earn the $36 million through a work together on whether we're doing -- we have a behavioral health engagement team, a psychiatric emergency services bridge. we also are looking at data sharing and platforms for stakeholders. this will mean that both the homeless department and the department can share data with each other, share data amongst our most vulnerable populations to ensure that we are working together in ensuring that we work with the most vulnerable populations who are homeless on our streets. over the last several years, we've developed a shelter health program in which we will engage with bringing nurses similar to the wellness centers in hope sf. we actually modelled it after this program, shelter health, which provides nursing services within the shelter system, and we found this to be incredibly important. prior to this program, the top

emf caller in our service system for ems and ambulance service was next door shelter. and today, that is no longer the case because the nurses are able to triage people at the door. we are able to send them to medical respite and able to engage with the hospital if necessary, so i think we've done a really good job of reducing ems calls and ensure that people are getting the right level of care. and we expanded medical respite just for that, to ensure that people in shelter who are not thriving well due to their health conditions can be moved to the medical respite. and you will see and you hear a lot about syringe access and d disposal, and i have to say with the last numbers that i received from dpw, those are reducing, not because we've reduced the number of needles, but because the department has really worked at trying to engage all of our youch reaout workers. we have a rapid response team,

we have a kiosks in order to reduce the number of syringe disposals in the city. then, we're really proud of the jailhouse services we have in the city and we've done a lot of work there, including bringing a stronger psychiatric service to jailhouse services and really connecting the discharge from jail. as you know, many of the individuals going to jail do not stay there long, and it's really important to do that transition for them. okay. i think that's the end of the report, and i'll take any questions. >> supervisor fewer: colleagues, any questions for miss garcia? supervisor sheehy? >> supervisor sheehy: so where are we on behavioral health capacity for mental health capacity in the system? i know you added 54 beds at st. mary's last year, and about what, 15 at hummingbird? >> we have over 300 beds in the

community, and that's one of the things we focused on this last year, where we brought in over 100 beds. we're just doing a review of the number of beds potentially that we could expand to, but that is still in the process of development, and it doesn't take -- one of the -- one of the issues for the federal government that may change and that the new opioid bill, presently today, we can not bill for anything over 15 beds. they changed that a bit for the substance abuse side, and that's because the government are the experience of institutionalization of mentally ill, and so we are no longer allowed -- we cannot bill anything over 15, 16 beds. so as an example in the st. mary's facility, that is all general fund. so that law may change as the institute of mental disease, that may change on their -- on

this new piece of legislation. it's something that we think is really important on the mental health side. on the substance abuse side, on the state level, because we had groups like hr-360 that already had 200 beds, they really fought for the exemption of that. and so we do see that there's the potential of lifting that. that would really help us because this -- as an example, our latest facility, the 54 bed was all general fund. we could not bill any medi-cal for. >> supervisor sheehy: and then, i'm trying to understand, what is the -- kind of the interface, like, for instance, someone goes to hummingbird or to -- or to st. mary's or they're at 360, and they're in a substance use. if they were homeless when you brought them in, what happens to them when you get -- get them stablized? >> right. as one of our doctors says,

homeless housing, right? we really have to work at the first day that they come into our programs to really start getting -- making sure they're where they are in their benefits, are they on ssi. it's a really long wait sometimes, and sometimes that wait is longer than when the housing is available. so sometimes we do try to work with organizations that have step down places, different levels of care that they can move individuals down. that helps with lengthening their length of stay at the facility to see if we can get them a housing bed. but it is something of an area that i know i've had conversations with you supervisors regarding the amount of spending on our individuals that go to our program, and then, we have no other alternative with them but to let them out the door back into the streets. i've been working very closely with the homeless department to making sure we do the coordination, as the date gets closer that they get their data system put together, that we

work with -- that's when people are most stable, when they've just done three months, six months with our department, and they've stablized their addiction or stablized the mental health issues. we know this is a long-term chronic disease, and that's the opportunity for us to really work with the homeless department to ensure that the clients get prioritized. >> right now, they're not prioritized. >> right now, it's a very difficult process to determine how the formula is what the homeless department is working on, but we do get some individuals in housing through our programs, but i think we could do better in terms of the way we coordinate that, and that's part of that whole person care model, as well. >> supervisor sheehy: when someone -- to what agree is the acuteness of someone's health need factored in by the department of homelessness. >> that's being worked on with them. we're working very closely with them. the whole person care program that i discussed, that's one of

