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Arming Minorities Against Addiction & Disease (AMAAD)

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Arming Minorities Against Addiction & Disease (AMAAD)

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Content Arming Minorities Against Addiction & Disease (AMAAD) Carl Highshaw, M.S.W. Final Capstone Project Submitted in Partial Fullfillment of t he Requirements for the Degree Doctor of Social Work Suzanne Dworak-Peck School of Social Work University of Southern California May 2021 2 Table of Contents I. Executive Summary ................................................................................................................ 4 A. Purpose and Relationship to Grand Challenge of Social Work ......................................... 4 B. Issues Related to Practice ................................................................................................ 5 C. Overarching Methodology ............................................................................................... 6 D. Summary of Aims ........................................................................................................... 8 II. Conceptual Framework ......................................................................................................... 9 A. Statement of the Problem ................................................................................................ 9 B. Assessment and Actual Practice ..................................................................................... 10 C. Socially Significant and Applied Implications ............................................................... 11 D. Framework and Theory of Change ................................................................................ 13 III. Problem(s) of Practice and Innovative Solutions ................................................................ 17 A. Capstone Innovation's Contribution to Grand Challenge ............................................... 1 7 B. Inclusion of Stakeholder Perspectives ............................................................................ 18 C. Positioning Within Broader Landscape .......................................................................... 20 D. Consideration of Opportunities ...................................................................................... 21 E. Connection with Theory of Change ................................................................................ 22 IV. Project Structure, Methodology, and Action Components .................................................. 26 A. Format of AMAAD's Community-based Organizational Design ................................... 26 B. Analysis ofthe Market for AMAAD's Innovation Solution ........................................... 27 C. Methods for Project Implementation .............................................................................. 29 D. Details of Financial Plans .............................................................................................. 3 3 E. Assessment .................................................................................................................... 35 3 F. Plan for Stakeholder Involvement .................................................................................. 36 G. Communications Products and Strategies ...................................................................... 38 V. Conclusions, Actions, & Implications ................................................................................. 40 A. Project Potential ............................................................................................................ 40 B. Context of Practice ........................................................................................................ 41 C. Implications and Further Action .................................................................................... 42 D. Recommendations for Future Work ............................................................................... 43 Exhibit List ............................................................................................................................... 44 References ................................................................................................................................ 46 4 I. Executive Summary A. Purpose and Relationship to Grand Challenge of Social Work The disproportionate impact of the human immunodeficiency virus (HIV) on the African American / Black (Black) community in Los Angeles, California (L. A.) is a microcosm of the HIV epidemic, a problem that has plagued the United States as a whole. Unfortunately, Black subpopulations especially vulnerable for HIV do not connect to or retain supportive services on a consistent basis. While disparity issues related to HIV among Black people broadly is especially alarming on its own, it is important to acknowledge that the problem is exacerbated by the context of social determinates; Black lesbian, gay, bisexual, transgender, questioning/queer, nonbinary, and gender nonconforming (LGBTQ+) individuals are disproportionately impacted as the result of systemic inequities. Missing within the existing service landscape are necessary community engagement activities and effective integration of interventions. These two elements would normally address multiple converging problems, which unfortunately are often perceived in society as separate from HIV, but which impact Black LGBTQ+ individuals in particular ways. The purpose of this capstone project, in alignment with the American Academy of Social Work and Social Welfare's (AASWSW's) Close the Health Gap Social Work Grand Challenge, is to assist in the elimination of the HIV disparity among Black LGBTQ+ people, and to do so through an effort that the innovator has termed Arming Minorities Against Addiction and Disease (AMAAD) (pronounced Ah-maad). AMAAD seeks to "achieve population health by moving beyond individual/clinical to the community and social determinants" (Fong et al., 2018, p. 41 ). 5 B. Issues Related to Practice Individualized intervention approaches have not been effective in engaging the identified priority population, and HIV disparity continues among Black LGBTQ+ people especially. A grassroots peer-based framework and theory of change that is rooted within the community guides the proposed capstone. This framework proposes an intersecting perspective that merges together Sense of Community Theory, Critical Race Theory, and Queer Theory. The framework emphasizes the construct known as 'psychological sense of community' (PSOC) that suggests that a person's sense of community may also be rooted in feelings of responsibility for that community. In the case of this project's focus, a sense ofloyalty, responsibility, and commitment to other Black LGBTQ+ people is integral to the sense of there being a Black LGBTQ+ community (Nowell & Boyd, 2011). A community-based innovation, the innovator is designing this AMAAD capstone project to be congruent with the Ending the HIV Epidemic (EHE) initiative that multiple federal agencies in the U.S. Department of Health and Human Services (HHS) developed. The initiative's goal is to end the HIV epidemic in the nation by the year 2030 (U.S. Health and Human Services, 2020). During the final capstone development phase, the researcher formalized a fiscal sponsorship agreement with the Los Angeles County University of Southern California (LAC+USC) Medical Center Foundation and secured $2.3 million in federal pass-through funding from the County of Los Angeles Public Health Department (PHD). AMAAD will use these funds to facilitate community engagement, outreach, and mobilization activities throughout the L. A. region during the period of April 2021 through June 2023. An annualized calculation of this new PHD funding award increases AMAAD's total allocated financial resources by nearly 40% over the coming years. There is a formal LAC+USC Medical Center Foundation and AMAAD partnership for the capstone. The innovator of AMAAD is also the founder and current Chief Executive Social Worker of the AMAAD Institute, an independent nonprofit 501(c)(3) community-based organization (CBO) with an established presence in the L. A region. The AMAAD Institute is a relatively young organizational entity, which inextricably links it to the community engagement innovation with Black LGBTQ+ youth, and various nuanced program components of the AMAAD Institute are relevant and intersectional to the effort. Prior to the PHD funding award, the AMAAD Institute's 2021 annual operating budget was approximately $2.6 million and derived from multiple federal, state, county, city, and private grants secured directly by the innovator. C. Overarching Methodology 6 This capstone project will employ Community-based Participatory Research (CBPR) as a primary method for project implementation and will identify and recruit Black LGBTQ+ community members and ally stakeholders who can bring fresh perspectives, creative thinking, and solutions to address HIV prevention and treatment. The CBPR implementation method makes the AMAAD capstone a community partnership. It equitably involves community stakeholders to contribute their lived experience and expertise towards shared decision-making and ownership. AMAAD's innovator adopted the following CBPR core principles to guide the project: 1) AMAAD will promote collaborative and equitable partnerships in all phases and engage in empowering and power-sharing processes; 2) AMAAD will recognize the Black LGBTQ+ 7 community as a unity of identity; 3) AMAAD will build on strengths and resources that already exist within the community; 4) AMAAD will facilitate co-learning and capacity building between all partners; 5) AMAAD will focus on problems of relevance to the Black LGBTQ+ community by using an ecological approach that attends to multiple determinates of health and disease; 6) AMAAD will balance research and action for the mutual benefit of all partners; 7) AMAAD will disseminate findings and knowledge gained to the broader community and involve stakeholders in the dissemination process; and 8) AMAAD will promote a long-term process and commitment to sustainability (Detroit, 2020). The capstone's anticipated short-term outcomes include: 1) Facilitating multiple cohorts of participant stakeholders; 2) Planning and facilitating targeted community presentations by stakeholder cohorts; 3) Linking individuals and making referrals to HIV Testing and Counseling services; 4) Linking individuals and making referrals to Pre-Exposure Prophylaxis (PrEP) services for HIV prevention; and 5) Linking individuals and making referrals to Antiretroviral Therapy (ART) for People Living with HIV (PL WH). The project's desired intermediate outcomes include: 1) Increasing HIV knowledge and awareness among cohort stakeholders and service participants; 2) Increasing leadership skills among cohort stakeholders; 3) Increasing stakeholders and service participants reported feelings of empowerment; and 4) Increasing abilities to implement HIV-related projects among cohort stakeholders. The endeavor's long-term expected outcomes include: 1) Decreasing transmission of HIV among Black LGBTQ+ community; 2) Increasing Black LGBTQ+ individuals participating in PrEP and ART services; and 3) Increasing feelings and perceptions of stability in HIV vulnerable Black LGBTQ+ individuals. 8 D. Summary of Aims Ultimately, the capstone aims to integrate the AMAAD Institute's broad program portfolio-which has continued to center around peer-based engagement and support services with an ever growing, solidly connected community footing. Implementing this effort in unison with Black LGBTQ+ stakeholders and other community partners allows the AMAAD Institute to significantly expand its reach. The capstone project's proposed community outreach and engagement activities will include planning, implementing, and managing community events that will enable stakeholders to focus on the four EHE Pillars: 1) Diagnose PL WH as early as possible; 2) Treat PL WH rapidly and effectively to achieve viral suppression; 3) Prevent new transmissions of HIV with proven intervention activities; and 4) Respond quickly to deliver services to people who need them (DHSP EHE Plan, 2021). Moreover, while eliminating HIV disparity in LA is the centering goal, the capstone's proposed community-based solution is not to be categorized as a siloed HIV "project" with static outcomes for one city. Rather, the AMAAD concept is more akin to that of Black Lives Matter (BLM), i.e., as an intersectional movement that prioritizes engagement of the nation's Black lesbian, gay, bisexual, transgender, questioning/queer, nonbinary, and gender nonconforming (LGBTQ+) individuals, i.e., people who are disproportionately impacted as the result of systemic inequities. 9 II. Conceptual Framework A. Statement of the Problem The disproportionate impact of the human immunodeficiency virus (HIV) on the African American/ Black (Black) community in Los Angeles, California (L.A.) is a microcosm of the HIV epidemic, a problem that has plagued the United States as a whole. HIV attacks cells that fight body infections. It spreads through contact with certain bodily fluids of an HIV+ person not being treated with antiretroviral therapy (ART) medication. The lifetime risk of an individual acquiring HIV has improved dramatically since the 1980s global epidemic of the acquired immunodeficiency syndrome (AIDS). Nevertheless, the improvement rate of Black LGBTQ+ individuals, and Black gay and bisexual men in particular, has not kept pace with that of the general population. In fact, if current HIV diagnoses rates continue for Black gay and bisexual men, there is a one in two (1/2) lifetime risk for contracting it, compared to one in eleven (1/11) for White gay men (CDC Lifetime Risk, 2016). This alarming disparity is within the context of the American Academy of Social Work and Social Welfare's (AASWSW's) Close the Health Cap Social Work Grand Challenge, and the proposed project seeks a solution that works towards "achieving population health by moving beyond individual/clinical to ... community and social determinants" (Fong et al., 2018, p. 41). Regrettably, in L. A. County as in the nation, there is a disparity among subpopulations accessing the HIV prevention and treatment service cascade, and particularly so Black people. Data of PL WH shows that Black people, who comprise 8% of the general L. A. population, are more than 20% of all PL WH, making them the most disproportionately impacted racial/ethnic population in the county. In contrast, L. A.' s largest population group, Latinx people, account for 49% of the general population, but represent nearly 40% of all PL WH (Los Angeles County Annual HIV Surveillance Report, 2017). B. Assessment and Actual Practice 10 To develop assessment of this unconscionable disparity problem, this innovator factored the existing and ongoing landscape of HIV services while espousing the understanding that what was at one time considered a life-ending acute diagnosis has become a chronic condition that can be managed effectively. Persons diagnosed with HIV may profit from antiretroviral therapy (ART), achieving viral suppression, improved health outcomes, and a nearly normal life expectancy. ART also reduces the likelihood of transmitting the virus to others. Moreover, ART may also work as a pre-exposure prophylaxis (PrEP) for individuals who are HIV negative. When an HIV negative individual adheres to an appropriate PrEP regimen, the likelihood of contracting HIV when exposed to the virus is virtually nonexistent (Eaton, 2015). This overwhelming evidence provides reasonable belief that if the most HIV vulnerable subpopulations are engaged more effectively, not only can the disparity become an issue of the past, but HIV itself may become completely eliminated. Today, the L.A. County region has approximately 58,000 PLWH, and many are effectively managing it via ART combined with other support services. There are people who are undiagnosed or unaware of their HIV-positive status, or who are diagnosed but unable to achieve and maintain viral load suppression. Testing and/or linking these latter individuals to ART in a timely and supportive manner will improve their and others' health while contributing to the efforts to end the HIV epidemic (Department of Public Health in Los Angeles County, 2020). Both federal and local public health officials have longed pushed for disseminating and implementing specific evidence-based interventions (EBis), now known as High-Impact HIV 11 Prevention (HIP), to "high-risk individuals" (Pinto et al, 2018). In theory, the touted portfolio contains proven intervention strategies, such as various linkage and retention best practices for both HIV positive and HIV negative individuals. Vulnerable people at risk for HIV presumably access this care continuum through a range of providers such as counselors, case managers, navigation specialists, and other social workers. Unfortunately, these services neither connect nor retain Black subpopulations that are especially vulnerable to HIV on a consistent basis. Moreover, while the HIV disparity in Black gay and bisexual men specifically is especially alarming, it is important to acknowledge that the problem is present within the broader community of Black lesbian, gay, bisexual, transgender, questioning/queer, nonbinary, and gender nonconforming (LGBTQ+) individuals. They, too, are disproportionately impacted as the result of systemic inequities. What is missing from the existing service landscape is an effective integration of interventions that address multiple converging problems. Unfortunately, society and support services often perceive these issues as separate from the HIV infection rate, and therefore Black LGBTQ+ individuals are uniquely impacted. Significantly, then, many of the issues that relate to HIV disparity are tangential to several other AASWSW Grand Challenges for Social Work, especially those that are counterparts to the Close the Health Gap Grand Challenge (Fong et al., 2018). C. Socially Significant and Applied Implications Black LGBTQ+ individuals face a particular set of challenges, and disrupting the HIV status quo may only occur when HIV prevention and treatment systems develop to engage this most vulnerable community. These systems must furthermore operate in culturally appropriate and effective ways. Unfortunately, many within this specific community face social stigma and 12 discrimination, and their families often reject them, all of which adds physical and mental strains. In turn, this stress triggers a host of intersected HIV risk factors such as risk for homelessness and mental health challenges. Sadly, the system is such that Black LGBTQ+ folk with these afflictions often become entangled with the criminal justice system, thus creating even more complex intersectional barriers and risk factors (Meyer, 2017). Black LGBTQ+ people affected by these complex issues report significant difficulty in finding support systems that fully accept and respect them. On top of their already considerable burden, they are also often at a heightened risk of violence, abuse, and exploitation, when compared with their heterosexual peers. Currently it is common practice to silo HIV prevention and/or treatment services, and this approach does not consider nor address the nuanced vulnerability of this community. The system continues to fail Black LGBTQ+ people. HIV prevention and medical care providers often note "treatment is prevention" when discussing promising ART advancements for HIV. These practitioners understand that adherence to medication is especially important. If individuals who are already HIV positive adhere to ART treatment, and if high-risk HIV negative individuals similarly adhere to the same medication ( e.g., PrEP) for prevention, then the "community viral load" within this defined community may become eliminated (van Doorn, 2013). These medical realities are promising, but AMAAD posits that it is not logical to believe that clients will be able to consistently adhere to ART and/or PrEP if they have unaddressed challenges. Housing, substance use disorder, mental health issues, and/or other factors challenge the medical potential. Thus, an appropriate integrated and intersectional approach is necessary. Furthermore, a model that facilitates the empowerment of people via communal perspectives is also necessary to create a sense of legitimacy with a community. 13 D. Framework and Theory of Change The theory of change framework for the capstone project supports the accompanying logic model, which is an adaptation of the Comprehensive-High Impact HIV Prevention Projects for Community-Based Organizations (CBOs) model (Exhibit 1). The theory of change guides the capstone project, while the logic model components and key pillars from the domain structures are necessary to secure HIV funding as allocated by government sources. As alluded to above, individualized intervention approaches alone have not been effective in engaging the population in question here, as evidenced in the continuing disparity of HIV infection among Black LGBTQ+ people. Thus, this proposed capstone project takes its direction from a grassroots peer-based framework and theory of change, both of which are rooted within community. The undergirding approach, then, arises out of intersecting perspectives that merge Sense of Community theory, Critical Race theory, and Queer theory. The framework emphasizes the construct known as 'psychological sense of community' (PSOC) that suggests that a person's sense of community may also be rooted in feelings of responsibility for that community. In the case of this project's focus, a sense of loyalty, responsibility, and commitment to other Black LGBTQ+ people is integral to the sense of there being a Black LGBTQ+ community (Nowell & Boyd, 2011). Within this project's framework, Sense of Community theory is congruent with Critical Race theory for both combine progressive political struggles for racial justice with critiques of systematic hierarchies. The project argues that high impact prevention and ART interventions, as identified by federal and local HIV prevention and treatment officials, have been structurally funded and delivered in ways that maintain White privilege and power. This system is incompatible with the cultural realities that make Black people specifically more vulnerable to 14 HIV (Einbinder, 2020). This project also maintains that the Black cultural perspective is further compounded by shared realities that are intersectional with sexual orientation and/or gender identity (e.g., LGBTQ+). The battle to erase the HIV disparity under study cannot ignore these identities, and thus the project also employs Queer theory, especially in its discussion of the Black LGBTQ+ community' s rejection of traditional roles and categories of gender and sexuality (Hicks & Jeyasingham, 2016). The integration of Sense of Community, Critical Race, and Queer theories into a culturally relevant community perspective aligns with the notion of integrating specialized interventions that improve vulnerable Black individuals' linkage to services. Pinto et al. (2017) identified provider, interpersonal, and environmental level factors that impact how HIV services are delivered to people. Those factors fall into four defined domains: 1) Individual; 2) Relationship; 3) Community; and 4) Policy. The study's conclusion indicates that each of these domains has an influence on the other. The researchers endorsed integrating intervention activities from the different factors in each domain to maximize improvements to the care linkage continuum (Pinto et al., 2017). Intertwined into the theoretical framework is also an understanding of what the World Health Organization (2017) termed the social determinates of health related to HIV infections. Social determinates are the conditions in which people are born, grow, live, work and age. These conditions dictate most health inequalities and preventable differences in health status. The interconnectedness of these issues for Black LGBTQ+ individuals shapes such life circumstances as access to money, power, and resources (World Health Organization, 2017). This projects specifically turns on the understanding that economic systems and social structures, such as health services, physical environment, social environment, as well as structural and societal factors, are converging social determinates of health (CDC, 2010). 15 In articulating the capstone's framework, it is imperative to highlight the cyclical nature of the HIV prevention and treatment systems, which are rooted in Pinto' s (2017) four domains Individual, Relationship, Community, and Policy. Black LGBTQ+ individuals may have an elevated risk of contracting HIV and experiencing more severe health outcomes than their White counterparts, and their susceptibility is further compounded by behavioral health issues such as depression. Additionally, the strain that accompanies discrimination based on race, sexual orientation, and HIV status builds a cumulative burden of stress that increases deleterious health outcomes. The framework further posits that so far, federal and local public health officials tend to provide HIV services in a way that focuses more on biomedical interventions (e.g. ART, PrEP) for individuals, rather than as combined public health services that serve communities. The latter has the potential to be more effective for disproportionately affected Black PL WH. The Black community has expressed a general medical mistrust rooted in such criminal historical events as the Tuskegee syphilis experiment, which sinisterly conflated healthcare research with Black people as expendable human subjects for experimentation. Moreover, medical care systems are often sterile, cold, and transactional environments, a fact also prevents vulnerable Black people from engaging with them (Scharff et al., 2010). In response, AMAAD' s concept is to build a trusted, peer-based ally approach that celebrates individual connection to the community, and which strongly emphasizes community building, interpersonal relationships, and warm connections. This framework may also apply to integrated environmental intervention 16 opportunities upstream, which would serve to shape and sustain good health further (Fong, et al, 2018). 17 III. Problem(s) of Practice and Innovative Solutions A. Capstone Innovation's Contribution to Grand Challenge In alignment with the Close the Health Gap Social Work Grand Challenge, the capstone project intends to assist in eliminating the HIV disparity among Black LGBTQ+ people through an effort that the innovator has termed Arming Minorities Against Addiction and Disease (AMAAD) (pronounced Ah-maad). AMAAD is designed to be congruent with the Ending the HIV Epidemic (EHE) initiative that multiple federal agencies in the U.S. Department of Health and Human Services (HHS) developed. The initiative's goal is to end the HIV epidemic in the nation by the year 2030 (United States Health and Human Services, 2020). Essentially, the national EHE Plan for America (Exhibit 2) infuses 57 local jurisdictions with additional resources, technology, and expertise to expand HIV prevention and treatment activities. The AMAAD capstone project locally operationalizes efforts as grassroots community-based components in the L.A. jurisdiction. AMAAD's founder and project director has proactively developed a formal fiscal sponsorship agreement (Exhibit 3) with the LAC+USC Medical Center Foundation. He has also secured federal pass-through funding from the County of Los Angeles Public Health Department (PHD) to begin the EHE related project. This AMAAD capstone project will facilitate EHE community engagement, outreach, and mobilization activities throughout the L. A. region. This effort is local in nature, but it may serve as a model for best practices in mobilizing Black LGBTQ+ people across the nation. Strategically, the AMAAD capstone will: 1) Empower Black LGBTQ+ community members to reduce HIV via a community-led approach; 2) Increase knowledge and awareness among Black LGBTQ+ people of HIV and HIV-related issues; 3) Develop partnerships with organizations and businesses to support HIV awareness efforts; and 4) Reduce HIV -related 18 stigma among the community. AMAAD offers a community-based solution that supports of the government's EHE initiative, but it does not have to be siloed as an HIV only "project," with finite or static outcomes. Rather AMAAD's concept is akin to that of Black Lives Matter (BLM) in that it is an intersectional 'movement,' and that it intends to facilitate progress and thought through grassroots engagement of individuals and peer groups. In time, the project will contribute to the elimination of HIV (Clare, 2016). B. Inclusion of Stakeholder Perspectives There are three stakeholder perspectives for this project. Stakeholder #1: Mario Perez is the Director of the Division of HIV and STD Programs (DHSP) at the L. A. County Department of Public Health (PHD). Perez has led DHSP to develop a formal EHE Plan for L. A. County (Exhibit 4). This local plan mirrors the national four EHE pillars-1) Diagnose, 2) Treat, 3) Prevent, and 4) Respond-important HIV strategies to bring about an end to the HIV epidemic (Department of Public Health in Los Angeles, 2021). Over the past year, with Perez at the helm, the DHSP facilitated a community planning process that included several local and critical contributors to inform and enhance the local EHE planning effort. As a result, DHSP issued a PHD Work Order Solicitation (Exhibit 5) in an effort to identify a sole vendor through which to advance EHE efforts among communities that are especially disproportionately impacted by HIV. The PHD Work Order Solicitation prompted this innovator to design and secure funding for the proposed capstone project as a community-based mechanism that helps to fulfill the EHE goal. Stakeholder #2: Rosa Soto is the Executive Director of LAC+USC Medical Center Foundation. Soto leads the LAC+USC Medical Center Foundation, which is a 501(c)(3) nonprofit that seeks to support and enhance the mission of the Foundation's namesake public 19 hospital, the LAC+USC Medical Center. Soto's responsibility is to ensure that the Foundation maintains its status as a leader in health and medicine, community care, education, research, patient care, and community well-being. Soto fulfills her brief partly through partnerships with hospital physicians and other social entrepreneurs to provide direct outreach programs, referrals, and social supports to people experiencing homelessness or suffering from substance use disorder. During this student's research to develop a capstone project, he became aware that Soto and LAC+USC Medical Center Foundation are both on the PHD Master List for Community Engagement and Related Services as approved fiscal sponsors. Being on that Master List was a prerequisite for any potential vendor interested in submitting a proposal in response to the PHD Work Order Solicitation. After communicating and meeting with Soto, they came to a collaborative agreement for this innovator to prepare and submit the AMAAD capstone proposal, with LAC+USC Medical Center Foundation as the fiscal sponsor. Stakeholder #3: Black LGBTQ+ Action Coalition (BLAC) Focus Group. Perhaps most importantly for the AMAAD concept is the perspective of the Black LGBTQ+ community in question. Over the last year, AMAAD's innovator identified and recruited community members from L.A. for the BLAC Focus Group in order to facilitate grassroots information gathering. The innovator was able to coordinate BLAC, in part due to funding from the L. A County Department of Mental Health (DMH) Underserved Cultural Communities (UsCC) (Exhibit 6). These BLAC meetings offered robust conversation and dialogue primarily on issues intended to highlight mental health, but they naturally progressed into broader interrelated issues, such as HIV. Several consistent themes emerged, mainly identifying the need for more resources across the service continuum that center around Black people's needs specifically. From this context, the researcher inferred a need to center the Black experience, for Black people have 20 unique experiences, culture/s, and challenges in comparison with other communities. Another consistent theme identified the need for more stakeholder engagement of Black LGBTQ+ people specifically. This focus again includes a certain community focus that prioritizes and centers the intersectional uniqueness of AMAAD's priority population. BLAC participants provided the innovator further insight about the demand for safe spaces that allow folks to speak of experiences without fear of judgment or retaliation. Another key point was the requirement for more accountability regarding the health and wellness of the community. 'Accountability" here means the obligations and responsibilities of institutions, community members, and leadership to ensure ongoing engagement of the Black LGBTQ+ community with relevant services, funding, stakeholder engagement, and client experience. The accompanying AMAAD Institute Black LGBTQ+ Action Coalition White Paper provides additional background for the BLAC Focus Group meetings (Exhibit 7). C. Positioning Within Broader Landscape Evidence points to the need for integrated community solutions with resiliency and protective factors that can help the priority population cope with adversity and manage stress related to cultural burdens (Herrick et al., 2011). The AMAAD capstone will address HIV disparity within the Black LGBTQ+ community engagement and seek to effectively empower individuals to make healthier and self-protective choices. The CDC asserts that to highlight and address social determinates, a program requires developing partnerships with groups that traditionally may not have been part of public health initiatives, including community organizations and representatives from government, academia, business, and civil society (CDC, 2012). Therefore, an approach that engages HIV services and related support must be holistic and collaborative in both concept and implementation. 21 At the heart of AMAAD is the drive to build strong social support networks as effective tools that empower individuals to live in ways that affirms who they are while also allowing them to protect and value themselves. Family support, positive peer groups, spiritual connections, and strong sense of self and self-esteem are all important protective devices to consider (DHHS, 2012). D. Consideration of Opportunities In addition to EHE strategies and voices from grassroots Black LGBTQ+ community members, the proposed AMAAD project is informed by studies that focus on how stigma impacts access to prevention and treatment, and how judgmental and culturally insensitive clinical care blocks people from accessing services. AMAAD's capstone proposal is new for the unfolding EHE, but the innovator already facilitates various direct service elements of AMAAD's concept, and he constantly considers opportunities for funding and program scaling. The Galbraith's STAR Model (Exhibit 8) is the organizational design, and the innovator imagines AMAAD to eventually grow to become an established network of grassroots chapter organizations. Together these chapters would function as comprehensive, peer-developed local CBOs throughout select regions, importantly working beyond HIV to address multiple social determinates of health issues. This specific capstone project presents an opportunity to transform AMAAD from a neighborhood effort into a regional jurisdiction organization, which in turn can further replicate into a national network. The unique peer-based chapter model provides community engagement and essential support services in a manner that purposely integrates a broad range of public health and social work-related services for Black LGBTQ+ people. Reviewing the literature allowed the innovator to contextualize how expanded grassroots system develop with local, peer-based chapter entities. In the process he uncovered a document 22 on organizational growth and change management prepared for the W. Clement & Jessie V. Stone Foundation. The report summarizes "best" and "next" change management practices for organizations seeking to scale their efforts. Regardless of the scale or impact an organization seeks, managing the changes necessary for these new goals requires building and deploying organizational capabilities. The report argues that scale can be achieved not only by expanding locations, the traditional definition. Scaling may also proceed by "going deeper" in existing program offerings; formulating long-term sustainability; advancing principles and beliefs; and 4) redirecting ownership to make activities self-generative (Stone Foundation, 2012). E. Connection with Theory of Change The AMAAD capstone project places significant value on community outreach strategies to prioritize engaging a priority population. This population includes a specific subculture of the Black LGBTQ+ familial/peer groups that socialize and congregate as a part of the underground House and Ballroom Community (Harper et al., 2020). AMAAD's Sense of Community theory speaks to the concept which relies upon Black LGBTQ+ members feelings of belonging and mattering to the community group, and a shared faith that the selfs and others needs will be equally met by a shared commitment. This sense is especially relevant within what the broader society may perceive as an underground population segment. Although AMAAD already has a reach within the Black LGBTQ+ community in L.A., opportunities for promotion and outreach engagement will dramatically expand to build upon the individual's psychological sense of community (PSOC). The AMAAD design includes ongoing discussions with key community opinion leaders to identify additional methods for expanded reach. Participants in AMAAD's EHE activities will purposely reflect the makeup of the priority population, and the effort will 23 leverage relationships to ensure that they are not just culturally competent, also meaningful and responsive. Logic Model: The context for the AMAAD capstone Logic Model is directly in alignment with the practical experiences and the theory of change already in place. AMAAD's concept understands that stigma contributes to risk behavior, HIV acquisition, and engagement in HIV services, especially for vulnerable Black people. Embedded in the model is a creative communal response; this philosophy behind it is that all people in the entire community benefit when every individual within it has access to support services that help them to manage their lives in a manner that embraces their racial identification, sexual-orientation, and/or gender expression. At the core of AMAAD are peer-based social support network environments that ignite community engagement and empowerment, with a host of prevention, treatment, and essential supportive services complementing them. It is essential that primary community engagement activities take place in local grassroots settings that do not look or feel like medical or clinical operations, and that are furthermore unapologetic about being blatantly welcoming and culturally relevant to the Black LGBTQ+ community. Inputs: The capstone's innovator takes pride in the fact that AMAAD's current integrated program portfolio will function as significant inputs, as they match the philosophical approach of being serviceable at the grassroots peer level. There are reasons to strategically position AMAAD to develop a national network infrastructure for a peer-based branch system by securing people, resources, and partnerships. Facilitating AMAAD will highlight its underlying values, philosophy, and culture by investing in people at the grassroots level. Investing in people means hiring individuals with a lived experience in the community, providing adequate training and resources, and offering management and support for (Poland et al., 2004). 24 Outputs: The AMAAD effort will produce holistic community engagement activities via a culturally meaningful and inclusive set of a responsive services. These activities will produce 1) targeted HIV testing; 2) proactive and culturally responsive program promotion and outreach; 3) harm reduction/ recovery coaching for those impacted by drugs and alcohol services; 4) empowerment and leadership development activities; 5) open and closed group sessions that address the social, educational, personal, professional, and spiritual wellness needs; and 7) referrals and linkage to a wide variety of health and social services. In addition to addressing the priorities as identified by key stakeholders, there are other activities that promote bonding and developing social support for Black LGBTQ+ people. These will allow participants to gain balance and stability and encourage a more seamless linkage of medical services into this integrated health and wellness organization. The project will also engage an evaluation consultant to assess impact and collect data to document such process outcomes as number of community engagement activities; numbers of attendance / participation; number of people referred for HIV Testing; number of people referred to ART; and number of people referred to Pr EP. These statistics will function to assess the short term, intermediate, and long-term outcomes. Short-term outcomes, by June 2023: 1) Facilitating at least ten separate cohort groups with a minimum of six participants each; 2) At least ten targeted community presentations planned and facilitated by each cohort stakeholder group; 3) Referring and/or linking a minimum of 500 targeted individuals for HIV Testing and Counseling Services; 4) Referring and/or linking a minimum of 100 targeted individuals to PrEP services; and 5) Referring and/or linking 100% of all individuals who test HIV positive to ART. 25 Intermediate outcomes, by June 2023: 1) Increasing HIV knowledge and awareness among cohort stakeholders and service participants; 2) Increasing leadership skills among cohort stakeholders; 3) Increasing reported feelings of empowerment in stakeholders and service participants; and 4) Increasing cohort stakeholder ability to implement HIV prevention projects. Long-term outcomes, by June 2023: 1) Decreasing transmission of HIV among Black LGBTQ+ community; 2) Increasing number of Black LGBTQ+ individuals participating in PrEP and ART services; and 3) Increasing feelings and perceptions of stability in Black LGBTQ+ folk who are vulnerable to HIV. AMAAD will use various standardized intake and follow-up assessment forms that the currently exist, and it will develop other relevant data tracking instruments (Exhibit 9). 