PC/PB Structure and Governance

1. PC/PB Structure and Governance Slides for Module 8.2 Topic: Membership

2. Membership • Membership Requirements and Challenges • Recruiting and Supporting Members • Supporting Consumer Members

3. Training Objectives Following the membership training, participants will be able to: • Explain legislative requirements for representation in PC/PB membership • Describe legislative requirements for consumer membership • Define and explain the concept and components of reflectiveness as applied to overall PC/PB membership as well as consumer membership • List at least 3 reasons why it is important for a PC/PB to have representative and reflective membership • Identify 5 key components of PC/PB member support

4. Training Objectives (cont.) • Describe a recruitment process to meet legislative requirements and local needs • Explain HRSA/HAB expectations for PC/PB member orientation and ongoing training • Identify at least 3 ways PC/PBs can encourage member participation • Describe at least 3 key challenges in member retention • Explain the concept of PC/PB succession planning • Describe HRSA/HAB expectations for consumer membership

5. Training Objectives: Membership (cont.) • Identify at least 3 challenges in ensuring active consumer membership • Describe at least 5 sound practices for supporting consumer members

6. Membership Requirements • Importance of Membership Composition • Legislative Requirements • HRSA/HAB Expectations • Reporting on Representation and Reflectiveness

7. Importance of Membership Composition • Foundation of RWHAP Part A community planning is bringing diverse expertise and interests to the table for joint planning and decision making • Legislation specifies membership composition in order to ensure needed expertise and diverse perspectives • Vacant membership slots or insufficient reflectiveness limit PC/PB’s ability to establish and maintain a comprehensive system of HIV services that leads to positive medical outcomes for all PLWH subpopulations

8. Legislative Requirements: Representation • Health care providers, including federally qualified health centers • Community-based organizations/AIDS service organizations • Social service providers (including housing/homeless service providers) • Mental health and substance abuse providers • Local public health agencies • Hospital planning or health care planning agencies • Affected communities (PLWH, Indian tribe, PLWH co-infected with Hepatitis B or C, and historically undeserved groups) • Non-elected community leaders • State government (Medicaid and RWHAP Part B) • Part C recipients • Part D recipients (or history of serving similar population) • Recipients under other Federal HIV programs (including prevention) • Representatives of recently incarcerated PLWH

9. Other Legislative Requirements: Membership • Chief Elected Official establishes the PC/PB and appoints or removes its members • Recipient is not involved in membership selection • Bylaws may call for a recipient representative to serve as a voting member of the PC/PB • A PC may not be chaired solely by an employee of the recipient • A recipient employee may serve as a Co-Chair • In integrated prevention-care bodies, the prevention recipient often serves as a Co-Chair since that is typical for HIV prevention planning groups

10. Membership Definitions • Representation = the extent to which the PC/PB includes individuals from each of the legislatively defined categories of membership • Reflectiveness = the extent to which the demographics of the PC/PB’s membership “look like” the HIV epidemic in the EMA or TGA • Unaligned consumers = individuals living with HIV who are receiving services from a RWHAP Part A subrecipient and are not employees, consultants, or Board members of funded agencies

11. Legislative Requirements: Reflectiveness “…the chief elected official…shall establish or designate an HIV health services planning council that shall reflect in its composition the demographics of the population of individuals with HIV/AIDS in the eligible area involved, with particular consideration given to disproportionately affected and historically underserved groups and subpopulations” [§2602(b)(1)]

12. Legislative Requirements: Consumers “Not less than 33 percent of the council shall be individuals who are: • receiving HIV-related services pursuant to a [Part A grant], • are not officers, employees, or consultants to any entity that receives [Part A funding], and do not represent any such entity, and • reflect the demographics of the population of individuals with HIV/AIDS” [§2602(b)(5)(C)]

13. HRSA/HAB Expectations: Representation • Membership should include all required categories • A member can represent only 1 category, except that 1 person may represent: • Both the substance abuse provider and the mental health provider categories if the agency provides both of those services and the person is familiar with both programs • Both the RWHAP Part B program and the State Medicaid agency, if in a position of responsibility for both • Any combination of RWHAP Part F programs and Housing Opportunities for Persons with AIDS (HOPWA), if the agency receives grants from more than one of those sources and the person is familiar with all the programs [Part A Manual, p 110]

14. HRSA/HAB Expectations: Representation, cont. • Membership is expected to include all specified categories • Each RWHAP Part A program reports on membership annually as part of the Program Terms Report • HRSA/HAB recognizes that some positions can be hard to fill, even with the best efforts of the PC/PB • PC/PB has some flexibility for broader thinking about how to fill such positions, provided that: • There is clear justification for the proposed entity or individual • The proposed representative can provide essential input and perspective for that category

