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 the

structure at any given time. and also for our treatment access program, we have people that are certified in drug and alcohol counseling, which is a requirement for a long of the substance abuse treatment provider dispalestine cipline, >> supervisor ronen: so after that decision is made, whether healthright 360 or progress or conor house decision is made, focused on treatment for the individual, how often is a bed available in one of those programs to immediately send a person there? >> so for mental health beds and substance abuse residential, there's -- there's detox and substance use residential treatment, and then, we also have recovery step down as another level. for mental health, if someone

needs to go into a residential treatment or a mental health residential facility, that is actually processed through our transitions team, which they will do that assessment and they will make the determination of the acuity, the criteria. but also, a lot of time, people may not go directly to there. they may go to an acute aversion unit. and someone can also go directly to the center, as well. they can go directly to healthright 360, and then, they send the authorization to us. we just want to make it more sort of accessible. so for substance abuse residential treatment, we usually actually have availability, and that is something that i think it's not known a lot of times. there -- the other day, when

you had a hearing on -- for hsoc, we had number of residential treatment beds availab available. and it wasn't that we were holding them. there are a number of reasons that someone may not choose to go in. they may have different ways -- the person may show -- the assessment may show they don't meet the criteria, they may not want to go to detox. we want to make sure we always have beds available for substance abuse treatment, but i would say the pressure there is little bit less because it's really trying to make sure that we can get the person in. and then, the reason also sometimes those are less is because somebody may get in, but they're not mandated to stay in. or two days later, they won't

stay there. for residential mental health, that is actually -- there is a list, and there's a wait, and there's not always immediate accessibility. >> supervisor ronen: what is that wait time? >> that one, i think our transitions team -- it could be weeks to months because again, depending on the location, as well. >> supervisor ronen: what's the average wait time? >> i would say -- few months? >> supervisor ronen: so three months, do we know the exact wait time? >> we do because we have been tracking that in a residential setting. >> supervisor ronen: could we get it right now? could someone find that number right now? the other thing is i'm hearing two totally different things. so i want to clarify this, and i think that's the whole point of this meeting.

any time one of my selself or colleagues tries to get into this subject matter, you talk to anyone in the city and you will hear a completely different story and emphasis. that's why i appreciate my colleague, supervisor stefani, for calling this hearing. i feel it's incredibly needed, and i don't feel like we have a system that makes sense. so i heard from mr. pickens that everyone is assessed at the task level, and then, i hear from you that that is not the case. so you finally agree after many outreach attempts by the d.p.a. and hot teams engagement specialists. and i'd love to hear how they work together, but that's a whole other story -- that the

person finally agreed to be assessed at t.a.p. and a nurse or a licensed clinical social worker has to make an assessment about whether the primary sort of need for this individual is a mental health disease or it's a substance abuse disease. and then -- and then, if it's substance abuse, it's healthright 360, but for mental health, where do they go? >> for mental health treatment and substance abuse access, that is not where we would determine the placement for residential mental health. that is for figuring out what the needs are and assessing that for our different levels of care.

>> supervisor ronen: wait, wait, wait. wait, wait, wait. sorry. can you clarify. you said they are triaged and referenced. >> the question is what level of service do they need? do they need an outpatient level of assessment where they can come and go, or do they need residential treatment where they actually have to go and stay. so that decision -- that assessment is done at bhac -- >> supervisor ronen: bhac is t.a.p.? >> they are at the same location. they are located at 180 howard. it's kind of like air traffic control for mental and substance abuse programs.

>> supervisor ronen: so the bhac-t.a.p. patients, they are being assessed by clinical workers or nurse practitioners. we need to treat the primary reason why the person is on the street or not succeeding in society, and then, what happens to that person? >> the next question is, is there -- is this a housing issue or a treatment issue? >> so this person is experienci experiencing homelessness. so what's happening to this person? >> basically, we're trying to figure out what is the treatment option for them? do they need option, do they need case management? if they need housing -- >> supervisor ronen: okay. so let me try to make this easy. it is clear this person needs

residential behavioral treatment bed, but there's a 90-day waiting list, although you don't have that number here today, which is frustrating, so you're going to get it for me. >> so that person would probably be referred to a navigation center to get them off a street. >> b >>. >> supervisor ronen: but it's a person that's a schizophrenic who can't handle a 120 person room or -- what happens to that person? >> if they're -- >> supervisor ronen: okay. let's walk this through. >> or hummingbird, to help out the nav -- the nav center that exists is hummingbird, which is not nearly enough beds.

