these members not paid, like family members? >> no, it's not training for respite care workers. these are people that would be hired in the community. >> okay. so it's all aimed towards people that are paid? i was curious about that phrase. and then, how do people learn about this program? >> well, self-help, we'll be doing outreach within their community in particular because it is the asian and pacific island community, they have a pretty brought reach, and they also have programs that can feed into it internally. >> it's not a problem of not filling -- >> no. i anticipate it's going to be very successful. >> okay. thank you. >> thank you. >> i know self-help has their

own inhome support staff service. is this training also open to the citywide besides their own staff? >> oh, absolutely. they'll be doing outreach to the wider community, not just their own staff. >> okay. another question i have is, like, the fringe benefit for part-time is 27%. isn't that a little bit high? i don't know -- i've been out of the workforce for such a long time. what does the 27% include? i know that when i was working, you have to pay health benefit for people that work 20 hours and up per week, but some of them are at, like, 10%, so are they still paying the housing insurance or what? >> yeah. i mean, the way the staffing is -- i mean, some of these,

they're being shared across programs, so for example, you know, the compliance officer, they're directing 10% of their salary towards this, but that officer is a full-time officer. >> so that's why they have the full fringe benefits? >> correct. >> president serina: okay. any other comments or questions? tiffany, what language will the training be provided in? >> i have the information right here. so self-help, maybe they can speak to this better, but they have capacity for cantonese, mandarin, and vietnamese. this is winnie. >> good morning, commissioners. we have the training staff with

capacity to deliver training in english, in chinese and with a career advising staff that has the ability to provide coaching services in can tonese, vietnamese, and tagalog. >> president serina: thank you. any further discuss discussion? any public comment? seeing none, call the question. all in favor? all opposed? motion carries. item d, requesting authorization to enter into a new grant agreement with self-help for the elderly for the provision of a workforce support program during the period of february 1, 2019 through june 30, 2021 in the

amount of $548,935 plus a 10% contingency, for a total grant amount not to exceed $603,829. welcome back, tiffany. >> gcood morning, commissioner. the needs assessment report confirmed that clients who are connected to daas services have positive experiences and enjoy their participation. the report also revealed that not all older adults and adults with disabilities know about the services available to them through the department, and there is a need to boost awareness of daas funded programs and services. consumers in districts one, two, four, and 11 in particular participate less in services

than in other districts, and although limited awareness is not the only contributing factor, it was a finding that was noted throughout the needs assessment support. the peer ambassador program is one of several approaches the department is using to increase visibility of our services. by using peer ambassadors and a word of mouth approach, the department will have a new way and opportunity to share information about services, and the consumers will have another way to learn about services they may need from a source they trust within their communities. self-help for the elderly will hire four peer ambassadors to work in the districts i

mentioned. at least one ambassador will be dedicated to each district to ensure continuity. they will share information about daas services within their appropriate district. they will use information tailored to the tridistricts a the communities within those districts. daas will work closely with self-help to ensure accurate information is distributed. peer ambassadors will be connected to our benefits and resource hub. they will have a working relationship with the adrcs within the districts. the daas hub and adrcs are great resources that the ambassadors will be able to access and refer consumers to as needed. collectively, the ambassadors

will provide information to at least 200 organizations and businesses annually who have connections to consumers that we serve with the specific intent of increasing awareness about daas programs and services. thank you, and i would be happy to answer any questions you might have at this time. >> president serina: commissioner pappas? >> yes, i'm joining the other commissioners in asking an entry question. when we include the programs, those include the dignity fund programming? >> yes. >> president serina: any other commissioner comments or questions? commissioner loo. >> okay. i have a question. in the table a, it said they were going to hire five -- >> yeah, sorry. when i said that, i realized i had said four because i was not reading my notes correctly.