15. HRSA/HAB Expectations: Reflectiveness • The PC/PB should reflect the local epidemic in terms of at least the following: • Race/ethnicity • Gender • Age • Reflectiveness expected at two levels: • Entire PC/PB membership • Consumer membership • PC/PB encouraged to • Maximize participation of “disproportionately affected and historically underserved subpopulations” • Consider other reflectiveness factors, such as place of residence within the EMA/TGA

16. Quick Discussion A: Understanding Reflectiveness In your EMA/TGA, 47% of PLWH are African American, 17% Latino, and 33% White non-Hispanic, and 28% of PLWH are immigrants and refugees from Africa, Latin America, and the Caribbean. Your Membership Committee wants to focus this year on recruiting consumers who are immigrants, one of your key target populations. One PC/PB member is concerned that if you succeed, the total proportion of consumers from communities of color will exceed the percent of PLWH who are minorities – and says this would violate reflectiveness requirements. • Is this correct? Why or why not?

17. Special Populations to Focus on for Reflectiveness • “Disproportionately affected and historically underserved subpopulations and groups” vary by jurisdiction • Recruitment should reflect the local epi profile and historical barriers to care – groups might include: • Communities of color with a history of disparities in access to health care • Immigrants, especially those with limited English proficiency (LEP) • Groups facing a high level of stigma and discrimination, such as gay, lesbian, bisexual, and transgender PLWH • Residents of less urbanized parts of the EMA/TGA • PLWH with very low incomes

18. Reporting on Representation and Reflectiveness All PC/PBs required to report to HRSA/HAB on membership representation and reflectiveness annually • Membership Chart = an Attachment to the Program Terms Report • Representation Roster: • Form asks for total authorized and current number of members, number of vacancies, percent unaligned consumers, number of publicly disclosed consumers, and term limits in Bylaws • Chart asks for each member’s name, PC/PB position, agency affiliation, gender, race/ethnicity, and membership category

19. Reporting on Representation and Reflectiveness (cont.) • Reflectiveness Chart asks about member race/ethnicity, gender, age • For each component, chart asks for numbers and percentages to compare: • Persons living with HIV in the EMA or TGA • Total members of the PC/PB • Unaligned consumer members of the PC/PB • Recipient must also “be able to demonstrate that the PC/PB is reflective of any disproportionately affected or historically underserved populations in the jurisdiction”

20. Quick Discussion B: Improving Reflectiveness Discuss the following, first with 1-2 other people, then in the full group. • How successful is your PC/PB in maintaining a reflective membership, based on HRSA/HAB requirements? • What, if any, reflectiveness factors besides those specified by HSRA/HAB are currently included in your Bylaws or considered as part of your open nominations process? • What, if any, factors would you like to see added, to make your PC/PB membership more reflective of the EMA/TGA?

21. Recruiting and Supporting Members • Recruitment and Selection • Orientation and Training • Participation and Retention • Succession Planning

22. Recruitment and Selection • Recruitment usually involves an annual process plus ongoing efforts • Members typically are recruited and nominated based on staggered annual terms – for example, 2-year terms ending on December 31 • Additional efforts are often needed year-round to fill vacancies due to resignation or non-participation • Term limits affect level of required recruitment • Existing members may apply for reappointment if not “termed out”

23. Recruitment and Selection (cont.) • Open nominations process is managed by a committee • Committee recommends one or more candidates for each available seat • Full PC/PB should approve candidates for recommendation to the CEO • Many PC/PBs keep member applications active for 1-2 years in case new vacancies occur

24. HRSA/HAB Minimum Standards for an Open Nominations Process HRSA/HAB expects open nominations to include: • A process that is described and announced ahead of time • Clear criteria for selection: include required membership positions, reflect the local HIV epidemic, reflect the geography of the EMA/TGA, meet locally determined needs, meet COI requirements • Wide publicity in HIV publications, local press, through service providers, on the PC/PB website, in the community • Option for individuals to apply or be nominated by others

25. HRSA/HAB Minimum Standards for an Open Nominations Process (cont. 1) • Information given to applicants about member roles, time commitment, COI standards, HIV disclosure requirements for consumer members • HRSA/HAB requires that at least 2 unaligned consumer members be publicly disclosed • Some PC/PBs have additional disclosure requirements • Process should provide confidentiality for undisclosed PLWH • Standardized, plain-language application form • Application form often available online

26. HRSA/HAB Minimum Standards for an Open Nominations Process (cont. 2) • Specific steps for review and selection of nominees to send to the CEO for vetting and appointment • Usually managed by a Membership Committee • Structured review of applicants based on stated criteria – many PC/PBs do individual interviews • Recommendations to the Executive Committee and full PC/PB • PC nominations sent to the CEO – may be 1 or more than 1 nominee for each open position • PB nominations and appointments are sometimes handled differently [Part A Manual, pp 117-121]

