Consumer Involvement in Governance Wednesday, April 23, 2014 We will begin at 3 PM EST This publication was supported by Grant/Cooperative Agreement Number U30CS 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 Chambers CEO, Fourth Street Clinic/Wasatch Homeless Health Care, Inc. Brian Zralek Consumer Advocate, National Health Care for the Homeless Council Presenters Vaughn Davis CAB President, Fourth Street Clinic/Wasatch Homeless Health Care, Inc. CDR Kent Forde CDR Kent Forde, MPH HRSA/BPHC Project Officer (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 PIN 23 April 2014 CDR Kent Forde, MPH HRSA/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) PIN : –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

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-

CDR Kent Forde Project Officer, ONASP U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Primary Health Care 5600 Fishers Lane Rm Rockville, MD Telephone:

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 ( Organize a Homeless Persons’ Memorial Day event Attend town hall meetings Collaborate with other service providers on agendas

Questions and Answers

Resources Visit 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

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