>> supervisor ronen: okay. so i just want to understand. they are at t.a.p. it's determined that they have a mental health disease. the options are to go to p.e.s., hummingbird or they go where? >> they could also go to urgent care, and after urgent care, they can decide if that person needs acute diversion, and they can go to housing for two weeks or plus, depending on their needs and what their needs are assess. and then, while they're there, they're continuously assessing what the next steps would be. >> supervisor ronen: okay. so let's say they go the urgent care route, which is probably

the best route, 'cause there's a 12-day stablization crisis. but there's still no bed in the residential. where do they go? >> they're done with the a.d.u., and the question is where do they go next? >> supervisor ronen: yes. >> i think there will be a conversation about where do they go next? we may be looking at stablization rooms, various options. residential treatment is one option. and again, we have to look at the condition of the person. not every person is presenting in a situation that are in a crisis. there are people who are also presenting in a crisis -- >> supervisor ronen: but they're homeless and schizophrenic and homeless and severe depression. >> people who are bipolar, the

illness is one piece. there are people who have schizophrenia what a schizophrenia who are doing very well and very much productive. so you're talking about a very, very highly sort of acute and someone who's in a major crisis. that would be a different approach we would have versus someone who has schizophrenia -- >> supervisor ronen: i'm just trying to understand the process. i'm trying to understand the person in your example who's been engaged by someone in your department, it's the person who's on the street. it's the person who every single person in this room has seen on the street countless times, who's talking to themselves, who needs help. it's the person that catherine stefani was talking about when she opened up this hearing. so that's who we're talking about we see every day on the

streets of san francisco. where does this system breakdown? >> supervisor stefani: can i just interject real quick, supervisor ronen? >> supervisor ronen: sure. >> supervisor stefani: i understand where you get behind we need to make sure we have enough resources. when the individual is at t.a.p. or bhac, and you're tlieitli trying to figure out -- they want help, and they want to get better. what we want to know as le legislators, what you need to do better. gosh, i wish there was really another mental health bed for

this person into, gosh, i wish there was another residential treatment bed to get this person into so they don't have to go back onto the streets. your wish list to basically serve everyone that is coming through t.a.p. and bhac. >> i can tell you that since -- more hummingbird. >> supervisor stefani: that's what we want to know. that's why i called this

hearing. >> chair mandelman: can i jump in for a second? >> supervisor stefani: yes. >> chair mandelman: is hummingbird expanded? i think they are at 15. >> yes. >> chair mandelman: and do you need a lot time? >> hummingbird is always full. >> chair mandelman: and you have a daytime at hummingbird. >> they treat people all day until 6:00. >> supervisor stefani: and just to follow up, it's not just about what the city and county of san francisco can provide, if what you need from us in terms of how we invest our dollars, but i want to know what can our other hospitals be doing? what can we step up to do? that's the information we need.

what can we ask kaiser to do? what can we ask cpmc to do? i want to know what we need, and then how we can ask the other places to provide it. >> we need more lsat, locked subacute treatment beds. >> chair mandelman: what does that mean? what is a locked subacute treatment bed? >> so it means the individual cannot come and go as they please. >> chair mandelman: so they would be inappropriate at s.f. general, and we would have a hard time justify keeping them there, but they don't have a place to go, and they can't be released on the street, and we also don't want to send them

out of county. >> right. >> chair mandelman: that's the point of expanding the healing center with the eraf dollars does. i know that supervisor stefani has a few more questions, but i know that supervisor ronen wants to follow up. >> supervisor ronen: yeah. instead of following the line that i started and i feel like i haven't gotten a lot of answers for, i'll follow up with what supervisor stefani said. so hummingbird is -- it's a navigation center. and granted, it's a navigation center that's focused on people with behavioral health conditions, but it's a temporary place for homeless individuals to be. it's not a treatment plan. it's not -- it's not the

stablize -- it's not going to stablize the individual or get them to a place. so what's next for the person? what are the exits for humming bird? where are those people who fill those 29 beds every single night go? >> so i would say it is a stablizing force, because number one, it gets people off the streets. >> supervisor ronen: no, no, i understand that. i'm looking for a path that -- you know, i believe that everyone can get well, and that everyone with the right set of circumstance can be somewhat reintegrated into society, maybe hold down a certain job, maybe living in a housing situation that isn't as restrictive as a residential treatment program. so i guess if that's where i'm

starting from, that is my firm belief, what is our past in san francisco to get that person there, and, and it worries me. while these are both very important, i don't believe that these are the two pieces that are going to get a person to reintegrate into society and no longer go through that cycle on the street of where they get to eight 5150s, etc. so i'm just looking for a vision from our departments that say here is our system, here's how it works, here's how you get from point a to being back in society and having a chance at a life again and off

the street. and i have yet to understand or hear that for?

