4:30-6:30 pm
Committee Members Present: Billie-Jean Kanios (co-chair); Dorothy Kleffner;
Laura Thomas; Catherine Geanuracos (co-chair); Allison Weston; Erika Takada,
Ken Pearce; Bill Blum;
Committee Members Absent: Tracey Packer, Jen Sareche, Randy Allgaier, Anita
Booker
Other Council Members Present: Brian DiCrocco, Raymond Banks
Council Support Present: Jack Newby, Skot Jonz
1. Introductions
CM Geanuracos called the meeting to order and asked those present to introduce
themselves.
2. Review/Approve Agenda
The group reviewed the agenda. CM Banks asked to add something to announcements.
Without objection, the agenda was approved by consensus.
3. Review and Approval of Minutes
April 19, 2005 and April 27, 2005
The group reviewed the minutes from April 19, 2005 and April 27, 2005. Without
objection, the minutes from April 19 were approved by consensus. Without objection,
the minutes from April 27 were approved by consensus.
4. Announcements
CM Banks made an announcement regarding the HIV Women’s Conference held
today from 10-2. With respect to the Needs Assessment survey, he indicated
that it seems that Latina women are getting hard hit by the epidemic and suggested
that the survey be directed toward this population. He indicated that Instituto
Familiar de la Raza should be contacted regarding disseminating the survey
to their clients.
CM Geanuracos suggested further discussion about this under the Harder and
Company update and focus group items on tonight’s agenda.
CM Kleffner made an announcement regarding the Brown Act issues and inquired
about a subgroup meeting held earlier to finalize the survive and questioned
why nobody was invited to attend.
CM Kanios informed her that the people who volunteered to participate did so
at the last meeting.
CM Kleffner commented that she is challenging the process.
Group discussed CM Kleffner’s concern and it was agreed that it is a
good issue to be looked at. She would like to get an answer at a future date.
CM Geanuracos agreed that there are rules regarding what is or is not a meeting
and suggested finding out what the real rules are.
CM Thomas added that it was primarily people doing work outside a regular meeting
to finalize the survey.
CM Pearce indicated that everyone was invited to participate, and it is difficult
to set quorum since there are not a set number of members.
5. Public Comment
There were no public comments.
6. Harder & Co. Consultants Progress Report
Harder & Company Consultants will give the group a progress report regarding
data collection
Erika Takada provided a project update. She read into the record their progress
report (Copy on file at Council Support Offices). She indicated that there
are approximately 140 completed surveys as of today. They are looking at a
total end number of 600 surveys and hoping to over-survey among women, severe
need populations, special populations, recently incarcerated, and homeless.
The sampling quota has not changed. She indicated that the phone rings at least
three times a minute, the voice mail is always full, and they are getting a
good response. She indicated 11 community interviewers have completed their
training, with more being trained.
CM Banks asked about qualifications for the interviewers. Allison provided
information on how trainers are identified and indicated that they have full
staff.
CM Banks asked if there were any consumer-trainers.
Allison indicated that at least half are consumers, and some are not affiliated
with any providers. Allison and Erika both mentioned that it is a good mix.
CM Pearce commented that he thought that all Council Members were disqualified,
and asked whether female and transgender interviewers are on board.
Allison indicated that there are female, transgender, and people of various
ethnicities, and hope that the interviewer staff mirrors the population of
HIV-affected people in the EMA.
The group discussed specifics regarding the training of interviewers.
CM DiCrocco indicated that he called today and indicated that Walden House
was one of the agencies where the survey was being done. He was concerned that
one agency would stack the deck.
Allison indicated that agencies are only offering space to administer the survey.
CM Banks indicated that he watched the survey being administered and felt that
there was no sign of bias and that the H&Co. staff were well-qualified.
CM Pearce did not call to fill out the survey, as he thought it was agreed
that Council Members would not participate, and wanted clarification whether
who would be allowed. Group discussed that this was not asked during the screening
process, and one person’s response is not going to adversely affect the
results; and how perceived conflict of interest plays into participation. Group
decided that Council Members’ participation is welcome, but if anyone
participated in the process of developing the survey questions that perhaps
they should not participate. After substantial discussion, group agreed that
any Council Member could take the survey even if they had participated in the
development process.
Erika indicated that the client data base has been completed, and the protocol
is developed so that reports can be run on a regular basis.
Allison provided a report on the Spanish survey, which is in the process of
being translated. Sessions are already scheduled for Spanish speakers, and
H&Co. staff is already screening and scheduling Spanish speakers. She indicated
that all the agencies that serve those populations have been contacted, and
recruitment efforts for Spanish speakers are being met. Spanish flyers are
being developed and distributed to the agencies. She indicated that language
issues with focus groups would be discussed under the next agenda item.
