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 the slide? >> sorry. >> and this is just, and it is a good question, and this will just two slides up. >> i think that would be great. and so for our housing, which is highly enhanced it has a lot of services on site and i have a slide on the kind of services that we have on the site, and for the people with the special needs who many of whom have been homeless for a very long time. and but even more so, have been in and out of long term care for facilities and of the emergency rooms and of the homelessness, again. and from the parents house and where they can crash, and then, back into long term care facility and treatment. and for dph, we really would need to have a system, where the kind of assessment that we

find that we need to make which is largely and clinickly based and looking into the different data bases that we have and where that is possible and we have been part of discussing the coordinated assessment of course, and we have made our referral, paperwork, available. and for review, and there definitely overlap. of course, of the certain elements but around the real clinical, you know, more indepth assessment. that is very different from looking at other kinds of populations, so that will be a burden for that population really. >> it makes sense. >> so, going, thank you, so going to our acts and the referral process which i hope that you can see better, i just wanted to show it very briefly to you, and so basically, the homeless does the case manager

refers us to our placement unit which is really for all of dph and people can be assessed therefore any kind of need that they have and these might be the people who are homeless and hospitals and the people in i higher level of care or stabilization units or shelters. and the placement then makes an assessment and looks at the different the long term and the record that we have on the mental health and on the primary care site and makes a preliminary decision whether or not people will be able to live successfully in supportive housing and so where it says to the right, no, really that means that the person would need a higher level of care, or maybe they are currently on a higher level of care, maybe that is the right level for them. maybe some other level of care is the right level for them. but supportive housing, might be too large of a jump and too high of a risk at this point. the majority of those people

are going right into our direct access and referral and our direct access and referral team and they look at what kind of housing do they have available and what kind of slots do we have available, and on or in a normal month, without bringing on the new units that is about 12. or 14 units. and so, in a year that is about 150 units and so unless we bring on new local operating subsidy programs, affordable housing, that is what we now have, and so, we tried to match the people that have the highest needs, and with the kind of housing that they have available, with those 15 units. and that is, and that is all of those teams, and clinical, and clinical, providers and they are social workers and so forecast and once we have matched, a person to an open unit at that building, these then pass that application on to the housing site, and the ten ate services as well as

property management and certain information that does not go to the property management. and our, access team does stay involved. and in case that there is any kind of barriers, and hiccups and something that, you know, where it seems like maybe the match is an accurate and we think of a higher risk can be taken than the on site provider thinks that the time can be taken and so we help all of the parties to go through that process. and i would think that in and i would say that at 98 percent of the time, and 95 percent of the time it is a successful referral and it ends up resulting in moving into the supportive housing site and i mentioned last time that we have to close our pool for a while because it was so large and we needed to exhaust it and there were a lot of inactive referrals in our pool and really opened our pool in january, and january second, and through april, we received over 500.

and looking at those, at least 40 of those referrals, are the highest need referrals that we can accommodate. in our sights and maybe not in every site, but the site that have it on site and that have, you know, a bust, and the support services team, and that can be accommodated. and now, of those 30 percent, more medium needs and maybe more of a gray area and maybe they could be going somewhere else but they will certainly benefit from the services, and very much so, and it would help them to stabilize and then they are the 30 percent might be a much lower need and we do, let the people know that we let the servicer and providers know that the chance for them to get placed in the direct access to housing is low and that they need to make plan b and we actually say that all along, the line because we have such little turnover. and so the priority for us is based on a lot of the different needs and not just homelessness. but, homelessness, certainly is

a factor. so, the target population just to remind us all is the eligibility criteria that the people are homeless and that the people have a mental health diagnosis and a substance abuse diagnosis and the medical needs and the majority have us, and the people have the income and that is usually seen as 30 percent of the medium that, that the referred and applicants agree to pay the income toward the rent and we are a third party and the payment provider in that the people and the city and county of residents and they might be placed in an out of county facility but they were placed there by dph. our access points, just reviewing once more acute and psychiatric hospitals and long term care that can be locked or not locked, intensive case management and these might be the people on the streets that are homeless, but a lot of

