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HomeMy WebLinkAbout10-2021 October 5 PHAB Minutes Deschutes County Health Services Public Health Advisory Board (PHAB) MINUTES MINUTES October 5, 2021 12:00 p.m. - 1:30 p.m. via Zoom videoconferencing Facilitator Keith Winsor, Chair Staff Coordinator Tom Kuhn, Community Health Manager Scribe Kelley Ward Next Meeting November 2, 2021 (or TBD) Topic and Lead Introductions and Approval of August Meeting Minutes Dr. Ross motioned, Tanya seconded, and all board members voted to approve the August meeting minutes. Announcements and Unfinished Business Recruitment for chair and vice chair positions:  David Huntley nominated himself for the chair position  Tanya Nason nominated herself for the vice chair position Central Oregon FUSE presentation - Colleen Sinsky and Elaine Knobbs-Seasholtz: FUSE (Frequent User System Engagement) was founded as a 501(c)(3) in 2019 as stakeholders across Central Oregon’s healthcare, law enforcement, and local government recognized a need for cross sector collaboration to address chronic homelessness. The mission is provide resources of housing and supportive services for those experiencing long-term homelessness to improve community health, safety and stability. Frequent users translates to individuals who are continuously popping in and out of emergency rooms, the justice system and other services within the community costing the system as a whole, a lot of money. By recognizing the chronic need and lack of resources around PSH (permanent supported housing), this is where FUSE steps in. PSH is low barrier housing for chronically homeless individuals who are most in need in the region. PSH is permanent housing, if needed. FUSE doesn’t assume that someone can live independently six months from now- it’s great if they can, but they don’t make assumptions. It is cost effective with bipartisan support and is the most prevalent homeless intervention in the country. PSH connects individuals to behavioral health and physical care, creating a huge decrease in crisis stabilization and ER services. Cost analysis- incredibly less expensive than the state hospital or incarceration. There is a severe lack in this type of unit and with chronic homelessness increasing throughout the county, this amounts to only two current units offered for every 100 people which shows the burden across shelters, police resources, crisis resources, etc. FUSE uses the Coordinated Entry System Assessment to identify vulnerability levels and what the appropriate level or support may be. FUSE has several “To promote and protect the health and safety of our community.” Updated 3/3/22 different projects (Bridges to Housing Program, Landlord Engagement and Retention Program, Community Education & Advocacy and Purpose-Built Permanent Supportive Housing) that allows FUSE to be able to pay application and move in fees; ongoing rental subsidy; advocate for tenants and help with housing search and waitlists; help acquire photo ID’s; provide cell phone and mailing address; and as mentioned before, ability to connect individuals to medical and mental health care while focusing on building partnerships. They are applying for state funding within the next several months. Keith had a question around if this is a sustainable model compared to a managed camp or purchasing hotels- the cost must pretty significant. Colleen doesn’t have a dollar per dollar comparison but to consider the cost period as an investment. They have federal and state funding as well as some limited local funding. Some of the high costs offset other costs. David shared that he can see how the grand cost to society becomes less overall in regards to police interventions and emergency services. He did some work with the Redmond Fire Department and those marginally housed and shared the effectiveness of nurse and ambulance support for those recently released from the ER. One finding was that someone wasn’t able to read their prescription bottle. The study was very consistent with a 2012 study in the New Yorker magazine around high ER users and how similar work has reduced costs. David would like to get Colleen connected with the Veterans’ groups. Elaine was shocked at the amount of money available from HUD because there were not organizations focused on this population and the lack of housing available to use vouchers on. Tanya mentioned a previous presentation from FUSE, their recap of the headcount of homelessness from the prior year and how only a certain percentage of vouchers were being used. Colleen acknowledged the voucher utilization rates and how by not having those supported resources, individuals are being left out. How do we uplift people and create incentives for landlords to accept these vouchers. Commissioner Chang emphasized the distinction between managed camps and tree life. The managed camps are a place