CM Blum offered additional support from his bilingual staff if H&Co. needs
anything with regard to translation. He also provided statistics with regard
to the percentages of women (22%) and Latinos (35%) in San Mateo County and
asked H&Co. personnel to keep this in mind.
CM Banks brought up the point with regard to definitions, specifically “peer
advocate.” He suggested that confusion around the meanings of these words
may cause problems and asked if there was anyway to use a more layman approach
to these definitions.
Allison mentioned that this is a valid concern and the group was aware of it
during the process of completing the survey. The pilot surveys had a mechanism
for highlighting things that were confusing. She indicated that H&Co. has
done their homework, and when training facilitators it was ensured that the
definitions were clear and the same definition will be provided across the
board. They have been trained to look for signs of people having trouble. She
suggested that all the necessary precautions have been taken, and she feels
confident that it is user-friendly given the number of questions and the information
being sought. She suggested that with surveys such as this that it is common
to have some difficulty with definitions.
CM Genauracos suggested that at this point it will be important for H&Co.
staff to monitor the people completing the surveys, and look at data as it
comes in to identify items that may be left blank. Erika mentioned that the
surveys are reviewed before the participant leaves, to identify any blanks
and help is offered to complete. Allison suggested that one H&Co. staff
and community facilitator are at each session, and she has attended several
sessions. She reported on a recent session where participants came from a wide
variety of backgrounds, and everyone provided a complete survey, and there
was support offered to all the people who needed it. She further explained
that there are detailed explanations provided ahead of time.
CM Pearce suggested in light of CM Banks’ concerns that it be communicated
to the interviewers to clarify some of the more technical terms. CM Pearce
added that this issue (defining peer advocate) was discussed in detail many
times and he would be interested if CM Banks has something that is more suitable.
Jack suggested that these definitions were kept the same in order to maintain
some consistency with the previous Needs Assessment. He added that it will
be impossible to get a perfect survey. He indicated that H&Co. was chosen
because the other consultant was going to have people complete the survey over
the internet without supervision or assistance, and suggested that H&Co.
was offering the best service, and they have addressed all the issues. He stated
that CM Banks has a good point, but suggested reasons for why it is what it
is.
CM Banks indicated that his contacts with H&Co. have been met with professionalism
and apologized if he has brought up issues that have already been discussed.
He thanked H&Co. for everything they are doing.
CM Thomas commented that the “peer advocate” issue was agonized
over for quite amount of time by the working group.
CM Blum suggested that Council Members participating in the pilot could help
strengthen the process, and brought up the idea of actually structuring this
into the process.
CM Pearce asked about special significance with the survey results.
Erika responded that is why they over-sample certain groups, because otherwise
when the pie is cut down it is too small a sample to predict. She indicated
that certain groups overlap anyway, and the numbers become big enough. If over-sampling
is not possible, they will consult with someone to help develop a model.
CM Kleffner asked about what groups were being over-sampled.
Erika mentioned that it would be provided at the next meeting, as well as some
hard data.
CM Kleffner indicated that in the proposal it was indicated that 40 surveys
would be done in Marin County, and asked specifically what over-sampling would
mean; whether 40 included the over-sampling number.
Group discussed that a goal was set with each population and as they go along
it would be determined how close they are to the goal.
Group agreed to look at this issue in greater detail at the next meeting.
Allison provided a brief synopsis of the approach, by looking at the percentage
of people with HIV in Marin County compared to the whole EMA, it is so small
that it is difficult to represent. Group agreed that 40 is the goal (with the
over-sampling included).
CM Blum asked how recruitment efforts are going in San Mateo. Allison mentioned
that they would provide this information to CM Blum later.
CM DiCrocco also commented on the terminology, and provided an example of Scientology
books that provide definitions on each page for difficult words. He suggested
a glossary or another means for providing definitions.
CM Pearce asked that when the in-service on over-sampling is provided, if something
could be added about how this skews the actual results. Group discussed that
it is inflated, then deflated to reflect the actual results.
Allison mentioned that Harder & Co. is interested in providing more than
just the needs assessment survey, and also want to ensure that Council Members
are knowledgeable and comfortable with the process.
Jack indicated that the contract includes a training for the Council on the
needs assessment process.
7. Discussion Regarding Focus Groups
The group will discuss issues with regard to focus groups
Erika provided a review on the approach regarding the focus groups and presented
a document that was taken from the proposal. (Document on file at Council Support
Offices). She indicated that about five focus groups are scheduled for different
populations, and that each would have about ten people. The purpose is to get
more in-depth information from hard-to-reach populations who may not benefit
from the survey. These focus groups focus on the service utilization aspect
of the survey. Recently incarcerated persons, those with lowest rates of HAART
usage, homeless populations, African-American women, and Monolingual Spanish.
It was also considered to do a Vietnamese focus group. It was discussed that
this is based on what was reviewed with special populations, and it may be
possible to add more.
