>> good morning. this is a thursday, october 17, 2019. i would like to reminds members of the public to please silence your mobile devices. devices. i would like to take role. (role call). >> we expect commissioner koppel and richards to be absent. >> i'll be taking role for the parks and rec. (role call). >> commissioners, you have one item under your special calendar, case number 2019

2019-106927-cwt for downtown park aloe caution, turk, hyde minimummy park and woo-woo park renovations, this is the special park allocation. >> great. good morning. i'm with the department staff and great to have you all together today. before i begin, i wanted to note one correction to the planning commission's packets, the first attachment illustrating the turk hyde is correctly labeled as attachment b didn't should be attachment a. the item before you today is the approval of an allocation from the downtown park funds for two recreation and park department assets. the first is an allocation of $550,000 from the downtown park fund for the renovation of the minipark and the second of $600,000 for the renovation of willie woo-woo playground. they will continue to upgraduate

the crucial neighborhood assets. the funding allocation considered today will withdraw $1,150,000 from the downtown park funds. attached is the staff report for rec part and the draft resolution that you all will be voting on today. with that, you would like to hand it off to the deputy director of planning at re rec k to provide additional details for this allocation. >> thank you, pa patrick. i'm stacie bradley and the item before you, as patrick mentioned is the allocation of funds for two of our parks and i'll walk you through the park area very quickly and then the two park renovations. if i could have the screen.

the zoning district is where the sea is levied and it can go towards parks that serves this district. we have circled turk hyde and willie woo-woo wong is in chinatown. for hyde, we're redoing the entire playground. this is in coordination of strengthening the existing parks. the park is expected to be opened in the end of the year and the renovation includes playground improvements, landscaping, irrigation, improved amenities and the current budget is $2.25 million

and we had provided bridge funding until we were able to come to the join commissio join. for the second park, it's in chinatown and it's a full park renovation. if yo.there is a new playgroundd new courts. the funding for this is to address un-foreseen site conditions and close the budget.

i am joined by our capital and planning director and our capital planning finance manager. if you have any questions about the project details or the financing, thank you. >> we will now take public comment on this item. i have one speaker card, full pp vitalli. >> i'm with the trust republic land. we're a national nonprofit. we've been doing a lot of work in san francisco for the past 45 years and a strong focus in the tenderloin area for the past five or six years.

we helped with the renovation park which opened five years ago and has been a model around the renovation in hyde turk. i want to support this fund to make sure this park is open on time. it's truly an asset in the community. they've been deeply engaged and will reflect their needs. there's a limited open space and getting this open on time is critical and we hope that you can support this allocation and make sure this renovation is completed on time, and open to the community, thank you. >> next speaker, please. >> good morning. on behalf of the committee for parks and recs in chinatown. our committee advocates and preserves open space in chinatown for the last 50 years. as you know chinatown is the most crowded town in the city. 400 to families are living in

single-room occupancy buildings. china's playground, th was builn the 1940s and the only playgrounds in chinatown for 80 years and the most popular. in 2012, many of our constituencies have worked with mr. ginsburg and the park's community, advocating for open space securing the funding for the china's playground and a lot of the families attend the committee meeting with the incredible design firm of cmg and we're looking forward to the opening next year, hopefully around chinese new year and where we create the plaza, where we call it the heart of the new

design. with dozens of exercise machines and we're anticipating that will be the heart of the new design moving forward, where it will benefit a lot of the families and seniors in chinatown. i hope you can support that from the funds. thank you for your support for chinatown and open space. >> next speaker, please. public comment is close. >> in, i believe it was 1992, i recall joining the citizen's group in the all-day tour of a potential open-space site across

san francisco. one of which was the turk hyde site. and the question that came up, and i sort of would like to ask staff whether the accessibility of that particular site or any site, where there is not a control component, whether it's a social service organization or are they related to it? is accessibility substantial within suppose open spaces? >> obviously when we do park renovations, sometimes the

motivating is to improve mobility, accessibility. >> not ada. >> with regards to the safety of the space? >> no, the amount of time that's available to the community. >> i mean, this is a playground. so for the sergeant mccaulley piece, there are to permitted activities that happen in a playground. for willie woo-woo wong, it's the community that will be doing the vast majority of the programming in the building itself. >> commissioner moore. >> i've been with the california

