and secretary will call the roll. [inaudible] singer, here. chow, present. chung-sanchez. approval of minutes of december 20, 2016. >> the minute are before you and motion for acceptance is in order. >> so moved. >> is there is second, please? >> secsd. second. >> any corrections to the minutes? not seeing any all in favor say aye. >> aye >> opposed. >> item 3 is directors report. >> director. >> happy new year commissioners and those in the audience. a couple item, every year the mayors office asks for nomination for good government awards and we send one so this year we sent the [inaudible] move team and they were selected fl the good government

award and so we are really proud of them. this recognizes outstanding leadership, creativity and kis tinction in san francisco government and since the program inception more than hundred city and county employees receive the award. individuals receive the award and glup award so happy to note all the good work that the team did to transition to the new hospital will be acknowledged and there will be a award ceremony across at city hall and let all the commissioners know whether that is. as we have the ceo ptd to give her part of that award. shape up san francisco was honored by the board of supervisors led by eric mar. they acknowledged decade of work to make healthy choices. this is a coalition of groups within the city san francisco department of public health

participates in. i want to give a update on a incident that happened on thursday. there was a shooting in front of 240 golden gate which is next door to tom ligal and it was two fatalities that happened there. tom [inaudible] there werefore staff members outside of the clinic at the time. one of the staff members were grazed by a bullet. they were not injured at all, but small cut on their arm. both roland and i went and talked to staff at night and went the next morning to the clinic. we also worked with the staff, had crisis counselors there. the staff shared with us their great concern of the safety of the neighborhood. we have a security person inside the clinic, but

outside on golden gate there is a lot of drug activity. this happened-this incident was a drug activ tee that happened. so, we immediately had bazal price a security director was in the middle 06 a security assessment of that location. we did know we would have to put a sheriff in that area, so we immediately put two sheriffs to do rotations on that street. i also had a conversation with the deputy chief of the police, we talk today the captain ofteneder loin station and the sheriff and the police are working together on trying to do a lot more rotation walks around in the clinic. not inside the clinic but outside the clinic is basically where the staff felt so concerned. we are also will be allowing staff who are

feeling unsafe to walk from-we had a couple incidence they shared of walking from the bart to the clinic and from the clinic to the bart that we will also encourage staff if they like reimbursement for that small frip trip on uber if that will support their safety. also, there will be escourts by the sheriff for those who park in the area. this was a unusual occurrence, i wanted the commissioners to know how we responded so the staff there felt that we responded in i think a quick fashion and we are very supportive of the actions we took and the leadership of primary care was involved and will do a lot of the follow up from our work on last week. i just wanted to inform the commissioners of that incident. >> thank you. commissioner-were there any public comments to the directors? >> not received public comment

requests for this item. >> commissioners questions to the director or comments concerning the report? we of course again congratulate the team for having won this award. >> shall i move on? >> if there are no further comments, then we will proceed to the next item. >> item 4, general public comment. not received requests. we can move to item 5 which is rart back from finance and planning committee from today. >> commissioner chung. >> good afternoon commissioners. the planning committee met before the commission meeting today and we have reviewed prop i request and also a contract report and two new contracts and we are recommending with

the exceptions of one contract in the contract report that belongs to theu csf on the employment service, the rest we are recommending for the commission to approve and the reason for post poning theu csf contract is we felt we needed a little more data to understand the operation oaf the program and so we will revisit the approval for that in the next finance and planning committee meeting. >> questions to commissioner chung concerning the finance and planning committee report? if not we'll

proceed to the consent calendar. >>ite 786 is consent calendar. as note #d by commissioner chung for the contract reportu csf f contract is removed as you move forward to approve. >> committee recommending is recommending approval . any discussion for the consent calendar or anyone like to take any other item off? we are prepared for vote on the consental caener de. all in favor of the consent calendar please say aye. >> aye. >> opposed ken sent calendar is passed. >> item 7 is the vision zero update and also a resolution. i believe commissioner chow would like to say something about that. >> as we receive the update on

