Working Together: Effective Committees and PC/PB Meetings

1. Working Together: Effective Committees and PC/PB Meetings Slides for Module 9 Topic: Inclusive Planning

2. Inclusive Planning • Benefits of a Diverse PC/PB • Strategies for Inclusive HIV Community Planning

3. Training Objectives Following the training, participants will be able to: • Explain at least 3 ways in which a diverse PC/PB contributes to successful planning and a comprehensive, high-quality system of HIV services • Describe what inclusive HIV community planning “looks like” • List 5 commonly identified components of diversity • Describe and differentiate “cultural competence” and “cultural humility” • List at least 5 strategies your PC/PB can use to make its planning inclusive

4. A Diverse PC/PB • “The greatest benefit of having a planning council is that a group of stakeholders from various perspectives (funders, providers, consumers, etc.) meets regularly to address the HIV epidemic affecting our community, each member sharing their knowledge, experience, and ideas towards improving the local service delivery system, removing barriers in access to care, and collaboratively working to reduce new HIV infections and improve client health outcomes” • − Part A recipient, 2016 national PC/PB assessment

5. Describing Inclusive HIV Community Planning Genuinely inclusive HIV community planning means that: • Membership meets representation and reflectiveness requirements • All members participate as engaged and equal partners • Diverse public input is regularly sought and used

6. HRSA/HAB Expectations • “A planning body should examine all aspects of its organization in terms of embracing and promoting diversity. Commitment to a diverse membership means that all aspects of the way the planning body conducts its business should be examined for how well they foster the comfort of all participants. If one culture or group’s values dominate, the membership tends to reflect only that one group or culture. Other cultures and groups do not feel comfortable, do not participate, do not feel valued, and are often treated as tokens.” • “All aspects of a planning body should reflect the values and norms of its diverse membership, from the way meetings are run to the language used to write policies and procedures. Diversity will not happen simply because diverse participants are invited to attend a meeting. The culture of the group must reflect commitment to competently managing diversity.” • Part A Manual, p 259

7. Components of Diversity • PC/PB members are diverse in many ways • Groups typically consider differences in “culture” – social and behavioral norms – based on characteristics like: • Race • Ethnicity • Nationality • Gender/gender identity • Sexual orientation • Age

8. Components of Diversity (cont.) • Attention to culture is helpful, but every person has an individual relationship to culture • Expectations about how someone will react or behave based on race/ethnicity or sexual orientation are often incorrect • Every person is influenced by many characteristics • Some determined at birth (such as, race, nationality) • Others developed or learned (such as, beliefs) • Some usually visible (such as, age, dress, language) • Others largely invisible unless shared (such as, family background, job history)

9. Each Individual’s Personal Pyramid • Everyone has a Personal Pyramid • PC/PB members don’t need to know everything about each other • They do need to be aware that what they know – and what they don’t know – may affect group interactions

10. The Personal Pyramid

11. Quick Reflection: Your Personal Pyramid On your own, take a couple of minutes to consider the idea of personal pyramid, your own and others. Jot notes, if you like. • What characteristics – visible, less visible, or largely hidden – are especially important in influencing how you interact with other PC/PB members? • What characteristics of other PC/PB members would you most like to understand, in order to fully involve those members in the PC/PB’s work? • Are the same characteristics important for all members, or are they different for each member?

12. Requirements for Inclusive Planning • Continuing effort • Openness to learning and change • Awareness of many components of diversity • Commitment to both tasks and process: • The tasks = getting the work done • The process = working for full participation, and making everyone feel welcome and valued

13. Aspects of Inclusiveness • Cultural differences • Language and interpretation • Sexual bias • Preferred terms of reference (he/she/they) • Power dynamics • Quieter members • Members who participate remotely

14. Strategies for Inclusive Planning: 1 • Adopt and enforce Bylaws, policies, Code of Conduct, and operating procedures that support inclusion For example: • If you want leadership diversity in terms of race, ethnicity, gender, and gender orientation, Bylaws should require or encourage such diversity • If you greatly value unaligned consumer input, adopt quorum requirements that address both total participation and the presence of a specified number of consumers

15. Strategies for Inclusive Planning: 2 • Understand and encourage both cultural competence and cultural humility • Cultural competence involves developing understanding of cultures other than your own – but if based only on academic learning rather than “lived experience,” can lead to stereotyping • Cultural humility focuses on increasing awareness of culture through ongoing personal reflection and co-learning along with people from other cultures • “Cultural competence is theory, cultural humility is practice”

16. Quick Discussion: Cultural Competence and Cultural Humility Discuss these questions with one or two other people, then with the full group. • Does your PC/PB use both these concepts? • What do you see as the value of focusing on both cultural competence and cultural humility in your planning work? • What are the challenges?

