feinstein, as well as leader lahood for the commitment to public transit, creating jobs, and investing in san francisco. again, thank you this morning for being here, and let's get it done. appreciate it. [applause] [applause] oh, my! haa ha ha! ha hha ha! [snortg]

supervisor campos: welcome to the may 24, 2012 meeting of the joint city and school districts elect committee. we are joined today by supervisor olague, commissioner maufas, commissioner mendoza, president chiu is en route. he is actually at a different meeting today. he will be joining us as soon as the committee meeting ends. commissioner fewer is en route. the clerks are gail johnson and -- we want to thank the as of the staff for covering the meeting.

madam secretary, if you could call item no. 1. >> it is a hearing about services provided to students and adults and organizations structure. supervisor campos: thank you. i will turn the floor over to commissioner maufas, who requested this very important hearing. i know that we have a number of people here for different items on the agenda. first, i would like to recognize janet riley, the president of the golden gate bridge highway transportation authority, which is celebrating its 75th anniversary. madam president, it is a pleasure to have you here. commissioner maufas. commissioner maufas: thank you. i wanted to bring this item for were to our combination of school district and city

committee, because it is something that is vital to both of our entities and the city of san francisco, particularly in the exiles your district -- the excelsior district. in areas where health care is not provided in the way that most of us have access to it. the clinic by the bay, i think it is a godsend. i am so grateful it is in that location, serving the community and the neighboring communities. i would like to bring forward ms. riley, who is the president of their board of directors. and eliza gibson, the executive director of the clinic by the bay. we have some audience members that will tell us all about it. then we can ask some questions

that will help to fill in the gaps of all of our understanding of this wonderful space that is on mission street. thank you and welcome. >> good afternoon. thank you so much for having us. commissioners, especially commissioner maufas, thank you for bringing this item for and championing our beautiful clinic. my name is janet riley and i am the co-founder of clinic by the bay and board of directors -- and president of the board of directors. eliza has joined me. she is the executive director. a little bit of history. clinic by the bay opened in november of 2010 and we are part of a national network of health clinics called volunteers in medicine for a -- called

volunteers in medicine. i think we have the presentation. there we go. thank you so much. we opened in november of 2010. part of a national network of clinics called volunteers in madison. it is a basic model for these clinics, free health care for the working uninsured and it is run primarily by retired doctors and nurses. there are 90 clinics throughout the country and we are the only one in northern california. what makes us special, we have a pretty robust safety net in san francisco. a few things that make us particularly special, we are absolutely free. we do not take any money or insurance. we utilize primarily retired doctors and nurses so the doctors in our community do not have to go to doctors without

borders. they can do it right in their own community, they can volunteer. we do not take any government money at all for it i know that in these tough fiscal times, that is absolutely a positive. we also do not just care for the disease of the person, but the entire person. that is really evidenced by our patient visit times, which average about 45 minutes. our mission is pretty self- explanatory, to understand and serve with dignity and respect the health and wellness needs of the underserved in the san francisco bay area. our clinic is located in the fifth excelsior district on mission street. we are open 16 hours per week to see patients. we also do health education workshops that are open to the entire community. the other four days, when we are

seeing patients for eligibility screenings, we are enrolling patients and working on the follow-up for the 16 patients we see every week. we have a strict eligibility criteria. we are not a walk-in clinic and we do not operate on the honors system. who do we serve? we serve the uninsured and underinsured who lived in the excelsior and outer mission in visitation valley, 94134, and in daly city and colma, 93014. we do have a criteria. income of 250% poverty level or below. that is about $27,000 annually for a single individual or for a

family of four, and income of about $55,000 per year. we do ask people, when they come to see us, if they are enrolled in health the san francisco -- healthy san francisco. if they are, we send them back to their medical home, so we can -- so we do not duplicate any services. >> when we opened this clinic, we have been seeing patients for about 1.5 years. we did a comprehensive needs and resources assessment. we did a landscape survey, focus groups and individual service. everyone here knows the excelsior is a very underserved area. we wanted to open our doors there and serve the community. because we are so close to county lines, we are able to serve uninsured adults and alleviate some of the stress on

the safety net for both counties. in terms of who we see currently, about 53% of our patients are from san francisco. 54% are over the age of 4375% of our patients are immigrants. -- are over the age of 40. 75% of our patients are immigrants. it is a diverse area of our city. 49% of our patients are hispanic. 35% of our patients speak spanish and 13% speak cantonese. we do provide multilingual services and we have both bilingual volunteer providers and interpreters always available. in terms of our services, janet mentioned we are not a walk-in clinic or honor system clinic. we are a medical home model. which provide comprehensive care. each new visit, the patients

received a medical health exam as well as a mental and dental exam. anything from additional employment support to being a care provider for a relative. we have a very strict no show policy. we expect our patients to engage and invest in their health care. if someone does not communicate with us that they cannot make an appointment, they are at risk of being dismissed from the clinic. as a result, we have a very low no show rate, which is good. volunteers are coming in giving their time. as of today, we have almost 800 patients enrolled in our care. we have completed over 2200 medical visits and we have made almost 2000 referrals. when i say referrals, we have a broad network of medical partners, which danna will tell you a little bit about in a