26 IV. Project Structure, Methodology, and Action Components A. Format of AMAAD's Community-based Organizational Design The prototype for this capstone project exists within a funding proposal (Exhibit 10) to the County of Los Angeles Public Health Department (PHD). On March 3, 2020, the innovator received notification that the PHD review committee had selected his proposal for contract execution, effective April 2021 through June 2023 (Exhibit 11 ). The proposal in question collaborates with the goal of Ending the HIV Epidemic (EHE). AMAAD's founder submitted the proposal to PHD in December 2020 as the result of a negotiated partnership agreement with the LAC+USC Medical Center Foundation, an entity that had been prequalified to compete for the Public Health Master Agreement Work Order that was issued by PHD's Division of HIV and STD Programs (DHSP). This award will allow community-based engagement activities that expand the scope and reach of an existing effort known as AMAAD (Arming Minorities Against Addiction & Disease), the proposed capstone. Project. Deploying an intersectional social work and public health approach, AMAAD specifically seeks to disrupt and impact the systemic inequities that drive the status quo of HIV and other disparities among Black lesbian, gay, bisexual, transgender, questioning/queer (LGBTQ+), non-binary, and gender-nonconforming individuals who are disproportionately. The partnership of LAC+USC Medical Center Foundation with AMAAD, and this innovator's role as the Project Director, profit from the fact that the latter is also the founder and current Chief Executive Social Worker of the AMAAD Institute, a nonprofit 50l(c)(3) tax exempt community-based organization (CBO) with an established presence in the L. A. region. In turn, AMAAD Institute's presence as a relatively young organizational entity links inextricably to the student's capstone project in partnership with LAC+USC Medical Center 27 Foundation. The innovator must reveal that all of AMAAD Institute's nuanced program components for community engagement are relevant to the project under question and will therefore inform the project's activities and their implementation. A great deal of professional effort over the last few years has developed the institute, originally designed solely by the innovator, into a fully functioning, peer-based entity, with nearly 30 fulltime employees holding integrated Care Coordination Team responsibilities. Annually, the AMAAD Institute serves the needs of more than 1,000 clients and/or program participants across a range of social work and public health services. The AMAAD Institute's staff roster currently includes HIV Testing Counselors, Linkage Navigators, Outreach Workers, Certified Addiction Counselors, Behavioral Health Therapists, Employment Specialists, Housing Coordinators, Resident Advisors, as well as Fiscal/Human Resource Administrative staff (Exhibit 12). The organization controls two program office locations and two residential transitional living facilities. With the new funding, the AMAAD Institute's capacity will expand to five additional Community Engagement Coordinators, a Social Media Technician, a Project Administrative Liaison, an Evaluation Consultant, and other resources that will contributing to ending the HIV Epidemic. B. Analysis of the Market for AMAAD's Innovation Solution This project distinctly ties into the EHE collaborative agreement with LAC+USC Medical Center Foundation, a competitive provider in the market. The endeavor, however, is essentially synonymous with the AMAAD Institute, which is a truly separate and one-of-a-kind boutique organization. The innovator is unaware of other entities in the nation that work to address the integrated needs of Black LGBTQ+ people in the same manner as AMAAD Institute. While there are a host of other targeted HIV projects and/or HIV/ AIDS service organizations, 28 those other efforts typically operate within specific HIV service silos. AMAAD's grassroots, community-based, integrated program portfolio is frankly unparalleled. Since initially receiving funding from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) for a Peer-to-Peer recovery support program in 2016, the AMAAD Institute has progressively become firmly positioned as a specialized premier agency that advocates for community-based HIV health and wellness services that address the need to intensify HIV co-factors and social determinants of health. the project's clear understanding of an undeniable absence of culturally relevant services for Black LGBTQ+ people, uniquely positions it to expand its community scope, a fact recognized by the County's award of competitive funds. Importantly, the AMAAD Institute's growing mainstay activities have continued to center around peer-based engagement and support services that exhibit ever growing community footing. Implementing this capstone in unison with community partners, the AMAAD Institute further expands its reach significantly into the Black LGBTQ+ community service market. The community outreach and engagement activities of the capstone will include planning, implementing, and managing community events that enable stakeholders to focus on the four EHE Pillars: 1) Diagnose PL WH as early as possible; 2) Treat PL WH rapidly and effectively to achieve viral suppression; 3) Prevent new transmissions of HIV with proven intervention activities; and 4) Respond quickly to deliver services to people who need them (Department of Public Health, 2021). A highlight of the AMAAD capstone engagement efforts will be regular community discussions. These interactions will disseminate pertinent information among Black LGBTQ+ community stakeholders in a manner that solicits their ongoing input. This key two way community strategy is absent from all other similar efforts. 29 C. Methods for Project Implementation The capstone will employ Community-Based Participatory Research (CBPR) as a primary method of implementing the project and identifying and recruiting Black LGBTQ+ community members and ally stakeholders who can bring fresh perspectives, creative thinking, and solutions to address HIV prevention and treatment. CBPR as an implementation method makes the proposed AMAAD plan a community partnership that equitably involves community stakeholders and solicits them to contribute their lived experience and expertise for shared decision-making and -ownership. AMAAD' s innovator has adapted the following CBPR core principles to guide the capstone: 1) AMAAD will promote collaborative and equitable partnerships in all phases and involve empowering and power-sharing processes; 2) AMAAD will recognize the Black LGBTQ+ community as a unity of identity; 3) AMAAD will build on strengths and resources within the community; 4) AMAAD will facilitate co-learning and capacity building among all partners: 5) AMAAD will focus on relevance to the Black LGBTQ+ community using an ecological approach that attends to multiple determinates of health and disease; 6) AMAAD will balance research and action for the mutual benefit of all partners; 7) AMAAD will disseminate its findings and knowledge to the broader community and involve stakeholders in the dissemination process; and 8) AMAAD will promote a long-term process and commitment to sustainability (Detroit, 2020). The project's design includes multiple points of entry for clients and/or participants, including street-based outreach where AMAAD staff may engage potential participants to complete a questionnaire via mobile tablet devices (Exhibit 13 ), and agency referrals for other programs. The AMAAD Institute currently uses the Social Network Strategy (SNS) (Exhibit 14) 30 for its rapid HIV testing activities. These activities center on the principle that people within the same social network-who know, trust, and can exert influence on each other-share the same risks and behaviors for HIV. The approach includes identifying peers who are HIV positive or at high risk for HIV to help recruit other participants (McCree et al., 2013). AMAAD has access to clinical laboratory licenses as the result of an oversight partnership agreement with Children's Hospital Los Angeles (CHLA), and thus the Institute's HIV testing activities are integrated into its operations (Exhibit 15). When facilitating HIV testing services, AMAAD's staff also facilitates Personalized Cognitive Counseling (Exhibit 16), which is a CDC-endorsed, single-session counseling intervention designed to reduce high-risk behaviors (Dilley et al., 2011 ). If an individual receives a preliminary HIV positive test result, AMAAD staff utilize Anti-Retroviral Treatment and Access to Services (ART AS) (Exhibit 17), a CDC-approved linkage to HIV medical care strategy. ART AS includes strength-based and motivational interviewing techniques to facilitate linked refe1rnls within three days ( or 30 days maximum) to an appropriate medical care provider for ART follow-up (Craw et al., 2010). If AMAAD testing staff identify an individual as HIV negative and/or high risk, they refer them to one of several medical partner providers that have the capacity to prescribe PrEP for HIV prevention. In addition, part of AMAAD's continued engagement protocol includes addressing a wide range of essential support needs by developing a personalized Linkage and Retention Plan. The AMAAD Institute designed its cadre of intersecting essential services to eliminate and/or reduce barriers to accessing HIV-related treatment and prevention services. For example, AMAAD currently provides licensed and/or registered Behavioral Health Counseling Services that are culturally relevant to Black LGBTQ+ individuals. The organization's current behavioral 31 health counseling team comprises a licensed supervising clinician who oversees five registered and/or licensed therapists as they facilitate individual and group Cognitive Behavioral Therapy (CBT) and other evidence-based approaches and interventions. AMAAD also continues to grow its initial programming that prioritized the lived experience of Black LGBTQ+ people at risk for substance use disorder (SUD) and to provide peer recovery support as a core operational component. Currently AMAAD has two Certified Addiction Specialists on staff who facilitate ongoing harm-reduction peer support and navigation services that connect individuals to appropriate peer support groups, activities, and/or treatment services. The various social determinates of health and the implementation that form the subject of this AMAAD capstone plan would be incomplete if they do not include L. A.' s current significant housing crisis. AMAAD's experience with Black LGBTQ+ younger people especially provides firsthand and relevant experience on the crisis. Homelessness is the reason that within the past two years, AMAAD has expanded its housing support portfolio to now include a team that consists of two Co-Housing Managers and four Housing Specialists and/or Resident Advisors that coordinate access to transitional and permanent housing support resources. In addition to coordinating access to one of the 25 beds at AMAAD's two transitional living facilities (Exhibit 18), the team also administers a Rental Assistance Program that provides eligible clients support in paying rental security deposits and/or monthly rental payment assistance. Further, AMAAD's efforts include employment and job performance support by working closely with partner agencies at employment readiness sites, including Watts Labor Coordinating Action Committee (WLCAC) and the Los Angeles Trade Technical Community College. In fact, two of the agency's Behavioral Health Therapists are co-located between AMAAD and their employment training sites. Also, AMAAD's team embeds an Employment Training Specialist who provides one-on-one and group coaching for career and educational guidance, resume preparation, and finding job leads. Finally, recognizing the unique needs of Black LGBTQ+ individuals who have been involved with the criminal justice system, AMAAD services also offer specialized reentry services that address anti-recidivism through evidence-based, trauma informed approaches. AMAAD's justice-centered work also includes specific youth diversion activities, where two staff members work closely with local police departments to provided structured activities to Black LGBTQ+ youth, disrupting potential cycling through a criminal justice system. 32 The integrated of program components of AMAAD is unique, and the new capstone project adds even more implementation value. Program participants will be recruited and selected from internal and external programs to form EHE stakeholder "cohort teams." These cohorts will plan and advance HIV-related projects with AMAAD guidance. As a strategy to achieve this and other objectives, the AMAAD project will develop a Community Awareness and Participation Plan (CAPP) to ensure widespread, ongoing, and meaningful participation of stakeholders with a focus on vulnerable groups. The "reach" and "sustainability" factors of the effort will improve, as all stakeholders, especially Black LGBTQ+ community members, will have an opportunity to participate in shaping the community engagement. The voice of each of these groups will speak and be heard at all levels of decision making. AMAAD has excellent working relationships with several other existing traditional HIV service providers, and the organization will maximize those to effectively involve their agency representatives and constituents more. In the effort to recruit a broader section of disproportionally affected communities, however, the project will intentionally prioritize engaging non-traditional HIV 33 service providers and their constituents, especially those that provide key essential support services. The project will strategically distribute outreach recruitment materials and social media posts to increase awareness, but AMAAD's efforts will also incorporate personalized invitations that purposely draw and recruit from identified and targeted stakeholders. D. Details of Financial Plans Just as the discussion cannot separate AMAAD Institute' s program operations from the capstone effort, neither can the project's fiscal resources be considered separately. The recent award from the PHD Work Order Solicitation as a part of the LAC+USC Medical Center provides a total of $2. 3 million for the contract period of April 2021 through June 2023. An annualized calculation of this new funding award increases the AMAAD allocated resources by nearly 40% for an agency annual operating budget of approximately $3.6 million. The project's itemized budget therefore includes the EHE award and AMAAD's other grants and paired resources (Exhibit 19). The project's innovator will continue to pursue funding to sustain the ongoing efforts. The following recent grant history for AMAAD Institute funding may function to foreshadow a realistic picture of potential future resources. For example, in 2016 the innovator received AMAAD's first significant grant, a three-year $750,000 award from the Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment (CSAT) Targeted Capacity Expansion Peer-to-Peer. The grant spurred AMAAD to build an infrastructure that engaged Black LGBTQ+ individuals in recovery and at risk for HIV. In 2017, AMAAD received a five-year $1 million cooperative grant agreement from SAMHSA's Center for Substance Abuse Prevention (CSAP) as a part of the Minority AIDS Initiative to provide individuals with HIV and SUD prevention services. The next year, 2018, after establishing a 34 more solid infrastructure, AMAAD received an annually renewable contract for $55,000 from the City of L. A's Office of AIDS to generate Ambassador leadership development and empowerment activities. Later in 2018, AMAAD also received an annually renewable $100,000 PrEP awareness grant from Gilead Pharmaceutical. The grant allowed AMAAD to facilitate health education retreats for Black LGBTQ+ community members. The first SAMHSA grant awarded in 2016 concluded in 2019, by which time the innovator had successfully established the agency's infrastructure and positioned it for success. In 2020, AMAAD formalized a subcontract with Children' s Hospital Los Angeles to complement their HIV testing effort as a part of a DHSP contract. In addition to AMAAD's specific HIV experience, the organization has secured funding for its integrated essential support services, including recovery support, behavioral/mental health therapy, tobacco prevention, housing supportive services, and reentry support. For example, the City of L. A Mayor's Office of Economic Opportunity subcontracts with the organization to provide behavioral health counseling for two geographic L. A. regions. Further, as part of a contract with the California Board of State Community Corrections (BSCC), AMAAD facilitates a Reentry-Rental Assistance Program (Re-RAP) that provides 1) rental security deposits; 2) monthly rent subsidy payments; and 3) emergency or flex transitional housing stipends that prioritize Black and Brown LGBTQ+ individuals who have been released from California State Prisons. One of AMAAD's newest contracts will also work with BSCC to facilitate a youth diversion program that aims to keep Black LGBTQ+ individuals from becoming entangled by police and criminal justice systems. The AMAAD Institute utilizes QuickBooks for Nonprofits and ADP Payroll for data processing, and it has an Office Manager who works closely with the Human Resources 35 Manager and a Certified Public Accountant to help maintain compliance across a diverse funding portfolio. In January 2021, the AMAAD Institute completed its first independent audit for fiscal year 2019 (Exhibit 20) with no negative findings. It is currently preparing for an independent audit for fiscal year 2020, for which the unaudited financial statements are attached (Exhibit 21). The innovator of AMAAD anticipants a continued fiscally sound operation, with appropriate internal controls enabling the agency to continue securing funding from city, county, state, federal, and private sources. E. Assessment AMAAD Institute employs various government accountability processes for assessment of different program consistently; the capstone AMAAD has established an agreement with Keith Green, Ph.D. to provide consultation services for evaluation and quality management. Green is an assistant professor at the Loyola University Chicago's School of Social Work with strong community roots and an extensive history as an HIV organizer, educator, researcher, and advocate. His attached Curriculum Vitae (Exhibit 22) provides the qualifications, background, and relevant experience that make him especially well-suited to work with AMAAD as a CBO. The capstone innovator will collaborate with Green to develop process monitoring procedures for ongoing assessment. For the EHE efforts, indicators will include collecting standardized individual- and cohort-level participant data (e.g., demographic characteristics, ethnicity, sexual orientation, gender-identity, community, etc.), and aggregated data (e.g., total number of meetings, attendees, etc.). In concert with a PHD data management system for standardized reporting, and as directed by DHSP, AMAAD staff will facilitate a process for entering this information into the County's data management system or sending data electronically via an electronic data interface (EDI) monthly, as directed by DHSP. Working 36 especially closely with the capstone innovator and the Evaluation Consultant to measure and maintain benchmarks, and document activities facilitated by the cohort Project Coordinators, an Administrative Project Liaison officer will organize and maintain project literature. AMAAD's assessment efforts will seek to answer the following key evaluation questions: 1) Is AMAAD reaching its target populations? 2) Does the community perceive AMAAD's engagement activities as reflective and responsive to the relevant population groups? 3) Is AMAAD reaching the expected number of stakeholder participants for each cohort? 4) Has AMAAD involved other community partner entities? 5) How satisfied are cohort participants? Project staff will work closely with the evaluator to develop standardized impact and outcome data collection instruments for education and awareness. These evaluation instruments will include questionnaires and pre/post-tests. They will use a secure and confidential online platform that will be compatible with both in-person and virtual meeting engagements. The project will measure individual cohort participants over time as staff will be able to see ifthere are changes such as viral loads increase, decrease, or stay the same. F. Plan for Stakeholder Involvement Employing a Community-Based Participatory Research (CBPR) as a partnership approach, AMAAD will identify and recruit Black LGBTQ+ community members from throughout the L. A. region to form cohort teams. Their role will be to advance an HIV-related project oriented to accomplishing the primary goal within the community. As a strategy to achieve this and other objectives, AMAAD will prepare and implement a Community Awareness and Participation Plan (CAPP) to ensure widespread, ongoing, and meaningful participation of stakeholders, who will be from vulnerable groups. The "reach" and "sustainability" of the effort will improve as all stakeholders, especially vulnerable Black LGBTQ+ people, have an 37 opportunity to participate in shaping the community engagement effort. Facilitators will proactively solicit and listen to the voice of each of these groups at all levels of decision making. AMAAD will ensure each cohort group conducts formal as well as informal HIV educational activities (i.e., presentations, workshops and/or trainings) to educate individuals and communities on 1) Ending the HIV Epidemic; 2) decreasing HIV's deleterious effects in LAC; and 3) disseminating other HIV-related information. AMAAD is especially attuned to the need of connecting unaware or unengaged people to public health efforts such as the EHE plan and social justice. AMAAD's philosophical approach recognizes that people in a community can become passionate about HIV -related work if they are able to see that their activism connects to fighting for themselves and their community. They can, in turn, become major voices and develop words to articulate complex intersectional public health and social justice issues. Within the context of the capstone project, AMAAD will especially ensure that cohort participants are engaged via an emphasis on the relevance of parity and inequity. By participating in community engagements, individuals will better understand that persons at risk and/or living with HIV often experience a range of health problems and economic, social, and environmental barriers that can impact their mental health and psychosocial wellness. Embedded within the cohort activities will be a challenge to cohort participants to push for social change, particularly on behalf of those vulnerable and oppressed people disproportionately impacted by HIV/ AIDS. Cohort participants will develop a better understanding of required change efforts that focus on issues of poverty, unemployment, discrimination, housing, and other forms of social injustice related to HIV. By better understanding community health disparities, cohort participants will also become more informed about personal activities that they can take to 38 challenge social injustices related to HIV, including promoting sensitivity and knowledge about oppression and cultural and ethnic diversities. AMAAD will ensure that issues related to equity and access are highlighted for each cohort, while stressing the inherent dignity and worth of all people. AMAAD's philosophy recognizes the importance of human relationships as critical vehicles for change. G. Communications Products and Strategies The project will use the AMAAD Institute's existing virtual Microsoft Teams platform to host virtual meetings, as planned for the immediate future due to COVID-19 social distancing recommendations. Microsoft Teams will also effectively engage stakeholders and constituents in planning and recruitment efforts. The project will routinely also use Facebook and Instagram social media platforms to build and maintain community awareness. In an effort to shore up online engagement activities, e.g., virtual meetings, social media, etc., a hired staff member will have the primary responsibility of coordinating social media postings and ensuring that cohort stakeholders have regular access to computers and the internet. They will track and maintain equipment that the project will regularly loan to cohort participants who need assistance with internet access. AMAAD's capstone innovation includes events and social strategies such as regular outreach events in partnership with local providers. When COVID-19 restrictions are lifted, planning expects these events to draw 200-300 participants; they will be significant opportunities for connecting with new participants. Rapid HIV testing and counseling services by way of a mobile testing unit will make these events effective in testing vulnerable individuals who may not know their HIV status. AMAAD will also leverage consumer advisors / key participants to extend its reach into new places and to ensure a presence at sites when multiple events happen on the same day and time. The effort will also turn to community partners and other collaborators for help in advertising and promoting special events and programming. 39 40 V. Conclusions, Actions, and Implications A. Project Potential While the impact of HIV has disproportionally persisted among vulnerable subpopulations, targeted community engagement activities complemented by integrated social work and public health services present an opportunity to change the status quo. The AMAAD project proposes an innovative way of achieving this equity. It is reasonable to believe that if the groups most vulnerable to HIV are engaged more effectively, not only can the disparity become an issue of the past, but HIV itself can eventually become eliminated. Significant evidence points to the need for multifaceted community solutions, with resiliency and protective factors at their hearts, to help vulnerable people cope with adversity and manage stresses related to cultural burdens. The concept of AMAAD understands that stigma relates exponentially to risk behavior and acquiring HIV. Engaging in HIV services is thus an empowering tactic that prioritizes the Black LGBTQ+ community even beyond the issue of HIV. Embedded in the model of practice is a creative communal response informed by the belief that the entire community benefits when individuals within it have access to support services that empower them to manage their lives while embracing their racial identification, sexual-orientation, and/or gender-expression. At the core of AMAAD are peer-based, social support network environments that ignite community engagement and empowerment. A host of prevention, treatment, and essential supportive services complement these environments. Importantly, primary community engagement activities will take place in local grassroots settings that neither look nor feel like medical or clinical operations. These settings are also unapologetic in blatantly welcoming the Black LGBTQ+ community in culturally relevant ways. The capstone innovator has a clear demonstrated history of success with regards to bringing this community-based model of practice to life as he as has already created the AMAAD Institute, a 501(c)(3) nonprofit peer-based entity, with nearly 30 fulltime employees who annually provide integrated services to more than 1,000 existing clients and/or program participants in the L. A. region. The Institute has become a premier organization, with progressively growing service components that appeal to the population in question in a culturally relevant manner. Partnering with the AMAAD Institute and other community organizations, this researcher will continue to seek funding from private, federal, state, county, and city resources-efforts in which he has had recent success. B. Context of Practice 41 The AMAAD capstone effort places significant value on Community-Based Participatory Research (CBPR) with efforts to identify and recruit stakeholders that can offer fresh perspectives, creative thinking, and solutions. The effort turns on a partnership approach, seeking to equitably involve community stakeholders to contribute their lived experience and expertise for shared decision making and ownership of a community-based solution. The AMAAD project will not be siloed as an HIV "project," with static outcomes. Rather, its concept is more akin to BLM as an intersectional "movement." The following CBPR core principles will drive the practice: 1) Promote collaborative and equitable partnerships in all phases and involve an empowering and power-sharing process; 2) Recognize the Black LGBTQ+ community as a unity of identity; 3) Build on strengths and resources within the community; 4) Facilitate co-learning and capacity building among all partners; 5) Focus on problems that are relevant to the Black LGBTQ+ community by using an ecological approach that attends to multiple determinates of health and disease; 6) Balance research and action for the mutual benefit of all partners; 7) 42 Disseminate findings and knowledge to the broader community and involve stakeholders in the dissemination process; and 8) Promote a long-term process and commitment to sustainability. The AMAAD capstone project's key strategies include a CAPP that ensures widespread, ongoing, and meaningful participation of stakeholders. The "reach" and "sustainability" of the effort will improve as all stakeholders, and especially vulnerable Black LGBTQ+ people, have an opportunity to participate in shaping the community engagement effort. All levels of decision making with solicit and hear the voices of each of these groups. AMAAD's philosophical approach recognizes that people in a community can become passionate about HIV-related work if they are able to see that their activism connects to fighting for themselves and their community. They can, in turn, become major voices and develop words to articulate complex intersectional public health and social justice issues. C. Implications and Further Action As a method for sustaining a grassroots financial infrastructure for the AMAAD organization, the innovator will continue his involvement with government planning bodies and officials that support various services components related to HIV. He has also become especially involved in Los Angeles County's Measure J Advisory Committee planning in an effort to prepare for forthcoming funding opportunities. This is a result of the new, voter-approved initiative that allocates at least 10% of the County's locally generated unrestricted funding to address social determinates issues. Ensuring that AMAAD is positioned for Measure J resources is especially pressing, for the initiative has an equity focus and therefore the ability to shift HIV related determinates, including economic opportunity, sustainability, and way of life for the most impacted people in L. A. County. 43 While the capstone innovator has envisioned an expanded national network of grassroots AMAAD CBO chapters, there are admittedly limitations that will slow progress toward that vision. AMAAD's development mostly relies on government funding, which is often localized. The practical dimensions of setting up other AMAAD CBO efforts in geographic areas beyond L.A. are large due to AMAAD's local operational infrastructure and restricted resources. If the innovator is to create a national network of AMAAD CBOs, access to broader and unrestricted funding will be necessary. These monies will facilitate hiring local people. Raising private funding for this highly targeted effort is admittedly a challenge for the innovator. D. Recommendations for Future Work Overall, the AMAAD project is exceptionally well-positioned in time and funding opportunities. It is furthermore ready to move into immediate implementation. A few next steps include finalizing the work agreement with the Evaluation Consultant, hiring program staff, and training them. The project's staff will flesh out day-to-day workflow processes and begin community engagement activities. And while this specific portion of the AMAAD effort is only just a beginning, the innovator is already thinking about sustaining the effort beyond the currently funded period. His next step is to draft a strategic plan that identifies future resources. 44 Exhibit List Exhibit 1: AMAAD Logic Model (1 page) Exhibit 2: Ending the HIV Epidemic: A Plan for America - Overview (3 pages) Exhibit 3: LAC+USC Medical Center Foundation Fiscal Project Sponsorship Agreement (3 pages) Exhibit 4: Exhibit 5: Exhibit 6: Exhibit 7: Ending the HIV Epidemic (EHE) in Los Angeles County ( 4 pages) County of Los Angeles Public Health Department Word Order Solicitation (3 pages) Los Angeles County Department of Mental Health Underserved Cultural Communities (UsCC) BLACK LGBTQ+ Network Agreement (4 pages) AMAAD Institute BLAC (Black LGBTQ+ Action Coalition) Black LGBTQ+ Network White Paper (16 pages) Exhibit 8: Galbraith's Star Model (6 pages) Exhibit 9: Standardized GPRA Assessment Forms (30) Exhibit 10: LAC+USC Medical Center Foundation (fiscal sponsor for AMAAD) Proposal for County of Los Aneles - Department of Public Health Community Engagement for the Ending the HIV Epidemic In Los Angeles County Work Order - Note: the attached is a is partial document (9 pages) Exhibit 11: Notice of Funding Award for LAC+USC Medical Center Foundation (fiscal sponsor for AMAAD) for Word Order Solicitation for Community Engagement for Ending the HIV Epidemic In Los Angeles County (2 pages) Exhibit 12: The AMAAD Institute - Organizational Chart March (1 page) Exhibit 13: AMAAD Outreach Assessment Questionnaire (4 pages) Exhibit 14: Social Networks Testing: A Community-Based Strategy for Identifying Persons with Undiagnosed HIV Infection- Note the attached is a partial document (7 pages) Exhibit 15: California Department of Public Health (CDPH) Clinical and Public Health Laboratory Licenses for AMAAD Institute (Inglewood and Watts Sites): Oversight by Children's Hospital Los Angeles (2 pages) Exhibit 16: CDC Guidance: Personalized Cognitive Counseling (PCC) A Single Session Intervention for MSM Who Are Repeat Testers for HIV (2 pages) Exhibit 17: CDC Guidance: ARTAS (Antiretroviral Treatment Access Study) Evidence- Based for Linkage to HIV Care and Retention in HIV Care Exhibit 18: AMAAD Public Health License for Residential (1 page) Exhibit 19: AMAAD Capstone Related Budgets (2 pages) Exhibit 20: Independent Auditor's Report The AMAAD Institute Audited Financial Statements December 31, 2019 (17 pages) Exhibit 21: Accountants Compilation Report The AMAAD Institute Unaudited Financial Statements December 31, 2020 ( 10 pages) Exhibit 22: Evaluation Consultant Keith R. 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Social determinates of health unit brochure, Department of Public Health, environmental and social determinates of health. https://www.who.int/social determinants/sdh definition/en/ Exhibits Exhibit 1 AMAAD Logic Model CONDITIONS ➔ INPUTS ➔ ACTIVITIES ➔ OUTPUTS Poverty Peoule Resources: Planning Phase: Planning Phase: Unemployment Program Staff Hire/train staff & Formal Plans Peer Ambassadors consultants; developed; Lower Education Develop Formal Plans; Increased number of Levels Funding: Build Partnerships; New Partnerships; Few Job Skills SAMHSA Finalize Work Local Plan Recruitment and CDC, City, & County & & Evaluation Plan engagement plan Substance Abuse State Health Solicit participant/CAB developed; Mental Health Issues Departments, input on program Referral policy and Homelessness Private Foundation/ implantation and internal procedure for Stigma *DHSP evaluation activities counseling, case (ongoing) management, testing, Silencing Organizational: housing, etc. Low Self-Efficacy Access to target Imulementation Phase: population Conduct Outreach Events, Imulementation Discrimination Facility/Space Activities and recruit Phase: Exchange/Survival/ Computers/Software participants; conduct Individual Anonymous/Internet- Human Resources assessment ,· Implement assessments, one-on- facilitated sex Accounting Systems with priority population one counseling, case Low-perceived social Black LGBTQ+,· management, Partners/Communitv: Refer to supportive participants support Local Clinics,· Recovery services such as Case recruited; Limited knowledge Programs; Local Health Management and other Ambassadors about results of HIV, Departments, House & services including engaged,· counseling, support Ball Community and integrated # of assessments in community others HIV/STI/hepatitis/TB conducted; *LAC+USC Medical screening; Provide #, counseling, case (i.e., Foundation Adherence Support/Peer management, housing disproportionate navigation; etc. Peer-to-peer health factors) Process/Outcome activities on going Evaluation ➔ OUTCOMES Planning Phase: CAB Meetings; Agency MOUs; Formal Work Plan for Collaboration; Process for outreach and client participation; Process evaluation tools developed; Increased capacity Imulementation Phase: Participant Outreach; Individual Assessment; Case Management Services; Mentee/Mentor Linkages; Mental Health Services; Peer Group Support; Social Activities; Increased Supportive services for Black LGBTQ+ people at risk/or HIV/AIDS t'I1 ~ ~ """"' . Cr" """"' . ~ ~ HHS funds communities to design and implement local programs to: A Diagnose Diagnose all people with HIV as early as possible after infection. Prevent Prevent new HIV transmissions by using proven interventions, including pre- exposure prophylaxis (PrEP) and syringe services programs (SSPs). Treat Treat the infection rapidly and effectively to achieve sustained viral suppression. Respond Respond quickly to potential HIV outbreaks to get needed prevention and treatment services to people who need them. The Initiative focuses resources on areas where HIV transmission occurs most frequently. Geographical Selection: To achieve maximum impact, the Ending the HIV Epidemic initiative focuses its Phase I efforts in 48 counties, Washington, DC, and San Juan, Puerto Rico, where >50% of HIV diagnoses occurred in 2016 and 2017, and an additional seven states with a substantial number of HIV diagnoses in rural areas. .. Counties, Territories, and States COUNTIES Arizona Maricopa County California Alameda County Los Angeles County Orange County Riverside County Sacramento County San Bernardino County San Diego County San Francisco County Florida Broward County Duval County Hillsborough County Miami-Dade County Orange County Palm Beach County Pinellas County HRSA Georgia Cobb County DeKalb County Fulton County Gwinnett County Illinois Cook County Indiana Marion County Louisiana East Baton Rouge Parish Orleans Parish Maryland Baltimore City Montgomery County Prince George's County Massachusetts Suffolk County Michigan Wayne County SAMH5:A ,-._.,.:,,_ ...... Content Source: Ofticc of Infectious Di:;easc and HtV/1\\llS Policy, !·\W, For more information: About [nding the HIV Lpid{~mic: Plan for /'\.mc~rica Nevada Clark County New Jersey Essex County Hudson County New York Bronx County Kings County New York County Queens County North Carolina Mecklenburg County Ohio Cuyahoga County Franklin County Hamilton County Pennsylvania Philadelphia County Tennessee Shelby County 11111111111111111 " ' Ill Priority U.S. counties, Washington D.C., and San Juan, Puerto Rico Priority States Texas Bexar County Dallas County Harris County Tarrant County Travis County Washington King County Washington, DC TERRITORY Puerto Rico San Juan Municipio ST.i\rE:S Alabama Arkansas Kentucky Mississippi Missouri Oklahoma South Carolina I Ending lthe 0 HIV I Epidemic Date last updated: October 14, 2020 I I Ending I the HIV I Epidemic About AHEAD AHEAD is an on line data visualization tool that reports data on six different measures (known as "indicators") that track progress toward meeting EHE goals. It makes it possible for EHE priority areas, communities, and stakeholders to monitor movement and make decisions toward reducing new HIV transmissions by at least 90% by 2030. AHEAD is the only tool that allows EHE priority areas to view their individualized indicator goals and track their progress toward reaching those goals. The data are standardized in order to allow EHE priority areas to easily compare them. Visit AHEAD at ahead.hiv.gov. HRSA Content Source: Ofiice of Infectious Disease and HIV/AIDS Policy, HHS For more information: About ending Uw HIV [pid< ~ mic Plan fo;· /l.m(irica ii 11 READY 9;~ SET PrEP About Ready, Set, PrEP Ready, Set, PrEP is a nationwide program led by the U.S. Department of Health and Human Services. The program provides free PrEP medications to people who do not have insurance that covers prescription drugs. It expands access to PrEP medications, will reduce the number of new HIV transmissions, and brings us one step closer to ending the HIV epidemic in the United States. Find out more about Ready, Set, PrEP on HIV.gov and visit GetYourr:>rEP.corn or call toll-free (855) 447-8410 to qualify and enroll. Ending the HIV Epidemic Date last updated: October 14, 2020 Exhibit 3 FISCAL SPONSORSHIP PROJECT AGREEMENT This Agreement is entered into by and between the LAC+USC Medical Center Foundation, Inc., ("Sponsor") and The AMAAD Institute rProject"). Sponsor: The LAC+USC Medical Center Foundation, Inc. is a nonprofit corporation, exempt from federal tax under section 501(c)(3) of the Internal Revenue Code. The Foundation was established to support the Los Angeles County-University of Southern California Medical Center, as part of the larger Los Angeles County health agency, and ensure its status as a leader in health and medicine, community care, education and research. Project: The Project is a nonprofit organization with a mission to facilitate personalized individual access to programs and services that foster safe and supportive healthy environments for people to live, learn, and develop to their fullest potential. Agreement: The Sponsor is willing to receive tax-deductible charitable contributions for the benefit and use of implementing the Project. The Project, with the administrative assistance of the Sponsor, desires to use these funds in order to implement the Project's purposes. By entering into this Agreement, the parties agree to the following terms and conditions: 1. Fundraising: The Project may solicit gifts, contributions, and grants on behalf of the Sponsor which are earmarked for the activities of the Project. The Project's choice of funding sources to be approached and the text of the Project's letters of inquiry, grant applications, and other fundraising materials are subject to approval by the Sponsor. The Sponsor's Executive Director must co-sign all original letters of inquiry, grant proposals, and grant agreements. All grant agreements, pledges, or other commitments with funding sources to support the Project shall be executed by the Sponsor. The cost of any reports or other compliance measures required by such funding sources shall be borne by the Project. The Sponsor shall be responsible for the processing and acknowledgment of all monies received for the project, which shall be reported as the income of the Sponsor for both tax purposes and for purposes of the Sponsor's financial statements. 2. Protection of tax-exempt status: The Project agrees not to use funds received from the Sponsor in any way which would jeopardize the tax-exempt status of the Sponsor. Any changes in the purpose for which grant funds are spent must be approved in writing by the Sponsor before implementation. The Sponsor retains the right, if the Project breaches this Agreement, or if the Project jeopardizes the Sponsor's legal or tax status, to withhold, withdraw, or demand immediate return of grant funds. Exhibit 3 3. Governance: Authority to manage the programmatic activities of the Project is delegated to the Project's leadership team, subject at all times to the ultimate direction and control of the Sponsor 1 s Board of Directors. The Projecf s leadership team designates Carl Highshaw, Chief Executive Officer (CEO) and Founder, to act as authorizing official. The authorizing official shall act as principal coordinator of the Project's daily business with Sponsor, and shall have authority to approve disbursement requests. Project will be responsible for notifying Sponsor if there is a change in the authorizing official. 