i know we need everything, but i just have a problem believing more nav center beds or more acute beds are really the missing link to get us to a system that works more seamlessly, and so

i just have one more question, and then, i'll cede it back to you. is there any system in the city that quantifies, sort of presents a vision for a hoalist holistic system or anything like that? >> that doesn't exist right now, but the mayor is considering bringing on a director of mental health the

gaps are, where, you know, the lack of coordination exists. it's incredibly complicated.

to me, it is broken. and whole i have a lot -- i mean, a tremendous respect for everything single person that i'm look -- every single person that i'm looking at right now, and i believe we have some of the top people in the country doing this work, we've got to be the model for the nation. you know, the thing is we know we have a broken mental health care system in the united states of america. this is not particular just to san francisco, and i want to recognize that. but we have such brilliant people here, we have such incredible programs, we have so much empathy in our city leaders, and we have a massive city budget. and we are the ones to do this right, and i just don't see the leadership, and i don't see the vision to get us there, and it's incredibly frustrating, and it's something that i hope that we can change in the

coming years. thank you, chair mandelman, for giving me so much time. i really appreciate it. >> chair mandelman: i think -- and i'm sorry to take more -- a few more minutes from your hearing, supervisor stefani. you know, i've shared sort of a lot of the frustration that a lot of the people feel about the gaps in our behavioral health system and have talked about it a number of times with the mayor. and i hope this director of mental health reform -- which i urged the appointment of that person -- will play an important role -- even though we play a role of oversight, none of us are mental health professionals, but i do want to applaud the mayor for her work on this and moving forward. similar to what happened in consolidating and making sense of our homeless services delivery to do something similar around -- around

behavioral health and make sure that we're actually spotting the gaps and filling them. the one piece of the system that i notice nobody identified as a key critical need is in fact that community mental health dual diagnose -- dual diagnosis treatment capacity, which i think is, you know, again, there are all these different log jams but having the place for the person that is both schizophrenic and meth using so that they can get the treatment that they find. supervisor ronen said those person are hard to engage in treatment, so if you don't have a slot, it's easy to engage that person for a really long time. whereas if we had a slot, we can bring in those folks and get them into beds. my understanding from talking to folks in that area is we haven't expanded our focus in

that area in over 20 years. so even though we see it on the streets every day, we don't have the additional progress or p.r.c., nonprofit would be providing it, sort of the longer term treatment, transitional treatment term placements. i have a question about this. so the interaction, coordinated entry, my fear that folks have a whole lot of stuff going on, whole lot of challenges have to get themselves to a place to be assessed for coordinated entry, and i'm kind of hoping that's not the case. but i want to understand if it those are the most vulnerable people, the people that are

going in and out all the time might not get themselves to a particular place where they can be assessed and given the priority for coordinated entry, how we're thinking about that challenge. >> i guess i'll take that one. so no, people don't necessarily have to go to a place. if they do, that's ideal, but hot team is assessing people on the streets. we also assess people at p.e.s. and at san francisco, we are looking to expand that and laguna honda and working with the criminal justice system, as well. with you agree there's no need to having people go to criminal access points. >> so your department has to assign a priority level to each person. >> correct. >> and d.p.h. is sort of working on people with their

mental health and physical health needs. what's the -- like, how do you -- so yesterday, i went -- there's a great new program at san francisco general. it's related to getting to zero, and h.i.v. and h.p.c. treatment. people get their treatment and they get social workers who try to get them into coordinated entry. they were saying it's a little bit of a mystery to them how the prioritization happens because it's of course from their perspective, 80 to 90% of these folks are not only hiv positive but have mental health or substance abuse issues. so how does prioritization happen? >> so i want to point out that

d.p.h. and h.s.h. work closely together to develop the prioritization tools, and it wasn't done -- and we use when available to us medical data to help eventually do the -- essentially do the data for the assessment. so the prioritization is based on a number of factors. length of homelessness, if somebody's in a current situation, but also looking at acuity based on a whole variety of factors, and then weighting all of the information we have. i think acuity is the highest -- has the highest waiting factor. if somebody is very, very sick and needs to get into housing, you know, they might get prioritized over somebody who's become homeless long -- been homeless longer but doesn't have the risk to their safety and help. >> chair mandelman: and there's

a good practice in place where d.p.h. and h.s.h. can continue those conversations -- >> yes. we're meeting at the macrolevel on those issues but also on a weekly basis at hsoc addressing specific cases because at the end of the day, as supervisor ronen pointed out, there's more demand than there is supply, and we're not trusting just a computer to make decisions. there are human beings that get involved and discuss individual cases. very manically, as we get more -- eventually, as we get more information into the system, we'll be able to adjust the algorithm that's making the

decision, so that we'll be able to consistently improve that -- that improve. >> chair mandelman: great. thank you. supervisor stefani? >> supervisor stefani: yes. thank you, chair mandelman. i think the questions from my colleagues clearly demonstrate that we're wanting to figure out how to do better, obviously. and i know that we have a presentation here that is going to, i think, expand upon some of the questions that we have. i'm really interested in looking at the presentation. i think there's information that we might have questions about, but i would really like to continue with the presentation and see -- i have all the departments here so that we could find out where we're -- like i said, where we can do better and what you need. i think there are some more

slides here that are -- >> chair mandelman: is there a clarifying question on this particular slide? >> it's a whole series of questions. >> chair mandelman: okay. let's keep going. >> all right. >> so this involves a 5150 process. so this is scenario of alex, who lives on the streets in the mission neighborhood and there have been complaints from neighbors about his behavior. in this case, there is a call into police and hsoc. police bring alex into p.e.s. on a 5150 hold. as you know, that hold can be up to 72 hours. in this case, p.e.s. stablizes alex, and he is released within 24 hours. while he's at p.e.s., we will have social workers engaging with alex, and he will also then be referred if he's

homeless to a navigation center and also plugged into outpatient services if he's needing them. everyone is referred to other services, whether it's an outpatient slot or hummingbird. p.e.s. is the largest resource for hummingbird services, so that's been a big improvement in our system to have that place that's really close by for them to go. while that person's at d.p.s., they're plugged into the whole system. i want to pause, supervisor stefani because this is an area you really wanted to focus on. i'm joined by my colleague, mark cleary, from san francisco general, who really operates

the p.e.s. process. >> chair mandelman: i have a question. all right. so my question is -- i guess i have two. one is -- so the recent audit of the behavioral health services system found that 38% of folks who leave p.e.s. are leaving without a referral. i think d.p.h. disputes that and disputed that in the hearing. how do we -- is there any way that you can help us make sense of why the b.l.a. is quite convinced that 38 -- at least when they did that survey or that study that 38% of folks were getting sent out without a referral and d.p.h. think that's not happening. >> i'd be happy to address that. p.e.s., as stated again, refers everyone who leaves p.e.s.

who's not being admit todted t inpatient unit to outpatient services. the 38% is a result of our faultily drop-down in our p.e.s. medical records. the 38% was attached to a category called discharge to self. it's an unfortunate vague and general item on our drop-down m m m menu, which we've since corrected. they were being discharged on their own. they weren't being taken into a treatment program, they were being allowed to pursue ongoing treatment. they were also being released with a referral to the behavioral health access center or to t.a.p. we disputed this in the draft process and thereafter, but it

wasn't changed, unfortunately. i've -- i have very direct knowledge of that process, and i'm very concern that that's the case. >> chair mandelman: okay. so then i actually -- so then, the other question is are social workers there 24 hours a day at p.e.s.? >> social workers are not at the present time in p.e.s. 24 hours a day. there's going to be the addition of two new social workers that's going to be working in p.e.s. they're in the process of being hired at this point. our clinical model in p.e.s. has been to have required psychiatrists and psychiatric nurses, and they're extremely active in the prime -- access for arranging for follow up. >> chair mandelman: and they would work on something about

is this person in the coordinated entry system? >> right. all portions of discharge. >> chair mandelman: so we're talking -- wouldn't the ideal wor world -- wouldn't a pretty significant number of the folks whogeneral.

and when i asked about people who are leave p.e.s. and do so, of course, at that point in time, they can't be held any longer. when they're determined -- on a 5150, i'm talking about, when they are no longer a danger to themselves or others and they're released. at that point, voluntarily, i asked whether you thought it's offer to bed or offered something else, they would go.

because at that point in time, they can just go. there's nothing we can do, but if we were to offer services to them at that point, you made a statement that i thought was pretty profouns in terms of how many people you thought would accept -- profound in terms of how many people you thought would accept? >> well, i think that most people, once their psychiatric crisis has resolved in p.e.s. and they're -- no longer meet the criteria to be held against their will and they're homeless, most of them would want to be able to accept a shelter. i mean that in the most generic of terms, a place where they could stay, a bed. >> supervisor stefani: and then, i asked how many beds you thought you would need to accommodate that population? >> you know, i actually don't

remember what number i gave you because it's not a number that i have any confidence in. we need -- there's great need there, and it's -- i wish i knew the answer to that question, but it's a large number. >> supervisor stefani: right. and you gave me 200 to 400. that's what i want to get, in terms of the numbers leaving the hospital, whether or not we have the services, whether or not we have the beds, those that are coming through the other bhac and whatever. you are the only people that can tell us what those individuals need, so that's really what i'm hoping we leave with today. >> and i would add that -- excuse me. >> chair mandelman: go ahead.

>> the importance of having those patients have a bed is their clinicians, case managers can find them or having a greater -- have a greater chance of finding them in that location with sustained ongoing treatment. >> supervisor stefani: also, a lot of people going into p.e.s., they could be under the influence of alcohol or methamphetamine. and then, when they sober up to have the ability to transfer to a bed where you continue days of sobriety, where your mind becomes more clear, where you get a chance to really, maybe at that point, think that i've had enough, and i do want to get help. the longer we're able to provide that type of environment for an individual who has substance abuse issues, and the longer we're able to provide a space where they're not on the street, tempted to use, the better it is and the most likely we are to be able to exit them into a treatment bed, so that's what i'm really

hoping to find out, is that how many beds or what can we be doing at the time to help those people. a lot of people who are on 5150 holds do not have a mental illness. a lot of people are addicted to alcohol or are alcoholics or have a drug problem. at that point in time, i just want to be able to capture those individuals and be able to provide them a place where they can go where it's not back out on the streets because you don't get well in the environment where you are sick. you don't get well in the environment where you're sick. with y we need to provide an environment where people can have days away from using meth, have days away from that first drink, have people that are interacting with them in that environment that are sober, people that are interacting with them that are case managers that tell them there's

a better way, and we have an option for you, we have a treatment bed, progress foundation, whatever. i want that space for those individuals, and i feel like that's what we're lacking right now. i want to be told by the professionals, this is what we need -- even if it is pie in the sky, even if it is 400 beds. because even if we might not be able to do it as a city and county, we can ask our partnering hospitals, we can ask other cities to help us. maybe they have beds, maybe they should help out, as well. that's really what i'm hoping we find out, and that's what i'm hoping that we as a city and county can figure out to provide that. >> chair mandelman: supervisor ronen. >> supervisor ronen: yeah. just to follow up on supervisor

mandelman's question on the audit of behavioral health services and the statistic about 80 people leaving p.e.s. without a referral. when i asked severin campbell about that statistic and why it didn't change, she said yes, the people might be handed a piece of paper for a referral, but the referral may be a waiting period of a few months. to her, it feels like the person is just released without any sort of follow up, which seemed reasonable to me. and i just wanted to get your response to that. this isn't be blaming, this is about figuring out what we need to advocate for. so we know the truth -- the more we know the truth, the more we know how to fix it. to me, that felt like a valid reason for not changing the statistic.

>> when someone is kn. >> chair nuru: -- when someone is new to our system, what we do is provide them with a referral to the behavioral health access clinic or btac. they can go in and walk right in or call and speak directly 24-7 to a clinician on the phone or walk in and get an assessment that day, and as was mechanicsed, they'll be asseted for level of care in the system. ousht washt care, whether it's residential or mental or substance abuse. and then, an appointment would being setup for them at some

later time. it's relatively soon, and that's what -- that's what we do. >> supervisor ronen: does anybody track how many people go from p.e.s. to tapper-bhac? >> i know there are efforts under way to track that. i haven't seen data about that. i know if it's during the day, we will taxi somebody over to bhac directly to ensure that it's more likely that they're going to enter the system. >> supervisor ronen, we actually realize that data was lacking. we've started this fiscal year the rate for p.e.s. we do have some numbers to show

you. a percentage do get admitted snoo psychiatry at san francisco general. we want to be able to get that same kind of information for p.e.s., and we're just now beginning to track it. >> chair mandelman: all right. keep going. >> and there was a question about how does someone with a physical -- a homeless person with a physical health issue, how are they seen according to our system? so this last scenario is maria who's living on the streets of soma and has open sores on her legs. the d.p.h. street medicine team, headed by dr. zephen will encounter maria on the street and treat her abseses right there on the spot and then also

