Planning 101: Model Training Session on The Ryan White HIV/AIDS Program Part A Planning Cycle This model training session was prepared for the PCS.

Planning 101: Model Training Session on The Ryan White HIV/AIDS Program Part A Planning Cycle
This model training session was prepared for the PCS Compendium by EGM Consulting based on Session 6660, Planning Bodies 101, part of the planning institute: Strengthening the Healthcare Delivery System through Planning, developed and presented by DMHAP and EGM Consulting, LLC as part of the 2016 National Ryan White Conference on HIV Care and Treatment, and funded through MSCG/Ryan White Technical Assistance Contract From: Compendium of Materials for Planning Council Support Staff. EGM Consulting, LLC  Available at:

Introduction/Background
Why This Session? Session Objectives Session Topics

Why This Session? Importance of the planning process and the planning council or planning body (PC/B) as the group with primary responsibility for Ryan White HIV/AIDS Program (RWHAP) Part A planning Need for all members to understand PC/B legislative requirements and HRSA/HAB expectations Demands on PCs to address large changes in the epidemic, HIV treatment, health care financing, and availability of data Refined planning cycle for PC/Bs provided by HAB’s Division of Metropolitan HIV/AIDS Programs (DMHAP) – presented at a planning institute during the 2016 National Ryan White Conference PCs bring great value as unique community planning vehicles & a source of consumer and other PLWH input & decision-making role Representative & reflective PCs contribute to improved care quality & positive clinical outcomes for diverse subpopulations EMAs and TGAs are most effective when the PC/B, PCS staff, & recipient work in partnership Rapid changes in the HIV landscape make community planning more difficult & active consumer engagement in decision making more challenging Most respondents, including recipients, support continuation of decision-making PCs but would like fewer mandated PC slots & more flexibility PCS staff play a key role, but sometimes lack needed training & support Some Part A programs are uncertain about the extent to which PCs are still expected to be independent bodies that work in collaboration with – but are not directed by – the recipient TGAs (and a few EMAs) with limited PCS funds & staffing find it very difficult to meet all PC legislative requirements Reduced DMHAP/HAB focus on PCs in recent years has negatively affected PC access to materials & TA Advisory bodies face considerable challenges

Session Objectives Participants will have shared knowledge and skills for carrying out PC legislative responsibilities and meeting HAB/DMHAP requirements and expectations, with focus on the following areas: The PC/B as a community planning mechanism The annual planning cycle Expectations and best practices for key planning tasks

Expectations for This Training
Share your responses to these questions in a small group. Choose a facilitator to coordinate the work and a recorder/reporter to summarize your group’s responses to the full group: What are your most important expectations for this training: What do you most want to learn? What questions about the PC and planning process do you most want answered? Comprehensive/integrated planning plays a central role in the revised annual planning cycle, especially with a new, 5-year plan, review and updating of the plan will be very important

Community Planning in the RWHAP Part A Program

What is Community Planning?
“Community health planning is a deliberate effort to involve the members of a geographically defined community in an open public process designed to improve the availability, accessibility, and quality of healthcare services in their community as a means toward improving its health status “That public process must provide broadly representative mechanisms for identifying community needs, assessing capacity to meet those needs, allocating resources, and resolving conflicts” Source: American Health Planning Association, “Community Planning,” John Stern, 2008;

Central Role of Planning in the Ryan White HIV/AIDS Program
Captures the community’s experience and voice Provides formalized opportunities/roles for continuous community input Provides multiple roles and opportunities for input and decision making for consumers of Ryan White HIV/AIDS Program (RWHAP) services and other PLWH Allows for shaping a system of HIV care at the local level, to reflect documented jurisdictional needs and priorities EGM