the major focuses. we're going to have a vulnerability in that that gives an objective view of how acute somebody is, and that will be measured out with the number of years that they're homeless, and that will be a factor in that, and i think that'll be the model that we're trying to go towards. and that has not been totally incorporated yet, and that's an area that we're still working on with the homeless department. >> supervisor sheehy: yeah, because i'm hearing anecdotally from people in the health department, it used to be much easier for people with hiv in getting a place to stay, but that's becoming more of a challenge. we give people with hiv medications because they're sick, but they're back out on the streets. eventually they end up in the ed at san francisco general with full blown aids, and so -- >> yes, sir. well, that i think is a whole city emphasis in trying to get more affordable -- ability of

housing, getting housing developed to people with acute illnesses and with homelessness, and it's something that we're worky -- working really hard on with other departments. >> supervisor sheehy: no, i appreciate that. thank you. >> supervisor fewer: yes. supervisor stefani. >> thank you so much for your presentation and thank you so much for your push to provide that san francisco healing center and to provide those 54 more beds. i'm just wondering how many more beds do we think we need to address what we're seeing on the streets, and specifically if senator wiener's bill passes, and what are we looking at? i get asked all the time, what will it actually take to address the problem and really help those who are suffering on our streets? how many more beds is it? do we have an understanding or any type of idea on what that will look like?

>> i can tell you we provide percapita than any other county for beds. i think you have the combination of the lack of housing -- that's why this last year we put another 100 beds on-line in anticipation they were going to get more housing. and so the level of care that we developed at st. mary's is the next level of care next to a psychiatric and inpatient stay. and we don't want people at that level of care. we really want people atloer levels of care and into housing. the fact that we have a methamphetamine epidemic right now does make it very hard to kind of estimate what our numbers are, but we do know that i'm still working on expansions of some of our other programs, and we are trying to find that formula. i believe that we have more beds than any other county in -- in this state, and if we can get the free -- of the

freedom of the ability to build 50%, we can develop more beds. but to have 50 more beds, costing us $50 million, a respite of between 5 and $10 million, that's pretty extensive. so to give you a number of 100 or 200, i don't think that would be fair, but in future hearings, we'll try to come closer to what the future maybe require, but our goal is to not to put people in closed beds. our goal is just like at the hospital to get this happen stablized and move them into the continuing. as an example, we have several of our programs that have coop housing, and they can develop that. so i would say if we're going to need more of something, it would be housing. that would really help us. >> so housing on the back end of all of the help that we can

provide. >> right. and i think from my discussions with providers, if they had that flow going with more housing at the back end, we don't have to develop as many more expensive licensed substance abuse and mental health beds. >> and just one more question on astive outpatient treatment. i was really happy to see the article that we are making headway after trying with supervisor alioto pier to pass it. is it education to family members, we do see the 82 patients that were helped. you know when people get their lives back, that's one person at a time, it is working. you know, the critics were wrong. i think it does show that it does work, and i'm just wondering how we can expand those efforts. >> well, i think senator wiener's legislation helped that. in san francisco, it's hard to

define, because we get many people into treatment. so what's really restricted with who we can put into the programme program. if you look at the bill, it allows us to look at people with homelessness and mental health issues and addiction, that will provide us the opportunity to provide stability for a small period of time because we are taking rights away from individuals, and we want to make sure they have the right of appeal and all other judicial support that they need. we do believe that that will give us opportunities for bringing people in, providing them care, and really providing the right level of care for them. i do think the senator's bill will help us if that gets passed, and then, i do think my work with doss, and we're trying to look at the conservatorship office and working very closely with them in trying to have a more integrated model with the

hospital. give you an example of a very good outcome that happened most recently. we had one of our highest utilizers that had over 100 51-50's. that means he was picked up by the police every three days. we were able to coordinate with all of the departments that we had with an interagency case review. we were able to alert the hospital, we were able to keep him at the hospital, we were able to give the full story of this individual for the five years that he's been in the community and all his 5150's to the judges, and we were able to conserve him, and we have him in a conserve bed, and he's going to get better, and he's not going to stay at that facility forever. he will be then brought down into another level of care and hopefully into housing. i think there's a lot of hope for recovery for individuals. it's just having the right mixture and having the right tools to provide the right care that sometimes they're not seeking themselves. >> thank you so much.