vision zero because the strategic plan is still in process and presented the resolution itself would be deferred until the presentation of the full strategic plan if that meets with the consent of the commission. >> i believe the date the resolution is presented is february 7, 2017. >> okay. please proceed. >> thank you so much. good afternoon. my name is megan we're, the director of the plan of health equity and sustainability and cochair the vision zero task force. thank you so much for the opportunity to provide the update today. i also want to acknowledge cochair mar wroe-hunter of the municipal transportation agency and a number of colleagues from dph i'mprieveolog privileged to work with on the initiative. i first

wanted to just open summarizing our iftality data and vision zero so the goal is eliminate traffic fatalities in the city by 2024. this chart depicts the fatalities in san francisco from 2005 to 2016 and i wanted to note the data is only through november of 2016. um, the blue is people killed while walking, green, biking and red in vehicles. roont years we had approximately 30 people kimed on ourb streets. i want to note data is being finalized for 2016 and will issue a end of year report in the next couple weeks. we have a traffic fatality protocol we implement with the mta and pd ochb a monthly basis that draws from international and national best practice to reconcile fatalities in the medical examiners aufs and please investigationism many are reported in the media, however, some of them are not and we also do include or

exclude suicides and other particular circumstances. we look forward to issuing that report as soon as we can. many people are interested and committed to having acprt data. while we don't have sth final numbers for this year we know we have lot more work with respect to vision zero. we have a lot going on with increase in population and construction, increasing in walking and bike and taking transit which is goal of our city and aults have increases a lot of attention paid toward the transportation network companies such as uber. we also have the national contacts, so we are seeing a estimated increase in fatalities in 2016 relative to 2015 of 10 percent so we know we need to do a lot more and look to international evidence and best

practice said. if san francisco was selected to be a part of innational network we meet including new york, seattle to share lesson learned and advance the agenda we are committed to to. we need to understand the data. the key thing weez know bat faltyties, my team worked with san francisco general troounderstand cost so there are approximately 50 percent of people at the trauma center at the hospital are there for transportation injuries at a cost of approximately 35 million as annually. i think of it as a health oriented. this helped eliminate for us

the opportunity to make a significant impact on the cost we see at the hospital as a third of the severely injuryed patients comprise [inaudible] we also see reduction in the medical costs. we know people walking comsprise over half the people killed thatd seniors are more much moreivaliable and speed is highly correlated with death and know yoi pass #d a resolution last year on automate #d speed enforcement. thank you so much, that is really important for us. we know large vehicles are more deadly particularly people walking and biking and iftalities are trait concentrated on the high injury network. a refresher how we go to today. we asopt dopted vision zero beginning of 2014 and worked on the two year strajied and

have a website and collaborate with multiple city agencies on this goal 6789 with respect to progress the team created the high injury network. we roll #d out city wide campaigns. the first is a driver yielding campaign, that is the number one cause of pedestrian injury and found target #d locations of 4 percent increase in driver yielding where we saw engineering and enforcement efforts. thiss year i'm excited boot the speed #c578 pain launched in aublth. every weeblg the sfpd targeted speed enforcement on high injury corridor. we have a team of data collectors in sth field evaluating this on a weekly basis and it is a year long campaign paired with educational and outreach that [inaudible] is also coordinating on and looging forward to seeing the results of thatd. we were ahead of schedule for implementing project said so the team committed to 24

projucts in 24 months and completed 30. the bautdm rate you see the tagt enforcement and i apologize sfr the lack of a legend but dark blue is yielding, the light blue running and the [inaudible] orange running and green [inaudible] those are the 5 more deadly violations that contribute to fatal injuries in san francisco. the police department committed to 50 percent and achieved that 50 percent this year in august for the first time and continued to achieve that important goal. at the bottom left is transbase and that is a integrated spatial own online data anamsis that links data with a host of factors to understand injury patterns in our city and san francisco is leading the way with respect to best practice on data. again, just we cant really struss enough the importance of

