicated that Oakland recently finished their prioritization process. The work needs to be done in two days. She expressed that she is not an expert on HIV/AIDS in San Francisco and indicated that the Council members are the experts and her job is to keep everyone on track.
She provided housekeeping details regarding bathrooms and taking breaks. She expects Council Members to play by the rules and to play nice. Robert’s Rules will be used as necessary, and she pointed the Council Members to the Rules of Respectful Engagement.
She facilitated an exercise in respectful engagement, assigning each Council Member to a particular concept regarding respectful engagement to assist her in making sure everyone plays by the rules, calling on Council Members to call out if they feel someone is not adhering to a particular rule.
She also provided a stress management squeeze toy shaped like a puzzle piece and instructed Council Members to use it to squeeze it when they feel stressed out.
She asked if there were any questions, and pointed Council Members to the meeting evaluation to be completed so that any adjustments could be made for tomorrow’s meeting.
Public Comment
No public comment.
VIII. Conflict of Interest Disclosure by Council Members
Council Members announced their conflicts, which is reflected on the Council
Members Conflict of Interest Matrix (Document on file at Council Support Offices).
CM Thomas asked to remove Congregate Meals from Matrix.
CM Callandrillo asked to add Facility based homecare to Matrix
CM Smelcer made changes to his conflicts form – adding Outreach and Emergency
Housing
CM Graham added Detox
CM Molnar removed ICM.
Public Comment on this item
No public comment.
IX. Break [break postponed because the meeting was ahead of time].
X. Goals of the Summit – Laura Thomas & Don Soto
A review of the legislative mandate, objectives of each day with final goals
of priorities, allocations, and funding scenarios. Draft priority sheets
to be used during the meeting.
CM Thomas provided a summary of the goals for the two days, reviewing the legislative mandate, objectives of each day with final goals of priorities, allocations, and funding scenarios.
CM Soto reviewed the priorities to be used during the meeting.
CM Thomas reminded the Council that the next presentation will be the results of the Needs Assessment, and suggested that Council Members take this information into account about what this says regarding unmet needs or underserved communities.
CM Thomas distributed Priority Worksheets. (Document on file at Council Support Offices).
Council asked questions of CM Thomas regarding the worksheet and the HRSA
categories.
Celinda Cantu of HHS clarified a question on funding of child care, which has
not been funded in the past couple of years, but child care is part of the
service delivery of other agencies. It is not a single service category in
and of itself for the community as part of Title I.
CM Simmons added that respite child care is provided by other funding sources at his agency.
Public Comment on this item
Tim Patriarca of Maitri commented on the worksheets, homehealth professional
and paraprofessional are separate categories, and indicated they are wrap-around
services and doesn’t understand how they could be funded separately
or differently. He suggested looking at Hospice as being reconsidered as
a funded category.
Bill Hirsch with ALRP thanked Council for all their hard work in preparation for meeting today. He reminded Council that HIV Provider network tried to speak with one voice, and one encouragement to consider is to use the same ranking and priority used in the past. He suggested this might make the process easier. Some of the ordering of services may be shuffled, due to HRSA requirements. He suggested being mindful of something the providers bring to the community is to leverage other resources. Some services are reimbursable through Medi-Cal, but constructed in such a way to leverage other resources. For instance, legal services, receives over $1 million yearly from community donations. The core comes from CARE but that is used to leverage other support.
BREAK --
XI. Needs Assessment Presentation
Allison Weston & Erika Takada from Harder+Co. reviewed their PowerPoint
presentation on the Needs Assessment data, community forums, and provider surveys.
(Presentation on file at Council Support Offices).
Due to time constraints, the Lunch Break was taken immediately after their presentation. Council Members will have an opportunity to ask questions after lunch. The members of the public will have an opportunity for comment after lunch.
XII. Lunch
XIII. Continued-Needs Assessment Q&A
After lunch break, Susan turned the meeting over to Allison and Erika for questions
from Council Members regarding the needs assessment data presentation.
Erika and Allison addressed all questions and comments succinctly and informatively,
providing additional information as requested. It was added that the needs
assessment data should be used as only part of the decision-making of Council
Members in the prioritization process, and the other data such as epidemiological
reports, Reggie data, and other information should also be considered equally.
Public Comment on this item
Patrick Monette Shaw expressed that it was disturbing for him that a low number of providers returned the provider survey. He added comments regarding the data that implies that not as many people are actually dying of HIV/AIDS, but are dying of co-morbidity factors, including general old age.
Bill Hirsch from ALRP reminded Council that some people with acute substance problems might not always report that substance abuse treatment is something that they need. He indicated that the same might be true for mental health care. These needs may not apply across the board to all people with HIV.