>> mm-hmm thank you. >> supervisor fewer: thank you. oh, yes, supervisor sheehy. >> supervisor sheehy: i'm sorry. i'm still trying to recover. 150 5150's. >> over 100 5150's. >> supervisor sheehy: over 100 5150's. >> that didn't include all the pds calls and all the disruptions in the community. >> supervisor sheehy: what does a 5150 call cost? >> if you think $2,000 a night, it's probably six to $10,000 a pop, plus the ambulance, plus the police. >> supervisor sheehy: so where in our system are we breaking down on that? >> well, this is what -- well, each of us have separate responsibilities, so we're trying to knit the story

together for the court service. i've been working on it together almost a year, utilizers that have the highest interest at the table. the police give us their -- they have to leave because of hipaa issues. they give us their top ten, their top 20, and we get everybody together to try to figure out the plan. i think it's very high intensity work together, but it's so much better for the client and so much better for all the agencies involved. and they say that, you know, for public health when nothing happens, that's the best public health that you get. and in this situation, the police probably will go to their next person to get that individual ever within their system, so we get them out into the right level of i can't irrelevant and out of the hands of the police and the ambulances, and -- but i do think with this interagency role that we're playing, that many of the -- the departments are seeing what we can do when we come together and really

work on a client's needs. >> supervisor sheehy: and as a -- it seems to me like it might be a better idea to go to the city attorney to help handle the conservatorships? i know that president breed has suggested that. >> yes. that's a doss project, and i know that they're working on that. >> supervisor sheehy: great. thank you. >> supervisor fewer: thank you. i just have a few questions. first, i want to commend you around your language access and that your language access is a model, actually, for the rest of the city departments. the investment that you have put into that is tremendous, and i just want to say thank you very much because when i held a hearing for the language access ordinance -- and we're sorry to lose colleen, quite frankly. i know. she's wonderful, and so i just wanted to commend you. i just want to ask you, are you proposing an increase or decrease in the number of fte positions. >> in our department? it will be very small amount of

fte's, but it will be based on, as an example, the staffing that we have to have at zuckerberg when we go over census but we've been really focused on trying not to increase fte's. >> supervisor fewer: okay. are you trying to increase or decrease in the number of civil service positions. >> no decreases. if we do, zuckerberg would be an increase in nurses. if we expand at hummingbird, it could be an increase in cbo's, so it cobb a small increase in both sectors. >> supervisor fewer: are there any positions that will be contracted to full-time positions or contracted out? >> we do not contract out positions, and i can probably get back to you if there's transitions going from temp to permanent. that's something that's a little deeper in the weeds of the department that we certainly can note that and come back at the next hearing.

>> supervisor fewer: thank you very much. >> thank you. >> supervisor fewer: thank you very much for your presentation. so now, let's move onto human services agency, and i'd like to invite up trent rohrer, the director of the human services agency to give a presentation.

>> good afternoon, again, supervisors. trent rohrer, director of human services agency. i'll go through the slides and presentation for the department of human services, and then, my colleagues from department of ageing and adult services and office of early case and education will go through theirs. but just as a quick overview, as you know hsa is the single agency that is comprised of three departments: department of human services, department of ageing and adult services, and oace, which is early adult

and children education. it supplies public ben mys to meet needs of people through cash assistance, food and nutritiousal support, and other thipgs, and specialized care for seniors, dependant adults and children who are victims of abuse or neglect. it's interesting to note we serve about 250,000 san franciscans every year throughout one of the three departments or a combination of them, which is about 60 is of san francisco san francisco's population. the white section of the pie is the administration that provides all of the infrastructure support for the three departments, which is really why the department was

created. this slide breaks down sort of a where our funding goes in our budget, as well as the fte across the three departments. about a third of the agency's budget is aid payment, so this would be foster care payments, payments to families on public assistance, single adults on public assistance, ihss wages, which is the largest single share. about 20% are contracted services which represent, of course, partnerships with our community based organizations to provide services to the whole range of populations that hsa serves. and then another 30% for salaries and friends which is the staffing of the three departments and the agency support. position wise, about 20 thirds under department of human services and the remaining sort of split equally between daas and program support, and then

oece with about 25 staff. sources, so you know, i'd typically say that hsa has funded a third, a third, a third, which is federal, state, and local general funds, county general funds, and you see the slide depicts this. the state part is a little harder to decipher from the slide. it's labeled as not only state but realignment one and realignment two, which is 1997 realignment and 2011 realignment. which supports ihss, child services, foster payments, but t it is dedicated state revenue for these programs. i talked in the last committee and hearing about the federal and state budget impacts. i don't think i need to repeat myself here. i talked about the ihss projected increase costs. the state allocations in cal

