wagner, who until recently was our chief operating officer, now is our chief financial officer. they got it done in collaboration with the mayor's office, focused on leveraging funding, reducing costs while increasing operational efficiencies. thankfully at this point we are not having to propose service reductions. that will allow us to continue support for vulnerable populations and, if things go forward with our covid-19 response, and the only position reductions proposed are related to the closure of county jail number four. next slide. so i thought it was important

to review the patients served in the department by race, ethnicity. you can see here that we serve a diverse population of people, more diverse than san francisco's population overall. you can see the breakdown by different service providers, including at the s.f.g., laguna honda, primary care, substance use, and then, the jail health program, where we provide health care in our county jails. next slide, please. so we continue to focus on advancing equity and investing in our workforce. we are focusing on normalizing, organizing, and operationalizing our equity approach with a focus on racial equity, specifically focusing on black-african american

health. this is consistently a data driven approach where we know there aren demmic, systemi-- e systemic, deeply rooted racism. we are continuing to focus on the work and the workforce. we understand and realize that the work of the d.p.h. team is key to better health outcomes in the community, and our relationships working with each other in s.f. relate directly to our approach with community. we are investing in our

workforce so that we can serve our communities better. so in terms of our new investments in equity, from the beginning of the covid-19 response, we have taken an equity focused approach. we knew early on that the pandemic would exploit existing structural and medical inequities in our society. we are supporting testing in our communities disproportionately affected by this pandemic, increasing outreach and contact tracing, providing city grants for members which had not been used previously, and then housing and support for our most vulnerable individuals and

family. if people are infected with covid-19, and we're not able to iso -- and they're not able to isolate or if they potentially have covid-19 and are unable to quarantine, we are providing housing for them in the form of hotels, and if they are infected, also offering a variety of wraparound services, including support. and there's our housing and support for our most vulnerable. and then, we have our behavioral health with a population focus. we are hoping to continue to implement programs including and especially mental health s.f. programs, which will

remove barriers to care for people with behavioral health issues who need them the most. we continue to focus on child mental health and focusing on black, african american, and pacific islander families to where those outcomes are not what they need to be to really optimize the health of mothers and children in san francisco. and then collaborating very closely with the human rights commission, we will be -- about $36 million of reinvestment from public safety will be coming to the health department. we will be working with the human rights commission to implement a process in terms of prioritizing those funds, some of which are likely to go to mental health and other

services that the community believes are most important in terms of, again, addressing health inequities in san francisco. next slide. so this is -- we are going to go a little deeper into the numbers. i'm going to turn the remainder of the presentation over to greg wagner, our chief operating officer, who will go through the next sets -- series of slides. thank you. >> so thank you, supervisors. again, greg wagner. give you a sense of the big pieces moving in our budget. dr. colfax highlighted some of the main items, but this is where the largest changes are. you can see between fiscal year 19-20 and 20-21, we're budgeted to increase by $344 million, and then, that drops off

somewhat in fisk of year 21-22, but it's still a big increase of 149 million. the big categories of change driving that increase are, of course, the covid-19 response. that's over 200 million and consistent with the citywide approach to covid-19, and that's in a single year. that accounts for a lot of the imbalance between the two years in terms of growth. we also have, as dr. colfax mentioned, $36 million per year included, and the d.p.h., as part of the reinvestment of public safety funds in a variety of racial equities, and we'll be working on that. on behavioral health, i'll go into a little bit more detail, but there are increases of over $100 million in each year. this includes both general fund

dollars, but very significantly, revenue assumed from the passage of a business tax measure on that november ballot. if that measure does pass, we would have appropriated dollars for both ongoing programs and one-time funds associated with the release of the 2018 problem c dollars are -- that have been collected and held in reserve until now, so those are the big things that are moving in the budget. next slide, please. similarly, on f.t.e.s in our budget, we grow, compared to the past fiscal year, by about 290 f.t.e.s in 20-21 and 220 in 21-22. the biggest driver of that is covid-19 response. we are adding a position

authority, temporary positions to do a lot of the work driving this response, and also with the redeployment of city resources. we have an annualized position of about 86 positions in behavioral health, as you saw in the last slide. we've also proposed 20 annualized positioned to expand our human resource function. this is identified as a critical need for us in order to meet our goals in terms of things like nurse hearing, behavioral health clinician hiring and also staffing up with some of the covid needs. we have other initiatives, including a specialty pharmacy expansion that's revenue neutral but does require an increase in our staff and an investment in our quality