they are actually hiring five. the minimum is four, but they're overcommitting, if you will. >> but my question here is on the salary sheet, it just says two peer ambassadors instead of four or five. >> because they're leveraging another source for the other two -- or actually, the other three. >> okay. that's what i think is really kind of nice is if they're matching, it would appear in the budget so it would make it cli kind of clear. >> on the budget revenues, on the summary sheet, it has match three, so it has the match

there. >> thank you. my apologies. >> no worries. no worries. >> president serina: thank you. any other comments or questions? any comments or questions from the public? hearing none, may i have a motion to approve? >> so moved. >> second. >> president serina: thank you. any further comment? all in favor? any opposed? thank you. >> thank you very much. >> president serina: thank you. item f, requesting authorization to enter into a new grant agreement with kimochi, inc, for sustainability for nonprofit licensed residential care facilities for the elderly, rcfe, during the period of march 1, 2019 through june 30, 2020, in the amount of 175,3 # will $4 plus a 10% contingency for a total grant amount not to exceed $192,922. well come, fanny lappitan.

it's been a while. >> yes. good morning, commissioners. i'm fanny lappitan, program coordinator for long-term operations at daas. i'm seeking authorization to enter into a new long-term agreement with kimochi. rcfes are assisted living facilities that have long been preferred community alternatives for those who are able to live on their own. they provide an increased level of care in a supportive and safe environment with 24-hour supervision for individuals aged 60 and over. in recent years, the number of rcfes in san francisco have costed due to decreasing

population, and inadequate funding. the smaller facilities have accounted for the greatest number of closures, making it difficult for lower income individuals to secure care. as mentioned earlier, there's an assisted living work group that's tasked by the long-term care coordinating council which recently researched this issue and its recommendation of support for this needed service are currently being considered by the city. this grant will support the sustainability of kimochi home rcfe by providing access, and quality care service. it's to provide care for 20 residents over the age of 60 who are able to independently walk. it is a two-story facility with

eight single occupancy rooms and six double occupancy rooms. the facility is currently owned and operated by kimochi. it is currently serving a majority of residents of monolingual japanese or those who speak english as a second language. kimochi has been built from the ground up in 1983, and no major renovations have taken place since that time. the funds from this grant will be used in three areas. first is to update their safety and security measures. the second is to improve accessibility of rest rooms on the first floor and the third is to modernize the facility which is showing 3.5 decades of wear and tear. these updates and improvements, kimmy chee home will update the

rcfes ablt -- kimochi home will update the rcfes ability to support the residents. the funds through this grant will help support the long-term safety of economy owe chee home and potentially create savings in maintenance and utility costs in the near future, allowing for increase in their general reserves and helping to maintain a sustainable business plan. a kimochi business administrator will be responsible for completing the projects and will do so in such a way to minimize the disturbance or negative impact on the residents as much as possible. at this time i'd be happy to answer any questions the commissioners may have commission scolaire de la capita capitale -- may have. >> president serina: thank you, fanny. that was a very comprehensive report?

commissioners, any comments or questions? >> is the whole kimochi home taken at this point? >> i'm just going to calling shawn for more comprehensive information? >> we currently have 17 residential residents and when we have beds available, we serve those rooms for respite care, so seniors who know they're going in for surgery or have a scheduled operation can reserve an open room so that they can stay with us for a few days before they go home and make sure they're ak and reduce the risk of hospitalization. so we're currently full with 17 residents and three residenpit residents. >> so do you have a waiting list? >> we don't have a waiting list with this right now. one of the things we'll track with this is the interest in our home and full-time

residency by hopefully growing our wait list so we can fill empty beds. >> i presumed kimochi owned the building. >> yes, we do own the building. >> thank you. >> president serina: thank you, commissioner. any further comments or questions? any comments or questions from the public? hearing none, may i have a motion to approve? >> so moved. >> president serina: second? >> second. >> president serina: any further comment? thank you. all in favor? all opposed? thank you. motion carries. item g, requesting authorization to enter into a new grant agreement with self-help for the elderly for sustainability for nonprofit licensed residential care facilities for the elderly, rcfe during the period of march

