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 care? this is an idea which has been in evolution for over five years. as i'll show you today, whole person care is specifically maria and her team's work to look at the data -- to gather data to help us coordinate care for this population. is what's key to sort of laying the programmatic foundation and groundwork for us to be able to bring previously really disparate clinical services together so that we are integrated and coordinated in our work to serve this population. so what we have had in the d.p.h. are different services

which were developed to still perceived gaps, but not this overall population-based strategy. so our urgent care services, clinical services in the supportive housing on the streets and shelters, but not really coming together to talk about individuals, to plan our services to take this population-based approach. in addition, we had different clinical models. so everywhere from an episodics or urgent care model to see people when they come in, to more of a longitudinal model like we have in street medicine and shelter health. also inconsistent coordination with behavioural health. so whole person care really provides this programmatic foundation that we needed to ground our work to indicate

these clinical services. so basically what we're talking about is these basically five different clinical programs and bringing them together under a new clinical service and ambulatory care called whole person integrated care. there is tom woodel and then also our permanent supportive housing nursing services. this very simplified organizational chart of the health network gives you some idea of where the services sit. some in the transitions division, some in primary care, and then also working with programs that are located in behavioural health services.

so the new whole person integrated care program is as i mentioned in a section of ambulatory care incorporates all of these services and brings together specialized staff who for years have been working across practice settings to work together to more effectively care for the population. we're really excited that, as was mentioned, we will be -- as we're doing this programmatic integration work, bringing together our staff, our leaders, our clients to develop the care model, we'll also be planning for our new home in the homeless health resource center at 7th and mission. so here, next slide is a timeline that shows how we've

gotten to this point, where, again, building on the work of whole person care, looking at our different disparate clinical services, and then given this exciting opportunity to team up with the mayor's office of housing and community development, with episcopal community services, with mercy housing, with the homelessness and supportive housing department, come together and -- i'm sorry, as well as the h.s.a. in a new building where there will not only be housing, but also on the first and second floor this whole person integrated care homeless services hub. so that's whole person integrated care. i'm happy to answer questions.

>> commissioners, there is a public comment before we get -- >> public comment from former commissioner romagiey. >> short people have to practice doing this. good afternoon, commissioners. first of all, i just wanted to say to commissioner gerardo, welcome to an interesting time. it's a new era and we're focused a lot on behavioural health because that's why we're listening today. i just want to say welcome to it because today is a good day. thank you for the resolutions on the arf because it really got us agitated. you did come together. thank you.

now we need to move from here and what i want to say is it's wonderful. usually i come with lots of challenges and criticisms and whatever. today is a day that i want to say thank you to ms. martinez, dr. hammer, and the whole team who has been working on this whole person care for years. i've met with you and asked lots of questions and whatever. a slide presentation is not everything, so i do have some questions. i'm going to leave that for another pay perhaps to understand it better. thank you very much because from our perspective, from taxpayers for public safety, this is not trying to better an old way that isn't working anymore, no matter how successful it was in the past, but on a new pathway and taking evidence to bring to a

new opportunity which always has a cautionary risk to it, but with monitoring and evaluation inside and out. so we want to thank you for that. we want to thank you for the leadership. we want to thank you for all the teams at the management level and at the frontline. i would just like to add that we would love you to also do public forums so we don't get so agitated because we don't know what's going on. we want to be a part of it because we are a part of it. we are a part of it as advocates, we are a part of it as past policy people, past consumers of your services, and current ones. we just want to be a part of it. we don't think it's okay when you don't share with the stakeholders and the taxpayers who are bringing our part of the contribution to your work.

so i want to thank you for that. on the jail, because i'm interested in the jails, i thank you for integrating a part of it. i notice that the jail is part of the service group, but i think also you're going to find that there are some real systemic issues in terms of immigration -- yes, immigration, but integration. i think maybe you want to look at putting someone on the systems group too. okay. thank you very much. >> seeing no other public comment, commissioners? >> thank you for the presentation. we in the beginning -- i also know about all the challenges to house the homeless especially those who have behavioural

health issues. the challenge back then, and i anticipate this might be the challenges once they're housed, they don't necessarily open the door for you anymore. so the issue of engaging them kind of shifted, but i'm glad to see that don nursing is part of the plan. they won't open the door for the case managers, but they will for the nurses. glad to see it's integrated and this is not just like one specific program, but this is a system-wide approach, you know, a new approach to things. so i am very hopeful with some, like, measured optimism. i look forward to hear your progress and the successes so we can celebrate with you on them. >> thanks for your comment,

commissioner. i would like to say one of the exciting things about whole person integrated care is bringing together these really different teams and giving them the forum to learn from each other. i completely agree with you, i think the don nurses have a lot to teach us all about engagement, opening doors, trust, and that continuity relationship that really is the cement that allows them to do such really effective work. thank you for saying that. >> commissioner chow. >> yes. thank you very much for actually helping to be so clear about what the whole person care project is and where you're all going. some of it is probably driven by current events, but the fact that you've been working on this

for a number of years and we've all tried different ways to deal with the most vulnerable populations. the fact that you're able to bring these agencies together and have also the force of the city's structure to say the agencies will work together has been part of the challenge. i had several just sort of clarifying questions. if we looked at the opportunity amongst the 17,600 in the surveys you all have been doing and perhaps i need a clarification -- in the coordinated entry assessment, on the 11,000 that are on your red lane, are those people who have chosen not to take it or they're people we haven't reached out to? >> it could be both. >> okay. >> because the system that we