where in a sense, we are holding people. People are staying in these camps until we are able to get them into temporary housing or other housing support. Obviously, four walls, a bed and a bathroom is way more expensive than a managed camp site but the managed camps are a last resort and a whole lot better than living in unauthorized areas. Managed camps are by all means, not the preferred option. Dr. Boehm asked how many families are in this population with school aged kids? Colleen responded that the biggest need is for adults who do not have kids and how this population is the biggest unmet need. There are programs specifically available for families with kids but FUSE is open to exploring this as it becomes a need. Tanya asked how individuals access the Coordinated Entry Assessment system. Colleen provided a link (COhomeless.org) that has a page on coordinated entry and information about a call-in line. FUSE is very thankful for PHAB’s interest in this topic and Commissioner Chang’s support. Feel free to reach out to CSinksy@centraloregonfuse.org. Central Oregon Racial Equity Data Roadmap - Brittany Liu: Data as a Valuable Tool to Dismantle Systemic Racism presentation. Brittany is currently an intern with DCHS and has been working on this project since the summer. Key terms: Health Disparities: preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations (CDC); Inequities: disparities in health status that are a result of systemic, avoidable and unfair social and economic policies & practices that create barriers to opportunity; Health Equity: actions to address and eliminate the systems & barriers that prevent some from the opportunities to be healthy; Racial Equity: achieved when racial identity no longer creates or reinforces differential outcomes for individuals or groups. Equality means everyone is treated the same way and equity is where everyone is provided the resources they need in order to be successful. Section 1 discusses “To promote and protect the health and safety of our community.” Updated 3/3/22 reframing how to understand and examine health outcomes through uncovering systemic conditions and barriers. Health disparities aren’t randomly created, they are connected by interconnected pathways. Social Determinants of Health (SDOH) influences and shapes health risks and outcomes, and drives health and health inequities from the conditions in which people are born, live, learn, work, and play. Section 2 discusses integrating data sources and characteristics to pinpoint health disparities and inequities. Data is a super important piece to this because it helps decision-makers make informed decisions and achievable plans for the future. It’s important to use data effectively and also collect data from a variety of credible resources as well as collect both quantitative and qualitative data in different ways. Quantitative data is broad, numerical and can be quantified and statistically analyzed. Qualitative data is in-depth, a narrative and based on non-numerical information. You can use data effectively by paying attention to the terminology used, considering race and ethnicity data may be collected differently, acknowledging missing data, biases, and limitations of data collection tools and taking time to research and understand where the data comes from before analyzing it. Section 3 discusses using Community-Based Participatory Research (CBPR) to advance equity. CBPR is a well-established partnership approach to research that emphasizes equity through mobilizing community members and organizational representatives in all aspects of the research process (Israel et al., 2010). There are 10 key principles for ethical and effective community engagement: 1. Avoid data extraction model; 2. Research with, not on communities; 3. Build on community strengths and existing resources; 4. Complex, inter- related problems demand interdisciplinary; 5. Focus on institutional and structural change, as well as short-term needs; 6. Action-orientation; often can’t wait until definitive ‘proof’; 7. Develop robust monitoring and tracking systems; 8. Share information widely and creatively; 9. Commit to long-term engagement, not short-term fixes; and lastly, 10. Leave the place better off, including local leadership. Section 4 discusses presenting data to enhance data literacy. When communicating data, consider who your audience is and what their goals are. It’s beneficial to visually display the data so the audience can better understand what you are talking about (excluding any difficult to understand language and being specific when describing data), including the location and timeframe of the data when writing data commentary- providing highlighting statements and discussing implications, problems, exceptions and/or recommendations, using storytelling to relay messages, consider data accessibility and report data in a