RWHAP Part A Planning Councils/Bodies
Legislation requires EMAs to have PCs established by the Chief Elected Official (CEO) TGAs funded after 2006 are not required to establish PCs if the CEO chooses another method for obtaining “community input (particularly from those with HIV)…for formulating the overall plan for priority setting and allocating funds from the grant” 2 of the 6 TGAs funded after 2006 chose not to have PCs PC requirement for all TGAs ended as of FY 2014 In December 2013, DMHAP strongly urged TGAs to maintain PCs as described in the legislation All 26 TGAs that had PCs have maintained them All PCs are expected to meet requirements as specified in the legislation and in HAB/DMHAP policies and guidances

Uniqueness of Planning Councils
RWHAP planning councils are unique – no other federal health/human services programs require such bodies Many federal programs require community planning, but planning bodies are usually advisory rather than decision making Federally funded nonprofits are sometimes required to include consumers on their boards (for example, community health centers) Some planning bodies require consumer input – but rarely 33% of voting members Almost none have such specific legislative responsibilities Two other examples, both from the anti-poverty program. 1. Community action agencies (CAAs) established by the Economic Opportunity Act – the War on Poverty – in There are about 1,000 of them today, some private nonprofit and some public agencies. Originally, “maximum feasible representation” of the poor meant that many agencies had a majority of low-income people on their boards. The passage of the Green Amendment in 1967 required 1/3 public officials and 1/3 representatives of the private sector, and reduced low-income representation to 1/3. Today, board membership must be at least 1/3 people from the low-income community, exactly 1/3 be public officials, and up to 1/3 members from the private sector 2. Community health centers (FQHCs), established as part of the War on Poverty, must have center patients be a majority of members of their governing boards

DMHAP’s Suggested Guiding Principles for RWHAP Planning
Ryan White planning: Is community-based, including diverse stakeholders Requires consumer input to needs assessment and decision making Is a collaborative partnership between the planning body and the recipient Is designed to meet National HIV/AIDS Strategy (NHAS) goals and strengthen performance along the HIV Care Continuum (HCC) Is an ongoing, cyclical process Requires data from multiple sources, gathered through varied methods Uses data-based decision making

PC/B Roles and Responsibilities
Most of the PC’s legislatively specified roles and responsibilities are related to planning No legislative requirements exist for RWHAP Part A planning bodies that are not PCs, but DMHAP typically urges them to carry out the same roles as PCs – though they are usually advisory rather than decision-making bodies

Planning Council/Body, Recipient, and CEO Roles & Responsibilities
Task Role/Responsibility CEO Recipient PC/B Determine Planning Body x Establish Planning Body Carry Out Needs Assessment Do Comprehensive Planning Set Priorities* X Allocate Resources* Manage Procurement Monitor Contracts Evaluate Effectiveness of Planning Activities Evaluate Effectiveness of Care Strategies Do Quality Management [Care Standards & Committee Involvement] Assess the Effectiveness of the Administrative Mechanism* The key planning responsibilities of a PC/B: Comprehensive Planning: Develop a comprehensive plan for the organization and delivery of health and support services Needs Assessment: Determine the size and demographics of the population of individuals with HIV/AIDS and determine the needs of this population Priority Setting and Resource Allocations: Establish priorities for the allocation of funds within the eligible area, including how best to meet each such priority and additional factors that a recipient should consider in allocating funds under a grant Plus some supporting roles, mostly carried out in collaboration with the recipient Note: Evaluating the cost and outcomes effectiveness of services is an optional PC role. One other special role that is often not fully understood: Assessment of the Administrative Mechanism: Assess the efficiency of the administrative mechanism in rapidly allocating funds to the areas of greatest need within the eligible area * Sole responsibility of RWHAP Part A planning councils

Full-Group Discussion: Other Community Planning Experience
Tell us about any prior experience you have in community planning: For what kinds of programs? What roles did the planning body play? Was it decision making or advisory? What worked well? What were the challenges? How does a RWHAP Part A planning council compare – in terms of roles, authority, consumer engagement, member diversity, and expected level of involvement?

