to 24 hours, and looking at efficiency in the 24 model. we worked with fha because many transports were from shelter to shelter. hsa -- this is why it's important to leverage with each other's department. hsa [speaker not understood], that freed us up to use utilizers. hope from shes and those who needed us to respond to areas of need for homeless individuals -- >> quick question because we talked about this earlier. the mobile outreach versus the hot time. ~ team. >> yes. let me talk a little bit how we're looking at the mobile crisis team. many of these services, this is part of our affordable care act and health care reform. we to look at including a lot

of our clinical services under one area. we're calling that the san francisco health network and we have another division called public health difficult have i. mobile crisis was set up many, many years ago under the single aspect of new york. we reorganized that area to become a behavioral health system. we have 24-hour teams. one of the directions i've given to our teams, we have a children's crisis team, mobile crisis, a community response team that goes out to violent issues, and two of those teams are 24 hours. so, we were hoping to do is merge mobile crisis -- see, we have a 24-hour team with expert in different areas. and try to leverage our 24 services are very expensive. for every person you have on the team, you have to think about the 24-hour position, and that equals to about 5 people to get really a 24-hour system.

you cover v. -- i anticipate. so, we want to leverage all of our 24-hour team's mental health. so, we'll be looking at mobile crisis, children's crisis along with a critical response team is how we look for new general fund dollars how can we expand and [speaker not understood] the 24-hour process? we did the hot team -- >> you view them definitely distinct? >> not necessarily either because as we move this 24-hour piece, we may look at the hot team as another model because they do have psychosocial support. >> right. >> and that might be included into this process. we're looking into that. >> this is advocacy payee, that is an important collaboration we've done with many community partners and payee services are important for them to manage

their dollars and ensure they are not getting addicted to [speaker not understood]. we talk a little about ssi presented disability in the mottv. we've been recognized nationwide housing a special part being part of that housing. and having supportive people in permanent housing, we've seen reductions in hospitalizations for those individuals who are in those units. and wire one ~ we're one of the first and hopefully not the last health departments with a component. staff has gone to los angeles. i know they're looking at that area as well for the health department in los angeles. primary care, urge care. we just built and reopened a new clinic now the tom adele

clinic. we're taking as much efficiency in the department -- we are a very large department. there are ways to become efficient. we merged tom adele and [speaker not understood], that's in a beautiful building on golden gate avenue. and that brought the clinic, [speaker not understood], had a high psychiatric staffing pattern with a primary care with a real focus on primary care in other words of homeless individuals together really i think stapled the program. this is a program i think we're very proud of. [speaker not understood]. one of the ways we look at prioritizing housing and prioritizing services is not program prioritization. it's an individual's prioritization based on their a queuity issue. so, a lot of individuals come to me wanting their program to be prioritized for different services ~.

we don't prioritize a program, we prior ~ use a priority [speaker not understood]. we put some of these programs under a placement area so that placement and direct services is much more smoother. we have seen an increase of over almost $30 million in our mental health area. that included -- we are now a behavioral health model. we've merged these areas because individuals need both types of treatment. [speaker not understood] given us an incredible amount of dollars to increase our case management and mental health area. you'll see some of that, i think, in some of our next slides. our [speaker not understood] center i think is another model. we took macmillan center which was a drop-in center, had no

real medical support. and we became a medically oriented much more sobering center and try to engage a psychosocial area but also looking at medication that are helping people reduce their alcohol use. this is an area we're focused on. many individuals are sick and it's their opportunity to engage with medical services. over the last several years we've worked very closely with hsa to do better in our [speaker not understood]. our mental health case management for the shelter and that's a great model to look at in terms of how we are managing our care of the shelter. this is an area that i would like to see the department work closer with. and you'll see as one of the recommendations to the affordable care act, every person in san francisco should be able to get a primary care

home. one of our goals is every individual to have a home health. you're aware with general hospital and as you see on mission street, we're almost finished with our building of new san francisco general hospital rebuild. i wanted to spend a moment on this ssi presented disability for homeless this. this was again, a drink between hsa and ourselves. it took 7 years for the federal government to take knowledge. we had a hard time getting paperwork and the background of medical services and they could have. this is population that is the most difficult to get into with the assistance that we have. [speaker not understood]. if we identify somebody with schizophrenia, they can automatically get on medi-cal

