one staff member so a really small case load. part of that is also providing housing money so contract with a local sro to provide housing. we also have flexible responding that we use to engage individuals. some individuals feel more comfort togging at a coffee shop or going out and getting close or whatever is needed so it gives us a tunlt opportunities to meet people where they are. >> can you put a dollar figure on that >> i would have to double check. i believe between the two programs and flexible spending it is probably arounds a million. >> the one area of this program that was pushed for [inaudible] didn't have a way to engage our system for their children or loved ones. that

seems to be still the major group that is giving you referrals, but yet they are also frustrated you can't giv details of their issue so i think that was the balancing act #23r5u78 the state is insure-many 06 these individuals could live at home with them. why not talk about who is qualified and who isn't qualified to provide the referral? >> having a family leize on is helpful. we still get calls from family members how people are doing long after we close their case. there are 6 parties that can make referral tooz the program. it is a family member identifieds a parent, sibling, spouse or a#2cu89 chide. the director of a treatment facility where the individual is housed, the dreblther director of a hospital, parole or probation

officer and a treatment provider. >> coming back to the the resource question for a second. >> absolutely. >> so, steady state you think this costs about $20 thousand a year per client touched, is that the way the map is? >> i trust you for doing the math, i would have to double check it. but that being said i think given the positive ruments results we are seeing cost savings for emergency services. >> i assume as you are longer in the tooth in the program you will weigh the cost. if you look at the results to date and it is early but statistically significant in one place and trnd and dont really know in the other and the other is inconclusive is a nice

way to say it, if you look at the 3 metrics where programs existed before, are those the results that tend to persist over time or do you have different expectations? >> i think given what we have seen from orebt programs as well as other conties i think we are in a great place. i'm impressed we have statistically significant results so have no doubt we will see positive results. >> your expectation is each category we will see statistically significant improvements? >> that is correct. >> commissioner pating. >> #245u7ck for the prezen station mpt on the funding u is there problems drawing it down from the state and is itfunded in advance or have to bill the state for funding? >> we have that in advance and

there haven't been problems krauing down the dollar said and when possible city wide case management bills medi-cal so able to recoup some of the costs. >> i like the results, i think you have similar results when nevada did the pilot. i think your rate of hopefulness around the services is higher than in nevada county. have you presented this to nan nami and client organizations and how the clients felt? >> i haven't presented the data anywhere else but when i did the stakeholder trainings they are important to do. what other count aiz have done is 1 to 5 trainings for the whole county and we did 63 before implementation so it made for a smoother implementation in san

francisco and i think peer groups part of the implementation process so hopeful of the intervention aot could offer and supportive of us as a team. >> are we linking to peer services too kr >> we give information to meet with them and support them in peer activities. many we cobelthed to peer wellness and orelt peer oceans in organizations in san francisco. >> that is great. >> arounds nev ada nev they have seen results but san francisco a more service rich county so the fact we see significant results here is more significant. >> nevada county likes to brag but we can brag too. the last question is operational issues, referrals from the court, how does it work and what does the judge need to do or what cases do

the judges make referrals on and lastly, once somebody is in the system, how do we determine when cases can be terminated or closed? when are people done with aot if they are evench done? >> we don't receive referrals directly from the court but had several with pending charges referred to us and support them being refer today the appropriate court for them. many individuals participated in behavioral health court. three of our first clients we worked with successfully graduated from health court in november and when somebody is done the beauty of the program is when they are ready so able to continue working with them. we work average 4 months and support them in the linkage to services and engagement before we close their case because we want to insure once they are in voluntary service they continue on the path to recovery.

>> thank you very much. >> commissioner chung >> you mentioned the average treatment is 4 months and way beyond the scope of treatment laura's law had suggested and that fs like one month, right? >> for the engagement period, correct. >> my question here is i appreciate when you mentioned that you know like it all depends on how well the person is before you graduate that person from treatment, but in general, like because we have such a complex safety-net and so much different types of mental health and behavioral service like city wide community focus and also you know like at the more acute like case

management services, are there any overlaps to transition them into a different funding stream and continue to retain some of them in services? that's is my first question. the second question is, do you think it is more unique for san francisco because of the safety-net we have that they are able to see better result than somewhere that may have less resources towards behavioral health service and also the sigma for the family, do we see any changes in terms how they talk about it and how they perceive the family member who are receiving services? one more-- sorry. >> you may have to remind me. >> i will remind you. the last one i have is, do we see less