27. Representation Challenges Some member categories may be challenging to fill: • State Medicaid Agency and RWHAP Part B program –especially if the Part A program is not geographically near the state capital • Health or hospital planning agency – since these agencies may have limited involvement with HIV • Recently incarcerated PLWH – where the PC/PB is an official city/county board or commission, and vetting may be used to exclude individuals convicted of a crime • Consumers or non-elected community leaders – where candidates may have a history of substance use or incarceration

28. Filling Challenging Member Categories • Think creatively and be flexible in finding ways to meet legislative requirements and obtain needed expertise • Where distance is an issue – State Medicaid Agency or Part B program: • Recruit someone from the specified agency who is located in the EMA/TGA – in a regional office • Allow participation via telephone or videoconference for members living more than a specified number of miles away • Health or hospital planning agency: • Consider various types of agencies involved in health planning, such as the local primary care association or a large community health center with health planning staff

29. Filling Challenging Membership Categories (cont.) • Recently incarcerated PLWH or other categories where candidates may have criminal convictions • Meet with CEO’s office or Boards and Commission officials to ensure understanding that this is a legislatively required membership category (exceptions to vetting rules are often possible where the rule is not based on legislation) • Ask for advice/assistance from your Part A Project Officer • If the issue cannot be resolved, look for someone who works closely with recently incarcerated PLWH and can represent their interests (such as, a staff member of a halfway house)

30. Quick Discussion C: Representation Discuss the following, first with 1-2 other people, then in the full group. • Which, if any, required membership categories have been hard to fill? • What has the PC/PB done or what might you do to fill these membership slots?

31. Process for Recruiting a Reflective PC/PB • Review the epidemiology of the local epidemic in terms of race/ethnicity, gender, and age • Identify target populations in the EMA/TGA that are “disproportionately affected or historically underserved” • Agree on other factors of local concern – for example, geographic representation including people from outside the central city or county • Determine current reflectiveness based on those factors: • For the PC/PB as a whole, and for consumer members • Identify gaps that will exist because of term limits

32. Recruiting a Reflective PC/PB (cont.) • Prepare a chart of needed affiliations and demographics • Recruit specifically for individuals with needed affiliations and demographics; for example: • List populations needed, such as individuals under age 30, transgender people, recently diagnosed PLWH, residents of outlying counties • Engage/assign individual PC/PB members to help recruit people from these specific populations • Contact organizations that work with these populations • Recognize that recruitment challenges may reflect a need to review/rethink some aspects PC/PB operations

33. Recruiting Representative and Reflective Applicants • Ask current members to reach out to people they know and assist with their applications • Ask provider agencies to identify and refer provider staff familiar with the work of the PC/PB • Recruit individuals in “line” as well as management positions at PLWH-serving agencies • Recruit provider personnel from non-RWHAP-funded agencies • Ask PC/PB and committee members to identify emerging leaders not yet involved with the PC/PB

34. Recruiting Consumers and Other PLWH • Many PC/PBs have “pipelines” to identify and prepare PLWH as potential applicants • Consumer committee or caucus • Committees that have participants who are not PC/PB members • Training programs for PLWH to prepare them for membership • Members of consumer advisory boards (CABs) of provider agencies • PLWH who frequently attend PC/PB meetings • Associate (non-voting) members, paired with current members

35. Orientation and Training • Includes: • Orientation for new members at the beginning of their service as members • Ongoing training during the first planning cycle • Training for the entire PC/PB • Shared responsibility between the PC/PB and staff • Membership Committee often takes the lead

36. HRSA/HAB Expectations for Orientation of New Members • Should occur before the member’s first PC/PB meeting or very soon afterwards • Delayed orientation contributes to low retention • Ideally, group session provided to each year’s “cohort” of new members – individual sessions provided if necessary • May be done in one or several sessions to avoid overload • Should be interactive, with activities and discussion • Parts of the orientation may be provided online using self-guided materials that include a means of self-assessment of content learned • Members should receive a member handbook or binder of materials

37. HRSA/HAB Expectations for Member Training beyond the Orientation • Training should be provided throughout the year, to enhance member knowledge and skills • Additional training often needed for new members without prior experience in community planning – including but not limited to consumers • Especially useful during a member’s first planning cycle • Each PC/PB is expected to provide at least one training event for all members each year • PC/PB may be asked to document that such training occurred in its letter of concurrence or assurance included in the annual RWHAP Part A funding application

38. Quick Discussion D: New Member Orientation and Training Consider Question 1 or 2, as assigned, and all consider Question 3, for discussion with the full group. • What are the most important success factors for new member orientation and training – the 4-5 things that contribute most to a member’s becoming actively engaged with the PC/PB and continuing as an active member? • What are the most important failure factors for new member orientation and training– the 4-5 things most likely to lead to a low level of new member engagement and retention? • Are there special or different factors for new members without prior community planning experience?

