New York State Interagency Task Force on HIV/AIDS
- Enhanced Agency Collaboration on HIV/AIDS Issues
- Training of State Agency Personnel to Increase Awareness OF HIV/AIDS
- Development of a Comprehensive List of Programs That Serve Persons Affected by HIV/AIDS
- Task Force Recommendations to Maintain Coordination of State HIV/AIDS Policies and Services
New York State government agencies are committed to providing a comprehensive and coordinated statewide response to the HIV/AIDS epidemic through community-based prevention activities, equal access to high quality health care and support services, and strong confidentiality and anti-discrimination protections.
New York State is a national leader in its response to the HIV/AIDS epidemic. As the State with the largest number of AIDS cases, New York has created a comprehensive, statewide network of health care providers and community-based support services to address the needs of persons infected with HIV and to prevent further spread of the virus. Responsibility for coordinating the State's HIV-related policies and programs rests with the AIDS Institute within the State Department of Health (SDOH).
All State agencies have a role to play in responding to the HIV/AIDS crisis. State agencies are employers, regulators, and care providers for some of the most vulnerable populations, including prison inmates, the mentally ill, the developmentally disabled, and children in foster care. Each agency has responsibility for educating its own workforce in HIV prevention and nondiscrimination to protect the confidentiality and rights of New York citizens who are infected.
To ensure that New York State maintains consistent policies and maximum efficiency in providing HIV-related services, Governor George E. Pataki established the New York Interagency Task Force on HIV/AIDS by Executive Order #54 on September 10, 1997. Constituted for a two-year term, the Task Force includes 25 State agencies, and is co-chaired by the Director of State Operations and the Commissioner of Health.
Meeting quarterly from November 1997 through November 1999, the Task Force members shared information about their existing HIV-related activities and policies, and sought to identify and develop interagency opportunities to enhance New York's response to the epidemic.
As directed by the Governor's Executive Order, the Interagency Task Force focused on four major goals:
- Enhanced coordination of programmatic and fiscal planning among State agencies, offices and divisions;
- Coordinated implementation of HIV/AIDS policies among all agencies;
- Education of agency personnel to increase awareness of HIV/AIDS issues, especially the potential consequences of agency decisions on persons infected with HIV/AIDS;
- Development of a comprehensive inventory of programs that serve persons infected with and affected by HIV/AIDS.
This report summarizes the major accomplishments of the Interagency Task Force and its recommendations for continued future collaboration among State agencies to ensure a unified and effective statewide approach to HIV/AIDS policies and services.
A significant outcome of the Governor's Interagency Task Force on HIV/AIDS was the extensive information sharing, networking and collaboration on HIV/AIDS issues that took place among the member agencies. The meetings helped to increase awareness of emerging issues related to HIV/AIDS and to clarify each agency's responsibilities, current activities and challenges in responding to HIV/AIDS.
To facilitate communication and interaction among agencies that deal with similar issues and/or populations, agencies were grouped in "clusters" for the purpose of making presentations to the Task Force membership. For example, at one meeting the Task Force heard presentations from six agencies responsible for various components of the criminal justice system. Other agencies were grouped into clusters focusing on services to women, children and families; health and human supportive services; special populations; and administrative services.
In its presentation to the Task Force, each agency shared the following information:
- a description of agency HIV/AIDS-related programs and policies;
- the agency's fiscal commitment to these activities;
- the type of information and assistance that would be helpful from other agencies in achieving its goals; and
- any barriers that may exist to interagency collaborations.
A. Creation of New Interagency Workgroups
While New York State agencies have a history of working together in concert with the AIDS Institute on HIV/AIDS issues, information shared during Task Force meetings led to the creation of three new Interagency Workgroups to address gaps identified by the Task Force. The new workgroups are focused on coordinated planning of services to meet the needs of special HIV-infected groups: housing needs of parolees; mental health needs of perinatally infected adolescents; and service needs of persons with multiple diagnoses (HIV, mental illness, substance use). The workgroups will continue their collaborative efforts to identify the emerging needs of these special populations and to develop effective and cost-efficient programs and services.
1. Criminal Justice Housing Workgroup
The Criminal Justice Housing Workgroup was formed to address the immediate housing needs of HIV-infected parolees and releasees transitioning from correctional facilities to the community. Emphasis was on identifying the barriers and possible solutions to successful housing placement for the intended population, particularly in New York City, to prevent placement of HIV-infected parolees/releasees in emergency shelters without supportive services.
Participating members of the workgroup included the AIDS Institute, Division of Parole and selected representatives of community based organizations that provide transitional planning and case management to inmates and releasees.
Workgroup activitiesand accomplishments include:
- Establishment of a Memorandum of Understanding between the Division of Parole and the AIDS Institute to support 10 transitional beds for HIV-infected state parolees who are active substance abusers. Under this program, 40 HIV-infected state parolees can receive three months of housing each year with access to substance abuse treatment services.