bus for over 35 years and i'm looking at the willie woo- o-woo playground, i'm wondering why it is in desire tate. this state. i'm wondering why making this particular site not only fully useful with the dense population and adults who are using that particular facility but also it's a visual gateway to chinatown and to union square, so it's an important land m foro acknowledge the park but giving it a phase that brings it into the family of well-designed parks in downtown san francisco. so i'm delighted to support it and see it realized as quickly

as possible. >> i'm thrilled that we're doing this and i think chinatown and the tenderloin are underserved communities when it comes to playground and i'm thrilled we're moving forward on this. did you want to chime in, commissioner johnson? not. >> any comments? seeing none on our side, what do we do next in. >> a motion. >> someone on both commissions will be taking this separately and you need to make a motion seconded to approve or act otherwise. >> commissioner johnson? >> i am delighted to make a motion to approve. >> second. >> so moved on our side. >> i think we wait for them and they vote on their side. >> thank you, commissioners. there's a motion and a second to

approve the allocation of the special park fund. so moved and that passes unanimously 4-0. >> the chair will entertain a motion. >> so moved. >> all those in favour. so moved. thank you very much. >> so we're done. >> short meeting.

. >> order. hi, everyone. i will note -- well, i'll take roll call. [ roll call ]. >> so before we begin, first of all, thank you, everyone for being here. the commission is grateful for all of the public comment that we've gotten in the past few weeks, specifically with regard to homelessness and behavior health. there have been some announcements in the news in regard to that. in keeping with our responsibility at the department of public health, at our last meeting we had a presentation on

the adult residential series. today it is part of the three presentations laid out by president loyce. we will be addressing some of the needs of the public health services. then at the next meeting we will have a presentation which will be an overall of behavioural health programs in the department. in addition, i would like to on behalf of the commission, welcome commissioner suzanne gerardo. she has been the chair of the san francisco families first five commission and the founder and trustee of the demerlac academy which is serving underserved children and families. you certainly bring a lot of credentials to the commission, and we're very happy to have you. would you like to say a few words? >> yes. i'm very happy to be here, and i

hope with my background in mental health, behavioural health, as a practising psychologist, i'm not just an administrator, i see families and adolescents daily. i look forward to being part of the planning, program, and solutions as the department of public health moves forward. so i welcome the opportunity to serve the city. thank you. >> thank you. welcome, commissioner. >> the second item on the agenda is the approval of the october 1, 2019, minutes. >> okay. after having a chance to review, do we have a motion to approve? >> so moved. >> second. >> all in favour? >> aye. >> minutes approved. >> thank you, commissioners. item 3 is the director's report.

>> good afternoon, commissioners, director of health for the county and city of san francisco. i also just want to extend my warm welcome to the new commissioner. you were just sworn in about 45 minutes ago and getting right to work. very much appreciate that. it is with the spirit of the health department that we get right to work in solving problems. we are so excited to have your wisdom here to help us figure out how to do it better across the department, but especially with behavioural health. as you know, as we talked, there's a lot to do in this area. i'm very excited. the health department has done big things in the past and we will continue to do big things with your leadership and the rest of the commission. thank you for being here and look forward to working with you. >> thank you. >> so the -- a couple of other things in my director's report that you have in front of you.

very exciting announcement from mayor breed with regard to launching the urgent care s.f. initiative. this is a bold vision to expand our behavioural health system, just focus on the people who need it most and for who our system of care is currently failing. it really is about focusing on the 4,000 people that our director of mental health reform has identified as the most in need identified by their being homeless, suffering from psychosis, and also substance use disorder. . the initiative reflects input from community partners, medical providers, and other clinicians, is informed by data and evidence, and i think most importantly reflects the public's passion for addressing this issue. at the end of the day i think from a public health perspective and just in general, this initiative will save lives and