agreement programs, primary care clinics again a lot of those people are actually actively homeless, and the medical respite, and then the street out reach teams and a lot of that is the homeless out reach team. and the services that we have in our housing, is taylored specifically to our population. and the whole premise for us is and what also our consider specify is that it is really on the support services staff to actively engage the tenants and it is not enough to say to put, you know, a shingle out and say that the support services come on in there has to be a lot of active out reach and the people that might need us the most have the hardest time taking advantage of the services available and the ideas of course is to help the people make sure that they reduce the physical and the psychiatric and their social harm and the on sight support services

include the case management and care planning and access to the benefits. >> supervisor mar? >> i just have a question about the eligibility criteria. >> it says that it is homeless, substance abuse and complex medical needs, what are examples? >> well it reaches everything from having received referrals of people that were going to have open heart surgery and they were just waiting for get a unit which is you know a bit extreme it took a while so that person could move in. to people that have really serious diabetes, people that have serious abscess and people that have chronic diseases such as hypertension, and then, of course, injuries as well, we see a lot of injuries and a lot of combination of physical diseases, so it is not, you know, we just have somebody

that has diabetes over here might be very over weight, and might also have problems that they are starting to experience and might be in a wheelchair might not be as mobile and maybe much more likely to end up as a problem as well. >> thank you. >> hiv sab absolutely, and hiv related, diseases and aids. thanks for asking. >> and so, after the maintenance of benefits, he want the people to have the ability to not only pay the rent, but also have money to for food and for other things that they may want to spend it on and access to the main nens and medical and behavior health service and substance abuse and life skills housing and harm reduction counseling and many

of our sites we have nurses and so they can provide the nurse management and medication management and we have community groups and building social activities sometimes the first wave that the people get involved is the results or getting engaged. and the people have secure food and clothing. we have educational connections and the support services help us with the assistance with the stability and the sf property management and we specify in the contracts that these are services to be provided and we have out come objectives around that services. >> and so the staff, continue to engage the residents in dialogue, and continually reminding the residents of the available service and for some people it is not necessary, and we definitely have a high service utilization and there is a lot of motivation of the interviewing. and the staff really tries to help the people set and achieve long term goals and that is at

times of includes housing goals and sometimes it is just to maintain housing and it is the first time in a long time that somebody is going to actually be in their own unit that is also for some people to move on and reunite with family and want to live in independent and not just project-based housing and then the exit from 2013. and 164 exits from the direct access to housing, and of those 52 people, deceased, some people at the site and some at the hospital and some people choose to receive hospice services on site and we have the teams to be able to accommodate that, that hospice services can come on and the support services facilitates that. and we have 22 people who were evicted. and of the 164 people that would be eviction rate of 13

percent, of the 1700 units that is 1.3 percent. >> so like we are going through all of these, and we can read these, just a question on all of these. is this consistent, year over year? >> yes, i think that it is. and i was lucky to have the possibility to also look at one of a specific program that they have for the chronic alcoholics program. and the statistics were amazingly different. so even just looking at a specific subpopulation and looking at the larger picture was very much the same. and representative. >> okay. >> and so higher level of care 21. >> again, we don't need. >> and yeah, thank you. >> so do you want to wrap up for anything? >> i guess that the one thing that i wanted to say was you know the certainly is if we have a more resources we could track, even better where the

people go. and what kind of exits that the people have. and i also we have had many conversations about the housing and as you can imagine and i really appreciate that we are talking about it and i think that for a long time, there was you know some what of a fear of looking at a housing, because we are just so, so, glad and grateful that people actually have the permanent housing and that it is actually sticking for many people. and we work as a population where, you know, ups and down,s and also downs can be part of the cycle of their disease and be that substance abuse or mental health or physical conditions, and so when we look at the housing ladder we really needs to look at how we go and what kind of safety net are we going to have when the people are able to move on to a level that we may be agree with maybe, not agree with in terms of the level of independence and we will assess that but then what kind of ability do we have, to catch people and not

have them, you know, fall all the way through the system again? i think that we need td subsidies and we need more case management services and to support the people on that level, that they need, when i talk to our medical director, he had a lot of ifs, and a lot of conditions around, and how he would be able to assess. because i said, just gave me a percentage and he was not able to do that he said it was just really depend on what we have available and what support is in place. but i think that there are people who would be able to and people who would like to have other choices. and who are stable. >> great. thank you very much. colleagues any questions? >> no. much appreciated. >> and we have olsen lee, from the mayor's office of housing and community development. >> good morning, supervisors, director of the mayor's office of housing and community development thank you for the