- Development of better connections and cooperation between regional parole officers and community providers doing transitional planning in prisons, resulting in inmates being released with appropriate housing and benefits in place.
- Enhancement of linkages to the New York City Human Resources Agency Division of AIDS Services and Income Support for upstate community-based organizations that conduct transitional planning services in State Department of Correctional Services facilities.
In addition, some members of the Criminal Justice Housing Workgroup are also participating in a recently established subcommittee which is part of the New York City HIV Planning Council's Housing Workgroup and Housing Opportunities for Persons with AIDS (HOPWA) Advisory Committee. This subcommittee provides HOPWA funding recommendations to the New York City Mayor's Office of AIDS Policy as part of the New York City consolidated planning process.
2. Workgroup on Mental Health Needs of Perinatally Infected Youth
An Interagency Workgroup has been formed to address the emerging needs of perinatally HIV-infected children who are reaching adolescence. Due to new treatments, it is estimated that 25 percent of perinatally HIV-infected children are now pre-adolescents or adolescents. Between 25 and 40 percent of HIV-positive children are in foster care. Anecdotal information indicates that a number of these youth are exhibiting psychological, emotional and behavioral problems, some of which are severe and will require comprehensive mental health and/or residential services.
Case histories of infected youth in foster care reveal a gap in services to address their overwhelming mental health needs. The turmoil of adolescence is greatly exacerbated by the psycho-social and medical problems that accompany HIV. The issues faced by all adolescents - emerging sexual awareness, peer pressure and the need for acceptance by peers - are particularly intense for youth infected with HIV and are further heightened by unstable family situations, fear of disclosure of HIV status, the need to adhere to complex medication regimens, death and dying issues.
Members of this workgroup include the SDOH (AIDS Institute, Office of Continuing Care, and Office of Medicaid Management), the Council on Children and Families (CCF), the Office of Mental Health (OMH), and the Office of Children and Family Services (OCFS). This workgroup is continuing its collaborative efforts to plan for and create appropriate services for this group of HIV-infected youth.
Workgroup activities to date include:
- Sharing information on existing services provided to HIV-infected youth through programs under the jurisdictions of the respective workgroup agencies. To learn more about specific service needs, the group also met with a New York City health provider who has direct experience caring for HIV-infected youth with mental health problems.
- Designing a survey process to gather data on the unmet mental health service needs of HIV-infected children in foster care, in collaboration with ACS. The survey is being completed by foster care agencies in New York City during the Fall of 1999, and data analysis is expected to be completed in early 2000.
- Exploring options for a residential service model to address the needs of seriously mentally ill HIV-infected youth that cannot be met in current residential programs.
Two physicians associated with the Incarnation Children's Center and the Special Needs Psychiatric Clinic of Presbyterian Hospital in New York City made a presentation to the workgroup proposing to develop a ten-bed residence in an available Manhattan building that could be renovated for this purpose. The physicians emphasized that the lack of appropriate placement options for youth who have complex HIV disease and mental illness, often coupled with marked behavioral problems, presents an urgent challenge to the health, mental health, foster care and education systems. The primary objective of the proposed residence is to provide a nurturing home-like environment in which comprehensive, high quality health, mental health, education and social services can be provided.
The workgroup currently is evaluating how such a residence could be licensed, since the necessary services overlap the jurisdictions of SDOH, OMH, and OCFS. The workgroup is exploring whether a dual licensure arrangement, probably by SDOH and OMH, will be needed. Next steps include a site visit of the available building by the SDOH Office of Continuing Care to determine if it would be able to meet Code requirements for licensure as a long-term care facility. Workgroup members will bring the proposal back to their respective agencies to further explore licensure options.
3. Workgroup on Multiply-Diagnosed Individuals (HIV-infected, Mentally-Ill, Substance Abusers)
This newly formed workgroup is evaluating Medicaid data to identify the health, mental health and substance abuse service patterns, needs and costs of caring for mentally-ill persons with HIV/ AIDS and a history of substance abuse. The goal is to examine trends in service needs for this group of HIV-infected persons to identify gaps and emerging needs and to ensure that services are provided in a more effective and cost-efficient manner.
Workgroup members include representatives of the SDOH AIDS Institute and Office of Medicaid Management, Office of Alcoholism and Substance Abuse Services and Office of Mental Health.
Preliminary data drawn from State Medicaid files indicate that a substantial proportion of Medicaid clients diagnosed with HIV/AIDS also had a mental health and/or substance abuse diagnosis and received services for these conditions. Such multiply-diagnosed HIV-infected clients account for a disproportionate share of Medicaid costs among HIV-infected clients.