1, 2019 through june 30, 2020, in the amount of $302,451 plus a 10% contingency for a total grant amount not to exceed $332,696. welcome back, fanny. >> thank you. good morning, commissioners. th autumn glow provides assisted living in a unique 24 hour residential care in the hayes valley located at 654 groev grove street. it has capacity for other cultural and language needs. the funds through this grant

will be used to access safety, security, and the quality of services delivered to residents, and this includes infrastructure improvements, accessibility improvements, technology infrastructure upgrades, safety and security improvements, and there'll be training from a registered nurse and nutrition improvements from a registered dietitian. with these upgrades, they will provide upgraded safety and security measures, and providing sustainability for at least five years after the grant ends. it will help support the long-term building safety and minimize the use of reserve funds that can be used for emergencies in unexpected business challenging. autumn glow's director of housing services will be responsible for the various

services and will have oversight of the construction to ensure project completion within the deadline. they have a plan to minimize disruption or negative impact on the residents as much as possible while this is happen. i'd be happy to answer any questions. >> president serina: thank you, fanny. any commissioner questions? commissioner loo? >> autumn glow serve only chinese? >> they don't just serve chinese. they do -- let's see, the demographic at this time is 72% chinese but they also have 14% vietnamese and 17% mandarin. >> president serina: any other

questions? >> how long have they been in hayes valley. >> oh, they've been in existence for 18 years. >> oh, all right. thank you. i live near there, so i hadn't realized how long it had been there. >> president serina: thank you. any further comments or questions? any comments or questions from the public? hearing none, may i have a motion to approve? >> so moved. >> president serina: second? >> second. >> president serina: any further comments or questions? all in favor? opposed? the motion carries. thank you very much, fanny. is there any general public comment right now? >> winnie yoo, self-help for the elderly. commissioners and director kaufman, thank you very much for the self-help for the elderly to implement these pilot projects and for the opportunity to serve additional

clients through the dignity fund mission population in need skpr , and we really look forward to updating on the implementation of these programs, and thank you again. >> president serina: thank you. any other comments or questions? you have a question, commissioner loo? >> since self-help is going to do the peer ambassador program, i'm just wondering if the department has updated their brochure of various kinds of services because i think we have new sorts of services added since the dignity fund kicked in. >> so we are in the process -- we have, commissioner, a service location and current services available. i think it was last updated in 2016-17, and we are in the process of updating is now. hopefully -- it now.

hopefully, it'll come out later. so we -- every month we have a meeting, things change slightly sometimes, so that is the goal to be as current as possible, but it does take time to implement that information. >> and it'll be in different languages? >> oh, that is an excellent question. that is something i will look into. i don't have that information now, but that is an excellent question. i will follow up with you. >> president serina: any other general questions? any other questions from the public? any announcements? hearing none, motion to adjourn. >> so moved. >> president serina: thank you very much.

>> shop and dine in the 49 promotes local businesses, and challenges residents to do their shopping within the 49 square miles of san francisco. by supporting local services in our neighborhood, we help san francisco remain unique, successful, and vibrant.

so where will you shop and dine in the 49? >> i am the owner of this restaurant. we have been here in north beach over 100 years. [speaking foreign language] [♪] [speaking foreign language] [♪] [speaking foreign language]

[speaking foreign language] [♪] [♪]

>> chair mandelman: is the a.l.u. here? come on up. >> good morning, members of the board, officer solomson, a.l.u.

unit. there are two letters of protest, zero letters of support. they're located in plot 558, which is considered a high crime area. they're in census track 162, which is considered a high saturation area. alcohol liaison unit recommends approval on the following conditions: number one, sales, service and consumption of alcoholic beverages shall be permitted between the hours of 8:00 a.m. and 11:00 p.m. daily. number two, petitioners shall actively monitor their area under their control in an effort to prevent the loitering of persons on any property adjacent to the licenses premises as certified on their most recent ab-253 form.