minute. it enables us to provide incredibly comprehensive care. all of the radiology lab work as well as a network of specialists. we also have a very robust preventative care program. we began offering health education workshops for the community before we were ever open for primary care services. our philosophy is grounded in preventative care. monthly workshops are open to the committee, all zero -- all run by volunteers. we have a patient population that we are seeing more folks with chronic diseases. we do have monthly diabetes workshops and quarterly asthma workshops. janet will tell you about our volunteer program. >> volunteers are the lifeblood of our program. in some ways, this clinic and

all of the clinics are built as much around the volunteer experience as they are around the patient is serious. we want to provide an excellent and meaningful volunteer experience for falls. currently, we of 100 volunteers engaged in clinic by the bay. 65 come to our clinic every single month. that is 10,000 -- more than 10,000 hours contributed. we value that at nearly $400,000. that is why we can operate so well, the fact that we have such incredible volunteers. we need more non-medical volunteers than medical volunteers. receptionists and eligibility screeners, interpreters, computer experts. we look for volunteers from all different types of fields. medical partnerships are incredibly important to us, as you can imagine, so we can

provide this comprehensive care. we rely on these medical partnerships extensively at clinic by the bakery for example, we get our lab work done by ucsf and labcorps. mri's and ultrasounds, we have a relationship with operation access, who does our outpatient services -- outpatient surgeries. we have an excellent relationship with walgreen's, who do our medications. we were fortunate enough to be able to open our clinic using all electronic medical records. we currently are working on allowing our patients' access to their medical records so they can take them with them. we are piloting a text messaging

program for disease management with our patients. we have always been very, very interested in technology. many times, this group of population we are seeing, they do not get to pilot these types of projects for it is very interesting to say we practice medicine in a very modern environment, but the old fashioned way pri is a good mix of both. supervisor campos: for the record, let people know that we have been joined by president chiu, who just got out of the government audits and oversight committee. >> thank you. a quick snapshot of what we have accomplished since we opened in november of 2010. we have been rolled almost 800 patients, completed 2200 visits and 1900 referrals for needed specialty care and surgical care. 100% of our patients, once deemed eligible, are able to see a medical provider within two weeks. that is an important part of how

we define access to care. one of the things we learned in our needs assessment was just how long people sometimes have to wait, even with our robust safety net for it -- with our robust safety net. it can be a very, very long time, months, to see a primary care provider. we are always evaluating our services and care so we have already done a volunteer survey as well as a patient survey. 71% of our volunteers have been volunteering for six months or more. 90% of our patients are satisfied with the care they are receiving and 90% of our volunteers are very satisfied with their volunteer experience. in terms of our growth plan, we have been determined to grow incrementally, to make sure we have infrastructure we need to continue to provide high-quality care. our plan is to add a saturday clinic.

our hours are tuesdays, 12:00- 8:00 p.m. as well as thursday, 10:00-6:00 p.m. i am excited to also offer a saturday clinic critz it is pretty unusual that a community clinic is open on saturday, so people do not have to miss work. we are working on developing a small dental program. we learned that dental is a huge need for every single person in san francisco. we are going to do what we can. we are working with the san francisco dental society to do that. our goal is to become a fully operating, six-day per week clinic. a quick note about our budget and how we manage to do what we do. as janet said, we are 100% privately funded. we do not take any government dollars. we are committed to that so we can remain adept and agile

responders to the community needs and keep our overhead low. a little over 50% from foundations and the rest is from small businesses, corporations, individuals. truthfully, the gift of time and professional service from all of our volunteers. as janet mentioned, to date, about $400,000 worth of professional services has been -- have been donated. that number will continue to grow. thank you. commissioner maufas: thank you so much. i think now everyone has a better idea. i am overwhelmed with excitement every time i tried to mention it. i could not tell them all the details. thank you for sharing all of that information. i really believe that you are -- that you have filled this gap that is so necessary, particularly for our families at

school, who do not have health care coverage. their busy lives, getting through with the hopes of seeing someone in a few months, it is just so daunting and such a discouragement factor, thank goodness you are there. that is why i wanted you to come to this particular meeting, not just the school district side, but to this combination committee, because i believe it is important that both sides here what you are about. i know there are some questions. while you were speaking, we were chatting in amazement about all of the things that you have been able to provide and how you have been able to do that. i know the supervisors have questions. i invite them to ask. supervisor campos: thank you for requesting that this item be put on our agenda. i think it is very important for us to have this discussion.