Workgroup activities to date include:
- Review of existing literature on the intersection of mental illness, substance abuse and HIV/AIDS.
- Review and revision of preliminary service utilization tables generated from New York State Medicaid billing files.
- Identification of key study questions and development of a study design to provide necessary information and descriptive data. Data analysis is in progress, with a final report targeted for mid-2000.
B. Other Interagency Collaboration Activities
In addition to the creation of three new Interagency Workgroups, numerous other interagency collaborations and meetings have taken place as agencies strive to improve the efficiency and effectiveness of the State's response to HIV/AIDS. Some of these collaborations were direct outgrowths of the Task Force meetings, where agencies found others working on similar issues, or identified agencies with information or expertise to help resolve their problems. Other collaborations began before the Interagency Task Force was formed and were strengthened by the ongoing meetings of the Task Force and contacts made through this process.
Highlights of these State agency interactions include the following:
HIV Services for Drug Users: A formal collaboration between the Office of Alcohol and Substance Abuse Services (OASAS) and the AIDS Institute combines State funds from both agencies as well as federal grants to provide a continuum of HIV-related services in drug treatment settings. The goal is to develop an effective means of reaching injection drug users to help prevent HIV infection and get those infected into treatment and care. Most recently, the two agencies collaborated on two grant applications to the federal Substance Abuse and Mental Health Services Agency (SAMHSA): 1) to link harm reduction and drug treatment, and 2) to expand drug treatment services for women, especially pregnant women and women with children. The latter application resulted in a recent award to OASAS of $500,000 per year in federal funds for three years.
The two agencies also are collaborating on development and operation of a social purpose business to train and employ HIV-positive individuals who are in treatment for substance abuse. The business, known as NewTel , is a call center that is ideally suited for the targeted population.
In addition, the New York State AIDS Advisory Council and the OASAS Advisory Council have recently formed a joint workgroup to explore ways to further improve the continuum of care and services for drug users. This workgroup is conducting a review of the current continuum of HIV-related and substance abuse treatment services. The workgroup will consider emerging needs and identify gaps that may exist in the service continuum, and develop policy and funding recommendations.
HIV Prevention and Treatment Services in the Criminal Justice System: The Department of Correctional Services (DOCS) has had long-standing collaborative agreements with the AIDS Institute to address the needs of HIV-infected inmates and parolees and those at risk for infection. Services provided by the AIDS Institute through an Interagency Memoranda of Understanding (MOU) include HIV prevention education in prisons, training of peer educators and prison staff, anonymous counseling and HIV testing for inmates, transitional planning for parolees/releasees, and short term community-based case management for those who have returned to their community. The AIDS Institute has supplied copies of the HIVQUAL health care quality assurance software package to DOCS and will be providing technical assistance for its use.
The Criminal Justice Housing Workgroup, mentioned above, was established to identify barriers and possible solutions to successful housing placement of HIV-infected releasees and parolees and served as a catalyst for other interagency collaborations, particularly with the Division of Parole. Collaboration has included the joint development of federal grant applications and the establishment of a new Memorandum of Understanding to provide transitional housing to support 10 transitional beds for HIV-infected state parolees who are active substance abusers, as described above.
The SDOH AIDS Institute worked collaboratively with DOCS, Division of Parole, Commission of Correction, OCFS, OASAS and the New York City Department of Health and Mental Hygiene in developing a federal grant application to support HIV prevention and continuity of care for incarcerated individuals and parolees. In late 1999, the Centers for Disease Control and Prevention awarded $1.1 million per year for three years to SDOH for services focused on: women, individuals with a history of substance abuse, persons whose primary language is Spanish, and young offenders.
HIV/AIDS Services for Children and Youth:A Memorandum of Understanding between the SDOH and the Office of Children and Family Services provides funding and training for HIV prevention counseling and appropriate HIV-related health and support services for children and youth in foster care and juvenile detention facilities. Building on this collaboration, the AIDS Institute recently received new CDC funding for a pilot program that will provide STD testing and treatment with HIV prevention counseling to 1,400 youth at a juvenile reception center in the Bronx. Meetings also are in progress among the AIDS Institute, the Council on Children and Families and the Division of Probation and Correctional Alternatives to create closer linkages to ensure that HIV services and outreach are provided to youth served by these agencies.
The SDOH AIDS Institute and the Office of Children and Family Services have engaged in a joint effort to update the 1994 New York State Department of Social Services manual entitled, HIV/AIDS and Children: Answers for Care Givers. The manual will be revised to focus on keeping children with HIV/AIDS healthy while providing practical tips for natural parents, relatives, or foster and adoptive parents as care givers. The updated manual will also be translated into Spanish. Due to the scope of the manual and the need for extensive revisions, it is anticipated that the updated version will be completed by mid-2000.