opposition from civil liberties advocate around the laura's law implementation for our program? >> work backwards, i think for opposition, as i mentioned, i think we worked hard to insure peers were part of our implementitation process and discussion how aot is implemented in san francisco. the one thing i heard consistently is they felt we embodied recovery and wellness so dont think we had the opposition. not that there isn't concern about aot and think it is important to revisit how we work with individuals but we had a successful relationship with peer advocacy groups. family members, we have haven't assess how they talk about the loved

one. i appreciate you bringing up the stig am piece because i think is it is important. the family lias onis trained by nami and utilizing that and it is something we try to educate family members to provide what mental helths needs are and support #24e78 so they are better equip to support the lubed one. remind me, i know there are two others. i apologize. >> one of them is is san francisco unique because we have so many different safety 46 -net services in place and makeathize transition easier? >> i #24i7ck implementing aot in a robust system of care is a privilege and when i talk to other counties they are very jealous for me being able to work in san francisco. i think it makes a transition easier because the

system is based in recovery and wellness and out#r50e67ing individual soze have that in plaiss. in terms of overlap, there are periods of time with ovlap with the new caiss manager to support the individual to get to the appointments to make it the community based. >> that is all the questions i have. i'm interested continuing to follow this, especially like when we can have participants maybe come and testify. >> absolutely. >> pause positive impact for them. i think it is a great program to have. thank you. >> thank you. >> commissioner loyce. >> thank you for your report. it was very informative. i have a couple questions having to do with incourseeration and reduction in jail time. that means to me that there is a

relationship between sheriffs department, jail medical and psychiatric services and police department who are the people who take people to jail, so do you have a relationship with them and have they been trained and how do we have the trends twhords reduction since the police department makes the decision who goes to jail? >> i worked with sergeant kelly groo kruger and appreciate your bringing that up. we have a trend towards significance for reduction in jail contact and where that lies is not that people are diverted from jail which is a important discussion to have, but we are able to support them so there are not behaviors that lead to contact with the police department in the first place. >> and the sheriffs department and jail and medical psychiatric services, when they are incourse- >> they have been trained. i was fortunate to work with jail fwhavioral health observe i came to this

position so have a close relationship with them and the courts. >> thank you. >> commissioner sanchez. >> excellent report. many many years ago i wish we had this program because there were many many #c458gs challenges for a number of families and they didn't know what to do and some are aware of this and think that it is a great opportunity that wasn't available before and wished it was available many years ago but glad [inaudible] well done and look forward for the reports. >> thank you. >> commissioner sanchez said what i was going to in the sense that this has been controversial and yet i think this report really shows it is a opportunity we have for our clients. i'm wondering on the part of trying to relate to families is there not a way or maybe you aurd already do

it where clients can give permission to allow you to lias onwith the family? >> of course. and we request that frequently when there is a family member involved. i have to say in many situations where family members don't [inaudible] are doing the best so it is unfortunate we couldn't share that information. i think that the annual report also helped a lot of family members to see data even though they didn't know specifics about their loved ones , they could see the impact the program was having. >> that you brought up the annual report i was going to bring this up because your report is due in may, right? >> correct. >> i think the update the commission appreciated especially since you took november to november, it is off cycle, so what would be the best that we get

on cycle to receive the annual report and work going on and perhaps what we should do is get a submission in may and start in may on the annual basis getting updates on this. would that make sense? >> i am happy to come at any point in time and make sure you receive the annual report but if it makes more sense to have two full years of data and can come back. >> i think we get to your may cycle, we could receive the annual report in may and begin the may to may-does that make sense? y whauv the commission prefers, i'm happy to come when sneeded. need. >> we'll get another update. >> i think that is a great idea and do every may as the report is done and be on track.

>> right, and start with the may report because this will be fresh. we got a good track record going and like to hear it continues to be successful and do it on a annual basis on the time you do your annually report. >> thank you. >> we had a successful implementation of the laura's law. >> thank you so much, always a pleasure. >> our next item. >> #50i89m 9 is the dph annual report for the year 2015 to 16. >> there is in your paper that i left for you a e-mail containing information which will highlight some of the presentation today.