works, cal fresh, and ihss, as well. and then, of course continued uncertainty around the federal budget, just given sort of the -- the first budget out of the trump administration and the blueprint as -- as you know mr. wagner for department of public health said, it's really more of a policy statement than actual budget proposals that will go anywhere, but the cues from the administration really show, for example, cuts to the federal snap which used to be called food stamps, work requirements for medi-cal, reductions in medicaid funding, significant changes to tanf, which supports our cal rich program. so really an undercutting of most of the safety net programs that we administer through the human services agency were proposed for reductions in the president's budget, which again was pretty much dead on arrival in congress. it does however indicate the direction that the white house would like to go towards entitlement and safety net programs as well as programs

that support our seniors and disabled adults. so now going into the specific program areas within the department of human services, the first is our family and children's services division, which is otherwise known as child protective services or child welfare services. this is our program that protects children from abuse or neglect through either placement into foster care or through wrap-around supports in the birth parents' homes. once kids are in foster care, we work quickly towards permanency, either through reunification with parents, through guardianship with nonrelated adults, adoptions or supported transition into adult hood out -- adulthood out of foster care. two numbers which i think are important, about ten years ago, the number of kids in foster care in san francisco was about 2600, and we now have about 600

kids underage 18 in foster care, so obviously, a significant decline. we have another couple hundred kids who are age 18 to 21 who are in what's called extended foster care which was established through assembly bill 12 which basically recognized that when kids left foster care at age 18, they were not equipped, nor would anyone be prepared to live on their own, so we extended the age of foster care to 21. a lot of people don't understand the significant work and achievement we've had in our departmented. we used to be, according to 18 the statewide measurements that we're held to, we were towards the bottom of 58 counties, and now we're above the averages in all of the measures and towards the top in most of the

measures. better prevention to keeping kids out of care and within their birth parents homes and after care supports, and then really aggressive work towards adoptions and older youth adoptions to make sure that kids don't grow up in fost irrelevant care but that they grow up in homes where they're supported and loved. and you see that bear itself out in the numbers with the significant decline of the number of kids in foster care. two majorests going on right now, one is through state assembly bill 403, which is knowing as the continuing of care reform or ccr. this is a significant undertaking and a significant reform to the child welfare system across the state, and it's probably the most significant reform in the last 20 years. the goals in the premise of ccr really are around keeping kids, keeping children with families, and transitioning away from

long-term group home placements through a number of different initiatives that are outlined in ab-403. what it means for us and what it means for children is we need to increase significantly the number of licensed foster homes in san francisco so we do have family based placement resources when we're trying to step kids down from group homes. group homes, as of january 1, 2019 will cease to exist in their current form, and they're all being transitioned to what are called short-term residential therapeutic centers or strtp's, which are six months placements that are intensely therapeutic in nature. the new model under ab 403 is short-term, therapeutic, step down to a family based

therapeutic center after six months. we have different case work models that involved family and children teams, but at all decision points in a child and families process a different rate structure that reimburses foster parents based on the needs of the child rather than simply based on the age of the child. it's a whole sort of host of reforms funded by the state, largely that attempts to make the system much more family based, family focused, and really family and children centered. just as an aside, i was at a senate hearing, and senator wiener said counties really embrace them, but it's a

significant shift away from what we do and it takes a significant amount of time and state funding. the second is a 4-e waiver, and what it basically does is allow us to use federal dollars in a much more flexible manner. without the 4-e waiver, we only get federal dollars once we remove a child from his or her home or birth parent and put them into foster care. well, good practice says you want to give supports to a family in either a preventative matter or before the abuse or neglect reaches a level where you have to remove a child. so under the waiver we get a fixed amount of federal dollars to allow us to do those preventative services, to allow us to develop things like a visitation center to support our kids who are placed in other counties, to support things like emergency placements for youth who have super high needs to they don't have to be in -- bounce from group home to group home or go awol or things like that.

