income and medical needs a variety of providers that will refer residents into the system and the different programs will have different evaluations and assessment so the single adult population no formal evaluation but there will be for family units and dph g side a clinical evaluation for the clinics as well as in terms of the compliance two broad areas maintaining the laugh behavior and paying rent and beyond those compliance criteria that are house rules in terms of you know expected behavior. >> so while there has been some increased standardization at

both h s a and the other agency those are still heavily focused on conceptual compliance and we need what is more expensive conceptual comparison of outcomes u outcomes across buildings and vendors and the city s is currently engaged in our main findings and speaking to the concerns you've raised supervisor farrell we believe at this time master lease and nonprofit support housing are necessary components of the system because the master lease unit do make up 2/3rd's of supportive housing portfolio and 3 thousand unit at this time it is less expensive and more available than the nonprofit housing they're less desirable the buildings are older

and although the city has created more 3 thousand unit since the adaptation of the plan in 2004 the homeless population has unchanged from 2005 to 2013 in general people that are being housed in addition while past analysis by the city and other government academic sources that provided the academics particularly compared to other expenditures and other expenditures such contraction and hospitalization the actual costs of per secret are expected to slate in terms of the development costs with the nonprofit or affordable housing development and finally there are numerous program procedures in case of the data

on high levels of key spending is not available because the contractors have been structured and the contracted performances and outcome manufacturer are not sufficiently detailed to track the effectiveness particularly having targets original towards transitioning people out of housing and specific details in the types of housing if and when they're able to support the housing so finally you know the 10 year plan considers the housing permanent and didn't discuss whether the residents ca can transition because they don't assess it from a higher to lower level service and the city therefore needs to consider whether africa be permanent housing or some sort of transition housing lard is

possible so we believe the board of supervisors should convene a working group of various city agencies or organizations and adapt a new 10 year plan on the housing those will discuss the citywide coordinated system and more expensive performance manufacturer to understand the services abatements which the auditors report will address the available of tentative housing and the projected heirs of the city's supportive housing thank you. >> thanks for your report thank you for the authorness and the power point a few questions i think that before we move on to our city's service audit report you talked about something we've been struggling where it's too

too much whether we should dive into the details and instead of talking about the structure i see the valid it but let's dive i love our personal opinion we've asked our housing provider and value everyone's opinion the coordinated assessment model system similar we talk about the central listed intact system although that's a separate topic that the general technology can you talk about where or not that's it feasible but if it's feasible to implement i see the benefits i want to me it's a no-brainer. >> certainly the other departments will be able to

speak around the funding challenges and the data challenges of having you know those various systems were not designed to talk to each other but i think that the point we're trying to make is that, you know a necessary and sufficient component of any long term planning in the city's housing so currently you know it is very difficult to assess people move in and out of the system during case points and having a better understanding of those needs will help evaluate costs in the future so i think they're currently they're doing a trial on the federally sports populations and i think that community colleges will be a worthwhile investigation we'll be taking lessons learned from the trial and moving into the city. >> in terms of you talk about the contract monitoring i think

the performance outcomes we'll here later from the general the people that have been involved in the housing providers network and they're already talking about measurement of performance outcomes on a multi year approach i don't want to put words in their mouth but looking at it from a long term there's a temptation to have the outcomes we is the board of supervisors determine they may not be the right outcomes that the department and the housing providers on the street really reels or building are the best to look at we're looking at more than a one year t there are anonymously i want to hear from our prospective do you think it is a good multi year kind of process look at outcomes, and,

secondly it it seems to me that some coordination between the departments and the provider to see up front in front of a contract those are the things we want to look at it and have a discussion that you know of what the outcomes are their ones we can measure and fit on the street i think the board of supervisors has a lot of great input but a lot of times we should allow the people, if you will to determine the metrics most feasible. >> i agree that the front line providers and departments are certainly in the best position to access contract performances but i believe that there information that can be gathered that doesn't necessarily need to inform the assessment of a

providers performance but should be available to policymakers in order to make determinations and the issue now that data that helps policymakers plan over horizons is simply not available it didn't need to go into the evaluation of a performance but still should be available so long term planning. >> if you could just thank you for your time if we could given you've done the deep dive that what are the sub points you upgraded see something to pursue and talk about and have available to us. >> we'll definitely do that. >> okay no other questions for the budget analyst again, thank you for your time and effort at this point livelihoods e i'd like to say to bring up the auditor to

