that is a-frame. this is where we are now. going forward we have huge opportunities. the health department has done big things and i see this going forward. >> we have public comment. some of the hand writing i cannot read. i will announce the first name and last letter. jessica w. doctor theresa palmer. jennifer e. dana k. >> i am jessica a student pharmacist from usf. first comment 85/12 passed the

edge later and requires cultural training. i would encourage as part of that plan the city of san francisco its own cultural competency training. the population in san francisco is different from much of california. a cultural training would not be adequate to help provide the compassionate care necessary for the population of san francisco. second part of comment is related to what came up earlier. i work at a retail pharmacy nothing breaks my heart more when they come in to pick up the medication and they don't have the insurance papers. it takes days. they are homeless and they have to leave the pharmacy after 14 hours and don't get medication. they might be without de beat esmedcase and we can't find them to get the updated information.

if we find the insurance we can't provide them what they needed. it is almost like the efforts of the healthcare providers are almost gone to waste because they don't get the therapy that they need. >> than thank you. >> i am jennifer. i have multiple comments. regarding cultural competency, i heard statements about linguistic competency. in recent bargaining dph changed the way that they compensate staff when they offer services to clients in the native language. staff are discouraged from speaking in the native tongues because they are not compensated

for it. staff are told do not speak the foreign language unless you are certified that is appalling. regarding icm. i have to say thank you for talking with staff. when the criteria for step down was developed, it was not developed with any input from staff. if we change the way we do things to expect it to work we should not rely on consultants or those of the administrators we need to talk to those doing the work and touching our clients on a day-to-day basis. there was a moment where we mentioned stabilize, adults who do not stabilize. this brings me to the arts. the clients who are users of services in a high way need more care for a long time. this is a severe illness. when beds at the arf are closed we are not able to stabilize

people to maintain the stagization. -- stabilization. we negotiated with the mayor and came to an agreement about if arf. there are 23 beds vacant and 54 beds lost right now. people are evicted from the man or, from the aurora home and from -- 54 are evicted, homes are closing with 23 vacant beds and are not allowed to move people. i do know why that is. these people need a home. >> thank you. >> the thing that strikes me as essential pieces to puzzle with 4,000 people is the intensive case management. basically doctor sung said they did not increase capacity for

intensive case management. thing whiteled down the waiting list and some could go to other places but they had to increase the caseloads. doctor bland tells me 4,000 people, 90% don't have intensive case management. there is a critical absence of staff. i heard a lot of acronyms and aspirational starts but i didn't hear about when these 4,000 people are going to get taken care of. it sounds like at the rate we are going they are not going to get taken care of unless you get more staff and you really do it. it is very discouraging.

>> thank you. i have deanna law. >> i am deanna long i work for the san francisco community clinic nonprofit community health centers throughout san francisco. we specialize in providing culturally competent care in different neighborhoods. i just want to call out two things. that doctor bland and could fax mentioned that i was happy to hear. one is emphasis on the behavioral health work force. you

there are those with an emergency medical bill. ab1611 would protect these patients against the emergency surprise bill. >> thank you. that is all the speakers i have. is there anyone else who would like to speak on these two items? if not it is in the hands of the commission. if you have a question or comment please identify the presenter to address that comment or question to. >> i think i don't actually have a question at this point because i think that the initial presentation on the challenges facing our behavioral health services was extremely

comprehensive. i thank the doctor for taking on the role of the acting director to move forward with as much progress as you have been able to do. i think that the key thing she has laid out and doctor bland identified was not so much the identification of the problems because those now have been very well elicited and certainly the doctor has helped summarize the issues that we are facing especially as you look at the homeless. i think the doctor has broadened that to say and the rest of our population needs a certain amount of support and health. we have heard the issue of cultural competent, the need clearly of language capability, the challenge of being able to actually meet the client. i don't think to say we are not

going to say that. any door wherever would come in and now we are also looking at how we can outreach and try to meet them where they are. i understand that we may go outside the doors to be able to bring them in at whatever location you are with your diagram, for example, but we need the outreach. this has been a very good discussion about how we are facing behavior health. i think the doctor for the next four or five years is saying that we may be looking at a change of even the entire process of both mental and physical health if the state's program about medicaid is actually carried out. going through a number of hoops yet, but she is warning us again and that fits fairly well with the rest of our presentations this afternoon in terms of all of the possible changes and even