4. Financial accounting and reporting: The Sponsor will maintain books and financial records for the Project in accordance with generally accepted accounting principles. The Project's revenue and expenses shall be separately classed in the books of the Sponsor. The Sponsor will provide financial reports to the Project upon request within five (5) business days of receiving the request. 5. Disbursements: On behalf of and with its funds, the Sponsor will pay for the Project's direct expenses. Sponsor will disburse funds from the Project account in the following manner: upon receipt of a request for payment by an authorized representative of the Project, including all required paperwork and documentation, Sponsor shall disburse funds as requested within ten {10) business days of receipt of the request. In no case will disbursements exceed total contributions for the Project. 6. Fees: Sponsor will charge the Project a fee of 15% of funds handled for fiscal sponsorship services. Fees will be charged when funds are deposited into the Project account. If additional project work by Sponsor staff is requested by Project, a separate fee from Project will be required. 7. Reporting: Project will provide all information and prepare all reports, including interim and final reports, required by funding organizations, with Sponsor's assistance and final approval. Reports will be submitted to Sponsor for approval at least one week prior to the reporting deadline. 8. Acknowledgement: The Project shall indicate proper credit to the Sponsor in all publicity and communications. Example: The Project is sponsored by the LAC+USC Medical Center Foundation, Inc. with funding provided by the Los Angeles County Department of Public Health. All communications including the name of Sponsor are subject to review and approval by Sponsor. 9. Term: This Agreement shall commence on date of execution and shall continue in full force and effect until July 31, 2023, unless terminated by either party. 10. Renewal of this agreement: If both the Sponsor and Project desire to do so, this agreement may be renewed on July 31, 2023 for two (2) additional one-year periods through July 31, 2025 subject to performance and availability of funds. 2 Exhibit 3 11. Termination: Either party may terminate this Agreement by giving 30 days' written notice to the other party. Upon termination of the sponsorship, the Sponsor's Board of Directors will determine the status of the remaining monies in the Project account in a manner consistent with Sponsor's Articles of Incorporation, Bylaws, the Internal Revenue Code, and pertinent regulations. By signing below, both parties agree to execute this Agreement on the day and year written below. PROJECT STEERING COMMITTEE Carl Highshaw ~ · ., ;·;:;:,:;,:"""' Name: Arletha Miller Mefh-ce r(Uler ~ ::; 111 : ;,:t"''" '" Name: Curtis Gregory Name: Name: LAC+ USC MEDICAL CENTER FOUNDATION, INC. By: Rosa Soto, Executive Director 1/15/2021 Date 1/15/2021 Date 1/15/2021 Date Date Date 3 Exhibit 4 ~Plb1iC 0 ii8iiih BARBARA FERRER, Ph.D., M.P.H., M.Ed. Director MUNTU DAVIS, M.D., M.P.H. County Hoalth Officor MEGAN McCLAIRE, M.S.P.H. Chief Deputy Director JEFFREY D. GUNZENHAUSER, M.D., M.P.H. Director, Disease Control Bureau MARIO J. PEREZ, M.P.H. Director, Division of HIV and STD Programs 600 South Commonwealth Avenue, 10th Floor Los Angeles, CA 90005 TEL (213) 351-8001 • FAX (213) 367-0912 www.publlchealth.lacounty.gov January 7, 2021 Dear EHE Colleague: BOARD Of SUPERVISORS HIida L. Soils First Olstrict Holly J. Mitchell Second District Sheila Kuehl Third District Janice Hahn Fourth District Kalhl'Jn Barger r-mh District SUBJECT: ENDING THE HIV EPIDEMIC (EHE) IN LOS ANGELES COUNTY On behalf of the Los Angeles County (LAC) Department of Public Health, its Division of HIV and STD Programs and many critical contributors, partners and stakeholders, I am pleased to announce the release of the Ending the HIV Epidemic Plan for Los Angeles County. In full alignment with the national initiative, Ending the HIV Epidemic: A Plan for America, our EHE Plan focuses on four key pillars designed to help us reach the goal of reducing new HIV transmissions and acquisitions in the United States by 75 percent in five years (by 2025) and by 90 percent in ten years (by 2030.) The four EHE Pillars are: 1) Diagnose people living with HIV as early as possible; 2) Treat people living with HIV rapidly and effectively to achieve viral suppression; 3) Prevent new HIV transmissions using proven interventions, and; 4) Respond quickly to HIV outbreaks and deliver prevention and treatment services to people who need them. Please know that while we continue to implement interventions to address these pillars, we are also guided by an overarching strategy to ensure that the interventions address and eliminate health inequities, that considers long-standing racial inequities that contribute to HIV-related disparities, that focuses on the communities and sub-populations most impacted by HIV, and prioritizes a client-centered, people first approach to this endeavor. To reach the goals outlined in the EHE Plan for Los Angeles County, significant scale up and expanded reach of both new and proven interventions is needed. We are hopeful that the plan, guided by the four pillars and undergirded by the most effective strategies and interventions will allow us to collectively meet our shared goals. Exhibit 4 EHE Colleague January 7, 2021 Page 2 of2 As we launch this EHE plan and with a renewed commitment and deeper understanding of the importance of public health, we remind ourselves that there are approximately 58,000 people living with HIV (PLWH) in our County in 2021, the majority of these persons arc male (90%), a smaller fraction are female (9%) and an even smaller fraction yet are transgender (but remain among the most disproportionately impacted sub-populations in our County). We are encouraged that the majority of PLWH in LAC are treating their HIV infection with highly active antiretroviral therapy (ART) and effectively managing HIV as evidenced by their achievement of sustained viral suppression - that is, reducing the level of HIV in the bloodstream to a level that is so low that it is undetectable. While we remain encouraged by areas of HIV progress, we recognize that this progress is uneven. Not only must we confront HIV-related health disparities fueled by structural racism, social inequity and economic inequality, we must also recognize that other threats to our HIV progress have persisted or have worsened in recent years, including those related to syphilis (and congenital syphilis), homelessness, and substance use disorders. We are aware that we are releasing this EHE Plan during the devastating COVID-19 pandemic, an acute economic crisis, and a time of heightened political, social, and racial tensions. We have been reminded of the fragile nature of our lives and the complex set of issues that impact our charge, our progress and the health and vitality of our communities. As we take this moment to launch our EHE Plan for Los Angeles County, we do this in the context of the realities surrounding our community, our County, California, the United States and the globe. Thank you all in advance for your commitment and action to operationalize this EHE Plan and for joining us as we remain undeterred to keep our promise to end to HIV, once and for all. 1 v y~urs, -,;c f PH Director Division of HIV and STD Programs Los Angeles County Department of Public Health MJP:JT Exhibit 4 Ending the HIV Epidemic in Los Angeles County December 22, 2020 Exhibit 4 TABLE OF CONTENTS Introduction .............................. .................................................................................................................... 2 Section I: Engagement Process for Plan Development Local Prevention and Care Integrated Planning Council ................................................... ...................... 3 Local Community Partners ... ............... .. ........................................... ...... ........................... ........................ .. 4 Local Service Provider Partners ...................................................... ....... ........................... .................... ... ... 6 Concurrence with Local Planning Council .......................................... ....................................................... 6 Section II: Epidemiologic Profile of Los Angeles County Pillar 1: Diagnose ..................... ........................................................ ................ ........................ ...................... 7 Pillar 2: Treat ...................................................................................................... ... .................. ...................... 9 Pillar 3: Prevent .................. ........................................................................................................................... 10 Pillar 4: Respond ............................................................................................. ........................ ... ................... 11 Section Ill: Situational Analysis & Needs Assessment Pillar 1: Diagnose ............ ... ........ .......... ......... .................. .................................... ...... .. .... ...... ... ..................... 12 Pillar 2: Treat ................................................................................... .............................................................. 15 Pillar 3: Prevent ......... .......................................... ......... ........................................................................... ...... 17 Pillar 4: Respond ......... ......... ... ......................... ............................... .............................................................. 19 Priority Populations ..................... ................................. ................................................................................ 21 Capacity Building & HIV Workforce ...... ........................................................................ ................... .. ........ 21 Section IV: Ending the HIV Epidemic Plan Pillar 1: Diagnose ........................... ................................. .................................... .................. ............... ......... 22 Pillar 2: Treat .............................. ......... ... ............................................. ............... .............. ................ ............. 24 Pillar 3: Prevent ................................. ...................................................................... ........ ...... ............... ... ...... 25 Pillar 4: Respond ........................ ............................................................................................................... .... 27 Appendices A. List of Acronyms ...................................................... ..................................................................... ............ 29 B. Commission on HIV - November 2019 Meeting Agenda .......................................... .......................... 30 C. Ending the HIV Epidemic Steering Committee ........................ ...... ... ......... ............... ............................ 31 D. Letter of Concurrence, Los Angeles County Commission on HIV ....................................... ............... 32 E. Rapid ART Resources and References .................................... ............................................................... 33 1 Exhibit 5 COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC HEAL TH WORK ORDER SOLICITATION {WOS) FOR COMMUNITY ENGAGEMENT AND RELATED SERVICES Project Title: COMMUNITY ENGAGEMENT FOR ENDING THE HIV EPIDEMIC IN LOS ANGELES COUNTY WOS Number: CES-WOS-003 Prepared by: CONTRACTS AND GRANTS DIVISION Exhibit 5 WORK ORDER SOLICITATION COMMUNITY ENGAGEMENT FOR ENDING THE HIV EPIDEMIC IN LOS ANGELES COUNTY TABLE OF CONTENT SECTION 1.0 INTRODUCTION .................................................................................................... 2 1.1 GENERAL INFORMATION ........................... .............. ................................ 2 1.2 OBJECTIVE/PROJECT TITLE ........... ..... ...... .............................................. 4 1.3 PROJECT BACKGROUND ............. ..... .............. ................. ... ... ........ .......... 5 1.4 PROJECT TERM/PERIOD ................ ...................... ............... ..................... 7 1.5 MASTER AGREEMENT WORK ORDER RATES ............... ... ........... .......... 7 1.6 COUNTY'S ESTIMATED FUNDING AVAILABILITY .............. ... .................. 7 1.7 COUNTY RIGHTS & RESPONSIBILITIES .............. .. ............... .................. 8 1.8 CONTACT WITH COUNTY PERSONNEL ................. ..... ........................... 8 1.9 FINAL AWARD BY THE BOARD OF SUPERVISORS ............................... 9 1.10 MINIMUM MANDATORY REQUIREMENTS ..... ......................................... 9 1.11 REQUIRED SERVICES ......................................... .. ... ................... ........... 10 1.12 COUNTY'S PREFERENCE PROGRAMS .... ....................... .. .................... 11 1.13 LOCAL SMALL BUSINESS ENTERPRISE (LSBE) PREFERENCE PROGRAM (INTENTIALL Y OMITTED) .................................................... 12 1.14 LOCAL SMALL BUSINESS ENTERPRISE (LSBE) PROMPT PAYMENT PROGRAM .. .... .... ............ ........................................ ............ ..... ... .... .......... 12 1.15 SOCIAL ENTERPRISE (SE) PREFERENCE PROGRAM (INTENTIALL Y OMITTED) ...................................................................................... ........... 12 1.16 DISABLED VETERAN BUSINESS ENTERPRISE (DVBE) PREFERENCE PROGRAM (INTENTIALL Y OMITTED) ....................... .. ..................... .. .... 12 1.17 CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION - LOWER TIER COVERED TRANSACTIONS (45 C.F .R. PART 76) ... ............................... 13 1.18 DEPARTMENT OPTION TO REJECT WORK ORDER PROPOSALS OR CANCEL WORK ORDER SOLICITATION ........................................ ...... .. 13 1.19 PROTEST POLICY REVIEW PROCESS ................................ ................. 13 1.20 NOTICE OF THE PUBLIC RECORDS ACT .... ..................................... ..... 14 2.0 PROPOSAL SUBMISSION REQUIREMENTS ..................................................... 16 Title: Community Engagement for Ending the HIV Epidemic in Los Angeles County Page i WOS Number: CES-WOS-003 December 2020 Exhibit 5 WORK ORDER SOLICITATION COMMUNITY ENGAGEMENT FOR ENDING THE HIV EPIDEMIC IN LOS ANGELES COUNTY 2.1 WORK ORDER SOLICITATION TIMETABLE .......................................... 16 2.2 WORK ORDER SOLICITATION REQUIREMENTS REVIEW .... .............. 16 2.3 PROPOSERS' QUESTIONS .................................... ................................. 17 2.4 PROPOSERS' CONFERENCE ................................................ .. ............... 17 2.5 PREPARATION OF THE PROPOSAL. ............... .. ........ ............................ 17 2.6 PROPOSAL FORMAT ...... ................ ................................... .. ................... 17 2.7 PROPOSAL SUBMISSION ....................................................................... 23 3.0 PROPOSAL REVIEW ANO SELECTION PROCESS .......................................... 25 3.1 SELECTION PROCESS ........................................................................... 25 3.2 STAGE 1: ADHERENCE TO MINIMUM MANDATORY REQUIREMENTS ....................................................................................... 26 3.3 DISQUALIFICATION REVIEW ................................................. ................. 26 3.4 STAGE 2: PROPOSAL EVALUATION ..................................................... 26 3.5 STAGE 3: FINAL REVIEW AND SELECTION ..... .................................... 27 3.6 DEPARTMENT'S PROPOSED CONTRACTOR SELECTION REVIEW .. 28 3.7 COUNTY INDEPENDENT REVIEW PROCESS ....................................... 30 4.0 MASTER AGREEMENT WORK ORDER AWARD .............................................. 31 Title: Community Engagement for Ending the HIV Epidemic in Los Angeles County Page ii WOS Number: CES-WOS-003 December 2020 Exhibit 6 AMENDMENT NO. 3 LOS ANGELES COUNTY DEPARTMENT OF MENTAL HEALTH UNDERSERVED CULTURAL COMMUNITIES (UsCC) BLACL LGBTQ+ NETWORK ORDER NUMBER: PO-MH-19995045-1 As the impact of Covid-19 continues to evolve, the BLACK LGBTQ+ NETWORK (PO-MH- 19995045-1) between Los Angeles County Department of Mental Health - Underserved Cultural Communities and The AMAAD Institute will be changed as follows: 1. In reference to Fee Schedule Amendment No. 3, BLACK LGBTQ+ NETWORK (PO-MH- 19995045-1) will commence on August 14, 2019 and will end on January 31, 2021 2. Maximum Project Amount remains unchanged at FORTY-THREE THOUSAND FIVE HUNDRED DOLLARS ($43,500) as stated on Fee Schedule Amendment No. 3. 3. Statement of Work Amendment No. 1 has been revised to accommodate changes in executing deliverables that require in person contact. 4. Except as provided in this Amendment to the Statement of Work Amendment No.l, all other terms and conditions of the Purchase Order (PO-MH-19995045-1) shall remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have caused this Amendment No. 3 to be executed by their respective authorized representatives on the 10 1h day of September, 2020. THE AMAAD INSTITUTE By: ~ Name: Carl Highshaw Title: C.E.O. I Executive Social Worker LOS ANGELES COUNTY .- · . / By: ij/f «1 c,/r ,t :i. t;1t;( L._tJ.-:\ \. ... MIRTALA PARADA WARD, LCSW Mental Health Clinical Program Manager Los Angeles County Department of Mental Health Underserved Cultural Communities (UsCC) Exhibit 6 AMENDMENT No. 3 LOS ANGELES COUNTY DEPARTMENT OF MENTAL HEAL TH UNDERSERVED CULTURAL COMMUNITIES (UsCC) UNIT MENTAL HEALTH SERVICES ACT (MHSA) BLACKLGBTQ+NETWORK FEE SCHEDULE (PO-MH-19995045-1) I. DISBURSEMENT SCHEDULE For the services described here, DMH shall pay THE AMAAD INSTITUTE (Facilitator) a total of $43,500 (Forty-three thousand five hundred dollars) for services · rendered. Payment to Facilitator for the following services shall be based on the deliverables from Facilitator to DMH as described below. No payment shall be made without prior approval of a designated DMH representative. The DMH representative shall review the invoice and project report to determine whether Facilitator is in substantial compliance with the terms and conditions stated. The County of Los Angeles will work with Facilitator to determine appropriate format for outcomes reporting . Delivery Window Deliverables Cost Invoice Amount • Create pre and post-test utilizing Likert Scale • Develop flyer and/or other Phase 1 promotional materials for Community Advisory Board August 15- • Create agendas for Community $6,000 $6,000 November 30 Advisory Board meetings 2019 • Coordination of securing the facilities to host the Community Advisory Board • Develop and distribute Community Survey Fee Schedule (Amendment 3)_9/23/2.0 Page 1 of 3 Exhibit 6 • Conduct Community Advisory Board meetings • Develop and distribute Community Survey • Participant recruitment for Community Advisory Board (20 Black LGBTQ+ Phase 2 community members) • Participant recruitment for $13,500 $13,500 December 1- Virtual Community February 29, 2020 Presentations (4 Community Presentations in total, 50 attendees at each) • Coordination of community groups and partners to host the Virtual Community Presentations • Conduct 2 Community Presentations • Begin development of White Paper • Conduct Community Advisory Board meetings virtually • Conduct 2 Virtual Community Phase 3 Presentations • Complete distribution of $18,000.00 $18,000 Sep 10 - Dec 31 Community Survey 2020 • Stipends for participants of Community Advisory Board ($200 for each participant, $4000 total) • Aggregate data from Community Surveys Phase 4 Completion of White Paper • Jan 1 • 31 • Final Summary Report including $6,000.00 $6,000 2021 pre and post-test results TOTAL COST $43,500 $43,500 Fee Schedule (Amendment 3)_9/23/20 Page 2 of 3 Exhibit 6 II. SUBMISSION AND CERTIFICATION OF INVOICES Facilitator must submit to DMH invoices, billable services not to extend beyond the 30- day period. Each invoice must be submitted within thirty (30) days of the last date the invoiced services were provided . The Facilitator must certify that invoices are for services and costs eligible under the terms and conditions for reimbursement. Facilitator must submit invoices to: LOS ANGELES COUNTY DEPARTMENT OF MENTAL HEALTH ACCOUNTS PAYABLE SECTION 550 SOUTH VERMONT AVENUE, 8TH FLOOR LOS ANGELES, CALIFORNIA 90020 apsvpuinquiries@dmh.lacounty.gov Ill. PAYMENT PROCEDURES Upon receipt of invoices by LACDMH Accounting Division from Facilitator, DMH shall make payment to Facilitator within thirty (30) days of the date the invoice was received. If any portion of the invoice is disputed by DMH, DMH shall reimburse Facilitator for the undisputed services contained on the invoice and work diligently with Facilitator to resolve the disputed portion of the claim in a timely manner. Fee Schedule (Amendment 3}_9/23/20 Page 3 of 3 Exhibit 7 AMAAD Institute BLAC (Black LGBTQ+ Action Coalition) Black LGBTQ+ Network White Paper Los Angeles County Department of Mental Health Underservcd Cultural Communities (UsCC) Unit Mental Health Services Act 1 Exhibit 7 Introduction The AMAAD (Arming Minorities Against Addiction and Disease) Institute, which was founded as a grassroots nonprofit Recovery Community Organization (RCO) intended to be culturally relevant to Black lesbian gay, bisexual, transgender, questioning/queer (LGBTQ+), non-binary, and gender nonconforming individuals that are disproportionately impacted as the result of systemic inequities was selected to facilitate the community engagement activities described in the Black LGBTQ+ Network Scope of Work Bid Solicitation (RFB-IS-19201500-3) issued by the Los Angeles County Department of Mental Health, Office of the Deputy Directors Strategic Communications Underserved Cultural Communities (UsCC) Unit in June, 2019. In accordance with the Mental Health Services Act (MHSA), UsCC created the Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, Interscx, Two-Spirit (LGBTQI2-S) subcommittee with the goal ofreducing disparities and increasing mental health access for the LGBTQI2-S community in the County of Los Angeles. UsCC's selection of the AMAAD Institute to facilitate the Black LGBTQ+ Network was directly in alignment with the UsCC LGBTQI2-S subcommittee which is intended tQ work closely with community partners and consumers in order to increase the capacity of the public mental health system to develop culturally relevant recovery-oriented services, specific to the LGBTQI2-S community. When the AMAAD Institute began to facilitate the UsCC prescribed Scope of Work activities, it did so as the Black LGBTQ+ Action Coalition (BLAC), primarily because the "Black LGBTQ+ Network" name was already an existing local group that had different priorities. While that other existing group would be represented in AMAAD's community engagement activities, a decision to use BLAC as an identifying name was made to not confuse efforts among local community members. With BLAC, the AMAAD Institute set out with a purposeful effort to identify the needs of Black LGBTQ+ individuals, while educating and empowering the community about the importance of mental health care to build awareness and connection. The project aim was to dcstigmatizc mental health issues among Black LGBTQ+ people and to highlight the diversity of the population and the need for culturally sensitive resources and providers. Background With a grassroots foundation that started as a Recovery Community Organization (RCO) offering resources and referrals, including specialized strength-based recovery management and navigation support services in a manner that is culturally relevant to the Black LGBTQ+ community in Los Angeles, the AMAAD Institute's philosophy, mission, and background make the organization uniquely qualified to facilitate community engagement activities of BLAC. With an emphasis on youth and young adults, the AMAAD official mission is "to facilitate personalized individual access to programs and services that foster safe and supportive healthy environments for people to live, learn, and develop to their fullest potential" and is perfectly aligned in partnership with the UsCC LGBTQI2-S subcommittee as the organization has had uninterrupted experience mobilizing and coordinating local residents, stakeholders and cohort groups targeting young adults (18-29 years old), Black/African American, transgender persons, and gay and bisexual men, and persons who use methamphetamine/inject drugs since the organization was founded. Today, the entity operates from four independently controlled sites 2 Exhibit 7 strategically located in the surrounding LAC community: 1) AMAAD-Watts Office is located in the Watts Civic Center which is considered ground zero of the 1965 Watts Rebellion, 2) AMAAD-Inglewood Office which is located in the Crenshaw/Imperial Plaza along an iconic community throughfare, 3) AMAAD-Resiliency House, a transitional residential living facility is nestled in the historic King Estates Neighborhood, and 4) AMAAD-Gibson House, a permanent supportive housing facility that is convenient to the Historic South Central area. The agency is also co-located at two distinct Employment Training sites as part of a multi-agency collaborative partnership effort, with one site at Los Angeles Trade and Technical College (LATTC) near downtown L.A. and the other at Watts Labor Community Action Coalition (WLCAC) in the southeast area of L.A. Additionally, within the past year, the AMAAD Institute has fully implemented a seamless virtual office platform that was necessary to manage COVID-19 public health concerns. The organization's mainstay activities are centered around peer-based engagement and support services while having a solidly connected community footing. In the earlier formative years of the AMAAD Institute, organizers primary facilitated informal community engagement and suppott with no dedicated financial resources. In 2015, the AMAAD Institute has become firmly positioned as a specialized premier organization and has advocated for community-based health and wellness services that also address intersectional social determinants of health. AMAAD's work is especially coordinated in a manner that is purposeful and culturally relevant to Black / African American youth and young adults who identify as LGBTQ+. To facilitate the BLAC community engagement activities, AMAAD identified two key internal master facilitators, Gerald Garth and Nina Barkers as well as an external consultant facilitator, Vanessa Warri whom provided support during the early kick-off phase for BLAC. Mr. Garth, who serves as AMAAD's Director of Operations, holds a bachelor's degree and has a solid track record of implementing and evaluating processes, policies, programs, and strategies to address the uniqueness of the Black experience, particularly among youth, LGBTQ+, and other underserved communities through trainings, policies, advocacy and team oversight. Mr. Garth's former roles include Manager of Training & Capacity Building as well as Manager of Prevention & Care, bringing a unique and informed approach to educating and informing Black, Black LGBTQ+, and other underrepresented groups. With over ten years of experience managing and facilitating the community and stakeholder engagement process in the nonprofit sector, Garth's work addresses inequity, and disparities through multiple lenses - largely, structural oppression, such as implicit bias in care, racism, classism, and other types of oppression, and their impacts on the care and wellness of Black people and other underserved and underrepresented groups. For years, he has worked with dozens of community efforts around the country all with a unique focus in prioritizing the needs of the Black community, especially women, LGBTQ+ people, justice involved people, people experiencing homelessness, people experiencing substance use/abuse, and people living with HIV through engaging numerous stakeholders including communities of faith and other traditional Black institutions (TBis). 3 Exhibit 7 Ms. Barkers is AMAAD's Program Evaluation Coordinator and is a proud Black transwoman of the millennial generation. Ms. Barkers is a fierce and leading sought-out voice for the trans experience, bringing strong insight and passion to her work. Ms. Barkers has a bachelor's degree and has been serving the LGBTQ+ community for over 8 years ranging from HIV prevention, counseling, linkage, education, and advocacy. Ms. Warri is a transgender Nigerian-American research, strategist, and advocate, committed to the liberation, empowerment of Black transgendcr women, and marginalized communities at various intersections of oppression. Mr. Garth, Ms. Barkers, and Ms. Warri were each committed to ensuring that BLAC was facilitated in a manner that was authentic to the local Black LGBTQ+ community. Program Overview The effort included three components: 1) Community Outreach and Engagement, 2) Community Presentations; and 3) White Paper. The outreach and engagement efforts were intended to identify Black LGBTQ+ community members for participation on a Community Advisory Board (CAB). Members of the CAB were intended to develop a survey that will be administered to Black LGBTQ+ people in Los Angeles County to identify the specific mental health concerns experienced by the community and any gaps in serve delivery, as well as lessons learned how to best be culturally relevant to the community. The Community Presentations component were intended to engage the Black LGBTQ+ community into discussions around mental health, disseminating the community survey, and collecting feedback to be incorporated in the White Paper. It should be noted that in early 2020, an outbreak of the novel strain of coronavirus (COVID-19) emerged globally. As a result, there were several social distancing mandates from federal, state, and local authorities resulting in changes to the way AMAAD could engage community participants. AMAAD responded to the crisis by delivery services and activities via online teleconferencing platforms, which provide some challenges and also necessitated an extension period to complete the State of Work. Methods AMAAD utilized the Community Based Participatory Research (CBPR) framework to identify and recruit Black LGBTQ+ community members and stakeholders from throughout LAC that could bring fresh perspectives, creative thinking, and solutions to address mental health issues in the community. AMAAD typically utilizes CBPR as a partnership approach because it calls for a process to equitably involve community members, organizational representatives, and other community stakeholders in all aspects of the process and in which all partners contribute expertise and share decision making and ownership. The below are core methods of CBPR that AMAAD adopted in facilitation of this effort: I. Promote collaborative and equitable partnerships in all phases and involve an empowering and power-sharing process. 2. Recognize community as a unity of identity. 3. Build on strengths and resources within the community. 4. Facilitate co-learning and capacity building among all partners. 5. Focus on problems ofrclevance to the local community using an ecological approach that attends to multiple determinates of health and disease. 4 Exhibit 7 6. Balance information collection and action for the mutual benefit of all partners. 7. Disseminate findings and knowledge gained to the broader community and involve all partners in the dissemination process. 8. Promote a long-term process and commitment to sustainability. As part of the implementation strategy for BLAC, AMAAD's facilitators began hosting regular meetings every second Saturday and fourlh Thursday of each month beginning in January 2020. In the planning process, AMAAD was intentional to identify creative, innovative workspaces. The initial location was The Metaphor Club at 4333 Crenshaw Blvd, located in the heart of the historic Leimert Park area. The topics of discussion and agenda centered around and analyzed the medical, behavioral, and emotional needs of the Black LGBTQ+ community. This discussion co-facilitated by the smart, savvy trio which included Gerald Garth, Nina Barkers, and Vanessa Warri. This is a groundbreaking approach because you don't see too many organizational programs lead by two Black transgender women not completely centered around how they identify as a focal point. Instead, the group showcases their knowledge in community and collective contributions to bridge building. As a result of AMAAD's outreach and engagement of the Black LGBTQ+ community that culminated with the CAB, community surveys, and community presentations, BLAC has prepared this white paper to act as a report or a guide that is intended to inform readers concisely about the complex issue and presents BLAC's philosophy on the matter. This document is meant to help readers understand and provide resolution to an issue and to speak to the mental health needs of the general Black and specific Black LGBTQ+ communities and to provide recommendations to LACDMH on how to engage the Black LGBTQ+ population into services as well as into the MHSA stakeholder process. BLAC developed a pre- and post-test that was administered during the Community Advisory Board (CAB) to gather infonnation on the level of knowledge gained by the members including basic knowledge of resources available to them, understanding of the specific mental health needs of the Black LGBTQ+ community, experience conducting community outreach, etc. The instrument utilized a Likert Scale. BLAC looked at a number of topics, areas of interest and concern, as well as needed that impact the Black and Black LGBTQ+ communities. These topics included such key areas as access to care, faith and family, self-care, stigma, and institutional accountability. The meetings always delivered robust conversation and dialogue around: • challenges/barriers to access mental health support • criminalization of Blackness relating to mental health • overall mental health concerns • creating next steps & solutions • building universally inclusive spaces for Black LGBTQ+ individuals • developing culturally appropriate materials and promotion • engaging community in care processes 5 Exhibit 7 Findings Several themes arose from the regular BLAC meetings. There was a consistent thread of the need for more resources centered around the specific needs of the Black commw1ity at large. Participants expressed an ongoing thought of not having "anything specific to Black culture" in Los Angeles. In order to address Black and Black LGBTQ+ needs, there needs to be a centering of the Black experience as Black people have very unique experiences, culture, and challenges as compared to other communities of color. One consistently emerging theme was the need for more stakeholder engagement of Black people in mental health processes. This again includes a certain community focus that prioritize and centers the intersectional uniqueness of Black LGBTQ+ people. Participants expressed much insight about the "safety" of the space, that is, being able to speak to experiences without fear of judgment or retaliation. One community advisor board member stated, "Everything [Black LGBTQ+ people] need points to the need of safe, affirming, and informed spaces." Another key point was around the need for more accountability regarding the health and wellness of the community. The group defined accountability as "the obligation and responsibility of institutions, community members, and leadership to ensure engagement of the Black LGBTQ+ community relating to services and care, funding, stakeholder engagement, and client experience. Another overwhelming response from the CAB and community at large was the need for more and ongoing training and opportunities. These training needs should be designed to: 1) Empower and equip Black leaders to serve as mental health advocates and teachers. 2) Create leadership opportunities for Black community members in care and service and advocacy. 3) Create leadership pipeline to connect Black mental health consumers and providers in positions of decision-making and influence. 4) Center the unique, intersectional experiences of Black LGBTQ+ people using trauma- informed, harm reduction approaches. 5) Build capacity for community as a whole. BLAC has determined that culture- and community-centered experiences are key to addressing mental health needs among the Black LGBTQ+ community. A major question emerged, "How is community and leadership looking at justice involvement and mental health of Black and Black LGBTQ+ people?" The group noted the disproportionate representation of Black people with justice- and system involvement and how much of those experiences are centered around anti-Black racism, socio economic issues, lack of access to care and education, and mental health stigma to name a few. 6 Exhibit 7 The group noted recommendations of client-centered approaches for addressing mental health needs among those Black people who are justice-involved: 1. Create a pipeline of training and opportunities for individuals who have been justice involved/ formerly incarcerated by supporting peer models and community health educator models by implementing peer-based, strength-based approaches. 2. Work with gatekeepers and influencers to train and support as mental health advocates and practitioners by implementing social networking and popular opinion leader strategies. 3. Peer to peer networking projects for empowering our community. The community recognizes there is a certain power in lived experience, so is the need to add more opportunities to highlight and center those individuals and their experiences to inform community engagement, community education, and leadership development, including trainers and providers. 4. Develop a community education toolkit. Having culturally appropriate, trauma informed informational, promotional, and educational materials led by or intentionally engaging Black and Black LGBTQ+ communities. One participant who identifies as a Black gay man age 24 spoke to his experience: For my personal experience, I worked with a lot of people of color, especially Black people. Now working with the AMAAD Institute and BLAC, you all gave me the tools and the confidence to still go out ofmy comfort zone but still know what I was talking about. So, when I get into the rooms like this, I'm confident enough to tell people about what I know. AMAAD gave me the tools, the resources, and the support so I can take that next level of growing and maturing for when I'm in the community. And when you say oh what does a leader look like? I can really say I'm a leader because I have the knowledge, the support, and the resources and tools that get you from point A to point Z. From these recommendations, BLAC identified the need for each to have two separate foci- community and structural/ institutional. Below lists key topic areas within each focus for Black and Black LGBTQ+ people: Focus 1: Community 1. Engage influencers and gatekeepers 2. Support peer to peer networking projects for empowering community 3. Support more community meetings centered around the unique culture with community and subcommunities 4. Foster community-driven peer reentry support, including prerelease and post-release linkage, navigation, and reentry services support. 5. Build parole/ probation education and advocacy 6. Center the value of lived experience 7. Increase resource education and access 7 Exhibit 7 8. Utilize creative expression as mental health support 9. Engage youth and young adults in a meaningful way Focus 2: Institutional/ Structural 1. Workforce development and LACDMH collaboration for entrepreneurship 2. Create more therapist and mental health professional development and economic opportunities 3. More effective information sharing 4. Allocate funds more directly to underserved areas 5. Explore more holistic, culturally centered approaches 6. Develop a communication toolkit to providers 7. Develop a competency checklist for agencies and providers 8. Provide more at-home/ community-based options 9. Meaningful engagement of community in expenditure planning 10. Parole/ probation education and advocacy 11. Examine mental health services in prison for trauma-informed, harm reduction approaches 12. Engage client-focused community stakeholders and organization to hold DMH accountable to effectively addressing the needs of Black and Black LGBTQ+. Another major part of discussion in BLAC centered on the role of faith and family in Black and Black LGBTQ+ communities. Black Americans for generations have cited the role of the Church in individual and community wellness. Yet for many Black LGBTQ+ people, their relationship with the institution and representatives of the institution has been strained at best. Participants spoke to their personal experiences within houses of faith. One participant who identifies as a Black transman shared: "The Black Church /for me] has been a major oppressor. 1 would like to see more of the Black Church not being afraid of being called to the table, not being afraid to be called out or rather, called in. You know, if /faith leaders] are preaching messages that are the incubator of hate they need to be called in. So, I would like to see more of that." Speaking to the resilience of the Black LGBTQ+ community, participants offered compelling insight and recommendations for faith leaders and communities of faith. One participant who identifies and represents the Black gay elder community notes: "This one little point in terms of the Black Church right now in LA, I think they need education about who we fBlack LGBTQ+ people] are and I think they need to be held accountable as to how they treat us and how they engage with us, because we are part of the community. And so therefore, if [Black LGBTQ+ people] are gonna hold office and serve in their organizations, that they need to treat us like everybody else. And if they don't know how they need to engage some workshops and some education, read some books, talk to somebody, yes. Yeah, they need some in-service training." 8 Exhibit 7 One participant who identifies as a Black gay man noted, "God is more than what we project onto God; God is complex. Just like there are different types of tigers or apples, there are different types of people. And [ faith leaders] should know how to navigate all of our differences." Another participant who identifies as a Black transwoman noted, "I would like to say that the Black churches need less of this self-righteous attitude. And thinking they just have the answer to it all, or even the right to tell people to live in any particular type of way." A participant shared: I think we should look at dismantling any institution or elements that actually foster violence. But I would love to see the Black Church implement more affirming celebratory love messages and I would like to see the Black Church also allow members to speak up in the name of love and not challenge them in those spaces where we're actually getting rid of violence and create safety. Recommendations for faith leaders and houses of faith for Black LGBTQ+ communities: 1. More dutifully recognize their roles as advocates for mental and emotional health. 