and no noise shall be audible at any nearby residents. i've just now spoken to them about agreeing to these conditions, and they have. >> chair mandelman: so the conditions have been agreed to, and they're done. i don't see any questions or comments from colleagues. is the applicant here? come on up. if you want to. >> so we've accepted the conditions from john over there. the epicurean trader, we're a husband-and-wife run business,

independently owned. our current markets are well reviewed and they're widely accepted in the neighborhoods in which we currently operate. in hayes valley, there are 5,296 residents in the immediate vicinity of the location, as well there's location. since we've aunited states noed our plans to open the location, we've received overwhelming support from the hayes valley. we've designed the protection with the neighborhood in mind and feedback of the residents. we're dedicating a portion of the store to necessity needs. less than 5% of the total square footage is dedicated to alcohol. it is a small part of the business but a key part of the business. in order to provide essentials

at a low price, we need to be able to sell shelf stable items at a high margin, which alcohol is one of those items. we're a very respected retailer. we have numerous locations and we've never had any problems selling alcohol, and we hope that you'll support our location to open in hayes valley. thank you. >> chair mandelman: okay. seeing no questions from my of any colleagues, is there anyone who wishes to comment on this? if not, i'm going to close public comment. public comment is now closed. [gavel]. >> chair mandelman: well, i want to thank the a.l.u. for their work to get this within our 90-day deadline. i know this required a little bit extra, but i think at least one member of the board has

expressed a strong desire for that. the a.l.u. will continue to respect the wishes of the city if we come in a little bit late. we are endeavoring to come in within that deadline. so thanks for all of your work. i understand that supervisor brown is in support of this item, and so i think we can direct our clerk to prepare a finding of public convenience and necessity, that granting this license would serve public convenience and necessity. and so colleagues, can we forward that resolution to the full board with a positive recommendation without objection? we will do that. fantastic. thank you. mr. clerk, please call the next item. >> clerk: agenda item number two is consider hearing the transfer of a type 23 distilled wine, beer and liquor license to on the run market located at

4100 market, will serve the convenience and necessity of the city. >> chair mandelman: thank you. we are joined by supervisor fewer. >> supervisor fewer: thank you, chair mandelman. given the location of this residential area in a proximity to an elementary school, a church, and a park, i feel it is important to have a thorough review and discussion about the conditions for this type 21 off sale general. i am questioning whether it is appropriate in this case to consider sales of liquor in bottles or containers that are less than one pint. the incidents of concern around liquor in the neighborhood previously have occasionally stemmed from the littering and consumption of these small bottles. i have also since been made aware that there are letters of protest from neighbors in proximity to establishment which is a consideration. i would respectfully like to

request a continuancetor additional time to continue discussions with the a.l.u., a.b.c., and the applicant. >> chair mandelman: great. seeing that request, if my colleagues are okay, i think we will be inclined to grant it. but we do need to take public comment on this item if there are members of the public that wish to speak on this item. i will close public comment. i will continue this until the next meeting of the public safety and neighborhood services meeting. >> clerk: and just to clarify, mr. president, that will mean it will be continued to april

18. >> chair mandelman: thank you. mr. clerk, call the next item. [agenda item read]. >> chair mandelman: great. supervisor stefani? >> supervisor stefani: thank you, chair mandelman. i want to start this hearing by telling you the genesis of why i called for this hearing. last year, i was on chestnut street in my district with my son, who at the time was 13 years old, and we saw an individual in distress. he was walking down the street with no pants, and looking drew

garbage cans for food, and acting in a way that made me think that this person was in need for our help. so what i did was i called the non-emergency police number, and i waited. and they came out, and they made contact with this individual who complied. and as the police were deciding what to do, they came up to me, and they said well, you know, you called it in. do you -- do you want to make a citizen's arrest for indecent exposure or something like that? i said absolutely not. this person does not need to go to jail. that's exactly what we do not need to happen. so after a series of questions, the police determined that i believe this person was a danger to himself. i don't know if to others at this point, but they ended up taking him to the hospital, to sf general on a 5150 hold. at that point, i don't know