17. Supporting Cultural Inclusiveness People from every cultural group need to learn about other groups – and the PC/PB can provide opportunities: • Include interactive sessions during meetings, focusing on a cultural topic like race/ethnicity or sexual identity • Always have members from different cultural groups help plan training • Role play situations where people have felt stereotyped or misunderstood and responses that increase understanding • Ask service providers and consumers from different cultural groups to share ways to increase cultural understanding • Bring in a trained facilitator to help members explore conscious and unconscious cultural biases

18. Strategies for Inclusive Planning: 3 • Build Relationships • Don’t focus only on completing PC/PB tasks • Spend time helping members get to know each other • Learn how culture affects behaviors and interactions • Build trust and mutual respect For example: • At each meeting, have 3 members share why they joined, what they want to accomplish, and what other members most need to know about them • If the PC/PB meets during mealtime, use that time for getting better acquainted

19. Strategies for Inclusive Planning: 4 • Be aware of culture when managing discussion and conflict • Encourage honest discussion while respecting cultural norms • Be aware of situations where cultural barriers to full participation may exist – like younger people deferring to elders, norms against public disagreement For example: • Go around the room asking each member in turn to present views or suggestions • Brainstorm in small groups of similar age or status • Discuss cultural differences openly

20. Strategies for Inclusive Planning: 5 • Use professional interpretation to fully engage members who are deaf or have limited English proficiency • The PC/PB and the jurisdiction have an obligation to provide language access for members, once appointed • Interpretation should allow all members both to understand what is being said and to participate fully • Interpreters should be professionally trained, know HIV & RWHAP terminology, and have needed equipment • Good quality interpretation can be challenging, especially if the jurisdiction uses a single contractor that does not have experience with RWHAP or HIV interpretation

21. Simultaneous vs. Consecutive Interpretation • In consecutive interpretation, the interpreter listens to the discussion and summarizes it every few minutes. after the speaker pauses or finishes • In simultaneous interpretation, individuals use earphones and hear content in their own language in “real time” – there is no time delay • If resources permit, simultaneous interpretation can be two-way, so everyone can hear and participate • Everyone wears earphones and speaks in their language • What they say is interpreted via earphones to all those who do not speak that language

22. Quick Scenario: Language and Interpretation Your PC/PB typically has at least 1 member who needs American Sign Language (ASL) interpretation, and 2-3 consumers with limited English proficiency, usually native Spanish speakers. Your health department has an interpretation contractor, but getting the right interpreters has been a problem. There is a new contractor this year, and the ASL & Spanish-language interpreters have no knowledge of HIV or the RWHAP. In addition, the Spanish interpreters are used to doing consecutive rather than simultaneous interpretation. By the time the consumers hear what was said, the discussion has moved on – so they rarely speak in PC/PB meetings. In committee meetings, where the group pauses discussion to wait for interpretation, they contribute a lot. What might the PC/PB do to improve the situation?

23. Interpretation Strategies • Rent, buy, or borrow earphones and related equipment • Provide available materials in Spanish (like the PC Primer) • Consider budgeting funds for translating key materials into languages needed in your EMA/TGA • For members who read English but more slowly than their native language, send out materials ahead and avoid introducing new materials at meetings • Educate the entire membership about interpretation issues • Ask contractors to send the same ASL or foreign language interpreter to each meeting so they learn HIV & RWHAP terminology

24. Strategies for Inclusive Planning: 6 • Recognize and address sexual bias • The belief that “men have more to contribute” may be conscious or unconscious • In many jurisdictions, males have much higher rates of HIV than females, which can contribute to a focus on male PLWH • Women sometimes feel uncomfortable or unwelcome in primarily male consumer committees or PLWH caucuses • Research shows that women in the workplace who speak in meetings are far more likely than men to be interrupted, have others get credit for their ideas, or be taken less seriously

25. Actions to Encourage Gender Equity • Adopt and enforce a Code of Conduct to prevent members from interrupting or “talking over each other” • Foster an environment in which all members are expected to “call out” problem behaviors • Assign a PC/PB officer or some other individual responsibility for talking individually with members who frequently show sexual bias • Help “level the playing field” by going around the room to get input from everyone • Be sure that members receive credit for their ideas in discussions and minutes

