the homeless out reach team and, the cash funded units come through the public assistance program for single adults which is cap. and then, the other identified, non-profits that serve the population and so the folks who are referred in and access these units are generally right from the street and the system and so, generally, we are talking about although, not necessarily, chronically homeless, and we know that certainly income challenged, and everything that sort of comes along with that in terms of low job skills typically and treatment and addiction, or substance abuse issues that we deal with. >> and so, quick question for you, i think that one of the ideas out there that we don't have in san francisco is the central center, we have multiple referral points and different agencies have that as well. i think that the different people have different opinions on it, can you maybe talk about

kind of whether that may or may not work? or plus or minus from your perspective? >> sure. so the notion of a single sort of intake center, came from a visit that we made to philadelphia probably, a decade ago. and really was targeted to folks who are on the street. and in philadelphia a lot of it was triggered by weather and hot weather protocol and cold weather protocols and will allow public entities who are interacting with homeless folks on the street and so out reach teams, like our hot team, and the police, and ems, and the emergency medical services and ambulances and it allowed them a central place to bring folks, rather than looking for where there might be space and the idea of the central service center and the central access point was a low level, assessment and then a look across it is spectrum of philadelphia options and since the shelter and been transportation to one of those.

and i have not visited the philadelphia model in a while and i think that amanda has done more research on it. and some of the benefits might be it would give folks on the street another resource, or potentially a permanent resource. or so when we are interacting and well, you can call 311 and maybe get a sheller bed and we might have a treatment bed for you in a couple of weeks and it will give them a place to come in doors immediately whether that is in a bed or a chair, and whether it is a place to go in doors during the day or each in the evening. to get out of the elements but also to get assessed and placed out into the system and maybe coordinated manner. and so that is the idea around that. >> so moving on to families, how do family and homeless families, get into supportive housing. we use what are called access point agencies.

and apas, and there are 19 cbos that provide, either managed emergency shelter wait list, and the family emergency shelter and dv shelter and transitional housing and stand alone housing, and the apa helps with the family's completing the applications and navigating to get one of the units and in beth of these systems. and there are no waiting lists, and sort of a rotational, and a rotational basis by access point, and and given the dynamic and instead of with the wait list that will get stale. what we are currently funded at to provide service and

operational dollars, if we are looking at a housing ladder approach, and the housing ladder is defined as getting positive exits as a result in increase in income and the improvement in a lot of ways that allows a single adult to move out of supportive housing. i think that we want to have the discussion on whether or not the current level of funding hsa wide and city wide is adequate to provide those supports, and you know i think that the pilot at 5th and harrison will help us a little bit and i will touch on the controller's study that will help to give us more information on what sort of the right mix is. so let me at least tell you where we are at. and as i said earlier, it was created at the direction of human services commission, and where they got to a point where they are approving contracts for supportive services where the per unit cost, of the services, were vary widely from a high of 8,000 a unit to a low, and the clean and there

was not any real rationality to it and there was, and sort of a bi product of where it evolved and expanded and the goal and the non-profit entities and what the service mix should be and without any standards or m tricks to look at. and the population is going into the building, and so i will walk you through, those, and this is done through an rfp process that we just concluded.

buildings and these are buildings where they do not control the access points, and sort of you know directly from the street or from the shelter

and although, many of the folks who are placed in these buildings may be from those areas, there also be a mix of tenants in the buildings and quite a long time and a lot of these have been on-line for ten or 15 years, with not entirely stable but a core of stable population that may need a less deep, you know, sort of services and that was sort of the thinking around there and you can see on the last line, which is i think that the most important, one that when you break it down, based on this, what you are looking at is support service staff to unit ratio, and this is basically what is called a case manager. >> right and for the adult units you are looking at one case manager or one fte for 75 people. and then on the family units it is one to 50. and again, the notion is the folks may need less deep services in these buildings and it may not necessarily be the case in all of these buildings but that is sort of idea. in tier two, what we are

calling, moderate support services to the master release buildings and this is where hsa does the placement and the operations and the subpoena power service and we do the referral and the placement in the support services here and these are all single adult buildings and it is one to 50. and as compared to 1 to 75 in tier one. >> now in tier three, these are the hsa masser lease buildings where we did the placement where we there are stronger support services that we feed are necessary and funding and that the providers applied to. again, important to remind you that this was done through an rfp process and so they were asked to propose what tiremembersinger they were going to be funded at and so this is given by a provider proposals. in these stronger support building, you are looking at