what happened because of hipaa laws, and you lose track of what's going on at that point. but the next day, i saw this individual on chestnut street with his hospital bracelet on almost in the same condition. so that, for me, what that said, i think when this person was taken to the hospital in need of help, that somehow when he was released, something -- we missed an opportunity, that we, in part, i think failed this person not getting him the help that he needed. to see him back out on the streets one day later in the same condition for me was heartbreaking, and i want to do better. i want us as a city to do better. and i see this individual time to time in my district, and i don't know how to help him. and i want to learn how to help him. we talk a lot about coordinated entry in the city and county of

san francisco, but we don't really talk a lot about coordinated exit. and when i'm talking about coordinated exit, i mean, what are we doing at the hospitals? we know that the homelessness crisis on our streets is not new information. we know for decades of thousands of people have lived without homes or shelters, and biennial counts, the number of people living on our streets have been relatively stable. i believe that the number of people who are unhoused has worsened in recent times. i believe homeless residents, some with mental abuse and substance abuse issues are homeless as we know, and months or years of living on the streets only exacerbates these conditions and makes it worse for the individual. we know that nationally, america has been hit with an opioid epidemic.

over 70,000 people have died nationally, and our city has not been immune to this. i think the doctors and physicians that pushed oxycontin on this country should be in jail. worse yet, san francisco has been affected by an increased use of methamphetamine. i believe as a society, we need to do everything we can, everything we can to destigmatize mental health and substance abuse issues. treating these is an ongoing challenge and requires ongoing effort, but we must lead with services and treatment. all of these problems under lie the heartbreaking crisis that we are witnessing on our streets. thousands of people, many with physical, mental and substance abuse related health conditions who are struggling to survive are unhoused and in need of our

help. our homelessness crisis is not just about homelessness, it is about mental health and substance abuse, as well. and i know this personally. i have a brother who is a heroin addict, and has been homeless in my hometown of merced. and i see how hard it is to help him. i see how hard it is for my parents to help him. we try everything we can to help my brother, but he wants to use, and it's incredibly challenge. and i understand those challenges for families, and i understand those challenges for people who want to provide services to help individuals who are suffering. we know this crisis will not be solved overnight. we know it will take years of building new shelters and supportive housing, improving upon our services, and holding providers accountable. so i have three goals for today. first, i would like to understand the processes in

which multiple departments coordinate and provide services to individuals with mental health and substance abuse issues with a focus on the 5150 process. and why i say the 5150 process is when i toured s.f. general, and i talked to the psychiatrists there, i learned that 68% of p.e.s. admissions are homeless. second, i'd like -- i want to identify key points where departments interact or do not interact and could, such as when a person enters and exits psychiatric emergency services. again, a coordinated exit. third, i want to identify opportunities to improve the current coordination and services. are there ways we can leverage existing resources to provide more or better resources.

are there points where we are losing people, where we can get them better services other than returning them to the streets? and i also want to understand what services could we be providing when people are leaving the hospital on a psychiatric hold? what are we lacking? where do we need to invest? is it more mental health beds? is it step-down beds? is it treatment on demand? what is it because i know we want to figure that out. we all do, and i want to figure out how to provide that. i also want to be clear in this hearing. this hearing is not focused on sb-1045 and conservatorship. this hearing is about what happens when people living on our streets with substance abuse and mental health issues enter the hospital whether on a 5150 hold or for any other reason and how we can better help them. i want this conversation to be not preventing us to ever --

about preventing us to ever getting to skefsh to haveship because as long as we have people out on the streets suffering from mental health and substance abuse and physical issues, the more likely it is we have to consider conservatorship. we have to figure out how better to coordinate services to make sure that happens. i think everyone can agree, and sb 1045 talks about eight 5150s. that's far too many for one individual, and we have to do everything in our power to help people the first time they need it. the hospital cannot be a revolving door that leads back to our streets. when we have an opportunity to help people, i believe we need to do everything we can to fix people at that point.