26. Strategies for Inclusive Planning: 7 • Use the terms members prefer when referring to them • People differ in how they want to be described • In terms of their racial, ethnic, or cultural group or gender identity • An inclusive PC/PB respects and uses preferred words • Members should: • Understand why these terms are important to people • Feel comfortable reminding others of these preferences – and being reminded

27. Actions to Support Use of Preferred Terms • Orient members to appropriate pronouns • Educate new members about why these terms matter • Ask all members to share their preferred terms – and terms that bother them • Refer to members by their preferred gender or gender-neutral pronoun – she/her/hers, he/him/his, they/them/theirs • Encourage putting them on email signatures or tent cards • Ask members of racial and ethnic groups and LGBTQ members about their terms • Use deaf, hard of hearing, or another term as preferred by PC/PB members from that community

28. Strategies for Inclusive Planning: 8 • Recognize and address power dynamics in the PC/PB • Power involves the ability of an individual or group to influence the actions of others • Power dynamics involve the way different individuals or groups of people interact with each other when some have (or are believed to have) more power than others • Members/groups of members may have power due to: • Access to resources and/or influence on services • Special knowledge and experience • “High status” based on characteristics like race/ethnicity, gender, education, income, and profession

29. How Power Dynamics Affect PC/PBs • More powerful individual members or groups may: • Try to guide discussion – weakening the Chair’s role • Dominate discussion – talking a lot, interrupting others • Strongly advocate particular decisions • Discourage or ignore input from other members • This can negatively affect participation and decision making – other members may: • Feel they have no influence • Speak less – so their ideas and experience are lost • Participate less or stop attending • Consumer members are often affected

30. Managing Power Dynamics • Recognize that difference in power exist • Take action to equalize the roles of all members For example: • Directly discuss power dynamics in orientation and training, emphasizing the importance of full participation by all members and the value of consumer input • Follow parliamentary procedure: “No member can speak twice on the same issue until everyone else wishing to speak has spoken to it once” • Use the Code of Conduct to address power differences and make all members responsible for enforcement • Train Chairs to recognize and address problem behavior

31. Strategies for Inclusive Planning: 9 • Encourage full participation from quieter members • People think and contribute differently • Extroverted thinkers are comfortable stating an opinion right after an issue is raised • Introverted thinkers like to think about an issue before offering ideas • Extroverted thinkers are not necessarily smarter and their input is not necessarily better – but they may dominate discussion • Quieter members who struggle to be heard or feel their views are not wanted may become less involved

32. Actions to Encourage Participation by Quieter Members • Share meeting agendas and materials in advance, so members can consider the issues • Before beginning discussion, ask members to think for a minute and write down their main ideas • This helps everyone get ready to share – and improves the quality of responses • On important issues, go around the room or call on members individually • Don’t allow members to be interrupted • Provide positive reinforcement to increase the confidence of quieter members

33. Strategies for Inclusive Planning: 10 • Fully involve members who participate remotely • Some PC/PBs allow members to connect to committee or PC/PB meetings by conference call or using technology that provides audio and video • Full participation is challenging when the group is large – or when only a few connect remotely • They may find it hard to hear the discussion • They may be largely ignored – unable to get the Chair’s attention when they want to speak • If remote participation is necessary, focus on including those members in the discussion

34. Actions for Including Remote Participants • Be sure remote participants receive all meeting materials • If new materials are presented, email them to everyone • Support technology that allows remote members to both see and hear other members • Invest in multiple microphones so they can hear all the discussion • Project materials online so they can see documents as they are discussed • For members who must frequently connect remotely (like members from outlying counties), consider lending them low-cost webcams

35. Sum Up • Truly inclusive HIV planning requires attention to many components of member diversity • All members need continuous learning about cultural and personal differences and their effects on member interactions • Managing diversity within the PC/PB involves integrating diverse values, norms, roles, views, and vocabulary • PC/PBs can take many actions, large and small, to create an inclusive environment that contributes to a system of care that meets the diverse needs of PLWH in the EMA or TGA

36. Optional Slide for Activity

37. Activity 9.4: Inclusive Planning • Work in a small group, choosing a facilitator, a recorder, and a reporter. • Review the Situation provided in the Handout for Participants. • Have the Inclusive HIV Community Planning Handout available for reference. • Choose an inclusiveness issue or member subgroup and complete the Work Sheet on your chosen topic.