it will address the behavioural health crisis that we're currently seeing on the streets. the mayor is proposing, among other things, an expansion of 1,000 beds in our behavioural health system from residential law facility to boarding care facilities. that's a 50% expansion in terms of what we already have. the initiative is built around four pillars. one is creating a more coordinated system of care, reinforcing and expanding our outreach efforts and further creating no barrier and low-barrier care. two is strengthening and expanding our treatment options. so our programs -- the programs that work are expanding, and we have new innovative programs being launched and eliminating wait times for care whenever is

possible. three is strengthening our behavioural health care workforce both in civil service and our community partners. we know that recruitment, retention, and career development is a challenge for people and this will make sound investments to make that work. number four is ensuring that people have access to housing options to help aid them in their recovery. another key component is ensuring that we have evaluation and monitoring systems. so we develop feedback loops to learn what is working. we develop a system to learn what's working and adjust for what's not. we know that recovery is possible for people who have behavioural health issues. we know the system is working for most of the 30,000 people who are already in our system. i think it's important and well timed for the department to start thinking beyond that number of people and look at where we're failing. we need to expand and have the

resources to do better using evidence-based ways. from helping san francisco to addressing the aids crisis, we've done great things and i'm confident on this initiative and the support of you in the public, we will be able to move forward. a few other things on the director's report. i'm proud to announce that mayor breed and a few other supervisors announced the adult residential facility that we talked about a couple of weeks ago at commission. i'm pleased to say there's a balance that we agreed to where there will be a continuation of the adult residential facility. the final state after april 2020 is we would be running 41 beds in that facility and maintaining 29 low-barrier hummingbird beds.

in the interim, five people will be moved, provided it's clinically indicated or they agree to move to other facilities, to open up a 14-bed hummingbird that would last in april. people would be moved from that hummingbird to other hummingbird options and we would reopen to the state of 41 beds. really pleased that we were able to come to some agreement. i think the staff input and the collective problem-solving let us move in the right direction. the governor -- just another key piece of news in our rapidly developing behavioural health field, the governor signed sb-40 into law which helps strengthen our conservatorship and will help more people in what i

consider life-safing conservatorship. we will be able to help people for up to six months, provided they meet a number of criteria with regard to what these bills regarding we see the multiple offers of care. so we are working on this. a work group has been established. we expect to enroll people starting the 1st of the year. those are my key updates. there are a number of other things in the director's report, but in the interest of time and with the respect of the commissioners, i wanted to stop and take additional questions of what i mentioned and answer any questions that answered you in the report. >> commissioner green. >> thank you so much. these are wonderful announcements and wonderful news. do you have any sense for when the plan to re-open the rf beds

might actually occur? is because we have to address the patient safety and quality care issues. i think it was uncertain when we could accomplish that and if you had a sense of that going forward. >> the current state of the r.f. needs improvement. while we don't think at this time any patients are in acute danger, we think things could be better in terms of strengthening our quality of care. i've asked for a root cause analysis going forward to determine what are the staffing, what are the resource, what are the cultural issues that we need to fix in order to improve that. i think one of the key things that will help us understand that better is the working group that this agreement reached. so there will be a working group problem solving on a wide variety of issues while we continue to make significant improvements in the r.f. going forward.

the thing is, the r.f. is not closing. we will have the r.f. as we -- in the interim between the final state. we will have the r.f. afterwards, right. so we need to continue our current efforts to make the r.f. better, but this working group that will be meeting soon and establishing a process for root cause analysis will really, i think, hold the deeper answers. in april when we're ready to go to the 41 r.f.s, hopefully, we'll be able to do that in a way that is optimal for patient care. >> thank you. >> other questions? okay -- sorry, dr. chow. >> i'm actually quite excited about the mental health plan, first of all, because i think it offers many specifics that are really right on the ground. it addresses our workforce problem, allows us to have

resources to do what the mayor would like to have as the program for our mental health and substance disorder. so it's very specific. do you have an idea within this -- is there a time frame that some of these will be coming on that we could also be monitoring with you in the mayor's office? i'm glad there's an outcome component at the end, but as some of these come online, would we get an update on these? now we're going into these other units or we're in the course of hiring this or we're now working. i know we're going to talk about the whole-person program today. so that's one element. i'm wondering if we sort of have a map of how we're going to work with this, knowing that these details are still in flux probably. as we get more specific, it