we need more shelter and we need every effective services. we need every city department to be accountable and raise the bar in what we do. no city in california has figured this out, and we are all facing similar problems, but i think what we can do is continue to fight for change and continue to demand that we do better. i think today can be a step in that change and i want to thank all of the representatives here and for my fellow committee members for being a part of this work. i do have -- i'm not sure if someone wants to speak, but i do have the leader of the san francisco foundation that's going to lead our presentation. >> hello. thank you for inviting me to speak. thank you.

i'm dr. barry zephen. our team cares for people who experience homelessness who are at risk to dieing who are not getting their health needs met by other services. i'm going to present a case. the title of this case is it takes a village. i'm using a supseudonym to protect his identity. john was on s.s.i. disability but somehow this was cutoff. he was homeless about before he came here and came "to get away from trouble." he was initially seen by street health worker shannon in october 2016 during civic center out reach. he was noted to be injecting into public and having several possessions, including electronics and several

bicycles in various states of repair. he had a long history of bipolar disorder that had initially been diagnosed when he was an adolescent. he stated his goals were to get or drugs and visit his family back east. he was among the first 20 patients in our low barrier buprenorphine pilot. over the next several months he had numerous police contacts and several periods incarcerated in jail. he is involved in community justice court. he had periods of depression, several medical and psychiatric emergency visits and two medical hospitalizations for serious skin and soft tissue infections. street medicine saw him

frequently, often several times a week, initially only in the streets, but gradually more and more in our open access clinic. he had several short stays at shelters and navigation centers and somewhat longer and more successful time at humming bird place. he had extremely fractured thoughts when he was in crowded social setting. he was assessed for housing by e.c.s. through the coordinated housing process and is receiving s.s.i. access through lawyers for homeless advocacy project. he was the first street medicine patient to receive the long acting injection form of

buprenorfine. he is on the housing priority list, and with assistance, he is working through the complex process of obtaining permanent supportive housing. we are about to start treating him for help tpatitihepatitis- goal of curing him. so what has changed? he still wishes to visit his family back east. now he has only one bicycle. he was not injecting drugs today and says he feels better than any time since he was a teenager. he is not blocking anyone's sidewalk with his possessions. he has not had psychiatric emergencies nor been admitted to hospital again. he speaks amazing that people

think he is doing well. he is likely to need a good deal of support. the department of public health cares for thousands of people experiencing behavioral and homelessness issues each year. i've presented the case of one individual. street medicine works to stablize those individuals who other services are not working for. i will pass it onto roland to talk about sfdph

from h.s.h. and h.s.a. and will provide you with an overview of the services we provide both individually and collectively as part of the process. i think it's important to note that a couple of years ago i didn't know my colleagues in h.s.h. and h.s.a., but because of the crisis that we see on our streets, it's really forced us to get together and work collaboratively. this past summer, we had a retreat for all of our workers and form an action plan how we can help our citizens. between our three departments last year, we provided services to over 13,000 individuals experiencing homeless. our collective mantra is that no door is the wrong door.

and actually, there shouldn't be any doors. it's really about seeing our clients where they are and many times, that's on the street. we -- when we encounter individuals on the street, that is done through a collaborative approach by b.p.h., h.s.h. and h.s.a., led by dr. zephen, n nurse practitioners, psychiatrists, special physicians and peers who are out on the street providing real medical care to patients, and not only providing that care but linking them to more permanent types of medical care. we also have engagement specialists, and these are like a health care level individual, and oftentimes peers, people who had previously been

homeless or addicted to substances and who are really out there and can realty to individuals -- relate to people that are out there on the street. the h.s.h., they have the homeless team, and that's the biggest team out there throughout the city in key neighborhoods where they're actively engaging individuals on the street. and then our colleagues in h.s.a., they provide a very important component, which is making sure that individuals have access to benefits because those benefits can be the stablizing force that really keeps them on the right track. so how does this all come together? within the last 18 months, it's really come together in a couple of places. the most prominent one is hsoc, healthy streets operation center. that's where we combine with other departments like the police department, like the department of public works on an every day basis, and it's