2. Recognize the role of faith and spirituality as a tool to address mental health 3. Address elements of systemic oppression within the institution 4. Increase education, training, and accountability of the community and faith leaders through workshops, educational materials, and other capacity building opportunities 5. Acknowledge and address the Church's complicit role in perpetuating stigma 6. More affirming faith leaders and parishioners showing up as allies and accomplices Best practices AMAAD set to engage the community in ways that were accessible and engaging to be inclusive of those community members who expressed challenges. In the beginning of the project, the AMAAD Institute very intentionally secured a meeting location that was accessible to participants, both with an amenable location as well as one that was accessible to public transportation. AMAAD also staggered its recurring meetings for times that we accessible as well, that is, one midweek evening meeting and one weekend, late morning meeting. BLAC recognizes the importance of acknowledging the intersectional experiences of the Black LGBTQ+ communities and how these unique identities affect health and health outcomes. With that, BLAC has identified some key suggestions for community wellness. Several recommendations for community empowerment as well. Participants spoke the need of continuous cultivation of healthy, informative, and affirming spaces like BLAC. "We are all leaders, and we have to start where we are," one participant expressed. Build effective allyships and collaborations. By looking exploring ways to collaboratively support our community by working together to cultivate spaces of healing and restoration. Through this collaboration comes healthy relationships, motivation, bonding, and appreciation. 9 Exhibit 7 1. Leadership development Having programs that fund, support, and nurture Black leaders in the various spaces of the mental health provider spectrum is key. Throughout the various roles in the mental healthcare spectrum, there is limited representation of Black people, if any at all. DMH and other institutions should prioritize creating, centering, and supporting Black and Black LGBTQ -1- mental health professions through educational and employment opportunities and leadership and employment pipelines. Increasing education increases opportunities and begins to address the barrier of access. One participant notes: "In communal or community spaces, we should actually allow for the individual strengths of those present to actually be affirmed and cultivated so that we can actually build a substantial significant leadership. And not take a person away from their core set of gifts, but actually build upon what they already possess. In additional instances where they are able to have more workshops that may be of interest to potential leaders. Where they are able to tap into areas that are of interest where they would like to express leadership.' 2. Leadership engagement With a new level of accountability, community involvement, and policy change, Black LGBTQ+ people need to be positioned for effective participation at all levels. This also positions the Black LGBTQ+ community to be better positioned for effective collaboration from the community, agency, and jurisdictional levels. One participant states: "We want to build up and position leadership in [Black] communities. We also want to make sure that we have resources and to know about those resources, we have to be inside. Yes, outwardly someone can be a leader, but when it comes to decision-making, budgeting, allocation, our communities need to be in those jpaces as well, because we are the ones that are most affected by it". 3. Cultural affirming and celebratory spaces designated to Black people The community advisory board shared much feedback to the fact of the lack of spaces that intentionally exist to encapsulate the entire Black LGBTQ+ experience. One participant noted, "We need more safe spaces to sit, share, and be supported. It's already hard enough to be vulnerable, and we need spaces to know that it's okay." This physical space creates a sense of home, history, and culture- elements that Black LGBTQ+ people have historically been stripped of or denied. A strong need across all services is centering the unique needs and experiences of Black LGBTQ+ people; that is, culturally relevant, culturally appropriate, and culturally specific content, practices, and responses. In regard to like-minded spaces, a participant shared: 10 Exhibit 7 I think one can certainly [ continue to J hold up the flag of advocacy for like-mindedness. That we advocate for a community of likeminded people who want to raise up a culture of people around mental wellness, that we want to advocate as leaders individually and collectively that we provide safe spaces all over Greater Los Angeles. So that people that look and think like us can have the privilege and the opportunity for resources. Our people, our community, our tribe deserves that. As one participant said, "Spaces to show up for ourselves, but show up for each other at the same time." "For us, by us," as an evidence-based approach, that is being able to show up as an individual, but also collectively to address consistently the mental and emotional healing of Black and Black LGBGTQ+ people. Throughout the project, participants consistently spoke to power of "the village," citing the historical context of the communal experiences of people of the African diaspora. These references highlighted the multi-generational, multi-experiential strengths that Black culture benefits from. These responses create culturally based, trauma informed opportunities to introduce and implement such approaches as family therapy, faith-based therapy and support, and holistic health as supplements to the mental and emotional health of Black LGBTQ+ communities. One participant quotes, "Centering the unique experiences of Black LGBTQ+ people allow [Black LGBTQ+ people] the opportunity to address the trauma and emotional labor we have been carrying around for generations." Recommendations The following recommendations are divided into DMH recommendations, provider recommendations, and community recommendations: What can DMH and other mental health agencies do? l. Create a path. Building and creating opportunities to align Black LGBTQ+ people to leadership development, skills building, job placement is a significant investment in the mental and emotional health of some of the most underserved and underrepresented communities. 2. Equity and equality for resources. By looking at the disproportionate inequity for Black and Black LGBTQ+ communities relating to access to services, barriers to services, the lack of culturally relevant and centered Black LGBTQ+ serving providers, and the burden of mental and emotional health care needs and services, resources and funding should be consistently aligned to the communities most in need. 3. Implement policies. Procedures and guidelines must be put in place to ensure the equitable distribution of and accountability for resources to Black and Black LGBTQ+ communities. 4. Available and accountable leadership. As those in leadership positions posture themselves to serve, they should be accessible to the communities they have committed to represent. 5. Build capacity. BLAC adamantly believes Black and Black LGBTQ+ communities need more education around mental health and treatment options. Along with this increase in 11 Exhibit 7 education must come increased opportunities, which include workforce development, job placement, and support. 6. Address barriers to linkage and navigation by looking holistically at other challenges to access such as bias within healthcare systems, benefits navigation, resource navigation, etc. 7. Effectively address co-occurring concerns. Recognizing the disproportionate impact of other determinates of health and their effect on mental health access ( ex. homelessness, substance use support, and navigation) relating to Black LGBTQ+ people. 8. The message and the messenger matters. By building succinct, culturally appropriate and affirming tools that amplify Black LGBTQ+ visibility and culture through creative, strategic tools and educational materials through spaces and platforms that allow people to listen and to be heard. What can providers do? Healthcare providers should lead with a client-centered, trauma-informed approaches for Black and Black LGBTQ+ communities. BLAC strongly recommends the following: 1. Lead with empathy, sensitivity, and awareness. 2. Ensure safe spaces, culturally and physically for Black LGBTQ+ individuals 3. Check intentions. Providers who care for Black LGBTQ+ clients must have the desire to be of service to these communities. This expresses itself in care delivery and retention in care. 4. Acknowledge the collective unique trauma and experiences specific to the intersectional needs of Black LGBTQ+ people. 5. Address implicit bias. 6. Address micro and macroaggressions. 7. Recognize privilege. What ca11 community do? Community should also look at how to create and sustain 1. Know your rights. Get educated and educate others on the power of mental health services, address stigma, roles and responsibilities of agencies and individuals positioned to serve the Black and Black LGBTQ+ community. 2. Build more collaborative efforts. Creating more collective, outcome-driven work through safe space centered in wholeness and wellness through nurturing skills-based, interest-based leadership. 3. Be empowered. Recognize your own leadership and contribution to addressing the needs of Black and Black LGBTQ+ communities. Also, build, nurture, and support those with expressed activism and advocacy for the community. 4. Hold leaders and agencies accountable. Community should use our platfonns and collective voice for a cause in a way that prioritizes Black and Black LGBTQ+ communities. 12 Exhibit 7 5. Define and prioritize self-care as a part of mental health and community care. Participants spoke to the ongoing need for prioritizing wellness. One said, "We're no good to community, if we aren't being fulfilled or refilled and refueled. You can't show up for others, if you haven't shown up for yourself," referencing the need to be personally well in order to work effectively and sustainably to address community mental health. 6. Continue to combat stigma. By fostering the cultivation of vulnerability and compassion, building self-esteem, sustaining holistic programs, activities, and workshops that nurhrre not only our forefront leaders but also our background leaders. The final recommendations centering the Black LGBTQ+ community: 1. Designated safe spaces (physical spaces and cultural spaces) 2. More resources - funding, materials, physical space 3. More opportunities - training, leadership development, employment 4. More holistic, integrated approaches to mental and emotional wellness 5. Center the culture: culturally mindful experiences. Participant Data BLAC represented a very diverse representation of the community. 78% identified as Black or African American, 14% identified as Latinx, with the remaining participants identifying as Asian or Asian American, Native American, or white. Of the participants surveyed, in response to "What is your sexual orientation?" responses are: 30% gay, 24% straight or heterosexual, 19% something else, 15% bisexual, l 0% pansexual, 1 % lesbian, 1 % intersex. (Note: the AMAAD evaluation team has assessed that for sexual orientation, some respondents may have opted for the "something else" option in place of "choose not to respond". Going forward, instruments will include this option.) 13 Exhibit 7 As related to age, half of the respondents were 40 years or older with 24% of participants from ages 18 - 29 and 25% ages 30-39. In response to "I believe there are enough mental and behavioral health programs for Black people as a whole," 91 % of respondents strongly disagree or disagree. 81 % of respondents believe there are not enough mental health and behavioral health program for LGBTQ+ people. When asked about mental health and behavioral health programs for Black LGBTQ+ people, 94% percent of respondents believe there are not enough. Respondents agree that there are not enough adequate mental and behavioral services for LGBTQ+ people (81 %) or Black people (88%). And while participants expressed being open to engaging in mental and behavioral health services, 65% percent were not sure where to find services for Black LGBTQ+ people and more than half noted having difficulty engaging in mental health services. Participants noted being familiar to fairly familiar (72%) and knowledgeable (75%) of mental health issues, yet more than half (52%) mentioned struggling to discuss their own mental health concerns. Yet even considering that, 78% of participants noted experience receiving mental health services. 14 Exhibit 7 BLAC participants brought a breadth of skills and strengths. 87% noted experience conducting community outreach, 94% noted experience facilitating meetings, Participants did note that the incentive was very helpful. Participants shared very strong approval and endorsement of BLAC. • 90% strongly agree or agree that BLAC is enjoyable. • 90% also mentioned the sessions were helpful. • 94% noted that BLAC facilitators were knowledgeable. • 90% noted that BLAC facilitators were pleasant. Of participants polled, three out of four noted a decrease in mental and emotional health stigma. - Eighty-five percent noted being more likely to engage in mental health services and 4 out of 5 noted an increase in knowledge since participating in BLAC. And 9 out of 10 expressed feeling more empowered to educate someone else about mental and emotional health since participating inBLAC. One regular CAB member shared about his experience with BLAC: Having the opportunity to speak for myself when you all are not around and I'm around other.folks, I talk like I know what I'm saying! That is all because I'm listening to you all, in the way that you use your words, your thoughts, your expressions, your company. 1 began to embody each of you and your spirits, so that when I go out in the community and I'm the only one that's present and in the community, I'm not letting you all down because you 're spending your time, your efforts and your hearts to help build up a community. And that's important to me. And it's important to all of us. " Another member mentioned the need for more concise and specific data collection and research skills building and education specific to the Black LGBTQ+ community. (add Shannon's quote?) 100 % of the CAB participants expressed interest in continuing the work and contributing their own strengths and skills to BLAC and addressing the mental, behavioral, and emotional health needs of Black and Black LGBTQ+ communities. Recommendations of expanding the work specific to Black LGBTQ+ people to include: 1. Addressing inequity in the workplace for Black LGBTQ+ people experiencing mental health needs 2. Addressing the needs of those people with disabilities 3. Addressing the needs of those people with co-occuring disorders 4. Increased intersectional efforts ex. transgender people, youth & young adults, aging, etc. 5. Increased intergenerational efforts 6. Centering lived experience 15 Exhibit 7 16 Exhibit 8 THE STAR MODELTM JAY R. GALBRAITH The Star ModelfM framework for organization design is the foundation on which a company bases its design choices. The framework consists of a series of design policies that are controllable by management and can influence employee behavior. The policies are the tools with which management must become skilled in order to shape the decisions and behaviors of their organizations effectively. What is the Star Model™? The organization design framework portrayed in Figure 1 is called the "Star ModelTM." In the Star Mode}TM, design policies fall into five categories. The first is strategy, which determines direction. The second is structure, which determines the location of decision-making power. The third is processes 1 which have to do with the flow of information; they are the means of responding to information technologies. The fourth is rewards and reward systems/ which influence the motivation of people to perform and address organizational goals. The fifth category of the model is made up of policies relating to people (human resource policies) 1 which influence and frequently define the employees' mind-sets and skills. skillsetsl mindsets direction motivation information Fixure 1- The Star Model™ power @ Jay R. Galbraith © Jay R. Galbraith. Do not post, publish or reproduce without permission. All rights reserved. Exhibit 8 JAY R. GALBRAITH THE STAR MODEL ™I 2 Strategy Strategy is the company's formula for winning. The company's strategy specifies the goals and objectives to be achieved as well as the values and missions to be pursued; it sets out the basic direction of the company. The strategy specifically delineates the products or services to be provided, the markets to be served, and the value to be offered to the customer. It also specifies sources of competitive advantage. Traditionally, strategy is the first component of the Star ModetTM to be addressed. It is important in the organization design process because it establishes the criteria for choosing among alternative organizational forms. (See the book, Designing Dynamic Organizations by Galbraith, Downey and Kates, published by Jossey-Bass in 2002, for tools to help translate strategy into criteria.) Each organizational form enables some activities to be performed well, often at the expense of other activities. Choosing organizational alternatives inevitably involves making trade-offs. Strategy dictates which activities are most necessary, thereby providing the basis for making the best trade-offs in the organization design. Matrix organizations result when two or more activities must be accomplished without hindering the other. Rather than choosing the "or," matrix requires an embracing of the "and.'' Companies want to be global and local. Structure The structure of the organization determines the placement of power and authority in the organization. Structure policies fall into four areas: • • • • Specialization Shape Distribution of power Departmentalization Specialization refers to the type and numbers of job specialties used in performing the work. Shape refers to the number of people constituting the departments (that is, the span of control) at each level of the structure. Large numbers of people in each department create flat organization structures with few levels. Distribution of power, in its vertical dimension, refers to the classic issues of centralization or decentralization. In its lateral dimension, it refers to the movement of power to the department dealing directly with the issues critical to its mission. Departmentalization is the basis for forming departments at each level of the structure. The standard dimensions on which departments are formed are functions, products, workflow processes, markets, customers © Jay R. Galbraith. Do not post, publish or reproduce without permission. All rights reserved. Exhibit 8 JAY R. GALBRAITH THE STAR MODEL ™I 3 and geography. Matrix structures are ones where two or more dimensions report to the same leader at the same level. Processes Information and decision processes cut across the organization's structure; if structure is thought of as the anatomy of the organization, processes are its physiology or functioning. Management processes are both vertical and horizontal. Figure 2- Vertical processes Vertical processes, as shown in Figure 2 allocate the scarce resources of funds and talent. Vertical processes are usually business planning and budgeting processes. The needs of different departments are centrally collected, and priorities are decided for the budgeting and allocation of the resources to capital, research and development, training, and so on. These management processes are central to the effective functioning of matrix organizations. They need to be supported by dual or multidimensional information systems. Figure 3-Lateral Processes Horizontal-also known as lateral-processes, as shown in Figure 3, are designed around the workflow, such as new product development or the entry and fulfillment of a customer order. These management processes are becoming the primary vehicle for managing in today's organizations. Lateral processes can be carried out in a range of ways, from voluntary contacts between members to complex and formally supervised teams. © Jay R. Galbraith. Do not post, publish or reproduce without permission. All rights reserved. Exhibit 8 JAY R. GALBRAITH THE STAR MODEL ™I 4 Rewards The purpose of the reward system is to align the goals of the employee with the goals of the organization. It provides motivation and incentive for the completion of the strategic direction. The organization's reward system defines policies regulating salaries, promotions, bonuses, profit sharing, stock options, and so forth . A great deal of change is taking place in this area, particularly as it supports the lateral processes. Companies are now implementing pay-for-skill salary practices, along with team bonuses or gain sharing systems. There is also the burgeoning practice of offering non monetary rewards such as recognition or challenging assignments. The Star ModeFM suggests that the reward system must be congruent with the structure and processes to influence the strategic direction. Reward systems are effective only when they form a consistent package in combination with the other design choices. People This area governs the human resource policies of recruiting, selection, rotation, training, and development. Human resource policies - in the appropriate combinations - produce the talent required by the strategy and structure of the organization, generating the skills and mind-sets necessary to implement the chosen direction. Like the policy choices in the other areas, these policies work best when they are consistent with the other connecting design areas. Human resource policies also build the organizational capabilities to execute the strategic directions. Flexible organizations require flexible people. Cross-functional teams require people who are generalists and who can cooperate with each other. Matrix organizations need people who can manage conflict and influence without authority. Human resource policies simultaneously develop people and organizational capabilities. Implications of the Star Model™ As the layout of the Star Model™ illustrates, structure is only one facet of an organization's design. This is important. Most design efforts invest far too much time drawing the organization chart and far too little on processes and rewards. Structure is usually overemphasized because it affects status and power, and a change to it is most likely to be reported in the business press and announced throughout the company. However, in a fast-changing business environment, and in matrix organizations, structure is becoming less important, while processes, rewards, and people are becoming more important. © Jay R. Galbraith. Do not post, publish or reproduce without permission. All rights reserved. Exhibit 8 JAY R. GALBRAITH THE STAR MODEL TMI 5 Another insight to be gained from the Star Model™ is that different strategies lead to different organizations. Although this seems obvious, it has ramifications that are often overlooked. There is no one-size-fits-all organization design that all companies-regardless of their particular strategy needs-should subscribe to. There will always be a current design that has become "all the rage." But no matter what the fashionable design is-whether it is the matrix design or the virtual corporation-trendiness is not sufficient reason to adopt an organization design. All designs have merit but not for all companies in all circumstances. The design, or combination of designs, that should be chosen is the one that best meets the criteria derived from the strategy. A third implication of the Star ModeFM is in the interweaving nature of the lines that form the star shape. For an organization to be effective, all the policies must be aligned and interacting harmoniously with one another. An alignment of all the policies will communicate a clear, consistent message to the company's employees. The Star Model™ consists of policies that leaders can control and that can affect employee behavior, as suggested in Figure 4. It shows that managers can influence performance and culture, but only by acting through the design policies that affect behavior. Bclwviors Podormancc 7 Different strategies = different organizations 7 Organ1zat1on is more than structure 7 Alignment = effectiveness Figure 4 - How Organization Design Affects Behavior and Culture © Jay R. Galbraith. Do not post, publish or reproduce without permission. All rights reserved. Exhibit 8 JAY R. GALBRAITH THE STAR MODEL ™I 6 Overcoming Negatives Through Design One of the uses of the Star ModeFM is to use it to overcome the negatives of any structural design. That is, every organizational structure option has positives and negatives associated with it. If management can identify the negatives of its preferred option, the other policies around the Star Model™ can be designed to counter the negatives while achieving the positives. Centralization can be used as an example. When the internet became popular, many units in some organizations began their own initiatives to respond to it. These organizations experienced the positives of decentralization. They achieved speed of action, involvement of people closest to the work and tailoring of the application to the work of the unit. They also experienced the negatives of decentralization. The many initiatives duplicated efforts and fragmented the company's response. There were multiple interfaces for customers and suppliers. They ran into difficulty in attracting talent and sometimes had to settle for less than top people. Most companies have responded by centralizing the activities surrounding the internet into a single unit. In so doing, they have reduced duplication, achieved scale economies and presented one face to the customer. They have combined many small internet units into one large one which is attractive for professional internet managers. But at the same time, decision making moves farther from the work, the central unit becomes an internal monopoly and the result can be lack of responsiveness to other organizational deparhnents who are using the internet. To minimize the negatives of the central unit, the management of the company can design the appropriate processes, rewards and staffing policies. For example in the planning process, the central unit can present its plan to service the rest of the organization. The leadership team can debate the plan and arrive at an approved level of service. The plan can be prepared by people from the central unit and a horizontal team of people from throughout the company. Along with its goals of reducing duplications and achieving scale, the central unit will also be expected to meet the planned service levels that were agreed. The central unit's performance will be measured and rewarded on the basis of meeting planned goals. And finally to keep the central unit connected to the work, it can be staffed by a mix of permanent professionals and rotating managers from the rest of organization on one or two year assignments. This complete design increases the chances that the central unit will achieve its positives while minimizing the usual negatives. © Jay R. Galbraith. Do not post, publish or reproduce without permission. All rights reserved. Exhibit 9 Form Approved 0MB No.: 0930--0357 Expiration Date: March 31, 2022 National Minority AIDS Initiative (MAI) Substance Abuse/HIV Prevention Initiative Adult Questionnaire TO BE FILLED OUT BY THE LOCAL GRANT SITE DATA COLLECTOR Participant ID#: _________ _ Exhibit 9 National Minority AIDS Initiative (MAI) Substance Abuse/HIV Prevention Initiative Adult Questionnaire Funding for data collection supported by the Center for Substance Abuse Prevention (CSAP), Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS) These questions are part of a data collection effort about how to prevent substance abuse and HIV infection. The questions are being asked of hundreds of other individuals throughout the United States. The data findings will be used to help prevention initiatives learn more about how to keep people from using drugs and getting infected with HIV. Completing this questionnaire is voluntary. If you do not want to answer any of the questions, you do not have to. If you decide not to participate in this survey, it will have no effect on your participation in direct service programs. However, your answers are very important to us. Please answer the questions honestly-based on what you really do, think, and feel. Your answers will not be told to anyone in your family or community. Do not write your name anywhere on this questionnaire. We would like you to work fairly quickly so that you can finish. Please work quietly by yourself. If you have any questions or do not understand something, let the data collector know. We think you will find the questionnaire to be interesting and that you will like filling it out. Thank you very much for being an important part of this data collection effort! Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of infonnation unless it displays a currently valid 0MB control number. The 0MB control number for this project is 093CHJ357 and the expiration date is March 31 , 2022. Public reporting burden for this collection of infonnation is estimated to average 0.20 hours per response. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, 5600 Fishers Lane, Room 15E57-B, Rockville, MD 20857. INSTRUCTIONS 1. Answer each question by marking one of the answer circles. Some questions allow you to mark more than one answer. If you don't find an answer that fits exactly, choose the one that comes closest. 2. Mark your answers carefully so we can tell which answer circle you chose. Do not mark between the circles. 3. It is very important that you answer each question truthfully. Your responses will not be helpful unless you tell the truth. MARKING YOUR ANSWERS • Use a No. 2 black lead pencil. EXAMPLES • Do not use an ink or ballpoint pen. • Make heavy dark marks that fill the circle completely. Correct Marks: Incorrect Marks: • Erase cleanly any answer you wish to change. • Make no stray marks on this questionnaire. o e oo Q )© o , ) Page 1 Exhibit 9 Record Management Section: To Be Completed by Designated Staff Grant ID Study Design Group (select one) 0 Intervention 0 Comparison Participant ID Date of Survey Administration I_LJ / I_I_I / I_I_I_I_I Month Day Year Interview Type (select one) 0 Baseline 0 Exit 0 Follow-up 0 Testing Services Only (skip to section B) A) Intervention Details Type of Encounter (select all that apply) Cl fndividual 0 Group Intervention Name(s) [fthe participant is receiving direct services from more than one intervention, please list each intervention below. I. 2. 3. Total Number of Direct Service Encounters Count each encounter once. If you provide multiple services during an encounter, it still only counts as one encounter. ___ _ direct service encounters Average Duration ofEncounter(s) Round time to nearest 5- minute interval. ____ minutes B) Service Type(s) (select all that apply) Testing Services 0 HIV Testing 0 Viral Hepatitis (VH) Testing 0 Other STD Testing Health Care Services 0 VH Vaccination 0 Primary Health Care Services 0 Other Health Care Services Individual Services 0 Risk Reduction Counseling/Education* 0 HIV Testing Counseling 0 Viral Hepatitis Testing Counseling 0 Psycho-Social Counseling 0 Substance Abuse Counseling 0 Substance Abuse Education 0 Opioid Prevention Education 0 Opioid Prevention Counseling 0 HIV Education 0 STD Education 0 Viral Hepatitis Education 0 Mentoring (Peer or Other Type) 0 Case Management Services 0 All Other [ndividual Services SPECIFY: _____________ _ Group Services 0 Support Group 0 Group Counseling/Therapy 0 Skills Building Training/Education 0 Health Education Classes/Sessions 0 Viral Hepatitis Education 0 HIV Education 0 STD Education 0 Substance Abuse Education 0 Opioid Prevention Education 0 Cultural Enhancement Activities 0 Alternative Activities 0 All Other Group Services SPECIFY: _ _____________ _ C) Referrals Please mark any topic areas in which staff facilitated participant access to prevention, treatment, or recovery services. Select all that apply. [fnot applicable, leave blank. 0 HIV Testing 0 HIV Counseling 0 HIV Treatment 0 VI-I Testing 0 VH Counseling 0 VH Vaccination 0 VI-I Treatment 0 Substance Abuse Treatment 0 Prescription Drugs/Opioid Treatment 0 Mental Health Services (exc/udi11g HIV and VH counseling) 0 Health Care Services (excluding SA, HIV, prescription drng/opioid, and VH treatment) 0 Medicated-Assisted Treatment (MAT) Please indicate the following: o NumberofdaysinMAT ___ _ o Type of medication received ____ (specify) 0 Supportive Housing 0 Other Social Support (e.g., job placement, public health care safety net, insurance programs, etc.) SPECIFY: _______ _______ _ Page 2 Exhibit 9 Section One: Facts About You First, we'd like to ask some basic questions about you. Your answers will not be used to identify you in any way. Instead, your answers will help us understand how different groups (like people from different generations or from different backgrounds) feel about substance abuse and HIV prevention. 1. What is your date of birth? 1_1_111_1_1_1_1 Month Year 2. Are you of Hispanic, Latino/a, or Spanish origin? o Yes 0 No 3. What is your race? (one or more categories may be selected) 0 White 0 Black or African American 0 American Indian or Alaska Native o Asian o Native Hawaiian or Other Pacific Islander 4. How do you describe yourself? O Male 0 Female O Transgender o I do not identify as male, female, or transgender 5. Which one of the following do you consider yourself to be? 0 StraighUHeterosexual O Gay/Lesbian 0 Bisexual O Other 0 Prefer not to say 6. Describe where you live. 0 In my own home or apartment 0 In a relative's home 0 In a group home O In campus/dormitory housing O In a foster home 0 Homeless or in a shelter O Other 7. Are you currently attending college? O Yes O No 8. Have you ever served in the Armed Forces, the Reserves, or the National Guard? 0 Yes 0 No 9. In the past 30 days, how many times have you been arrested? O ·····-····· . . Times O Refused 0 Don'tknow 10. Are you on parole or probation? o Yes 0 No 11. Have you ever been informed of your HIV status (that is, whether or not you are HIV-positive) based on the result of an HIV test? 0 Yes 0 No 12. Have you ever been informed of your viral hepatitis (VH) status (that Is, whether or not you are infected with a hepatitis virus) based on the result of a VH test? O Yes 0 No 13. Would you know where to go near where you live to see a health care professional regarding a drug or alcohol problem? 0 Yes 0 No 14. Would you know where to go near where you llveto see a healthcare professional regarding HIV/AIDS or other sexually transmitted health issues? 0 Yes 0 No Page 3 Exhibit 9 15. Think about the household members who live with you right now. About how much income have you and your family members made in the last year before taxes? (Include child support and cash payments from the government-for example, welfare [TANF], SSI, or unemployment compensation.) 0 $0-$10,000 0 $10,001 - $30,000 0 $30,001-$50,000 0 $50,001-$70,000 O More than $70,000 Section Two: Attitudes & Knowledge Next, we'd like to ask you how you feel about substance use and sexual behavior. Again, your answers are private and will not be used to identify you. 16. What level of risk do you think people have of harming themselves physically or in other ways when they use tobacco once or twice a week? By tobacco, we mean menthol cigarettes, regular cigarettes, loose tobacco rolled into cigarettes or cigars, pipe tobacco, snuff, chewing tobacco, dipping tobacco, snus, and others. 0 No risk 0 Slight risk 0 Moderate risk O Great risk 0 Don't know or can't say 17. What level of risk do you think people have of harming themselves physically or in other ways when they binge drink alcoholic beverages once or twice a week? Binge drinking is five ormore alcoholic beverages at the same time or within a couple of hours of each other for males; four or more forfemales. By alcoholic beverage, we mean beer, wine, wine coolers, malt beverages, or hard liquor O Norisk 0 Slightrisk o Moderate risk 0 Great risk 0 Don't know or can 't say 18. What level of risk do you think people have of harming themselves physically or in other ways when they use marijuana or hashish once or twice a week? Marijuana is sometimes called weed, blunt, hydro, grass, or pot. Hashish is sometimes called hash or hash oil. 0 No risk 0 Slight risk o Moderate risk 0 Great risk O Don't know or can't say 19. What level of risk do you think people have of harming themselves physically if they share needles, syringes, or other injection equipment when using drugs? o No risk 0 Slight risk 0 Moderate risk 0 Great risk O Don't know or can't say 20. What level of risk do you think people have of harming themselves physically or in other ways when they use nonprescription opioid drugs once or twice a week? By non prescription opioid drugs, we mean the illegal drug heroin and illicitly made synthetic opioids, such as fentanyl. 0 No risk 0 Slightrisk o Moderate risk o Great risk O Don't know or can't say Page4 Exhibit 9 21. What level of risk do you think people have of harming themselves physically or in other ways when they take prescription opioid drugs without a doctor's order once or twice a week? By prescription opioid drugs, we mean pain relievers such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, methadone, tramadol, hydromorphone, oxymorphine, tapentadol. o No risk 0 Slight risk 0 Moderate risk o Greatrisk O Don't know or can't say The next few questions ask about having sex. By sex or sexual activity, we mean a situation where two partners get sexually excited or aroused (turned on) by touching each other's genitals (penis or vagina) or anus (butt) with their own genitals, hands, or mouth. 22. What level of risk do you think people have of harming themselves if they have sex (oral, vaginal, or anal) without a condom or dental dam? 0 No risk 0 Slight risk o Moderate risk 0 Great risk O Don't know or can't say 23. What level of risk do you think people have of harming themselves if they have sex while high on drugs or under the influence of alcohol? O No risk O Slight risk O Moderate risk 0 Greatrisk 0 Don't know or can't say 24. I could refuse if someone wanted to have sex without a condom or a dental dam. O Strongly agree O Agree 0 Disagree 0 Strongly disagree Page 5 Exhibit 9 """'"-"""""''"'·,..,••••----,-•,..•• .. • .. ••""11.,.re,w_....,_n .... _.,. . m.,.· .,.21i,..,..,RF11"''•""'""'~ia!!!M'""""',._ __ .,.m.., ______ , _____ ..,,..a•••""""""""_, __ ~..,•••••""'• · --•""'"' Section Three: Behavior ?TBUIIIM'Mlsal~Wlkll & WZL C.JMBllll& Zllliliilll - . Tobacco, Alcohol, and Drugs llftlllQi n rec-.., ltlliili:ftWlilaHtiilQl c fi!Jlli!R r:mw:enmenr nu • x m Ul& li rr BttR<fffP1f1'flm'Mlltl Think back over the past 30 days and record on how many days, if any, you did any of the following activities. Over the past 30 days, how many days, if any, did you ... Definitions 25. Smoke cigarettes? I_I_ IDays By cigarettes, we mean menthol cigarelles, r-egular 0 Don't know or can't say cigarettes, and loose tobacco rolled into cigarettes 01 cigars. 26. Use other tobacco 12roducts? I_I_IDays By other tobacco products, w<➔ mean pipe tobacco, Please exclude cigarettes. 0 Don't know or can't say snuff, chewing tobacco, dipping tohacco. snus, and others. 27. Use electronic vaeor eroducts? I_I_IDays By electronic vapor products we mean Vapes, () Don't know or can't say vaporizers, vape pens, hookah pens, electronic cigarettes (e•cigarettcs or o-cigs), o-pipos, or e/fJctronic nicotine delivery systems (ENOS) . Some brand examples inclucle JU UL. , NJO'I, Blu, Vuse, Marl<Ten, Logic, Vap in Plus , eGo, and Halo. 28. Drink alcohol? (any use at all) I_I_IDays By alcohol, we mean bee,; win e, wine coolers. malt 0 Don't know or can't say beverag1:>s, or hard liquor. 29. Binge drink? I_I_IDays Bingr:1 clrinking is five or more alcoholic beverages at () Don't know or can't say the same time or within a couple of hours of each other for males; four or more for females. 30. Use marijuana or hashish? I I I Days Marijuana is sometimes called c:annabis, weed, blunt, 0 Don't know or can't say hydro, grass, or pot. Hashish is sometimes called hash or hash oil. 31. Use i;1rescrit;1tion oi;1ioid drugs I_I_IDays By prescription opioid drugs, we mean pain relievers without orders given to you by 0 Don't know or can't say such as oxycodone (OxyCon/111@) , hycJrocodone your doctor? (Vicodin@), codeine, morphine, metlwdone, tramado/, hydromorphone, oxymorphirw, tapentadot. 32. Use other erescrietion drugs l_l_!Days By other prescription drugs, weJ mean substances without orders given to you by () Don't know or can't say like barbiturates, seclalives, hypnotics, non-benzo your doctor? Please exclude tranquilizers . prescription opioid drugs. 33. Use non-erescrietion oeioid I_I_IDays By non-prescription opioid drugs we mean the illegal drugs? 0 Don't know or can't say drug heroin and illicitly made synthetic opioids such as fentanyl. 34. Use any other illegal drugs? I_I_IDays By other illegal drugs, we mean substances like Please exclude marijuana/hashish CJ Don't know or can't say crack or cocaine, amphetamine or and non-prescription opioid drugs. methamphetamine, hallucinogens (such as LSD/acid, Ecstasy/MDMA, F 1 CP/angel ciust, peyote), inhalants (sniffed substances such as glue, gasoline, paint thinner, cleaning tJuid, shoe polis/1) . 35. Inject any drugs? I_I_IDays Count only injections without orders from your () Don't know or can't say doctoic-those you had just to foe/ good or to get high. 36. Share injection egui12ment? I_I_IDays By injection equipment, we mean needle ancl drug 0 Don't know or can't sav paraphernalia. Page6 Exhibit 9 Sexual Behavior I Now, we'd like to ask you about your experience with sex. Remember, your answers will be kept private. 37. During the past 30 days, how many sexual partners have you had? A sexual partner is someone with whom you have sex, that is, engage in sexual activity. O None 0 1 person O 2 people 0 3people o 4people O 5 people o 6 people O 7 people O 8 people 0 9 people 0 10 people or more 38. The following questions ask about unprotected sex. Unprotected sex is vaginal, oral, or anal sex without a barrier such as a condom or dental dam. During the past 30 days, have you had unprotected sex with ... A male o yes A female 0 yes A transQender individual 0 yes A significant other in a monogamous relationship 0 yes Multiple partners O ves An HIV positive person O yes A Hepatitis positive person O ves A person who injects drugs o yes A man who has sex with men O ves 39. Have you~ had sex (vaginal, anal, or oral) with someone in exchange for money, drugs, or shelter? O No, never had sex in exchange for money, drugs, or sheller 0 Yes, within the past 3 months o Yes, more than 3 months ago O no 0 no O no O no O no 0 no O no O no 0 no 40. In the past 3 months, how often has anyone with whom you had an intimate relationship (sexual or not) abused you emotionally, physically, or sexually? 