would be really helpful to understand the road map of this. you certainly put together, and so have -- with the supervisors the adult facility use and you have a timeline for that, which i think is really good. it would be nice to know how we would be looking on, as best as we could, what we would be expecting in now called urgent care san francisco. is that unreasonable? >> so -- absolutely not, commissioner. just to also provide a little more perspective. urgent care s.f. is really a continuation of things the mayor has already started investigating in. if you think about the hiring of the director of mental health reform, if you think about the mayor investing in new behavioural health beds, around increasing the transparency of

care around our beds -- and what i asked for -- i asked to prioritize is a data analysis to identify exactly who we need to help. i think urgent care s.f. has been with us, we didn't call it that, but it's been with us for a while as we moved forward. when we looked at the data around the 4,000, for instance, only 10% of those currently have an intensive case manager. there's no way we have the tools right now to help the people on the street that we need to help. we are doing really good things with case management, we're doing it with some people on the street, but not nearly enough. what this vision does is sets a ro roadmap forward for the types of investments we need to do. we're starting with the 230 that we identified of those 4,000 that have been prioritized by the department of health and department of homelessness and

housing. you'll hear about that with the whole-person care presentation. whole-person care is the operationalizing of our work with those 230 that really reflects i think the broader vision of what urgent care s.f. is trying to do. i don't have a start time for these additional investments. i do think that that's a conversation that's going to be happening at the mayor's office. the mayor's been very clear that she's looking for resources across a number of different entities to support this initiative, but regardless this work is going to continue in this direction in the principles i laid out. once i have more specific information about if and when -- or when i should say additional resources will be brought forward to invest in this, i'll be happy to bring it forward with the commission.

as well as an operational roadmap. i think that is key. again, we've done these things before. we will do it here, and i'm excited to share the next steps with you when i have those. >> so i would imagine some of that would be showing up in the budget for the coming year also, right, in terms of the 2020-21 program -- because these are new programs that were not part of the two-year plan? >> i certainly think that is one of the several mechanisms by which resources will be brought forward to support the department doing this work. >> thank you. >> other questions? we can move on to the next item. >> there was no public comment for that item. item 4 is general public comment. i have not received any requests, so we can move on to item 5, which is a report back from today's public health committee meeting. >> there were two presentations.

the first was from derek smith. we got an update on some of the initiatives of youth and adult smoking, some of the different approaches, pricing approaches, reducing exposure and accessibility. we also got an update on the flavored tobacco ban and some of the enforcement measures there and some additional information as we tackle youth vaping. that presentation is available online if anyone is interested in taking a deeper dive. we also had a presentation on h.i.v. health services, where we looked at a lot of the progress that's been happening in san francisco in these last few years since we heard from them last, with regard to having people obtain and maintain care. we also got an update on the centers of excellence, as well as other progress that's been made, of course acknowledging that there is still a lot of

work to be done, particularly with regard to the african-american community, and particularly transgender women of color. that presentation is also available online for anyone who would like to see more. >> shall we move on, commissioners? >> yes, please. >> item 6 is a resolution honoring dr. susan sheer. >> we have dr. sheer right up here up front. thank you very much. >> actually, yes, her supervisor is going to say a few words. >> oh, great. >> my name is wayne noram. i am the director of arches. i am here today to ask the health commission to honor dr. susan sheer for her many years and many contributions to public health and h.i.v. epidemiology and surveillance. >> so i believe that dr. cofax

also has something to say. >> so, dr. sheer, susan, i want to personally thank you for your contributions to the department. we met each other i think my first day of work in 1998. i just want to express my deep appreciation. you are a very humble person who does not have a lot to be humble about. i think your work in the department really extends not only to improve the lives of people living with h.i.v. and members with h.i.v. living in the city, but also across the country and across the world. we have to mention that you have published in international journals, you've done ground-breaking research, you've supported an incredible team of folks to do the work, you've mentored many epidemiologists