like an air traffic control. you mentioned the call to the non-emergency number, those calls come into hsoc. all the parties are at the table and really determines who's best to handle the call? it may involve some of our street specialists or street medicine or e.m.s. 6 from the fire or it may involve the police department, depending on the nature of the call. our role is to provide medical and behavioral health services. h.s.h., our housing partners, and h.s.a., those benefits linking services. and then, the police. we're fortunate to have a police force that's out on the streets and actually have relationships with some clients, and so we rely upon them and to be their partners

to support them in their out reach activities. we already talked about hsoc, but another way that we all come together is through what's called whole person care. whole person care is a program through the state of california's 1113 medicaid waiver that provided funding to counties in california to focus on high utilizing populations. in san francisco, d.p.h., h.s.h., h.s.a., we've all come together the past two years in our whole person care program to again figure out how we can collaborate better to provide services. one of the things we -- i mentioned the retreat we did this past summer. one of the things that came out of that retreat was we need to have a better way in terms of who would get access to what

services? i'd like to share this. this up side down triangle really represents the spectrum of services available in public health. i want to highlight it includes both substance abuse services and mental health services. just to acclimate you to this gra graph, on the right-hand side, you see acuity. that is acuity from the lowest, all the way to the highest, which are locked mental health facilities. now dr. zephen provided you with a pretty illustrative case

with what our workers encounter on a daily basis. but we wanted to give you more general overviews of how individuals are encountered and how we work together and collaborate. so in this scenario, it's a scenario of someone actively using substances on the street. in many cases, someone like this, the call may come into hsoc or it may be one of the s.f. hot team members or an individual who encountered this on the street. often times, it's not one encounter, it's just that repetitive process. so for example, john may have been engaged over several weeks or months by annen gaejment specialist in attempting to refer him for treatment.

he's finally decided he's ready for treatment, he right landev relationship with that engagement specialist, who will often walk john over or drive john over to a treatment access program. that's located at 1380 howard street, run by d.p.h. that's the place where all of the substance abuse beds coordinated by d.p.h. is. those types of services include residential treatment. these are actually facilities, many of which are run by healthright 360. they're usually a 90-days, but it can go lessor more, depending on what the individual needs, and they can be placed there. in addition, while john is in that residential treatment center, h.s.h. is involved, and they're putting him through

their coordinated entry process which then prioritizes where he is in the housing pipeline. >> chair mandelman: hold. supervisor ronen has questions and i have questions. >> supervisor ronen: thank you, chair mandelman. so a couple of questions. so first of all, i know that 90 -- what i've been told is that 90% of individuals that are suffering from a mental health disease have also an accompany substance abuse addiction. that's what some providers have told me. that's an estimate of the figure. so are we talking about someone that has a substance abuse disease but not an accompany

mental health? my understanding is they're offering co-occurring. >> and they're also trioccurring, so not mental health and substance abuse, but hypertension. >> supervisor ronen: when is the decision made to go into a heath rig healthright 360 treatment program or conor house, where the emphasis is a little bit different, conor house, and, maybe progress, mental health being the primary disease, and healthright 3 healthright 360, substance abuse be the primary disease. >> if a person needs a mental health placement or substance abuse placement, they're in the same room, so they can determine which way that person

needs to go. >> supervisor ronen: and is that a doctor who makes that determination? >> i'll have our director of public health answer that, but it's usually some type of social worker or clinician who is trained in what is the priority, what is the clinical presentation of that person? they will review that and say based upon these criteria, you need this level of care. >> good morning, supervisors. so the assessment is done by a qualified practitioner, and that may be a clinical social worker or licensed family marriage therapist or nurse practitioner, and these individuals are all qualified to diagnose and assess treatment, so that is