one fte for 35 units. and i should say on the one to 35, that does not necessarily and the one to 50 and one to 75, does not represent a caseload, because we have different levels of sort of up take of case management services and some folks in the buildings may not engage at all and we may feel that they are fine and other reasons this they are not engaging and sort of the residual population will be those that access and you are looking at sort of the case manager per unit and rather than the case manager per tenant. >> kind of a proxy. >> it is, but we don't have 100 percent of up take and so the controller's study is going to get at what that utilization rate is to help us define and think about the support services and patterns. >> tier four, is several, types of buildings, so our local operating subsidy program, and the hud supportive housing program and shelter plus care

and moderate need we are calling it for single adults and family and we do it and in the referral and placement here. and the eligibility criteria for these buildings does not require a distinct from tier five, and it does not require all of the referrals to be chronically homeless or to have a certification of disability. and so some may be but not all of them are necessarily the critical chronic homeless and the service staff to unit ratio in the moderate need, in this set of buildings is one to 25. and for adult and families. and then, in tier five is the same mix of buildings, but we are framing this as the high need of adult and family and this is, buildings where the eligibility criteria does require all referrals to be chronically homeless and have a certification of disability or the 100 percent of the building is a low operating building, which is the general fund and partnership with the mayor's

office of housing and so we fund the support services here and additional funding for staff that have the higher training and a sort of a higher level of case management, and we can either experience, or social work and grounds and that sort of thing. and in this, the ratio of one to 25, as well. and what we are asking here, generally, family and adults in these buildings would be more active engagement in case management planning and that sort of thing. so, the next and bevon did a nice job and did a nice job of describing the coordinated assessment and so i will not go through it and i will only say that we are beginning the pilot in july on the center plus care buildings but it is a requirement for the hud funded buildings and we agree with them that we think that it will be a good tool to assess the service need of folks and we are getting the chronically

homeless into the buildings, and the folks that are in the most need. which leads into the national goal of ending chronic homeless by chronic homeless bye-bye december, 31, 2013, and s recommended to prioritize them for placement in supportive housing, and then i added the third bullet for this hearing, because i think given the number of units we in the portfolio in the city, and the department of public health and us, and if we are successful at creating a housing ladder and getting positive exits out are our buildings, obviously it will access rate the placement of chronically homeless people and get them to access the service and cycle out. we were developing this ro bust system, you know, a decade and a half ago, or more and we were thinking about as housing first of all and so permanent and

sort of, and by saying, permanent, what we mean is that they have tenant rights and it is the permanent housing and it is not a transitional program, and it can be construed as housing for this individual or family and that is where they are going to be for the rest of their life. and thes permanent and although that may be the case for some, and i think that now, as we stoert of think about it more, there are opportunities for exits and while they do have tenants rights and it is permanent and maybe we want to think about the service mix of more of a transitional housing model not to say that the folks move out after 12 or 18 months, it is more of a program, that folks come into our buildings, and again, this is just, and i am just, throwing out ideas, to discuss. and maybe the folks enter the program, knowing that they have tenant's rights and they have a program that requires a certain level of engagement and what that looks like, i think will be a nice dialogue with the providers and clients and you all but you know, whether it is volunteer activities or employment training or

agreement, or applying for disability and getting on the benefits and the range of things that we think would lead to positive, you know, improvement to people's lives and getting them out of permanent housing to open up another unit, to someone who is chronically homeless. so, a few quick questions. >> yeah. >> so in that vein, i think that what i have heard from a lot of the providers as well is sometimes we have the supportive housing services, but for one reason or another. we don't have the tenants in those services actually are or become part of our street population during the day, if you will and add to this kind of public around the homelessness, which i think is healthy because we want to get the people off of the streets and focus on those people but if we are publicly funding the units and then they are during the day or night or what have you. and out on the streets, and you mentioned some ideas, i mean, any other thoughts around that?