meaningful way, linguistically appropriate and in a culturally sensitive manner. Section 5 discusses evaluating data to plan actionable goals. When framing an issue, be specific about what the issue is, how it reveals racism and systemic inequities, who is involved and to what extent, what are contributing factors to the problem and what contributes to the solution. Successful framing puts your group in a favorable position to direct the discussion of the problem and improves the changes of successful solution. The R.A.C.E (reveal racism, assess alternatives, engage and create change) tool is a great resource for this- see presentation. Monitoring, evaluating and reflecting is necessary because it provides valuable insight on the effectiveness of the intervention, helps refine program delivery and the evaluation should be an ongoing activity over the life of the program. When evaluating, consider the implementation/process which looks at if the program was implemented as intended, why or why not, as well as which activities are taking place, who is conducting activities, who is the target audience, and if inputs are allocated or mobilized. Another type of evaluation would be to look at the effectiveness/outcomes which assesses progress on the sequence of outcomes: change in people’s attitudes/beliefs; changes in risk or protective behaviors; changes in the environment and changes in trends in morbidity and mortality. It’s also important to consider efficiency, cost-effectiveness and attribution when evaluating a program. Brittany wanted to thank Channa Lindsey for her help on this project as well as “To promote and protect the health and safety of our community.” Updated 3/3/22 several different committees and workgroups for their support and all those on this call. Keith asked how this applies to Bend? Brittany responded that she worked closely with Deschutes County and reviewed various graphs and charts on the Central Oregon Health Data cite. She noticed there is difference in certain variables but was really focused on how we can use this data as a tool to push forward racial equity. Commissioner Chang appreciated the very thorough presentation and asked if there are any insights Brittany can offer us based on what she saw from the data. Brittany shared that health is really influenced by Social Determinants of Health. In terms of recommendations, we can start by really digging into the data to prove to people that there is a need to really reduce health disparities and racial exclusion. It’s about connecting all of the interconnected systems and dismantling systemic racism. Sarah Baron is very interested in these models and if they can be replicated. Brittany and Sarah will connect offline about this. For your reference, you can also access the fully published roadmap here. November retreat – Tom: It doesn’t look like we will be able to make an in person retreat happen this year. The plan was to review the priority topics for 2021. Do we want to schedule something via Zoom for November? Retreats in the past have been 4hrs long with a lunch break- we could start with a group discussion to start and then go into breakouts to allow for smaller discussions? Several members are feeling Zoomed out. Commissioner Chang asked if the product of the retreat is the annual goals? Yes. He suggested we could meet in person in January and then have a set of annual goals by February. There is a lot of value for in person interaction. Dr.Ross shared that is hard to predict if we be able to meet in person in January based on the current numbers. Have any of these priorities changed? Tanya shared that a lot of these items haven’t been able to happen due to the pandemic. Suggestion to create a four to five member workgroup to meet outside of the regularly scheduled meeting to review the current priorities and bring back to the group at the next meeting. Plan to have a regular meeting next month and make a decision then based on how to proceed. Adjourn 1:31PM Action Items:  Tom will share the Racial Equity presentation, 2021 priority topics, gather a consensus on the chair & vice chair positions and will get the subcommittee together to the review the 2021 priority topics. Board Members Present: David Huntley, Peter Boehm, Keith Winsor, Robert Ross, Sharity Ludwig, Tanya Nason, Charla DeHate, Steve Strang, Commissioner Phil Chang Staff Members Present: Tom Kuhn, Kelley Ward, Shana Falb, Nahad Sadr-Azodi Guest Presenters: Colleen Sinsky & Elaine Knobbs, Brittany Liu Guests: Renee Wirth – COHC Emily Cummins – Bristol Hospice Sarah Baron - COCC Brittany Liu – DCHS Intern Shana Falb – DCHS DEI Coordinator “To promote and protect the health and safety of our community.” Updated 3/3/22 Colleen Sinsky – FUSE Executive Director Elaine Knobbs – Mosaic Medical & FUSE Board “To promote and protect the health and safety of our community.” Updated 3/3/22