Mental Health Services for HIV Infected Persons: Mental health services for HIV-infected persons have been consistently identified as a priority service need throughout the State. The AIDS Institute conferred with the State Office of Mental Health (OMH) and the New York City Department of Health and Mental Hygiene, Mental Retardation and Alcoholism Services regarding availability and accessibility of a continuum of mental health services for persons living with HIV/AIDS. Using new Ryan White Title II funding, the AIDS Institute issued a Request for Proposals (RFP) to expand available mental health services for persons living with HIV/AIDS. OMH will assist in reviewing these proposals.. The AIDS Institute and Office of Mental Health also are working to coordinate the development and interface of Medicaid Managed Care Special Needs Plans for HIV-infected persons and those with severe mental illness.
HIV Welfare to Work Pilot: With technical assistance from the AIDS Institute and new State funding, the State Department of Labor is funding a demonstration project to help HIV-infected welfare recipients find and maintain appropriate employment. The goal is to enhance the employability of HIV-positive persons by connecting them with jobs that provide health insurance coverage and assisting them in maintaining their health status by staying engaged in care and receiving needed support services. The amount of $2.8 million was awarded in August, 1999, to six agencies for the provision of vocational training, case management, psycho-social support, job placement and post-employment services to meet this goal. The AIDS Institute is working collaboratively with the Department of Labor to oversee the implementation of this new initiative.
Housing for Disabled Persons: A coalition of State agencies, led by the State Division of Housing and Community Renewal, seeks to increase use of Section 8 rental assistance for persons with disabilities, including HIV. The coalition brings together the resources of public housing authorities and non-profit disability organizations on the local level.
AIDS Discrimination Investigations: Under a Memorandum of Understanding, the AIDS Institute and the Division of Human Rights (DHR) have formed a strong partnership in confronting the discrimination issues of people living with HIV/AIDS in New York State. Both agencies work closely to ensure that consumer complaints are appropriately referred and thoroughly investigated. DHR gave a presentation to the AIDS Advisory Council as a result of discussions at the Interagency Task Force.
Training for Nonprofit Boards: Four State agencies (Office of Alcoholism and Substance Abuse Services, Department of Health AIDS Institute, Office of Mental Health, and Office of Mental Retardation) have formed the State Board Training Consortium to work together to implement a comprehensive training program to support the effectiveness of board members of funded nonprofit organizations. An RFP was issued in the summer of 1999 and a training contractor has been identified to begin work early in 2000. A set of core courses will be offered around the state including: Duties and Responsibilities of Nonprofit Board Members; Legal Obligations of Nonprofit Boards; Fiscal Management and Fund-raising; Human Resources and Issues; and The Role of Nonprofit Boards in Assuring Quality Care. Advanced courses will be offered on a limited basis in year one and to a greater extent in subsequent years of this three-year training initiative.
HIV Prevention Planning Group: The New York State HIV Prevention Planning Group (PPG), established as a requirement for federal HIV prevention funding through the Centers for Disease Control (CDC), includes representatives of all groups affected by the epidemic, and all geographic areas of the State. State agencies that are directly involved in providing HIV/AIDS services (Health, Correctional Services, Parole, Children and Family Services, Education, Mental Health, Alcoholism and Substance Abuse Services, and Mental Retardation and Developmental Disabilities) have traditionally played an active role in the planning process by bringing agency-related information to the group. Representatives of these agencies routinely attend PPG meetings. Based on interest expressed during Interagency Task Force meetings, all State agencies are welcome to become actively involved in the PPG planning process.
ACT for Youth Request for Proposals: The Department of Health's Center for Community Health and AIDS Institute are spearheading a multi-agency initiative to promote positive health outcomes for youth. The focus of this initiative is the prevention of abuse and violence (physical, emotional and sexual), and the reduction of risky sexual activity that can result in HIV infection. A coalition, representing State and local government and voluntary health and human service agencies, will award grants totaling $2.6 million annually for three years to demonstrate the effectiveness of community-based partnerships in promoting positive development and improving health outcomes for youth. The RFP for this project was developed in collaboration with the Partners for Children Adolescent Project Team, a major state level partnership designed to improve health, education and other outcomes for children and adolescents. It is expected that grant awards will be made in early 2000.
HIV Prevention for Youth: The AIDS Institute and the State Education Department are collaborating on educational initiatives to reduce the risk of HIV infection among youth in high-risk areas of the State. Nine Comprehensive School Health and Wellness Centers have been created across New York State to increase the capacity of school/ community-based organization teams to provide, on a collaborative basis, HIV prevention education to youth. The AIDS Institute and State Education Department are working to develop a uniform training model and follow-up protocol for use by teachers and community-based educators. The educational model will be consistent with proven research strategies identified by the Centers for Disease Control and Prevention.