speed and speed is the focus of vision zero for the last two years. at the top we see the likelihood of surviving at 20 miles per hour a 9 opercent, 40 miles per hour is 20 percent and that is why as you saw last year we are pursuing the policy team from mta and other key staim holders automated safety or speed enforcement that enable automate #d speed enforcement in san francisco. i'm excited to say that i believe is legislative sponsor has been secure squd look forward to a formal announce 789 at the thochbd months and think you know the potential impact this can have and we also at the end of last year saw the families for safe streets launch and that is modeled on a similar group in new york city of the families of victims of severe and fatal traffic injuries and automated speed enforcement is a key initiatives that they will work with us to help

advanss vance. now the action strategy frathe coming two years. we are again really refocus and taking what we strong foundation we developed the last two years and looking forward to launching the end of inmonth the next two year action strat ag. in the past we focused on the tools that we used, engineering enforcement and education and refocus on the outcomes we need to create. we need to create safe streets and that has a lot to do with engineering but for everyone to understand what we are trying to create toort and thiss drawing on international practice is helpful 6789 safe people is the cull chrm change we need to see in san francisco to realize vision zero and elevating safe vehicles. there is a lot emerging with ecknowledge we think is a opportunity for us. this is list of the active agencies that have provided

feedback, ateneded stakeholder meetings and are really committing to actions within the strategy. we also conducted community outreach meetings having a workshop in city hall and went to vision zero coalition meeting and on a line survey and thrilled with the response. the core sprinsple for the stratd strategy are grounded in public health to prevent traffic deaths and are preventable and safety and preserve ation of human life is our highest priority. the health department has a important role elevating equity and by that we mean prioritizing #450u78en life in all communities and eliminating historic disparities with injuries and insuring actions are sensitive to community context and exacerbating existing disparities. we have been wurging with the police department and a lot of the work they are

doing on racial justice to insurethosis opportunities and the work they are doing are advanced through the vision zero actions. safe streets, safe people, safe vehicle jz speed round out ourb coreb principles. this is-not only equity but community engagement. a important lesson learned in the last 2 years is the importance having the community engaged and invested in improvement s that can help save lives. community engagements has its own section and [inaudible] done a lot of great work to elevate community engagement. with respect to the outreach, we received a lot of great feedback being more transparent about the challenges we have and stakeholders engaged seems to grow and think

we have a lot of opportunities with respect to affordable housing and the tech industry and other areas with respect to equity particularly given the importance of seniors. [inaudible] program is advancing the non web and text base communication for outreach to the population jz opportunity. automated [inaudible] how to become a model. for considering actions included we ask ourselves is it promoting the core principles and pushing the city to gobebusiness as usual and also accomplish what we want in the two years. looking how to target resources, having evidence based actions, making sure somebody is owning it and started or completed within the two years. i wanted to end with a samp 8 of actions that highlight a lot of things that dph is involved in.

some examples include working with our mta and launching a comprehensive analysis of bike injury collisions and looking at predictive modeling, not only the high injury network but faketers that predict where bike injurys are happening so we can target improvements before they occur. we are working close with the mta to look at transit relate #d injury collision jz how improvements with respect to transit can prioritize safety. continuing the safe routes for schools and safe streets for seniors led by ana and safe street for people with disabilities. we have a lot of great resources at the city to help people-we have interest in the police department and dph and make sure the immediate days following tragedy families have the most support they can have.