0 Never 0 Rarely O Sometimes 0 Often O Veryoften 0 don't know 0 don't know o don't know 0 don't know YOU ARE DONE! Thank you for your help! Page7 Exhibit 9 Form Approved 0MB No. 0930-0208 Expiration Date 0 1/3 l/2020 CSAT GPRA Client Outcome Measures for Discretionary Programs (Revised 04/24/2017) Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information, if all items are asked of a client/participant; to the extent that providers already obtain much of this information as part of their ongoing client/participant intake or follow-up, less time will be required. Send comments regarding this burden estimate or any other aspect of this collection of information to SAMHSA Repmts Clearance Officer, Room 15E57B, 5600 Fishers Lane, Rockville, MD 20857. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid O1\IB control number. The control number for this project is 0930-0208. SPARS_ GPRA _ Client_ Outcome _Instrument v6.0 Exhibit 9 A. RECORD MANAGEMENT Client ID I_I_I_I_,_, Client Type: 0 Treatment client 0 Client in recovery l_l_,~,----'~1-I_I_I_I Contract/Grant ID ~~~-1_1_1_1_1_1_1 Interview Type [CIRCLE ONLY ONE TYPE./ Intake [GO TO INTERVIEW DATE./ 6-month follow-up -+-+-+ Did you conduct a follow-up interview? 0 Yes O No [IF NO, GO DIRECTLY TO SECTION 1./ 3-month follow-up [ADOLESCENT PORTFOLIO ONLY/-> Did you conduct a follow-up interview? 0 Yes O No [IF NO, GO DIRECTLY TO SECTION 1./ Discharge --> --> -+ Did you conduct a discharge interview? 0 Yes O No [IF NO, GO DIRECTLY TO SECTION J.J Interview Date 1_1_111_1_111_1_1_1_1 Month Day Year [FOLLOW-UP AND DISCHARGE INTERVIEWS: SKIP TO SECTION B.J 1. Was the client screened by your program for co-occurring mental health and substance use disorders? 0 YES 0 NO [SKIP la./ la. {IF YES} Did the client screen positive for co-occurring mental health and substance use disorders? 0 YES 0 NO [SB/RT CONTINUE. ALL OTHERS GO TO SECTION A "PLANNED SERVICES.''] SPARS_ GPRA _ Client_ Outcome_ Instrument v6.0 Exhibit 9 THIS SECTION FOR SB/RT GRANTS ONLY [ITEMS 2, 2a, & 3 - REPORTED ONLY AT INTAKE/BASELINE/. 2. How did the client screen for your SBIRT? 0 NEGATIVE 0 POSITIVE 2a. What was his/her screening score? AUDIT I_I_I CAGE I_I_I DAST I._.J __ _I DAST-10 I_I_I NIAAA Guide I __ I_I ASSIST/Alcohol Subscore I __ I __ I Other (Specify) = I _ _I_ __ I 3. Was he/she willing to continue his/her participation in the SBIRT program? 0 YES 0 NO SPARS_ GPRA _ Client_ Outcome_ Instrument 2 v6.0 Exhibit 9 A. RECORD MANAGEMENT - PLANNED SERVICES [REPORTE?) BY PROGRAM STAFF ABOUT CLIENT ONLY AT INTAKE/BASELINE./ Identify the services you plan to provide to the client Case Management Services Yes No during the client's course of treatment/recovery. [CIRCLE I. Family Services (Including Marriage "Y" FOR YES OR "N" FOR NO FOR EACH ONE./ Education, Parenting, Child Development Modality Yes No Services) y N [SELECT AT LEAST ONE MODALITY./ 2. Child Care y N l. Case Management y N 3. Employment Service 2. Day Treatment y N A. Pre-Employment y N 3. Inpatient/Hospital (Other Than Detox) y N B. Employment Coaching y N 4. Outpatient y N 4. Individual Services Coordination y N 5. Outreach y N 5. Transportation y N 6. Intensive Outpatient y N 6. HIV/AIDS Service y N 7. Methadone y N 7. Supportive Transitional Drug-Free Housing 8. Residential/Rehabilitation y N Services y N 9. Detoxification (Select Only One) 8. Other Case Management Services A. Hospital Inpatient y N (Specify) y N B. Free Standing Residential y N C. Ambulatory Detoxification y N Medical Services Yes No 10. After Care y N 1. Medical Care y N 11. Recovery Support y N 2. Alcohol/Drug Testing y N 12. Other (Specify) y N 3. HIV/AIDS Medical Support & Testing y N 4. Other Medical Services [SELECT AT LEAST ONE SERVICE./ (Specify) y N Treatment Services Yes No [SRIRT GRANTS: YOU MUST CIRCLE "Y" After Care Services Yes No FOR AT LEAST ONE OF THE TREATMENT 1. Continuing Care y N SERVICES NUMBERED 1 THROUGH 4./ 2. Relapse Prevention y N l. Screening y N 3. Recovery Coaching y N 2. Brief Intervention y N 4. Self-Help and Support Groups y N 3. Brief Treatment y N 5. Spiritual Support y N 4. Referral to Treatment y N 6. Other After Care Services 5. Assessment y N (Specify) y N 6. Treatment/Recovery Planning y N 7. Individual Counseling y N Education Services Yes No 8. Group Counseling y N 1. Substance Abuse Education y N 9. Family/Marriage Counseling y N 2. HIV/AIDS Education y N 10. Co-Occurring Treatment/ 3. Other Education Services Recovery Services y N (Specify) y N 11. Pharmacological Interventions y N 12. HIV/ AIDS Counseling y N Peer-to-Peer Recovery Support Services Yes No 13. Other Clinical Services 1. Peer Coaching or Mentoring y N (Specify) y N 2. I-lousing Support y N 3. Alcohol- and Drug-Free Social Activities y N 4. Information and Referral y N 5. Other Peer-to-Peer Recovery Support Services (Specify) y N SPARS_ GPRA _ Client_ Outcome _Instrument 3 v6.0 Exhibit 9 A. RECORD MANAGEMENT - DEMOGRAPHICS [ASKED ONLY AT INTAKhtBASELINE.J 1. What is your gender? 0 MALE 0 FEMALE 0 TRANSGENDER 0 OTHER(SPECIFY) _ _ _ ____ ____ _ 0 REFUSED 2. Are you Hispanic or Latino? 0 YES 0 NO 0 REFUSED [IF YES} What ethnic group do you consider yourself? Please answer yes or no for each of the following. You may say yes to more than one. YesNo Refused Central American y N REFUSED Cuban y N REFUSED Dominican y N REFUSED Mexican y N REFUSED Puerto Rican y N REFUSED South American y N REFUSED Other y N REFUSED {IF YES, SPECIFY B.BLOW.J (Specify) 3. What is your race? Please answer yes or no for each of the following. You may say yes to more than one. Black or African American Asian Native Hawaiian or other Pacific Islander Alaska Native White American Indian 4. What is your date of birth?* Yes No y N y N y N y N y N y N Refused REFUSED REFUSED REFUSED REFUSED REFUSED REFUSED I _ I_I / I_I_I / [*THE SYSTEM WILL ONLY SA VE MONTH AND YEAR. Month Day TO MAINTAIN CONFIDENTIALITY, DAY TS NOT SAVED./ 1_1_1_ 1 _ 1 Year 0 REFUSED SPARS_ GPRA _ Client_ Outcome_ Instrument 4 v6.0 Exhibit 9 MILITARY FAMILY AND DEPLOYMENT 5. Have you ever served in the Armed Forces, in the Reserves, or in the National Guard? /IF SERVED/ What area, the Armed Forces, Reserves, or National Guard did you serve? 0 NO 0 YES, IN THE ARMED FORCES 0 YES, IN THE RESERVES 0 YES, IN THE NATIONAL GUARD 0 REFUSED 0 DON'TKNOW /IF NO, REFUSED, OR DON'T KNOW, SKIP TO QUESTION A6.J Sa. Arc you currently on active duty in the Armed Forces, in the Reserves, or in the National Guard? /IF ACTIVE/ What area, the Armed Forces, Reserves, or National Guard? 0 NO, SEPARATED OR RETIRED FROM THE ARMED FORCES, RESERVES, OR NATIONAL GUARD 0 YES, IN THE ARMED FORCES 0 YES, IN THE RESERVES 0 YES, IN THE NATIONAL GUARD 0 REFUSED 0 DON'TKNOW Sb. Have you ever been deployed to a combat zone? {CHECK ALL THAT APPLY./ 0 NEVER DEPLOYED 0 IRAQ OR AFGHANISTAN (E.G., OEF/OIF/OND) 0 PERSIAN GULF (OPERATION DESERT SHIELD/DESERT STORM) 0 VIETNAM/SOUTHEAST ASIA 0 KOREA 0 WWII 0 DEPLOYED TO A COMBAT ZONE NOT LISTED ABOVE (E.G., BOSNWSOMALlA) 0 REFUSED 0 DON'TKNOW [SBIRT GRANTEES: FOR CLIENTS WHO SCREENED NEGATIVE, SKIP ITEMS A6, A6a THROUGH A6d.J SPARS_ GPRA_ Client ___ Outcome _Instrument 5 v6.0 Exhibit 9 6. Is anyone in your family or someone close to you on active duty in the Armed Forces, in the Reserves, or in the National Guard or separated or retired from the Armed Forces, Reserves, or National Guard'! 0 NO 0 YES, ONLY ONE 0 YES, MORE THAN ONE 0 REFUSED 0 DON'TKNOW {IF NO, REFUSED, OR DON'T KNOW, SKIP TO SECTION B.J {IF YES, ANSWER FOR UP TO 6 PEOPLE} What is the relationship of that person (Service Member) to you? /WRITE RELATIONSHIP IN COLUMN HEADING} l = Mother 2 = Father 3 = Brother 4 = Sister 5 = Spouse 6 = Partner 7 = Child 8 = Other (Specify) Has the Service Member experienced any of the following? /CHECK ANSWER IN APPROPRIATE COLUMN (Relationship) (Relationship) (Relationship) (Relationship) (Relationship) (Relationship) FOR ALL THAT APPLY/ l. 2. 3. 4. 5. 6. 6a. Deployed in support of 0 YES 0 YES 0 YES 0 YES 0 YES 0 YES combat operations 0 NO 0 NO 0 NO 0 NO 0 NO 0 NO ( e.g., Iraq or 0 REFUSED 0 REFUSED 0 REFUSED 0 REFUSED 0 REFUSED 0 REFUSED Afghanistan)? 0 DON'T 0 DON'T 0 DON'T 0 DON'T 0 DON'T 0 DON'T KNOW KNOW KNOW KNOW KNOW KNOW 6b. Was physically injured 0 YES 0 YES 0 YES 0 YES 0 YES 0 YES during combat 0 NO 0 NO 0 NO 0 NO 0 NO 0 NO operations? 0 REFUSED 0 REFUSED 0 REFUSED 0 REFUSED 0 REFUSED 0 REFUSED 0 DON'T 0 DON'T 0 DON'T 0 DON'T 0 DON'T 0 DON'T KNOW KNOW KNOW KNOW KNOW KNOW 6c. Developed combat 0 YES 0 YES 0 YES 0 YES 0 YES 0 YES stress symptoms/ 0 NO 0 NO 0 NO 0 NO 0 NO 0 NO difficulties adjusting 0 REFUSED 0 REFUSED 0 REFUSED 0 REFUSED 0 REFUSED 0 REFUSED following deployment, 0 DON'T 0 DON'T 0 DON'T 0 DON'T 0 DON'T 0 DON'T including PTSD, KNOW KNOW KNOW KNOW KNOW KNOW depression, or suicidal thoughts? 6d. Died or was killed? 0 YES 0 YES 0 YES 0 YES 0 YES 0 YES 0 NO 0 NO 0 NO 0 NO 0 NO 0 NO 0 REFUSED 0 REFUSED 0 REFUSED 0 REFUSED 0 REFUSED 0 REFUSED 0 DON'T 0 DON'T 0 DON'T 0 DON'T 0 DON'T 0 DON'T KNOW KNOW KNOW KNOW KNOW KNOW SPARS_ GPRA _ Client_ Outcome_ Instrument 6 v6.0 Exhibit 9 B. DRUG AND ALCOHOL USE 1. During the past 30 days, how many days have you used the following: a. Any alcohol [IF ZERO, SKIP TO ITEM Blc.J bl. Alcohol to intoxication (5+ drinks in one sitting) b2. Alcohol to intoxication (4 or fewer drinks in one sitting and felt high) c. Illegal drugs /IF Bia OR Blc = 0, RF, DK, THEN SKIP TO ITEM B2.J d. Both alcohol and drugs (on the same day) Route of Administration Types: l. Oral 2. Nasal 3. Smoking 4. Non-IV injection 5. IV *NOTE THE USUAL ROUTE. FOR MORE THAN ONE ROUTE, CHOOSE THE MOST SEVERE. THE ROUTES ARE LISTED FROM LEAST SEVERE (1) TO MOST SEVERE (5). 2. During the past 30 days, bow many days have you used any of the following: [IF THE VAL UE IN ANY IT.EM B2a THROUGH B2i > 0, THEN THE VALUE IN Bl c MUST BE> 0./ a. Cocaine/Crack b. Marijuana/Hashish (Pot, Joints, Blunts, Chronic, Weed, Mary Jane) C. Opiates: 1. Heroin (Smack, H, Junk, Skag) 2. Morphine 3. Dilaudid 4. Demerol 5. Percocet 6. Darvon 7. Codeine 8. Tylenol 2, 3, 4 9. OxyContin/Oxycodone d. Non-prescription methadone e. Hallucinogens/psychedelics, PCP (Angel Dust, Ozone, Wack, Rocket Fuel), MDMA (Ecstasy, XTC, X, Adam), LSD (Acid, Boomers, Yellow Sunshine), Mushrooms, or Mescaline f. Methamphetamine or other amphetamines (Meth, Uppers, Speed, Ice, Chalk, Crystal, Glass, Fire, Crank) SPARS_ GPRA _ Client_ Outcome_ Instrument 7 Number of Days REFUSED DON'T KNOW I_ I_ I 0 0 I_I_ I 0 0 I_I_I 0 0 I_I_I 0 0 I 0 0 Number of Days RFDK Route* RF DK 1_1_1 ° 0 I_I 0 0 I _ _ I __ .I o 0 I _ I 0 0 1_1_ 1 0 0 I_ I 0 0 I_I_ \ 0 0 I_I 0 0 I. ___ _I _ _ _ _I 0 0 \ _ I 0 0 \_\_1 0 0 \ __ _ \ 0 0 \_I_ \ 0 0 I_\ 0 0 \_I_ \0 0 \_\ 0 0 I \0 0 I_\ 0 0 I_\_ \ 0 0 I_\ 0 0 \_I_I 0 0 I_I 0 0 ' I_I_I 0 0 \_\ 0 0 \0 0 I_\ 0 0 1 _ _1 ___ \ o 0 \_\ 0 0 v6.0 Exhibit 9 B. DRUG AND ALCOHOL USE (continued) Route of Administration Types: 1. Oral 2. Nasal 3. Smoking 4. Non-IV injection 5. IV *NOTE THE USUAL ROUTE. FOR MORE THAN ONE ROUTE, CHOOSE THE MOST SEVERE. THE ROUTES ARE LISTED FROM LEAST SEVERE (1) TO MOST SEVERE (5). 2. During the past 30 days, how many days have you used any of the following: [IF THE VALUE IN ANY ITEM B2a THROUGH B2i > 0, THEN THE VALUE IN Blc MUST BE> 0./ Number of Days RFDK Route* RF DK g. l. Benzodiazepines: Diazepam (Valium); Alprazolam (Xanax); Triazolam (Halcion); and Estasolam (Prosom and Rohypnol- -also known as roofies, roche, and cope) 2. Barbiturates: Mephobarbilal (Mebacut) and pentobarbital sodium (Nembutal) 3. Non-prescription GHB (known as Grievous Bodily Harm, Liquid Ecstasy, and Georgia Home Boy) 4. Ketamine (known as Special Kor Vitamin K) 5. Other tranquilizers, downers, sedatives, or hypnotics h. Inhalants (poppers, snappers, rush, whippets) 1. Other illegal drugs (Specify) _____ _ _ ___ _ I_L_ I 0 0 1_1_ 10 1_1_ 10 I I 10 I _ I_ I 0 I_I_I 0 0 I_I 0 0 0 I_I 0 0 0 I_I 0 0 0 I_ I 0 0 0 I_.I 0 0 0 L_I 0 0 0 I_I 0 0 3. In the past 30 days, have you injected drugs? /IF ANY ROUTE OF ADMINISTRATION IN B2a THROUGH B2i = 4 or 5, THEN B3 MUST= YES./ 0 YES 0 NO 0 REFUSED 0 DON'TKNOW [IF NO, REFUSED, OR DON'T KNOW, SKIP TO SECTION C./ 4. In the past 30 days, how often did you use a syringe/needle, cooker, cotton, or water that someone else used? 0 Always 0 More than half the time 0 Half the time 0 Less than half the time 0 Never 0 REFUSED 0 DON'TKNOW SPARS_GPRA_Client_Outcome_Instrument 8 v6.0 Exhibit 9 C. FAMILY AND LIVING CONDITIONS 1. In the past 30 days, where have you been living most of the time? [DO NOT READ RESPONSE OPTIONS TO CLIENT./ 0 SHELTER (SAFE HAVENS, TRANSITIONAL LIVING CENTER [TLC], LOW-DEMAND FACILITIES, RECEPTION CENTERS, OTHER TEMPORARY DAY OR EVENING FACILITY) 0 STREET/OUTDOORS (SIDEWALK, DOORWAY, PARK, PUBLIC OR ABANDONED BUILDING) 0 INSTITUTION (HOSPITAL, NURSING HOME, JAIL/PRISON) 0 HOUSED: /IF HOUSED, CHECK APPROPRIATE SUBCATEGORY:/ 0 OWN/RENT APARTMENT, ROOM, OR HOUSE 0 SOMEONE ELSE'S APARTMENT, ROOM, OR HOUSE 0 DORMITORY/COLLEGE RESIDENCE 0 HALFWAY HOUSE 0 RESIDENTIAL TREATMENT 0 OTHER HOUSED (SPECIFY) ____ ___ __________ ___ _ _ 0 REFUSED 0 DON'TKNOW 2. How satisfied are you with the conditions of your living space'! 0 Very Dissatisfied 0 Dissatisfied 0 Neither Satisfied nor Dissatisfied 0 Satisfied 0 Very Satisfied 0 REFUSED 0 DON'TKNOW 3. During the past 30 days, how stressful have things been for you because of your use of alcohol or other drugs? /IF Bl a OR Bl c > 0, THEN C3 CANNOT= "NOT APPLICABLE."/ 0 Not at all 0 Somewhat 0 Considerably 0 Extremely 0 NOT APPLICABLE /USE ONLY IF BIA AND Bl C = 0./ 0 REFUSED 0 DON'TKNOW 4. During the past 30 days, has your use of alcohol or other drugs caused you to reduce or give up important activities? /IF Bla OR Blc > 0, THEN C4 CANNOT= "NOT APPLICABLE.''} 0 Not at all 0 Somewhat 0 Considerably 0 Extremely 0 NOT APPLICABLE /USE ONLY IF BIA AND Bl C = 0./ 0 REFUSED 0 DON'TKNOW SPARS_ GPRA _ Client_ Outcome_ Instrument 9 v6.0 Exhibit 9 C. FAMILY AND LIVING CONDITIONS (continued) 5. During the past 30 days, has your use of alcohol or other drugs caused you to have emotional problems? {IF BI a OR B 1 c > 0, THEN CS CANNOT= "NOT APPLICABLE.''] 0 Not at all 0 Somewhat 0 Considerably 0 Extremely 0 NOT APPLICABLE {USE ONLY IF Bla AND Blc = 0./ 0 REFUSED 0 DON'TKNOW 6. {IF NOT MALE/ Are you currently pregnant? 0 YES 0 NO 0 REFUSED 0 DON'TKNOW 7. Do you have children? 0 YES 0 NO 0 REFUSED 0 DON'TKNOW /IF NO, REFUSED, OR DON'T KNOW, SKIP TO SECTION D.J a. How many children do you have? /IF C7 = YES, THEN THE VALUE IN C7a MUST BE> 0./ I_I _ I 0 REFUSED O DON'T KNOW b. Arc any of your children living with someone else due to a child protection court order? 0 YES 0 NO 0 REFUSED 0 DON'T KNOW [IF NO, REFUSED, OR DON'T KNOW, SKIP TO ITEM CJD./ c. /IF YES] How many of your children arc living with someone else due to a child protection court order? [THE VALUE IN C7c CANNOT EXCEED THE VALUE IN C7a.J I _ I _ I 0 REFUSED O DON'T KNOW d. For how many of your children have you lost parental rights? [THE CLIENT'S PARENTAL RIGHTS WERE TERMINATED./ /THE VALUE IN ITEM C7d CANNOT EXCEED THE VALUE IN C7a.) 1_1_1 0 REFUSED O DON'T KNOW SPARS GPRA Client Outcome Instrument 10 v6.0 -- --·· - - Exhibit 9 D. EDUCATION, EMPLOYMENT, AND INCOME 1. Arc you currently enrolled in school or a job training program? {IF ENROLLED/ ls that full time or part time? {IF CLIENT IS INCARCERATED, CODE DJ AS "NOT ENROLLED."/ 0 NOT ENROLLED 0 ENROLLED, FULL TIME 0 ENROLLED, PART TIME 0 OTHER (SPECIFY) _______ ___ _ 0 REFUSED 0 DON'TKNOW 2. What is the highest level of education you have finished, whether or not you received a degree? 0 NEVERATTENDED 0 ISTGRADE 0 2NDGRADE 0 3RDGRADE 0 4THGRADE 0 5THGRADE 0 6THGRADE 0 7THGRADE 0 8THGRADE 0 9THGRADE 0 lOTHGRADE 0 1 lTHGRADE 0 12TH GRADE/HIGH SCHOOL DIPLOMA/EQUIVALENT 0 COLLEGE OR UNIVERSITY/I ST YEAR COMPLETED 0 COLLEGE OR UNIVERSITY/2ND YEAR COMPLETED/ASSOCIATES DEGREE (AA, AS) 0 COLLEGE OR UNIVERSITY/3RD YEAR COMPLETED 0 BACHELOR'S DEGREE (BA, BS) OR HIGHER 0 VOC/TECH PROGRAM AFTER HIGH SCHOOL BUT NO VOC/TECH DIPLOMA 0 VOC/TECH DIPLOMA AFTER HIGH SCHOOL 0 REFUSED 0 DON'TKNOW 3. Are you currently employed? {CLARIFY BY FOCUSING ON STATUS DURING MOST OF THE PREVIOUS WEEK, DETERMINING WHETHER CLIENT WORKED AT ALL OR HAD A REGULAR JOB BUT WAS OFF WORK./ {IF CLIENT JS "ENROLLED, FULL TIME" IN DJ AND INDICATES "EMPLOYED, FULL TIME" IN D3, ASK FOR CLARIFICATION. IF CLIENT JS INCARCERATED AND HAS NO WORK OUTSIDE OF JAIL, CODE D3 AS "UNEMPLOYED, NOT LOOKING FOR WORK.''/ 0 EMPLOYED, FULL TIME (35+ HOURS PER WEEK, OR WOULD HAVE BEEN) 0 EMPLOYED, PART TIME 0 UNEMPLOYED, LOOKING FOR WORK 0 UNEMPLOYED, DISABLED 0 UNEMPLOYED, VOLUNTEER WORK 0 UNEMPLOYED, RETIRED 0 UNEMPLOYED, NOT LOOKING FOR WORK 0 OTHER (SPECIFY) ___________ _ 0 REFUSED 0 DON'TKNOW SPARS_ GPRA _ Client_ Outcome_ Instrument 11 v6.0 Exhibit 9 D. 4. 5. E. 1. EDUCATION, EMPLOYMENT, AND INCOME (continued) Approximately, how much money did YOU receive (pre-tax individual income) in the past 30 days from ... {IF D3 DOES NOT= "EMPLOYED" AND TIIE VALUE IN D4a IS GREATER THAN ZERO, PROBE. IF D3 = "UNEMPLOYED, LOOKING FOR WORK" AND THE VALUE IN D4b = 0, PROBE. IF D3 = "UNEMPLOYED, RETIRED" AND THE VALUE IN D4c = 0, PROBE. IF DJ= "UNEMPLOYED, DISABLED" AND THE VALUE IN D4d = 0, PROBE./ RF DK a. Wages $ I_ J_I_I , I_I_J_I 0 0 b. Public assistance $ I_J_I_I, I_ I __ _I_ I 0 0 C. Retirement $ I_ I_ I_I, I_I_ I_I 0 0 d. Disability $ I_I_I_I, 1_1_1_1 0 0 e. Non-legal income $ I_I_I_J, L_ I_ I _ I 0 0 f. Family and/or friends $ I_ I_ I_J , I_ I_ I ___ I 0 0 g. Other (Specify) $ I_ I_ _ _.I_I , I_ I_ I __ J 0 0 Have you enough money to meet your needs? 0 Not at all 0 A little 0 Moderately 0 Mostly 0 Completely 0 REFUSED 0 DON'T KNOW CRIME AND CRIMINAL JUSTICE STATUS In the past 30 days, how many times have you been arrested? I_ I_ITIMES 0 REFUSED O DON'T KNOW {IF NO ARRESTS, SKIP TO ITEM E3.J 2. In the past 30 days, how many times have you been arrested for drug-related offenses? {THE VALUE IN E2 CANNOT BE GREATER THAN THE VALUE IN El.) I_I __ _I TIMES O REFUSED O DON'T KNOW 3. In the past 30 days, how many nights have you spent in jail/prison? [IF THE VALUE IN E3 IS GREATER THAN 15, THEN CJ MUST= INSTITUTION (JAIL/PRISON). IF CJ = INSTITUTION (JAIL/PRISON), Tl/EN THE VALUE IN E3 MUST BE GREATER THAN OR EQUAL TO 15.J I_I_I NIGHTS O REFUSED O DON'T KNOW 4. In the past 30 days, how many times have you committed a crime? [CHECK NUMBER OF DAYS USED ILLEGAL DRUGS IN ITEM Blc ON PAGE 7. ANSWER HERE IN E4 SHOULD BE EQUAL TO OR GREATER THAN NUMBER TN Blc BECAUSE USING ILLEGAL DRUGS IS A CRIME.) l_ l_~ _I TIMES O REFUSED O DON'T KNOW SPARS_ GPRA _ Client_ Outcome _Instrument 12 v6.0 Exhibit 9 5. Arc you currently awaiting charges, trial, or sentencing? 0 YES 0 NO 0 REFUSED 0 DON'TKNOW 6. Are you currently on parole or probation? 0 YES 0 NO 0 REFUSED 0 DON'TKNOW F. MENTAL AND PHYSICAL HEAL TH PROBLEMS AND TREATMENT/RECOVERY 1. How would you rate your overall health right now? 0 Excellent 0 Very good 0 Good 0 Fair 0 Poor 0 REFUSED 0 DON'T KNOW 2. During the past 30 days, did you receive: a. Inpatient Treatment for: [IF YES/ Altogether YES for how many nights NO RF I. Physical complaint 0 nights 0 0 ii .. Mental or emotional difficulties 0 nights 0 0 iii. Alcohol or substance abuse 0 nights 0 0 b. Outpatient Treatment for: [IF YES/ Altogether YES for how many times NO RF I. Physical complaint 0 times 0 0 ii. Mental or emotional difficulties 0 times 0 0 iii. Alcohol or substance abuse 0 times 0 0 c. Emergency Room Treatment for: [IF YES/ Altogether YES for how many times NO RF i. Physical complaint 0 times 0 0 ii. Mental or emotional difficulties 0 times 0 0 iii. Alcohol or substance abuse 0 times 0 0 SPARS_ GPRA _ Client_ Outcome_ Instrument 13 DK 0 0 0 DK 0 0 0 DK 0 0 0 v6.0 Exhibit 9 F. MENTAL AND PHYSICAL HEALTH PROBLEMS AND TREATMENT/RECOVERY (continued) 3. During the past 30 days, did you engage in sexual activity? 0 Yes 0 No -t [SKIP TO F4.J 0 NOT PERMITTED TO ASK -t [SKIP TO F4./ 0 REFUSED -t [SKIP TO F4./ 0 DON'T KNOW -t [SKIP TO F4.J [IF YES/ Altogether, how many: a. Sexual contacts (vaginal, oral, or anal) did you have? b. Unprotected sexual contacts did you have? [THE VALUE IN F3b SHOULD NOT BE GREATER THAN THE VALUE TN F3a./ [TF ZERO, SKIP TO F4./ c. Unprotected sexual contacts were with an individual who is or was: [NONE OF THE VALUES IN F3cl THROUGH F3c3 CAN BE GREATER Tl/ANTHE VALUE IN F3b.J 1. HIV positive or has AIDS 2. An injection drug user 3. High on some substance 4. Have you ever been tested for HIV? 0 Yes .......................... [GO TO F4a.J 0 No ........................... /SKIP TO F5.J 0 REFUSED ... .. ........ .{SKIP TO FS.J 0 DON'T KNOW ...... [SKIP TO FS.J a. Do you know the results of your HIV testing? 0 Yes 0 No SPARS_ GPRA _ Client_ Outcome_ Instrument 14 Contacts I_ I_I_I I_I_I_I I_I_I_ I 1_1_1_1 1_1_1_1 RF 0 0 0 0 0 DK 0 0 0 0 0 v6.0 Exhibit 9 F. MENTAL AND PHYSICAL HEALTH PROBLEMS AND TREATMENT/RECOVERY (continued) 5. How would you rate your quality of life? 0 Verypoor 0 Poor 0 Neither poor nor good 0 Good 0 VeryGood 0 REFUSED 0 DON'TKNOW 6. How satisfied are you with your health? 0 Very dissatisfied 0 Dissatisfied 0 Neither satisfied nor dissatisfied 0 Satisfied 0 V cry satisfied 0 REFUSED 0 DON'TKNOW 7. Do you have enough energy for everyday life? 0 Not at all 0 A little 0 Moderately 0 Mostly 0 Completely 0 REFUSED 0 DON'TKNOW 8. How satisfied are you with your ability to perform your daily activities? 0 Very Dissatisfied 0 Dissatisfied 0 Neither Satisfied nor Dissatisfied 0 Satisfied 0 Very Satisfied 0 REFUSED 0 DON'TKNOW 9. How satisfied are you with yourself? 0 Very Dissatisfied 0 Dissatisfied 0 Neither Satisfied nor Dissatisfied 0 Satisfied 0 Ve1y Satisfied 0 REFUSED 0 DON'TKNOW SPARS_ GPRA _ Client_ Outcome_ Instrument 15 v6.0 Exhibit 9 F. MENTAL AND PHYSICAL HEALTH PROBLEMS AND TREATMENT/RECOVERY (continued) 10. In the past 30 days, not due to your use of alcohol or drugs, how many days have you: Days RF DK a. Experienced serious depression I_I_I 0 0 b. Experienced serious anxiety or tension I_I_I 0 0 c. Experienced hallucinations I_I _ _I 0 0 d. Experienced trouble understanding, concentrating, or remembering I_I ___ I 0 0 e. Experienced trouble controlling violent behavior L _ __ I_I 0 0 f. Attempted suicide I__ _ _ I_I 0 0 g. Been prescribed medication for psychological/emotional problem I _ I_I 0 0 /IF CLIENT REPORTS ZERO DAYS, RF, OR DK TO Al.L ITEMS IN QUESTION FIO, SKIP TO ITEM F12.J 11. How much have you been bothered by these psychological or emotional problems in the past 30 days? 0 Not at all 0 Slightly 0 Moderately 0 Considerably 0 Extremely 0 REFUSED 0 DON'TKNOW VIOLENCE AND TRAUMA 12. Have you ever experienced violence or trauma in any setting (including community or school\ violence; domestic violence; physical, psychological, or sexual maltreatment/assault within or outside of the family; natural disaster; terrorism; neglect; or traumatic grief?) 0 YES 0 NO /SKIP TO ITEM F13.J 0 REFUSED 0 DON'TKNOW {IF NO, REFUS~ED, OR DON'T KNOW, SKIP TO ITEM Fl3.J SPARS_ GPRA _ Client_ Outcome_ Instrument 16 v6.0 Exhibit 9 F. MENTAL AND PHYSICAL HEALTH PROBLEMS AND TREATMENT/RECOVERY (continued) Did any of these experiences feel so frightening, horrible, or upsetting that, in the past and/or the present, you: 12a. Have bad nightmares about it or thought about it when you did not want to? 0 YES 0 NO 0 REFUSED 0 DON'TKNOW 12b. Tried hard not to think about it or went out of your way to avoid situations that remind you of it'! 0 YES 0 NO 0 REFUSED 0 DON'TKNOW 12c. Were constantly on guard, watchful, or easily startled? 0 YES 0 NO 0 REFUSED 0 DON'TKNOW 12d. Felt numb and detached from others, activities, or your surroundings? 0 YES 0 NO 0 REFUSED 0 DON'TKNOW 13. In the past 30 days, how often have you been hit, kicked, slapped, or otherwise physically hurt? 0 Never 0 A few times 0 More than a few times 0 REFUSED 0 DON'TKNOW SPARS_ GPRA _ Client_ Outcome_ Instrument 17 v6.0 Exhibit 9 G. SOCIAL CONNECTEDNESS 1. In the past 30 days, did you attend any voluntary self-help groups for recovery that were not affiliated with a religious or faith-based organization? In other words, did you participate in a non-professional, peer operated organization that is devoted to helping individuals who have addiction-related problems such as: Alcoholics Anonymous, Narcotics Anonymous, Oxford House, Secular Organization for Sobriety, or Women for Sobriety, etc.? 0 YES [IF YES] SPECIFY HOW MANY TIMES I_I_I O REFUSED O DON'T KNOW 0 NO 0 REFUSED 0 DON'TKNOW 2. In the past 30 days, did you attend any religious/faith-affiliated recovery self-help groups? 0 YES /IF YES] SPECIFY HOW MANY TIMES I_I_I O REFUSED O DON'T KNOW 0 NO 0 REFUSED 0 DON'TKNOW 3. In the past 30 days, did you attend meetings of organizations that support recovery other than the organizations described above? 0 YES [IF YES] SPECIFY HOW MANY TIMES I_I_I O REFUSED O DON'T KNOW 0 NO 0 REFUSED 0 DON'TKNOW 4. In the past 30 days, did you have interaction with family and/or friends that are supportive of your 0 YES 0 NO 0 REFUSED recovery? 0 DON'TKNOW 5. To whom do you turn when you are having trouble? [SELECT ONLY ONE.] 0 NOONE 0 CLERGY MEMBER 0 FAMILY MEMBER 0 FRIENDS 0 REFUSED 0 DON'TKNOW 0 OTHER (SPECIFY) _ _________ _ 6. How satisfied are you with your personal relationships? 0 Very Dissatisfied 0 Dissatisfied 0 Neither Satisfied nor Dissatisfied 0 Satisfied 0 Very Satisfied 0 REFUSED 0 DON'TKNOW SPARS_ GPRA _ Client_ Outcome_ Instrument 18 v6.0 Exhibit 9 I. FOLLOW-UP STATUS [REPORTED BY PROGRAM STAFF ABOUT CLIENT ONLY AT FOLLOW-UP./ 1. What is the follow-up status of the client? [THIS IS A REQUIRED FIELD: NA, REFUSED, DON'T KNOW, AND MISSING WILL NOT BE ACCEPTED./ 0 01 = Deceased at time of due date 0 11 ' Completed interview within specified window 0 12 = Completed interview outside specified window 0 21 = Located, but refused, unspecified 0 22 = Located, but unable to gain institutional access 0 23 = Located, but otherwise unable to gain access 0 24 = Located, but withdrawn from project 0 31 = Unable to locate, moved 0 32 = Unable to locate, other (Specify) ---------- 2. Is the client still receiving services from your program? 0 Yes 0 No [IF THIS IS A FOLLOW-UP INTERVIEW, STOP NOW; THE INTERVIEW IS COMPLETE.] SPARS_ GPRA _ Client_ Outcome_ Instrument 19 v6.0 Exhibit 9 J. DISCHARGE STATUS [REPORTJ:,'JJ BY PROGRAM STAFF ABOUT CLIENT ONLY AT DISCHARGE.] 1. On what date was the client discharged? I._I_I/I_I_I/I_ I_I_~~ MONTH DAY YEAR 2. What is the client's discharge status? 0 01 = Completion/Graduate 0 02 = Termination If the client was terminated, what was the reason for termination? /SELECT ONE RESPONSE.] 0 01 = Left on own against staff advice with satisfactory progress 0 02 = Left on own against staff advice without satisfactory progress 0 03 = Involuntarily discharged due to nonparticipation 0 04 = Involuntarily discharged due to violation of rules 0 05 = Referred to another program or other services with satisfactory progress 0 06 ' "' Referred to another program or other services with unsatisfactory progress 0 07 = Incarcerated due to offense committed while in treatment/recovery with satisfactory progress 0 08 = Incarcerated due to offonsc committed while in treatment/recovery with unsatisfactory progress 0 09 = Incarcerated due to old wan·ant or charged from before entering treatment/recovery with satisfactory progress 0 10 = Incarcerated due to old warrant or charged from before entering treatment/recovery with unsatisfactory progress 0 11 = Transferred to another facility for health reasons 0 12 = Death 0 13 = Other (Specify) ____________ _ 3. Did the program test this client for HIV? 0 Yes 0 No [SKIP TO SECTION K.] [GO TO J4.] 4. [IF NO] Did the program refer this client for testing? 0 Yes 0 No SPARS_ GPRA _ Client_ Outcome_ Instrument 20 v6.0 Exhibit 9 K. SERVICES RECEIVED [REPORTED BY PROGRAM STAFF ABOUT CLIENT ONLY AT DISCHARGE.] Identify the number of DA VS of services provided to the client during the client's course of treatment/recovery. {ENTER ZERO IF NO SERVICES PROVIDED. YOU SHOULD HAVE AT LEAST ONE DAY FOR MODALITY./ Modality Days 1. Case Management 1 __ 1_1_1 2. Day Treatment 1 _1_1_1 3. Inpatient/Hospital (Other Than Detox) 1_1 _1_ 1 4. Outpatient I_I_I_ I 5. Outreach I_I __ _ J_ I 6. Intensive Outpatient I I_ I 7. Methadone I _ J_I_ I 8. Residential/Rehabilitation I_I_I_I 9. Detoxification (Select Only One): A. Hospital Inpatient L_I _ I __ I B. Free Standing Residential I_I _ L _ I C. Ambulatory Detoxification I_I_ I_ I 10. After Care I_I_ I_I 11. Recovery Support I_I_ I_ I 12. Other (Specify) I_I_I_ I Identify the number of SESSIONS provided to the client during the client's course of treatment/ recovery. {ENTER ZERO IF NO SERVICES PROVIDED.] Treatment Services Sessions {SB/RT GRANTS: YOU MUST HAVE AT LEAST ONE SESSION FOR ONE OF THE TREATMENT SERVICES NUMBERED I THROUGH 4.J 1. Screening I I I_I 2. Bricflntervention I_I_ I_ I 3. BriefTreatment I __ I _ I_ I 4. 5. 6. 7. 8. Referral to Treatment Assessment Treatment/Recovery Planning Individual Counseling Group Counseling 9. Family/Marriage Counseling l 0. Co-Occurring Treatment/Recovery Services 11. Pharmacological Interventions 12. HIV/AIDS Counseling 13. Other Clinical Services (Specify) ______ _ _ I_I_I_I I_L_I_I 1_1_1_1 1_1_1_ 1 1 _ 1 _ 1 _ 1 I ___ I _ I_ I I_I_I_I I_I _ I_ \ 1._ 1 _ 1 _ 1 I_I_.I__I SPARS_ GPRA _ Client_ Outcome_ Instrument 21 Case Management Services I. Family Services (Including Ma1Tiage Education, Parenting, Child Development Services) 2. Child Care 3. Employment Service A. Pre-Employment B. Employment Coaching Individual Services Coordination 4. 5. Transportation 6. HIV/AIDS Service 7. Supportive Transitional Drug-Free Housing Services 8. Other Case Management Services (Specify) _ ______ _ Medical Services I . Medical Care 2. Alcohol/Drug Testing 3. HIV/ AIDS Medical Support & Testing 4. Other Medical Services (Specify) _ ____ __ _ After Care Services 1. Continuing Care 2. Relapse Prevention 3. Recovery Coaching 4. Self-Help and Support Groups 5. Spiritual Support 6. Other After Care Services (Specify) _______ _ Education Services 1 . Substance Abuse Education 2. HIV/AIDS Education 3. Other Education Services (Specify) _ _ _____ _ Sessions I _ \ _ I. __ J I_ I_ L __ I I _ _I_ _ ___ I_\ I _ L._I_I L__I_I_ \ I_ I_ \ __ J I_I_I_ _ _ I I _ I_ __ __I_I 1 _1_ 1_1 Sessions L _ I_I _ _ I I I L _ I 1 _1 __ 1_1 1 _ _ 1 _ 1 _ 1 Sessions I_I_I_I I I I I 1_1_1_1 I_I_I_I \_L_ I _ \ 1_1 _1_1 Sessions I_\_ I_I I_I_I_\ 1_1_ 1_1 Peer-to-Peer Recovery Support Services Sessions l. Peer Coaching or Mentoring I_I_I_I 2. Housing Support I _ _ I_I_I 3. Alcohol- and Drug-Free Social Activities I_I_I_I 4. Information and Referral I I I_I 5. Other Peer-to-Peer Recovery Support Services (Specify) ____ _ _ 1_1_1_1 v6.0 Exhibit 10 EXHIBIT I COUNTY OF LOS ANGELES - DEPARTMENT OF PUBLIC HEAL TH COMMUNITY ENGAGEMENT FOR ENDING THE HIV EPIDEMIC IN LOS ANGELES COUNTY WORK ORDER NUMBER: CES-WOS-003 PROPOSAL SUBMISSION CHECKLIST PROPOSER'S NAME: Los Angeles County - University ofSouthcm California Center Medical Foundation, Inc. (fiscal sponsor for AMAAD The purpose of this document is to ensure that Proposer has submitted all applicable sections, forms, exhibits, attachments, etc. with its proposal. Please check the appropriate box: Proposer has completed and submitted the following: Section 2.7.2 One (1) electronic copy of entire proposal. Section 2.6.1 Table of Contents Section 2.6.2 Proposal Content, Section A - Proposer's Qualification • Proposal Submission Checklist (Exhibit I) • Proposal Transmittal Form (Exhibit II) • Proposer's Affidavit of Adherence to Minimum Mandatory Requirements (Exhibit 111) Section 2.6.2 Proposal Content, Section B - Proposer's Experience (3 pages max) Section 2.6.2 Proposal Content, Section C - Proposer's Approach to Required Services (3 pages max.) Section 2.6.2 Proposal Content Section D - Proposer's Staffing Plan (1 page max) • Proposer's Personnel (Exhibit IV) Section 2.6.2 Proposal Content, Section E - Proposer's Social Distancing Plan (1 page max) Section 2.6.2 Proposal Content, Section F - Proposer's Data Reporting Plan (1 page max) Section 2.6.2 Proposal Content. Section G - Proposer's Evaluation and Quality Management Plan (2 pages max) Section 2.6.2 Proposal Content, Section H - Required Fonns • Exhibit V, Proposer's Budget • Exhibit VI, Acceptance of Terms and Conditions Affirmation • Exhibit VII, Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions (45 C.F.R. Part 76) 1/07/2021 Signatur'e of Authorized Representative of Vendor/Contracting Entity Date Rosa Soto Executive Director Print Name Title G2JYes D No i \ BYes D No G Yes D No B Yes D No BYes D No 0Yes O No l:;;1 Yes D No BYes O No B Yes D No ~Yes LI No Bl Yes D No BYes □ No BYesONo BYes D No I Exhibit 10 EXHIBIT II COUNTY OF LOS ANGELES - DEPARTMENT OF PUBLIC HEAL TH COMMUNITY ENGAGEMENT FOR ENDING THE HIV EPIDEMIC IN LOS ANGELES COUNTY WORK ORDER NUMBER: CES-WOS-003 PROPOSER'S TRANSMITTAL FORM PROPOSER'S NAME: Los Angeles County- University of Southern California Medical Center Foundation, Inc. (fiscal sponsor for AMAAD) PROPOSER'S ADDRESS: _1_2_o_o_N_. _s1a_t_e_S_tr_ee_t ________________ s_u_it_c_10_0_ 8 ___ _ Street Suite Los Angeles CA 90012 City State Zip Code PROPOSER'S AUTHORIZED REPRESENTATIVE: Please provide the below information as it relates to Proposer's authorized representative. Proposer's authorized representative must be authorized to sign on behalf of the Proposer, able to make representations for the Proposer during contract negotiations, and able to legally bind the Proposer to any resultant MAWO. Rosa Soto Authorized Representative: _____________________ _ Executive Director Title: ____________________________ _ Address: 1200 N. State Street Street Los Angeles CA Suite 1008 Suite 90012 City State Zip Code TELEPHONE NUMBER: (213) 784 - 9252 --- --------- FAX NUMBER: ___ _ ____ _ _ EMAIL ADDRESS: __ ro_s_a_@_la_c_us_c_fo_un_da_Li_on_.o_r_g _____________ _ PROPOSER'S CONTACT PERSON: Please provide the below information as it relates to Proposer's contact person. Proposer's contact person will serve as the Proposer's main contact with the County for any matters related to this WOS. Contact Representative: _c_ar_l _H_ig_h_sh_a _w_, o_sw_-c_,_M_s_w ____________ _ Title: AMAAD Director/ Program Manager Address: 10221 S. Compton Ave., Suite 105 Street Suite Los Angeles CA 90002 City State Zip Code TELEPHONE NUMBER: (323) 569- 1610 FAX NUMBER: ________ _ EMAIL ADDRESS: carl@amaad.org ------------------------ CONTRACTING AFFIRMATION: □ Proposer intends to solely perform the duties of the MAWO as defined in Attachment A (Statement of Work) and Attachment B (Scope of Work); OR Proposer intends to act as a fiscal sponsor and duties of the MAWO as defined in Attachment A (Statement of Work) and Attachment B (Scope of Work) will be performed by the Service Provider. flf Service Provider Name: AMAAD Duties: Community Engagement Services for HIV Service Provider Name: Duties: Service Provider Name: Duties: Exhibit 10 EXHIBIT 111 COUNTY OF LOS ANGELES- DEPARTMENT OF PUBLIC HEALTH COMMUNITY ENGAGEMENT FOR ENDING THE HIV EPIDEMIC IN LOS ANGELES COUNTY WORK ORDER NUMBER: CES-WOS-003 PROPOSER'S AFFIDAVIT OF ADHERENCE TO MINIMUM MANDATORY REQUIREMENTS NOTE: Completion of this form without sufficient details to substantiate that Proposer meets the minimum mandatory requirements as outlined in Section 1.10, Minimum Mandatory Requirements and/or any inconsistencies or inaccuracy in the information provided in this form, or this form and your proposal, may subject your bid to disqualification or other action, at the sole discretion of the County. Proposer acknowledges and certifies that on the day on which the proposals are due, it meets and will comply with all of the Minimum Mandatory Requirements listed In Section 1.10 - Minimum Mandatory Requirements, of this Work Order Solicitation (WOS), as listed below. Please check the appropriate boxes: Section 1.10.1 Section 1.10.2 Section 1.10.3 Master Agreement: Proposer must have a current executed DPH Master Agreement for Community Engagement Services and Related Services DPH Master Agreement Number: _P_H_-_0_0_4_0_5_5 __ Contract Status: Proposer must not be debarred, suspended, or excluded from securing United States Federal Government (federal), State of California (State) and/or County contracts at the time of the proposal submission due date @Yes 0No @Yes 0No Unresolved Disallowed Costs: If a Proposer's compliance with a County contract has been reviewed by the Department of the Auditor-Controller within the last 10 years, Proposer must not have unresolved questioned costs identified by the Auditor-Controller in an amount over $100,000 that are confirmed to be disallowed costs by the contracting County department and remain unpaid for a period of six months or more from the date of disallowance, unless such disallowed costs are the subject of current good faith negotiations to resolve the disallowed costs, in the opinion of the County. County will verify that Proposer does not have unresolved disallowed cost. e) Proposer does not have unresolved disallowed costs as explained above. D Proposer has unresolved disallowed costs as explained above. Page 1 of 5 Exhibit 10 EXHIBIT Ill COUNTY OF LOS ANGELES - DEPARTMENT OF PUBLIC HEAL TH COMMUNITY ENGAGEMENT FOR ENDING THE HIV EPIDEMIC IN LOS ANGELES COUNTY WORK ORDER NUMBER: CES-WOS-003 PROPOSER'S AFFIDAVIT OF ADHERENCE TO MINIMUM MANDATORY REQUIREMENTS Section 1.10.4 Experience (Community Engagement and Mobilization: Proposer must have a minimum of three (3) years experience within the last five (5) years implementing community engagement and mobilization programs focused on health equity and social justice. Check the appropriate box: 0 Yes. Proposer does meet the experience requirement stated above. D No. Proposer does not meet the experience requirement stated above. Proposer must document their experience below that clearly demonstrates ability to meet the above-referenced requirement. Provide dates, names of agencies/departments in which Proposer provided the required service that substantiates Proposer meets the above-referenced requirement (attach additional sheets as necessary). Indicate Years of Experience from 0l/2016 to ---- 01/2021 mm/yr. mm/yr. Describe experience here. Established in 1988, the The LAC+USC Medical Center Foundation's (Foundation) mission is to support and enhance the mission of the LAC+USC Medical Center (Medical Center) and ensure that ii maintains its status as a leader in health and medicine, community care, education, research, patient care, and community well-being. For more than 30 years, the Foundation has served as a strategic partner to the County and the medical center on a range of projects that are mission-aligned, collaborative, systems-oriented, and designed to support community health in a culturally competent manner. In 2014, the Foundation opened its first in class Wellness Center, a community beacon rich in services that address the social determinants of health and has deep ties in our local community and with more than 100 community-based organizations to maximize its reach and impact. The core functions of the Foundation's work, and that of our partner - the AMMO Institute, are community engagement, collaboration, and relationship and trust-building. The Foundation and AMMO team works with those most affected in shaping the decisions that will impact their health and wellbeing. The Foundation and AMMO team has years of demonstrated success in soliciting input from community members to understand their needs, interests, and priorities, and to develop solutions to address those needs. The Foundation approach to effective community engagement consists of 1) creating bidirectional communication channels that empower residents to share their perspectives, 2) work with residents to learn and additional information to make their decisions, and 3) to include residents in future discussions that impact their communities and wellbeing. These communications include not only notifications promoting health and safety and opportunities for community dialogue, but also developing resident leadership potential to act as agents of change in the community. The Foundation and AMMD's approach to implementing community engagement reflects a commitment to hear community voices and embrace, consider, and act upon community feedback, with a report back to residents and stakeholders to acknowledge the actions taken. The Foundation has received multiple grants from the California Endowment since 2014 to conduct community outreach, engagement and coalition building activities with the desired outcome to generate policy, systems and environmental changes to improve health equity and social justice. In 2017, the Foundation received a contract with the LA County Board of Supervisors to create and support the Health Innovation Community Partnership (HICP) to provide residents and stakeholders of LA's eastside communities a voice in developing a healthier eastside community. In 2019, the Foundation was awarded a contract to conduct community outreach and engagement activities focused on the LA County Department of Public Works' numerous development projects on and around the medical center campus. Finally, in 2019, the Foundation received a contract from the LA County CEO to conduct community outreach and engagement activities relative to the County's General Hospital Reuse Feasibility study. Page 2 of 5 Exhibit 10 EXHIBIT Ill COUNTY OF LOS ANGELES - DEPARTMENT OF PUBLIC HEALTH COMMUNITY ENGAGEMENT FOR ENDING THE HIV EPIDEMIC IN LOS ANGELES COUNTY WORK ORDER NUMBER: CES-WOS-003 PROPOSER'S AFFIDAVIT OF ADHERENCE TO MINIMUM MANDATORY REQUIREMENTS Section 1.10.5 Recruitment Experience: Proposer must have a minimum of two (2) years of experience within the last five (5) years recruiting cohorts to participate in a community engagement project related to improve health outcomes related to identified public health issues. Check the appropriate box: @'Yes. Proposer does meet the experience requirement stated above. D No. Proposer does not meet the experience requirement stated above. Proposer must document their experience below that clearly demonstrates ability to meet the above-referenced requirement. Provide dates, names of agencies/departments in which Proposer provided the required service that substantiates Proposer meets the above-referenced requirement (attach additional sheets as necessary). Indicate Years of Experience from 01 /2016 to 01 1 2021 mm/yr. mm/yr. Describe experience here. The Foundation supports the community it serves through project management, fund development, public service, community engagement, and patient care and education, achieved through coordinated commitment from funders, community partners, residents, and stakeholders. Foundation activities focus on addressing health inequities through developing systems, programs, campaigns and policies that empower vulnerable populations to achieve and maintain their best health. Current Foundation projects include The Wellness Center at Historic General Hospital (TWC), Boyle Heights-Building Healthy Communities (BH-BHC), Health Innovation Community Partnership (HICP, and the California Accountable Communities for Health Initiative. The Foundation's flagship community benefit program is TWC, a community resource hub on the Medical Center campus that houses and coordinates services from more than 23 community-based organizations to serve in excess of 15,000 unique clients. The Foundation helms the California Endowment's BH-BHC collaborative of 24 community organizations working towards a comprehensive vision of community health and equity. BH-BHC emphasizes authentic development of adult and youth voices and community capacity-building to create policy and systems changes to improve health and wellbeing outcomes in historically undeserved communities. The Foundation also manages HICP, a coalition of residents, 40-plus community organizations, County agencies, and anchor institutions designed to inform local development planning and community benefit. The Foundation has been deeply involved for many years in community engagement and advocacy for health equity, chronic disease prevention and management, and substance abuse programs. The Foundation has received multiple grants from the California Endowment since 2014 to fund health and wellness programs that address the social determinants of health to improve health and wellbeing outcomes for underserved communities. In 2017, the Foundation received a contract with the LA County Board of Supervisors to create and support the Health Innovation Community Partnership (HICP) to provide residents and stakeholders of LA's eastside communities a voice in developing a healthier eastside community. HICP currently is focused on address Adverse Childhood Experiences (ACEs) in families with children ages 0-5 to improve health and wellness outcomes in future generations. In 2019, the Foundation was awarded a contract to conduct community outreach and engagement activities focused on the LA County Department of Public Works' numerous development projects on and around the medical center campus with a focus on ensuring these projects provide health and economic benefits for the local community while minimizing gentrification, displacement and environmental harm. Finally, in 2019, the Foundation received a contract from the LA County CEO to conduct community outreach and engagement activities relative to the County's General Hospital Reuse Feasibility study with the goal of ensuring any final plan for the reuse of the Historic General Hospital includes programs and/or facilities that will benefit the community through economic and workforce development, increased access to health and wellness services, and improve the community's access to open, green and/or public space for recreation and community gathering. Page 3 of 5 Exhibit 10 EXHIBIT 111 COUNTY OF LOS ANGELES - DEPARTMENT OF PUBLIC HEALTH COMMUNITY ENGAGEMENT FOR ENDING THE HIV EPIDEMIC IN LOS ANGELES COUNTY WORK ORDER NUMBER: CES-WOS-003 PROPOSER'S AFFIDAVIT OF ADHERENCE TO MINIMUM MANDATORY REQUIREMENTS Section 1.10.6 Recruitment Approach Experience: Proposer must have a minimum of one (1) year of experience within the last three (3) years utilizing the Community Based Participatory Research (CBPR) approach and/or Youth Participatory Action Research (YPAR) framework. Check the appropriate box: IZ1 Yes. Proposer does meet the experience requirement stated above. 