management functions, which is the group that's responsible for regulatory but also ensuring that we're providing high quality and appropriate services in the department. next slide, please. briefly, i know you've already had information on the covid-19 budget, but this is the summary of the budget that's within the department of public health. we have a total effort of about $300 million, as you can see in the first column, and the rows show you the category use that that effort is in. it will see what you have heard about and expect, large investments in personal protective equipment, in testing, but then also a lot of the service areas that are at the core of the response, including our community branch, contact tracing and investigation, health management to help control the spread of the disease, and then

also in our response, hospital operations and medical support and search activities, which are the medical staff that are needed to be prepared to treat the patients that are affected by covid-19. you can see on the additional columns that of that $299 million, we're anticipating 95 [inaudible] that is the large number of d.p.h. employees that have been deployed to the command center, and also from other city departments which are partnering with us to meet that need and redeployment of other financial resources, but can he did have about $205 million of total new proposed expenditures in the budget, categories that you can see, and a portion of that will be reimbursed, if not all of it,

reimbursed by fema, and then by c.a.r.e.s. act federal funding, if not more in the future. next slide, please. so mental health s.f. -- i'll go through this briefly, and we have our subject matter experts from the behavioral health system here to talk about this in depth. but as you know, mental health s.f., a comprehensive overhaul of our behavioral health system, this is an ordinance adopted last year. full implementation of the program is estimated to be $100 million or more, so this is something that we'll need to work for over time, we don't have that full $100 million of implementation, but the budget has some significant steps forward to really get moving on the core components of this initiative and start building our momentum.

as i said, it does assume that we'll have funding from the business tax reform on the november ballot. if that's passed, it would generate $28 million in the first year of it, and $38.4 million in the second part. there's also one-time funding associated with the tax measure and releasing revenues previously collected under 2018's prop c, but because they're one time in nature and the issues around the resolution of the prop c measure, there's strict resolutions on those funds, so they're appropriated here, but to program those funds will require further conversations, and we will be working with the controller's office on that process of working through these. next slide, please.

at the highest level, four main pillars to the mental health s.f. response. the office of coordinates care, which is in some ways the glue and the lynch pin of this initiative, it's the function that will coordinate across our system of behavioral health care that will do -- make sure the system is functioning to meet the patient instead of in silos and also supervise our case management. we of course have behavioral health bed investments. as you know, under our mental health reform predecessor, before mental health s.f., our

director, dr. anton nicussa-bla nicussa-bland, did a survey and outreach. we would have a behavioral health presence out on the street to be able to respond to calls that come through the system that today, are predominantly responded to by the police department but also our outreach teams that have a lower clinical level of intensity. and then lastly, the mental health service center, number four, which is the vision of a

single site where people can come for behavioral health services, and will also be a part of this coordination function to make sure that our services are coordinated seamlessly together, and i'm sure you'll have questions on those that we can dig into with our clinical team hear. so next slide. and then lastly, there are also beyond business tax reform measures, a significant investment of general fund dollars and behavioral health initiatives that are listed here, and i won't go overall of this in detail, but we have, over the past few years, funded a lot of detailed work in our expand with behavioral health dollars and time limited dollars, including some of the eraf and funds that got us a couple of years of service but

didn't get us on in the base. in the mayor's budget, there's a line for us to continue to build this vision of mental health s.f. so that includes continued funding for vet expansions. it includes backfillng key grant services that are critical to our response and our capacity to do care coordination and case management, and then also clinical support associated with a lot of the housing and shelter programs that are being expanded in the department of public housing program and those facilities. next slide. so that is the last one. this is about the rates ordnance, which we already

discussed earlier. so i will leave it at that, and we will collectively take questions. >> chair fewer: thank you very much. let's get back to supervisor mandelman, who originally had his hand up earlier. supervisor? >> supervisor mandelman: i wouldn't have charged past supervisor ronen if i knew she wanted to speak on this, so i think you should call on her first. >> chair fewer: okay. supervisor ronen? >> supervisor ronen: oh, thank you, supervisor mandelman. that was very nice of you. i think we'll just tag team here. a couple questions here. when you provided the additional budget investments to mental health s.f. to supervisor mandelman and myself. i had 34.4 million in the first year and 43.7 million in the second year, so i don't know how those have been reduced in