support evaluation and monitoring and also looking to develop a speed monitoring cystism. we know speed is the biggest predictor so how to get a better sense of are we changing speeds on city streets. improving engineering project development and implementing citations to see what is cited and where and how it relates to injury patterns. that concludes my normal presentation. the resolution is in your packet and welcome any questions you may have. >> thank you. is there public comment? >> there is not public comment for this item. >> commissioners, questions to our presenter? >> if you had two wishes, some of these things are hard to get done in

the context of multicity departments, the state-what are the two things you twd would do if you could snap your fingers that are trickiest to do to get through but would have the biggest impact on the number of traffic deaths? >> i really do believe the city is in the right direction with respected to automate #d speed enforcement. in san francisco i think it will be a true game changer. we know the evidence from other cities. i think also the opportunities with the more comprehensive street improvements that create a much slower traffic and more of a pedestrian scale experience. we have like some examples of like linden alley is a [inaudible] a lot of times with respect to the public involvement, things that require trade-offs

like parking removal are also things that have the highest impact or [inaudible] reducing the number of lanes on a street to 1 to 2 from the 3 to 4 lanes we have seen. those are the potential for some of the most significant impacts and that is why we focus on community engagement this year and how we can help everyone understand the traif-offs trade-offs we are making as san francisco moves forward. >> thank you. >> commissioner [inaudible] >> the streets trat are targeted in san francisco i assume there is a data that supported the #2we6b8 streets that you chose. can you give a example of those 12 streets in san francisco? i live here too and think my street is danger. >> yeah. i will call my-devon. i know devon with rattle them off. pop quiz

or at least 56789 >> i know geary, harrison, >> could you state your name? >> devon morris. >> geary, harrison,-what else? sunset, pine, i believe, kirk, couple more. >> we have a great map that was included. >> you got a big- >> san jose [inaudible] i can't get them all. >> maybe you can provide the 12 to us. >> he is my gis spatial analyst genius and leads the evaluation so thank you for letting me put you on the spot. you can bring them next month.

>> appreciate that and like to see. the other part is the actively engaged in the targeting for speed is that now or up pcoming? >> it launched in october so actively enforcing one a week they have a targeted about 3 hour operation. >> okay, thank you very much. >> you want the schedule of those? >> i may drive down the street. >> commissioner sanchez. >> i just think the work that is done is really significant and you have put up parameters and radar and think we are getting-the database is within a year period but as we look at different variables and there is more discussions with areas being targeted or whatever, we will come in with really

additional material. there is one area though that is always stuck in my radar even when it was first introduced and that pertains and brought up again and you do a very good job is seniors and hand icapped. i'm saying that because in particular mta has with the feds have worked on a design, especially on mission street where i'm familiar with and we have the red zones so this way transportation can go very rapidly. there was a elimination of multitude of bus stops, which many of not only store owners but seniors and people living in the area felt were very important to have input but felt maybe there is another round for discussion because they felt elim naseing a number of bus stops were putting people at higher risk especially hand icapped

and elderly. let me give you a example, 24th and mission, very very busy place. the bart station t we have the red zones coming this way, you have the school bruss and buses coming down 24th street to 48 and kids from the middle school and high school or whauv. whauv. you have the other bus line and bart and street vendors, you have preachers, you have music-you have a little community there, but what happened is because a multitude of inbus stops have been eliminated like a block down in front of wallgreens was a bus stop and many seniors would #145u7 in the fruit market and get on the bus there knowing they did ptd want to go to 24th and mission because it is hectic. i'm saying it is becomes a zone of concern because there are times

you can't even cross mission street or 24th when you have that critical mass. there is 48 and another bus gets off, the bart people run for bart and with the new community have a lot of people with the suit cases trying to run to get to bart to go to the airport. it becomes hectic. all i'm saying as we look at this further if we can make take a look and not just areas where there are cars and buses but also sidewalks and elderly and hand icapped who live in the communities and directly effected by this, it really effects sthem. even on 16th and bart where we have a multitude of unique things mpt . we have the center for the homeless and native american center a block away and center of latino a block away and elementary

schools. buses, school kids and bart andu csf shuttles come and drop people off from mission bay tou csf so it is very very invested and i know i helped a number of our people just navigate through at this time or they get confused because they can't go anywhere for about 15 minutes until everything clears out. in essence, i want to be positive because i am about the report and what we are doing, but i'm saying especially because you shared the equity part about listening to the community and their needs and a way to meet the needs by safety and for all our citizens not to just speed up transpor tation or the bikes or whatever, but we have to take a look at the human variable especially those who have lived in the city for many many years and our hand