CM Blum suggested operationalizing the definition for “incarcerated”.
He suggested that there are few homeless people in San Mateo and a focus group
would not be useful. He added that adults aged 21-30 is a group that is often
not addressed and suggested considering a focus group there. He also suggested
a focus group with non-Mexican immigrants.
CM Pearce asked whether someone could overlap into two separate focus groups.
Erika mentioned that they would not want someone to participate in more than
one group. Ken also indicated that “homeless” is not clearly defined
and asked how H&Co. was dealing with this.
CM Kanios provided information on the general population of homeless.
CM Pearce added that it would be helpful to get a grasp on how broad this category
is.
Allison mentioned trying to operationalize this definition.
CM Pearce agreed about looking at younger age groups and added that it might
be helpful to include older age groups. Group discussed whether this should
be 55+ or 60+. H&Co. mentioned that they have looked at this.
CM Kleffner suggested adding a focus group for the transgender population.
CM Kanios suggested that the transgender population has the highest rate of
infection in the community and it would be helpful to get a sampling.
CM Geanuracos suggested one focus group that is county-specific rather than
population-specific.
CM Kleffner added that it would be necessary to ensure that it was a wide spectrum
that was sampled.
CM Geanuracos indicated that the PNP (party ‘n play) group could be sampled.
In terms of youth, the absolute numbers identified as HIV-positive under age
20, are very small. The bulk of infections are from age 19 and up in San Francisco,
but may not be true for other counties. The numbers for ages 13-20 are very
small. CM Geanuracos suggested a Hepatitis C co-infection focus group and it
would be useful to have some information about this.
CM Blum indicated that other groups to look at would be newly-infected and
long-term survivors.
CM Thomas commented on the “lowest rates of HAART” that this is
from different populations. Doing a focus group among African Americans sounds
good, but by defining it lowest rates of HAART as a category may not be as
useful. She indicated that a focus group for people who are not on treatment
would be very useful, to identify service access needs. She indicated that
it would also be useful to identify people who are not in care, but that this
population is difficult to contact, to discuss barriers to care. She suggested
advocating two neighborhoods in San Francisco – Tenderloin and Bayview.
She agreed that San Mateo and Marin county focus groups would be useful.
Jack commented that a way to get to those not in care would be to work with
testing to see if it would be possible to get those late testers in a group
to identify why they tested late or are not in care.
CM Blum indicated that this might be a bit oxymoronic, to identify those not
in care to participate in a group. Group clarified that “on HAART” pertains
to specific clinical guidelines, but the goal is to identify those who are
clinically appropriate to be on HAART but the client or the physician has decided
not to start treatment.
CM Pearce added that he would like to really push Bayview and Visitacion Valley.
He commented on the “not on HAART” is a choice by a considerable
group in San Francisco, by some people who believe that HAART is not an acceptable
treatment route, and different than those who are not on HAART for financial
or other reasons.
CM Thomas suggested that those people are different, because they are choosing
not to be on HAART and nothing the Council can do will change that. She suggested
that there are people who are not on HAART that could benefit from something
the Council has to offer.
Erika indicated that there is the “nice to know” and the “need
to know” when moving forward with the needs assessment and focus groups.
CM Pearce replied that an element of education could help some of these people.
CM Kanios asked about outreach activities in Marin with regard to focus groups
and surveys, and suggested that it is not reaching appropriate populations
(such as transgender and people of color), specifically in Marin City.
Erika offered for people to suggest any outreach activities that might be effective.
Jack suggested there is prevention outreach and testing in Marin City that
reaches these people.
CM Kleffner added that what has been tried in Marin City is not working very
well. She added that a focus group in the County may be unreliable because
of the wide variety of experiences.
CM Thomas asked about what the group should be focused on that would be the
most useful.
CM Kleffner suggested that a Spanish group in the canal area would be helpful.
If a focus group is done in the county it would be helpful to be clear about
what kind of information is being sought.
CM Thomas added that with limited resources it is necessary to be selective
in the number of focus groups.
Group discussed the effects of sampling a few people from a wide geographical
area.
Allison commented that recruitment efforts for the survey are effective enough
to cover a broad area in Marin County to receive input from all people affected
by HIV. The purpose of the focus groups is to hone in on service needs, barriers,
and why.
Allison asked if the group could prioritize the 20-some item list of focus
groups that has been discussed. The items were listed on a flip chart and reviewed:
Young Adult (~21-30)
Non-Mexican immigrants
55+ (or 60+)
Transgender
Marin Specific
San Mateo Specific
Meth/PNP Population
Co-infection (i.e. HCV)
Recently diagnosed
Long-term survivors
Not using HAART (and clinically indicated)
Not in primary medical care
Tenderloin
Bayview
Recently released from jail (prison)
African American (male)
African American (female)
Homeless
Spanish (2)
Vietnamese?