Health Insurance Issues: The State Department of Financial Services collaborated with the AIDS Institute on publication of a pamphlet that informs persons with HIV/AIDS of their legal rights to health care, options for health insurance coverage and viatical settlements. The Insurance Department also participates with the Department of Health on programs to expand health insurance coverage for the uninsured, including Child Health Plus, New York State Small Business Health Insurance Partnership Plan and the Early Intervention program.
Domestic Violence & HIV: The State Health Department, in consultation with the Office for Prevention of Domestic Violence as well as statewide and community-based organizations, developed a protocol for the identification and screening of HIV-infected persons for domestic violence as part of the State's new HIV test reporting and partner notification process. The protocol, which is undergoing revisions based on public comment, outlines a step-by-step process for domestic violence screening and provides resource materials on domestic violence risk assessment as a standard of patient care. Staff members of the Office for Prevention of Domestic Violence also have collaborated with the AIDS Institute in developing training materials on domestic violence, and in conducting training sessions for AIDS Institute staff and health care providers.
Prevention of Perinatal HIV Transmission: Using federal funding recently awarded by CDC, the AIDS Institute is funding the establishment of four community coalitions (one each in the Bronx, Brooklyn and Manhattan, and one in Buffalo) to prevent mother-to-child HIV transmission through recruitment of high-risk pregnant women into prenatal care. Core members of the community coalitions will be HIV, substance abuse treatment and maternal/child health programs funded or sponsored by the State Health Department, the New York City Health Department and the State Office of Alcohol and Substance Abuse Services. Other components of this grant include a social marketing campaign regarding the importance of prenatal care, and technical assistance to hospitals with low rates of prenatal counseling and testing.
HIV/AIDS Clinical Provider Program: The AIDS Institute convenes clinicians with extensive expertise and experience in providing care for HIV-infected persons to develop guidelines for the management of HIV disease. These guidelines become the standard of care for State of New York funded and/or operated facilities, including community health centers, correctional settings and residential treatment facilities. The guidelines also are available to all clinical providers through the Department of Health's web site.
In addition, the AIDS Institute funds 14 academic medical centers to provide state-of-the-art information on HIV clinical care to community-based clinicians and those working in the prison system, substance abuse treatment programs and other settings.
Interagency Memoranda of Understanding (MOU)
To facilitate interagency collaboration and funding of HIV/AIDS-related services, the State Health Department's AIDS Institute has entered into formal Memoranda of Understanding with a number of sister State agencies.
Department of Correctional Services - AIDS Institute - $637,700
Allows for transfer of funds from the Department of Correctional Services to the Department of Health to implement a comprehensive program of HIV prevention, education, support and referral services for persons incarcerated in State prisons or recently released from prisons.
Office of Alcoholism & Substance Abuse Services - AIDS Institute - $250,000
Provides Department of Health funding for the phased implementation and operation of a social purpose business to train and employ HIV-positive and at-risk individuals who are in treatment for substance abuse.
Department of Education - AIDS Institute - $200,000
Allows for transfer of funds from the Department of Health to the State Education Department to support school/community organization training teams to implement effective HIV prevention education in high need school districts.
Office of Children & Family Services - AIDS Institute - $150,000
Provides Department of Health funding to the Office of Children & Family Services for the continuation of HIV policy development and HIV training programs for agency and contract staff serving youth at high risk for HIV infection.
Division of Human Rights - AIDS Institute - $100,000
Provides Department of Health funding to support the Office of AIDS Discrimination Issues, within the Division of Human Rights, which responds to reports of discrimination against persons with HIV/AIDS.
Division of Parole - AIDS Institute - $150,000
Provides Department of Health funding to support 10 transitional beds for HIV-infected State prison parolees who are active substance abusers. This program provides temporary housing (up to three months) and access to substance abuse treatment services.
HIV/AIDS Funding Initiatives (1997 - 1999)
Information shared at meetings of the Governor's Interagency Task Force on HIV/AIDS and workgroup meetings, regarding priority HIV/AIDS service needs, target areas and populations, was incorporated into Requests for Proposals (RFPs) issued by the State Health Department's AIDS Institute and other State agencies.
$2,000,000 - Federal funds - HIV Mental Health Care and Supportive Services
Provides funding to community-based organizations to increase access to comprehensive mental health services for HIV-infected persons and their families, and to increase the availability of HIV/AIDS related health and supportive services for ethnic/racial minority communities.
$2,800,000 - State funds - Welfare to Work Pilot Program
The Department of Labor, with assistance from the AIDS Institute, is funding six agencies to provide vocational training, case management and job placement to enhance the employability of HIV-positive persons.
$1,100,000 - Federal funds - HIV Prevention & Support Services for Prisoners and Parolees
Provides HIV prevention and continuity of care for incarcerated individuals and parolees, with a primary focus on services for women, persons with a history of substance abuse, those whose primary language is Spanish and young offenders.