icapped and vets are having tough times now. i just hope we may look at that in the future and maybe after we goat our data for the next year we might have more insight on if there is a possibility we could meet some of the concerns shared but not heard sometimes. >> i really hear you and the more we look at the data the more we see prioritizing seniors and people with disabilities is crilesh. the mayor issued a executive director on vision zero reaffirming our commit in august and the item that has a lead on is doing what you are describing for a deeper dive of analysis for seniors and people with disubltds and youth. we did a survey of organizations serving seniors, people with disabilities and youth this fall and we broke

our survey account and had to subscribe because we had such a good response. we have over hundred responses. [inaudible] leads our safe streets for seniors program as well. ona i don't know if you want to say anything about your workshops. >> would you like to come up and make your comments so we--thank you. and identify yourself. >> anna [inaudible] with the health department. we have done about 16 to 18 presentations at different seniors center across the city on high injury corridors including the ones mentioned in the mission, central latino and the one at mission neighborhood center and we heard that trade-off issue

between wanting to be safe but also the issue about bus stop removal and funneling the nrfshz back to mta to incoperate seniors concerns. i doment want to add we heard from one of the seniorsenters it was a spanish speaking only presentation where the seniors requested automated cameras in the mission and why we didn't have that and had to explain we don't have state approval so that is something we are also taking back to mta. >> thank you mpt commissioner chung. >> thank you for the presentation. there are two things i think it is new year so st. is fresh in my minds. every time when there is a new year there is always at least one fatality that is related to like driving under the influence so this year we

know that somebody like lost their life to like the same reason. so, are we also tracking to see you know like, if like driving under the influence is one of the factors and the other one i think because there is state law that is going into effect now that we cannot touch our cell phone in the car, so do you think that will have a huge impact to what vision zero? >> not in the top 5, driving under the influence is a leading factor and fortunate the state does provide a good amounts of funding for du i enforcement that the sfpd gets avenue year and they do a good job routinely implementing enforcement for du i and we also-the office of traffic safety grants

are coming up this month and sf as a part of vision zero will aprive for a distracted driving enforcement campaign as well so think both of those things will be up included in the next strategy. >> thauj. >> did you have a question? >> kind of but i don't think-the other one is i watch a lot of news. i dopt do any of those things, i don't touch my phone in the car. the other one is when someone having a medical crisis while they are driving and it seems this year we saw more incident that somebody was have agstroke or heart attack and cost a injury to pedestrian related injuries recollect so what kind of message can we give to that because that isn't something you can put a stop

sign or like you know a yield sign to control that? >> i think that is a really good question, it is a challenging question i think for vision zero for me, it kind of fundamentally boils down to how fast is the person drivejug are you driving. because two people walking and bumping into each other doesn't-we dopt have a report of fatalities that i know of. so, i think it is thinking about what alternatives in the city like san francisco where we have so many people on the streets and know walking has so many health benefit physically and mentally as well as cycling and the environmental impacts of driving, how can we better create better alternatives so more people are out of their vehicles and the consequences of a medical incident wouldn't

necessarily be death. >> thank you. i had two questions, one was, from the information that you are getting from other jurisdictions and it is really sad the numbers continue to go up but that could be a number of factors. but are there factors there that we should learn from and you could describe-you didn't bring any hear but you can bring it next time in terms of lesson learned. >> i would love to do that. the vision zeeree network i was looking today issued a great lesson learned from 2016 on the website what they learned from different jurisdictions. the importance of community engagement. i was encouraged and thij their themes are consistent with our action strategy. >> this was more a observation

because we have so few like 31 deaths, is there a change in the composition of where these were? are they still in the high incident areas? >> we'll 234clude a full analysis of that otour 2016 year end report. we find the high injury network is still quite predictive of where we see severe and fatal injuries but we are thank tooz the work that [inaudible] epidemiologists is doing thinking the police and hospital data we will update the high injury network and better understanding are there corridors dropping off. are there hot spot said coming up and doing more work to understand that. >> maybe you can sort of [inaudible] at the next meeting. the last was simply a observation that i had made also similar to what commissioner shan chez had. on the streets that are

