they're going to go to where those services are like a consumer. and our experience has been those kind of movements definitely exist, but they're not dissimilar to folks that are the general population that are attracted to the city for employment opportunities, friends and family, resources that they have in looking for an opportunity with their safety net. and hoping that that safety net can turn them around. and this whole idea of residency and what really defines a resident is not very specific, but our feeling is the numbers are for the homeless residency of san francisco are not that different than the general population numbers as far as

transiency goes. to sum it up, the magnet theory is not something city services has to worry about as a big impact in attracting homeless. their ability to move around and respond even within the city is limited. we specifically did a study in las vegas in '07 where there what a feeling that in the summertime the homeless would leave las vegas because of the heat and would come back in the wintertime when the weather was better. and we did a seasonal study and determined from that that there's virtually no impact on seasonality.

empirically when we did some of the surveys, we found that they had significant challenges in moving around. so, they don't have the ability to quickly respond to things like weather. there are other kind of more normal reasons for moving around, mainly to access new opportunities that they think they may have. we also kind of compared from the survey results, we compared some of the qualitative data, specifically the subpopulation data that we saw in san francisco and compared it to other communities and it's consistent with the other communities in the bay area and in california. the chronic numbers are as a percentage fairly consistent.

hud had been narrowing down the definition on chronic homelessness. as i said in their rules, definition every two years. so, that contributes to the reduction in the number as well as the services and interventions that are taking place. >> so, the count we have, that was like 4,000, it went down to 1.9 thousand,000. [speaker not understood]? >> some of it is. i'm not going to say all of it or whatever, and i don't want to lessen the contributions that have been done by different programs, but there's absolutely definitional impacts on the numbers. and that's not just true of the chronic definition. that's true of the overall count. communities have done better

job through the years of doing the counts, but there ha been a lot of clarification and technical assistance by hud provided to communities and a lot of that technical assistance has resulted in the elimination of a lot of data sources. >> so, that doesn't change the definition. how about the information that's collected, is there a difference in how it was collected before to the last time, the last count? are we seeing the numbers now not appearing as accurate as was reported earlier in this hearing? >> so, it's just different. in 2004 there was not a survey that was administered which would be the source for the reporting. that didn't happen until -- that survey with different applications of the definition which included a more

significant unsheltered outreach didn't happen until '09 when i believe we did the first survey here. >> lookinging at the numbers for san francisco between 2009 and 2011 for chronic homelessness there is a drastic increase. that is an increase we didn't see in the count of other communities we work with even though they went through the definitional changes. using the same process, they didn't see the same outcomes, but helpful. the definitional change wasn't really drastic in san francisco. due to the way that we've been collecting data in san francisco consistently since 2009-2011-2013, the data that we've been using to kind of define the definition of chronic homelessness has been relatively consistent. so, using the sour va that is a follow-up to the census, the questions that are used were pretty much right on par as what has been used in the past, the trending is very different in san francisco compared to

other communities. >> supervisor mar? >> yes, i nowakly years ago supervisor tom ammiano when he was a supervisor and s-r-o organizations had an s-r-o census, and i'm wondering is that a part of your surveys and your counts as well? >> no, s-r-os are not included. supported inclusive housing is not included in a time count, nor is section 8 part of a point in time count ~. >> thank you for representing. it would be helpful if you don't mind whatever you are presenting on or even follow-up questions, if you wouldn't mind sending that data over, that would be helpful. you can send it to my office. i'll distribute it to my colleague on the board of supervisors. >> great, i'll get together a little abstract for you. >> thank you. colleagues, any further questions at this time? okay, thank you very much.

much appreciated. at this point i know [speaker not understood], bash garcia, director of bph, thank you for your patience. sfgov-tv, i think we have some slides for ms. garcia. >> my assistant is going to try to put this up on. i think i lost that document. good afternoon, supervisor farrell and supervisors, thank you so much for having this hearing. i started my career in homelessness and i'm still in homelessness in my career. i consider myself still the director of homelessness for the department. i started my career at [speaker not understood] and ran that clinic and went on to subsidy services in the 12th. i hope you can give you the broad [speaker not understood] particularly as the plan came out . and i was part of that whole process.

so, i wanted to talk a little bit about some of the new projilts that we put online and some of the improvements. but as one of the largest departments and one of the larger general fund departments, being the director of health for the last three years has been really important to me to really look at how we use our resources. and, so, i've done a lot of reorganizing in the department to look at efficiencies without searching for new dollars because that's a really important process for us, particularly as we go forward with affordable care act and affordable care act is demanding the health departments like ourselves with healthy living system to become more efficient in the way we deliver services and we're going to do that with us by not only looking at outcomes but also the way we're going to pay for our services. so, we know in the future we're going to have to get much more efficient. and i'll share with you a little bit of the process that we've gone through. i also want to thank trent rohr from hsa and bevan dufty from hope and my partner through

this process. we work very honestly together in looking at how to improve our services. so, we talked a little about project homeless connect and daily connect is a new service added to that, knowing that project homeless connect and, supervisor mar, you talked about how to get involved from a policy perspective, i see project homeless connect [speaker not understood]. i go to as many homeless [speaker not understood] as i can. there are 10,000 volunteers in the community, 1,000 come in [speaker not understood] in seeking services. having spoken to many of them, some who come to ever connect, they've made a real big change in their attitude and perspective of homelessness in san francisco and they also contribute to that. that was [speaker not understood] project connect. we developed daily connect as a way to look at what happens when homeless connect is not around with all these rich services we try to bring on a

quarterly basis. daily connect is over every day. they use a lot of social media, they get 20 to 25 people that come daily to their office. they look at that need of the day, they look at shoes, they look at material goods for options involving volunteers. at the end of the day they get many things individuals had requested that day. they do a great job of looking at ensuring how the people get needs met through our daily connect. they're moving daily connect to shelter connect. we'll be starting that next month and engage with some of the individuals in the shelter and kind of bring them into the daily connect. outreach and engagement, we talked a lot about the hot team. the hot team became 24 hours not by magic. what we did is literally used

to take the lap band you used to see transporting people and we took that model of the 24-hour component and merged it into the hot team to bring it 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 h