the planning commission issues of what to do about facilities. i think that only shows the dynamic process that healthcare is undergoing. what i i see is one of the biggest challenges to try to answer these needs is really what is it that we are going to be able to have as a work force and it goes back to i think our health network was talking about. the real challenge right now is we are going to have all of these ideas, some of which are going to need immediate implementation to help the homeless, to help those who actually also have other mental health programs that are not homeless but need the same help because some of them are also on the streets. they are not getting the care they need. how many are not going to be

able to be from the homeless population in the intensive care they need. where do we get that? we heard from the community consortium they have trouble and we have heard that, i think that is really one of the biggest challenges. i understand with the new director of human resources we need to identify people or we can't put them in a system and we have to accelerate how we work with identified personnel, potential personnel because they will go elsewhere. the identification of personnel and keeping them going is almost as critical as looking at opening the new hospital or as we were looking at the personnel for management of the epic program. i see that as a lesson that i

have gotten today that is a real challenge and how our director is going to be able to work with the different -- well what opportunities they are going to have. i could ask the director what he view views as a way to move on this and what we might look for in terms of implementing what are very nicely developed and certainly well thought out ideas. >> i am sorry are you specifically asking about the work force? yes, we can't identify personnel to carry out the programs that we are working on, we are not really going to move the needle. >> this is something that is for michael brown in the back now, our new hr director i talked

with nim within his first hour of starting laying out a plan to focus and recruit on these positions. going back to your comments, we have a proof of concept with regard to hospital skill. it takes considerable resources to do that, right. if you look at what mayor breed has talked about as increased investments in the work and we need to talk across the different stakeholders including unions and civil service to provide incentives for people to come and stay in the work. we have been looking at things to have more opportunity for people to stay, other incentive programs as well. we also need to create a culture of excitement with h.i.v. having reengaged in the h.i.v. clinic there.

there are people that worked there for years. i think they could get compensated better in other places. they are mission driven and inspired. i think many of our behavioral health team are committed to that. we need to expand that perspective in our culture that people can be shown to make a difference in that way. it is a combination of focus, data, priorities and making sure that this is a priority and people are supported in moving that forward. i would repeat that. also, shifting the culture with regard to where we call a difference when we do epic. many in the room were major contributors. it was a heavy lift, but we did that lift when we addressed the h.i.v. epidemic, we found a way to do that.

key is those were not issues just one part of the department, right? that was not the only job of a director within the units or section. that was a department priority and resources were brought forward to do that to make a difference. this problem didn't happen overnight and we are not going to solve it overnight. as you saw with the behavioral health network we are making structural changes to have a road map to go forward starting now and into the near future. >> one final comment with jeff. in regard to the work force. it is very important that work force be able to not just have the knowledge and the credentials. this is where i think unless we

do that we don't reach equity. we can't answer the disparities. whether it be because of a cultural issue in terms of working with african-american communities or with some of our other foreign language speaking communities that we are able to also work with that. i know that is the real challenge. it is very important for us to be able to answer the disparity especially for a fairly sizable part of our population. >> thank you. >> i would make a comment that for the first time in many years i have been a part of the system i see a cultural shift in the government entities in relationship to the community that we have been serving all of this time. what we need to do is continue that cultural shift in the government and cb o community so that when we deliver what has

been presented today that those communities, those cb os and the department people are invested in and committed to doing the work because without that shift, we will be having this conversation next year and i do not want to have it next year. i want to also suggest that because it was so explicit in doctors presentations we understand where we are going now we have though create resources and will to get there. i thanks you both for the reports that were educational for me as well. other comments. >> i would echo that. you have done a very comprehensive job of identifying the population. of course, the challenges of the work force and the aspects about the population that is so critical. i wonder if you collaborate a

little bit how you envision the behavioral health services working to the goals. do you have any targets? i know there are some about how long it takes to house people, what percentage would be housed in certain period of time. that is not part of mental health. are there any new targets you have developed that you think you can reach in the near term? i also notice i think there are 800 people right now working within the mental health system. have you thought about how you u can redeploy these people to the top of their licenses, incorporate remote providers, which is a huge opportunity for us, where you are going with that. where within the system you expect to find did leadership and creativity to move along in these paths you have outlined?