$525,191 - State/Federal funds - HIV Prevention Services for At-Risk Populations
Funds HIV prevention services for African-American, Caribbean and Latino women and youth; minority gay/lesbian/bisexual/transgender youth and young adults; immigrant populations.
$600,000 - Federal funds - Community Action for Prenatal Care
Funds the establishment of community coalitions to help prevent mother-to-child HIV transmission through education and outreach efforts to encourage high-risk pregnant women to receive prenatal care.
$2,250,000 - State/Federal funds - HIV Clinical Provider Program
Supports the development of clinical practice guidelines and comprehensive clinical education for community-based clinicians delivering HIV care.
$1,500,000 - Federal funds - Expand Drug Treatment Services for Women
Provides $500,000 annually for three years to the Office of Alcohol and Substance Abuse Services to expand drug treatment services for women, particularly pregnant women and women with children.
$100,000 - State funds - AIDS Clinical Trials Information & Outreach
Supports development of a comprehensive directory of HIV/AIDS clinical trials and expanded access treatment programs in New York State, and distribution of the directory to health care providers and interested members of the public.
$304,000 - Federal funds - Health & Supportive Services for HIV-infected persons
Addresses locally-defined HIV-related service priorities in regions and neighborhoods with high rates of HIV infection.
$7,800,000 - State/Federal/Local funds - Assets Coming Together for Youth
Provides $2.6 million annually for three years to demonstrate the effectiveness of community-based partnerships in promoting positive development and improved health outcomes for youth. The principal focus is prevention of abuse, violence and risky sexual activity.
$150,000 - Federal funds - Needs of HIV-Infected Deaf & Hard of Hearing Persons
Addresses the needs of Deaf & Hard of Hearing Persons as they pertain to both prevention and care of HIV/AIDS. The Initiative funds research regarding identification of barriers to access to HIV primary care, as well as access to HIV primary and secondary prevention/education information.
$1,185,221 - State funds - State Board Training Consortium
Four State agencies have pooled resources to fund a comprehensive training program to support the effectiveness of board members of State-funded nonprofit organizations.
Up to $30 million - State funds - Medicaid Managed Care Special Needs Plans
Provides developmental funding to Medicaid managed care plans that qualify and are approved as Special Needs Plans capable of providing comprehensive medical care for persons with HIV/AIDS and for those with serious mental illness.
A key goal of the Governor's Interagency Task Force on HIV/AIDS is to ensure that the needs, interests and recommendations of all State agencies and their constituents are taken into account in developing New York's HIV/AIDS related policies, statutes and regulations. It also is important for all State agencies to have full information and understanding of HIV/AIDS-related public health provisions and confidentiality protections in order to ensure that HIV-infected persons receive appropriate and equitable treatment, consistent with New York statutes and policies.
A. HIV Reporting and Partner Notification
The Interagency Task Force meetings provided an important forum for discussion and clarification of agency responsibilities under New York State's HIV Reporting and Partner Notification Law, implemented on June 1, 2000. Follow up meetings were also held with agencies most directly affected by the law and the proposed regulations - the Department of Correctional Services, and the Offices of Mental Health, Alcohol and Substance Abuse Services, and Prevention of Domestic Violence.
The meetings have led to improved information dissemination among New York State agencies, as well as input from those agencies into regulation development and implementation plans. There has been extensive consultation around various provisions of the law and implementation options, particularly concerning partner notification when the index case and/or contacts are in residential placement. As the regulations to implement the new law are finalized, additional meetings will be held to resolve operational issues and to ensure consistent and coordinated implementation of the statute.
B. New Treatments, Testing Technologies & Post Exposure Prophylaxis
The AIDS Institute briefed all Interagency Task Force members on the latest developments in HIV treatment and new, rapid HIV testing methods. The Institute also outlined the Health Department's recommendations for post-exposure prophylaxis following occupational exposure to HIV. Post-exposure prophylaxis (PEP), using new antiviral drugs, has proven beneficial in preventing infection if administered within 48 hours of exposure.
Several agencies, including the Department of Health, the Crime Victims Board, and the Division of Criminal Justice Services, are addressing issues related to HIV post-exposure prophylaxis for victims of sexual assault. Such issues include: the need for training of hospital emergency room providers and law enforcement personnel in PEP guidelines; development of consumer information materials; and eliminating financial barriers to prescription medications and follow-up care for uninsured victims of sexual assault.
C. Medicaid Managed Care Special Needs Plans (SNPS)
As part of New York's continuing effort to improve health care for HIV-infected persons, the State has undertaken a groundbreaking initiative to develop special Medicaid Managed Care plans capable of providing high quality, comprehensive and coordinated care for persons living with HIV. Staff from the State Health Department's AIDS Institute and Office of Managed Care worked cooperatively to develop criteria for the plans with guidance from workgroups representing persons with HIV/AIDS and the HIV/AIDS service community.
