Consumer Involvement in Governance

Wednesday, April 23, 2014We will begin at 3 PM EST

This publication was supported by Grant/Cooperative Agreement Number U30CS09746-04-00  from the Health Resources and Services Administration, Bureau of Primary Health Care (HRSA/BPHC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of HRSA/BPHC.

Kristy ChambersCEO, Fourth Street Clinic/Wasatch Homeless Health Care, Inc.

Brian ZralekConsumer Advocate , Nat iona l Hea l th Care fo r the Homeless Counc i l

Presenters

Vaughn DavisCAB President, Fourth Street Clinic/Wasatch Homeless Health Care, Inc.

CDR Kent FordeCDR Ken t Forde , MPHHRSA/BPHC Pro jec t Of f i ce r (HCH NCA)

Webinar Agenda

• Consumer involvement in governance – federal

regulations and the new PIN

• The Consumer Advisory Board – the Fourth Street Clinic

experience

• National Consumer Advisory Board (NCAB)

HCH Governance PIN23 April 2014

CDR Kent Forde, MPHHRSA/BPHC Project Officer

HCH National Cooperative Agreement

Agenda

• Overview of PIN• Purpose• Board Composition• Public Center• Waiver• Mechanisms for Consumer Input• Resources

Purpose

• New Governance Policy Information Notice (PIN) 2014-01

• PIN 2014-01:– Clarify Existing Policy– Board Requirements– Eligibility for Patient Majority Waiver– Eliminates Monthly Meeting Waiver

• Health Center Program Governance Policy into One Document

III. Board Composition

• One Board Member from Each Special Population Funded to Serve

• Best with Patients, but Advocates Meet the Requirement for Multi-Funded/Designated

• Advocates Not Included in Patient-Majority Unless They Were Also Health Center Patients

III. Board Responsibilities

• Board: Provides Leadership and Guidance• CEO and Staff: Daily Operations &

Management• Board Duties:

– Monthly Meetings (In-person or Virtual)– Approve Applications– Approve Annual Budget– Long-term Strategy– Evaluate– Select Services, Location, Delivery– Hours of Operation– CEO– Establish Policies and Procedures

IV. Public Centers

• Clarifies: Public Agencies may meet Governance Requirements through a Co-Applicant Structure, but all other Requirements Apply

• HRSA Considers both that Agency and the Co-Applicant Collectively as the “Health Center”

• Co-Applicant Model Governing Requirements

• Co-Applicant Agreement Requirements

V. Waivers

• Only (g), (h), (i), and (p) are Eligible to Request a Governance Waiver

• Only Requests to Waive the “Patient Majority” Governance Waiver Will be Granted

• No More Monthly Meeting Waivers Will be Granted

• Good Cause is Described in Detail in PIN 2014-01

V. Monthly Meeting

• EHB: Coming Soon, EHB Will Have a Mechanism to Submit Implementation Plan/Documentation of Compliance with the Monthly Meeting Requirement.

• Late Fall/Winter 2014: Non-Compliant Health Centers Without an Acceptable Plan Will Receive a Progressive Action Board Authority Condition.

V. Good Cause

• Good Cause: – Documentation

• Documentation includes:– Description of Population– Health Center’s attempts– Why not Successful

V. Alternate Mechanism Plan

• Alternate Mechanism Plan:– Description of Gathering Patient Input– Type of Patient Input– Collecting/Documenting Input– Communicating Input Directly to Governing

Board– How Input will be Used

Consumer Involvement?

• Why?– Essential Element

• How Consumer Input?– Substantial Involvement Consumers on Board– Patient Advisory Council (eg. CAB; Not a Board)– Advocate Inclusion– Focus Groups– Patient Interviews– Surveys– Suggestion Box or Complaint Line

VI. Additional Considerations

• Requirement That an Outside Organization May Not Compromise or Limit in Any Way the Governing Board’s Required Authorities.

• A Minimum List of Types of Agreements HRSA Would Need to Review from this Programmatic Perspective, as Well as the Types of “Delegation” HRSA Would Not Allow.

Additional Questions?

• Questions:– How PIN Relates to Health Center’s

Individual Circumstances• Questioner- Health Center• Who to Ask- BPHC Project Officer

– General Policy Questions (Not Related to Specific Health Center Circumstances)• Questioner- General Public/External Parties• Who to Ask- BPHCPolicy@hrsa.gov

CDR Kent FordeProject Officer, ONASP

U.S. Department of Health and Human ServicesHealth Resources and Services Administration

Bureau of Primary Health Care 5600 Fishers Lane Rm. 6-41

Rockville, MD 20857Telephone: 301.443.6164Email: kforde@hrsa.gov

THE CONSUMER ADVISORY BOARD (CAB)

The Fourth Street Clinic Experience

Consumer Advisory Board

CAB’s are comprised of people experiencing homelessness or who have previously experienced homelessness, advocates, health care providers, and community members who come together to positively affect change within their local HCH

project.