>> thanthank you for the questi. i am going to invite doctor sung the invite the second half of the question. i was assigned for two years to complete in survey to make these recommendations. it is important to acknowledge with in the two year timeframe there are many recommendations that our team is working to help the health development develop a framework for implementation we won't be present to see them did deployed. with respect to the work force, it is important to come back to the community member's comment. one of the key investments the mayor agreed to make is to supplement the number of

intensive case managers. we have a target and goal. right now we have one case manager for every 17 clients. when people have complex needs like the 4,000 based on our success in the department, full-service partnerships is one case manager to every 10 clients that requires more people, more case managers and also resources to recruit and retain. in thinking about the outcomes i have been pleased with the support and collaboration with the deputy director of support services looking at developing clear outcomes for the intensive case management services across the board. as pointed out earlier the system has been very closely focused on compliance and regulatory measures which are

process measures. we are now taking the shift to ask the difficult questions about what where the actual outcomes associated with the interventions. we think about care coordination and particularly for intensive case management, what is happening with housing status? how much do they spend time in jail? are they engaged in meaningful activity? are they engaged in physical and mental healthcare consistently? the baseline measures. we are pleased to have the partnership to assess the case management services at that level. i would like doctor sung to respond to the second half of the question. >> thank you for the question. i think the question was redeploying staff? yes, because we have to meet the needs of the changes moving forward.

how do we deploy them? what will it lookalikes? we need to fill the current positions. that is one of the challenges. we prioritize this and i appreciate the partnership as well. thinking about what is it going to take to hire staff and keep staff? what they see is you know what happens when you change staff, there is a loss of connection with clients. they have to learn. they get burned out if you have a one to 17 caseloads and they leave again. it is a cycle. the shifting will have to happen at the same time. does that make sense? >> thank you. >> thanthank you, doctor sung fr your service today and as we go

forward. >> would you like to economic in? i would like to know the commission has lost quorum. this is an informational session. would you like to check in about if rest of the agenda? >> yes, we have two other items the fourth quarter report and the office of compliance and private seize annual update. i would request that we move those to a meeting in the future. i am making that request to my colleagues up here. if there is no objection we will do that and i will have mark schedule it for us. >> i agree. >> we have agreement. we will move those items to a future meeting. >> you can consider adjournment at this point. you are unable to vote because

you are not a full body so the meeting is adjourned. meeting is adjourned.

[applause] >> let me begin by thanking you all for joining us this morning right here in the heart of san francisco, right in front of our famed and beloved turnaround. we are here today to announce a very exciting initiative that involves the downtown and waterfront neighborhood here in san francisco. and what people can expect to see during the holiday season. i would like to begin by

introducing our mayor, london breed, who is providing our city with the leadership and the investment that are helping us keep san francisco clean all your own -- all year long. just this past spring, the mayor announced nearly $12 million in dedicated funding to street cleanliness initiatives and programs. these new investments are critical in our efforts to keep san francisco beautiful, sustainable, and a clean city. join me in welcoming our mayor, london breed. [cheers and applause]. >> thank you, mohammed. thank you to all the ambassadors , to the people who work with pcw, to urban alchemy, to downtown streets, to all of the amazing nonprofit and city organizations that work every single day tirelessly, every single day to keep this safety

green and clean. thank you all so much. [applause] today i want us to have an honest conversation about what we need to do better to make sure that people understand how much we love our city. we want people to make sure that they are cleaning up after themselves, that they are not trashing this amazing and beautiful city and the people that are here today are the folks, who every single day, they do the work. they are out there cleaning up the streets, but they are not your housekeeper. we all have to take responsibility for cleaning up san francisco. everyone. everyone who is out here, there are garbage cans, there are places to dump trash and i know

that it's important to make sure that this city is green and clean for all of. it matters. it matters that we care and it matters that we show that we care by making sure that we are cleaning up after ourselves and taking care of the city, but we also know there are real challenges. what that means is we need to make the kinds of investments that will make sure that we are doing power washing and all the other amazing things that will enhance the beauty of this already beautiful city. i want to thank mohammed and the department of public works. they have been the leaders in the effort to get creative around taking care of san francisco in ways that sometimes go unnoticed and unappreciated. i want you all to know that we see you out here every single day doing the hard work. [applause]

we are truly grateful for our partners. the san francisco police department are out here every single day keeping people safe. the folks who are part of our community business districts who raise private funds to invest in more big belly trash cans. to invest in more resources so that we can do everything we can to keep san francisco clean. we will go a step further. we decided that it is clear that during the holiday season we have so many people who are visiting san francisco, where shopping in san francisco, and we want people to have good experiences. let's be clear. the way that we pay for the services that we provide, whether it is munimobile, whether it is street cleaning and all these other things, whether it is shelters and services for our homeless community, a lot of how we generate revenue depends on our

economy. it depends on the shopping and the things that people do to help to generate the revenue necessary to keep san francisco going. so we have to do a better job of creating a better space, a festive space, and exciting space. and the new program that we are providing will do just that. eco- blitz, i don't know who came up with that name, but why not, it is an effort to invest even more resources into cleaning and greening the downtown area so that people who visit this area, so that people who shop in this area and people who work in this area have a clean, safe, green place that they can enjoy their experience in. today is about the enhancement that we need in order to make san francisco a better place.