wide are there [inaudible] people can stop at? it is not always clear that you could or should stop at those between the lights. embarcadero is one that very often you cant make all the way across as you rush to the ferry building. it is not really always clear the median stream is the comfortable spot you are supposed to stop at and i would imagine van ness is similar and some of the others, so having put in some of the streets even a median stop, i'm wondering if that is part of the education that could go on and think this also impacts seniors and all who walk slower. it isn't necessarily to try to make the end of the next street but you might just get partly through and wait for the next one.

that may be part of education. those stops be made more clear as somewhere you could really be pedestrian friendly stopping at. i think that can be a part where there is feeling you should get all the way across the street. so, that was just a observation and whether that was something other places have fond or we could be clearer. now that we take the effort of putting the- >> the medians are seen as important to service that #23u7ckz. function. >> i think those are good ideas to tell people you don't have to rush across, you can't in most cases. otherwise i think we will look for wrd to your presentation of the strategies you have at our next meetding and we will take up the resolution that you will be proposing. >> thank you so much. >> sorry, commissioner loyce.

>> yes, you mentioned in your report you do not count suicide as a part of your vision zero. i'm wondering sp there data collected on suicide in relationship to the traffic and where is that data deposited and it will be helpful for monetal health sunch services we look at that as a issue. you dont have to have a answer today. when you said that it struck me that it doesn't make sense to add it here but it needs to be somewhere. >> i think that is a good point and something that we have discussed with respect to institutionalizing the protocol and getting more into detailoffs the fatalities raised other issues. >> thank you. >> thank you very much. >> thank you. >> our next item, >> item 8 is assisted out 237 patient treatment. aot. >> thank you. let me know if

you need help getting there. >> i think i'm okay, thank you. >> good afternoon and happy new year. angelica [inaudible] director of outpatient treatment and pleasure to give you a update. i want to start out the conversation by reoriented to what assisted out 37 patient treatment is. it is outpatient treatment aot and not something new to the united states. the first program was 1972 in washington dc and 44 states currently have existing aot laws, but they do vary greatly from state to state. in california aot became part of our law as assembly bill 1421 passing in california in 2002 becoming part of our welfare and institution code. it was a recommendation of mayor lee's

task force and adopt bide the board of supervisor july 2014. at that point a implementitation committee was convened of diverse group of stakeholder tooz talk how to implement aot in san francisco which we'll talk about in more detail moment airly. my primarily responsibility of the director up to implementation is insure our community is aware how we implemented aot and conduct strake holder training. i conducted 63 stakeholder trainings to hospital, the jail, peer organizations, peer advocacy groups, patient rights, family groups and anyone interested knowing more about aot. we implemented the program in november 2, 2015. assistant outpatient in california is rirfed to as laura's law based only laura

wilcox. what is unique about the law is adopted by each county and not a mandate to adopt. it is a new tool in the tool belt to support and assist individuals with severe melthal ilmss and families and communities where they live. what it is is the goal of getting ahead of a criseish and supporting individuals with severe melthal illness not engaged in treatment, have a history of treatment non compliance and on a downward spiral. what the law allows in certain circs is allow the individual to participate in the treatment and utilize the black robe effect by the court to leverage someone in the care. in the case of aot, this is civil court order and if somebody 12349 compliant wa#2r50e789 plan they are not held in contempt or arrested and not sent to the hospital unless they meet the 5150. a long term goal is reduce

negative outcomes such as reducing hospitalization, incourseeration and victimization. these are counties that have aot programs or adopted programs in the planning implementation in california. i would like to note san francisco has besxh a leader in the conversation as aot and convened and hold a conference call quartly to discuss challenges we are facing, tools for engagement and successes to learn from other counties. the substance abuse and mental health service adminlstration named aot as a evidence based practice provided feedback for a study on aot and support other counties adopting. how is san francisco different and how we implemented aot? while this is required by law to offer multiple opportunities to engage someone in voluntary services