this presentation to 28.1 and 38.4. could you explain the discrepancy there? >> chair fewer: i believe you're on mute. >> you'd think i have that down. >> chair fewer: it happens to all of us. >> yeah, so thank you for that, supervisor. so the $28 and $38 million is the ongoing value -- the value of ongoing values associated with the business tax reform measure. in addition to that, there's some other sources that we've incorporated over and above that for support for the mental health s.f. initiatives, so that includes a portion of the dollars that are backfillng previous eraf appropriations, and that's a little over $5 million there. there's a little over $5 million that the mayor's office

has appropriated in general, and the idea is that would give us a head start ahead of the november election, where we'll know the outcome of prop c, and have the revenues available and released to get started on particularly the core staffing for the office of coordinated care and the crisis outreach teams in partnership with the fire department. and then, i believe that those were the two main changes relative to the 28 and the 38. so we've budgeted those on top of the big tax revenues, and part of that -- that slightly larger package that you described. >> supervisor ronen: okay. so then, the spreadsheet that i have that said we're spending 34.4 to implement in the first year and then 43.7 in the second year is correct? >> correct.

>> supervisor ronen: okay. and then can you talk a little bit more about the presentation that you just did on the initial 69.4 million in the first year and 46.9 in the second. what is that for? >> sure, thank you. so -- yeah, i glossed over that pretty quickly for the size of those dollars. so as part of the -- and i'm sure that the controller will weigh-in on this, as well. as you know, the business tax measure that's proposed for the november ballot is tied to the 2018 proxy measure, which was a business tax for homelessness services serving those homeless that are homeless or formerly homeless, including behavioral services, and behavioral health is a portion of those dollars. because of lawsuits over that

2018 measure, that revenue has been collected but held by the controller's office pending outcome of -- and i see ben popping on, but pending outcome of those issues. and if the business tax measure passes, it will result in one-time revenues that come to the city as a result of that interaction, but those revenues are restricted because of the various issues -- legal issues around the interactions. i'll let ben explain it much more clearly. >> commissioner renne: and, ben, before you chime in, so those additional pots are not included in the 34.4 and the 48.37? >> that's correct. because they're one-time dollars only, they would not be eligible for any of those uses that i've described because

they're ongoing programs, so we appropriated them in the budget, but there's work yet to do on determining what the eligible uses of those funds are, and those are going to be restricted -- pretty restricted by the controller's office to make sure that we protect ourselves financially regarding those business tax revenues. but we've appropriated them, but we haven't programmed them for specific uses because we need to go through that extent with the controller's office. they would need to be used for strictly one-time expenditures, such as capital expenditures, other one-time expenses. >> supervisor ronen: go ahead, ben. >> no, i was just going to add in, what greg said is correct. you're going to see this

throughout the budget that's in front of you that fully appropriates should the measure pass. i think that money is on controller's office reserve at this point, and then, the outcome of that november measure, which needs to pass to make it available. i think the idea that you have here is the department has suggested spending plans for some of those funds, but in other case, spending plans still need to be developed, frankly. and so the budget appropriates it, but detailed spending plans are not in place for all of those sums. >> supervisor ronen: okay. so let me ask you this: i'm going to have a really hard time that does not include an additional $4 million and change in the first year for mental health s.f. and $5

million in the second year for mental health s.f. because mental health s.f. only works in a way that will make a visible difference in our streets if both the crisis teams and the mental health service center operates 24 hours a day. and the cost of including an additional crisis team and increasing the stacenter to 24 hours a day is close to $4 million the first year and $8 million in the second. so given the fact that we've programmed into our budget a one-time $4 million into the operation of the mental health s.f. capital health service center, could we reappropriate is in t-- it in the first year

to take care of that $4 million and then -- so we've taken care of, at least in the first year, that $4 million. and then, i don't know if we can reprogram in the second year the rest. i would like to find -- whatever we generate in an add-back fund, there are so many competing needs for it that are so crucial, and d.p.h.s budget is so big, and the amount of money we spend on mental health is so much, that i know collectively, we can find an additional $4 million in the first year and $8 million in the second year to cover the needs of mental health s.f. and make it the most effective it can possibly be. i want n, between now and the time your budget comes back to us, to be brainstorming to figure out how to do this because i think we're going to have a hard time getting that amount of money from the

add-back amount, and i'm going to have a hard time voting for this budget without it. so i just wanted to -- these numbers frighten me. i didn't know about these additional dollars that are one-time in nature and aren't programmed. i also would love to barrel in on, you know -- you said there's an additional 113 that we're spending on mental health s.f. -- i'm sorry, on behavioral health, only 34 of which is going to mental health s.f. in year one, and only 48 in year two to mental health s.f. are there ways to move that around? i want to drill really deeply into that over the next week.