have integrates all the information from the emergency room, these could be people coming in quickly and exiting the city. so the 2,400 people who have not been assessed who have a history of psychosis and substance use disorder, the lower left, those are going to be the people we prioritize with the homeless department to get assessed. now that we have this sort of tacit agreement that this is how we're going to prioritize people, what i hear is music to my ears. has he been assessed yet? if not, let's get him assessed. so it is -- all paths are going to go through this filter. then we have 5,266 folks who did go through that process somehow did not get prioritized. so the director and myself will be working with the homeless department to figure out how to

get them re-evaluated or re-think this or have an ability to do a secondary assessment. maybe it's possible also that we begin over time to think about how to prioritize people without expecting them to sit through a 20-minute interview. so there may be people that as we work together and fine-tune this, i would say a year from now we will figure out how to get folks assessed and prioritized in maybe an alternate way. >> i read that while we're working at the 237 level, we think there may be another 3,000 or so who might, in fact, use this type of process in order to improve their lives and be able to treat them too. >> we're working together from the street to home.

the 3,735 is the 4,000 that you hear about rounded up. >> right. no, that's very good. i think that helps at least define for me what you're looking at and what this is a cohort of. then i looked at the street to home, but the home ends at the navigation center. we know that the navigation center is not a permanent home. what are we proposing as item 6? because ultimately a year goes by and we will now have used up a year in navigation, right? >> so -- well, 6 would be home. so that would be getting to their home and the right, safe place. >> i see. >> we need to have six there. >> it looks like navigation is the -- >> no. >> sorry. >> so that's a visual problem

there. the navigation center is probably the path to getting them to the home. so the 1,000 people who got prior -- we saw that we're serving them, we assessed them, we prioritized them, the 1,000 people doesn't necessarily mean that the other folks are not vulnerable in any way, but what it says is it's a very complicated department of homelessness with h.u.d. methodology for how many beds or homes they project to be open with some sort of like how you book a plane, they assume people will drop off, which is true, some people have dropped off. that's where the 1,000 comes from. >> good. thank you. i'm looking at a client standpoint. we have a nice chain that's put together to integrate and understand the client, often it

seems to me the client actually responds better if there is sort of an individual that they feel is their advocate or their person or their doctor or their -- is that how we're going to also be assigning that somebody will sort of be your key contact and someone that in case you go into crisis, have an issue where you would like to pick up the phone, there would be somebody they could talk to? there could be an individual assigned point person. >> yes, some of them are already engaged with an intensive case manager, some of them with case management through the h.u.d. team. so there is a commitment that we will have a street-to-home plan for 135 of them, go find them and find out what they really want and what their real needs are because we don't have enough information about them. that's where the high-intensity

care team is critical to get those folks. the other folks, there is a commitment through the center agency that they will prioritize case management of some sort. so we have the navigation case managers who will help them navigate through it. if they have a higher case manager, this navigator might not be necessary. if they have an intensive case manager, that might be a different route for them. the idea is who is the person and how do they get from here to there. >> you have a two-pronged approach and some are already in a relationship with their case manager. you're thinking there are 135 that you really need to work with and decide what they need? >> right. >> very good. i guess lastly i'd like to know what we'd think would be a good way to be able to track how this is coming if this is such an important program. what would you all be suggesting in terms of a follow up and at

the right time? do you think six months would be good to bring something back as to where we are? does that make some sense? >> we show up anywhere and talk to anyone about -- and we can talk for ever about it. >> okay. i'd leave that to staff to schedule. >> commissioner green. >> yes, thank you. this is incredible, the work you've done and the effort you've put into this, very optimistic. i was wondering whether you could tell us a little more -- kind of what commissioner chow was asking about when you think you'll be able to gather data. especially on some of your outcomes. for example, you can put people in housing, yet what's your benchmark for how long they stay there? i think that "new england journal" article said there was a pretty impressive percent that stay there one to two years.

do you develop your targets in some of the areas you're looking for outcomes, targets for avoiding e.r. targets and quality of life. how long do you think you will get data and assessing the data. and correlating that with the center not opening for two years and with the staffing you may need to be successful as well as the physical placement for individuals. i gather the tipping point opportunity is great, but i'm not sure how all the timing of all that fits together. can you elaborate a little more on that? because it seems like you could be facing barriers with regard to the staff that could both give inadequate care for the patients as well as the placement. and then what about, given those things and the potential funding issues, where you think you'll be able to really give back information, you know, on your

237. we don't expect you to boil the ocean, but it would be interesting to know what you think. >> i would say that the 237 we will have the dashboard that they were creating in about a month. there's about 29 of the folks who have already been housed in it. so we are trying to, together, get them from here to there and figure out what is stopping them from getting from here to there. the real difference here is that health is showing up and saying that we are there to figure out how to get them services that -- it's a housing-first model, but is there something that they need before they can get in or after they get in to keep them there successfully. so i can't say -- one, we need to know more about the 135, but all the 237, except for three

unfortunate folks who've already passed, all the 237 folks have had -- they say, i want housing. they showed up somewhere and said, i will answer your questions to try to get into housing. they are definitely motivated to get there, but they're also experiencing psychosis and they're not necessarily always regulated to be able to get from here to there. so we're trying to figure out how to do that and what level of care is needed to help them do that. i don't know if we can say right now that we're going to house all of them. certainly we have three months before we start and get reflective about is this the right approach to it. so i don't know that i can safely say how many of them will be housed. can i go so far to say half? maybe.