i don't know about you, but i'm tired of people talking trash about our city. it is time that we continue to do what's necessary to create a different environment, a different way in which how we take care of our city and it starts with more investment in areas where we know we have lots of people who are walking, who are catching munimobile, who are working, who are shopping. we are going to make san francisco better now during the holiday season and in the future because of our new investment. we are excited about what this is going to do to enhance the experience in our downtown community. thank you all so much for being here. at this time, i want to introduce our city administrator , naomi kelly. [applause] >> thank you for the love our city campaign.

thank you to mohammed and the public works crews and teams. it has been 20 years since we have been doing this. i can't tell you how important it is that we love our city and keeping it clean. thank you to karen from the union square business improvement district for partnering with us. i go out once a month with my family to the community clean team. we hit different neighborhoods. i can't tell you how important it is because a, not only are we upping our -- loving our city and giving back to our city, but i'm bonding with my family. i am meeting different neighborhood associations, merchants associations, different public works crews, different downtown streets, everyone is coming out. it brings everyone together for common cause keeping our city clean, keeping it sustainable, and giving civic pride. this is why these events are very important.

i also oversee the city's 311 call center. it is a 24-hour operation where we have folks taking phone calls from different residents and many of the phone calls are about graffiti removal, illegal dumping, downed trees and encampments. they're very much a part of working with everyone here so that we know where the areas are that we need to focus and keep clean. i want to thank everyone again for being here today and taking pride in keeping our union square, our market street corridor and all of san francisco clean. thank you. [applause] >> all right. before i introduce our next speaker, there's quite a number of people to acknowledge. the echo blitz is coming together of everybody. it is like a village. it brings all types of city departments, the community, the businesses and everyone together so that is what an eco- blitz is

and rec -- representing the port is byron matz. please give him a hand. tom maguire from m.t.a. is here. the police department, chief bill scott, all of the officers making sure we are safe. recreation and parkas here. the department of environment is here. give them a hand. our fire chief is here. give her a hand. our office of economic workforce development and our partners at recology. [applause]

we are also joined by several community leaders and these are partners that we are working year-round -- year in and year out. they have stepped out for the holiday season. they have been part of this campaign. a few weeks ago we went to all these various neighborhoods and we did a punch punchlist. now we are all out of work with all the agencies and community works, making it able for the city to shine. i want to thank randall scott from the fisherman's wharf, captain marvin from the community benefit district, andrew robinson from the east coast community benefit district , and speaking on behalf of all of those community groups , i will ask karen to come up and say a few words. [applause] >> thank you, mohammed. good morning, everyone. i am the executive director of union square. as mohammed mentioned, we are here at the historic cable car turnaround, also known as the gateway to union square and to

san francisco. here in union square all of our merchants and hotel owners are getting ready for the holidays. they are putting the finishing touches on the holiday windows. the ice rink has opened, the tree is up and it will be lit the day after christmas. we are getting ready to have an even cleaner and safer and festive holiday season down here we are looking forward to this. this is our most favorite time of the year. i would like to thank madam mayor for suggesting that we bring back the eco- blitz. it is sort of like when you have family and friends over for thanksgiving. you have to clean up the house and clean up the living room, but visitors are coming and that is what we are doing. thank you so much, mayor breed forth adjusting the eco- blitz, and also for making it making it a priority. it is really so important for us down here. thank you to mohammed newer with public works and for sending us all of your team.