The purpose of a CAB is to:

• Advocate for participants and their needs• Identify potential participants for HCH services through

outreach & promotion• Nominate a consumer representative to serve on and

advise the health center’s board of directors• Inform the board of directors and executive leadership of

current needs within the community

CAB Membership

• A CAB includes 5-25 members (most are small)• Representatives of community• Current and former participants of Health Care for the Homeless

project; may be residents of permanent supportive housing• Clients and staff from other homeless service provider agencies• Community advocates and leaders• Staff support

• At least 75% of CAB should be consumers • Terms of membership should be outlined in

by-laws/operating rules (i.e. number of years, participation, conduct, service requirements, etc.)

• NCAB Manual has helpful tips

The work of the CAB must appropriately

represent its constituents, the HCH

project, and people experiencing

homelessness.

Effective CAB Members’ Attributes

• Demonstrates a willingness to learn leadership qualities

• Willing to represent others, advocate• Respectful, good listening skills• Open-minded, tolerant of diverse opinions • Collaborative• Consistency• Flexibility

Willingness to use life-experiences to listen to and help others.

Decision Making Process

NCAB uses and recommends consensus as the model for the decision making process. Consensus places emphasis on thinking with regards to what is best for the group.

Consensus basics:• Listen patiently• Focus on the topic at hand• Presentation of proposal• Options: affirm, do not affirm, stand aside, block• Proposal is approved or not• All voices are equal to that of the majority

Consumer Advisory Boards

A Consumer Advisory Board is an advisory group

Works closely with agency management and staff

Does not make decisions on day-to-day operations of the agency

Does provide insight into how agency policies and practices affect those accessing services

A Consumer Advisory Board should be autonomous

Makes its own decisions and recommendations

Develops its own mission statement, guidelines/by-laws (which can be approved by the agency Board of Directors)

CAB Activities

• Outreach – library, farmers’ market

• Medicaid expansion advocacy

• Homeless Persons Memorial Day

CAB Activities

• Special events• Survey of potential patients

• Board advisement – sign and tag-line

• CAB logo and business cards

NATIONAL CONSUMER ADVISORY BOARD (NCAB)

PROMOTING NATIONAL ACTIVITIES

Homeless Persons Memorial Day

HCH Day

Consumer Participation Outreach Survey

Consumer-driven process

Council staff involved in analysis and reporting

Purpose – develop skills, better understand issues, inform programs and policies

2014 – Barriers to and Facilitators of Housing study

2010 – Violence Study• Recommendations: increasing screenings for violent attacks and

referrals for domestic violence services as well as improving relationships between law enforcement and individuals experiencing homelessness

HONORING FELLOW CONSUMER ADVOCATES

Ellen Dailey Consumer Advocate Award

Conference Attendance Subsidies

SUPPORTING AND FACILITATING COMMUNICATION BETWEEN CABS

38

Regional Representatives

Technical Assistance (TA)• HCH project requests TA• TA Coordinator responds• Consumer Advocate, TA Coordinator and SME determine

specific needs• Consumer Advocate and SME provide TA

ADVOCACY

What is HCH Advocacy?

“The educational process through which data, experiences and insight are shared with those who craft public policy so that they make informed decisions.”

McMurray-Avila, Organizing Health Services for Homeless People

Advocate for Change

• Advocacy influences public policy and practice— enabling you to create change in your community

• Advocacy supports, protects, and advances the civil and human rights of people experiencing homelessness

• Advocacy gives people experiencing homelessness a voice

Advocacy Activities

• Promote advocacy agenda in your local community, state and Congressional District – or RALLY!

• Conduct consumer needs assessment in clinic• Organize an Advocacy Day or HCH Day• Invite public officials to tour your clinic• Distribute HCH Mobilizer (www.nhchc.org)• Organize a Homeless Persons’ Memorial Day event• Attend town hall meetings• Collaborate with other service providers on agendas

Questions and Answers

ResourcesVisit http://www.nhchc.org/resources/consumer to

• Connect with other CABs by visiting the CAB Directory

• Join NCAB

• Learn about important NCAB activities

• Download CAB Manual

Register for the National Health Care for the Homeless

Conference and Policy Symposium in New Orleans from

May 28 – 30 at www.nhchc.org.

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