invitation. you know, we have talked about the housing ladder, and many circumstances not just related to the supportive housing, but we are going to focus a little bit about the supportive housing today in terms of the housing ladder and what the mayor's office does but there is also the question about the housing ladder for people who are in our affordable housing and what steps, do they go, beyond the affordable rental, and how do they create sort of the opportunity for people for them to move up the ladder further? >> but, i wanted to first talk about our role in support of housing. and i have the pleasure of working with some great colleagues, at the department of public health and human services agency. and it really is that collaboration between the departments that has allowed san francisco to be so successful in creating the supportive housing and mo is, you know, buy itself, could not

do the things that the three departments are doing together and they are the experts, and in the area of services, and they are the experts in the area of care and we have bricks and mortar to create that affordable housing and stock and so what we do in this process is through our fees and that we create the opportunity to develop more permanently supportive housing as well as affordable housing and we look at a video of models and one, the stand alone 100 percent supportive and also the whole motion that we integrate supportive housing in all of our affordable housing and at the minimum, we have and many of our elements, 20 to 25 percent, support housing units and that are incorporated into a larger affordable housing development whether that is at

mission bay or the shipyard, or elsewhere in the city. >> and so, i think that the important part tf is that we, when we issue a nofa for some development, and for, the opportunity to develop the rfp in conjunction with our partners in dph and hsa and we evaluate those who are given the opportunity to develop on that side, both from the standpoint of the capacity to actually create the housing and operate the housing, and you know, sort of the bricks and mortar as well as on the service side and together, that has to be there, because it is not just about creating the structure, but it is how the structure is operating in the future, and how that structure you know supports the work of the two departments. and it is really critical, and as i said, we could not do that without them. and for a variety of reason, one is especially on the 100 percent supportive housing.

where we are serving a population who have the lowest incomes in the city and sometimes no income at all and their rent, cannot support the operation of a building. let alone pay for the services that are needed to operate a building. and so, we could not, you know, literally, run a building, without dph and hsa, their funding is critical, to the ongoing operation of that building, beth from the operation side, as well as the service side. but we managed the development process and we under write this process, and we provide our gap financing for the developers, and but, again, that is just the capitol side. and it is the combination of the two organizations or three organizations sometimes, that looks at how the building gets operated over a long period of time and that the building is

sustain able over that long period of time because what we are trying to do is we are trying to bring lenders and investers who, you know, basically want some assurances that the project will be financially feasible for an extended period of time and probably for the tax period or for the period that they have a loan outstanding, and they need the assurances that the city funding for the operation will be there for the long term and we have been able to convince the lending community and the investing community at san francisco, and is committed to its supportive housing and that funding, although it is subject to annual appropriations or sometimes, 15-year contracts will always be there, to support those projects, because that is such a critical piece to it. and the other thing that the office provides us long term asset management for these supportive housing making sure that, again, these buildings

will be maintained properly and it will be, assets for san francisco, for the residents for the future. >> and both trent and margo talked about the types of housing, that are in our existing support housing system. and one of the things that we wanted to note, is that as we are building new affordable, and new supportive housing or new affordable housing there is the advantage, that over, you know, in some respects master leasing some of the existing buildings, and these buildings, are often created, with the supportive housing and supportive services in mind, and you can go to i think that the most recent ground breaking or not ground breaking but the opening that we had was the cousin of the community and that was the designed from the ground up and knowing that we

were going to serve, formerly chronic homeless individuals there and part of the whole design of that building was about the service space and how the service space would engage the residents in a way that would sort of entice them to the services, services are voluntary but really plan for that service space to be bright and active as opposed to being in the basement of an sro and the tl. and you know, sometimes, you know, we will have the resource for that but to the extent that we can create, housing, that is you know, designed for the population, if we can serve that population better, it does raise the question of will anybody ever leave... because it is a wonderful building and a location and but i think that clearly, having the appropriate service spaces, in the building, and designing the

spaces along with the service program, is a wonderful way to go and it is one of those only in san francisco sort of moments. so, in addition to, you know, the other projects i just wanted to note, you know, some of the other projects the mayor's office and the former redevelopment agency have assisted in the category of the supportive housing and octavia court for the developmentally disabled or challenged, and the mission bay senior, which had both housing for independent seniors and seniors who are being diverted from laguna honda and that had an adult day, of center on the ground floor which provided some support services not only to the residents of that building, but to the entire neighborhood. and as an example of how we create supportive housing that is not the traditional image of a supportive housing. >> so a quick question for you, as we look at, you know, the