and scientists. you've led a life that i'm grateful for and personally very impressed by. thank you so much for your work. i hope you will enjoy your retirement. i also hope, as we work to get to zero and your leader in the getting to zero campaign, that you will stay engaged in some way. best wishes for you to spend more time with your wonderful family, who also do great things in their own way, but i think it's because of your support of the department that we'll miss you the most. thank you so much for everything that you've done and for your amazing team of people. >> dr. sheer, may i also -- some of us want to say a few words as well. first of all, thank you so much, dr. sheer. for my time here on the commission but also for many years before, you've been one of my heroes. for someone who has been living

with h.i.v. for 30 years and someone involved in the advocacy community and the service community, your work has been extraordinary. every time you come and see us here at the commission, it always gives me hope and reminds me of the amazing work that has been done by you and others for decades in creating the model of care in san francisco that became the basis of the ryan white care act and the ground-breaking research that has been done that has put us on course to be the first city in the country to limit h.i.v. transmissions. of course you're -- i didn't realize that you started as a volunteer in 1989. that was even a year before we had the ryan white care act. your work has been ground-breaking and it has given hope to so many people. i think i speak for the whole commission in expressing our gratitude for your best wishes

in the future. i know we'll be seeing you as well. >> i just want to say that while the other commissioners took all the words out of my mouth already, but having known you for so long and all your work and thanking you for helping to create an that my community feels safe and comfortable enough to see care and your brilliance working in this department. >> and, dr. sheer, before you speak, we would like to vote on the resolution. >> that's passed. >> thanks so much for those kind words. when i was deciding whether i wanted to be an epidemiologist or not, that i landed as a volunteer here at the department of public health. that was just a stroke of

fortune that i'm thankful for every day. i've had amazing support and colleagues. as what was said we worked together for many years. the commission has just been wonderful. i really appreciate the oversight, the questions, the pushing of the ideas and the topics. it's just been a really wonderful experience. what i'd really like to do is recognize the amazing h.i.v. surveillance team. basically anything i've accomplished has been with their support. they do the heavy lifting. their collecting the data, coding the data, cleaning the data, entering it, analyzing it, and then i get to stand in front of you and present it. they make me look good, make my job easy. i want to recognize them and thank them for that.

>> please stand. [ applause ]. >> dr. sheer, would you come up this way and shake everyone's hand.

[ applause ] [ cheering and applause ].

>> commissioners, the next item is the whole-person care, shared priority launch. the second person is whole-person integrated care. >> hi, commissioners. thank you for welcoming us today. i'm going to -- i'm the director of whole person care. i haven't seen you for a while. nice to see you. >> welcome. >> i'm going to be talking today along with dr. hallie hammer

about some of the work that we're doing around trying to think more innovatively for the people we serve who are experiencing homelessness on the streets. so i'm going to talk about the inter-agency shared priority launch. and dr. hammer is going to follow he and talk about the whole person integrated care that we're working towards. it's not moving forward. the there. whole person care, as you may recall, i was here about a year ago, whole person care is a medical waiver. it is -- so can i get this whole thing on the screen there? whole person care is a medical

waiver started in 2017, will end in december 2020. the department of public health services gave money for counties to address vulnerable populations. counties were invited to apply for innovation for their particular vulnerable population, and san francisco chose adults experiencing homelessness. part of the deal was that we were to work in across agencies to address the social determinants of health in order to improve healthcare. we are paid to deliver services that medical doesn't pay us to do, we get money for sobering center, medical respite, care coordination, housing services, for assessing people to

prioritize them into housing. so all these services, about $36 million a year to san francisco, half of it is a match. i am going to talk today a little bit about what we're doing now with whole person care. these are our departments. department of health and homelessness are the co-leads with the state. included is benefits to the department of human services, aging and disability services -- aging and adult services. and then e.m.s. services through the fire department. in addition, we do a lot of work with ucla and we can talk a little bit about that. three prongs. what we need to accomplish by the end of december 2020 is how are we going to come together and think from an inter-agency perspective how to prioritize the over 17,000 people that between the health department

and the homeless department touch who are adults experiencing homelessness. i am really excited to say we have achieved that. i am going to talk a little bit about how we got to that. once we establish what our priority is, now we need to agree how we are going to gather and address that population. the inter-agency shared priority launch today we will talk about as well as the whole person integrated care. those are two ways significantly -- different innovative ways we want to address the population. the first is a coordinated care management system that integrates data from 15 different datasets. we've had that from 2005 which -- all the data i'm going to share with you came from that system, could not know these systems without integrated data. i'm not going to talk about