talk about their report. >> good morning supervisors i'm laura marshall with the controller's office thank you for having me and just want to be clear all the information alike the last presentation that relates to the human agencies so we didn't look at the department of health it is not part of report last year h s a asked the controller's office to look at the fengs of services services for the portfolio for the housing sites we've analyzed the main areas on whether or not the

includes are utilizing the public benefits two the trajectory of the folks able to address some of the issues that led to their homelessness and 3 whether and how includes are exiting the housing so we interviewed case managers and surveyed many includes and analyzed public data for all of the clients housed we found they're generally successful at stabilizing their clients and helping them maintain their housing there are quite a few areas of success and their detailed in the report as well as the clients oar today, i'm going to focus on the areas where we recommend certain improvements be made so clients generally see their

case managers monthly but the interactions maybe more informal rather than a service provision and also i think that a lot of sites deliver important crisis management than case management so the case managers address the housing instability and talk about the stability for clients but the issues of self-sufficiency like housing searchers may be left unattended in addition to the self-sufficiency services for clients more severe clinical needs or health issues as well as for senior clients so supportive housing clients are older and tend to stay in housing for a long time their aging in place and the case

managers are not prepared clinically or otherwise to look at those populations we have an interest 2, 3, 4 clients have been referred to benefits there's some that nuance data that doesn't show up in the slide but we see an enrollment in the medi-cal for the adult population their hearing about it but in the getting gold and we noticed a pretty good gap in the inn house services enrollment and given the age of the population and the general level of need there we will expect much higher engrossment and commissioner moran the overall san francisco service in that that he matched supportive housing folks with the emergency

utilization do not for the transition data the data suggests positive outcomes for the emergency health services that means that ones housed clients are more appropriately utility lists the services we saw the actual cost savings per client in the emergency care is fairly low not a significant costs savings but it suggests benefits to the housing in stabilizing their clients when we examined the client access we see that clients say a long time 5 years per 0 client in the fiscal year 2013 many clients existed housing nearly a

quarter of the adult exits were the result of that represents on 3 percent of the total housed population administrative data identifies the clients were not evicted and didn't - when we reviewed the case files it showed that the actual outcomes for many clients were unknown to case managers in contrast and kinds managers have no engagement with existing scandalizes with over half of the case files reviewed showing no document files exit so it is important to know that the services are voluntary and clients may have refused the services is it so not documented in the case files we don't know

what kind of services were delivered to the clients there were plenty of examples of active and engaged case managers case managers have little roll in the exits whether positive or negative we made our recommendations in the four core areas first the steps to fill gaps in service including the health services as well as clinical services we recommend the agency use a dloibl roving service since the level in need vary by site for example, the housing applications are easier to maintain and the kinds managers railway are able to fulfill the need based on our interviews and also not you'll clients will be appropriate for this they may

not need the application support so we recommend a central listed or roving housing support specialist to fill the needs next, we recommend h f a have fence by clarifying the documentation for the provider and their standard will also help supported and a improved outcome tracking to better understand how and why clients may succeed or be stabilized. >> third we recommend h f a explore ways to track the clients throughout the housing system we need to request client information from each provider we got a lot of variance in response making it difficult to

understand who is being served without a lot of extra work to effectively track clients and program outcomes we need to know who we're serving and the are a structure for the analysts to work lastly we ask for self-sufficiency to point out the definition of self-sufficiency varies by clients it is not reasonable to say that all clients will transition off of certain things for each client we also courage sf a to support a full spectrum of housing san francisco has gaps to be filled particularly subsidized housing

that allows clients with self-sufficiency filling the gaps is a regional and citywide issue and requires a lot of collaboration we recommend piloting and an expansion of the existing subsidy for the clients the full report expands on all the topics i'll be happy to answer any questions. >> thank you for the report and for again, all our work on this issue as well if no questions from my colleagues, i should have done that before why not focus on h s a i saw traefr do you want to come up and maybe we'll have a