it's really been for us a much more effective tool at serving or kids and our families and really has contributed to that decline in the number of the foster kids that i talked about earlier. next, what cap does is it's basically our assistance programs for adults that don't have any kids under 18. it provides supportive services, emergency shelter through care, not cash, housing assistance through the same, and then, ssi advocacy for folks or clients who were disabled and need help moving onto the federal benefits known as ssi. two years ago in 2016, a whole series of reforms were passed by the board of supervisors that really attempted to stream line our caap process on the eligibility side to make it easier to get onto caap and

stay on, but also the path for employment services to those who wish to avail themselves of job training, community college and the like. so we're really focusing on making sure that those reforms are moving in the right direction through enhanced quality insurance, tracking data, as well as training and retraining of staff. second area, we received a grant from the state of a little over $2 million for those on caap moving towards federal disability. what we moved for and advocated at the state, when individuals are disabled, very typically mentally disabled, when they're homeless, the decline rate or the denial rate at the federal level is very, very high. what we're trying to do is when they're trying to apply for assistance, we're putting them into housing, and hopefully,

the approval rates for federal disability is much, much highwayer, so we're approving that in the next couple of months. the next thing is a gap that was sort of created when the department of homelessness and supportive housing was created, and that is the separation between the agency that administers benefits for homeless adults and the agency that is responsible for housing them, which is the new department, and so what we've established is sort of benefits linkages system, headed by a new linkages manager which will make sure individuals who are served in the program who are homeless get the housing that they may need and then conversely, folks who are served through the department of homelessness and supportive housing can more quickly get onto the benefits that we administer through county administer assistance program, county advocacy and the like,

and that person just came on board last week. another program is medi-cal. when the affordable care act passed, we saw it as an opportunity to merge two of our benefit programs for a couple of reasons. one, to make a more efficient service delivery system knowing that our medi-cal caseload was about to double, also knowing that we knew we were not going to have -- we were not going to double the number of staff to provide the benefits, enrollments for these medi-cal -- eligible for medi-cal population, so we established what's called sf benefits net, which basically is an enrollment specialist, eligibility specialists who do both medi-cal enrollment and cal fresh enrollment, again, taking advantage of the expanded eligibility under the affordable care act that really mirrors the availability for cal fresh, so the training that our workers require to do either was not as significant

as it was prior to the affordable care act. what we saw, of course under aca was a doubling of our medi-cal caseload, and you can see that clearly illustrated in the graph. about 62,000 households or a little under 100,000 people onto medi-cal. we do -- one of the other advantages of having sort of a combined sf benefits net is program outreach and inreach, so we can look at our medi-cal caseload, identify house loads that are not receiving cal fresh and expedite them onto cal fresh to get the benefits that they need, and then, the other way, if they're on cal fresh but not on medi-cal, which is a lot less, we did that same effort. so you can see the caseload as well, which has increased a little over 10% since the imp of willmentation of the affordable care act.

i talked a little bit about the abod requirement, estimated between 4500 and 5,000 people that have to activities to maintain their benefits. we've been working over the last year to prepare for implementation of the work activities and the job training opportunities for this population. in our workforce development area, this really is -- it goes across several areas that i just discussed. it's really helping people on public assistance, whether it's a family or a single adult find a job which driving access to pla employment training. really, this is sort of cornerstone of our workforce development and job services program is jobs now. this began under the federal stimulus act in 200 # 8-2009,

and has been successful not only in moving folks into employment for the first time, but helping them maintain employment after substance diesed placement. almost 60% of individuals for example continue to have earnings over three years after they are substance diesed employment placement ended. 70% of them were no longer on public assistance. it really is the most effective intervention at getting someone off of public assistance and into a job. it not only pays well while they're in the program but also provides them with the experience and the skills to maintain that employment either in the existing job or in a new job because of the experiences and skills they had in their new jobs now placement. and then of course we continue to maintain a fairly robust system of job training through community-based organizations.

46 different contracts or grants are agencies. in addition to jobs now providing services for everyone from transitional aged youth, individuals with disabilities, the transgender population, families, single moms, and single adults, among others. and then, lastly is the cal works program, which i did also briefly mention that had suffered from state reductions over the past few years. this is the california's and san francisco's response to federal welfare reform. provides financial assistance, job training and education, child care, support services, counseling to families, predominantly single moms who have kids under 18. the case works, when welfare reform passed in 1996, the caseload was 14,000. we're down to below 6,000

families. i want to note a few of the initiatives that we're currently implementing now. one is project 500, which is mayor lee's legacy program to really break the intergenerational circle of poverty, focus on new moms, focus on moms with kids underage two, in a cross department effort that involves various departments to really approach these families in a different way, recognizing sort of a -- the whole family need, recognizing that -- that very often for families who have been in poverty for a very long time, that the first goal should not necessarily be a job, but should be a family goal -- goal is around familiar plea functioning, whether or not, you know, a child is getting their child care placement, whether or not if it's an older child, they're