and take the time to get the paperwork done. so, this is a really important program. and, again, it took us 7 years that this was an important pilot, along with santa cruz county acseeds in san francisco, but also shares throughout the country. on housing area, you've heard a lot about the housing area. direct access to housing, supportive housing is about 17 and we still have some in the pipeline coming. emergency stabilization bids have been very important for us. in the aspect of trying to get somebody the more stabilized, getting the benefits on board, getting their ids to be qualified, in the past what we've done is come back to you a couple of days later, take you to dmv and you're still in the streets. we're able to try to get as many people into emergency stabilization and move them on to the next level of supportive

housing. through mhsa dollars there has been a problem of behavioral health and traditional housing. and then [speaker not understood]. >> supervisor mar? >> i know that bevan dufty mentioned in his costs and the mayor has said lord's law -- he's looking into that. and i know mr. dufty said there is the possible proposal for a pilot project -- you could talk about the schizophrenic illness supports. if you could talk about what that process is going to be like. there have been pro and con, different concerns especially from community based mental health providers. could you give us a little built of what to expect as that goes forward. >> in working with the mayor's office, in his model of looking

at community stakeholders, he's very much supportive of bringing people together. i've been directed to bring a stakeholder group together. everything's on the table. we have over 7 years ago, we did this before. where laura had come up with we developed a stakeholder group and a community placement program. i can go into details with you at a later date. lori's law will be on the table. lori's law will serve a population and what we want to look at is the large of this, and if lori law can serve a need, what i like about [speaker not understood] we have so many family members concerned about their loved ones and don't have a real pathway ensuring they get.

~ their support. and then you have providers that feel the same way. so, we have all those processes and we're going to look at it from a stakeholder prosakes and try to see what the best kind of plan and recommendations we can get from community benefit in the field and ultimately what the mayor [speaker not understood]. >> thank you. >> just some demographics. over 32% have experienced homelessness. the average age is [speaker not understood], 10% over 60. largely the male population 23%. and we just started looking at -- relooking at how to identify and ensuring that particularly the transgender community is counted and identified. and, so, you'll see this number may grow because we're trying to -- thises was never asked in

the past in our demographics. so, we've been working on this for several years trying to identify and count people who are important to us to ensure their care. supervisor mar, you talk a lot about african americans, disproportionate number in our system. i'm concerned about that as well. we will be rolling out an african-american health initial ans. 50% we have african americans presented in our programs. as we did many years ago. we treat it like a man system. we may not have the appropriate cultural programming for this and i want to look at that. and ensure our cbos are focused on this population and are we diverse, do people see themselves as they are getting served. so, it's a initiative i'm hoping to work with other

departments as well, too, to make sure the african-american community is served well. we have our goals -- i left our executive meeting today where we're looking at outcome measures, whether that's heart disease, how do we look at violence and some of the top health conditions for african americans. so, i just want to assure you that is an area we definitely acknowledge and one we want to really everyone sure that african americans get the best care in our system. [speaker not understood]. same area of psychosis and depression, high use of history of alcohol and drug use. and what's disturbing for me and that's an area that we pry orx ties is those with [speaker not understood] mobility. those are all three conditions and we have a core group of people that have that. we see a high mortality rate. we are trying to focus. this is one of the directions

we give to our hot team. we know where they are and where they are and try to get them the case management and supportive services. we feel they'll get out of it, many of the individuals with these three issues also in our urgent and emergency services and trying to get them stabilized services and case management. and 3% have had history of mental health conservatorship. this is an area we will be looking at as our stakeholder group. estimated about $135 million in total annual dph expenditures. again, looking at the fact that we're a very large department, so, we're looking at how many homeless individuals are served by the hospital and by distinct areas. and we figure about $12,000 per person for all dph services. but some of our [speaker not understood] will go up to $75,000. when we see we provide case

management services and that's why this affordable care act is important for us. that is why it is important to give every individual in our city [inaudible]. just a little bit about s.f. hot, had a lot of focus today. it has been continuously in operation. it is an evolutionary program. it will move and respond to the needs as we see it. i think trent talked a lot about the skill being needed that needed lifting and having higher levels of skills. we also agree with that and we're looking at that for the future. in fact, you'll see this year mayor's office did help us increase some of that, those areas. but of the 530 clients served in 12-13, 90% of them were