0 No. Proposer does not meet the experience requirement stated above. Proposer must document their experience below that clearly demonstrates ability to meet the above-referenced requirement. Provide dates, names of agencies/departments in which Proposer provided the required service that substantiates Proposer meets the above-referenced reqwi·ement (attach additional sheets as necessary). Indicate Years of Experience from 0112016 to ----- 01/2021 mm/yr. mm/yr. Describe experience here. The Foundation and AMMO team has years of experience with utilizing the Community Based Participatory Research (CBPR) approach and/or Youth Participatory Action Research (YPAR) framework in our work to address numerous issues from creating healthy food and beverage environments to conducting exploratory research for technology use and preferences for mobile phone-based HIV prevention and treatment among Black Young Men Who Have Sex with Men (YMSM). Most recently, in 2018, the Foundation and AMMO team was awarded contract by the Los Angeles County Department of Public Health - Tobacco Control Prevention Program to implement a Policy Adoption Model (PAM)-based campaign in the following four (4) funding categories: 1) Reduce Youth Access to Tobacco Products: New Tobacco Retail Licenses; 2) Reduce Youth Access to Tobacco Products: Strengthen Tobacco Retail Licenses; 3) Reduce Exposure to Secondhand Smoke in Multi-Unit Housing; and 4) Reduce Exposure to Secondhand Smoke in Outdoor Areas. Funded activities include recruit, train and support adults and youth to take leadership roles within their communities to achieve desired outcomes. Activities include: • Conduct a Community Assessment to collect much-needed data that will identify and document local problems and issues to educate and inform key policy/decision makers. Data collection includes conducting key informant interviews and more than 1,000 public opinion surveys from residents in four age groups ages 18 and older. • Develop and implement a Policy Campaign Strategy that will inform the development of an educational campaign strategy to inform policy/decision makers, community stakeholders, local business owners and local residents of the importance and benefits to proposed policies. • Facilitate Coalition Building/Broadening to build and/or broaden a local, issue-based community coalition by recruiting and training residents and stakeholders to inform and support the development of campaign strategy and goals, take lead within the community to implement campaign activities, and ensure that adopted policy changes will be implemented moving forward. • Conduct Policy Campaign Implementation activities to provide education and information at meetings with policy/decision makers and conduct educational presentations at public meetings to inform the broader community. • Develop and implement a Policy Implementation and Enforcement plan to ensure that the provisions of the policy are implemented and enforced in the selected jurisdiction. Page 4 of 5 Exhibit 10 EXHIBIT Ill COUNTY OF LOS ANGELES - DEPARTMENT OF PUBLIC HEAL TH COMMUNITY ENGAGEMENT FOR ENDING THE HIV EPIDEMIC IN LOS ANGELES COUNTY WORK ORDER NUMBER: CES-WOS-003 PROPOSER'S AFFIDAVIT OF ADHERENCE TO MINIMUM MANDATORY REQUIREMENTS Proposer further acknowledges that if any false, misleading, incomplete. or deceptively unresponsive statements in connection with this Proposal are made, the Proposal may be rejected. The evaluation and determination in this area shall be at the Director's sole judgment and his/her judgment shall be final. On behalf of (Proposer's Name) Los Angeles County - University or s,,ulhe.rn Ca lifornia Medical Center Foundation, Inc. (fiscal sponsor for i\MA/\1)) I, (Proposer's Authorized Representative) Rosa Soto hereby certify that. this Proposer's Affidavit is true and correct to the best of my information and belief. ,/" ., ) I) j Signature \/z-;<-- .. ✓--t?J'.:? _ -· ___ _ _ _ _ _ __ -· _____ Title Executi vc Di retor i . ----------- , / Page 5 of 5 Exhibit 10 B. Proposer's Experience (Community Engagement and Mobilization The LAC+USC Medical Center Foundation, Inc. is a 501 (c)(3) nonprofit established in 1988 to support and enhance the mission of the LAC+USC Medical Center and ensure it maintains its status as a leader in health and medicine, community care, education, and research, and provide the highest caliber of care to patients and members of the community. A part of the Foundation's role includes serving as a collaborator and nonprofit fiscal sponsor for public education service and engagement activities involving leaders, stakeholders, and the community as it strives to address issues of health equity. With this charge, the Foundation is ideally positioned to serve as fiscal sponsor of Arming Minorities Against Addiction and Disease (AMAAD) to "conduct community engagement, outreach, and mobilization throughout the County of Los Angeles to help implement the strategies and help reach the goals of the national initiative, Ending the HIV Epidemic (EHE): A Plan for America" as described in Work Order Solicitation (WOS) Number CES-WOS-003: Community Engagement for Ending the HIV Epidemic In Los Angeles County. In addition to the role as fiscal sponsor, the Foundation's Wellness Center at the Historic General Hospital will serve as a key AMAAD partner site located in L.A.'s eastside community of Boyle Heights. The AMAAD Institute, a local grassroots community-based organization (CBO) whose mission is "to facilitate personalized individual access to programs and services that foster safe and supportive healthy environments for people to live, learn, and develop to their fullest potential" is perfectly aligned in partnership with the Foundation to facilitate the activities prescribed in the identified WOS. The AMMO Institute has had uninterrupted experience mobilizing and coordinating local residents, stakeholders and cohort groups targeting youth (12-29 years old), Black/African American, Latinx, transgender persons, and gay and bisexual men, and persons who use methamphetamine/inject drugs since the organization was founded. Today, the entity operates from four independently controlled sites strategically located in the surrounding LAC community: 1) AMMO-Watts Office is located in the Watts Civic Center which is considered ground zero of the 1965 Watts Rebellion, 2) AMMO Inglewood Office which is located in the Crenshaw/Imperial Plaza along an iconic community throughfare, 3) AMAAD-Resiliency House, a transitional residential living facility is nestled in the historic King Estates Neighborhood, and 4) AMAAD-Gibson House, a permanent supportive housing facility that is convenient to the Historic South Central area. The agency is also co-located at two distinct Employment Training sites as part of a multi-agency collaborative partnership effort, with one site at Los Angeles Trade and Technical College (LATTC) near downtown L.A. and the other at Watts Labor Community Action Coalition (WLCAC) in the southeast area of L.A. Additionally, within the past year, the AMAAD Institute has fully implemented a seamless virtual office platform that was necessary to manage COVID-19 public health concerns. The organization's mainstay activities are centered around peer-based engagement and support services while having a solidly connected community footing. In the earlier formative years of the AMAAD Institute, organizers primary faciliated informal community engagement and support with no dedicated financial resources. In 2015, after nearly two decades of working within other formalized health and human service agency structures, including the Division of HIV and STD Programs (DHSP), the AMAAD Institute secured private seed funding to establish a dedicated office located in the heart of LAC, which is the South L.A. neighborhood of Watts that is internationally known for a historic civic community uprising which was the result of prolonged systemic injustices. Since then, the AMAAD Institute has 1 Exhibit 10 EXHIBIT IV COUNTY OF LOS ANGELES - DEPARTMENT OF PUBLIC HEAL TH COMMUNITY ENGAGEMENT FOR ENDING THE HIV EPIDEMIC IN LOS ANGELES COUNTY WORK ORDER NUMBER: CES-WOS-003 PROPOSER'S PERSONNEL PROPOSER'S NAME: Los Angeles County-Unvcrsity of Southern California Medical Center Foundation, Inc. (fiscal sponsor for AMAAD) Please provide the information below that specifically identifies the Proposer's Project Manager, Evaluation Services subcontractor and other key individuals assisting in this project, including any other proposed subcontractors. Proposer may assign up to two (2) subcontractors (optional) to provide the requested Community Engagement Evaluation Services and or as needed services. Proposer must assign personnel who possess the background and experience necessary to successfully complete this project. Please refer to Attachment A, Statement of Work for experience requirements. Attach additional pages if necessary. There is no page limit. Carl Highshaw, DSW-C, MSW AMAAD Director/ Project Manager Years of Experience from 01/2016 to 0112021 ------- mm/ r mm/ r Describe experience: Highshaw has many w1interupted years of experince developing, implementing, & monitoring community engagement activities. Since 2015 he has developed several essentail support services that are supported with a broad funding portfolio at AMAAD. Prior to that, he served as the Deputy Director ofln The Meantime Men's Group, responsible for community HIV testing and health education and risk reduction. Previous roles include Contract Program Auditor at DHSP, Director ofLBLGP, Inc., and Community Outreach Directoer for L.A. LGBT Center. He completed MSW at Washington University, B.S. Psychology from Western Illinois University, & is scheduled to complete Doctor of Social Work degree at USC in May Percentage oftime on requested services: __ i_ .o_F_T_E _____________ _ Phone Number: ___ (_32_3_) _56_9_-1_6_10 ____________________ _ Email Address: carl@amaad.org Subcontractor Evaluation Services Name: Title: Keith Green, PhD (Resilient Solutions) Evaluator / Consultant Personnel Describe experience: Dr. Keith Green is an assistant professor at the Loyola University Chicago's School of Social Work with strong community roots and an extensive history as an HIV organizer, educator, researcher, and advocate. Since 2008, Dr. Green has lead and published several community participatory researech project articles related to Urban Health and Health Disparities; Health Policy; Social Determinants of Health; Sexual Health: Substance Use and Abuse; HIV/AIDS Prevention and Intervetion; Implementation Science; Social Welfare Policy; Human Service Organizations; Community Organizing; and Social Enterprise.He graduated summa cwn laude from Northeastern Illinois University with a Bachelor of Arts degree in Social Work, where be was also named a Ronald E. McNair Scholar. From then:, he earned a Master of Social Work degree from the University of Wisconsin-Madison, with a specific focus on the needs of people living with severe and persistent mental illness. Prior to earning a PhD in Social Service Administration from the University of Chicago, Dr. Green served as an associate editor for Positively Aware magazine and as director of federal affairs for the AIDS Foundation of Chicago. Percentage of time on requested services: __ s_u_h_cu_n_tr_a_ct_l_C_o_n_su_lt_an_t ________ _ Phone Number: ( 773 ) 562 - 6872 ------------------------------ Email Address: swkgrecn@grnail.com Page 1 of 2 Exhibit 11 ~ Plib1i~ 0 H88iih BARBARA FERRER, Ph.D., M.P.H,, M,Ed. Director MUNTU DAVIS, M.D., M.P.H, County Heollh O!ficer MEGAN McCLAIRE, M.S.P.H. Chiel Depuly Director AKIKO TAGAWA Aclinq Deputy Director. Operotiom Suppof! Bureau KAREN BUEHLER tnlerirn Chief. Conlrocts ond Gronls Di•1ision 5555 Fergu;on Drive, Se,ile 210, '120~0-l Commerce. CA 90022 TEL (323) 91 ,1-7478 • FAX (323} 838-8356 Y,, .YfytJ;>Ublk: ileallh.loc ounly.qov March 3, 2021 Rosa Soto, Executive Director BOARD Of SUPERVISORS HIida L. Soll, f·irst Disuic: Holly J. Mitchell SH<:ond f)is!flcl Sholla Kuehl H, ir<:J DisHict Janice Hohn i'ovrlh CisHk: t Kath1yn Barge, rnm t)is:iici Los Angeles County - University of Southern California Medical Center Foundation , Inc. 1200 North State Street, Suite 1008 Los Angeles, California 90012 Dear Ms. Soto: WORK ORDER SOLICITATION NUMBER CES-WOS-003 FOR COMMUNITY ENGAGEMENT FOR ENDING THE HIV EPIDEMIC IN LOS ANGELES COUNTY Thank you for submitting a Work Order Proposal in response to Work Order Solicitation (WOS) Number CES-WOS-003 for Community Engagement for Ending the HIV Epidemic in Los Angeles County, issued by the County of Los Angeles Department of Public Health (Public Health) on December 1, 2020. This is to inform you that the evaluation committee has completed proposal evaluations and, as a result, Public Health intends to recommend your agency to the County Board of Supervisors (Board) for Master Agreement Work Order (MAWO) award in the amount of$ 2,333,333. The award includes funding in the amount of $333,333 for the term starting date of execution through July 31 , 2021, and $1 ,000,000 respectively for the periods of August 1, 2021 through July 31, 2022 and August 1, 2022 through July 31 , 2023. Public Health anticipates recommending your agency to the Board in April 2021. Please note that the Board makes the final decision on the MAWO award, as stated in the WOS, Section 1.9, Final Contract Award by the Board of Supervisors. Prior to Public Health recommending your agency to the Board, a Letter of Intent (LOI) , similar to the attached document in Word (Attachment I), must bEp submitted by March 8, Exhibit 11 Soto, Rosa March 3, 2021 Page 2 of 2 2021 . Please e-mail in PDF the signed Letter of Intent on agency letterhead to Jose Cueva, at jcueva@ph.lacounty.gov Upon receipt of the signed LOI, Public Health's Division of HIV and STD Programs (DHSP) staff will contact you within two business days to initiate negotiations, which includes submission of budget forms and client goals for this MAWO. Budget forms and client goals will be needed for each period . Please note Period 1 of the MAWO is about four months, and budgets and goals should be aligned accordingly. If your agency and Public Health cannot successfully negotiate the final terms of the MAWO, Public Health may terminate negotiations with your agency . Public Health looks forward to working with your agency and to a successful negotiation process. Public Health anticipates services will begin April 2021. However, this is contingent upon the timely submission of the signed Letter of Intent and required contract documents. For questions regarding the forthcoming contract negotiation documents, please contact Paulina Zamudio, Chief, Contracted Community Services, DHSP, by email at pzamudio@ph.lacountv.gov. If you have any questions, or need additional information regarding this solicitation process, please contact Jose Cueva, Contract Analyst, by email at jcueva@ph.lacounty.gov. Again, thank you for your interest in contracting with the County of Los Angeles. We look forward to working with your agency. Sincerely, Karen Buehler, Interim Chief Contracts and Grants Division KB:jc #05511 Attachment The AMAAD Institute - Organizational Chart March 2021 Carl Highshaw, M .S.W. Chief Executive Officer Reports to Board of Directors Gerald Garth I Director of Operations I I I J I I j · I I I · I I i Administration Health & Wellness Housing Services Behavioral Health Polley & Advocacy j ~-----.,-------- J ' I I I I ---~I----, C\I ~ -t,-1 ■- ..c ■- ..c. >< w Darnell Green Kenneth Ted Julia Lunderberg, LC.S.W. j Jamar Moore I 2021- TBD i Manager, Heal th & Wellness Martin Booker Supervision for Behavioral Health Senior Policy Coordinator Manager of Administration J Co-Ma~ager Co-Ma~ager \ I Housing Housing ~-----------, Donald Wilson 1 1 Lanell Laws, AMFT I Tyrone Thompson Dennis Hughes Navigator I Coordinator TBD Tony Hawk Behavioral Counselor-imPACT Policy Coordinator Office Manager J Vacant Reclaiming 1 ' I Resiliency Housing E · w lk AMFT j ~-----------, Christopher Webb . nc a er, Nina Barkers Maria Gomez/Caelyn Liang Outreach Special/ Com Ho~song Navigator Behavioral Counselor-imPACT 1 , Data & Evaluation MC Accounting Navigator J I I I Coordinator , Clarence Ronald Ryan Sample, AMFT ~---- 1 -------, i TBD Wade Jackson Behavioral Counselor-Reclaiming Black Equity for j Roger Gallogan I SUD Recovery Specialist P~er Peer I Transgender Resiliency [ Facility Maintenance I Resident Housing Advisor Navigator David Argueta, AMFT Joshua Thompson 1 ~----- Behavioral Counselor-Youth Diversion ~-------------, Anthony Singleton Linkage Navigator Terrell I j Misc. Subcontractors I Human Resources & J Tillman / Employment Training Servs Peer Crysta l Bender, AMFT Jarran Hinnant Resident Behavioral Counselor - Resiliency Recruitment & Referral Advisor Coordinator ~----------- / Exhibit 13 1. Have you ever in the past or have people believed you to have been frequently high or intoxicated? * If "Yes" above, choose one below. Outreach Assessment 0 No, never 0 Yes* 0 Over 5 years ago 0 Over 2 years ago 0 About 1 year ago 0 About 6 months ago O About 3 months ago O About 1 month ago 0 N/A: I answered No above 2. Does your current or did your previous social activities focus on drinking or other drug use?* 0 No, never 0 Yes* 3. Have you ever thought about O Never O Rarely needing to cut down on use of drugs or alcohol?* 0 Sometimes * 0 Almost Always * 0 Always*· 0 I did in the past* 4. Does your current or did a O Never 0 Rarely previous peer group encourage substance use?* 0 Sometimes* 0 Almost Always* 5. Have you ever in the past been socially isolated from others and used alcohol and drugs alone? * 0 Always* 0 I did in the past* 0 Never 0 Rarely 0 Sometimes · A- 0 Almost Always * 0 Always* 0 I did in the past* Exhibit 13 6. Are you reluctant to attend O Yes social events where chemicals O No won't be available? * 7. Do you or have you ever used O Yes alcohol with prescribed O No medications? * 8. Do you have an elevated tolerance with the ability to use large quantities of alcohol or other drugs without appearing intoxicated? * 0 Yes 0 No 9. Have you ever used drugs O Yes and alcohol to cope with stress O No or problems? * 10. Have you ever shared needles or works (syringe, water, spoons, filters, cotton, etc.) to inject drugs?* 11. Do you have medical conditions which decrease your tolerance or increase the risk of substance use problems? * 12. Do you have recurring bladder infections, chronic infections, bed sores, seizures, or other medical conditions which are aggravated by repeated alcohol or other drug use?* 0 Yes 0 No 0 Yes 0 No 0 Yes 0 No 13. Have you missed work or O Yes gone to work late due to use of O No alcohol or other drugs? * Exh i b it141a~ family member or friend ever expressed concern about your use of alcohol or drugs?* 15. Have important relationships been lost or impaired due to substance use?* 16. Have you ever been in trouble with authorities or arrested for any alcohol or drug related offenses?* 17. Have there been instances when you could have been arrested related to drug and alcohol use, but wasn't? * 18. Has there ever been a time when you'd spend your money on alcohol drugs instead of on life necessities (food, housing, Gender* 0 Male etc.)?* 0 Transgender (Female to Male) 0- 0 Yes 0 No 0 Yes 0 No 0 Yes 0 No 0 Yes 0 No 0 Yes 0 No 0 Female 0 Transgender (Male to Female) Which of the following describes your sexual orientation? 0 Straight /Heterosexual O Lesbian 0 Gay O Bisexual 0 Questioning 0 None of these - "My sexuality does not fit in a box." Are you Hispanic or Latino? 0 Yes (Mexican, Puerto Rican, Cuban, Dominican, Other) 0 No Exhibit 13 What is your race? 0 Black or African American 0 White 0 Asian 0 American Indian or Alaska Native 0 Native Hawaiian or Other Pacific Islander O Multi-Racial 0- Please hand device to AMAAD Staff Representative. (Is follow-up appropriate and okay?) * V Outreach Team Member V First Name Last Name Phone Number Email Address Outreach Location/ Notes: Exhibit 14 TABLE OF CONTENTS OVERVIEW ..................................................................................................................... 4 SECTION ONE: PROGRAM PREPARATION AND DESIGN ......................................... 8 Part 1: Overview of program phases ........................................................................... 8 Part 2: Protocol development ... ................................................................................. 10 Part 3: Planning and initiating the program ................................................................ 10 Involving the target population ............................................................................... 10 Promoting the program .......................................................................................... 11 Part 4: Procedures ............... ...................................................................................... 11 Core Phases .......................................................................................................... 11 1. Recruiter Enlistment ....................................................................................... 11 2. Engagement (Orientation, Interview, and Coaching) ...................................... 13 3. Recruitment of Network Associates ................................................................ 17 4. Counseling, Testing, and Referral Phase ....................................................... 18 Part 5: Incentives .................... ................................................................................... 19 Part 6: Privacy and confidentiality .............................................................................. 20 Part 7: Potential risks for recruiters ............................................................................ 21 Part 8: Informed consent ........................................................................................... 22 Part 9: Collaborations ................................................................................................ 22 Health departments ................................................................................................ 22 Other collaborators ................................................................................................. 23 SECTION TWO: RECORD KEEPING AND DOCUMENTATION ................................. 24 SECTION THREE: QUALITY ASSURANCE ................................................................. 26 Part 1: Policies, operational procedures, and protocols ............................................. 26 Part 2: Regulatory compliance ................................................................. .................. 26 Part 3: Training .......................................................................................................... 27 Part 4: Technical assistance ........................................................................... ........... 28 SECTION FOUR: MONITORING AND EVALUATION .................................................. 30 Part 1 : General approach to program monitoring and evaluation .............................. 30 Part 2: Program monitoring ........................................................................................ 30 Monitoring program implementation and management.. ........................................ 30 Monitoring processes ............................................................................................. 30 Monitoring program performance ........................................................................... 31 Monitoring achievement of goals and objectives .................................................... 34 1. Goals .............................................................................................................. 34 2. Process objectives .......................................................................................... 34 3. Outcome objectives ........................................................................................ 34 Monitoring resource requirements (costs and personnel) ...................................... 34 Progress reports ..................................................................................................... 34 Part 3: Program evaluation .......... .............................................................................. 35 Part 4: Data management. ......................................................................................... 35 Data collection and entry ........................................................................................ 35 Data security .......................................................................................................... 35 REFERENCES .............................................................................................................. 38 Page 2 of 38 Exhibit 14 OVERVIEW Background An estimated 40,000 persons in the United States become infected with HIV every year (1). Of the one million persons living with HIV in the United States, approximately 250,000 are not aware of their infection and their risk for transmitting HIV to others. Of those who are unaware, many are diagnosed late in the course of their infection, after a prolonged asymptomatic period during which further transmission may have occutTed. Persons who are diagnosed late in their infection miss a valuable opportunity to start HIV care and are at greater risk for AIDS-related complications (than those diagnosed earlier). Therefore, it is a national priority to identify HIV-infected persons and link them to medical, prevention, and other services as soon as possible after they become infected. CDC currently funds health departments and community-based organizations (CBOs) to conduct HIV counseling, testing, and referral (CTR) in a variety of settings. These publicly funded sites, which perfonn approximately two million HIV tests yearly, account for approximately 30 percent of positive tests in the US (2). The prevalence of positive tests in these sites is highly variable, but is often very low (less than 1 %), suggesting a need for more efficient targeting strategies that will reach persons not being reached with current strategies. One strategy for reaching and providing HIV CTR to persons with undiagnosed HIV infection is the use of social networks. Enlisting HIV-positive or high-risk HIV-negative persons (i.e., recruiters) to encourage people in their network (i.e., network associates) to be tested for HIV may provide an efficient and effective route to accessing individuals who are infected, or at very high risk for becoming infected, with HIV and linking them to services [ originally developed by Jordan and colleagues (3)]. The social network approach has proven to be a viable recruitment strategy for reaching people beyond current partners. In CDC's Social Networks Demonstration Program (2003 - 2005), social network strategies were used to identify people who were unaware of their HIV infection in communities of color. Across nine sites.funded for the program, approximately 6% of people tested were newly diagnosed with HIV (4). This prevalence rate is six times higher than the average of most HIV CTR programs, illustrating the great value of using social networks to reach people at risk for HIV i11fectio11. Introduction to the Social Networks Strategy for HIV CTR The use of social networks is a recruitment strategy whereby public health services ( e.g., HIV CTR) are disseminated through the community by taking advantage of the social networks of persons who are members of the community. The strategy is based on the concept that individuals are linked together to form large social networks, and that infectious diseases often spread through these networks. The social network approach and ethnographic assessment provide a broader understanding of HIV transmission in the community and the role of all members of the network, whether infected or not, in transmission and its prevention. Page 4 of38 Exhibit 14 Although similar in some ways, the social networks strategy is not partner counseling and referral services (PCRS), partner notification, outreach, health education, or risk education-and it is not intended to replace these services. It is a programmatic, peer-driven, recruitment strategy to reach the highest risk persons who may be infected but unaware of their status. This technique is accomplished by enlisting newly and previously diagnosed HIV-positive and high-risk HIV negative recruiters on an ongoing basis and providing HIV CTR to people in their networks. This type of strategy facilitates expansion and penetration of testing within networks. Participating as a recruiter in a social networks testing project gives people living with HIV the chance to help protect others in their community. In addition, if people in their networks are infected, it gives them the opportunity to get medical care and treatment. Most people living with HIV understand the importance of getting tested and can be powerful allies in this type of HIV prevention effort. Below is an illustration ofa network diagram (Figure 1 ). In this figure, an HIV-positive recruiter (large solid black square) was responsible for the ultimate identification of eight different individuals who were diagnosed with HIV and previously unaware of their infection (big and small black solid circles). Six of these eight individuals were directly identified by the recruiter and are considered to be part of the recruiter's network; the remaining two were identified by a network associate who later decided to enlist as a recruiter himself (bottom right). 0 • ■ Recruiters O • Network associates Black node HIV-positive White node HIV-negative FIGURE 1-Example social network of an HIV-positive recruiter and his network associates Page 5 of 38 Exhibit 14 The primary goal of a program using a social network strategy is to identify persons with undiagnosed HIV infection within various networks and link them to medical care and prevention services. Purpose of this document This guide is intended to provide an overall description of a social networks strategy to identify persons for HIV CTR and, also, to guide the development of protocols, policies, and procedures for agency's planning to use this strategy. Lessons learned from the field (from sites funded for CDC's Social Networks Demonstration Program) are highlighted throughout this document so that future program managers can learn from past social network experiences. Thanks We would like to thank all the staff of the nine CBO sites that took part in the Social Networks Demonstration Program. Because of their hard work, dedication, and valuable input, we are able to disseminate the social networks testing toolkit to CBOs and health departments nationwide. In addition, we would like to acknowledge Wilbert Jordan's seminal research in the area of social networks (3). Without his early work identifying HIV-positive patients in networks, the development of this social networks testing strategy would not have been possible. --CDC, Division of HIV/AIDS Prevention, Social Networks Team Social Networks Testing "Socia{:Networf?.J is a[[ a6out 6reakjngfrom tfie ouf mode[ of just cfoing outreacfi. Jl main goa[ of socia[ networkjng is to prevent J{Jrr). Wfiat is put into tfie community in terms of k,nowCecfge and awareness is Getter tfian just random testing of peopCe. " ****** Page 6 of 38 Exhibit 14 SECTION ONE: PROGRAM PREPARATION AND DESIGN Part 1: Overview of program phases There are four major phases to a social networks program. Agencies conducting a social networks testing program to reach persons with undiagnosed HIV infection should model their programs after these phases. These phases are • Recruiter Enlistment • Engagement (Orientation, Interview, and Coaching) • Recruitment of Network Associates • Counseling, Testing, and Referral (CTR) Each phase is briefly described below. A flow diagram illustrating all four phases can be found on the next page (Figure 2). Recruiter Enlistment In this phase, HIV-positive or HIV-negative high-risk persons from the community who are able and willing to recruit individuals at risk for HIV infection from their social, sexual, or drug-using networks arc enlisted into the program. To identify recruiters, agencies approach their HIV positive clients and identify additional people through the agency's existing counseling and testing, medical, social services, or through HIV prevention programs. On an ongoing basis, program staff will approach and enlist new recruiters who may be able to provide access to additional networks. Engagement (Orientation, Interview, and Coaching) After recruiters are enlisted into the program, they are provided with an orientation session that explains the nature of the program and the social network techniques that might be used to approach their associates and discuss HIV testing with them. Next, recruiters are interviewed to elicit information about their network associates. The period of time needed to elicit infonnation from recruiters is typically brief-recruiters may be able to give all of their network information within just a few interviews. Unlike peer outreach workers, recruiters' participation time overall may be relatively short. Coaching may be required on an ongoing basis throughout the period of the recruiter's participation. Coaching may involve discussion with recruiters on how to approach associates about 1) obtaining HIV CTR, 2) disclosing their own HN status if they wish to do so, and 3) how to avoid disclosing status if desired. Recruitment of Network Associates Next, recruiters will refer individuals for testing who they have identified as being at risk for HIV infection. All individuals should be approached by the recruiter alone, without the provider). Page 8 of38 fr' - ·----·- -······--·-- Recruiter Enlistment Phase Identify and Invite screen potential potential 1----. recruiters to recruiters participate in the program Orient 1----. recruiters to the program Engagement Phase Interview recruiters to elicit info. r-' about network associates '-- Coach recruiters on effective Lt techniques for approaching network associates Recruitment of Network Associates Phase .______ Recruiter recruits Counseling, Testing, and Referral Phase Agencies provide counseling ,-ti Low-risk, HIV network associates End 1----. network 1----. and testing to - HIV+ and high-risk, HIV- associates for network CTR associates network associates Agencies link associates to .______ L.....a care and prevention services ----------- --- ---- --- -- -- -------------- ---------- ------ -------- -- - - - - FIGURE 2-Four phases of the Social Networks testing strategy Page 9 of38 Exhibit 15 I :>~• •'C~I)H 7 l , ldurnu ll,!'"''"""' .,f Public Health CLINICAL AND PUBLIC HEAL TH LABORATORY LICENSE In accordance with the provisions of Chapter 3, Division 2 of the Business and Professions Code, the persons named below are hereby issued a license authorizing operation of a clinical laboratory at the indicated address. AMAAD INSTITUTE (INGLEWOOD) 2930 W IMPERIAL HWY STE 300, INGLEWOOD, CA 90303-3141 :\",,;,.~Iii STATE ID:CLP-00307779-8 LICENSE TYPE: . -- - SCAN QR CODE TO VERIFY UCENSE OR VISIT: WWIV.c;dp/1.c:a..govlt.FS EFFECTIVE DATE: 06/1412020 EXPIRATION DATE: 06/13/2021 O~: CHILDRENS HOSPITAL LOS ANGELES CLINICAL LABORATORY REGISTRATION CUA ID: 05D0679210 DIRECTORIS: JUDKINS. ALEXANDER R DISPLAY: State law requires that the clinical lllboratocy license shall be conspicuously posted in the clinical laboratory. CHANGE OF LABORATORY NAME. DIRECTOR, OWNER ANDI0R ADDRESS: State law requires that the laboratory owner andlor the director notify this office within 30 days of any Change in ownership. name. location. or laboratory directors. YOUR LICENSE MAY BE REVOKED 30 DAYS AFTER A MAJOR OWNERANOIOR DIRECTOR CHANGE. If your license Is rewked. you must cease engaging In clinical laboratory practice and apply for a new clinical laboratory license. To make these changes or to submit a new application, vlslt our website: https:llwWw.cdph.ca.gov/LFS (Go to Clinical Laboratory Facilities) :\,-ll .f i iil' , ·· · ''(I ~~~-~ 8RANCH CHIEF LABORATORY FIELD SERVICES Exhibit 15 > J~ •'C~J)I-I 7 , ,;,,,,.,,,,P,1 •,,,,.,,,,. .. ; PubHcHealth CLINICAL AND PUBLIC HEALTH LABORATORY LICENSE In accordance with the provisions of Chapter 3, Division 2 of the Business and Professions Code, the persons named below are hereby issued a license authorizing operation of a ciinical laboratory at the indicated address. AMAAD INSTITUTE (WATTS) 10221 COMPTON AVE STE 105, LOS ANGELES, CA 90002-2805 - STATEID:CLP-□□307779-7 SCAN QR CODE TO VERIFY LICENSE OR VISI~ wmv.cdpn.ca.gov/LFS ~ - EFFECTIVE DATE: 06/14/2020 LICENSE TYPE: CLINICAL LABORATORY REGISTRATION EXPIRATION DATE: 06/13/2021 0~: CHILDRENS HOSPITAL LOS ANGELES CLIA ID: 05D067921 0 DtRECTORIS: JUDKINS. ALEXANDER, R DISPLAY: State law requires that the dinlcal laboratory license shall be conspicuously posted in the clinical laboratory. CHANGE OF LABORATORY NAME, DIRECTOR, OWNER AND/OR ADDRESS: State law requires that the laboratory owner andtor the director notify this offlce wl1hln 30 days of any change in ownership, name. location. or laboratory directors. YOUR LICENSE MAY BE REVOl<EO 30 DAYS AFTER A MAJOR OWNER ANDIOR DIRECTOR CHANGE. If your license is revoked, you must cease engaging in dlnlcal laboratory practice and apply for a new clinical laboratory license. To make these changes or to submit a new appUcation, visit our website: https://www.cdph.ca.gov/LFS (Go to Clinical Laboratory Facilities) ;:,.!iU ·i -: ~O.~ ROBE'" J. THOMAS BRANCH CHIEF LABORATORY FIELD SERVICES Exhibit 16 t 'iif";r::'J Centers for Disease I '1 ~ .~ Conlrol and Prevenlion //ff/#"'AG!l. Personalized Cognitive Counseling (PCC) A Single Session Intervention for MSM Who Are Repeat Testers for HIV The Research The Science Behind the Package Personalized Cognitive Counseling (PCC) is a single session counseling intervention designed to reduce high-risk behaviors among men who have sex with men (MSM) who are repeat testers for HIV. The PCCintervention is based on the work of cognitive psychologist Ron Gold and colleagues, hypothesizing that the decision to engage in high-risk sex happens when the person rationalizes the potential risk by minimizing the known risk. Target Population PCCis for MSM who are HIV-seronegative, who have had at least one HIV test before, and who report unprotected anal intercourse (UAI) in the past 12 months with a partner of unknown HIV serostatus or a partner who was HIV-positive. The intervention is for men 18 years of age or older of any race/ethnicity. Intervention PCCis delivered in the context of HIV test counseling in a 30 to 50 minute individual session. Typically the setting is a community HIV testing site. Counselors should be trained in HIV prevention counseling and testing and have at least one year of experience conducting HIV counseling. The process is aided by the PCCQuestionnaire, a list of self-justifications that men often use to rationalize risky behavior. PCC is a five step process: 1) The client is assisted to recall a memorable episode of UAL 2) The client completes the PCCQuestionnaire with the specific incident in mind. 3) The counselor draws out the client's story about the incident, along with the thoughts and feelings the client experienced. 4) The counselor helps the client identify the self-justifications that facilitated the UAI. 5) The counselor asks the client what he will do in future similar situations to avoid risk. Research Results Two controlled studies of PCCwere conducted at the AIDS Health Project (AHP) in San Francisco, In the first study, participants were 248 MSM eligible for PCC Two intervention groups received standard HIV test counseling plus the PCC cognitive behavioral intervention, delivered by mental health professionals, and two control groups received only standard HIV test counseling. A second similar study tested PCCversus standard HIV test counseling using experienced bachelors-level HIV test counselors who were trained in the PCCintervention. Participants were 336 MSM who were randomly assigned to PCCor standard HIV counseling in the second study. In both studies, the PCCintervention significantly reduced the number of UAI episodes with non-primary HIV-positive or unknown status partners in the six months after counseling. In the first study, the average number of unsafe episodes significantly declined by about half at six month follow-up and maintained 12 months later. Men who participated in the second study were asked how helpful they found the services; those who received PCC were more satisfied with the services received. For Details on the Research Design Dilley JW, Woods WJ, Sabatino J, Lihatsh T, Adler B, Casey S, et al. (2002). Changing Sexual Behavior Among Gay Male Repeat Testers for HIV: A Randomized, Controlled Trial of a Single-Session Intervention, Journal of Acquired Immune Deficiency Syndromes, 30(2), 177-86. Dilley JW, Woods WJ, Loeb L, Nelson K , Sheen N, Mullan, J, et al. (2007). Results From a Randomized Controlled Trial Using Paraprofessional Counselors.Journal of Acquired Immune Deficiency Syndromes, 44(5), 569-577. The Intervention Exhibit 16 A Package Developed from Science Replicating Effective Programs (REP) is a CDC-initiated project that supports the translation of evidence-based HIV/AIDS prevention interventions into everyday practice, by working with the original researchers in developing a user-friendly package of materials designed for prevention providers. PCCis one of the REP interventions. The PCCintervention package is the product of extensive collaboration among researchers, training developers, community service providers, and community-based agencies. The intervention has been field tested in two community agencies by non-research staff. Core Elements Core Elements are intervention components that must be maintained without alteration to ensure program effectiveness. The core elements of PCCinclude: 1. Provide one-on-one counseling focusing on a recent, memorable high risk sexual encounter. 