Members of the Governor's HIV/AIDS Interagency Task Force were brought up to date on the status of this initiative and the standards managed care plans must meet to qualify as HIV Special Needs Plans. Applications submitted by 10 managed care plans in response to an RFP are now under review by the Department of Health. Qualified plans must include experienced HIV service providers, and also must demonstrate how they will guarantee access to care, how they will reach multi-cultural and non-English speaking communities and what procedures they will use to monitor quality. It is anticipated that voluntary enrollment of Medicaid recipients in HIV Special Needs Plans will commence in the Fall of 2000.
Special Needs Plans for Medicaid recipients with serious mental illness also have been developed by the Office of Mental Health in collaboration with the Department of Health. Both agencies will work together to develop policies and procedures to determine how the HIV SNPS will interact with the Mental Health SNPS for patients who meet the eligibility criteria of both plans.
D. HIV/AIDS and Mental Health
Reverend Terry Troia, Co-Chair of the Statewide AIDS Service Delivery Consortium (SASDC) made a presentation, Painting a Portrait: A Multi Need Community Living with a Mental Illness, at a special workgroup session on HIV/AIDS and mental health. Rev. Troia highlighted key issues that need to be addressed for persons who are multiply diagnosed with HIV/AIDS, substance abuse and mental illness including prevention needs, availability of HIV counseling and testing, harm reduction strategies, and access to case management and other support services. Rev. Troia presented recommendations developed by SASDC to address the special needs of this population including: the importance of recognizing and addressing the stigma faced by these individuals and designing services that are sensitive; developing low-threshold housing models; providing access to health care and other support services in a co-located model where individuals may receive several services; developing methods of surveying this population to better ascertain their health problems and service needs; and designing specific case management models to serve this population. This presentation was very well received by Interagency Task Force members and offers many opportunities for future interagency collaboration.
E. Response to Proposed Federal Health Information Privacy Regulations
The Interagency Task Force served as a venue for alerting State agencies to proposed new confidentiality regulations for health information under the federal Health Insurance Portability and Accountability Act of 1996. This Act is intended to reduce the costs and administrative burdens of health care by making possible the standardized, electronic transmission of health-related data. Legal staff from all affected State agencies met to discuss the new
proposed federal regulations, including the potential impact on New York State health care providers and patients, particularly those with HIV infection. The goal of this meeting was to encourage State agencies to submit official comments on the proposed regulations pointing out problematic issues for New York State, and to reduce, if possible, inconsistent responses from New York State.
F. New York State AIDS Advisory Council
The State AIDS Advisory Council at each meeting of the Interagency Task Force provided updates on the major issues the Council is addressing. Members of the Interagency Task Force were invited to attend all AIDS Advisory Council meetings. These contacts resulted in both groups focusing on pressing and emerging HIV/AIDS issues related to services within the criminal justice system, the disproportionate impact of HIV/AIDS on communities of color, HIV among substance users, and the challenges of providing services for mentally ill, chemically addicted persons with or at risk for HIV/AIDS.
The Council shared copies of its recently completed reports, includingHIV/AIDS Services in NYS Correctional Facilities (February, 1999), Ethnical Issues in Access to HIV Treatment Workgroup (September, 1998), and Findings of the HIV Surveillance Workgroup/Majority and Minority Reports (April, 1998).
One of the responsibilities given to the Task Force was the development of plans to educate State agency personnel to increase awareness of HIV/AIDS, including sensitivity to the consequences of programmatic decisions on persons affected by HIV/AIDS. Agency personnel need education and information consistent with their State responsibilities and duties as well as information to protect themselves from becoming infected with HIV through personal behavior or occupational exposure. Program managers must be alert to potential discrimination against HIV-infected persons, or those perceived to be infected or at risk. They also need to understand the implications of policy decisions they make on persons with HIV/AIDS and HIV/AIDS-related services.
As a first step, the AIDS Institute conducted focus groups and surveyed all member agencies to assess the level of past and current HIV/AIDS training available to employees. The survey also gathered data about training needs and the most desirable methods for future training/information dissemination. Based on the results of this survey and variety of agency needs, the Institute developed a menu of available training options for consideration by member agencies. Agency managers and training staff, where available, are responsible for selecting and carrying out the training interventions deemed most appropriate for their respective employees.
Training options and tools offered to member agencies of the Interagency Task Force include the following:
- written materials, videotapes and a listing of Internet resources;
- regional training programs offered by the AIDS Institute on specific HIV-related topics; and
- "train the trainers" programs designed to prepare agency staff to provide their own in-house training programs.
