good afternoon, everyone. welcome to the san francisco board of supervisors budget and finance committee meeting for wednesday march 19, 2014. we are at 1:15 right now and we'll continue this meeting until 230 :30 to allow people to continue to an arrive. can we take this > welcome back t

budget and finance committee. my name is supervisor mark farrell. i will be charg this committee. i'm joining by supervisor avalos and breed and we'll be joined by scott wiener and i would like to thank sfgtv committee. >> madam clerk, any items. >> yes, please submit speaker cards to the clerk. the action will be submitted to the board of supervisors agenda. >>supervisor mark farrell: please call item no. 1. >> item -- item

>> this is item 140121. >> this will put more homeless members and provide additional housing for homeless. our homeless outreach is critical to reducing our homeless population. current funding levels facilitates 2-4 people on the streets. for people sleeping on the streets isn't enough. this will increase the outreach to enhance the team and provide greater levels of service. as we start to dive deeper into our homeless situation in san francisco. realize there will be contentious issues and in in

supplemental in our early discussions with both inside and outside of city hall that our staff was under funded even though they will provide a crucial result. this will take a step to solving this issue. as a bit of background on the homeless outreach team otherwise known as our hot team is the public outreach team consisting of city civil service. they perform outreach to bring persons to dpa and emergency stabilization rooms and provide management and treatment and housing opportunities. the team will be better poised to address the most critically homeless. this is the area of the city which that is highest need and highest concentration with

individuals living on our streets. many have high clinical and management experience and some are homeless and all share and compel treatment services and housing opportunities to better their lives. i see marie here, i want to thank all the members of the homeless outreach team for all of their hard work and thank you for your continued service. we are allowed to do four things. first to increase the number of things they do direct outreach on the street, they will get more individuals into services and housing opportunities. >> second, dph will be able to include more in the levels of backgrounds and third, the capacity to allow 160 new managed clients meaning new individuals will have more to

work with to better their situations and lastly a new funding and stabilization beds which will better stabilize themselves in homelessness. over all if we are going to be serious about significantly addressing our homeless population in city hall, we need target investment and programs that are proven to work and services for individuals within our streets. greater targeted investment will drive a positive impact for a homeless population and start pulling people off the streets into services and shelter wechlt all -- we all know there is no silver bullet to reducing homelessness but we continue the dedication to continue to move this forward. colleagues, i will ask you to support to the full board with full recommendation. i would like to ask barbara garcia who runs our department of public health and involved in the

supplemental barnard -- barbara i want to thank you for your hard work. >> thank you. barbara garcia department of public health. we are glad to be here and share with you the work that we have done and looking at how we can improve the services. a bit of background, we've been developing the hot team for over ten 10 years and it has a history of outreach and case management and has a large component of transportation and we've transported thousands of people throughout the city in terms of interpretations. services. we have improved that as well. throughout the history we have tried to improve as we've gone along. today i will share my presentation with maria who has been a lead to get into more details of the center you are that we are going to be creating. just as an overview,

the hot team members who are looking at case management and engagement look at those with critical homelessness and substance issues and high users of urgent and emergency care services and those that may not be able to navigate systems on their own. on the case management side, we served over 3,000 individuals with case management. one of the things that i have watched with the hot team over the years is they really do a great job of ensuring there are outcomes when it comes to work for individuals. 40 percent of them are security with financial benefits. that's one of the important parts of having the stabilization bids and 20 percent are qualified and secured ssi entitlement.

>>supervisor mark farrell: supervisor avalos? >> there is a lot of terms that we are familiar with. can you describe what stabilization bed is. and can you tell the difference from a shelter and sro bed that might be more permanent. >> the stabilization beds are temporary housing. >>supervisor john avalos: temporary because there is a limit about how long they can stay in it? >> yes. it's part of the concern we had frs exit situation with the beds that allow some to stay longer. as an example those who are having difficult times to try to connect to permanent beds. what we found out as we put up stabilization beds, the history of our outreach is we go out and engage, but no where to take an individual. shelters are full and then we

kind of lost the momentum that we were trying to work with individuals to ensure they got those benefits. knowing where the individual was was one of the most important parts we came up with. so the stabilization beds provided us the opportunity to provide housing for the individual as we look for benefits and try to connect them to permanent services. >>supervisor john avalos: so stabilization beds is one room, 1 unit. >> it's one. >> over the track period over the years it's fluctuated, but how long are we able to move someone from stabilization bed to housing? >> 60 percent are moved to housing. and the others are moved to shelter services and that's one of the reasons they