i want to thank director riley and ms. gibson for their presentation. many of us are speechless because it is so incredible to see this happening. commissioner mendoza. commissioner mendoza: thank you. this was wonderful. what a great gem. this is how we find out about things oftentimes and oftentimes we stumble upon them ourselves. thank you for the great work you are doing for our families. it sounds like it is throughout the city and not just in the excelsior community. i am curious about how many of your patients are sfusd students or kids that attend public schools. is there anyway of knowing what that is? >> we do not track that currently. we do track when people come to our clinic, how they heard about us. we have been getting the word out through weekly bulletins in

elementary schools. one of the things commissioner maufas was talking about was getting the word out more so people know about it. i do not know off the top of my head and it is not something we asked specifically. but i do know that some people have come in through the schools. commissioner mendoza: we work closely with our department of health on immunizations prior to the school year. with the mandatory whooping cough vaccine coming out, we hope we can work with you closely to ensure that those who do come through the public school system are getting that opportunity prior to school. i look forward to working more closely with you. thank you. supervisor campos: thank you. any other questions? i want to thank you for the tremendous work you are doing. i think it is really incredible. the fact that all of this is

privately funded is something that certainly we, in city government, like to hear. a couple of quick questions. how do people find out about you? i know you are tracking that information, but i am wondering how people know about the clinic and the services that you provide. >> the number one way people hear about us now is word of mouth. we do a lot of grassroots outreach. we have a volunteer and her primary project is to develop community partnerships and oversee outreach. we have volunteers to put fliers in merchant corridors, go to transit corridors, connect with churches, that type of thing. word of mouth and fliers are the top two ways. >> we have a number of articles in local media and mainstream media as well. getting the word out, sometimes even door-to-door to tell neighbors about our clinic. supervisor campos: one of the

things that just happened today is we had the last meeting of our task force working on the health care services master plan for san francisco. i am wondering if there was any communication you had with our health department so they are aware of what you are doing and could identify specific needs you are addressing. >> that is a great question. we do work collaborative late with them and i participate in those communities. we met recently with barbara garcia. we are committed to being part of the safety net and working cooperatively. supervisor campos: thank you very much. why don't we open it up to public comment? this is an opportunity for anyone who would like to say anything to come up and speak on this item. seeing none, public comment is closed. again, we want to thank director

riley, ms. gibson, and commissioner maufas for calling this hearing. madam secretary, i wonder if you could call item three out of order. >> thank you. it is the hearing on transitional kindergarten, sponsored by you. supervisor campos: great. thank you. what happens at the kindergarten level is something that is very important to the success of any child. we wanted to hear from the school district and, as i understand it, we have chris from the school district but we also have the honor of seeing carlos, the associate superintendent for early education for the san for cisco unified school district. we welcome our associate superintendent. >> thank you.

i have to say this has turned out to be one of my favorite conversations, wink. [laughter] this has been probably the most interesting ride for the last four-seven months around implementation of transitional kindergarten. what i am hoping to do is provide some context as to why this ride has been interesting, due to the governor's budget that, quite honestly, was not very helpful. but also how we have been able to take that information and still be able to implement transitional kindergarten within our own community. before i get started, i want to thank some people who are not here. to actually implement a brand new grade for 25% of a population has been quite interesting when you think about the education system set

up on 12-month cycles and it has been for at least 100 years. to do this brand new thing for a quarter of a year actually has put a lot of districts in turmoil. i will talk about how we have been able to monitor that process. to do this, it has literally taken legal, labor, epc, instructional cabinet, communications. just to wade through how does one implement a process like this in a wonderful city like san francisco? and the pc -- epc means educational placement centers. thank you for taking this out of order. we have a 5:00 that we have to get over to that we are actually doing the meeting. we need to be there on time.

otherwise, we make everyone late. but we are going to do this by simply talking about what is transitional kindergarten? we will quickly go through that and then dived into the governor's budget and what it has missed, not only for kindergarten, but pre-k. this is important to know because in this county, preschool for all, for the last seven years, has been a really big thing and a lot of effort has been placed into building a sound and robust pre-k. you will see where the governor starts to intertwine tk with pre-k in his may revise. after we put some context to this, we will move to some of the things we have been able to gather from talking to our communities. i see a couple of my parents. i think heather and i must talk

every other week. [laughter] at least. even though we talk about how many families we have actually met with or communicated with, it does not say how frequently we chat with our parents. we talk about that information and how we use information to modify how we are going to roll this out. still remembering that we are trying to maneuver the governor's budget and our current budget climate in california. right behind me comes our budget, who will also put some context as to why this is kind of complicated. what is at tk? -- what is tk? in a nutshell, we have authorized the change of the kindergarten entry date. literally, where the

kindergarten entry date was in september, for the next three years, we will roll back that entry date. for a subset of students, 300 to be precise, each year, we roll back and they are eligible for a 2-year kindergarten experience. i want you to realize. these same 200 children, there will be some kids who will also receive services in pre-k because we have such a robust system in this county. the law states that this is a 2- year opportunity. we call it a gift of time. we give children enough time to be prepared for kindergarten upon entry. now, also embedded in that gift of time is some assumption that

all children need some of this time. even though they built in a little system to allow for students to continue on to kindergarten, some of the ways they put it in their actually made it problematic for how to implement it. we have policy makers putting things together that are -- that do not necessarily mesh with what was currently in place. in a nutshell, 2-year, 3 years to roll it out. this is for that subset of students to stay in pre-k for one more year. to give you an idea of what that means, slide 7. it is not in there.