going to school, really working with them in a social work orientation at a very low caseload level to see if we can move the needle on families who have been in poverty for a very long period of time. we currently have 90 families in enrolled. our goal is 500 families. we have 70 or 75 families waiting to be enrolled. what we hope through project 500 is we have some learnings that could then be applied to the broader cal works caseload. in the state budget there's a proposed pilot for a nurse home visiting for new parents. it's a $27 million pilot across the state. there's a new state diaper -- state funded diaper benefit for cal works families that have kids under three. they get $30 a month towards diapers. we of course have a locally funded diaper program, as well.

this is abattempt to look at the cal works program program wide, not just focusing on moms with newborns. and then, the continued implementation of our cal works housing support program, which has to date provided housing subsidies to almost 300 single moms and two parent families on cal works who are homeless. the idea around this is it's very difficult of course for parents to engage in employment training, to hold a job when they're homeless and worried about where they're going to spend their next night sleeping, so this program provides a rental subsidies to these families which then allows them to stablize and allow is us to place them in whatever path or job placement training that they want to pursue. and then the last is family stablization. these are for families or parents that aren't yet ready to participate in familyist its, and it provides them the stablization they need to move to the next level of support.

this could be mental health supports, domestic violence counseling. support with children -- they may have special needs, whatever it is that family might need to move to that next step. so with that, yeah, i think that concludes dhs, so we can either do questions, if you have them, or i can turn it over to sherry mcspadden who's the director of the department of ageing and adult services. >> supervisor fewer: since we've just received a wealth of information, let's see if we have any supervisors that would like to check in. yes, supervisor sheehy? >> supervisor sheehy: so i had a question about some of your job training programs? so there was a job training program that worked with people who are homeless that has fallen off and now is only going to people who are kind of -- >> this was the -- i think you're referring to, supervisor the homeless collaborative, which was a federally funded

set of employment services with about eight different agencies. because hud is moving more towards funding just housing and supportive services related to housing, they're moving away from funding employment services about three years ago, the city decided not to -- to use federal funds for these programs and instead put in, in our budget, restored county general funds to continue to provide county homeless services. we provide these services. it's about $900,000 worth. ear earlier this year, what we attempted to focus on were recently homeless individuals or homeless individuals who are in shelter, so not street homeless, and also homeless individuals who are on our cal fresh program, which basically is most homeless. and the reason we did this was manyfold.

one reason is it really syncs up through the department of homelessness and supportive housing, which is a ladder approach, attempting to increase the number of homeless into housing. one way to do that of course is through employment, and so these funds in some of the proposals and contracts are targeted to homeless individuals who are recently housed in supportive housing and then they would avail themselves of housing funded by this collaborative in hopes they could get a job and earn enough to move out of the publicly -- city supported funding and housing on their own. the other area is focusing on homeless who are in shelter rather than on the street is simply because it's very, very difficult to have success in employment for a homeless individual who is on the street and who doesn't have a stable place to go night after night. the success numbers, the positive outcome numbers for that population were very, very low compared to other

interventions, employment training interventions for other populations. and unlike 20 years ago, 25 years ago when these programs were first funded, where a job might have been a path out of homelessness for folks who are on the street, given our extremely high rent now in san francisco, that's really no longer a viable path. even if someone on the street gets a job, a minimum wage job, it's very unlikely that he or she is going to be able to take that money and move into housing without support from the city. so we're attempting with these really small amounts of money, we want to target them to programs that are the most effective for folks, whether that's in supportive housing to open up units for folks in the street, and folks some shelters in shelter beds, moving them into supportive housing and interventions that really are more effective. >> supervisor sheehy: okay. i mean, it does seem like we're

making choices here, because having talked to these providers, they felt like -- >> well, you know with $1.1 million of funding, you have to make choices, and the choices that we are making are the ones that try to reach more folks, and the one that align better with the system of care that's being developed and implemented under the department of homelessness and supportive housing, rather than scatter shots of small grants of $50,000, $60,000 here and there that really i don't think move the needle on homelessness. >> supervisor sheehy: what does the alignment look like? we've had this new agency for about a year and a half, and it seems like you were doing -- weren't you do a lot of this -- you were doing all the supportive housing before. >> department of public health and the human services agency. >> supervisor sheehy: yeah, both of you. so what has been -- have our outcomes improved in this transition period or did we get

a large addition connecdisconn you're trying to realign after having broken the vase and trying to glue it back together. >> with regard to the outcomes on the homeless karen, that's a question better addressed to jeff, but there were some advantages of having a very large supportive housing and homeless services division within the human services agency. you know, we are the agency who serves the lowest income folks in san francisco through our benefit programs and other interventions, and so having that linkage certainly helped. i think one of the disadvantages was the systems of care that were being developed and that evolved in the human services agency and the department of public health became massive. in the year 2000, for example, my first budget before the beerd, the homeless program within the human services agency was about $11 million.