39. Approaches for Meeting Orientation and Training Needs • Agree on committee and staff responsibilities for training • Under the committee’s leadership: • Hold one retreat or training session a year – with attendance a stated part of member participation • Regularly ask members and committees about their training needs • Develop an annual training calendar • Schedule interactive mini-training sessions during PC/PB meetings and committee meetings

40. Participation and Retention Includes: • HRSA/HAB expectations • Member attendance/participation requirements • Policies and practices that support member participation and retention • Making meetings member-friendly

41. HRSA/HAB Expectations for Participation and Retention • PC/PB should have clearly stated participation requirements, usually including: • Number or percent of meetings a member must attend to remain a member • Requirement for similar level of participation in one committee • Required participation in new member orientation, one member training session, and specified priority setting and resource allocation activities • Clear procedures for documenting and consistently enforcing attendance requirements

42. Supporting Member Participation and Retention • PC/PB should implement activities to support the active engagement and participation of members • Includes policies and procedures such as: • Reimbursement of direct costs of participation for consumer members • Committee and PC/PB meetings held at times and in locations that reflect member needs and schedules • Allowing members to connect electronically to meetings under certain conditions – based on geographic distance, weather, or other factors

43. Supporting Member Participation and Retention (cont.) • PC/PB can also improve participation through practices such as: • Providing annual meeting and event calendars that enable members to plan ahead • Follow up with members who miss meetings to offer information and support and try to identify and address barriers to participation • Providing food when meetings are at regular mealtimes – to address income limitations and the need for protein along with some medications • Continuing retention challenges may suggest a need for refining PC/PB or committee operations

44. Making Meetings Member-Friendly • The PC/PB can encourage attendance and participation by: • Having all members help discourage the use of abbreviations, acronyms, and jargon – and explain terms that are used • Mentoring new members through pairing them with veteran members in ways that work for both • Sending out meeting agendas and materials well ahead to allow newer members to prepare • Providing quick pre-meeting preparation sessions • Making meetings more interactive • Committing to a friendly and “safe” meeting environment, with PC/PB Co-Chairs taking the lead

45. Succession Planning • PC/PB needs plans and practices in place to address changes in membership and leadership • Succession plans are needed because: • Many PC/PBs have term limits for members and for officers • HRSA/HAB encourages PC/PBs to make room for new members and new perspectives • Members may leave for many reasons: they may become employed, take new jobs, move to other locations, have health issues, or change interests or priorities • It takes time to replace a veteran member or someone representing a key target population

46. Techniques for Succession Planning • Assign committee responsibility for succession planning – usually to Membership Committee • Adopt policies that support an orderly leadership succession: • Consider choosing a Vice Chair or Chair-Elect up to one year before the Chair’s term ends • Elect Co-Chairs using staggered terms, so their terms do not end the same year • If your committees have only Chairs, add Vice-Chairs or Co-Chairs for training and continuity • Ask members to indicate interest in leadership position a year ahead and provide appropriate training

47. Techniques for Succession Planning (cont.) • Develop a pipeline for new members • Establish and implement a succession process, for example: • Identify PC/PB leaders (officers, committee Co-Chairs) likely to leave at a specified time • Identify members who will not be eligible for renomination due to term limits • Ask members and leaders eligible for renomination to tell the committee their plans before recruitment • Chart succession planning requirements • Integrate succession planning into overall recruitment

48. Quick Discussion E: Succession Planning Consider the following based on your own situation within the PC/PB. Discuss with 1-2 other people, then with the full group. • If you are in a leadership position: What caused you to agree to serve in such a position? What helped prepare you? What was missing that would have helped? • If you are not in a leadership position currently: Would you be willing to serve in a leadership position in the future? What do you need to help prepare you? Is that kind of help currently available?

49. Supporting Consumer Members • Importance of Active Consumer Members • HRSA/HAB Expectations • Challenges • Sound Practices

50. Importance of Active Consumer Members • Consumers provide an essential and unique perspective on service needs and the system of care, including direct experience in: • Seeking and obtaining care • Addressing barriers and challenges • Consumers can serve as a link to the community and to specific PLWH subpopulations • Legislation requires 1/3 of voting members to be unaligned consumers – and consumer members to be reflective of the local HIV epidemic