XIV. Sub-Category Designation- VOTE
Council Members will vote on designating Residential Case Management as a sub-category
of case management.
CM Antonetty provided a background on the motion coming from the Planning Committee
to create a new service subcategory under the case management category referred
to as Residential Case Management. She added that no funding would be cut in
the services, it only means that those services in the subcategory of residential
and subsidies will get moved to case management. She referred Council Members
and the public to a document that was distributed on the subcategory reassignment
motion. (Document on file at Council Support Offices). She added that there
was some concern from HRSA regarding the high amount funded to housing, and
indicated that the HRSA Consultant suggested no longer artificially inflating
this category and move the funds to case management.
CM Antonetty referred to the written text of the motion from Planning Committee:
This motion requests to create a new subcategory under the Case Management service category, called Case Management in Residential Programs. The programs that provide the case management in residential programs and which are currently part of the Residential and Subsidies subcategory under the Housing service category, should be moved to the new Case Management in Residential Programs subcategory under the Case Management service category.
CM Blum seconded.
CM DiCrocco called the question.
Public Comment on this item
Patrick Shaw indicated that the Council has been hiding $1 million from the
public. He stated that there are too many case managers, five to six per
client. He suggested getting rid of some of the case managers and save a
lot of money. Instead of cutting services to people who need services, they
should cut case managers.
Roll Call Vote: 26 in favor, 4 abstentions, none against. Motion carried.
[See Attachment A, Column 2].
XV. Counties Presentation - Vote
Representatives from the Counties of San Mateo and Marin will provide information
on their prioritization and allocations process and proposed budget. Council
Members will have an opportunity for questions.
CM Spaeth reviewed the data from the priority setting process in Marin County for FY 05-06. She distributed documents to support her presentation. (Documents on file at Council Support Offices.)
Council Members asked questions to CM Spaeth regarding the Marin County presentation.
CM Spaeth provided succinct and informative responses to the questions and
comments.
Co-Chair Booker applauded the work of CM Spaeth and the others in Marin County, and indicated that a lot of progress has been made.
CM Byers explained the process why the Council is being asked to approve the list of Marin County’s priorities from this July to next July until Marin is able to get on the same calendar as the SF Council calendar.
CM Thomas explained that these are the priorities and allocations for Marin County, and the budget will include the County allocations to be voted on that will include the budget for the full EMA. This is a way to respect their local process and accept their priorities and allocations.
CM Siron seconded and called the question.
Public Comment on this item
Patrick Monette Shaw referred Council to a book called “When AIDS Began” that
points out the same fact that CM Spaeth pointed out that the number of AIDS
cases has not gone up because they have OI’s but because they have other
medical needs. He suggested to find out what people are presenting with and
what they are dying from.
Roll Call VOTE on Marin County budget and priorities: 29 in favor, 1 recusal, none against. Motion carried. [See Attachment A, Column 3].
CM Sweetin provided background on the San Mateo County process of prioritization. She indicated that there has been over-utilization of dental services. She indicated that the allocations have not changed a great deal. She opened to questions from Council Members and succinctly and informatively addressed all comments and questions.
CM Ortiz indicated that he appreciates the report, but asked about what is being done to address the increasing number of AIDS cases, especially among the Latino population, and the obvious number of out-of-care individuals.
Marshia Herring from HHS/AIDS Office indicated that a recent study she performed indicates that there are transportation issues, trust issues, and other matters that are at work preventing people from accessing care in San Mateo County.
CM Kleffner asked what people do in San Mateo if they need a specialist.
CM Sweetin indicated they are referred to the County Medical System.
Public Comment
No public comment.
CM Blum seconded the motion presented by CM Sweetin.
Roll Call Vote on San Mateo County budget and priorities: 26 in favor, 2 recusals, 1 abstention, none against. Motion carried. [See Attachment A, Column 4].
XVI. Data Review – Small Group Discussions
Laura Thomas and Don Soto, Planning Committee Co-Chairs.
The Council will review major data information that has been presented during
the year. This will include epidemiological information, Reggie data, Summary
Sheets, etc. Council Members will break-out into small groups for discussion
of the data and how it applies to their decision making process and any trends
they are seeing.
CM Thomas explained that this is the first attempt to use this type of process and will be done differently if it doesn’t work. She indicated that past evaluations provided feedback that Council Members desired more time to discuss matters with each other.
Council Members reorganized into pre-assigned small groups to discuss the
data review.