[speaker not understood], 35% of them were terminally housed. again, they are part of the pipeline as we go through. so, when we do open up new facilities as part of the referral program for the youth, one of the most important processes we try to get as individuals to receive the financial benefit. you can see they worked really hard at sfi school. let's remember, jim, as the affordable care act, many individuals unless you're greatly disabled before january 1st of this year, you would not be put on medi-cal. you have to be greatly disabled and that is no longer flu on january 1st. individual can be put on medi-cal and insurance plans. the benefit issue is ssi is still based on disability, but not the medi-cal component of that. and i believe over 13, 14 a beesers were kicked off of ssi because they were seen as not eligible for that because there

was a story and some data that showed they were using the dollars for drug abuse and they were kicked off literally, not off ssi, but off medi-cal. i know in groups like coalition and ourselves really worked hard getting people back onto medi-cal, but we had to become greatly disabled to do that. with the affordable care act they don't do that. now are qualified and that's why it's important for us to work closely with that population. we did a street survey recently at the request of supervisor farrell just to get a sense and get a little bit closer to the issue. [speaker not understood] went out and touched 100 individuals in haight, [speaker not understood], found that 80% were living outdoors. 50% of them met the criteria

for chronic homelessness. 90% have -- >> let me ask you a question. there are staggering stats earlier on as well, have they been in our [speaker not understood] 10 plus years or in the streets? >> the detail is not there in the survey whether or not they were homeless in santa cruz, monterey is -- we can't say they are homeless in san francisco. we did not do that. 20% were under 30 years old, particularly in the haight stanyan area. 5% over 60 in the mission was 12%. and over 70 in embarcadaro. 25% female in the mission. there was some indication that was an area we needed to focus,

female outreach. and we know that the city of mayor knew about somewhat surprised [speaker not understood]. 30% report health concerns, but we observe 60% and that's one of the things we find when we look at an individual, their health status. they many times don't know that they're sicker and have reported their homelessness due to finances and other half reported it due to their health and social reasons. just to let you know a future initiative in the department. again, i talked a lot about the affordable care act. we want every homeless individual to have a primary care home. we have done some work around crisis residential. last year in the budget we did a good job of repurposing our behavioral health center because what we found was that

the federal government is now changing what is acute in psych for psych beds. and, so, those who were -- so, we have a large group of people who were not acute in the hospital at the very expensive level of care. so, we wanted to build some layers of care that were more appropriate for them and, so, we are going to be opening up 23 psych respite bed so those who are not acute in january san francisco general in the psych area, they'll be transferred over to the psych respite area so they can continue to get care, not acute. we won't have to spend the dollars on an acute hospital and we can still provide the kind of stabilization that they need before their next level of consider. we just [speaker not understood] they will open 12 crisis beds in merger with medical respite. we'll have 60 additional direct

access to housing units. and in this year we have expanded our hot team to 50 stabilization rooms and additional social worker, three case managers, and one outreach worker. we will be looking at an rfp to increase our social workers and our staffing model and we've been working a lot with our business improvement district through the support of bevan who is out there with these businesses and we're looking at trying to have them support us by helping us hire staff to focus directly on the areas that they're concerned about. we're opening one in union square in 2014. and as i've said, one of the areas that we really wanted to have the hot team focus on is targeting outreach to our managed care i don'teder nation of high users of multiple systems. the department is going to be very challenged. we're a fee for service. so, any time anybody came into our health area, any time they came in, if they came in five

times a week, they would get the same reimbursement. in the future we only get one reimbursement a month so we really have to care manage and ensure people are case managed so we can be more financially feasible in the future. i talked a little bit about shelter connect. and i'm in conversation with the public health nurses to really look at how to -- we can't really set up -- it's not as efficient to set up many clinics in the shelters, but we certainly can have public health newerctiones in our shelter. we're looking at that for 114 now who has done a fantastic job at many of the shelters. we need to give her support to assure she's providing linkage for those in the shelter needing care. and as i said, we are looking at convening a stakeholder group to review the behavioral health needs for the entire city.

>> so, thank you so much for your presentation, for all of your hard work again, and working together. you've been a great person to work with and thank you for all of your efforts. >> thank you. take care. >> colleagues, any questions at this point? okay, all right, thank you very much, ms. garcia. >> thank you. >> last but not least, we have jennifer friedenbach from our coalition on homelessness to speak for a few minutes. and thank you for being here and all the work you do as well. >> thank you for having me. i appreciate it. jennifer friedenbach. so, i'm the director of coalition on homelessness. i've worked at the coalition for 19 years, 19 very long, sometimes acutely painful and often very inspiring years. sometimes they're in the same year, bolt of them. i was also part of the ten-year implementation planning council and so we really got very specific read backs progress on