we spent last week with them. a big round of applause. absolutely. here they are. easily recognizable. and we walked the district. we developed a punchlist and we will get some curbs painted. we needs some help from m.t.a. on that. we will build potholes, we will plant flowers. i heard that was already done. we will shine of up these bricks right here. we are going to do a deep clean and we really appreciate it and a comp went all the work that our team here has done. thank you so much. also to add another round of applause. yes, yes, yes. good job. and this service has already enhanced with the property owners down here just recommitted to. we recommitted to the bid for 10 more years which means committing assessments to the tune of about $6 million. this is a 60% increase. you will see more of these folks in red out and about, especially

in the afternoon and evening, keeping the area cleaner and safer. we will be upping our pressure washing of the sidewalks to weekly. we are excited to have a new toy we have this new machine right behind you. it is super cool. it is a vacuum. we are getting our vacuuming done here. it works really well. it helps with the morning crew. [cheers and applause] absolutely. so as mohammed mentioned, a lot of the other communities are also getting an eco- blitz. there's big events down there, too. i know the auto show is happening. join us for that. if you haven't been down to union square in a while, please come down. there's so much to do. there is a harry potter show going on. i mentioned the tree lining, and shopping. lots of shopping. thank you. we have some really nice shops

here. make sure you stop by. finally, stockton street is open central subway has cleaned up stockton street. you can drive down and we are going to move the winter walk over to grand avenue. please doing us there. we are hoping to have a much cleaner and safer and more festive holiday season for us all. thank you. >> thank you. we are really serious. we will get down to the level of government. that is a level of cleaning that we will get down to. we have a long punchlist and we will work hard and make sure that our city continues to be clean. this is the most beautiful city in the world. we all know it and we will keep it that way. [applause] i want to thank all the agencies and the community partners and our mayor for coming up today. we are starting this eco- blitz. we started two weeks ago. we are starting today in tenth

city. when you visit these neighborhoods, you will see crews getting ready. we are bustling and getting ready and cleaning for the winter. please say hello to them and thank them for the work that they are doing. again, this program will be in full force. many of the neighborhood commercial areas, please visit them. spend some money and make sure people who come to san francisco have a great experience. are we going to make sure that happens? [cheers and applause] this is part of our love our city campaign. and the eco- blitz will be there for public works reminding people and property owners to do their part. the mayor said it, the agencies alone cannot do it. all the businesses and everyone has to do their part. right? we will be out there reminding them to do their part and love our city campaign is on. i want to thank you all for coming. we will take the mayor and show her a few of our machines. you all have a great day.

>> the bicycle coalition was giving away 33 bicycles so i applied. i was happy to receive one of them. >> the community bike build program is the san francisco coalition's way of spreading the joy of biking and freedom of biking to residents who may not have access to affordable transportation. the city has an ordinance that we worked with them on back in

2014 that requires city agency goes to give organizations like the san francisco bicycle organization a chance to take bicycles abandoned and put them to good use or find new homes for them. the partnerships with organizations generally with organizations that are working with low income individuals or families or people who are transportation dependent. we ask them to identify individuals who would greatly benefit from a bicycle. we make a list of people and their heights to match them to a bicycle that would suit their lifestyle and age and height. >> bicycle i received has impacted my life so greatly. it is not only a form of recreation. it is also a means of getting connected with the community through bike rides and it is also just a feeling of freedom.

i really appreciate it. i am very thankful. >> we teach a class. they have to attend a one hour class. things like how to change lanes, how to make a left turn, right turn, how to ride around cars. after that class, then we would give everyone a test chance -- chance to test ride. >> we are giving them as a way to get around the city. >> just the joy of like seeing people test drive the bicycles in the small area, there is no real word. i guess enjoyable is a word i could use. that doesn't describe the kind of warm feelings you feel in your heart giving someone that sense of freedom and maybe they

haven't ridden a bike in years. these folks are older than the normal crowd of people we give bicycles away to. take my picture on my bike. that was a great experience. there were smiles all around. the recipients, myself, supervisor, everyone was happy to be a part of this joyous occasion. at the end we normally do a group ride to see people ride off with these huge smiles on their faces is a great experience. >> if someone is interested in volunteering, we have a special section on the website sf bike.org/volunteer you can sign up for both events. we have given away 855 bicycles, 376 last year. we are growing each and every

year. i hope to top that 376 this year. we frequently do events in bayview. the spaces are for people to come and work on their own bikes or learn skills and give them access to something that they may not have had access to. >> for me this is a fun way to get outside and be active. most of the time the kids will be in the house. this is a fun way to do something. >> you get fresh air and you don't just stay in the house all day. iit is a good way to exercise. >> the bicycle coalition has a bicycle program for every community in san francisco. it is connecting the young, older community. it is a wonderful outlet for the community to come together to have some good clean fun. it has opened to many doors to

the young people that will usually might not have a bicycle. i have seen them and they are thankful and i am thankful for this program.

>> good morning. welcome to the transportation authority board meeting for today, tuesday, november 19. our clerk could you please call the role? [roll call]