where we are and where we're going with new technologies, but i will be back to talk about that. we have touched and served over 17,000 people in a 12-month period. they either showed up is and said in an emergency room that they're homeless and we record them, or we're on the streets and seeing and observing that they're homeless. of those folks, the doctors asked me of those folks experiencing homelessness, who among them are suffering the most from psychosis and co-occurring substance use disorders. using that data, we were able to identify almost 4,000 people who have a history of being and psychosis in their background and also co-occurring substance use disorder, which includes alcohol, cocaine, opioids, or

stimulants. that's about one in five of the individuals who have that history. of those folks, most of them, 80% of them, are getting their care in emergent and urgent fashion. 95% of them have had some history of alcohol use disorder, but only 6% of them have utilizing the sobering center. 35% of them identify as black african-american. we've always known that there is a high -- a disproportionate share of homeless adults who identify as black or african-american. if i find source data and say those folks experiencing in and out of homelessness for more than 15 years, that will go over 50%. that gives you some sense of the

equity issue here. in terms of of homelessness and psychosis, we've known this is a fragile and medical condition, it's very serious. we see 12% who have some history with h.i.v./aids, congestive heart failure almost two-thirds, hypertension and many in renal failure. a very significant number. aging, there are 113 of them who are between the ages of 18 and 24. jail interaction and over 40% of them cycling in and out. it's a vulnerable population. we've been working together on this population in one form or another since with barbara

garcia in 2003. we've known from a population perspective it's very vulnerable folks out there on the street. for whole person care we engaged with 400 people to ask them what their priorities were. we did a summit with the department of public health and the department of homelessness and supportive housing under the leadership of roland and carie and together built this vision and designed the process that i'm going to walk you through today. for the inter-agency prioritization method, essentially, if you are familiar with the coordinated entry assessment tool, it was a tool that was designed by the homeless department last year. 17 questions. you sit down with a person for 20 minutes, ask the questions, you enter it in and it ranks them in terms of vulnerability. so we have endorsed that tool by the -- the department of public

health endorsed it because we looked at the historical data and looked at who they're assessing and prioritizing, and there was a proof of concept. we endorsed and adopted that tool as a way of prioritizing folks. we have added to it that individuals experiencing the psychosis and co-occurring substance use, it's a way of ranking those folks. i'm going to talk a little bit about that. so there are a lot of numbers here. again, 17,000 unique people who have been experiencing homelessness. if you stay in the green lane there, 6,500, almost a third of the people have actually sat through that 20-minute interview and been assessed. of those, a thousand people have been prioritized, and of the thousand people 237 have that history of co-occurring psychosis and substance use disorder. does that make sense?

that's how we got to 237 is following all those yes's. essentially what that is is we have two big departments, different perspectives, housing and health, who come together and say we agree how to prioritize folks for these services for permanent supportive housing. on the no side, there are still people who have been assessed and not prioritized with that health history. there are people who have yet to be assessed with that tool. those two lanes, the director and myself are working with the homeless department to try to have a solution for that. how do we get this tool to people experiencing psychosis who maybe cannot show up and sit through a 20-minute interview. how do we get the folks experiencing homelessness assessed by the homeless department?

so now we have agreement of who is our highest priority. now we are working in the midst of figuring out together how we're going to respond to these folks. all those summits and workshops brought us to a number of things. one is the launching of the shared priority response, which i'll talk more about today. dr. hammer will talk a little bit about the homeless health resource center. so let me talk a little bit about the launch. so before we started on the actually delivery of these services, together we came -- all these agencies came together and said what are our principles? we need to follow these. one is this prioritization process used to be who do you know and what are the work-arounds from how the system isn't working? so this is now a process that

was developed with this -- how can we be very transparent, do it fairly and equitably to prioritize people, even when we make exceptions, how can we be transparent on that? the pathway to the services needs to be clear. it needs to be adaptable to individuals. it needs to be hopeful. there needs to be a sense that positive change is positive. then obviously the racial equity lens and that together -- because we're doing this with all the agencies together, that we need only share in the success but also share the accountability. there are three teams working on the shared priority launch. the first one is an internal group of people. whole person care is providing a lot of the structural support in helping us implement this. that's the inter-agency project team.