the plan. what i went through today is i went through the original plan and tried to outline what the successes have been, losses have been, some policies for the future. i wanted to talk a little before that how coalition of homelessness works to put it in context. we do community organizing which means we organize homeless and poor people to create permanent solutions to poverty and homelessness while protecting the civil and human rights for folks who remain on the streets. we do a ton of outreach to folks who are homeless and poor between four and eight outreaches every week. that is an attempt to keep ourselves accountable. we truly represent people who are impacted by the housing crisis. that a lot of time puts us right in line with what city officials is trying to do with

homelessness and puts us in an oppositional place. beforehand i make these comments, i can say we've had the most successes when we worked together and tried to develop consensus and moved away from divisive issues and came up with amazing solutions. we've been able to do that collectively as a city. some of the successes, you know, there are more than 1400 units, new units of permanently affordable housing for homeless men, women and children. it's been hugely helpful. we've had a mass expansion and prevention effort to keep san franciscans in their homes. last year the board and the mayor put a million dollars into expanding prevention. they've shaved off displacement for 1200 households. amazing. we doubled efforts. we'll see. that only met 15% of the need. as we talk about this, we put all this stuff in homelessness. why does homelessness persist. that is what i'm going to try

to deconstruct today. it resulted in 300 families exiting homelessness. we opened critical psychiatric services. we moved a bay from line bay systems. we hope in the next couple weeks we'll be having a more accessible shelter system for single adults. there's been a lot of work integrating substance abuse and mental health treatment. we passed a housing trust fund. all of these have been milestone perspectives with regard to homelessness. since 2004 we've lost about a third of our shelter beds. there's been, you know, now of course talk of expanding in the bayview and lgbt shelter that will open up hopefully soon. we've lost about half of our drop-in capacity since 2004. i did an analysis that i talk about a lot in 2011 around the

department of public health cuts. and between 2007, which is when we first started doing some pretty dramatic cuts, to that time we had about $40 million in direct service cuts to behavioral health. the reverse of all three of these things, i can't really put into words. i mean, it's been very dramatically negative. we've seen increased a queue it, deteriorating health, the impact on the combination of those cannot be overstated ~. we've also had huge losses in housing funding. so, when we look at homelessness and we kind of go back to the early homeless crises days, we often talk about the 74% kudo in hud that happened between '78 and 1983 that created this huge homeless crises. we've had really huge losses over the last 10 years and -- in housing from the feds. we've lost construction for seniors and people with disability housing. section 8 has been seriously

cutaway at. we've lost federal funding for public housing. we've seen serious deterioration for public housing as a result. many of us believe was trying to eliminate public housing. we've seen huge losses in cdbg. we've seen funding losses in redevelopment. of course we tried to replace that with housing trust fund. ideally we would have the housing trust fund and redevelopment so we could augment this huge housing crisis we're facing. we've lost, you know, state funding through the affordable housing bond since 2010. so, all of this is really adding very dramatically to the really severe housing crises that we're facing in san francisco. i want to spend a little bit of time around challenges. we still continue to have a challenge around discharge. discharge from private hospitals and public hospitals. we're still having people ending up in our streets and shelters that are in no position to be there. of course it's very expensive to keep people in the hospitals. so, this is an ongoing

challenge. one of our biggest challenges from the perspective of coalition on homelessness is the very deliberate and continuous demonization of homeless people themselves. and this has kind of ranged from this sort of intense mythology around homelessness. you know we talked today a little bit, i think the gentleman from applied research did a good job of showing [speaker not understood] is not real, but that has really entered into i think a lot of our policy. a lot of our policy has been making it as comfortable as possible for people to simply disappear, that people are choosing to be homeless and that's why they're out on the streets. this sort of -- it's gotten to the point where it's such a creation of what feels like almost a permanent under class in our dialogue. it's almost as if it's a separate population that came from another planet the way we

talk about it. i mean, really. you hear it all the time. i was walking my dog in the park, a man in the park said, i didn't know homeless people jogged. a really negative thing. homeless people are no different from impoverished people. the only difference is if you have a housing subsidy or not. i tried to cut this, you know, this idea of people coming from other places in a bunch of different ways. one of the things i looked at, it's a number of bus tickets given out of town versus the number of people based on the raw numbers from the homeless count who came here for services. and san francisco has given -- for every 22 homeless people, a bus ticket out of town, one person has come here for services. so, you know, that's one way to look at it, but there's a lot of different ways. and i think what this sort of mythology has done