Agencies were encouraged to develop an evaluation process for their HIV/AIDS training activities to assess the success and adequacy of these programs. All member agencies were added to the AIDS Institute's mailing list to regularly receive information about available trainings statewide and the HIV/AIDS educational literature catalog.
Given the cross-cutting policy issues regarding HIV/AIDS, it was recommended that a training program be developed to serve program managers from all member agencies. Plans were made for a future workgroup, co-chaired by the AIDS Institute and the Governor's Office of Employee Relations, with representation from key member agencies, to oversee development of this training program and to ensure relevancy and appropriateness of topics, content and teaching methodology. This workgroup will be one of the ongoing activities of this Task Force.
As required by the Governor's Executive Order creating the Interagency Task Force on HIV/AIDS, several major compendiums of AIDS-related programs and services were developed during 1999. These reports demonstrate the scope and comprehensiveness of New York State's response to HIV/AIDS.
A. Interagency Task Force Service Program and Policy Inventory
The Interagency Task Force Service Program and Policy Inventory is a comprehensive compilation and description of the current HIV/AIDS related policies, programs and services of all New York State agencies. Contact names, addresses and telephone numbers are given for each agency to obtain additional or updated information. This important reference document will be distributed to State and local government agencies, contractors providing HIV/AIDS services, and other organizations and groups involved in HIV/AIDS related activities. Copies are available upon request from the New York State AIDS Institute.
B. AIDS Institute Directory of Resources and Services
This resource directory, organized by region and borough, is intended for use as a referral tool for providers and individuals seeking HIV/AIDS services. The document provides information on HIV/AIDS services funded by the New York State Department of Health AIDS Institute. The directory was distributed in July 1999 to all State agencies, local health departments, AIDS Institute contractors, and members of the AIDS Advisory Council and Prevention Planning Group. The document will be updated annually, and is available upon request from the New York State AIDS Institute. A copy of the Directory can be obtained by contacting Mary Ellen Mancinelli, Administrative Assistant, NYSDOH AIDS Institute,at (518) 474-6399 or via e-mail at email@example.com.
C. HIV Counseling & Testing Resource Directory
A statewide directory of HIV counseling and testing services was developed by the AIDS Institute based on a survey of all providers funded by the Institute and those reimbursed by Medicaid for HIV counseling & testing services. The purpose of this directory is to assist health and human service providers in referring individuals who need HIV counseling and testing to available community services. In addition to basic information about each service provider (name, address, telephone number), the directory specifies the languages spoken by counseling staff, hours of operation, and availability of reduced cost or free services for low-income, uninsured clients. A copy of the Directory can be obtained from the Department of Health's website.
The Governor's Interagency Task Force provided a highly effective forum for information sharing and enhanced interagency coordination and planning of HIV/AIDS services. To ensure that this intensified level of collaboration among State agencies continues, the Task Force recommends the following actions:
A. Hold Twice-yearly Task Force Meetings
Twice-yearly meetings of the Interagency Task Force on HIV/AIDS will be held to provide updates on the status of the epidemic and State programs, and to identify new and emerging issues that would benefit from interagency collaborations. The AIDS Institute will schedule and organize these meetings. Additional meetings on important, breaking topics will be scheduled as needed.
B. Continue Interagency Collaborations on Funding
The AIDS Institute will help to identify opportunities for joint or multi-agency applications seeking federal and private funds for HIV/AIDS related programs. The Institute will add all members of the Governor's Interagency Task Force on HIV/AIDS to its quarterly mailing list of HIV/AIDS funding opportunities. The AIDS Institute also will take a leadership role in coordinating multi-agency funding proposals, and provide technical assistance to sister agencies in applying for grant funds.
C. Coordinate State Responses to Federal HIV/AIDS Policies and Regulations
The Interagency Task Force on HIV/AIDS will serve as a venue for identifying and coordinating State agency concerns and recommendations regarding existing and proposed national HIV/AIDS policies, laws and regulations. By submitting a consistent, multi-agency response New York may have greater success in influencing national HIV/AIDS policy and funding decisions.
D. Continue and Expand Interagency Workgroups
The new interagency workgroups created to address services for special populations and training of State agency personnel will continue their collaborative efforts, and work with the State AIDS Advisory Council to develop any needed State policy or legislative recommendations. New interagency workgroups will be formed as appropriate to focus on emerging HIV/AIDS issues and service needs.
E. Foster Interagency Collaborations
Heightened awareness by member agencies of the Governor's Interagency Task Force on HIV/AIDS of the mutual benefits of interagency collaborations is expected to lead to additional multi-agency initiatives in the future. These collaborations may encompass formal Memoranda of Understanding, multi-agency funding applications, coordinated responses to HIV/AIDS policies and legislative proposals, and informal meetings seeking consultation and advice on issues of mutual interest or responsibility.