has that been the case for a while and again i have just heard that sentiment from people, and no data around that but i heard it from the providers as well. and so, i imagine that is at least to some degree the case. >> i think that is right. and i think you know, when you look at placing thousands of people in permanent supportive housing and look at the funding levels that i just walked you through and where in the buildings it is one to 75 and one to 50, if everyone were to up take and they could not handle that, one to 75, given the depth of the need for a lot of these tenants and it is not possible to provide that rich case management and service coordination and that sort of thing, so, for those reasons, i think that some of our tenants and you know our providers, you know talked to agree, and sometimes they don't have any activities during the day and it is not a realistic

expectation that someone is going to stay in his or her room all day and no one will do that or want them to do that. >> right. >> and so the community activities in the building and things that they will engage folks in the community or in the building rather than being idle and subject to the disease of addiction and mental illness and panhandling on the day and on the street and which, in sort of the, the maco view of your, you know, when you hear about citizen complaining about homelessness, some of it is not homelessness, they are in housing but it is sort of a level of activity in the day that we are not able to provider the folks are not up taking and so you know, there is sort twof ways to go about this or maybe even a combination or you can develop rich in the buildings and a rich array of services and a really healthy community in the buildings where they know each other and it is vibrant and you have the buildings and that is

not as much the case because they have a good case manager and more of them but sometimes it is, and you know might we think about requirement in exchange for you know this rich subsidy in housing and you know, the permanent nature of the housing that you know, ten hours of activity a week and maybe that will help to breed more activity and involvement among the tenants and we do that in and required to do that in our web fair to work programs and a lot of families who have not engaged for a very long time and in our system and once they see the services but they are not only required to engage in, but that we offer it is a positive impact. i am just throwing out the ideas, based on the world of human services. fupds, and operates. you know just for thinking around how do we improve engagement.

>> and those rich services and perhaps, a higher expectation of what our tenants should be doing in housing. >> one of the things that was mentioned before, we have some people in our shelter system i think that we talk about the aging in the system as well, and certainly, a critical issue as we talk about the medical needs and funding those. but there is also the concept of the people in our shelter and you think about the housing ladder and you think about the hearing and the housing ladder and you want the people to climb up the ladder to make the space available for the people that are on our streets and having it clogged up makes no sense at all. so, i think that i have heard there is not enough supportive housing inventory to push the people along. >> sure. >> and then you also hear that some people, don't want to leave. and maybe they found the community in where they are. and the people who have been in the shelter two years and seven years, shocking when you hear those numbers for the first

time. the truth in that, that there are these super long shelter stays and how do we unclog that part of our system? >> both devon and amanda mentioned that there is a cohort of folks that are in the long term shelter and we run the data and i wish that i would have brought it with me. i will give you an example and we can extrapolate that to some what of a whole and we opened, i am looking at the data now as i am speaking. and so 4 percent and so let's just do the data and i will talk about potential strategies. and so if you look is he number of bed nights, the current population has been in that bed

over 700 bed nights and another 5 percent has experienced 600 or 700 bed nights and another five percent, 500 to 600 and five percent, 400 to 500. and so that almost 20 percent being categorized as the longer term stayers and we can go further and kaor late that by age and gender and all of that and you know we do that and we sort of look at what population we are talking about. when we opened the ramon hotel in 2007, 2006 or 7, and this was a building that was burned out, and brand new and construction and renovation and nice roof deck and it was on howard and 6th and 7th. we were offering the opportunity for the senior to go into those buildings and the rent was on ssi it would have been 35 percent of their income. many of them said that they

didn't want it. and for those reasons, supervisor, that you highlighted, i built the community in my shelter andvy been in this bed a long time and it is my space now and i am paying rent i am getting my meals prepared. if was not until we actually took a van to the shelter and actually drove folks to the building to walk through the buildings and then the natural life and the roof deck and the people say, well actually, we still have some say no and it opened their eyes to really what we are talking about when we are saying, housing. so i tell you this because i think that it leads to a few explanations and one is perhaps a misunderstanding among longer term shelter stayers and many of who are seniors or women. and about what the supportive housing program is. and sort of maybe the picture of them as sn aro, that is, you know in the middle of the tender loin that has no support services and sort of

delapidated that is the vision that people have in mind and i don't want that and who can blame them, that is not the reality. when we bring the housing on-line, it is rehab and brought up to code and we require, the building owners to, and upgrade all of the systems and we have 124 hour desk clerks and they are good environments and i think that is part of it. and i think that part of it is not wanting to spend any of their income and ssi right now and 875 dollars a month, and that is not a lot and they don't get food stamps. and so that is the income. and even though, it is 35 percent of their income, you know it leaves them with, you know a little under $500. that are the possible solutions it is a nice housing unit that is yours, forever, as long as you pay your 35 percent of