when it transitioned over to the new department, it was about $145 million. we had less than 100 supportive housing units. we now have 4,000 units just in human services agency. department of public health had exponential growth, as well. when you have massive systems of care in two different departments, it really begged the question of what are we doing around alignment, and i think suggesting called for a new department under mayor lee that was formed and i think that was the right thing to do under that system. so now we have to say, what other ancillary supports around these individuals do we need to do to make it work. i mentioned earlier, the homeless benefits, linkage manager in that group, to be able to identify where the gaps are.

unfortunately, because folks who used to work in this division under human services agency now work in the new department, they know our agency well, and it works. and really, the broken vase that you say really wasn't that broken. but what we're trying to do is create a system and an infrastructure, so when those folks leave and retire, and when think folks currently at hsa leave, that the system is in place that ensures the benefits that homeless individuals and families are entitled to under hsa still get them even though they're being served through the new department. >> supervisor sheehy: i'm trying to see where the system's breaking down. it does seem we have the people on the streets are more acutely unhealthy than i think we've ever seen, and that's true -- you know, it's been said, we have had homeless in san francisco for a long time. and i'm not completely sure

that part of it isn't we continue to retrauma advertise people because we continue to get them in settings skm don't keep them in settings or they get access to the -- to the -- to the benefits that would help them stablize and stay in housing. it just feels like i see a lot of same people all the time, and they don't seem to be getting care. >> sure. director garcia mentioned the whole person care and the need to identify those high need people that you may see over and over again. you know, in the mac coview, and i'm stepping out of my lane a little bit, but i guess i'll do that since i used to run these programs is capacity. we don't have enough housing units to provide for everybody on the street. we don't have enough shelter beds to how's everybody on the

street. last census, we had about 7,000 homeless, 3500 are on the street. it's not difficult to do the math and say we have gaps in our services, and i think that's the biggest challenge, and one where, you know, mr. -- director koczitsky are prioritizing, and we are, and we are, so what do we do? so what do we do? we attempt to take the most acute, we attempt to increase programs for the most significantly mentally ill, and those who are addict dangerous drug. you saw with the st. mary's bed expansion, you see the senator with his bill in sacramento, attempting to deal with the issue we struggle with around

severely mentally ill individuals on the street. but i think in answer to your street, why does the street look so bad, it's capacity. >> supervisor sheehy: i accept the capacity argument, but when i hear someone's been 5150 100 times, there is a disconnect. when i hear people with hiv they're not getting connected to housing. >> sure. >> supervisor sheehy: we have this knew prioritization process is just now being implemented, so we've had a different prioritization process up to now, and you know, i think if supervisor ronen was here, i think she and i would both discuss, you know, our cycles that we've observed wher where encampments are broken up. 70% go to a navigation center. 30% then are on the street, you know, wandering back and forth between her neighborhoods and my neighborhoods, in a bit of

distress, traumatized, and of those 70% who go into the navigation center, if they're not homeless ten years or more, in 60 days, they're back on the streets. so you take that, and people i've talked to are not making these incident faces with services necessarily like the benefits that you offer. all these incident faces which seem like were more robust before we created this department, maybe not as comprehensive, and maybe not linked in the way that maybe next week we'll be linked, i don't know. but we seem to have this middle period where we assemble some things that were working, maybe not perfectly into an agency where they cease to work necessarily as well as they used to with a whole new prioritization process that from my observation has made it much more challenging for both the people on the streets and the people who live around them on the street.