CM Thomas indicated that by the end of the review of the data information presented
throughout the year everyone should be able to complete their ranking of service
categories with some sort of confidence. She added that Harder + Co. staff
is available, as well as Celinda Cantu for Reggie questions, and Russ Zellers
and Marshia Herring from the AIDS Office.
CM Thomas referred Council Members to the binder about questions to ask when
looking at the data. She referred Council Members to the Reggie Data and the
Epidemiology Report.
She discussed her concern that two pieces of data are supporting the fact that
there are a high number of out-of-care patients who are late testers, meaning
that they present late and receive and HIV and AIDS diagnosis in the same year
or at the same time.
CM Thomas referred Council Members to the Provider Summary.
CM Thomas referred Council Members to the Needs Assessment data. She suggested
starting with a particular population and track across all the data sources
and see what can be learned from each report. She asked Council Members if
there were any questions.
CM Allgaier asked for specifics regarding what should be in the report back.
CM Thomas suggested whatever the group found significant or if there was any
sudden realization, or unanswered questions.
Council began their breakout group discussions. It was announced that the conversations at the tables are for Council Members. Members of the public are welcome to observe and listen, but they cannot participate. Susan Strong reminded everyone that staff from Harder+Co. and HHS, AIDS Office are available to answer any questions during the discussions.
Notes from the groups will become part of the official record. Groups are to appoint a recorder and a reporter to speak about the findings to the larger group.
XVII. Break
Public Comment on this item
No public comment relative to the small group work.
XVIII. Report Back From Small Groups
Representatives from the small groups will give reports on their discussions
to the larger group.
Susan began directing the groups to each highlight the main components of their
discussions.
CM Ortiz reported on his breakout group and discussed: three most important
trends and information that the Council is already aware of:
•
the co-existing diseases of HIV and Hepatitis C;
•
housing as an unmet need in all the data sets including the forums and the
epidata;
•
and there seems to be many barriers related to demographics.
•
One sticky piece of data seemed to be the transient nature of people coming
in and out of the city. This was highlighted by the increased number of people
over 50 years of age in the 2005 NA compared to the 2002 NA, who may live elsewhere
and access care here.
•
Advocacy seemed to be a need in overcoming barriers that had been identified,
there needs to be a way to help people connect to services. Clients know the
services exist but there are certain barriers preventing them from accessing
the services.
No questions from Council for that group.
CM Soto reported on his breakout group and discussed:
•
surrounding categories of food and housing – with other funding streams
how do you factor in HRSA mandates?
•
How to help clients access those other services outside of Ryan White funding
was identified as a solution.
•
Transportation and vouchers for transportation seems to be a high demand. Those
with more severe need for access to transportation was discussed.
•
Decreased funding for subsidies and with new people coming into the system,
how are they affected by new clients coming into the system.
•
HOPWA was discussed with regard to residential treatment services.
•
Discussion also around not cutting money for mental health. Both primary care
and case management share the burden for working with mental health issues.
•
COEs were discussed.
•
Treatment adherence with regard to residential facilities was discussed.
•
Not to pull apart the categories of professional and para professional home
care.
•
Complimentary care and dental care was discussed in light of the governor’s
proposals.
•
Three ideas from NA: 67% of people surveyed had a diagnosis of HIV – seemed
that the severe need population was growing.
•
Emergency financial assistance was also discussed, and changes for eligibility
requirements to serve the severe need population.
No questions from Council for that group.
CM Blum reported on his breakout group:
•
Data questions, wanted to have more information about young adults.
•
Some questions about epi data report, regarding the actual number of HIV/AIDS
cases.
•
Regarding the Needs Assessment survey, was the number of African Americans
not in care accurate?
•
Trends noted: marked increase in Latinos testing positive.
•
Needs Assessment impacted: information on co-infection.
•
It was surprising that food rated so high as a need.
•
The number of people not in care seemed to be alarming.
•
Group was surprised at how highly clients ranked case management.
•
Housing and primary care not to be touched for cuts.
•
Transportation services, what types of information are getting to participants
regarding eligibility for services.
•
Alternative funding streams: incomplete information to factor this in. As we
move forward and look at alternative funding sources that this be tied into
HRSA categories.
•
Reggie Data: zipcode information and housing information was useful.
•
Three most important trends: demographics (skew in age, Latinos and race, increasing
cases of HIV, and survival of quality of life, do not cut housing and primary
care. The top ten categories prioritized last year have high utilization.
No questions from Council for this group.
CM Allgaier reported on his group.
•
One discussion centered around being struck by the ability of people to get
into primary care and that the issue was looking at wrap around services, vital
to keeping people in care. That seemed to rise to the top on different levels.