2. Provide the service with counselors trained in HIV counseling and testing and in the PCC intervention. 3. Use the questionnaire specifically tailored to identify key self justifications used by clients in the target population. 4. Using the questionnaire and discussion, identify specific self-justifications used by clients in making the decision to engage in specific high-risk behavior. 5. Explore the circumstances and context for the risk episode in detail (before, during and after). 6. Clarify how the circumstances and self-justifications are linked to the decision to engage in high-risk behavior. 7. Guide the clients to re-examine the thinking that led to their decision to have high-risk sex and Identify ways they might think differently, and therefore have protected sex in future potentially risky situations. Package Contents PCClmplementation Manual with guidance and materials for implementation. Timeline for Availability The package is available from CDC along with training on program implementation and technical assistance. For More Information on the PCC Intervention Package To find out more about future trainings, please visit Effective Interventions. Page last reviewed: January 21. 7020 Exhibit 17 ARTAS (ANTIRETROVIRAL TREATMENT ACCESS STUDY) Goal of Intervention • Improve linkage to HIV care • Improve retention in HIV care Target Population • Recently diagnosed, treatment na'ive HIV-positive persons Brief Description The Antiretroviral Treatment Access Study (ARTAS) is a strength-based case-management intervention to link recently-diagnosed HIV-positive persons to care and sustain them in ca re for more than a single visit. The case manager maintains a client-driven approach by (1) building an effective, working relationship with the client; (2) encouraging each client to identify and use his/her strengths, abilities , and skills to link to medical care and accomplish other goals ; (3) meeting each client in the environment where he/she feels comfortable; (4) coordinating and linking each client to available community resources, both formal (e.g., housing agencies, food banks, accompanying to medical appointment) and informal (e.g., support groups) based on each client's needs; and (5) advocating on each client's behalf for medical care and other needed services. Working with the case manager, clients identify and address their needs and barders to health care and develop a step-by stcp plan to accomplish their goals using the ARTAS session plan. Intervention Duration • Up to 5 case management sessions over 90 days or until the client is linked to medical care - whichever comes first Intervention Setting • Settings where clients feel comfortable Deliverer • Case manager/linkage coordinator INTERVENTION PACKAGE INFORMATION For information on training and intervention-related materials, please visit CDC'sHfV EHectiveJ;:,Jerve:nt}ons_ weh§H:e. Exhibit 17 Study Location Information The original evaluation was conducted in Atlanta, GA; Baltimore, MD; Los Angeles, CA; and Miami, FL between 2001 and 2003. Recruitment Settings Health department testing centers, STD clinics, hospitals, and community-based organizations Eligibility Criteria Men and women were eligible if they were HIV-positive, were 18 years or older, had been to a care provider no more than once in the past, and were not an antiretroviral medications. The study attempted to enroll participants as early as possible after HIV diagnoses. Study Sample The baseline characteristics of 273 participants with complete outcome data over a 12-month study period are characterized by the following: • 57% black or African American, 29% Hispanic/Latino, 7% white, 7% other • 71% male, 29%Jemale • 63% 18-39 years old, 37% 40 years or older • 54% did not complete high school, 46% high school or greater • 78% diagnosed with HIV< 6 months; 22% diagnosed with HIV> 6 months; 0% receiving antiretroviral therapy • Mean log10 HIV-1 RNA viral load of 4.52 Comparison The standard of care comparison group received standard CDC-produced informational pamphlets about HIV, information on local care resources, and a referral to a local HIV medical care provider. Assignment Method Participants (N = 316) were randomly assigned to one of two study arms: ARTAS (n == 157) or a standard of care comparison (n = 159). Relevant Outcomes Measured • Linkage to HIV care was defined as visiting an HIV clinician at least once within the first 6-month follow-up period. • Retention in HIV care was defined as visiting an HIV clinician at least once during each of two consecutive 6- month periods. Significant Findings on Relevant Outcomes • A significantly greater percentage of intervention participants than comparison participants visited an HIV clinician at least once within the first 6 months (78% vs. 60%, adjusted RR= 1.36, p < 0.001}. • A significantly greater percentage of intervention participants than comparison participants visited an HIV clinician at least twice within 12 months (64% vs. 49%, adjusted RR= 1.41, p = 0.006). • Among those with 2 or more contacts with the case manager/linkage coordinator, a significantly greater percentage of intervention participants than comparison participants visited an HIV clinician at both 6- and 12-month assessments (adjusted RR== 1.48, p = 0.004). Exhibit 17 Considerations • Reported HIV primary care data were confirmed with clinic medical records. Rates of confirmation were 93% at 6 months and 86% at 12 months. • For 121 participants with viable plasma viral load samples at 6 and 12 months, both intervention and comparison participants who were linked to care had significant reductions in logl0 viral load (intervention participants: 4.75 vs. 4.30, p = 0.02; comparison participants: 4.62 vs. 4.37, p = 0.02). For participants not linked to care, no significant reductions were observed. • A demonstration project implemented the ARTAS intervention in 10 local and state health departments and non-profit service-oriented community-based organizations in rural, mid-sized, and urban settings (Craw et al, 2008). The research findings show that 79% of all participants visited an HIV clinician at least once within the first 6 months after enrollment. Gardner, L. I., Metsch, L. R., Anderson-Mahoney, P., Loughlin, A. M., del Rio, C., Strathdee, S., . .. the Antiretroviral Treatment and Access Study (ARTAS) Study Group. (2005). Efficacy of,1_brieL.ci:,>e 1rEu:1,rne1 :neni i nte,ven tiontuHn !< ween tlv diafn oscd_ Hi\/ infcctt;d persons to_ec,r-2 . AIDS, 19, 423-431. Craw, J. A., Gardner, L. I., Marks, G., Rapp, R. C., Bosshart, J., Duffus, W. A., . .. Schmitt, K. (2008). Br:k:f ]_n- 1 at i-rn,~ntJ\cces ~,_Studv Ii. JAIDS Journal of Acquired Immune Deficiency Syndromes, 47, 597-606. Researcher: Hubyn L rii~h>eH ;-:;:nhi: . . NW, l'-/! PH Epidemiology Branch, Division of HIV/AIDS Prevention National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention 1600 Clifton Road, NE Mailstop US8-4 Atlanta, GA 30329 Email:_ iyo$@{:dc,gov C e. r,e ·rE R S FO il D ISEASI! ~ CONTHO L ,~ru> Pn r:, v r:NTI O N Exhibit 18 AMAAD Ending the HIV Epidemic in Los Angeles County 12 • Month Budget PERSONNEL Subtotal Full-Time Salaries Full-Time Employee Benefits 24.27% Total Salaries & Benefits Subtotal Full-Time Salaries Part-Time Employee Benefits 12.14% Total Salaries & Benefits Total Full-Time & Part-Time Salaries & Benefits Travel 1 Mileage Total Travel Supplies 1. Program Office Supplies 2. Furniture 3. Computers/Laptops/Hotspot Devises 4. Outreach & Educational Material Total Operaing General Other 1. Participant Incentives/Stakeholder Stipends 2. Communications (Telephone, Virtual, Wi-Fi, etc.) 3. Promotional Activities 4. Program Rent / Lease Cost Total Other Consultant/Subcontractor 1. Evaluation 3. CBO Engagement Total Other TOTAL BUDGET TTC MH Bud Mod 1/05 ATTACHMENT A BUDGET $ 470,400 168,992 $ 639,392 $ 81,400 9,878 $ 91,278 730,670 2,002 $ 2,002 $ 9,000 10,000 10,000 14,200 $ 43,200 $ 43,000 9,360 35,000 36,768 $ 124,128 50,000 50,000 $ 100,000 $ 1,000,000 AMAAD Institute - Board Approved Budget FY: 2021 Exhibit 19 Revenue SAM HSA CSAP - Prevention Navigator $ 197,500 SAMHSA CSAP - Minority AIDS lnitaitive $ 275,239 SAMHSAS CSAT - Building Communities of Recovery $ 181,737 SAMHSA CSAT - Grant to Benefit the Homeless $ 386,267 City of Los Angeles - Office of AIDS $ 54,000 Children's Hospital Los Angeles $ 30,000 County of Los Angeles - Department of Public Health $ 250,000 County of Los Angeles - Department of Mental Health $ 54,000 City of Los Angeles - Mayor's Office of Reentry $ 272,480 State of California Board State Community Corrections -Rental Assistance $ 626,306 State of California Board State Community Corrections -Warm Handoff $ 157,781 Gilead Health Sciences $ 65,000 AIDS Healthcare Foundation $ 20,000 Fundraising Donations $ 35,000 .. . . ·.' . .. , < .·. , . \.c '' ,.•··.,, ... . ·, .. ,.. > ,. ' :,. '$ 2;605;310 .·. ",.,, ,, : ·. " •'··· Expense Personnel Executive Office Component $ 331,910 Health & Wellness Componet $ 397,029 Housing Services Component $ 285,865 Reentry Component $ 222,500 Policy & Advocacy Component $ 164,300 Total Salary & Wages $ 1,401,604 Payroll Taxes $ 105,137 Retirement $ 9,707 Disability $ 2,791 Workers Comp $ 15,805 Health lnurance $ 209,448 Fringe Benefits (Taxes, Retirement, WC, Insurance) $ 342,888 '(ottil Saltiffes & Frit,ae Benefits '' , ·.-, , •. ··_;_>-i ·-· -·· ,· :: .'··,·'· .· .. , ,, $ 1;744,492 Travel ,.,_. :--·. ·,, ,, ,. < ',', ' • ,, ... > ' .. .". ,·: " ' '·· $ 23;705 " .,. tt1ufpment . ·.·· : .·., . . >;.,,,.,.' · . . .'/' ' ·i ' . :,, $ l5;7SQ .. Cons,:,ltont/Coritro~or. · .. ,, ,··. ' ,, ,.,: "·'' '·· ',, · • . '· <, ,$.: . 70;000 ,,; .,,. " $ - s , u'jfpll¢s ' .. ·.· . "' ... .. ,,, , : ,, -~. '. ' ,., ' ',: " .· . . · .. .·• Office Supplies $ 21,814 Duplication $ 3,000 Program Supplies $ 12,787 Postage $ 1,540 Computers & Licenses $ 10,448 Tcitqf. Siippflet . > ·.' ,.i i: ,.· .. \ ' ·,,·, '··•··' ·. ," ' $ ... , . • '49,S, S!l ,:., . . •, ' :;, - other ,, ,, ., ::. ,. . ,• ,, " '\ .· " ,· :-,c i ' : . . · .. ,." .... .. -,c .,,cc: Rent $ 148,953 Cubicle Office Set up $ 2,000 Food - Retreat & Group $ 487 Telephone & Internet $ 19,646 Utilities $ 7,600 Incentives/ Advocacy Material Items $ 22,000 Promotion/ Communication $ 15,983 Outreach & Education Material $ 7,500 Staff Development $ 8,632 Special Events $ 21,929 Technical Assistance Projects $ 1,250 Insurance $ 9,400 Accounting & Payroll $ 21,000 Audit $ 10,000 Misc Other $ 398,130 Facility Maintance $ 5,000 Tpti.Jl!Qili!iiC' ... : "''- ., ·• .• ""'· .. · ·it , .• ,,. '·' \ .. ,, :c. \:.:t :;,,::;-.,, ' . ' .. ' \,,.,•-'. .. · ', .. ·, ?" $ , : ~$9,,510 · Total Cost Direct $ 2,603,046 Exhibit 20 · OZUROVICH + associates INDEPENDENT AUDITOR'S REPORT To the Board of Directors of The AMAAD Institute Los Angeles, CA Report on the Financial Statements We have audited the accompanying financial statements of The AMAAD Institute, which comprise the statement of financial position as of December 31, 2019, and the related statements of activities, functional expenses, and cash nows for the year then ended and the related notes to the financial statements. Management's Responsibility for the Financial Statements Management is responsible for the preparation and fair presentation of these financial statements in accordance with accounting principles generally accepted in the United States of America; this includes the design, implementation, and maintenance of internal control relevant to the preparation and fair presentation of financial statements that are free from material misstatement. whether due to fraud or error. Auditors' Responsibility Our responsibility is to express an opinion on these financial statements based on our audit. We conducted our audit in accordance with auditing standards generally accepted in the United States of America and the standards applicable to financial audits contained in Government Auditing Standards, issued by the Comptroller General of the United States. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free from material misstatement. An audit involves performing procedures to obtain audit evidence about the amounts and disclosures in the financial statements. The procedures selected depend on the auditor's judgment, including the assessment of the risks of material misstatement of the financial statements, whether due to fraud or error. In making those risk assessments, the auditor considers internal control relevant to the entity's preparation and fair presentation of the financial statements in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the entity's internal control. Accordingly, we express no such opinion. An audit also includes evaluating the appropriateness of accounting policies used and the reasonableness of significant accounting estimates made by management, as well as evaluating the overall presentation of the financial statements. Exhibit 20 We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our audit opinion. Opinion In our opinion, the financial statements referred to above present fairly, in all material respects, the financial position of The AMAAD Institute as of December 31, 2019, and the changes in its net assets and its cash flows for the year then ended in accordance with accounting principles generally accepted in the United States of America. Other Matters Other Information Our audit was conducted for the purpose of forming an opinion on the financial statements as a whole. The accompanying Schedule of Expenditures of Federal Awards is presented for purposes of additional analysis as required by the audit requirements of Title 2 U.S. Code of Federal Regulations (CFR) Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance) and is not a required part of the financial statements. Such information is the responsibility of management and was derived from and relates directly to the underlying accounting and other records used to prepare the financial statements. The information has been subjected to the auditing procedures applied in the audit of the financial statements and certain additional procedures, including comparing and reconciling such information directly to the underlying accounting and other records used to prepare the financial statements or to the financial statements themselves, and other additional procedures in accordance with auditing standards generally accepted in the United States of America. In our opinion, the Schedule of Expenditures of Federal Awards is fairly stated in all material respects in relation to the financial statements as a whole. Our audit was conducted for the purpose of forming an opinion on the financial statements as a whole. The Supplementary Schedule # 1 - Statement of Functional Expenses - Department of Aging is presented for purposes of additional analysis and is not a required part of the financial statements. Such information is the responsibility of management and was derived from and relates directly to the underlying accounting and other records used to prepare the financial statements. The information has been subjected to the auditing procedures applied in the audit of the financial statements and certain additional procedures, including comparing and reconciling such information directly to the underlying accounting and other records used to prepare the financial statements or to the financial statements themselves, and other additional procedures in accordance with auditing standards generally accepted in the United States of America. In our opinion, the information is fairly stated in all material respects in relation to the financial statements as a whole. Exhibit 20 Other Reporting Required by Government Auditing Standards In accordance with Government Auditing Standards, we have also issued our report dated February 3, 2021 on our consideration of The AMAAD Institute's internal control over financial reporting and on our tests of its compliance with certain provisions of laws, regulations, contracts and grant agreements, and other matters. The purpose of that report is solely to describe the scope of our testing of internal control over financial reporting and compliance and the results of that testing, and not to provide an opinion on the effectiveness of The AMAAD lnstitute's internal control over financial reporting or on compliance. That report is an integral part of an audit performed in accordance with Government Auditing Standards in considering The AMAAD Institute's internal control over financial reporting and compliance. Ozurovich & Associates Ozurovich & Associates Rancho Santa Margarita, California February 3, 2021 Digitally signed by Ozurovich & Associates ON: cn:-Ozurovlch & Associates, o, au, email::-,matt@Ozandassocl ates.com 1 c :.:,US Date: 2021.02.03 09:37:24 -08'00' Exhibit 20 THE AMAAD INSTITUTE AUDITED FINANCIAL STATEMENTS DECEMBER 31, 2019 Exhibit 20 TABLE OF CONTENTS INDEPENDENT AUDITOR'S REPORT FINANCIAL STATEMENTS Statement of financial position Statement of activities and changes in net assets Statement of functional expenses Statement of cash flows Notes to financial statements SUPPLEMENTARY INFORMATION Schedule of expenditures of federal awards Notes to the Schedule of Expenditures of Federal Awards Independent auditor's report on internal control over financial reporting and on compliance and other matters based on an audit of financial statements performed in accordance with government auditing standards Independent auditor's report on compliance with requirements applicable to each major program and on internal control over compliance in accordance with the Uniform Guidance Schedule of audit results, findings, and questioned costs Page 1-3 4 5 6 7 8-14 15 15 16 -17 18- 20 21 Exhibit 20 ASSETS Current assets Cash and cash equivalents Accounts receivable Other receivables Prepaid expenses Total current assets THE AMAAD INSTITUTE STATEMENT OF FINANCIAL POSITION DECEMBER 31, 2019 Property and equipment - net (Note 3) Deposits TOT AL ASSETS LIABILITIES Current liabilities Accounts payable Credit card payable Deferred revenue Total current liabilities NET ASSETS Net assets without donor restrictions TOTAL LIABILITIES AND NET ASSETS See independent auditor's report and accompanying notes. -4- $ 976,668 129,990 1,503 4,628 1,112,789 805 11,446 $ 1,125,040 $ 5,415 38 962,374 967,827 157,213 $ 1,125,040 Exhibit 20 THE AMAAD INSTITUTE STATEMENT OF ACTIVITIES FOR THE YEAR ENDED DECEMBER 31, 2019 REVENUE AND PUBLIC SUPPORT Government grants Private grants Contributions Rental income NET ASSETS RELEASED FROM DONOR RESTRICTIONS TOTAL REVENUE AND PUBLIC SUPPORT OPERA TING EXPENSES Program services Health and wellness Policy Reentry Total program services Supporting services Management and general TOTAL OPERATING EXPENSES OTHER INCOME Interest income TOTAL OTHER INCOME CHANGE IN NET ASSETS NET ASSETS, Beginning of year NET ASSETS, End of year See independent auditor's report and accompanying notes. $ $ -5- 1,244,995 16,967 12,254 25,800 1,300,016 1,300,016 698,374 42,814 217,553 958,741 208,847 1,167,588 9 9 132,437 24,776 157,213 -6- THE AMAAD INSTITUTE STATEMENT OF FUNCTIONAL EXPENSES FOR THE YEAR ENDED DECEMBER 31, 2019 Pro9..ram Services Management Health & Wellness Policy__ Reentry Sub-total and General TOTAL Salaries and wages $ 378,301 $ 27,802 $ 188,097 $ 594,200 $ 32,959 $ 627,159 Payroll taxes 28,818 2,653 18,241 49,712 2,096 51,808 Employee benefits 45,950 45,950 5,418 51,368 453,069 30,455 206,338 689,862 40,473 730,335 Advertising 9,217 60 9,277 4,941 14,218 Auto 4,300 4,300 4,300 Bank charges 4 4 120 124 Depreciation 247 247 Dues and subscriptions 3,498 295 3,793 2,968 6,761 Equipment rental 246 246 954 1,200 Insurance 18,928 170 2,122 21,220 330 21,550 Office 9,021 3,104 12,125 17,982 30,107 Outreach 16,264 16,264 26,439 42,703 Outside services 62,664 4,995 67,659 59,557 127,216 Postage 47 47 355 402 Printing 126 126 1,070 1,196 Program supplies 11,647 1,542 13,189 14,169 27,358 Rent 75,092 75,092 12,424 87,516 Repairs and maintenance 3,367 3,367 Staff training 634 10 644 1,283 1,927 0 Taxes and licenses 10 10 N Telephone 8,841 3,504 3,062 15,407 3,247 18,654 Travel 24,780 3,680 1,026 29,486 11,877 41,363 ~ Utilities 7,034 7,034 ■- .c TOTAL EXPENSES $ 698,374 $ 42,814 $ 217,553 $ 958,741 $ 208,847 $ 1,167,588 ■- .c >< LU See independent auditor's report and accompanying notes. Exhibit 20 THE AMAAD INSTITUTE STATEMENT OF CASH FLOWS FOR THE YEAR ENDED DECEMBER 31, 2019 CASH FLOWS FROM OPERATING ACTIVITIES Change in net assets Adjustments to reconcile change in net assets to net cash provided by operating activities Depreciation (Increase) decrease in assets Accounts receivables Other receivables Deposits Increase (decrease) in liabilities Accounts payable Prepaid expenses Deferred income Net cash provided by operating activities CASH FLOWS FROM FINANCING ACTIVITIES Principal payments on credit card payable Advances from credit card payable Net cash (used)/provided by financing activities NET INCREASE IN CASH CASH AND CASH EQUIVALENTS, beginning of year CASH AND CASH EQUIVALENTS, end of year See independent auditor's report and accompanying notes. -7- $ 132,437 247 (49,786) 472 (5,146) (3,390) 1,851 801,370 878,055 (225,065) 220,595 (4,470) 873,585 103,083 $ 976,668 Exhibit 20 THE AMAAD INSTITUTE NOTES TO FINANCIAL STATEMENTS FOR THE YEAR ENDED DECEMBER 31, 2019 NOTE 1- ORGANIZATION -8- The AMAAD Institute (the "Organization"), is a Los Angeles-based not-for-profit corporation, incorporated in 2005 under the laws of the State of California. The Organization facilitates personalized individual access to programs and services that foster safe and supportive healthy environments for people to live, learn, and develop to their fullest potential. NOTE 2 - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES This summary of significant accounting policies of the Organization is presented to assist in understanding the Organization's financial statements. The financial statements and notes are representations of the Organization's management who is responsible for their integrity and objectivity. These accounting policies conform to generally accepted accounting principles and have been consistently applied in the preparation of the financial statements. Basis of Accountine The financial statements of the Organization have been prepared on the accrual basis of accounting and accordingly reflect all significant receivables, payables, and other liabilities. Basis of Presentation The Organization is required to report information regarding its financial position and activities according to two classes of net assets: net assets without donor restrictions and net assets with donor restrictions. Net Assets Without Donor Restrictions - Include contributions, fundraising, fees and other forms of unrestricted revenue and expenditures related to the general operations and fundraising efforts of the Organization. Net Assets With Donor Restrictions - Include gifts and grants received that are restricted with respect to time or use by the donor or grantor. When the restrictions expire, the net assets of this fund are reclassified to net assets without donor restrictions. Restricted gi~s and grants received are reported as unrestricted revenue if the restriction is met in the same reporting period. For the period ended December 31, 2019 the organization had no net assets with donor restrictions. Estimates The preparation of financial statements in conformity with generally accepted accounting principles requires management to make estimates and assumptions that affect certain reported amounts and disclosures. Accordingly, actual results could differ from those estimates. (Note 2 continued on the following page) Exhibit 2 O THE AMAAD INSTITUTE NOTES TO FINANCIAL STATEMENTS FOR THE YEAR ENDED DECEMBER 31, 2019 NOTE 2 - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Continued) Tax Status -9- The Organization is a nonprofit benefit corporation organized under the laws of California and, as such, is exempt from federal and state income taxes under Section 501(c)(3) of the Internal Revenue Code, and corresponding state provisions. However, the Organization is subject to income taxes on any net income that is derived from a trade or business, regularly carried on, and not in furtherance of the purposes for which it was granted exemption. The Organization's federal income tax and informational returns for tax years ending December 31, 2015 and subsequent remain subject to examination by the Internal Revenue Service. The returns for California, the Organization's most significant jurisdiction, remain subject to examination by the California Franchise Tax Board for tax years ending December 31, 2015 and subsequent. The Organization has adopted the provisions of Accounting Standards Codification ("J\SC") 740-10- 05 relating to accounting and reporting for uncertainty in income taxes. For the Organization, these provisions could be applicable to the incurrence of any unrelated business income attributable to the Organization. Because of the Organization's general tax-exempt status, the provisions of ASC 740-10-05 are not anticipated to have a material impact on the Organization's financial statements. Contributed Services and Gifts In-Kind Contributed services are recognized if the services (a) create or enhance long-lived assets or (b) require specialized skills, are provided by individuals possessing those skills, and would typically need to be purchased if not provided by donation. A substantial number of volunteers have donated significant amounts of their time and services in the Organization's core activities. Only those amounts that meet the criteria above are recorded in the Organization's financial statements. The Organization recognized no in-kind donations as income during the year ended December 31, 2019. Restricted and Unrestricted Revenue and Support Contributions that are restricted by the donor are reported as increases in net assets without donor restrictions if the restrictions expire (that is, when a stipulated time restriction ends or purpose restriction is accomplished) in the reported period in which the revenue is recognized. All other donor-restricted contributions are reported as increases in net assets with donor restrictions, depending on the nature of the restrictions. When a restriction expires, net assets with donor restrictions are reclassified to net assets without donor restrictions and reported in the Statement of Activities as net assets released from restrictions. (Note 2 continued on the following page) Exhibit 20 THE AMAAD INSTITUTE NOTES TO FINANCIAL STATEMENTS FOR THE YEAR ENDED DECEMBER 31, 2019 NOTE 2 - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Continued) Revenue Recognition -10- Grants - The Organization receives funding through government grant<;. Grant revenue includes exchange transactions under which revenue is recognized when earned and expenses are recognized when incurred. Grant receipts from exchange transactions not earned are reported as deferred income. Program Service Fees - Program service fees are based on established rates and are reported at the estimated realizable value from patients. Cash and Cash Equivalents For purposes of the statement of cash flows, the Organization considers all unrestricted highly liquid investments with an initial maturity of three months or less to be cash equivalents. The commercial banks have FDIC coverage up to $250,000 per depositor per bank. At December 31, 2019, the uninsured amount was $734,717. Accounts Receivable Accounts receivable are stated less an allowance for doubtful accounts. The Organization provides for losses on accounts receivable using the allowance method. The allowance is based on experience and other circumstances, which may affect the ability of grantors to meet their obligations. Receivables are considered impaired if full payments are not received in accordance with the contractual terms. It is the Organization's policy to charge off uncollectible accounts receivable when management determines the receivable will not be collected. Based on management's assessment of the past history with grantors having outstanding balances and current relationships with them, it has concluded that losses on balances outstanding at year-end will be immaterial. Therefore, the allowance for doubtful accounts at December 31, 2019 was none. Property and equipment Property and equipment are recorded at cost if purchased and at fair value at the date of donation, if donated. Repairs and maintenance are expensed as incurred and improvements of property and equipment items in excess of $1,000 are capitalized. Depreciation is computed on the straight-line basis over the estimated useful lives of the related assets. Vacation and Sick Leave Benefits Neither vacation pay nor sick pay accumulates or vests. Therefore, no accrual has been recorded. (Note 2 continued on the following page) Exhibit 20 THE AMAAD INSTITUTE NOTES TO FINANCIAL STATEMENTS FOR THE YEAR ENDED DECEMBER 31, 2019 NOTE 2 - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Continued) Expense Allocation -11- The financial statements report certain categories of expenses that are attributable to more than one program or supporting function. Therefore, these expenses require allocation on a reasonable basis that is consistently applied. The expenses that are allocated include salaries and wages, payroll taxes and employee benefits which are allocated on the basis of estimates of time and effort for the Organization's personnel. The following expenses are allocated using the same percentages as the personnel costs described above because they are incurred in support of the day-to-day job functions of the Organization's employees: insurance, telephone, and travel. Risks and Uncertainties The Organization's contracts are subject to inspection and audit by the appropriate governmental funding agencies. The purpose is to determine whether program funds were used in accordance with their respective guidelines and regulations. The potential exists for disallowance of previously funded program costs. The ultimate liability, if any, which may result from these governmental audits cannot be reasonably estimated and, accordingly, the Organization has no provision for the possible disallowance of program costs on its financial statements. Conditions created by the COVID-19 environment could contribute to short-term financial challenges that adversely affect the Organization's cash flows. Specifically, there is the potential for reductions in private donations and decreased grant awards if related program activities are forced to be significantly curtailed due to government mandated shutdowns. The Organization's Board of Directors has discussed these risks and uncertainties and has formulated alternative strategic plans to mitigate the effects of these concerns. New AccountinK Pronouncements Leases - In February 2016, the FASB issued ASU No. 2016-02, Leases (Topic 842), which requires organizations that lease assets (lessees) to recognize the assets and related liabilities for the rights and obligations created by the leases on the statement of financial position for leases with terms exceeding 12 months. ASU No. 2016-02 defines a lease as a contract or part of a contract that conveys the right to control the use of identified assets for a period of time in exchange for consideration. The lessee in a lease will be required to initially measure the right-of-use asset and the lease liability at the present value of the remaining lease payments, as well as capitalize initial direct costs as part of the right-of-use asset. ASU No. 2016-02 is effective for fiscal years beginning after December 15, 2021. Early adoption is permitted. The Organization is currently evaluating the impact that the adoption of ASU 2016-02 will have on its financial statements. (Note 2 continued on the following page) Exhibit 20 THE AMAAD INSTITUTE NOTES TO FINANCIAL STATEMENTS FOR THE YEAR ENDED DECEMBER 31, 2019 NOTE 2 - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Continued) New Accounting Pronouncements (Continued) -12- Guidance for Contributions Received and Made - In June 2018, the FASB issued ASU No. 2018-08, Not-for-Profit Entities (Topic 958): Clarifying the Scope and the Accounting Guidance for Contributions Received and Made. This update requires a recipient of funds from a resource provider to determine if those funds should be classified as a reciprocal exchange transaction or as a contribution based on the value that the resource provider is receiving from the transaction. Additionally, the update requires recipient organizations to determine whether a contribution is conditional based on if the agreement includes barriers that must be overcome, and either a right of return of assets transferred, or a right of release of a resource provider's obligation to transfer assets. If the agreement includes both characteristics, the recipient is not entitled to the transferred assets, and therefore does not recognize the associated revenues, until the barrier is overcome. ASU No. 2018-08 is effective for fiscal years beginning after December 15, 2018. Early adoption is permitted. The Organization has adopted ASU 2018-08 in these financial statements on a retrospective basis. No adjustments to net assets as of January 1, 2019 was necessary and adoption of the new guidance did not have a material impact on the Organization's financial statements. NOTE 3 - PROPERTY AND EQUIPMENT Property and equipment consisted of the following for the years ended December 31: Method Furniture and equipment Straight-line Less: accumulated depreciation Estimated Useful Lives (Years) 5 Depreciation expense for the year ended December 31, 2019 was $247. $ 1,239 (434) Exhibit 20 THE AMAAD INSTITUTE NOTES TO FINANCIAL STATEMENTS FOR THE YEAR ENDED DECEMBER 31, 2019 NOTE 4 - LEASE COMMITMENTS -13- The Organization leases office facilities, housing facilities and equipment for use in day-to-day operations. The leases are currently scheduled to expire on various dates ranging from June 2020 through September 2021. The monthly lease payments are fixed and range from $356 to $5,403. Future minimum lease payments under noncancelable operating leases as of December 31, 2019 are as follows: Years ending December 31: 2020 2021 2022 Total Rent expense totaled $87,515 for the year ended December 31, 2019. NOTE 5 - RELATED PARTY TRANSACTIONS $ 167,757 141,306 54,030 $ 363,093 ======= During the year ended December 31, 2019, the Organization paid consulting fees totaling $40,500 to a company that is owned by the Executive Director of the Organization. NOTE 6 - AVAILABILITY OF FINANCIAL ASSETS The following reflects The Organization's financial assets as of December 31, 2019, reduced by amounts not available for general use because of contractual or donor-imposed restrictions within one year of the balance sheet date. Amounts not available include amounts set aside for long-term investing in board designated funds that could be drawn upon if the governing board approves that action. However, amounts already appropriated from a board designated fund for general expenditure within one year of December 31, 2019are subtracted as unavailable. There were no such board designated funds as of December 31, 2019. The Organization's financial assets available within one year of December 31, 2019 for general expenditure are as follows: Financial assets, at year end Cash and cash equivalents Accounts receivable Less those unavailable for general expenditures within one year due to: Contractual or donor-imposed restrictions: Total $ 976,668 129,990 $ 1,106,658 ~-------- Exhibit 20 NOTE 7 - LITIGATION THE AMAAD INSTITUTE NOTES TO FINANCIAL STATEMENTS FOR THE YEAR ENDED DECEMBER 31, 2019 -14- The Organization may be subject to certain outside claims and litigation arising in the ordinary course of business. In the opinion of the Organization's management and its counsel, there are no matters which could have a material effect on the accompanying financial statements. NOTE B - SUBSEQUENT EVENTS Events subsequent to December 31, 2019 have been evaluated through February 3, 2021, the date at which the Organization's audited financial statements were available to be issued. Except as noted below, no events requiring disclosures have occurred through this date. In early 2020, an outbreak of the novel strain of coronavirus (COVID-19) emerged globally. As a result, there have been mandates from federal, state, and local authorities resulting in an overall decline in economic activity. The Organization has responded to the crises by delivering its services remotely via online teleconferencing platforms and limiting in person services. Furthermore, on April 6, 2020, the Organization received loan proceeds in the amount of $102,835 under the Paycheck Protection Program ("PPP"). The PPP, established as part of the Coronavirus Aid, Relief and Economic Security Act ("CARES Act"), provides for loans to qualifying businesses for amounts up to 2.5 times of the average monthly payroll expenses of the qualifying business. The loans and accrued interest are forgivable after twenty-four weeks as long as the borrower uses the loan proceeds for eligible purposes, including payroll, benefits, rent and utilities, and maintains its payroll levels. On January 8, 2021 the Organization received full forgiveness of its PPP loan. Additionally, on April 21, 2020 the Organization received a $10,000 grant under the Economic Injury Disaster Loan ("EIDL") program as well as a $149,900 fixed rate loan on May 29, 2020. The fixed rate loan accrues interest at 2. 75% per annum and is payable in monthly installments of principal and interest of $64 7 starting in May 2021. While it is reasonably possible that the virus could have a negative effect on the Organization's financial statements and results of operations, the specific impact is not readily determinable as of the date of these financial statements. The financial statements do not include any adjustments that might result from the outcome of this uncertainty. SUNRISE COMMUNITY COUNSELING CENTER, INC. Exhibit 20 SCHEDULE OF EXPENDITURES OF FEDERAL AWARDS FOR THE YEAR ENDED DECEMBER 31, 2019 Federal Grant/ Pass - Through Granter/ Program U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration CFDA# -15- Federal Expenditures Block Grants for Prevention and Treatment of Substance Abuse 1H79SP021682, SH79SP080233, SH79TI026590 93.959 $ 646,178 ----'---- GRAND TOTAL $ 646,178 ======== Note 1 - Basis of Presentation The accompanying schedule of expenditures of federal awards (the "Schedule") includes the federal grant activity of The AMAAD Institute (the Organization) under programs of the federal government for the year ended December 31, 2019. The information in this Schedule is presented in accordance with the requirements of Title 2 U.S. Code of Federal Regulations (CFR) Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance). Because the Schedule presents only a selected portion of the operations of the Organization, it is not intended to and docs not present the financial position, changes in net assets or cash flows of the Organization. Note 2 -Summary of Significant Accounting Policies Expenditures reported on the Schedule are reported on the accrual basis of accounting. Such expenditures are recognized following the cost principles contained in the Uniform Guidance, wherein certain types of expenditures are not allowable or limited or are limited as to reimbursement. Pass-through entity identifying numbers are presented where available. Exhibit 21 To the Board of Directors The AMAAD Institute Los Angeles, California ',,JC .\CCOU\Tl!"iC SOLUT1 l¾iC. r:~ F1.1x Sl'n ·ice.\ ._ ... ...... . ....... . ,., ..................... _.._. « .............. ~.-~ ,,.~.. - ~ ---~ 4· · • .,...,.,._, .... , .. ~,-~.•··· .. ·····--· .... -~ .... -·~---··- ,. • . _. _ _ ' " _ . ••• ,_,..~ ,-- - ACCOUNTANTS' COMPILATION REPORT We have compiled the accompanying statement of financial position of The AMAAD Institute as of December 31, 2020 and related statements of activities and changes in net assets for the twelve months then ended. We have performed a compilation engagement in accordance with Statements on Standards for Accounting and Review Services promulgated by the Accounting and Review Services Committee of the AI CPA. We did not audit or review the financial statements nor were we required to perform any procedures to verify the accuracy or completeness of the information provided by management. Accordingly, we do not express an opinion, a conclusion, nor provide any form of assurance on these financial statements. We are not independent with respect to The AMAAD Institute. MC Accounting Solutions, [nc. Los Angeles, California March 7, 2021 . ........... - -- _._ ······- -------- --- ... .... - . - --- ... ......... .. ···-··· . ......... ·- ... •·· · ···-· ,,__ - - ---- ------ -···---·-· ··----· .... ·-·-· ····--- -- .. - .. -- . - _,.,,,., ~-•--rn,,••••"•~ •~•• •• ' . ~.•· ••·~ ••<•••~ ·; • ; • •• • •·••-- , • •••W~,.,.., _ _, .. _,...,_, ••••••· _,., ........ •~r• '-'-'• .~. ,• _ ,,..v,, .... ,. • •-,•~> ..,,. ,>••••>'•~~•--••~--~'"•• ·· -Mm•<••-<~ •~~· 1/ ,-.~-- -,,.,~~,, .. -.,.., , ,-. • ~••••• ,._ ... - • • .s.,.,, ... ~~ - • ~- • · • - ~••-"• /'.(). l?/)Xsn55 · ', S,: m.v!w·ino. CA 9//08 (3!/J(iOn -3 i.? r\ ' 0 I 01 80 ! .6888 Exhibit 21 THE AMAAD INSTITUTE STATEMENT OF FINANCIAL POSITION AS OF DECEMBER 31, 2020 ASSETS CURRENT ASSETS Cash Grants receivable Prepaid expenses Deposits Other Total Current Assets Furniture and Equipment TOT AL ASSETS LIABILITIES AND NET ASSETS CURRENT LIABILITIES Accounts payable Credit card payable Deferred revenue Total current liabilities LONG-TERM LIABILITIES Loan - SBA PPP TOT AL LIABILITIES NET ASSETS Net assets without donor restrictions TOTAL NET ASSETS TOT AL LIABILITIES AND NET ASSETS -1- $ 1,010,798 10,015 4,365 31,346 104 1,056,628 13,396 $ 1,070,024 $ 10,314 18,877 396,047 425,238 252,835 678,073 391,951 391,951 $ 1,070,024 Exhibit 21 THE AMAAD INSTITUTE STATEMENT OF ACTIVITIES FOR THE TWELVE MONTHS ENDED DECEMBER 31, 2020 SUPPORT Corporations Foundations Individuals Government - ACO Government- irnPACT Government - CSAP Government - CSAP MAI Government- CSAT- Housing Government- CSAT- Recovery Government - County of LA - Tobacco Government - BSCC Re-RAP Government - BSCC Warm Hand Government - WDACS Other Occupancy fee Interest income Total support Net assets released from restriction TOTAL REVENUE AND PUBLIC SUPPORT OPERATING EXPENSES Program services Health and wellness Policy Housing Reentry Total program services Supporting services Management and general TOTAL OPERATING EXPENSES CHANGE IN NET ASSETS NET ASSETS - BEGINNING OF PERIOD NET ASSETS - END OF PERIOD $ $ Unrestricted 219,050 10,375 2,643 35,421 104,032 290,139 324,750 223,190 102,200 209,539 306,164 121,596 60,000 10,000 37,266 13 2,056,378 2,056,378 513,051 156,721 125,618 701,279 1,496,669 324,971 1,821,640 234,738 157,213 391,951 -2- m / fHHn;uuw1'1 i~~[ ijg,~ m~~~§,~111 m~qm~mmum1~ ~ II ii Ui I~ ~ , . . . ., ·1 l l . 