>> i guess i would disagree a little bit with your characterization that there's a -- that the new department created a disconnect that is resulting in more people on the street or more significantly ill people on the street. i don't -- i don't see that. our -- looking at different metrics, one of the things we look at are the number of homeless people or the percent of people that are on benefits. that hasn't changed. our ability to refer people from the hot teams to get them onto ssi are robust. the hot teams were under us before they were dph, and that connection remains. i think it might be too easy to explain the problem on the street as a result of system gaps when i don't really think it is. i think it's a lack of capacity, and i think it's -- to take your example of encampments, people despite our best efforts, best intentions, don't want to accept services.

they're comfortable. they don't want to go indoors. they might want to continue the behavior, behavior that's not productive for them or behavior that's not productive for people in san francisco, and i don't think they want to move. the tents on the street, which weren't around three years ago, i think that's a new phenomenon, i think that has led to more people being on the street. i think you saw a cycle that would get enough money to get a room for a couple weeks on and off. i think they can live in a tent right now and be sheltered from the elements, and some of them sheltered from illicit activity that they may be participating in. i see it as a capacity issue, i see it as a resource issue, and i see it as a human behavior issue. mental health, mental behavior, addiction, and these are not

easy things to solve. through the 5150, through the judges, moving it over to the city attorney to do the representation, these are changes we're trying to do, but you look all up and down the coast in california, you're going to be nothing different. you're going to see tents on the street, you're going to see severely impaired people on the street. you know it's amazing that our census was flat from two years ago. every other major city in the country went up. every other major city in california went up double digits, from seattle to san diego, portland. i think it's remarkable that we didn't. i think what you're seeing on the street though is a lot different than what we saw three or four years ago. i think it's younger people, i think it's people who are more impaired. i think people -- people that director garcia mentioned, methamphetamine crisis, hard-core users, and i think

it's making our job much more difficult. i'll stop editorializing now. >> supervisor sheehy: anything? thank you. >> you're welcome, supervisor. >> so i know with regard to foster care sometimes we house people outside of the county. i know there was a case in merced county that i knew about. and also i know with ageing and adult services, a lot of times people go out of county. and i'm just wondering as a -- director garcia was speaking earlier, people coming out of the conservatorship programs and things like that, when we talk about housing or capacity, do we look out of county or are we just talking about capacity in san francisco or do we look out of county? >> on the adult side? >> yes. >> i can let director mcspadden answer that, but people are placed out of county under

conservatorship. in fact one of the difficulties in conserving people is the lack of resources, so you might get somebody conserved through the court, but there's no room for the individual. the opening of the 70 beds at st. mary's was an attempt to do that. director mcspadden will have more detail, but it is a significant detail. if you don't have a place to put them, you know, conserve torship very often doesn't happen. >> so in the case that we do conserve them, and they say they want help -- mental abuse services is a beast. you have to want to get well if you have an addiction. nothing else it going to make you get well. you have to want it. i've seen it time and time again. so let's say we have a successful intervention through a conservatorship program.

do we look for housing at that moment outside the county or do they lose for housing outside the county or are we looking only within? >> yeah, once someones conserved, we would look for a placement anywhere, but an exit from that into housing, supportive housing, at this point, we are looking only in san francisco. so you know, and you can talk to jeff more about this, but when we have more flexibility with our subsidy programs, for example, so we have rapid rehousing subsidy programs for families and single adults, very often they will go throughout throughout -- go out of county. when our nonprofits are doing

saemps, that's where they're finding housing. when we're looking to place an impaired single adult who really can't manage housing on their own, that's a different intervention, and that's supportive housing. the placements we look for are entirely within san francisco within the supportive housing portfolio which is something like seven or 8,000 units, i believe. >> supervisor fewer: yes. thank you very much. wow. this is huge, i think. i just have a couple of questions. one, i just want to get some more clarity around our change in how we're working with youth and not in the homes anymore, and that's a really big shift, and you're right. i think it takes a whole realignment and a redesign, quite frankly. but i wanted to know, so there in, you mentioned that they're in a group home for -- what was it that you called it, again, for six months? >> i called it an strtp,

supported therapeutic residential treatment program. >> supervisor fewer: right. so then, are there -- in these programs, are -- so they're housed for six months there, and there's a whole bunch of supportive services. there's medical services, psychiatric services, all those kind of things. and what happens after six months? >> yeah. so if they remain in foster care, they are dependant, so they're basically our child. we -- every child in foster care has a social worker, you know, our social workers probably have 15 -- 10 to 15 kids on their caseload, so they are -- they're not released to nothingness. they don't move out of the strtp shall did-and again, it doesn't go into effect until another six months, sev months. they don't move out of the strtp until there's a suitable placement for him or her, which is sort of the crux of the challenge that i talked about. is once january