Best Practices for Planning
Organize the planning process with a work plan and calendar Follow a multi-year comprehensive needs assessment cycle Obtain data from multiple sources and present data in user- friendly formats “Triangulate” data, considering variations in quality and value Use worksheets and other decision-making aids EGM- Stress work plan

Best Practices for Planning, Cont.
Engage diverse communities and entities as data sources and decision makers, with a focus on consumers and specific affected subpopulations Provide targeted, interactive training for the planning body – new and continuing members Ensure PC/B understanding of Conflict of Interest and advocate vs. planner roles Make data-based decisions using approved processes EGM- Stop and ask for questions and clarifications from audience.

Benefits of a Planning Cycle
Provides a transparent, public process Engages diverse communities and entities as data sources and decision makers, focusing on consumers and specific populations most affected by the disease Contributes to NHAS goals, including improvements at each stage of the HIV Care Continuum Helps reduce health disparities in HIV services and outcomes Provides opportunities for cooperation/collaboration with HIV Prevention and with other Ryan White Parts EGM

Prevention-Care Cooperation
Unified Planning Body for HIV Prevention, Care, Other Programs (HOPWA, STDs) Unified Prevention-Care Planning Body Integrated Committee of a Larger Planning Body [or Linked to Prev & Care Bodies]* Integrated Prevention and Care Plan [often Parts A-B]* Joint Projects or Activities (e.g., Information Gathering, Data Analysis)* Cross Representation* Information Sharing* 7 6 5 4 3 2 1 * Also Cross-part Cooperation Source: Integrated HIV Prevention-Care Planning Activities, EGM Consulting for HRSA/HAB through the Ryan White Technical Assistance Contract, 2014.

Purpose of the Planning Cycle: Putting the Pieces Together
Knowing who needs the services and how to reach them Knowing who, where, what and to whom Making data driven decisions about which services are most needed EGM

An Updated Annual Planning Cycle for RWHAP Part A Planning Councils/Bodies

Updated Annual Planning Cycle
Core responsibility of a PC/B: carry out community planning to establish and maintain the best possible system of care for PLWH in the jurisdiction – through a well-defined and fully- implemented planning cycle Integrated/comprehensive/integrated plan: central role in the planning cycle Importance of access to many types of data for decision making

Updated Annual Planning Cycle
Comp Plan Review/Updates Annual Plan to Plan Epi Profile & Needs Assessment Review of All Data Priority Setting & Resource Allocation Data Review & Reallocation Evaluation & Planning Outcomes

Feedback Loop Input Analysis Decision Making Report Back Includes obtaining input from stakeholders, analyzing that information, using it for decision making, and reporting back to the community

Comprehensive Plan Review/Updates
Comp Plan Review/Updates Annual Plan to Plan Epi Profile & Needs Assessment Review of All Data Priority Setting & Resource Allocation Data Review & Reallocation Evaluation & Planning Outcomes AMELIA

Expectations for Comprehensive Plan
Legislation requires RWHAP Part A and Part B programs to prepare comprehensive plans that set goals and objectives and guide the work of the program All Parts expected to participate in the Statewide Coordinated Statement of Need (SCSN) process In 2016, RWHAP Part A and Part B recipients prepared integrated plans based on a guidance from CDC and HRSA to submit 5-year Integrated HIV Prevention and Care Plans, including the Statewide Coordinated Statement of Need (SCSN) Plans for were submitted in September 2016 AMELIA

Expectations for Comprehensive Plan, Cont.
Combined guidance designed to help reach the goals of the National HIV/AIDS Strategy (NHAS) and improve performance along the HIV Care Continuum (HCC)/Treatment Cascade Programs expected to regularly review Plan progress and refine objectives and strategies as needed – plan should be a living document that guides the annual planning cycle AMELIA

Discussion: Using Our Plan
Choose a facilitator and a recorder/reporter, discuss in a small group, and then report back to the full group: How is the PC/B using this EMA/TGA’s comprehensive integrated plan? How is the plan being implemented? Who is responsible for monitoring implementation? Is the plan currently the foundation for our planning process? If yes, what are the benefits? If not, why not? What could be done to change this?

Annual Plan to Plan Annual Plan to Plan Comp Plan Review/Updates
Epi Profile & Needs Assessment Review of All Data Priority Setting & Resource Allocation Data Review & Reallocation Evaluation & Planning Outcomes

Expectations for Annual Workplan
Annual work plan – often in chart format – to guide the planning process, based on the current comprehensive/integrated plan, annual application including the Implementation Plan, legislative and administrative requirements, and local structures and processes Annual master calendar for the jurisdiction that integrates planning body and recipient meetings, events, products and deadlines Committee work plans that provide for coordinated task completion Continuing attention to engaging consumers and other diverse community stakeholders in the planning process EGM

Sample Work Plan Format
Task/Event Deliverable Timing (Start/End) Responsi-bility Notes/Concerns Needs Assessment ▪ PLWH Survey Report ▪ Special Study on Youth Linkage & Retention October-April Needs Ass’t Committee Must hire consultant by 10/31 Data Presentation PPTs with key data & analysis End of May PSRA Committee Need data from all sources PSRA ▪ Prioritized services ▪ Allocations by category – 3 scenarios June-August Recipient must receive by 9/3 Application Submission Application – submitted online August- early October Recipient Exact date not known EGM

Epi Profile and Needs Assessment
Comp Plan Review/Updates Annual Plan to Plan Epi Profile & Needs Assessment Review of All Data Priority Setting & Resource Allocation Data Review & Reallocation Evaluation & Planning Outcomes EGM

Expectations for Epi Profile
Epidemiologic profile describes “the burden of HIV on the population of an area in terms of sociodemographic, geographic, behavioral, and clinical characteristics of persons with HIV” Should be based on the CDC/HRSA Integrated Guidance for Preparing Epidemiologic Profiles, updated in August 2014* Profile should include “advice on how to interpret the data in ways that are consistent and useful in meeting the planning needs of both HIV prevention and care programs” Often prepared by State but should focus on jurisdictional data and needs * Available online at: EGM

Expectations: Needs Assessment
Determine what services are needed, what services are being provided, and what service gaps exist, overall & for particular populations, in & out of care – including PLWH input on service needs and gaps Components: Epi profile of HIV & AIDS cases and trends Estimate & assessment of unmet need and undiagnosed – PLWH who know their status but are not in care and PLWH who do not know their status Service needs of PLWH in & out of care Existing services, including a resource inventory & provider capacity/capability (availability, accessibility & appropriateness overall and for specific populations) Barriers to testing and care Service gaps for those in and out of care Disparities in access to services for subpopulations

Needs Assessment: Challenges
Establishing a plan and budgeting funds annually to carry out specific needs assessment activities in the plan Updating of methods and tools to reflect changes in the epidemic Including each expected component of a comprehensive needs assessment Ensuring appropriate sampling and data analysis to maximize data quality and make best use of available data Avoiding over-dependence on small-sample methods like focus groups

Needs Assessment: Best Practices
Multi-year needs assessment plan that includes 1 major activity or component/year Use of both qualitative and quantitative measures, and inclusion of some large-scale data gathering from PLWH based on a careful sampling Innovative approaches to finding PLWH in and out of care Training of PC members/consumers to conduct focus groups, chair Town Halls, and help with surveys Use of technology

Reflection on Needs Assessment
Discuss in small groups or the full group: What is the current needs assessment process in this EMA/TGA? To what extent does it meet HRSA/HAB expectations? What aspects of needs assessment should the PC/B focus on during the next year?