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I " a ' a ·1 ! -, i I .. --1 I.I J -5- Exhibit 2 1 Tllll AMAAD INSTITUTE STATEMENT OF ACTMTIES ·HEALTH AND WELLNESS FOR THE TWl!LVE MONTHS ENDED DECEMBER 31, 2020 HEALTH & WELLNESS SAMIISA-CSAP SAMIISA-CSAP SAMIISA-CSAT BSCCVOUTII ACO NAVIGATOR MAI RECOVERY DMRSION TOTAL REVENUE ACO 35,421 35,421 BSCC YOUTII DIVERSION SAMIISA 290,139 324,750 102,200 717,089 Total revenue 35,121 Z90,U9 '.U4,7SO 102,200 752,510 SALARIF.S, PAYROLi, TAXES ANO HMPLOYEF. RENHFITS Salaries 21,310 126,692 154,502 35,392 30,019 367,915 Payroll taxes 1,915 7,478 6,582 672 l,243 10,890 Payroll fees Health insurance 2,920 9,763 13,210 7,206 188 33,287 Employee benefits Retirement Staff development Workers comp insurance l19 1,426 1,748 447 296 4,136 Total salaries, payroll taxes and employee benefits 26,364 145,359 176,0<12 4],717 32,746 421,228 PROGRAM EXPENSES Community events 787 39 251 400 1,477 Confrenc:e and meetings lnsurunc:e 550 2,012 2,622 19 20 5,223 Partidpation incentives 386 3,135 5,747 9,268 Program promotion 21 77 101 70 75 344 Rental assistance Vouchers Supplies 10 35 46 91 Total program expenses 1,754 5,298 8,76~~-- 489 95 $ 16,403 OPERATION EXPENSES Ai::counting 1,241 1,6T/ 2,232 35/ 5,513 Audlt 168 623 817 566 605 2,779 Auto 4,300 4,300 Bank charges Depreciation Dues and subscriptions 103 599 768 259 245 1,974 Equipment rental and maintenance Officf.! supplies 98 683 715 26/J 129 1,889 Outside services 131 205 267 603 Postage Printing and coping Rent l,118 17,727 23,2l4 3,278 46,347 Rental assistance Repairs and maintenance 62 225 294 581 Shelter Small equipment Sponsorships Taxes anrl license Telephone 936 6,060 917 65 70 8,048 Travel 260 120 386 Utilities Total operation e,cpenscs 5,12.3 32,105 29,354 4,789 1,049 72,420 1'otal Bxpenses Before Donated Services 33,241 182,762 214,163 "18,995 33,890 513,051 Donated se!Vlces Total Expenses 33,241 182,762 214,163 48,995 33,890 513,051 CflANGR IN NRT ASSETS $ 2,180 107,377 110,587 53,205 (33,890) 239,4S9 Exhibit 21 THE AMAAD INSTITUTE STATEMENT OF ACTIVITIES· HOUSING FOR THE TWELVE MONTHS ENDED DECELMBER 31, 2020 REVENUE SAMHSA- CSAT Total revenue SALARIES, PAYROLL TAXES AND EMPLOYEE BENEFITS Salaries Payroll taxes Payroll fees Health insurance Employee benefits Retirement Staff development Workers comp insurance Total salaries, payroll taxes and employee benefits PROGRAM EXPENSES Community events Confrence and meetings Insurance Participation incentives Program promotion Rental assistance Vouchers Supplies Total program expenses OPERATION EXPENSES Accounting Audit Auto Bank charges Depreciation Dues and subscriptions Equipment rental and maintenance Office supplies Outside services Postage Printing and coping Rent Rental assistance Repairs and maintenance Shelter Small equipment Sponsorships Taxes and license Telephone Travel Utilities Total operation expenses Total Expenses Before Donated Services Donated services Total Expenses $ $ $ $ $ HOUSING 223,190 223,190 61,949 4,869 1,734 107 624 69,283 41 154 195 1,246 508 264 10,860 7,094 6,275 29,750 143 56,140 125,618 125,618 -6- Exhibit 21 THE AMAAD INSTITUTE STATEMENT OF ACTIVITIES - POLICY FOR THE TWELVE MONTHS ENDED DECEMBER 31, 2020 REVENUE LA-Tobacco Total revenue SALARIES, PAYROLL TAXES AND EMPLOYEE BENEFITS Salaries Payroll taxes Payroll fees Health insurance Employee benefits Retirement Staff development Workers comp insurance Total salaries, payroll truces and employee benefits PROGRAM EXPENSES Community events Confrence and meetings Insurance Participation incentives Program promotion Rental assistance Vouchers Supplies Total program expenses OPERATION EXPENSES Accounting Audit Auto Bank charges Depreciation Dues and subscriptions Equipment rental and maintenance Office supplies Outside services Postage Printing and coping Rent Rental assistance Repairs and maintenance Shelter Small equipment Sponsorships TaJCes and license Telephone Travel Utilities Total operation expenses Total Expenses Before Donated Services Donated services Total Expenses $ $ $ $ $ POLICY LA-TOBACCO 209,539 209,539 110,328 866 8,746 1,248 121,188 62 2,621 1,382 177 3,741 7,983 2,185 785 622 1,254 267 79 10,108 293 1,333 11,205 (581) 27,550 156,721 156,721 -7- Exhibit 21 THE AMAAD INSTITUTE STATEMENT OF ACTIVITIES, REENTRY FOR THE TWELVE MONTHS ENDED DECEMBER 31, 2020 REENTRY BSCCRENTAL BSCCWARM ASSISTANCE HANDOFF REVENUE imPACT $ $ $ BSCC 306,164 121,596 Total revenue $ 306,164 $ 121,596 $ SALARIES, PA YROl,L TAXES AND EMPLOYEE BENEFITS Salaries $ 117,743 $ 97,442 $ Payroll taxes 25,132 8,739 Payroll fees Health insurance 6,967 3,744 Employee benefiL, Retirement Staff development 38 129 Workers comp insurance 1,236 1,078 Total salaries, payroll taxes and employee benefits $ 151,116 $ 111,132 $ PROGRAM EXPENSES Community evenL, 124 28 Confrence and meetings Insurance 6,378 1,478 Participation incentives 321 74 Program promotion 180 44 Rental assistance Vouchers Supplies 772 26 Total program expenses 7,775 1,650 OPERATION EXPENSES Accounting 5,330 1,234 Audit 1,449 353 Auto Bank charges Depreciation Dues and subscriptions 1,087 256 Equipment rental and maintenance Office supplies 1,349 248 Outside services 651 151 Postage Printing and coping Rent 24,657 5,711 Rental assistance 99,935 Repairs and maintenance 716 167 Shelter Small equipment 4,100 Sponsorships Taxes and license Telephone 7,980 689 Travel 20 5 Utilities Total operation expenses 147,274 8,814 Total Expenses Before Donated Services 306,165 121,596 Donated services Total Expenses $ 306,165 $ 121,596 -8- I.A-IMPACT SUBTOTAL 104,032 $ 104,032 427,760 104,032 $ 531,792 178,468 $ 393,653 15,537 49,408 15,643 26,354 229 396 1,970 4,284 211,847 $ 474,095 2,302 2,454 2,326 10,182 392 787 69 293 280 1,078 5,369 14,794 2,096 8,660 556 2,358 405 1,748 853 853 403 2,000 4,397 5,199 14,602 44,970 99,935 261 1,144 29,750 29,750 4,100 2,971 11,640 8 33 56,302 212,390 273,518 701,279 $ 273,518 $ 701,279 Exhibit 21 THE AMAAD INSTITUTE STATEMENT OF ACTIVITIES - GENllRAL ADMIN FOR THE TWELVE MONTHS ENDED DECEMBER 31, ZOZO REVENUE Corporate Foundations Individuals Other Income Rental Assistance Interest income Total revenue SALARIES, PAYROLL TAXES AND EMPLOYEE BENEFITS Salaries Payroll taxes Payroll fees Health insurance Employee benefits Retirement Staff development Workers comp insurance Total salaries, payroll taxes and employee benefits PROGRAM EXPENSES Community events Confrence and meetings Insurance Participation incentives Program promotion Rental assistance Vouchers Supplies Total program expenses OPERATION EXPENSES Accounting Audit Auto Bank charges Depreciation Dues and subscriptions Equipment rental and maintenance Office suppl!es Outside services Postage Printing and coping Rent Rental assistance Repairs and maintena11ce Shelter Small equipment Sponsorships Taxes and license Telephone Travel Utililies Total operation expenses Total Expenses Before Donated Services Donated services Total Expenses MANAGEMENT AND GENERAL $ 219,050 10,375 2,643 70,000 37,266 13 $ 339,347 $ 39,243 4,427 4,835 2,377 175 5,088 3,430 472 $ 60,047 13,895 791 210 12,989 2,839 1,000 7,739 39,463 1,359 832 357 265 982 8,198 2,900 15,135 117,245 438 40 36,743 6,390 353 3,195 5,437 4,500 689 5,000 8,740 6,663 225,461 324,971 $ 324,971 -9- Attachment Keith R. Green, CV, 2020 Pagel Exhibit 22 CURRICULUM VITAE Keith R. Green swkgrcen@gmaiI.com (773) 562-6872 EDUCATION Ph.D. 2018 A.M. 2018 M.S.W. 2009 B.A. 2007 The University of Chicago School of Social Service Administration The University of Chicago School of Social Service Administration Concentration: Social Service Administration University of Wisconsin-Madison School of Social Work Concentration: Mental Health Northeastern Illinois University Major: Social Work, Summa cum laude ACADEMIC AND RESEARCH APPOINTMENTS 2019 - Present 2018 - Present 2016- 2018 2013- 2019 2015 - 2016 2013 - 2015 2008- 2018 Fellow, Community Engaged Scholars Faculty Fellow Program, Loyola University Chicago Assistant Professor, School of Social Work, Loyola University Chicago Predoctoral Trainee, NRSA Health Services Research Training Program, The University of Chicago Research Affiliate, The Chicago Center for HIV Elimination, The University of Chicago Teaching Apprentice, School of Social Service Administration, The University of Chicago Ford Foundation Scholar, The Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health, The University of Chicago Ronald E. McNair Scholar, U.S. Depa1tment of Education, Northeastern Illinois University RESEARCH INTERESTS Urban Health and Health Disparities; Health Policy; Social Dete1minants of Health; Sexual Health; Substance Use and Abuse; HIV/AIDS Prevention and Intervention; Implementation Exhibit 22 Attachment Keith R. Green, CV, 2020 Page 2 Science; Social Welfare Policy; Human Service Organizations; Community Organizing; Social Enterprise PUBLICATIONS PEER-REVIEWED JOURNAL ARTICLES Iverson, M., Dentato, M., Green, K., Busch, N. (2019). The continued need for macro field internships: Support, visibility and quality matter. Journal of Social Work Education, DOI: l 0.1080/10437797.2019.1671265. Schneider, J., Kozloski, M., Michaels, S., Skaathun, B., Voisin, D., Lancki, N., Morgan, E., Khanna, A., Green, K., Coombs, R., Friedman, S., Lawnann, E., Schumm, P. (2017). Criminal justice involvement history is associated with better HIV care continuum metrics among a population-based sample of young black MSM. AIDS, 31(1), 159-165. Britt, L., Michaels, S., Green, K., Nelson, C., Westbrook, M., Simpson, Y., Prachand, N., Benbow, N., Schneider, J. (2013). Estimating the number of young black men who have sex with men (YBMSM) on the South Side of Chicago: towards elimination within US urban communities. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 90( 6), 1205-1214. Hosek, S., Green, K., Sibeny, G., Lally, M., Balthazaar, C., Serrano, P., Kapogiannis, B., & The Adolescent Medicine Trials Network for HIV/AIDS Interventions. (2013). Integrating behavioral interventions into biomedical prevention trials with you: lessons from Chicago's Project PrEPare. Journal of HIV/AIDS and Social Services, 12(3-4), 333-348. Hosek, S., Siberry, G., Bell, M., Lally, M., Kapogiannis, B., Green, K., Fernandez, I., Rutledge, B., Martinez, J., Graofalo, R., Wilson, C. & the Adolescent Trials Network. (2013). The acceptability and feasibility of an HIV pre-exposure prophylaxis (PrEP) trial with young men who have sex with men. Journal of Acquired Immune Deficiency Syndromes, 62(4) , 447-456. SELECT MONOGRAPHS, REPORTS, AND OTHER PUBLICATIONS Khanna, A., Michaels, S., Skaathun, B., Morgan, E., Green, K., Young, L., Schneider, J.; for the UConnect Study Team. (2015). Pre-exposure prophylaxis (PrEP) awareness and uptake in a population-based sample of younger black men who have sex with men. JAMA Internal Medicine. Published online November 16, 2015. Green, K. (2008, July/Aug). Nightsweats and T-Cells: where business and social service meet. Positively Aware, 19(5), 39-39. Green, K. (2008, July/ Aug). Challenges of the young and trans gender: A physician describes a population near and dear to his heart. Positively Aware, 19(4), 34-35. Exhibit 22 Attachment Keith R. Green, CV, 2020 Page 3 Green, K. (2008, May/June). Prevention updates from CROI: Suppression of genital herpes, circumcision, and sero-sorting as prevention. Positively Aware, 19(3), 30. Green, K. (2007, Nov/Dec). Highlights of biomedical prevention strategies: Methods to prevent HIV from the angle of biology offer hope. Positively Aware, 18(6), 18-19. Green, K. (2007, March/ April). When opposites attract: an exploration of serodiscordant relationships. Positively Aware, 18(2), 20-23. Green, K. (2006, July/Aug). Dating, youth, and HIV - from both sides: teenagers try to make sense of it all. Positively Aware, July/ August 2006; 17(4), 40-41. Green, K. (2006, July/Aug). Having a ball: A look at an underground youth community that has taken HIV prevention and awareness into its own hands. Positively Aware, 17(4), 29-30. Green, K. (2005, Sept/Oct). Haiti - the intersection of race, poverty, and HIV. Positively Aware, 16(5), 39. MANUSCRIPTS UNDER REVIEW McDowell, H., Green, K., Harper, G., Hosek, S., Jadwin-Cakmak, L. (in progress). Navigating vulnerability for Black GBT youth: From familial rejection to limited support and conditional acceptance in the House Ballroom community. Green, K., Tally, A., Bouris, A. (in progress). Using digital storytelling to engage young, black queer men into participatory action research that illuminates the structural factors affecting sexual health. MANUSCRIPTS IN PROGRESS Green, K., Wilton, L. (in progress). Crystal CLEAR Chicago: Engaging community-based participatory research to understand the rise in methamphetamine use among Black gay and bisexual men in Chicago. Green, K. (in progress). Exploring CBO responses to the emerging biomedical HIV prevention practice ideology and the call to address social determinants of health within the CDCs program for community-based prevention. Boyd, D., Green, K. (in progress). The source of education matters for increasing HIV testing rates among Black and Latinx. youth and young adults. COMPETITIVE GRANTS & FELLOWSHIPS AWARDED 2019- 2021 Community-Engaged Scholars Faculty Fellows Program Exhibit 22 Attachment Keith R. Green, CV, 2020 Page4 Center for Experiential Leaming at Loyola University Chicago 2019- 2020 PrEP Corporate Grant Award ($100,000) Gilead Sciences, Inc. 2019-2020 Community Development Award ($40,000) Howard Brown Health/Chicago Department of Public Health 2016 Research and Travel Grant ($2,500) Center for the Study of Race, Politics, and Culture at the University of Chicago 2015 2012 - 2018 2008- 2009 Graduate Council Travel Fund ($600) The University of Chicago Doctoral Student Fellowship The University of Chicago School of Social Service Administration Graduate Opportunity Fellowship College of Letters and Sciences, University of Wisconsin-Madison APPLIED BUT NOT AW ARD ED 2016 AHRQ Grants for Health Services Research Dissertation Program (R36) $40,000 2016 Ruth L. Kirschstein National Research Service Award Individual Predoctoral Fellowship (F31- Diversity) PROFESSIONAL PRESENTATIONS PEER-REVIEWED CONFERENCE PRESENTATIONS Green, K. (2019, October). Leveling the Playing Field: Exploring Community-Based Efforts for Improving African American-led Nonprofits in Philadelphia. Council on Social Work Education 2019 Annual Program Meeting. Denver, CO. Green, K. (2019, September). CBO Leaders' Responses to Shifting Government HIV Prevention Mandates. United States Conference on AIDS. Washington, DC. Green, K. (2018, January). CBOs and PrEP: A Deeper Dive. National African American MSM Leadership Conference on HIV/AIDS and Other Health Disparities. Atlanta, GA. Green, K. (2018, January). "There's No Superhighway to PrEP ": Illuminating the Roles and Challenges Facing CBOs in the Biomedical HIV Prevention Era. Society for Social Work and Research 20 th Annual Conference. Washington, DC. Exhibit 22 Attachment Keith R. Green, CV, 2020 Page 5 Green, K. (2017, June). Pre-Exposure Prophylaxis and the Expanding Institutional Logics of HIV Prevention: Implications.for CBOs. Agency for Healthcare Research and Quality 23 rd Annual NRSA Research Trainees Conference. New Orleans, LA. Green, K. (2017, January). Overcoming Racial Discrimination to Improve Access to HIV Prevention Services in Chicago. National African American MSM Leadership Conference on HIV/ AIDS and Other Health Disparities. Dallas, TX. Green, K., Bouris, A., Pollack, H. (2015, January). Integrating Biomedical Prevention Technologies: HIV/AIDS Focused CBOs Finding Their Way. Society for Social Work and Research 19 th Annual Conference. New Orleans, LA. Green, K., Bouris, A., Pollack, H. (2014, November). HIV Prevention in the ACA Era: A CBO Perspective. American Public Health Association 142 nd Annual Meeting and Exposition. New Orleans, LA. Green, K., Pollack, H. (2014, October). A Day in the life: Integrating Biomedical Prevention Technologies at the CBO Level. 23 rd Annual Illinois HIV/STD Conference. Springfield, IL Bush, S., Green, K., Keglovitz-Baker, K., Mera, R., Rawlings, K. (2014, October). Age and Provider Differences in Utilization of Truvada for Pre-Exposure Prophylaxis. United States Conference on AIDS. San Diego, CA. Denson, D. and Green, K. (2012, January). LoveFest: Sharing Best Practices on Conducting and Evaluating the CBMGC's Annual HIV/ST! Testing and Educational Event. National African American MSM Leadership Conference on HIV/AIDS and Other Health Disparities. New Orleans, LA. Simmons, R., Fields, S., Green, K. Symposium. (2011 , January). Shifiing Paradigm of HIV Infection Among Black MSM Communities and the Development of New Strategies for Culturally Relevant Prevention. National African American MSM Leadership Conference on HIV/ AIDS and Other Health Disparities. Brooklyn, NY. Green, K., Hosek, S., Bell, M. (2010, January). Exploring the Acceptability and Feasibility of a Pre--Exposure Prophylaxis Trial Among Young Men who have Sex with Men. Black Gay Research Summit. Atlanta, GA. INVITED PRESENTATIONS Green, K. (2020, November). Tuning Out the Noise (or How to Keep from Going Mad During These Ve,y Peculiar Times). Michigan Department of Health HIV and Housing Summit. Virtual. Green, K. (2020, August). Understanding Methamphetamine Use Among Black Gay, Bisexual and Other Men who Have Sex with Men in Chicago . Desire Driven Science: HIV Prevention Research, Pleasure and Equity. Virtual. Exhibit 22 Attachment Keith R. Green, CV, 2020 Page 6 Green, K. (2020, May). Social Work Solutions to End the Epidemic. National Conference on Social Work and HIV/AIDS. Virtual. Green, K. (2019, May). Caring/or Self while Caring/or Community: A critical conversation with the Black HIV/AIDS workforce. The 7 th Annual Saving Ourselves Symposium. North Charleston, SC. Green, K. (2019, May). Research with Community-Based Organizations. The Doctoral Scholars Institute at the Network for Social Work Management Conference. Chicago, IL. Green, K. (2018, October). Resilience in the Face of HIV (or How to Overcome a Plague). FORUM 2018. St. Louis, MO. Green, K. (2017, July). Exploring Strategies for Improving Field Seminar Engagement. The University of Chicago School of Social Service Annual Field Consultant Retreat. Chicago, IL. Sprague, L., Mthembu, S., Green, K. (2016, February). Stigma, Trauma and Stress: Consideration for HIV Research and Programs. Conference on Retroviruses and Opportunistic Infections. Boston, MA. Green, K. (2014, March). Getting to Zero: Challenges and Possibilities for Ending the HIV/AIDS Epidemic Among Black MSM. Tennessee Statewide HIV/STD Meeting. Nashville, TN. Green, K. (2014, February). Biomedical Prevention for HIV/AIDS. The Black Treatment Advocates Network (BTAN) Conference. Chicago, IL. Green, K., Hosek, S., Bell, M. (2010, March). Exploring the Acceptability and Feasibility of a Pre-Exposure Prophylaxis Trial Among Young Men who have Sex with Men. AIDS Clinical Trials Group (ACTG) Health Promoter Program Retreat. Chicago, IL. Green, K. (2009, January). New Emerging Research: MSM and HIV. The AIDS Foundation of Chicago Prevention Conference. Chicago, IL. RESEARCH EXPERIENCE 2019 -- present Principal Investigator Crystal CLEAR Chicago A qualitative exploration of crystal methamphetamine use/abuse among Black gay, bisexual, and other men who have sex with men in Chicago. Conceptualized study and methods. Currently conducting focus groups with members of various communities of Black gay, bisexual and other men who have sex with men as well as social/medical service providers to understand: the scope of crystal methamphetamine use/abuse among this population; motivations for use; and available, culturally-sensitive Exhibit 22 Attachment 2015 - 2018 2013 - 2016 2013 -2016 2013 -- 2015 Keith R. Green, CV, 2020 Page 7 treatment resources throughout the city. In-depth interviews will also be conducted with a smaller sample of Black gay, bisexual and other men who have sex with men. Principal Investigator Pre-Exposure Prophylaxis (PrEP) and the Expanding Institutional Logics of HIV Prevention: Implications for Community-Based Organizations Comparative case analysis exploring the challenges that local health departments and community-based organizations (CBOs) confront with integrating PrEP into existing HIV prevention programming in varying Affordable Care Act (ACA) implementation contexts. Conceptualized study and methods. Conducted in-depth interviews with public health officials and administrators as well as frontlinc prevention staff from CBOs in Atlanta, Baltimore, Memphis, and New Orleans. Graduate Research Assistant South Side Stories Principal Investigators: Melissa Gilliam, M.D. and Alida Bouris, Ph.D. Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health, University of Chicago Assisted with the facilitation of digital storytelling workshops designed to collect black youths' narratives around sexual and reproductive health. Conceptualized and designed an independent research study to explore the impact of racial discrimination on access to HIV prevention, education, and testing services for young, black queer men in Chicago's gay enclave. Graduate Research Assistant Social Network Dynamics, HIV, and Risk Reduction Among Young Black MSM Principal Investigator: John Schneider, M.D. NORC at the University of Chicago Assisted with community engagement and recruitment to ensure a diverse representation of study participants. Assisted with data analysis and co authoring of research articles and reports. Co-Principal Investigator Exploring the Challenges Facing HIV/AIDS-Focused Community-Based Organizations in the Affordable Care Act Era Principal Investigator: Harold Pollack, Ph.D. The School of Social Service Administration, University of Chicago Conceptualized study and methods. Conducted in-depth interviews with 12 executive administrators of HIV/ AIDS-focused organizations in Exhibit 22 Attachment 2010 - 2011 2009 2011 2006-2007 2006 Keith R. Green, CV, 2020 Chicago to understand the impact of the ACA on infrastructure and programming within these CBOs. Project Director Page8 Project POSSE: An HIV Intervention Tailored for YMSM in the House Ball Community Principal Investigators: Sybil Hosek, Ph.D. and Isabel Fernandez, Ph.D. Cook County Health and Hospital System Co11aborated with the principal investigators on the design and implementation of the research protocol. Managed the day-to-day activities of the project including budget oversight, staff supervision, and ensuring fidelity to the core components of the behavioral intervention. Project Director Acceptability and Feasibility of a Pre--Exposure Prophylaxis (PrEP) Trial with Young Men Who Have Sex with Men Principal Investigators: Sybil Hosek, Ph.D. and Margo Bell, M.D. Cook County Health and Hospital System Collaborated with the principal investigators and researchers from the Adolescent Trials Network on the design and implementation of the research protocol. Coordinated an interdisciplinary team of researchers to achieve the aims of the study. Managed the day-to-day activities of the project including budget oversight, staff supervision, and ensuring fidelity to the core components of the behavioral intervention. Co-Principal Investigator Exploring the Relationship Between Possible Selves and Sexual Risk Behaviors Among College-Age African Americans Principal Investigator: Jade Stanley, Ed.D. Northeastern Illinois University Collaborated with the principal investigator to design and implement the research protocol as an independent summer research project for the Ronald E. McNair Scholars Program. Research Assistant The Impact of Gender Role Conflict and Black Racial Identification on Sexual Risk Behavior Among Black MSM in the United States Principal Investigator: David Malebranche, M.D. Emory University Assisted with study recruitment and administered survey instruments to participants in Atlanta-based venues. Exhibit 22 Attachment Keith R. Green, CV, 2020 Page9 TEACHING INTERESTS Organizational Theory & Management; Human Service Organizations; Social Welfare Policy; Health Policy; History of the Social Work Profession; HIV/AIDS Prevention & Intervention; Research Methods for Social Workers; Social Determinants of Health & Health Disparities TEACHING EXPERIENCE LOYOLA UNIVERSITY CHICAGO SCHOOL OF SOCIAL WORK (*Denotes newly created course) 2020 --Present 2020 2019 - Present 2019 2018 - 2019 Promoting Social Justice and Empowerment: The Intersection of Oppression, Privilege and Diversity in Social Work *Community-Based Responses to Social Injustice: Dcconstructing post Katrina recovery efforts in New Orleans Methods of Social Work Research Organizational Analysis Introduction to Social Work UNIVERSITY OF CHICAGO SCHOOL OF SOCIAL SERVICE ADMINISTRATION 2016 - 2018 2016- 2017 2016 2014 2014 Lecturer and Liaison, Field Seminar Adjunct Instructor, Organizational Theory and Analysis for Human Services Adjunct Instructor, Social Interventions: Programs and Policies lI Graduate Teaching Assistant and Guest Lecturer, Organizational Theory and Analysis for Human Services Instructor: Jennifer Mosley, PhD, MSW Graduate Teaching Apprentice and Guest Lecturer, Social Interventions: Programs and Policies II Instructor: Jennifer Mosley, PhD, MSW UNIVERSITY OF CALIFORNIA AT LOS ANGELES 2013 - 2015 Teaching Assistant, Center for World Health, African American HIV/AIDS University NORTHEASTERN ILLINOIS UNIVERSITY 2012 2011 - 2012 2011 2011 Adjunct Instructor, Research Practicum II Adjunct Instructor, Research and Quantitative Applications in Social Work Adjunct Instructor, Research Practicum I Adjunct Instructor, Social Welfare Policy II Exhibit 22 Attachment Keith R. Green, CV, 2020 Page 10 UNIVERSITY OF ILLINOIS SCHOOL OF PUBLIC HEAL TH 2010 Guest Lecturer, The Epidemiology of HIV/AIDS Instructor: Nik Prachand, M.P.H. CLINICAL AND PRACTICE EXPERIENCE 2017- 2019 2017 - 2018 2012- 2015 2011 - 2012 2010 - 2015 Project Coordinator Philadelphia African American Leadership Forum Coordinate the organization's fundraising/development activities, manage website and social media platforms, assist with recruitment and curriculum refinement for the Leadership Development Institute. Lead Community E11gagement/Data Collection Specialist HIV Workforce Certification Project, Black AIDS Institute, Los Angeles, CA · Designed and assisted with the implementation of a national community engagement strategy (including regional focus groups, town hall meetings, and key informant interviews) to determine the acceptability and feasibility of an HIV workforce certification program. Principal Evaluator Chicago Black Gay Men's Caucus, Chicago, IL Managed the organization's program development, implementation, and evaluation activities including grant writing, staff training, and co facilitation of CDC-sanctioned evidence-based behavioral interventions. Director of Federal Affairs AIDS Foundation of Chicago, Chicago, IL Organized HNI AIDS-related policy and advocacy initiatives with a specific focus on the National HIV/AIDS Strategy and the Patient Protection and Affordable Care Act. Assisted with fundraising, program planning and implementation, and community-based research activities. Lead Science and Treatment Curriculum Specialist Black AIDS Institute, Los Angeles, CA Collaborated with a team of HIV/ AIDS science and treatment experts/advocates to develop and facilitate the National Black Treatment Advocates Network (STAN) training for service providers in 13 U.S. cities where black people are dispropo1tionately affected by HIV/AIDS. Exhibit 22 Attachment 2009- 2011 Youth Therapist Keith R. Green, CV, 2020 Page 11 Fantus Clinic, Cook County Health and Hospital System, Chicago, IL Provided mental health assessments and individual-level therapy to low income adolescents and young adults. HONORS AND A WARDS 2020 Heroes in the Struggle inductee (activist award) Black AIDS Institute 2017 Flame Thrower Award for being a pioneer of social justice within black LGBT communities The Red Door Foundation 20 l 0 Inductee Chicago Gay and Lesbian Hall of Fame 20t0 Outstanding Community Service Award Pridclndex.com Esteem A wards 2008 Student Award of Excellence Northeastern Illinois University SERVICE ACADEMIC SERVICE 2019 - present 2019 - present 2018 - present 20t8 - 2019 2018 - present 2017 - present 2013 Committee Member, Loyola University Chicago Public Health Steering Committee Member Committee Member, Loyola University Chicago School of Social Work, Leadership Development in Social Services Curriculum Revamp (Ad Hoc) Committee Mentor, Arrupe College Chicago, Black Men for Success (BMS) Mentor, Loyola University Chicago, Brothers 4 Excellence (B4E) Committee Member, Loyola University Chicago School of Social Work, Community Engagement Committee Manuscript Reviewer, Journal of the Society for Social Work Research Guest Manuscript Reviewer, HIV/AIDS and Social Services Exhibit 22 Attachment Keith R. Green, CV, 2020 Page 12 PROFESSIONAL/PUBLIC SERVICE 2020 - present 2019 - present 2019 - present 2019 - present 2018--2019 2017 - 2019 2016-present 2014- 2020 2007 - 2011 Board Member, Chicago Black Gay Men's Caucus Chicago, IL Advisor, ViiV Healthcare ACCELERATE! National Advisory Board Task Force Member, Getting to Zero Illinois Implementation Council Board Member, Wieboldt Foundation Chicago, IL Advisor, Howard Brown Health South Side Community Advisory Board Chicago, IL Coordinator, Philadelphia African American Leadership Forum Philadelphia, PA Chair, Gilead Sciences North American Research Community Advisory Group Board Member, Task Force Prevention and Community Services Chicago, IL Board Chairman, Chicago Black Gay Men's Caucus Chicago, IL PROFESSIONAL MEMBERSHIPS Academy Health American Public Health Association Council on Social Work Education Society for Social Work and Research DATA ANALYSIS TRAINING Qualitative Qualitative Research Seminar (University of Chicago) Qualitative Research Methods (University of Chicago) Software: n Vivo, Dedoose Quantitative Statistical Research Methods I and II (University of Chicago) Applied Regression Analysis (University of Chicago) Software: SPSS, Stata Exhibit 22 Summary Points Carl Highshaw 2533 E. 220 th Street, Carson, CA 90810 (323) 569-1610 / carl@amaad.org Attachment • High functioning Executive Social Worker with a unique blend of administrative and lived experience that is relevant to organizations that works towards systemic change and racial justice. • Skilled leadership and knowledge of socio-economic co-factors related to homelessness and interrelated public health challenges that have disproportionate impact on disenfranchised subpopulations. • Especially versed at facilitating nuanced partnership agreements and collaboration among grassroots community-based providers and governmental entities. Formal Education I Degrees School Institution Doctor of Social Work (D.S.W.) Candidate University of Southern California • Scalinq intemated behavioral health services Los Angeles, CA Master of Social Work (M.S.W.) Washington University in St. Louis • Social & Economic Develooment St. Louis, MO Bachelor of Science (B.S.) in Psychology Western Illinois University • Minors: African American Studies & Sociology Macomb, IL Other Certificates, Registrations, & Trainings California Consortium of Addiction Program Professionals Credential Los Angeles Training Institute for Alcohol & Drug Counselinq Anti-Retroviral Treatment and Access to Services (ARTAS) Training Rapid HIV Testing CounselinQ, Los Angeles Division of HIV & STD Programs Human Resource Management Training, Cal State Univ. - Dominguez Hills Employment Experience The AMAAO Institute President & Chief Executive Officer Years 2019 - 2021 (projected date) 1996 - 1998 1992 -1995 Years 2016 2014 2012 2012 2006 2013 - current • Provide executive oversight and direction for multi-site comprehensive integrated community-based organization that prioritizes disenfranchised Black and Brown populations; • Developed and negotiated wide range of scope of work activities with multiple federal, state, city, and county government partners, including U.S. Substance Abuse and Mental Health Services Administration, California Board of State Community Corrections, City of L.A. Mayor's Office of Economic Development, City of L.A. Department on Disability Office of AIDS, County of L.A. Department of Public Health Division of HIV and STD Programs, Division of Chronic Disease and Injury Prevention, County of L.A. Department of Mental Health, • Significantly expanded organizational infrastructure and resources to implement Board directed strategic plan to address homelessness and housing insecurities experienced by agency's priority population in South and Metro Los Angeles; • Solidified agency housing program portfolio that is inclusive of coordinated transitional/shelter and permanent supportive placements, as well as monthly rental assistance voucher payments. • Formalized unique Peer Based service model that include components for recovery coaching for substance use disorder (SUD), mental health therapy, HIV prevention, • Faciliate client counseling and recovery support services, including the supervision of Certified Substance Abuse Counselors and Licensed Behavioral Therapists. • Coordinate full range of Substance Use Disorder Recovery Program including client intake, individual counseling, group counseling, discharge planning, and follow-up. • Work with establish broad-base partners including multiple health and human services organizations for effective linked referral system. • Organize client services in concert with U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) protocols and standards. Exhibit 22 Carl Highshaw - Resume Continued Attachment • Developed and implemented strategies to maximize client's well being and connection to recovery supportive services. • Hands on work with clients and staff to assist individuals to navigate within the community, referral to various county agencies, community organizations, accessing benefits, personal medical services and case management. • Establish links and working relationships with appropriate service providers, community agencies, and educational institutions. In The Meantime Men's Group Case Management Deputy Director 2011-2013 • Provide day-to-day coordination of Risk Reduction Counseling, HIV Testing, and Linkage to Care Activities, Support Groups, Substance Abuse Counseling, and individualized Case Management Services for Black Gay Male Priority Population • Worked as lead member of treatment providing substance abuse treatment and case management. • Worked to faciliate all client treatment needs, including crisis management, substance abuse treatment, physical health management, mental health management, accessing affordable housing, accessing employment and educational opportunities. • Encourage families to make use of all of their identified resources. • Assist in a variety of support activities including client support groups and client recovery. • Provide supervision of client assistance and mentoring on a one-to-one basis. Long Beach Pride, Inc. - Administrative and Counseling Director 2007 - 2010 • Provided administrative management within a service learning model for a broad base of volunteers for annual community festival event. • Establish a comfortable working relationship with all of the program participants (clients) and their families. • Act as a liaison/advocate to ensure that the collaborative networks in the community are providing services in a respectful, user friendly and welcoming way. • Communicate, represent and promote the client perspective within the mental health system. • Assist the multidisciplinary team in identifying the strengths and needs of the community networks. • Advocate for clients in a strength-based wellness and recovery plan. • Develop effective working relationships with agencies and organizations to advocate for consumer and family/caregiver empowerment including self-help and relapse prevention and recovery movements. • Advocate that clients' needs are met by appropriate caregivers. Crystal Stairs, Inc. - Program Continuity Coordinator 2006 - 2007 • Collaborated with multi-discipline team to effort to facilitate interagency partnerships within large and complex social service organization. County of Los Angeles - Contract Program Auditor 2003 - 2006 • Perform administrative and programmatic oversight reviews to determine contractual compliance with County, State and Federal requirements. L.A. Gay & Lesbian Center - Director of Outreach & Education 2000 - 2002 • Coordinated counseling, health, education, social, recreational, and cultural activities. Military Service Illinois Army National Guard 1990-1995 Exhibit 23 Innovation Description The innovator's proposed capstone project will bring to scale an existing effort known as AMAAD (Arming Minorities Against Addiction & Disease), an interscctional social work and · public health approach that seeks to disrupt the status quo of HIV and other disparities among Black lesbian gay, bisexual, transgender, questioning/queer (LGBTQ+), non-binary, and gender nonconforming individuals that are disproportionately impacted as the result of systemic inequities in response to the Close the Health Gap Social Work Grand Challenge. It should be made clear that the innovator is the founder and current Chief Executive Social Worker of the AMAAD Institute, a nonprofit 501(c)(3) tax-exempt community-based organization (CBO). The AMAAD Institute is a fully operational peer-based entity that currently has twenty-six fulltimc employees and six consultants with responsibilities that fall in alignment with what may be categorized as Care Coordination Teams. AMAAD' s staff roster includes HIV Testing Counselors, Linkage Navigators, Outreach Workers, Recovery Specialists, Behavioral Health Therapists, Employment Specialists, Housing Coordinators, Resident Advisors, as well as Fiscal/Human Resource Administrative staff. While COVID-19 has necessitated social distancing and staggered remote work options, activities are coordinated from two program office locations and two residential transitional living facilities that are controlled by the AMAAD Institute. The organization's 2021 annual budget is $2.6 million with revenue derived from federal, state, county, city, and private grant sources. Prototype Purpose The purpose of the prototype for the AMAAD capstone is to serve as a grant template proposal for community-based engagement activities that are intended to help expand the scope and reach of the efforts described above. The proposal will be prepared for submission to the 1 Exhibit 23 County of Los Angeles Division of HIV and STD Programs (DHSP) as a plan to conduct community engagement, outreach, recruitment, and mobilization efforts that will: 1) Empower Black LGBTQ+ community members to advance HIV-related projects aimed at accomplishing the HIV reduction goal utilizing a community-led approach; 2) Increase knowledge and awareness among Black LGBTQ+ people of HIV and HIV-related issues; 3) Develop partnerships with organizations and businesses to support HIV awareness efforts; and 4) Reduce HIV-related stigma among the community. Prototype methodology The prototype will utilize Community Based Participatory Research (CBPR) as a partnership approach to identify and recruit Black LGBTQ+ community members from throughout the L.A. region to form cohort teams to advance an HIV awareness related project. As a strategy to achieve this and other objectives, AMAAD will prepare and implement a Community Awareness and Participation Plan (CAPP) to ensure widespread, ongoing, and meaningful paiticipation of stakeholders with a focus especially on vulnerable groups. The "reach" and "sustainability" of the effort will be improved as all stakeholders, especially vulnerable Black LGBTQ+ people have an opportunity to paiticipate in shaping the community engagement effort and the voice of each of these groups are heard at all levels of decision making. AMAAD currently has great working relationships with several existing traditional HIV service providers and will maximize on those relationships to effectively involve their agency representatives and constituents; however, in an effort to recruit a broader section of disproportionally affected Black LGBTQ+ people, intentional steps will be made to prioritize the specific engagement of other non traditional HIV service providers and their constituents, especially those that provide key essential support services. While outreach recruitment materials and social media posts will be 2 Exhibit 23 strategically distributed to increase awareness, efforts will be made to incorporate personalized invitations to purposely draw and recruit from identified and targeted stakeholders. Results The proposal prototype will include a plan to work closely with an Evaluation Consultant to develop standardized impact and outcome data collection instruments for education and awareness activities. The developed evaluation instruments will include questionnaires and pre/post-tests utilizing a secure and confidential online platform that will be compatible with both in-person and virtual meeting engagements. Individual cohort participants will be measured over time as AMAAD staff will be able to see if there is any change (increase, decrease, stays the same). Outcomes measurements will include the degree to which cohort participants have an: A) Increase in HIV knowledge and awareness; B) Increase in leadership skills; C) Increase in reported feelings of empowerment; D) Increase in ability to implement HIV-related projects. ln addition to collecting data to measure impact on cohort participants, AMAAD staff will also facilitate the collection of data from community members at large to assess impact of cohort education and awareness activities. AMAAD will administer a confidential electronic community impact survey using texting, social media, internet (e.g., Formsite, Survey Monkey) and/or app technology to community members that may encounter various cohort faciliated components. Prototype impact implantation of the project? If the AMAAD prototype grant proposal is funded, it would help expand the scale and scope of the already existing AMAAD Institute and its ability to facilitate targeted community engagement/ empowerment activities among the prioritized Black LGBTQ+ community. 3

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Asset Metadata

Creator Highshaw, Carl (author)

Core Title Arming Minorities Against Addiction & Disease (AMAAD)

School Suzanne Dworak-Peck School of Social Work

Degree Doctor of Social Work

Degree Program Social Work

Publication Date 04/22/2021

Defense Date 04/08/2021

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag Black,close the health gap,community engagement,HIV,LGBTQ,OAI-PMH Harvest

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Araque, Juan Carlos (committee chair), Blosnich, John (committee member), Manderscheid, Ronald (committee member)

Creator Email highshaw@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-449379

Unique identifier UC11668559

Identifier etd-HighshawCa-9511.pdf (filename),usctheses-c89-449379 (legacy record id)

Legacy Identifier etd-HighshawCa-9511.pdf

Dmrecord 449379

Document Type Capstone project

Rights Highshaw, Carl

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA