initiatives on the agenda explicitly for you for request to approval for today. >> good afternoon, commissioners i'm with the dpa budget. for the items before you in terms of the second set of proposals, the first set is around revenues. we have the projected 2011 realignment and the county is responsible for maintaining the mental health services and we get a portion of the dollars realigned from the state. we've seen it in prior years before and now we're projecting an additional $3 million for services. then the back fill of funding losses is a loss in revenue. we've seen similar reductions in

prior years as the federal funding changes its formulas and for a variety of reasons and sometimes it's because we're doing such a great job on the work we do. they tend to shift dollars to where the greatest need is. this back fill of almost $400,000 represents support, continued support for key areas and the population area is core services it does not want to continue without in the areas of workforce development which will is our emergency preparedness branch as well as s.t.d. on the budget neutral side, we have a new initiative for the new environmental health data system. while there's no general fund impact, there was a significant initiative because it's a $5 million cost over the life of the implementation of it.

it's also an exciting thing environmental health is doing so we wanted to highlight it but the current debate is a very outdated access database i think has outlived -- it's expanded beyond it's initial purpose and outlived it and time to replace it and environmental health works with many customers that may request multiple permits and right now it's got a very laborious, partially p.d.f. and paper and electronic systems and the goal is to replace processes with a robust tracking system that will actually include information on all of our customers so we can find them quickly and efficiently as well as track the permits to know where permits are at any given state. we'd be in process of going with an r.f.p. on this so once we

identified it there'll be more details on it but the goal is to replace existing system with a permit tracking system. funds would come from our provision in the administrative code which assesses liens for landlords that are delinquent on their refuse collection bills and we've had dollars accumulating in the past and per admin code the dollars can only be used to support environmental health administrative functions so it's a perfectly aligned use and a great opportunity to use the dollars to better serve our clients because with the reduced burden of the paperwork on our staff, they can actually help the clients themselves with the actual work in understanding the rules and regulations and with the goal of compliance. in terms of emerging needs, we're bringing four. the first is the office of equity which is a combination of

reallocation of existing staff as well as a request for new positions or two new f.t.e.s from the mayor's office. i know dr. colfax is very interested in this and has championed it. i'd like to defer to him to provide more details on this one. >> good afternoon, commissioners. first i want to stay we'd come back and provide you with much more detail about the work of this office as anticipated but to give you the perspective i have in talking to other members of the department during my short tenure here, as you'll recall the equity is one of the true north goals of the department. there's sometimes discussion about how does one define equity and what's it mean? right now, my definition in this work is that it's providing fair and just opportunity for everyone to optimize their health when we're talking about health equity and talking about equity in the workplace and fair

and just opportunity for everyone to realize and optimize their true potential in the workplace. this work would basically allow equity to be at the highest level of the department. this office will report directly to me. the director of the office and dr. anne bennett from the inner divisional initiative. when you look at how that work's evolved, the most salient and important work of that office has been around health equity and the african american health initiatives and putting equity front and center of the work. the office will be catalytic in the sense that equity work will still be owned and need to be owned by people across the department but this office will be the catalytic engine for that work not only within the

department including human resources, but also with other departments across the city and county and particularly with the human rights commission which is increasingly taking an interesting and a role in driving this work across the city. the office will codify specific tools and policies related to equity. rather than well intentioned groups doing one thing here and other well intentioned groups doing something different over here, we can understand and codify the goals as the department moves forward and develop the skill set through trainings and inquiry and picking specific outcomes. we'll able to make this work more salient, more tangible and i would say more metric driven as well as more scientific. we'll come back to you with more specific presentations but we think the investment is in keep

the value of the department. we'll hear with regard to the initiative coming forward today. that's an equity issue. when you look at the populations most affected in the incarceration system that has health equity. we have work to do internally with our partner in h.r. with regard to optimizing opportunities for everyone across the department. i think this is the right move at the right time and the right investment. if you have further questions i can answer them or dr. bennet is available as well. >> commissioner: do you want to continue and we'll take questions. >> clerk: next item is the combined scheduling and registration work flow within the department. this initiative has really come up because of the implementation of epic and when you look at the epic system it adopts what's

considered industry standard of having a single point of contact through scheduling and preregistration and any eligibility work that may be required. when we looked at our existing processes, there's variation between how scheduling registration and eligibility are happening depending on the setting if you're in a clinic setting or in-patient. there were gaps where we believed the work flow needed to be changed and areas where we had staff who were perhaps working on one or more of the three components. perhaps not all three and what we need to do when we do up plent epic is to make -- implement epic is to ensure they're ache to -- able to do the scheduling and registration properly. in some cases it means adding additional job functions where they did not have it before.

we are going through an h.r. process working closely with labor to identify the areas and have applicants interested in becoming into this role and competing and applying and we want to make sure we can keep them and want to make sure these are permanent roles. the overall work isn't going away but we're just combining them so that everyone has the same skill set. some of the benefits are beyond the very costly work around from the industry standard epic work flow is improved patient experience because where we might schedule an appointment and say hold on, i may need you to talk to someone to make sure we're eligible and it could be done in one place and there's reduced handoffs. people know up front what their financial status is and we're

not getting patients that may not belong within the network and it can increase revenue capture because maybe someone isn't currently on insurance but we have an opportunity at the point of scheduling to say you're not on insurance but you're eligible so let us help you out opposed to showing up the day at the clinic and work it on the spot. we will have a better work force to support epic. the number is an estimate based on an average cost. we're expecting the conversion will come primarily from the health worker class and the clerical class. we don't know until we complete the h.r. application process.

we need to know what are the classifications to be converted. i've estimate the average cost of 130 people who schedule and registering is $40,000 per position including mandatory benefits. we want to make sure we have the position authority and the actual amount may change. our goal is that no one will be left behind and we'll train staff to make sure we're up to speed once we go live august 3. next initiative is around increasing capacity as members of our finance committee may know. we have a significant number of contracts and over the past two years the dollar amount has grown significantly and the complexity and additional dependencies and new programs. the department is growing and we've been expanding our

services. to make sure we keep up with the contracts and following the appropriate protocols, we're requesting to increase the capacity within contract. some commissioners may know in prior years we've done some work in increasing capacity within i.t. and h.r. i think it's time for the contract staff to also serve a little bit of a right sizing to make sure we're supporting the contracts and they're getting through in a timely manner to make sure the services are really getting out the door. the last item in our emerging needs is around equipment needs at zuckerberg hospital. we opened up a new hospital in 2016 and with that new hospital we purchased new pieces of furnitures or primarily new pieces of equipment to support the new facility. when we purchased them, when we

purchased or leased them, the time is up and we ned to maintain them. -- need to maintain them. planning ahead knowing in 2021 we will have additional cost that we'll need to incur. so we're budgeting for the continued support for those pieces of equipment. and then lastly, our contingency proposal. as we mentioned in december in our first hearing the mayor asked to us provide a 2% reduction going to 4% as well as a 1% contingency proposal on increasing to 2%. for our contingency proposal nor time we're putting forth additional salary savings in our budget to be used and should the

mayor's office want to implement the department's contingency proposal we'd like to have a further conversation with the mayor's office but this is what we feel comfortable putting forward now. >> we grew by 280,000. so with your approval, we will submit both synonymous of initiatives to the mayor's office and controller's office and work with them on the next step towards the june 1 proposed budget and then we'll move on to the board's review process in june. that's all i have. i'm happy to answer any questions. >> commissioner: was there any public comment? >> clerk: i have no requests.

>> commissioner: prepare for discussion at this point. commissioner green. >> with the schedistration you have toe you have to look at the salary and whether the system gets up and running and whether the number for fiscal year '21-'22 may shift. >> there are some efficiencies but the overall work load hasn't. you still need to make that appointment and you still need to check the eligibility and we still need to register with the patient again. i think the initial understanding was we were a little bit wary in making assumptions about any reduced actual work as more of an idea

of combining the work flows together so that something we can look at sort of as we move beyond once we get into implementation but it seems too early to bank on efficiencies at this point. >> my other question as you look at the other mental health initiatives and the extra beds coming along and so forth, how will that affect the lower level of care issues we face at the general hospital? in other words, the budget seems to be the same from january to now in terms of cost. do you have a sense whether there'll be an impact or will it be so small it's not worth putting it there? >> thank you, commissioner. that's a highly relevant question for all of us. so there's definitely a

connection and the aspects of how we look at that and we have lower level care days in-patient and acute psych. there's a number of different types of needs for what patients need coming from those different facilities. in a lot of cases and i believe we'll have a conversation at the commission the in-patient lower-level of care discharge needs are for sniff and then that of course goes to laguna honda and it has it's own level of patient care flow element we need to address to flow through laguna honda. that's a big part of the system. we have a number of that are high, repeat utilizers of our

system that includes psych emergency, in-patient psych, hospital for physical health issues. a lot of these investments we're making in terms of capacity but then in terms of system improvement to capture patients or engage patients when they hit our system and get them into a different level of care so they're not repeat hospital users. that's a big area of focus. a lot of our focus in terms of the beds is on individuals that are frequent users of our system. how do we create some capacity so that when they engage with our system we can get them into care and get lower level of care bed and prevent that recurring visit to the hospital. so there's definitely a connection there. one thing we've been spending a lot of time on in dr. colfax has

been pushing us to think hard about is develop more rigorous model for how we measure the success and the outcomes that we are anticipating from the investments in those beds. then how we translate that into success and outcomes we'll see at the hospital so that is worked we're pushing on and we hope to come back to you with data on. it definitely all fits into that conversation. >> thank you. thank you for this wonderful report. >> commissioner: commissioner sanchez. >> yes. i would like to congratulation our new director and our exceptional staff. in reference to the additional budget initiatives we look to focus on things that are critical in reference to due diligence in the department and as you said, the established office of equity.

we just got a couple years ago the office of compliance in order to do diligence at that level but for the whole system because of navigation problems which may flow flew a given department or division whether it's hospital or etcetera. i think this fits right in with the oversight and review that both our staff and community partners and the board will undertake with greater information and greater outcomes and presentations. also in reference to the combined scheduling work flow, that's part of the compliance unit. that's part of the equity unit. all these new departments will work together under your watch and i think it focuses on what we've learned over the years in preference to some things that have worked well and some things

we could have done better and some things we're still looking at. here we have a unique opportunity to utilize these funds to generation a more comprehensive model that integrates a lot of the positive best practices that have been going on in the past few years in particular that have been addressed because of the changes that have taken place. your budget speaks to these issues and i present it well and a know the commission looks for wa to additional presentations pertaining to how this overall operation works. i think it's an exceptional budgets with an exceptional staff and we thank you very much. >> thank you, commissioner. commissioner loyce. >> commissioner: thank you for the presentation. i had this conversation earlier today. the question of definition of terms when we talk about equity. ensure people inside the

department and outside the department understand what equity means from a department point of view and dr. colfax has explained that and disparity. it's important that as a department we articulate what we mean and repeat it because i don't think people learn the first time they hear equity versus disparity. i think you continue to intertwine and make sure intermly we speak from the same and externally people understand that and it's a process. it take time but we need to put it out quickly. thank you very much and thank you dr. colfax for your definition. >> thank you. i had one or two questions going back to the emerging needs. commissioner sanchez has articulated very well the reason we can ask these questions is

because of the fine work the department has done and particularly the presentation of the budgets because we can get down to what the issues are we're able to understand in the text where some issues are. if we go back to c5 and the registration process i'm still looking for a more definitive reason why we need to spend $14,000 per employees reclassifying and therefore giving them inincrease. there has to be -- an increase. there has to be an improvement not just because patients feel better. >> i'm the human resources director. the way we had been doing appointment scheduling and

registration we had 32 different employee classifications touching the process. it was spread out all over the clinics. so under the epic h.r., they told us you have to pull it together to be a more combined efficient process and we recommended the new classification and do away with the 32 and use the one. we turned to our own classification and the eligibility worker would fit that bill. so we worked with the unions and created and came up with a way to do -- the city has these skilled people. we had taken people and said we demoted them to more classifications an took away some of their duties and they call that deskilling. they were angry about that though it happened 10 years ago. we approached them about

upskill. we would take the lower classifications an up-skill them to the new 2903 eligibility workers and give them the opportunities to do the higher level work. we get a single classification versus 32 different classifications doing higher level work which is very good for the employee, it's good for the union and for us. we worked out an engagement to do that and we have 20 of the new eligibility workers online. we'll have 60 on board by the first week of april and have all on board by the third week of april. we're on schedule to do up-skilling. we have a good relationship with the employees and union and more efficient process under the e.h.r.

>> i like the nal gy -- the analogy. but you're telling me analogous loy we're asking them to do more than they were in their 30-different classifications because we're going to ask for greater skills and that part of this was educating them to more skills for greater efficient though there's an increased cost for these employees. >> correct. the employees in this classification will have additional responsibility go along with that. that means the cope of what they'll do in their day to day duties will be broad. i will add to what ron said, going back to when we were in the early stages of our journey

on epic, we hired a consulting firm to come in and evaluate our revenue cycle practices an tell us -- and tell us where our strengths and weaknesses were and one piece they identified early as weakness and an opportunity was the fact we had often inconsistent practices and in our scheduling across our department and we were not up to modern-day standard or best practices in terms of early financial clearance and in terms of gather the data we need early in the process which then will translate through the process of engagement and higher collections on the back end. when have you the data you have financial clearance and it translates to an easier billing

process and capturing more revenue through the revenue cycle. that's been one of our goals. one thing about epic, the way the system's set up, you have no choice but to do the schedistration concept where you do the process together-happily for us we want to and need to doit because that's the exact strategy we identified that's a revenue cycle for the department. when we look at how we're going change our practices going into epic and use this as a way to not just build the system that recreates what we're doing in the past but actually change the way we operate so we'll maximize the new tool we're invest inning, it's an opportunity we have. if we look at the current financials on just our fee for service collections alone, it's not even thinking about our

capitation but 1% increase in productivity in terms of revenue is $5 million to $6 million if you have capitation and get people enrolled earlier you're talking about a small improvement in cycle productivity having a big revenue outcome. for all the reasons of the labor reasons and personnel and respect for our people and the ability to train our people in new skills, in addition our financial strategy depends on us being successful in using the epic cool in the way it was designed and using it optimally to drive i mproved collections for the work we're doing today and the%s -- and the patients we're seeing today. >> commissioner: thank you. i appreciate that explanation.

i think it helps all of to us understand moving forward >> commissioner: a new process with new skills and improved services and improved collection. thank you. let me go on to one or two other questions mostly on my tone get clarification. on the contingency proposal, there are salary savings reductions. to put that into some perspective, what percentage is $6.5 million over our total salaries now? >> our current salaries are about $900 million to $1 million. salary represents half the department's budget. it should be in terms of actual -- i can't do the calculation but that's the context for the salary savings. >> commissioner: so it's a small percent of our total salaries.

>> yes. and i'd add for context on this, jenny, described it a little bit but we're putting this up as a place holder. as you know in the past, sometimes the contingency proposals are factors into our balancing. for example, if you look at our last year's budget proposal, we had sufficient revenue projects to be able to meet our target and meet our contingency. in this case, we don't have the revenue projection that allows us to cover both of those. we've kind of put this in as a place holder. we know there's a real financial concern on the city's behalf because there's uncertainty about big items. the one being the cost of almost every labor contract being

budgeted in the labor season. it means there's a possibility there'll be a need for the contingency proposal but we haven't fully get fined -- defined this. we put this out as a place holder and communicated with the mayor's office about the fact that we're presenting a general proposal. if it does come to be the case that we need to actually implement a proposal, we will work with the mayor's office and come back to the commission with more details about how we would profoes -- propose to implement it but at this moment we're not defining it as the level saying how we'd operationalize the savings until we know we are actually going to need to operationalize and need that contingency proposal. >> part of my reason for asking

some of the down grading of the employee status is at one time salary proposal. i wanted to make sure it was not locked in stone. that was the only way we were going to need to meet a contingency because that sends different signals about being prudent about the $6 million. the department lost some time in doing our initiatives because we lost part of the expertise within the department to do that when we had to then take the entire budgets when there were other areas that should be looked at. >> for the moment it's a place holder. if there's need for to us implement this we'll refine it

and come up with something we feel we can operationalize versus something to be unspecified proposal that ends up harming us. >> commissioner: my last question is because of my total ignorance, i cannot understand under the breaking newsing slide, i -- the balancing slide, i don't understand revenue growth assumed in deficit. what really does that mean? >> from the prior budget proposal we showed you the mayor's five-year financial plan. what you saw in the five-year

financial plan was assumed growth in revenue as well as assumed growth in baseline growth in expenditures and there's this gap expenditures were outpacing the growth. and so the assumption behind the 12.9 going to $29 million is a 2.5% increase in baseline revenue growth for capitation and fee for service and some adjustments related to laguna honda baselines. because it's already assumed as the solution for a portion of it was assumed to close the deficit, we didn't want to double count it and we had to back it out. >> commissioner: so we're taking out what was an assumed growth

and that's what you mean by reducing the revenue growth. >> again with the assumed growth and expenditures you'll see what you don't see in the d.p.h. proposal is increasing infringe benefits lithe health care costs and pension costs or m.o.u. related to overall salary increases currently being negotiate order inflationary costs such as pharmaceuticals. it goes both ways. where we lost some credit in terms of revenue we're putting forward but in terms of what we get back in support in our expenditure growth, you're not seeing that in the def fit or proposal. >> commissioner: that's just what a needed was the definition, thank you.

commissioners, further questions? we have a delayed submitting this to the mayor's office in order to allow our director to also envision the budget as the director happy with the -- >> i'm grateful to the team for the work and they make it seem to clear but it's tremendous clear up front and in the background. i want to thank craig wagner who did much of the work and being acting director and jenny louie to help me understand the budget process so just to acknowledge them and their team. >> commissioner: realize with that this is now your budget. >> thank you, commissioner. i appreciate that

responsibility. thank you. >> commissioner: if there's no further discussion a motion for approval is in order. >> so moved. >> second. >> commissioner: is there a further discussion? if not all those in favor say aye. opposed? dr. colfax' budget has been submitted. >> clerk: item eight is incarceration as a public health issue and this was considered at the community and public health committee twice in january and february. >> good afternoon commissioners. naveena bobba the health direct.

you have the updated resolution in front of you. i wanted to talk about the process from here. so you have an idea where we're headed. one of the things we've been looking at is the risk factors for incarceration. you'll see from the slide the risk factors are on the individual level, family level, peer level and community level. it's going to be incumbent on us from a health perspective to look at the risk associated with each level and what's the work happening in the department to address he's risks. some things the department is directly responsible for and some are working with partner but on the individual level, substance use, mental illness, physical and emotional abuse or neglect which stems from the aces, trauma, prior incarceration, sexual abuse as well and risk factors for

incarceration and prior substance use or mental health issues, pregnancy and on the peer level and this is talking for adolescent population peer groups that engage in risky behaviors, adverse learning environments, gang involvement and a low socioeconomic status, neighborhood violence and crimes, poor housing and living conditions and discrimination. they're all risk factors and incarceration impacts all these levels. when somebody is incarcerated the community is all impacted. in looking at that -- this is a sample of the initiatives on the prevention, what we do to prevent people potentially being traumatized or getting into a violate situation or being

incarcerated and some prevention efforts you heard about. the nurse family partnership, hope s.f., school-based programs and our treatments and substance use and mental health and the people in risk. comprehensive crisis services, street violence intervention program, street medicine and mental health diversion. for the incarcerated population the jail health services is fundamental in providing services and our collaborative core connections. and post incarceration in the re-entry process. there's several initiatives including the center treatment program and the clinic network. these are a snapshot of the ways we're looking at incarceration. the goal is after this is for us to take an internal catalog and

determine the goals of the group and objectives and time line. after those are set ensuring there's a mechanism we incorporate and partner feedback. and to develop the backbone needs of the work group. though it's interm there'll be a significant amount of effort include need for a consultant and we're hoping to have a kickoff in the late summer or fall around this. we'll provide updates to the health commission as progress is made. that's the general overview once the resolution is passed. and i'm happy to answer any questions. >> thank you very much. we do have a number of public speakers. we'll take each in the groups

and i'll call the names and i'll call the names. [reading names] >> to those that are new, i have an egg timer and when it goes off, your time is up and let the next person speak. >> taxpayers for public safety. president chow and to the commissioners and new director colfax, thank you for taking us through and letting us contribute to this proposed resolution. incarceration is a public health issue. we have dearly appreciate the

two critical committee meetings we had chaired by commissioner loyce and members bernal and chung. and the robust may 5th discussion here and so we really believed that the resolution has been improved and we really like the action plan. thank you for that. in addition i want to thank the staff leadership of dr. pratt and their teams and dr. bobba because without them we wouldn't have been able to go through the robustness of this and the exchang exchanges back and forth in plowing the interest and developing our relationship to preventing incarceration and inappropriate incarceration. so we look forward to that and

appreciate your ability and commitment to include in the 2019, 2020, 2021 budget of the jail replacement project recommendations from 2016, 2017 and 2018. we appreciate you're not waiting for the kickoff but are accepting what the consensus of the jail replacement project already brought forth. thank you and my last comment is to quote mayor breed who says as often as she can, thank you for your leadership and your service and we still have a lot of work to do. thank you very much. >> commissioner: thank you for coming to continue the work i

understand our social service is here and wondering if at this time we can recognize her and ask her if she'd like to say a few words and then we'll proceed with the rest of public comment. i'm sorry i didn't recognize you out of uniform. >> but i am wearing clothes. thank you, commissioner chow and commissioners. dr. colfax, good to see you. i work very hard on the work group to reenvision -- re-envision the jail and working hard with the people here and the recommendation recommendations i can support. i do have to say i was listening and talking about appropriate and inappropriate incarceration. i know we have a lot of work to do. i also realize it's been over

three years since we started this process and county jail still has the same count and the same issues going on and i have to stay that i am as a person in charge i hate the facility is still open. as a person who accepts people in jail and my role as social service, that's my responsibility is to run the jail in a humane and safe way and safety being the top priority for everything we do. i'd like to see more movement in the direction of the other part of the resolution that created the re-envisioning the work group to re-envision the jail. we have beds being operated in a way i don't like to operate.

do i think eventually as the years pass and time passes and as we decide to close the hauls -- halls of justice completely we'll have people in another county jails possibly alameda because it's the only place with room. and one more note, in san francisco, we have more people out on pre-trial release than anywhere. 53% of people on felonies, mostly felonies are out on pre-trial release. san francisco has been at the forefront of reducing the jail population. i'm hoping the steps we're taking here will result in the population going down and people being more appropriately housed i support that fully but in the meantime i'm concerned about the people remaining in the facility i think is pretty bad. so that's all i have to stay.

i do support the resolution though in the fact it's building upon the hard work everybody did, community members, people in service to the city and others. they worked hard to put this together and i do think everything has value they put together in the resolution. >> commissioner: thank you very much. proceed with our continuation to public testimony, please. >> clerk: good afternoon, i live in san francisco and work at help rate 360 a non-profit health care provider offering mental health services to more than 30,000 california ans. last year we served over 500 people in seven jails and prisons throughout california. we appreciate the department of public health's department to provide health interventions for those incarcerated dealing with

trauma and other identified health needs. it's encouraging to d.p.h. recognizing social inequities are involved and recognizing the wrongful homelessness and other situations lead to incarceration and we should help improve their lives not punish them for the help they need. we know those in california lose their medi-cal upon incarceration and it's a major obstacle for our clients needing treatment after imprisonment. we applaud the interventions offering help to those after release. we believe community-based treatment is the best way to

address behavioral health or substance use disorder. we look forward to d.p.h.'s report and looks to evidence-based practices for expanding care and improving re-entry services. thank you. >> commissioner: as we wait for the next speaker, i'll call four more. [reading names] >> good afternoon, commissioners i want to join in thanking you. >> commissioner: identify yourself for your records if you wish. >> i'm kate monaco cline. i worked as the director of the

friends of gate project until a few years ago a program of jail health services. i also worked in the sheriff's department as well. i want to thank you for taking on this issue. i've looked at this many years and it's exciting to see it to move to public health where i believed for a long time it belonged. i was going say more about this but we talked about a discussion in the last haith commission meeting about data. one of the things that struck me is in all the years we talked about jail overcrowding, data always comes up as a reason we're unable to move forward. i don't think that's going to happen this time and i don't want to minimize the significance of good data but in looking at this from a public

health perspective we can't let the data slow us down. secondly, there's a new book that's come out written by the director of the richter's island health service and by san francisco is by no means at all -- [indiscernible] there is one commonality the author raises and that's jail confers simply by virtual being in custody confers new public health risks. the sooner we move the discussion about incarceration into the public health venue, the sooner we'll have a healthier city. thank you very much. >> commissioner: thank you. next speaker, please.

>> good afternoon. i'm javier bomond. we're a supportive housing provider based in the tenderloin. i want to thank everyone who put in the work to bring this resolution to light. because with the residents we work with in our buildings, there's been countless people i've worked with who have been effected by the incarceration system and have been formally incarcerated and it's good to know san francisco is on its way to showing it's communities and recognizing some of our biggest issues such as homelessness and substance use and mental health issues and incarceration and our justice system are linked and our low-income communities face

the most. i think one of the great things about recognizing incarceration as a public health issue, what our residents face when they get in the system is an incredible sense of isolation and to know the city is treating this as a public health issue and looking at the wired community as opposed to singling out individuals and keeping them in cycles of poverty and they'll be able to get the help they need and they can reintegrate to society in a more just way. i want to appreciate the work in the resolution and i'm in full support of it. >> commissioner: thank you. next speaker, please. we had one more speaker i want

to call, sophia simon ore it's and those are the only speaker cards i have now. if anyone else wishes to speak, then please turn it in to our executi executive sect -- secretary to the list. >> i'm ron perez. i am formerly with the sheriff's department and i left in approximately about eight years ago, 10 years ago. the sheriff's department made a bold move that originated in our san francisco county jail. they recognized we had a

significant population of veterans. again i'm with plows shares and you've aware of the work we've done with the veterans population addressing swords plow shares and we identified veterans in the county jail and providing services but the social service created a special housing unit just for veterans and we had a unit that housed 48 veterans and we were able to show we warranted having a veterans court. three years later we were able to get a veterans court up and operating and because of the combination of works, plow shares and the veterans administration and the community, the program i run now in the county jail which once had 48 beds and a waiting list,

i now average between 15 to 20 veterans on a daily basis. we currently have approximately 90 veterans that would have been incarcerated now in veterans court. one think they received was obviously getting shelter, treatments and continuing care and this has had a dramatic impact on our veteran population in the county jail as i said before. we started with a housing unit of 48 and now we're down to 15 as of today. >> commissioner: thank you very much. next speaker, please.

>> good afternoon, commissioner. i'm the city wide social work at pretrial die -- diversion. i work with those with schizophrenia and bipolar disorder and i was brought on to access services for them in mental illness. as it turns out none of my clients are only dealing with their mental health. they're all experiencing homelessness, chronic homelessness, addiction, zero family or community support. many are survivors of complex trauma such as financial abuse, sexual abuse and institutionalism and much more. when folks are taken by police and taken into custody they lose support. i have seen them lose medi-cal and social benefits and families

have cut them off financially and emotionally. if a client was lucky enough to have housing they often lose it and back on the streets. many clients are too disorged disorganized to deal with the challenges. i support clients in accessing food, water, housing, clothing. i escort them to doctors appointments and make referrals and advocate for clients to get treatment and medical care. i intervene in in criseses to deescalate and make safety plans and as you can see my role does not translate in custody. of course we know clients receive services in custody but can be provided with more intensive services out of custody but deeply support them to stabilize in