Early to mid-recovery
Non-Urban (1 or 2)
Erika discussed that the questions are open-ended and they are looking for
qualitative information and it is important to keep the groups smaller.
Group agreed to eliminate groups to get the list down to fifteen.
CM Geanuracos commented that it would be appropriate to scratch Bayview from
this list of potential focus groups since a recent needs assessment was done
there. She also indicated that a Tenderloin group would not be further help
because of the recent forum.
CM Thomas suggested that the data from the prior Needs Assessment in Bayview
was disappointing. Group decided to leave it on the list for now.
Group discussed that the county-specific groups could be removed and add a “non-urban” focus
group.
Group agreed about how difficult it would be to come up with a group in San
Mateo that is non-Mexican immigrants, and whether this was African, Asian or
other.
Erika discussed that this would be logistically challenging because of the
language issues, but discussed the possibility of one-on-one interviews. Group
agreed to remove non-Mexican immigrants. Group discussed that the information
needed by the Council regarding service utilization should determine which
focus groups would be useful. It was agreed that long-term survivors could
be removed. Group agreed that the group in early to mid recovery would be difficult
to identify and screen. Group discussed that there are other studies with regard
to the meth/PNP group and not much more information could be obtained. Group
discussed the reasons why Vietnamese came up as a possible focus groups. Allison
mentioned that it was determined by service providers that this was a population
that could offer information, but that the survey was not going to be translated
into Vietnamese. Group agreed to look at the number of Vietnamese affected
by HIV and revisit whether this should be a focus group or not.
Group discussed the difference between those not on HAART and in care, and
those people not in care and not on HAART.
Group discussed the recently diagnosed focus group. Allison and Erika mentioned
that this could probably be identified in the survey, and it may not be necessary
to have a specific focus group for this.
CM Thomas indicated that recently diagnosed and new to care could have a lot
to offer that is not provided by the survey alone.
Group discussed whether to leave the county non-urban focus groups.
Group discussed that it might be helpful to look at the Needs Assessment from
Marin.
Allison mentioned that by the time of the next NAWG meeting that some of the
focus groups will already be underway. She asked if an interim meeting would
be necessary.
Group discussed but came to no firm decision.
Jack expressed concern that H&Co. needs input on the draft provider survey.
Erika passed out copies.
8. Review of Draft Provider Survey
The group will review the draft Provider Survey
[due to lack of time, this item was initially tabled for discussion at the
next meeting].
CM Kanios made a motion to extend the meeting 30 minutes to address this issue.
CM Kleffner seconded. Group agreed to stay longer to discuss the Draft Provider
Survey.
Erika and Allison distributed the following documents to the group (Copies
on file at Council Support Offices):
Draft Plan for Provider Survey
Preliminary matrix of Populations Served by Title-I Funded Service Providers
Sample Provider Survey
Group reviewed and discussed the survey list. Allison mentioned that this is
not an exhaustive list.
CM Genauracos endorsed the online survey. Erika mentioned that since it is
being administered on Survey Monkey which has the ability to move back and
forth, as well as forward to other people.
Group discussed how to ensure that the provider survey goes to the most appropriate
person at the agency.
Group reviewed and discussed possible changes to the provider survey.
CM Thomas asked about question #10 to add local general fund dollars and CDC
funding.
Regarding Section II, eligibility requirements and so forth were confusing.
Erika indicated that the survey would be set up to clarify this.
Group discussed adding a question with regard to CARE-funded agencies providing
Prevention with Positives services. If so, what does that look like?
Regarding Section II, Number 8, it was agreed to add something to allow for
remarks and comments.
CM Genauracos reminded the group that these questions were asked before, and
it would be helpful to maintain consistency and not change too much.
Group agreed to add “Health Plan of San Mateo” regarding how client
pays for services.
CM Thomas asked if Council wants information about Title I funded programs,
or does the Council also want to hear about programs funded by other sources.
Group agreed that there is no way to get the whole service picture, because
some agencies do not receive CARE dollars, but it might be helpful to identify
what other funding sources are available in CARE-funded agencies.
Allison and Erika discussed that a question could be added to determine if
an agency provides services not funded by CARE money, which could trigger additional
questions. Allison indicated she would cast a wider net to identify other agencies,
and new agencies, but follow-up would focus on the CARE-funded agencies.
Group discussed getting feedback from HAPN before the survey goes out. Several
committee members agreed that they would be at the next HAPN meeting. Jack
agreed to provide information to H&Co. regarding HAPN and he would attempt
to get something on their agenda.
Harder and Company agreed to get a copy of the finalized provider survey to
committee members when it is available.
10. Next Meeting Date & Agenda Items - June 22, 2005.
Discussion of Over sampling and San Mateo and Marin Counties
Outreach Efforts in Counties
CM Geanuracos adjourned the meeting at 6:55 pm.
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