hud applies for point in time count. specifically, double up persons and couch surfers are excluded from the count. they're very difficult to actually observe and officially enumerate in any kind of methodology because of privacy concerns and our inability to get into private property and homes. but the county office of education and the education districts throughout the state have a slightly broader definition which includes double ups and we know from the data that they supply that the double up number is a very significant number. sometimes, you know, 5 to 6 times the point in time number that can be reported. so, there's also specific outreach challenges, as you

said, with ethnic groups to get to, and our ability to outreach to them is dependent upon the ability of the community to have folks that can reach into those, into those communities and get a window to their living conditions. and then commonly, what we'll find in a lot of ethnic groups that they vary significantly fall into that double up category. we found that latino families and many asian families that are what are probably homeless by most common definitions. even if we knew about them, they would be excluded from the specific reporting. so, in general, we always -- we don't do any adjustments of our observed count because we're restricted from doing so and we

don't have the certainty to be able to do it. more often than not, we've felt that the definition is probably more limiting to the count number than any kind of statistical estimations. >> too much in transitional, have we seen an increase in 50 years, the love era, are there more younger people coming now or is this a common trend that's been flat? >> well, it's kind of hard to say. we certainly don't -- we don't have the quantitative data back up in san francisco because thises was the first year that we did the youth count we have as a firm been doing youth count since 2005 and have been advocates of coming up with

dedicated youth count strategies. in los angeles is where we first rolled out the dedicated youth counts and we haven't seen increases in los angeles as youth category. but until recently youth was defined as under 18. and generally unaccompanied youth under 18 is not as great as that 18 to 24 age group which is -- which is now an official reporting category. did you have numbers on vehicles? >> i don't have it with me. [speaker not understood]. >> the vehicle numbers in our observations in other communities have been increasing dramatically in places like santa clara, santa cruz in particular, monterey where we've seen huge increases

in the vehicularly housed, as we call them because historically we know that youth -- not youth. historically we know that living in your own car is one of the first places, one of the first refuges that homeless will go to if they have it. and then anecdotally, our experience has been that that is rarely sustained longer than a year because the high cost of keeping up your car, the tickets and the code enforcement issues with parking and other related issues. >> do you want to help me out here, 13% -- >> can you speak into the microphone, that would be great. >> it was 13% of those found in the point in time counted living in their cars, 13%. >> and, again, that's consistent with other communities. whereas the san francisco

overall point in time count was, 2013, was roughly flat when compared to the 2011 number. some comparative numbers in neighboring communities, santa clara went up 8%. los angeles 18%. new york city 22%. i didn't include it in my notes here. santa cruz went up 28%. and consistently, the numbers of unsheltered are even higher than san francisco's 59%. they range from, you know, 60, 67, 68% to 82% in santa cruz county, which is our home county. what we -- one of the other questions you asked earlier was

commented on is that even in this environment where there have obviously been a tremendous number of successes from various departments and programs that have been developed in the city, why isn't the number going down. and our observations, and again, the point in time count doesn't get to all the why's. it's not really the purpose of it, unfortunately. this has been a very tough economic period. and just to stay flat in this environment represents a huge accomplishment. the other thing that we've observed in some of the other communities is this whole double up population which, because it's ineligible for putting time counts, doesn't get quantified very effectively. it's also very challenging to quantify it. what we have noticed in

particular in one community that we did measure double up homeless was in santa cruz county that the number of double ups in santa cruz county in the last two years increased approximately 50 to 75%. and what we're getting from that data and from other anecdotal sources is that throughout the communities that we've worked in, the first safety net of friends and family is being severely tapped by folks that have lost their housing and are on the verge of homelessness. so, the traditional family housing safety net that has been able to absorb these

recession cycles that we're in right now is add a saturation point forcing more and more folks onto the street as that safety net is unable to support the friends and families that they've taken in, you know, during these economic hard times. so, we think that that's likely happening in san francisco as well which, of course, is further exacerbated by, you know, the housing shortage that exists here and the increasing demand for that housing. you know, you can see it in communities like los angeles where they have the 18% increase in homelessness amidst a real renaissance in their whole service sector and public-private partnerships that -- with united way and other agencies which, you know, have not been done in years,

yet even with those interventions they saw a significant increase. one of the other comments that i did want to talk a little bit about, we did note that roughly 39%, you know, came to san francisco as homeless. trent mentioned this. this is whether services locally are magnet for homeless. this is another fascinating area, homeless mobility. the numbers that we've seen in other commutes are very consistently in the 60 to 70% range that the homeless in a

measured community had lived previously in that community as part of a normal life. so, the actual mobility of services attracting the homeless is something that we haven't seen any empirical data to support. and the numbers in san francisco are very consistent with the other communities that we've worked in. >> have you seen over time as well? that is really helpful information to know. >> yeah, there's -- i think there's a miss understanding that the homeless move around almost in a market-based system where they see where services are and make a calculation that 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.