the inter-agency project work group are people from the homeless department, people from behavioural health services who are working together to go through the list of 237, where are we now, and where do we need to be with these folks. then we have a group of folks who got together last friday for the first time who have the ability to unstick or unjam doors who can think from a systems perspective, who will be responsible for making sure that what we're doing is actually aligned with all those shared principles. we'll be bubbling up recommendations to the executive directors of these departments to say this is how we think we need to move forward. there's a list of people and roles and responsibilities in your -- you can look at it more closely. so what our priority goal is

that we health, housing, and human service together will adopt whatever it takes. approach to place these vulnerable clients who are experiencing homelessness into housing or other safe settings. we will be developing a street to home plan for each of the 237. this is a one path, but essentially the idea is to keep everyone focused on what we're trying to accomplish here. it's not to solve everything, a lifetime of i'm sure very complex psychosocial and medical issues. it is how can we together show up and help these folks get from the street to their home? how can we help them stay successfully in their home? so there are many ways that they enter. some go through pt vment subsidy some through the emergency room, in-patient, on the street. so we are working together with

them to figure out these pathways. when this happens, who gets called next and how do we get them there? what's different about this, because you've probably heard me come and talk to you about hums and other things in terms of our most vulnerable population, this is really different than anything i've been able to experience in the last 22 years and i'm really excited about it. one is that we are prioritizing individuals in an inter-agency way. there is no longer 14 lists, there is no longer, well, who's at the table to advocate for it, engaging -- we're activating alerts in the systems. we have a single coordinator who has identified an air-traffic controller. for each one of the street to home plans, we'll be identifying is a navigator sufficient, do

they need a certain case manager. we are developing what i think is very exciting, something called a high-intensity care team. i'll talk a little bit about that in a second. with the street to home plans is integrated for each of the individuals and the resources of people coming to the table will be prioritized. this is based on evidence. i'm not going to read all those. that's for your reading pleasure. for the first response high intensity care team is a combination of e.m.s. 6. they started in i think 2003 with neil singerlinni looking at high users. it's come back and been successful, but it's also fairly narrow. we've taken that success of that team and added a psychiatrist from the street medicine team and added a case manager from

the hut team and that's the inter-agency part of it. they will be the first responders. those alerts will be put into epic and avatar and c.c.m.s. and the systems in the homeless department to say if this person shows up, you will be able to see that it says this is a shared priority client and it's high priority for housing, health, and human services and to contact the high-intensity care team. they will show up -- this is something that is new and has been asked for from the hospitals and the emergency rooms for years. when they show up, we need somebody to come because they go in and out, in and out, over and over again. this team will be available from 6:00 in the morning to 2:00 in the morning every day, seven days a week to respond. i'm really excited about this. what we will be measuring with the help of the university of

california evaluation team, we'll be looking at creating a dashboard. when i left my office, they were creating the dashboard to be able to see how many of the 237 have been housed or placed into a safe setting. is the quality of their life improving. we'll be using the behavioural health assessment tool, the ansa, for individuals to look at that score. we want to reduce avoidable use of the urgent/emergent services and increase their engagement in more community-based behavioural health treatment. and also to make sure that they're increased in enrolment benefits, be it s.f. advocacy or food stamps. 100% of these folks should qualify for the food benefits, and i think half of them have it currently. we're going to be evaluating the

pilot itself. my team will look at how we're working together in this intense focus so we can know how to sustain this. we will be evaluating it probably in february and then course correcting on it. i'm happy to answer any questions, but i think i'll turn it over to dr. hammer and i'll be back if you have questions. >> thank you. good afternoon, commissioners. it's such an honor to stand before you on this exciting day for public health in san francisco and tell you about an important new initiative that we're working on that's directly linked to whole person care and is an important part of the care delivery system for the people that were just described. so why whole person integrated