conversation about the report. >> thanks for being here and obviously for participating you know i have a bunch of questions if you want to talk as well feel free. >> traer with the agency i'm happy to be here thanks for sharing this i think i'll attempt to frame this a little bit from h s as historical information and adjust some of the recommendations that will address our questions supervisor so i think both the reports you've heard this morning as well as the research for a decade or more shows we're in agreement of the housing is the most effective intervention without a fact folks stay in

housing and others move on but the costs with homelessness s are mitigated by the hospital stays and admissions and emergency room visits and law enforcement on the street, days in jail all of that is reduced and several studies show that there is no debating that the debates centers around what is next in how's in san francisco and before i sort of go there i want to fracas a little bit of the initial thinking around the massive growth in san francisco probably from 2003 did strategy was to bring on 3 thousand or more affordable housing and with the service strategy was housing

retention we've built in partnership with the providers a services mix with a single goal housing retention we note we did that well over 90 percent retention after a year the report shows 3 percent and actually folks got evicted or leave so this great but what has happened the population is now sort the population has packaged their needs are more acute the folks we're housing off the streets have been on the street a long time and they have needs far greater than the needs they're not cash clientele for example so the housing retention yes, but a need and the reports point to this addressing the kline clinical shortcomings and other shortcomings with a mix of

residents that can move out of support housing with help before i go there i want to address one of the utilization it is the key beginning or step to getting to the next rung towards self-sufficiency or getting dablth benefits or other federal benefits and leading into other housing so the report does speak to characterizing as a low benefit of the population whether it is medi-cal or cal fresh or cooling works for family there is was that the controller conducted that and limbs were on their end data limitations specific not having information from the federal

databases and that is significant because phone calls folks from ssi are not available for cal fresh and others programs but automatically enrolled in medi-cal because the controller didn't have access they could only look at the don't that identifies cal fresh and cal works, however self-reporting from clients show 58 percent of self-report ssi it has its limitations but if you take that proxy because of the high penetration rate this is the population that is not eligible for cal fresh but it is also the population is automatically on medi-cal and this ssi included children their

parents are not available and adults so the 50 percent phase we're looking at meager that with the controllers uptake 15 percent 15 of adults are available for cal fresh and 27 are available for medi-cal that is a far lower number than the controllers numbers suggests i note that because i think we were a little bit far along in the uptick so i might add that we are compared to whether the study is done we're much more mature so adults from 65 and up are available for medi-cal so

those numbers will imagination in terms of service provision there are 2 main recommendations that recommendations was around how to deploy services and services should be more ordinary towards clinical services and among the providers and the exceptions of what their services should deliver and the outcomes frousz from the services knowing what the population needs and is i started my remarks talking about housing first and the housing retention the focus because that was the single focus we staffed up in mind and we saw buildings per sites that had one case manager per one hundred units which given the

outcome for the housing retention was the right radio if we're going to figure out what clients need and how to craft a service approach that meets that need it is necessary and the board recommendations we're going to need a lower case management to client radio i think talking about the roving teams to do that gets we're getting ahead of ourselves we don't necessarily know how or where to deploy the roving teams given the report suggests doing better client assessments and fourth as provider was the the city administrator figuring out what the clients needs e needs through the commission on an approach to lower the case

ratios a 1 to 35 portal we're talking about single adults across the portfolio will get us to a place to get better information on clients the thinking we'll simply not drop if 35 to 1 but relook at our fingers with the lower case ratios with a set of recommendations with the service quality while their voluntary in the building that didn't meet that each tenant can't be engaged case managers in buildings with a tendency to come forward and work i don't believe there's any tenant p and quality of case management could engage in services that benefit

him e.r. her we'll be engaged that the mayor's office and with you we'll be dropping those if not to expand the budget dui but to add the lower ratio while we expect xyz a couple for things i'll open up to you guys the report noted some administrative improvements we could make within h s a i am glad we've tubed with our providers a little bit which is the interaction with cash and the cap program and the stability of tenants in the supportive housing issue with that through the cash program even folks who are not accident cash grant the local system cash between 480 up pays for rent the cap has requirement

independent of the tenancy such the workfare or participation in the activities renewal for that your dependency or benefits historically when a client misses a benefit they get discontinued and not have means to pay the rent should they get back on the program they could be evicted i don't know i don't think it's smart to have one arm of the county government doing or reacting to a clients behavior that client is no longer in the system with that kind of ann annie approach we're looking at and changing the requirement within cap