income in rent. with the services on sight and a nice senior community, if you are offered that once or twice and turn it down, maybe you will look access to your long term bed and maybe that will incentivize what is better for them and certainly provide, you know, an opening in the shelter system. and better out comes for that individual. if that was the alternative that they could not stay there, maybe they will take it up some more. there was thrown around, just as a long time ago. 7 or 8 or 9 years ago, in the social security administration, you should be charging them, we never went there and it was difficult and we didn't think that it was sort of the best way to go. but you know, perhaps, if, shelter services were required to pay a little bit towards

contributing to the food and the shelter that is there, and after they have been offered, and again, 1, 2, 3, times the housing and you know, maybe that is another sort of incentive to take the housing up. >> is that... i never heard that before, is that a current regulation actually. >> it is. >> or is it glossed over. >> it is current reg and it can be interpreted to mean, either permanently permanent or a shelter and the shelter room out of that. >> got it. >> when you look at someone in a shelter two years it is not an emergency it is permanent. >> thanks. >> thank you. >> and i will just conclude with just sort of the, and i will, the effort to get more data and information to inform or what the housing ladder might look like in our buildings and is there a controller study of our supportive housing units and it is currently under way and the final report will be in the fall and what we are looking at is the residents and what i spoke to earlier what are the

needs and linking to service and follow through on referral and accessing it is services in the buildings and the trajectory of the residents, and what are we talking about and how long have the clients stayed in the housing and have the needs changed over time and is the service there now, and totally, mismatch with what is going on. and then in the fine out comes after exiting the supportive housing are important as well. and so what is a positive exit? how many exits every year? where do they go? who are those that are exiting? are these the employ ables or the folks on ssi or the folks with roommates and all of that sort of stuff. we are looking forward to that and really further or dialogue internally and with our community partners and with the board. >> okay. >> i will conclude with that. >> thank you, colleagues any questions at this time? >> okay. thank you for your presentation. much appreciated. so next we have margo, and director of housing and urban health for dph, thank you for being here. >> sure, good morning.

supervisors so, we are here today to talk about entrance transitions and exits of supportive housing. and i will give you a little report from dph, we talked last week about the cost effectiveness of the supportive housing and i will link back to that at times. and trent gave you a lot more information as well, about the system. and so just to remind you why dph does the housing at all, and given that we actually have and the health department and that is to improve the health and well-being of homeless persons why reducing the cost of over utilization of the emergency services which are mostly our services at the health department. our philosophy around that is that housing is a healthcare intervention and that we support our tenants to recover from trauma and improve the over all health and well-being that is our goal.

i also that the department of public health facility that with all of our patients and clients and residents in all of the systems that we have our priority is to have people be in the least restrictive and the most appropriate setting possible. so, i want to show you our little bit of our current housing ladder and you will remember from last time that the incorrect access to housing we have 1700 units, and part of that is the lease and most of that is in local operating subsidy programs. and we also have the site program and we currently have 150 units in the market rented for people that are directly coming from laguna honda and another 150 people that are in that particular program are actually in direct access to housing because the scattered site and the housing program has a lot of the wrap around services and does not meet their needs on the appropriate

level. they will not be able to live that independently. there is also other dph housing, and they are small and they are smaller parts of the housing and so we don't offer for them but i think that it is weather it to point them out here and we have quite a few mental health core and that is basically where the people that are having severe ongoing, chronic mental health site diagnosis live together in apartments and those apartments are rented by the non-profit providers and we have it with the people with hiv and recovering from the substance abuse programs and those are all long term permanent housing and that the people have leases. and we also have many hiv funded subsidies. and we talked about that a little bit last time, some of those in the free market people take the subsidies and found their own apartment and we have about ten or so that turnover of those a year and many of

them are in the housing so that is mostly project based. and so inaffordable housing and in, affordable subsidized housing, how do people get to this step of our ladder is that some people come directly from homelessness and often people come from stabilization and the transitional housing, that the dph, funds and so that is a medical, and we have 38 units and the emergency stabilization units and we have 361 of those and then on it is about, we have hundreds of treatment programs, mental health, substance abuse, and hiv and the diagnosis programs and the people come from long term healthcare facility and people come from a lot of systems and these are people that if they are able to live a more independent housing, the supportive housing is a permanent housing that they have for them.

>> quick question for you. as you talk about this and we have, he was talking about the intake referral points. you know, would the city benefit, do you think from having a data base and this is a technology question, there are referral systems that i dent want to put the words on your mouth, would seem to be a challenge from a city perspective and the different silos of the departments having units and the families and certainly we learned last week is a centralized one. and would that be beneficial? and i mean, that from your perspective and i am asking you to take a step back. >> yes. >> how would you think about that >>. and can you go to