have stayed so long at our stabilization beds. it's one of the 10 years experience that we found we lift the schedule of our staff to ensure we are able to provide the kind of services the individual needs. but 50 percent into trying to get permanent housing is a statistic. before we never had that stick because we didn't have the connection to permanent housing and the fact that the funds manage a type of housing, we are able to provide the housing because of that connection. many of these people are very sick and they do qualify for adult housing. >> thank you for your response. how many stabilization beds are there? >> over 300. >> thank you. >> and again, a big component to our work is to ensure the

affordable care act that there are treatment care providers and through our treatment and health providers. as you see, many of them as we spoke to supervisor avalos many are engaged in housing as part of stabilization and many are secured into permanent housing. one of the things we recognized was to increase capacity for medicine and address significant medical conditions and prioritize these individuals. we also needed to look how to coordinate some services on the street to ensure they have homes and pro medical services to our team and also just capacity itself to reach more individuals in our process. if there are no other questions for myself, i'm going to

bring up maria martinez who will go through a very detailed process of how this team works. >> hello, i'm maria martinez and the director of the program and i will talk about what we do. the homeless outreach was created as a housing first program. everyone who gets into home management get a street to home plan. usually that entails being in a stabilization room. which how that is different from sro room is that there is no fee. they are able to stay there while we are stabilizing them and also giving them benefits for permanent housing. we have two lines of service. one is our first response and

targeted outreach. we have a number of staff who are in vans and go around the city looking for people we call man down, people who are in need. we also respond to phone calls from ed, from the police, 311 saying there is somebody on my stoop or look if they are in harms way or we need to have this person transported between san francisco general hospital or the engagement center. the investigate teams do both of those things. one of the things that barbara mentioned that we wanted to increase is our ability to have currency on the street and that is to be able to provide health care services on the street and having someone licensed as appropriate on the street. do we need to prioritize someone into supporting housing and having the skills to assess

them. and right now if there is anyway the compromise sand we would like to bridge those more efficiently and effectively for folks living on the streets. so we have the transparent where carving out where we do our transparent where we have many more people in vans being able to go to hot spots targeted areas and respond to need from various people throughout the city. that's our first responders. the second piece barbara mentioned was about our case management. the whole focus is to remove barriers from individuals who are very sick, been homeless for a long time. the barriers to getting and keeping permit housing. that takes a lot of work. it takes a lot of work to get someone comfortable to being inside and takes a lot of work to be

stabilized in hotels with neighbors and also requires them getting financial benefits. many of our priorities is to get them on ssi if possible if they qualify. we have a very high rate of ssi, some on food stamps and some are felons and they are disorganized to do that on their own. the case managers, the whole thing, the street to home plan addresses each one of those things. everyone has a unique street to home plan. what is happening that is new for you now is there is a lot of people in the affordable care act that need to be coordinated. these folks often travel to saint mary's and saint frances and getting

sporadic care in a fashion and not able to connect well to a home. the team will act as a health home on the street and will begin to take a lot more responsibility for coordinating care and making sure that folks stay within our managed care system. that requires a level of expertise to be able to be a care coordinator. so we are as part of the enhancement looking to increase the skill level of some of our care managers and to bring in more health services. we are recommending , this is a lot to take in here. but the yellow ones are the additional positions. it's 27 additional positions for moving from 3 teams to 5 teams. and you will see the blue area where we are enhancing the skill requirement and the skill

level needed in the care team. at the bottom you can see where we are bringing in a program coordinator, a temporary housing coordinator. we are going to have almost 600 stabilization units, a tremendous amount of units to take care of. two rpe's a person that helps individuals manage their funds. if they get ssi check or income, we'll help them to be able to bank and that and be able to move onto permanent housing and we are bringing in a public health nurse. we have 640 clients. we have a lot of sick people we are trying to keep stable in the room, not got to the ed and not go into other urgent care services and we need more health capacity. we'll also be expanding the number of people we have on the street doing targeted

outreach. these folks are going to have to find people to follow up with. we use the emergency use which is about $20 million a year on those folks. they get lots to follow up. we are going to use the outreach folks to go find the folks and bring them back and reconnect into system. also the nurse practitioner is one we are utilizing to do the street medicine. all that boils down to moving from 480 cases being managed to 800 to a total cost of $3 million. >> annually? >> annually. >> so the $1.3 million before us today, i'm sorry chair

farrell, is just for today. >> it's pro rated. >> we prorated through the end of this fiscal year when the department could actually use the funds themselves and dph is in the middle of doing a quick new rfp for some of the homeless outreach. for those individuals that want to make sure the money was being spent, being spent this fiscal year, we can talk about the process. >> happy to answer any questions you might have. farrell >>supervisor mark farrell: maria, we basically have three teams that we allocate as you administer the program. what this supplemental will do is add two additional teams to that and that will increase the amount of individuals