>> good evening commissioners. kristin putell, a planner in the office of policy and planning and i want to thank you for the opportunity today to prept our annual report for fiscal year 2015-2016. as you know, the report is mandated by city administrative code and provides general summary of the departments activities for the #23isical year. overall, the report follows our mission and also there are efforts to make the report consistent from previous fiscal years, so the look and feel is very consistent. also, there were efforts to make sure the report was visual and there was less text. just as a remindser, the report was presented to finance and planings committee december 6 and afterwards the comments and feedback were

incorporated ipthe vision along with a few other design changes as well. in this presentation i will go through major sections of the report and just to give you more context. the report begins with a message from our director barbara garcia. this roids a introduction to the rorlt and highlights two major accomplishments that are featured later in the report as well. these are the first plxment the opening of new hospital building which is in the works for the past few year jz the second is community health needs assessment which is completed triannually by the population health division in collaboration with community partners and it is a important tool to inform decision makers about the health status of san francisco and better understand of disparities and inequities that

exist and i'll talk more about that in the future stories later on. moving forward, similarly the message from dr. chow also provides a introduction to our annual report. dr. chow's letter covers the opening of the new hospitalbleding similar to drickter garcia and talks about the public health accreditation process and electronic health record preparation happening. overall these two letters provide our leetdership introduction to department highlight moving forward. in order to provide the reader with more context this section provides a ovview of the two divisions, the population health division and san francisco health network and the roles protect ing and promoting the health of san franciscans. it provides a ovpch view of functions and services, so for the san francisco health

network focus on clinical suvls while population health focus on population wide activities. this section has the organizational chart, which is the most current includesing the directors and sections within the divisions. next we have a ovview of the health commission, which includes the structure, the function, the committee and a few ort information. the commissioner bio's and photo's are included to help the reader understand who sits on the health commission and as a note commissioner tail r mu gee was added back after the committee meeting per our discussion just to give all-to have all the commissioners who served on the fiscal year. this section is our last introductory section for the annual report because brf we go into two major sections on the highlight jz also the numbers. on the slide

there are two snap shots from the annual report which are two feature stories. these highlight two major accomplishments for the fiscal year that go back to dr. chow's letter and drecktder garcia. big move, can had is the new hospital building focus on the opening of the new space and also the efforts to move the 200 patients from the old building to the new space. this involves countless hours of planning and also over a thousand clinicians and staff. the second feature story, the chna is the key piece for ourpublic health accreditation. the population health staff worked in collaboration with san francisco health improvement partnership and community partners as well. this identifies key helthd needs for san francisco and will help inform the community health improvement plan to address the health needs

for the city. the continuing with the highlights, the next section provides stories and includes 18 shorter highlights that show case the commitment to the commission. the highlights were collected from all divisions and sections within dph and these show case the activities for fy 15, 16. there are nigh highlights which includes vision zeer so and zika preparedness and plaque african american health andteneder loin helths and building infrashuck struicture which are lean and med i-cal. [inaudible] this was added to focus on administration and infrastructure. the next major section of the annual report focus on the numbers and data. we start the section off with the

dph budget. this includes our expenditures, revenue and key investment made for fiscal year 15-16 which some included the $26.8 million for operating cost for the new building and $12.8 million in it investment. following the budget, we have dat spanning our two division so san francisco health network and population health division. starting with san francisco health network we include encounters on different visit types and patient demo graphics across the hospitals and clinics. per the commissioners request add finance and planning this was verified by the business intelliance unit as dph and followed the data definition when possible. the next section is on the population health actiskties so

this focus on the 6 areas of the strategic plan and have key highlights within each. lastly, in this section we have our health commission resolutions for fy 15-16. these highlight the major actions taken by the commission ovthe fiscal year and this section or this page was moved to the section per the commissioners request as the finance and planning committee as well. the last piece of the annual report focuses on dph services sites and our contractors. the service sites are shown on the map as such and showcase locations for civil sunchss primary care and behavioral sites. we didn't include all the contracted sites because we have over wn 15 and couldn't showcase it on the map. lastly, we ends with community contractors to acknowledge the contributions

to the work at dph. there is a limited number of copies printed at no cost to the city and will be provided to the commissioners and also the board of supervisors and will post the final version afterwards on our dph website. thank you again and want to acknowledge commissioner chow had a question about the dph budget section and included a write up for the budget director and have [inaudible] in case there are questions on the budget. thank you again. >> thank you very much. commissioners you have sth annual report before you. >> there are no requests for public comment on this item. >> comments from the commission? >> we look at this at the finance committee and looked even better in the final. >> thank you. >> public health and think

putting meaningful data there. >> yes, we collected more data from the population health division and they suggested those were the key highlights for this fiscal year. >> good. >> i wonder whether we may be able to consider one amendment. you wrote a important message to the public about the san francisco's commitment to maintaining peoples insurance in our environment going forward. while this document is ret rospective on the mission page it is wonderful to see part of your statement there representing our full commissioners efforts of maintaining full insurance for our-not sure where that-for our san francisco population. only because this is out there, maybe a place people look about what we are about and think it is a statement about saying what we are about going forward in the