•
They looked at the data, and the big three seemed to be: primary care, food,
and housing. These seemed important in all the data sets looked at.
•
Despite own definition of severe need: substance abuse and mental health care
seemed important. Not much consensus on residential mental health and residential
substance abuse., based on many things.
•
Case management and peer advocacy and client advocacy seemed important, to
help people stay in care or accessing different types of services.
•
Transportation – surprised that are is de-funded, seemed to be more of
a need than previously realized. When someone is not feeling well, they might
not want to take public transportation. This might contribute to someone not
getting care. Looking at certain neighborhoods, to see why people are not accessing
care, there may be neighborhoods where public transportation is not that great – which
can influence people accessing care, staying in care.
•
Dental Services – Seemed to be important, based on the data.
•
Alternative therapies seemed important regarding health care.
•
Case management as it relates to peer advocacy and treatment advocacy to help
people get and stay into care.
•
As a category of service that was important to ensure other funding streams
utilized, seemed to be around benefits counseling, to ensure that people are
accessing the appropriate benefits available to them, and not relying solely
on CARE funds.
•
CM Molnar mentioned that he has a conflict around peer advocacy, and there
seems to be a disconnect around Council Members about transportation. Public
transportation is good, but it is not consistent and may prevent some from
accessing treatment. He indicated that Peer Advocacy has no separate line item
and has been rolled into case management.
No Council questions for this group.
CM Thomas reported on her group.
•
She indicated that their group was in agreement with regard to housing and
all the data sources.
•
Regarding medical care, it is funded, but substance abuse and mental health
services can be accessed better if they are included under primary medical
care.
•
Regarding Adult Day Health Care – indicated a severe need, especially
for mental health, medication adherence useful for chronic care, and aging
population.
•
Food – Other resources in Community to rely on. Seems to be the highest
need among homeless, and may not want to cut resources.
•
Dental Care – underutilized by Native Americans, because they have other
priorities.
•
Alternative therapies – Native Americans using, would like more access
available, as it is important service for that population.
•
Need to have culturally appropriate mental health services for American Africans,
Latinos, or Native Americans. People won’t go if the provider is not
culturally competent.
•
Regarding benefits counseling – it is important.
•
Linking people into care seemed to be a barrier in linking Latinos to services.
•
Discussed Medicare Part D, but no decisions on what was needed.
•
Two Populations: one older, gay white male who need mental health and medical
care and do a good job of accessing them. If those services are cut, they fall
down into other categories.
•
Folks with history of incarceration, homelessness, multiple diagnoses, mostly
people of color, need everything, a continuum of care, and the Centers of Excellence
are good for this.
Questions for this group: None.
CM Byers reported on his group:
•
Nothing new to share that wasn’t already talked about.
•
Three important trends: people of color especially those presenting late; issues
around aging population and the number of women in Southeast Corridor with
HIV/AIDS. Spent a lot of time discussing what was interesting individually,
but less time accomplishing the tasks.
•
A lot of discussion around cultural competency.
Questions for this group:
CM Ortiz indicated that a subset of cultural competency included age-cultural
competency. To be able to understand a young person who is poor and illiterate.
Susan reviewed the discussions that covered housing, food, aging populations, people of color, people coming late to care, barriers to care, were among some of the commonalities.
Public Comment on this item
Patrick Monette Shaw: suggested being cautious about epi data from DPH. Cited
book again, about ways that the epi data from SFDPH is skewed, including
the no identified risks data, and zip code assignments are guessed at. He
suggested the data with maps need to be looked at cautiously. He discussed
multiple ways that double counting of AIDS cases occurs, including from other
jurisdictions. He suggested advocating for cleaning up the data (after reading
the book he is referring to). He implored the Council to advocate for retaining
the beds at Laguna Honda for HIV/AIDS patients. With the closure of St. Mary’s
dementia beds it can be difficult to place patients with dementia. He suggested
the Council urge Mayor Newsom to fully fund Laguna Honda, and work with Board
of Supervisors to avoid shutting down St. Mary’s dementia beds.
XIX. Development of Initial Service Priority Order
Council members will individually develop their service priority order to begin
preparing for priority setting discussions for the next day.
Susan advised the group to complete their prioritization order sheets and turn
them in. Simultaneously, the group completed their evaluations.
Public Comment on this item
No public comment.
XX. Adjournment to Saturday, August 27, 2005.
Meeting adjourned upon completion of priority forms – 5:15 pm
Note: Agenda items are subject to change, postponement, or removal. Meeting agendas are considered to be in DRAFT form until reviewed and approved by Committee attendees.
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