refer her to primary care or urgent care. at the same time, s.f. hot workers would be call today the scene to begin to engage with maria. and at that point, maria is started within the coordinated entry system of h.s.h. in terms of housing options that might be available for her. and so again, the goal is treat her immediate needs on the street, make a referral back to a more permanent source of medical care, primary care or urgent care, but then, also make sure she gets plugged into the coordinated entry system for housing priority. and just -- the final slide from d.p.h. before we turn it over to our colleagues from h.s.h. is to see all the investments we've made. as we begin to see this, these

are the investments we've made over the past few years. dr. seven talked about the individual who was -- zephen talked about the individual who was in our first pilot program for low barrier medication. we started that in 2016 and it's now been expanded in 2018. we also started health fairs, and these are health fairs throughout the city in almost every supervisorial district where we have our early prevention professionals. we also opened the hummingbird place in 2017 with an original 15 beds and now we've added 14 more, up to 29. again, hummingbird is always fun. we've started our hsoc coordination among our other three departments plus the police department skpp d.p.w. and hsoc has involved.

it's really -- i think a really good working process where we're all together and prioritizing what's going on out in the community. we talked about the healing center, the collaboration between ucsf, and d.p.h. and -- >> chair mandelman: is that 54? >> that's 54. we're also planning, expecting in july of this year, opening 72 new transitional housing beds for people with existing substance abuse treatment services. so this is just a down payment on all the work we know that still needs to be done. as barry and others have said, we know we need more, and we probably need more of everything. it's a question of what's the proportion of those -- that

more, and we're really looking hard with all of our partners to figure it out and figure it out quickly so we can come back to you and say this is what we need. so i'm going to turn this over to my colleague and my partner, carrie abbot from h.s.h., and we oversee the coordination process from h.s.h. and susie from h.s.a. so we are all working together, coordinating, to have the biggest impact possible. skbl supervisors, my name is carrie abet. i'm the deputy director of our programs at h.s.h. i'm going to go through our systems and how we coordinate with the other departments, and

obviously, i am available or jeff is available to answer questions as we go. so these are the framework. entry, this is where we bring everyone in and try to bring everyone into the system and get them through the assessment process? straight outreach. that's our hot team. it's lrkin street and homeless youth alliance doing outreach on the street for young people? and problem solving, which is where we, with our home ward bound team or in our access points or now working directly with the hot team offer people the resources to choose something other than going into the homelessness response system. we try to connect people with family, we try to help them get back to the last place they

stayed to prevent them from going on the streets? we have our transitional happened housing, we have permanent housing, and we have our housing ladder. that's where we move people in different settings if they no longer need intensive services. starting with the san francisco homeless outreach team. this is connecting unsheltered san franciscans with medication, services and shelter. it's a multidisciplinary approach. we have a hot dispatch that both hsoc and 311 access? they work in every district in san francisco? they work directly in the b.a.r.t. stations and muni stations with b.a.r.t.

representatives. they're really excited about the new movie, the public about library support services for homeless services. we also have the encampment response team going out and working with people in larger encampments and now also working with people who are staying in vehicles who are unsheltered. a couple of collaboration points with hud, and hud, i would say collaborates with every system in san francisco. they are sort of famously mobile, and they are extremely well educated on resources and good at finding them kind of with whatever presents. a collaboration point, they're deployed in partnership with street medicine? our hot dispatch and supervisor

worked directly with dr. zephen to figure out where they're all going this week and how they can support each other? they're in constant contact and it's a really -- it's a really beneficial relationship to both of our departments and to the clients that they're interacting with. another collaboration point, the encampment response team wor works with d.p.h. to provide very specific health resources to people in the encampments? that includes health fairs, getting people vaccinated, getting people medicated if they are lacking critical medications. they give people access to medical treatment, appointments and referrals, and they bring all of that out to the encampments or to other places where homeless people might be congregating. coordinated entry. so here's our system map, and it's -- we have tried to incorporate how the other departments work within this

map with us? so people come to us because they are seeking assistance or because we encounter them out on the streets, an encampment or of course coming and seeking shelter. our street outreach and our mainstream systems, the mainstream systems including hospitals, including the criminal justice system and including h.s.a. benefits program? they come in to coordinated entry access points, and those access points, again, can be the ones we've setup on 10th street, 121 10th street and jennings. people can walk into those spots. we have people going into the coordinated access shelters and the hot team, and they are just deployed where we ask them to go. so w