Review of Data Review of All Data Comp Plan Review/Updates
Annual Plan to Plan Epi Profile & Needs Assessment Review of All Data Priority Setting & Resource Allocation Data Review & Reallocation Evaluation & Planning Outcomes EGM

Data Needs for Ryan White Planning
Assessment Data Epi Profile HIV Care Continuum Data Data Testing and Unmet Need Data Service Expenditure Data Data collected/analyzed as part of the epi profile and needs assessment Most recent HIV Care Continuum for the jurisdiction Population health level RWHAP level Specific subpopulations Data from prevention, especially testing data Program data: Client characteristics from Ryan White Service Report (RSR) Service utilization data, including disparities in access to services among PLWH groups Service expenditures Quality Management and other performance and outcomes data Client Characteristics & Utilization (RSR) Data Clinical Quality Management Data Performance & Clinical Outcomes Data

Review/Comparing of Data from Multiple Sources
Epi data Needs assessment findings for the past 3 years Most recent HIV Care Continuum for the jurisdiction Population health level (All PLWH) RWHAP level (Ryan White clients) Specific subpopulations (e.g., women, young MSM of color) Demographics of Ryan White clients from the Ryan White Service Report (RSR) Service utilization data, including costs and use/disparities among PLWH groups Quality Management and other performance and outcomes data EGM

Expectations: Access to & Use of Data
Use of many types of data from multiple sources Includes program data, provided regularly by the recipient, in formats useful for analysis Presentation of data at PC/B meetings throughout the year, and use these opportunities to familiarize members with review and use of data Formal data presentation to summarize data from all sources at start of the Priority Setting and Resource Allocations (PSRA) process Major focus on data-based decision making by the PC/B and recipient

Expectations: Review of All Data
Data needs are determined annually, negotiated with recipient & made a part of the work plan Ideally, data sets and formats are specified in an MOU between the PC/B and the recipient Data are provided in clear, user-friendly formats Members received training on assessing & using data Comparisons are made of data from various sources Assessment of the quality of different data sets/reports “Triangulation” of data: obtain and compare data from more than one source to see if findings are consistent

Activity: Scenario Consider the scenario and questions in pairs or in a small group with a facilitator and recorder/reporter, then discuss in the full group: You are planning this year’s data presentation and PSRA process, and you have a good deal of data, such as a new epi profile, results of a consumer survey, year-old data on providers, and summaries of focus groups with 3 key subpopulations You just received an HIV Care Continuum for RWHAP clients, but no breakdowns are available by subpopulation You received some tables showing the overall characteristics of RWHAP clients served last year, but no information on use of specific service categories by client characteristics such as race, gender, age, place of residence within the EMA/TGA, or other characteristics – and the recipient says it won’t be available in time for use in the PSRA process Why is this a problem? What can the PC do to address it?

Priority Setting and Resource Allocations (PSRA)

Expectations: PSRA Most important legislative responsibility of PC/Bs – should actively involve the whole PC/B (not just a committee) Includes: Priority setting: deciding what services and program support categories are most important for PLWH in the EMA or TGA Resource allocations: deciding how much RWHAP Part A funding to provide for each service priority Directives to the recipient on how best to meet these priorities – e.g., what service models for what populations in what geographic areas Reallocations during the year – including a rapid reallocation process to use near the end of the funding year Decisions based on data, not “impassioned pleas” Ensure clarity: resource allocation does not mean procurement – PC/B has NO involvement in selection of particular entities to provide services

PSRA: Issues and Best Practices
Provide data presentations and discussions throughout the year – not only at PSRA time Use these data presentations as an opportunity for training on use of data in decision making Have a process to hear consumer needs and concerns during needs assessment, while avoiding “impassioned pleas” during PSRA meetings Have a policy and process to manage conflict of interest – and enforce it fully Ensure a process to weigh, summarize, compare, and use data to reach decisions

Ensuring Fairness and Avoiding Grievances
Every PC/B must have a grievance procedure regarding funding, and can face a grievance if the PSRA process does not follow established policies and procedures For a fair process that is unlikely to face a grievance: Have an updated, written PSRA process, guiding all steps from town halls through allocations – and follow it! Manage Conflict of Interest Involve the whole PC/B in decision making, ensuring diverse decision makers Ensure that members understand when they need to be advocates and when they must plan for all PLWH in the EMG/TGA