recollect san francisco took it step further to make it is a part of our health safety so allow 30 days of engagement before filing a court putension but on achberage allow longer than that around 60 day squz that shows the erftd to engage in voluntary services and utilize the court order and petition process as a last re-sort. san francisco insured we had a care team which is multidisciplinary melthal health team that consists of a director which is psychologist and myself, peer specialist and family leize on. these are unique to san francisco but many other counties in california followed suit and what we do is embody the principles of recovery and wellness and insure the services are commune

tee based individualized and strength based. move toog discussion of what we saw in the first year of implementation. again, we started the program november 2, 2015 so this covers november 2, 2015 to november 1, 20s 16. we had 214 goals one 06 chs information only where a individual wanted to know about what aot is and 108 were referrals. 53 of the individuals we had contact with. we'll discuss in more detail but as we discussed the program is based on a law so many individuals do not meet the strict eligibility requirements, however all the contacts were able to talk to the poren and provide support and provide information about resource squz the best pathway for treatment. this gives a ovview of the

number of referrals we receive each mupth. the first month of impmentation we had 30 referrals which is not surprising. most were from family members and family members are a long proponent adopting aot in san francisco. since that time it leveled off and on achberage we have 9 referrals a month. looking at the number of court orders in total in the first year of implementation we filed 7 core petitions. two of which were extensions of existing core putensions so only 5 individuals that we putensioned the court to order into treatment. the result of those are three resulted in a settlement akbrument where the individual agrud to work with us, three court ordered to participate in outpatient service and one withdrawn because we were unable to contact the individual. in

total 60 percent of the individuals we had contact with accepted voluntary sunchss. the number of core petitions filed is lower than in other counties and speak tooz the uniqueness of our program and care team outreaching kwl engage individuals in voluntary services. looking at who made referrals, as you can see family members and treatment providers counted for most referrals made and total account for 8 seven percent of the referrals. we also received furts from adults libing with the individual and parole agent. we had 8 referrals made by [inaudible] only certain individuals with report to the program but in all the circumstances we were able to work with incaller to figure another person in the individuals life who is qualified requesting party and can make the referral so there wasn't anyone that missed out on the

opportunities offered by aot. in regard to the location of refrlts, most originated from san francisco county accounting for 74 percent of referrals and neighboring counties. one thing we didn't anticipate is we had a lot of referrals out of state and made by family member jz aconted for 9 percent of the referrals. these were family members contacting us who luchbed ones traveled to san francisco who had severe mental illness. mubing to demo graphics who we were working with, orient avenue wn to the graph you are seeing, the top graph which is total referrals we received. the orange graph is who we saw in the program and the teal graph is individuals court ordered. across the board for individuals referred recollect seen and core petition was filed we saw predominantly male. age of

referrals for individuals referred and seen, the age group is between 26 and 45, however we saw a sligetly higher skew for individuals with core petition filed and that fsh 36 to 45. in terms of ethnicity, you can see that we had a diverse group of individuals referred to us, however, for individuals referred, seen and core petitions filed were predominantly caication and african american. wanted to take a couple minutes to talk about reliminary outcomes from the first year. the average length of time we worked with each individual is 124 days or 4 months with a average number of two contacts a week, but this fsh as frequently as 5 contacts a week dependent on the needs of the individuals we are working with. again, i think it speak tooz the level of intensity och the individuals we work and even if somebody agrews to vaulden volunteer services

it takes time to stabilize them and continue in long term care. 40 percent of individuals reported a history of homelessness and 36 month prior to aot contact and at the time of discharge we had 65 percent of individuals housed. again, 60 percent of individuals accepted voluntary services and time of discharge 62 percent of individuals connected to long term case management service. part the requirement for aot is provide a annual report to state department of minuteal health and that is a may each year. i believe you have a copy of that report see the first report delivered to the state may 2016 and there was a small period implemented, the data in the report is primarily qualmitative, however, 2 gabe