mayor obviously has the ambition plan. >> yes, he does. >> and so, what is in the long term pipeline in terms of those funding, if you think about homeless, formally homeless individuals and it is always a mix of affordable and there is a wide, array of needs out there. but what is, what in here from your perspective, either in terms of pipeline or anticipate kind of those funds going toward the homeless population. >> well, in the pipeline, it is over 8500 units over the next six years. and where we are going to start or complete. and then many of those are going to have you know, a supportive housing ing component to that. what i said earlier is critical is not the question of whether i can build the bricks and mortar is that whether i can provide the appropriate level of service it is the discussion that we will have as we get close to each individual

development and i will talk to my colleagues, and you know, at hsa and dph as well as the budget office to say do you have, the ability if we go forward with an rfp to fund the services on the particular site? so we will look at that on sort of a year by year budget basis. and on part of it is, you know, again, the project's only work, and if i have a long term commitment, from the dph or hsa and the general fund. >> thanks. >> and so, in terms of, you know, we spent a little bit of time talking about a couple of our affordable housing developers and asked them about, you know, what were the exits and the people moving up and out of, you know, our supportive housing and they talked about you know, somewhere in the neighborhood of five to ten percent, could move out of, or move up the ladder and talk about some of

the options for the people. and in terms of both, you know, family placement reuniting with their families, and some of the residents have been able to get prioritized for public housing. and i will talk about more about the role of public housing and the housing ladder, unfortunately barbara smith had another appointment and she could not stay, and as well as moving to other more funded affordable housing and again, part of supervisor avalos? >> perhaps you will not go into it, but the five to ten percent of the residents in supportive housing who are ready to move up the ladders and you have the examples? within these examples what are the most common placements that happen? >> it did like, these are just like for example, but it is skewed in one direction more than others? >> yeah. i can't really tell you and i will get that information back to you. you know, there are discussion that was no one and sort of,

you know, predominant exits, in terms of the ladder, obviously the people talk about, you know, our affordable housing, rental and already moving up to affordable home ownership and out to the market rate housing. and obviously, that has become, you know, going to the market rate housing out of our affordable housing system has become, much much more difficult over the years as the gap between what we charge, and in our affordable housing whether it is just our affordable rental verses our supportive housing, pails in comparison to what the current market rents are. >> so, what are the... excuse me. >> what are some of the challenges of moving from supportive housing to traditional affordable housing. initial lease up is through the lotteries and so it is, and

there is's lot of demand, for the few affordable housing units that are made available. and i think that the biggest issue are the rents are too high. and someone who is going from supportive housing to our affordable housing, even though our affordable housing rents are generally peged at something around 30 percent of 50 percent of the median income, which is very, very low compared to the market, it is still too high for someone who is trying to exit from the supportive housing unless they have section eight, vouchers or some sort of rental assistance, but those rentals are very, very scarce, and you know, and, to be able to get them, and then go into an affordable housing development, is pretty unusual. and what was the better scenario, is that a vacantcy, occurs, and in a development that has project based vouchers

and then, somebody could, could move, from supportive housing, and to that affordable housing, and because, they would only pay 30 percent of the income, for the rent and the federal government will pay the difference. >> and the other question is whether the services would be sufficient or not. and i think that we talked a lot about, you know, the question of getting, residents into the right type of housing. but it works both ways, you know, we have residents who are in our affordable housing, and obviously, you know, barbara smith and the acting director of the housing authority have residents in the public housing that need more supportive housing and not less and then we have the folks who could potentially move from supportive housing to some lesser, now know, less supportive housing and the goal is really, you know, there is movement in both directions and the question is, how do we accomplish that? and so, in terms of moving from

supportive housing to public housing, and there is a wait list. and but the housing authority over the past two years, based upon, you know, lots of conversations with the community, have prioritized and have created ipreference for homeless and for the veterans. and is it considering creating a preference and it means a few things, supportive housing if this does go forward, i know that they are talking about it now, and but, if that preference does go forward, it means that making sure that they get on the wait list and the only process that the housing authority has is a wait list process and that is how it is with the federal regulations but that has been used successfully, on in the past by the departments to get their clients on to a wait list.