next 2 or 3-years that is important even though this is ret row spect #6b. >> we have been on that journey many years. i think we can do something like that. it isn't on the final final yet, right? >> no. >> i see on the mission page you have a gab- gap. >> that is good. >> maybe a letter to the mublic. the directors memo-i don't remember the words. basically don't worry btd your benefits, wree got you covered. >> that is a great idea. thank you. >> i see what you talking about trying to fill in here insurance to the public. >> that is the message we sent to the public regarding continueic to come to seek care. >> perhaps there could be a box of some sort. >> we'll figure that out. >> on the mission page 6789 >> okay. >> we are open for business

maybe - >> that is a good point. >> absolutely. >> we haven't pushed the button to send out the final report so we can do that >> commissioners any objection to that adding that to the report? i don't see any then we will work to add a such statement. >> great. >> any further comments? we probably have enough-the document that i really thank staff for producing and didn't need as extensive as it is and put into context because it showed under the budget line a series of items that we had particularly highlighted or targeted and just wanted to be sure we understood what that meant because if the public asked you what was

the 22 $22 million or 26 $26 million we highlighted in these 5 items you could have a backgrounds for that. and because they are not really related exactly to the budget numbers because our support for sf jenroom is far greater than the $26 million but the fact we are also putting in $1.2 million >> student the zeer ofep zeer oaf initiative is there so you have some backgrown on that so asked to give context so the commission could understand where those numbers came from. and you have that before you for your reference. if there are no further discussions on this once we added the reassurance to the public we are still open for business- >> i believe commissioner xhung has a

comment. >> we will sends this to the board of supervisors with a cov letter as we normally do. >> the mayor's office as wrel. >> and the mayor pfss office. >> the other commissioners reviewed the bio graphic information, but if i have a update-- >> sends to colleen. >> she wim send it to me and i'll pass that on. >> we will place that in and thank you. updates are definitely welcome. anybody else wish to update that? that will update our website also? >> yes. >> yes. >> should we move to the next item? >> we will send this forward to the board of supervisors and mayor's office with the connections or additions we just talked about. thank you. >> next item then, please. >> item 10, other business.

>> hearing none, item 11 is the joint conference knhity committee report and commissioner singers has a report back. >> i have december 12. >> december 13th i apologize for the typo. >> we met december 13? >> that is sf general? >> yes. sf general. >> that is right because it wasn't listed as sf general. >> open session the committee reviewed the quaultd manlagement regulatory fairs report, the hospital admip strairtd report and patient service report and hiring a vac aenss report. those are stanered reports. the only thing i say to everyone about what is going on over there is that

there really is quite a attempt to take advantage of the new facility to redo many processes and get the performance metrix that i think susan expects, susan [inaudible] ceo expects of her staff and that is very encouraging what is going on, but it is long process and has a long way to go. there is a lot of inurshia in the way staff does things and that combined with a new physical plan is a recipe for hard management situation, but they are attacking it and hope in the future we will see the benefits. they attack through the lean process and we had a briefing on that as well. in particular we had-probably the most visible issue in that area is the rate of diversion and time the er is on diversion and that is a

substantial amount of time that has gone up significantly and i think we are all hopeful there is a lot of work in progress to start to bring that down to something that is within the realm of palletable for avenue everyone about there is a lot of work going on there. we did defer the neurology clinical rules and regulations report and the logic is we did not have anyone with a md among the commissioners at that meeting and felt it was appropriate commissioner shan chez and i to wait to approve changes in the medical rules to have a doctor ovsee that. the closed session we apruchbed the credential and tips minutes. commissioner sanchez anything i missed? >> [inaudible] >> any questions? thank you

very much for the report. >> the next item is committee agenda setting and you have the calendar in front of you. >> the calendar is before you. any comments on the calendar? >> the february 9 is the joint commission meeting. >> yes. >> february 9 of the planning-with the planning department is a joint meeting as a additional meeting to our calendar. >> [inaudible] >> i believe it is 10 o'clock. 10 o'clock at city hall. >> 10 to noon february 9th. >> yes. i was informed actually from the director that the budget

submissions will be coming as instructions issued as ayou know ast month in the coming months to the commission. i don't see that actually calendared here. >> we are working on that now. >> thank you. are there any other comments from the calendar or areas you wanted to add? we are looking at a potential of our community meeting in-and that is under process with mr. morewitz now working with the department in terms of what is the appropriate time for community meeting and we are at the moment projecting the bayview. no other comments on the committee agenda thaen we are ready to accept a motion for adjournment. >> motion to adjourn. >> is there a second? >> second 6789

>> all in favor please say aye. opposed? the meeting is adjourned, thank you. [meeting adjourned]