Members as Advocates and Planners
Members often come as Advocates: Bring passion Provide a voice for their communities or for populations their organization serves Also learn to advocate on behalf of other subpopulations that may be underrepresented in PC/B deliberations Need to know when/how to be Planners: Consider the entire community Seek Win-Win versus Win-Lose Listen to others/ask questions Come prepared – review data and reports; ask questions Use data to make decisions – not “impassioned pleas” Understand boundaries

Full-Group Discussion: Advocate or Planner
Read the descriptions individually and consider: Which situation(s) benefit from a PC/B member serving as an advocate? Which needs the member to act as a planner? Why are the needed roles different in these two situations? The PSRA committee is planning consumer town halls as input to PSRA. The committee is deciding to drop the town hall in Spanish this year, because of interpreter costs, even though 23% of PLWH in the jurisdiction are Hispanic/Latino. You are Latino. Data indicate a greatly decreased demand for mental health services under RWHAP Part A, apparently because more PLWH are receiving such services under Medicaid or private insurance, plus a local mental health center received a large grant from SAMHSA to provide services to PLWH. You have been getting mental health services through Part A and would hate to have to change providers.

Data Review and Reallocations

Expectations for Data Review and Reallocations
Regular review of monthly expenditures by service category including over- and under-spending Training to ensure that all PC/B members can read and understand financial reports, with more extensive training for members of the responsible committee Identification of trends in expenditures and service utilization – including any serious under- or over-expenditures Rapid reallocation procedure, especially during last quarter, to ensure full expenditures EGM

A Best Practice for Reallocations
After the program receives its Notice of Grant Award and revises allocations, the PSRA committee reviews funding decisions and identifies service categories that would benefit from additional resources, overall or for particular service models or populations – e.g., funds to add community health workers as assistants to medical case managers to improve retention among specific subpopulations, additional funds for medical transportation to cover participation in support groups and enhance assistance to clients who live in outlying counties These priorities, including amounts and directives on use of funds, are provided to the recipient If funds become available and reallocations are necessary, the recipient is urged to recommend actions to address these priorities – which shortens the PC/B review process, since the recipient already knows the priorities

Evaluation and Planning Outcomes

Expectations: Evaluation and Planning Outcomes
Completes the updated planning cycle Includes a “review of variances” Actual versus planned services and performance (e.g., clients and subpopulations served, units of service, expenditures) Actual versus planned quality measures and client/program outcomes Requires comparing PSRA-approved priorities and allocations vs. actual use of funds Provides an assessment of the planning process Helps meet the requirements of the assessment of the efficiency of the administrative mechanism Provides data for refining the integrated plan where appropriate

Key Planning Challenges
Insufficient PC/B and/or recipient: Knowledge: of community planning, RWHAP legislation, COI Skills: needs assessment, analysis & use of data, group decision making, negotiations, group process Resources: for needs assessment, data analysis, PC/B staffing & support Access to data: client characteristics, utilization, costs, service needs & gaps

Discussion Re Planning Challenges
Discuss in pairs, then in the full group: Which of these challenges are most important for this PC/B? What can you to prevent, resolve, or minimize challenges related to each of these areas: Knowledge? Skills? Resources? Access to data? What should be the PC/B priorities in addressing these challenges?

Discussion: Next Steps
Discuss in a small group, with a facilitator and a recorder/reporter, then report back to the full group: What action should the PC/B take to implement the planning cycle – identify up to 5 key tasks What committee or entity should be responsible for each of these tasks? What, if any, additional information or training does the PC/B need to implement the planning cycle?

Planning 101: Model Training Session on The Ryan White HIV/AIDS Program Part A Planning Cycle This model training session was prepared for the PCS.

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Planning 101: Model Training Session on The Ryan White HIV/AIDS Program Part A Planning Cycle This model training session was prepared for the PCS.

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Presentation on theme: "Planning 101: Model Training Session on The Ryan White HIV/AIDS Program Part A Planning Cycle This model training session was prepared for the PCS."— Presentation transcript:

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