gave a great opportunity to provide information from participants as well as family members and other support persons and how we can improve our program. happy to report 100 percent of participants surveyed reported feeling hopeple hopeful about their future and respected by the case manager and staff is trying to support and engage in volunteer services. feedback from family members reported increase awareness of resources and service in san francisco, however, not surprisingly did report frustration in the limited amount oaf information we could share with them due to confudenchality laws and not able to require someone to traik psychiatric medicine. i had a opportunity to do data analysis due to negative

outcome. commissioner chow, i know you wond ered about the 36 month prior so have data regarding the year prior. the reason we use 36 month is that is what the state department of healthal health requires. psychiatric emergency contactss, each individual had a average number of 7 contacts and the 36 mujt leading up >> student sth contract with us. since that time we how shown a reduction in pef contacts. we look at the year prior individuals had a average of 4 contacts and that is less than 1 currently since 6789 what we did for the comparison for the statistical analysis and compared the daily average so we look at everything on the same scale. so, the significant reduction is on the.05 level, hourfbl,

however, when we look at the year proir and post it is more significant at the.o1 level. related to psychiatric hospitalization, individuals had a average of 3 sake atric hospitalizations totaling 24 days on inpatient unit in a 36 months prior to aot. we haven't shown significant changes we are hopeful that with ongoing data collection we can show significant chaisk in this point as well. related to incourseeration, individuals had a average of two contacts totaling 44 days incourseerated. we also don't have statistically differences hereby but have have a trend. for this analysis it is.o8 and hopeful with additional time and data analysis we will be able to show positive outdcomes. we can't say aot is the cause of the

outcomes. there is lot that has change in someones life but look forwardworking to look at more data analysis and efficacy of the program. in terms of next steps, we look forward to hiring a 293 twoe senior behavioral health. we think this is invaluable to support the outreach and engagement and will continue to provide our annual report to state department 06 minutem health which includes quantitative and qualitative data and go to the state may 2017 and posted on the website soon after. the board of spl vise rbs adopting aot require that we do more in-depth and robust analysis and that will look at the efficacy of the program as well as cost savings realized and working with hard earned company to support in the

evaluation. we are happy to have positive outcomes to report and hope because of success och engaging individuals who have not successfully been engaged previously we can have best practice and implement across the system of care so better prepared to support our population. of course happy to answer questions and look forward to continuing to come back to provide updates on aot. >> can you talk about the 800 line and is that the major way people are refered? >> we try to make refirms as easily as possible and meeting people where they are at so there is a tol free number and local 415 number and have a referral form on the website in the languages completed and e-mailed to us. >> very good. was there public comment?

>> i didn't receive public comment request. >> commissioner singer. >> thanks for that comprehensive report and documents that supported it, super helpful. a couple questions. one, how do you-what is your expectation how many more lives we will touch with this program in the next few years? >> that is a great question. it is hard to say since we only have a year under the belt to know the impact but haven't seen reduction in the referrals so imagine it is comparable to year 1 so 100 to 150 referrals avenue year. >> so it isn't growing at a expotential rate? >> correct, not at thiss time. >> what are the resources we are putting gans this? >> we are fortunate to be funded by mhsa so have a lot of flexible money to spend. we have a team atu

csf case management to provide case management to those involved in the court process. we have to have a staff to client ratio of 10 clients to 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]

>> with the equipment in the room and please rise for the pledge of allegiance and to the republic for which it stands, one nation under god, indivisible, with liberty and justice for all. >> commissioners commissioner vice president turman i'd like to call roll. >> sure. >> commissioner president loftus is accused commissioner vice president turman commissioner marshall commissioner dejesus is excused commissioner mazzucco commissioner serlina commissioner hing commissioner vice president turman we have quorum and also with us the intern