reaching out onto the street as the team does of course and also all five of these team will have the skill level and skilled nursing and others that will be critically important from an administrative perspective to run the program. >> correct. >> great. i wanted to make sure of that. colleagues, any questions? comments? supervisor wiener? >>supervisor scott weiner: thank you for being here today. my apologize for missing the beginning of your presentation. i'm very supportive of expanding the hot team. i think it's given the scope of the challenge that we have in san francisco, i have always been a little dumbfounded as to how the limited resources that we've been putting in our outreach efforts given the scope of

the problem. i'm glad that we are moving in this direction. i know that i have seen plenty of instances over time where a hot teamworkers have been able to help deal with encampments and other challenges in my district. when i talk to folks on the hot team they are as frustrated as i am and my constituents are that they don't have the bandwidth to respond with and do it in a timely manner and they do the best with what they have. i guess my question is with this supplemental and then assuming it gets analyzed into subsequent budgets, what difference can residents of the city expect to see on the streets with the extra resources? i'm not

suggesting that extra resources are going to be able to make you snap your fingers and solve the problem. the frustration level in the city right now and i know in my district is as high as i have ever seen it in terms of people not understanding where there is so many people on the streets, so many people who clearly need help and people who are just creating camp sites in the middle of neighborhoods and a lot of frustration. so what difference do you think our residents can expect to see if this budget augmentation occurs? >> i think there will be quicker response to individuals who are identified as being significantly compromised. will be able to prioritize them more effectively into limited resources we do have. the two key things for homeless

outreach is until we have some currentey -- currency to change their lives, after a while you are just harassing them. the idea of having care on the street be much more accessible with this team enhancement, we think we can engage people more to be part of the system. and the stabilization rooms are key to getting people off the streets. most people want to get off the streets. the stabilization rooms are very effective ways to get people off the streets. once they are in stabilization rooms the work is not done. there is the big question of do we have permanent housing but i would say with quicker and broader response. more visibility for people who live and work

here. i would see more visibility. yeah, we are focusing on the more seriously ill chronicallien entrenched people. it could be people that you are seeing may not fit that mode, so we would have to talk about how to spread the services in a different way. >> i appreciate that and i guess you touched on this in terms of geographically my sense that there is a big focus on certain areas where we have the most extreme challenges and sometimes it's harder to get attention on some of the areas that maybe are or not quite as concentrated in terms of the challenges that have problems in the castro or parts of upper market and do you think that this will allow the hot team to have a more

consistent broader geographic reach? >> yes. >> okay. thank you. >> one thing i would like to add, colleagues, when i first started talking with barbara and maria around this idea is how do we increase the number of people on the streets reaching out to individuals and what i respect quite a deal is behind every person working on the streets of our case managers is detailed behind them and stabilization beds. i would like to thank all of you working on the supplemental and really thinking about what an enhancement means and obviously something i thought about and why it's important and as you described it is making a real different. supervisor mar? >>supervisor eric mar: i wanted to thank ms. garcia and matter in ez for the data.

i'm looking for the data on the creation of the teams and a lot of it was visible in golden gate park where people are veterans and people with mental illness and lots of women i noticed on my ride a longs. i know we discontinue the vans that went out. could you give us some sense of when we cut back and i see in the data from 2009-2010 there is a significant drop to 2010-2011 with the number of examples of connections with behavior health providers were other types of data. when did we cut back and what were the justifications for that. >> cut back in the numbers that we've seen? >> and the outreach to golden gate park and key places

whenever the homeless were identified. >> dr. para couldn't be here today and could speak more to specifics. as i recall there was no point of investment going to parks. they did a lot of work and there was a mutual decision that the city department wasn't among theany longer getting an investment or return and they would go back in. what we found was that the hot team wasn't very productive. so what we did was make them citywide and designed to respond when there was an issue. so i think what we'll be able to do now is begin to have them create some relationships with the merchants in the area and to be able to come back and respond more quickly. but to dedicate a team to a physical

area when something is not happening is like they are sitting there waiting for something to happen is not a good use of time. that's when we began to go citywide. >> i do want to acknowledge the leadership by supervisor farrell and your staff. i know there is groups homeless organizations and others i think need to be involved in the planning. you are saying that you are looking at how effective it has been and adjusting it's expansion including many new staff and really adjusting to the input. but to what level has the homeless community been involved with this planning process? >> i can certainly address that supervisor to 1 degree. i will say that before introducing this supplemental we have met with a number of individuals and some of the advocacy groups and obviously as we are doing a lot