>> i certainly understand the concept you're raising, supervisor ronen. we'd be happy to work with you and the department and supervisor mandelman in the week ahead to see what's possible. >> supervisor ronen: okay. and could you -- thank you, thank you, thank you, ben. and greg, could you describe a little bit more, or dr. colfax or dr. hammer or anyone who's the appropriate person to do so, sort of what this additional money in this year's budget for behavioral health is that doesn't fund mental health s.f.? >> greg, do you want to start with that, and then, we can have dr. hammer fill in the other points on the question? >> sure.

so these funds are the one-time funds that we discussed, and that is the vast majority of it. the other category is -- and i'm not sure who's got the slide show, but if we could bring it up to the second-to-last slide. it's the slide that is entitled -- >> it's slide 13, right? >> i believe so, yes. >> sorry. do you see it? >> yeah. i'll -- yeah, and so the other category is this slide. >> supervisor ronen: i see. >> so these are the backfills of various funds that were set to expire, and also some new programs, such as -- i failed to mention previously, but one

of the larger ones is the creation of a new psychiatry class, which will make us more attractive in retaining psychiatrists. [please stand by]

>> there was outreach in linkages, i believe at pes. >> this 2.3, is that going to the new system under healthy with the coordinated care? >> this would allow us to continue to fund for existing programs where the state grant behind them has run out. so without the backfill of these programs, we would lose funding for those programs and have to reduce services there.

what we did in the hiot and a smaller precursor in the lead of up to mental health sf and building out programs, testing these concepts out and there's definitely a deep interconnection and some of the things we've learned like dr. hammer mentioned like navigators or pes and connecting them to services upon exit from pes and some of our target case managing programs and all very consistent with the office of coordinating care and a lot of the work that we're doing.

>> the mental health sf will basically become the umbrella for all of the services that we will conduct across the department and so, these programs will feed up into that into the new investments that we're proposing. >> this will work in its optimal form and what's more important, you know, as we're getting this

up and running and i will say i've been under-whelmed by the lead programs the entire time. it's not been very effective in my district and, you know, i went to seattle to see how their lead program operates and it's night and day. is that something we could redirect into what would be a much more effective crisis response team and is somewhat of

a similar idea. >> supervisor, i definitely see what you're getting at and i think it might be worthwhile for us and i'll dr. hammer and others to weigh on that, specifically, but if they wish to, i would say it might be a good thing to take this category of programs and what we're doing and we could talk through with you and other supervisors who are interested to kind of do that thinking about how these interrelate with one another over the coming four or five days.

>> can we put the last slide back up? i totally see and well aware of the need for expanded clinical support for housing and expanding the shelter health. if there was anything you wanted to say to sort of what that gets you and how that will change what's happening. >> those two items expanding shelter house and clinical,

those are dollars to just clarify as a part of the business tax reform that the hsh is receiving a portion of the dollars for some of the services that are not clinically related for homeless and includes expanding hopefully the permanent supportive housing units as well as shelters. as a part of their proxy dollars, they're work-ordering a portion of the funds over to dph to expand our support for shelters and for permanent supportive housing. and so the first item is tied entirely to proxy for shelter health, a portion of it is a part of the expansion under covid and there's another portion that is primarily under proxy, as well, and so, in anticipation of the expanding services that hsh will provide,

and again, it's all dependent on the passage of that ballot measure. >> so this page is a mix of proxy and non-proxy? >> yes. those two items do include proxy dollars. and they are not coming from dph's allocations which is focused on mental health. it's coming from shs on homelessness services through which they purchased a portion of our clinical services to support their entire operations. >> the other items are general fund. >> correct, yes. >> that's reassuring. and that what's the new homeless resource facility? >> yes, the homeless resource

center is our new building at seventh and stephenson which is the new urgent care cling from 50 ivy to this new building. there will be hsa and hsa staff for benefits and hsa staff. it's half of the first floor. there's permanent supportive housing, 250 units of new housing, as well, in that building.

this is a adjacent to the federal courthouse there on mission and we expect to open the new resource center in the fall of 2021. the construction has started. >> and how big is it? >> how big is the facility? >> yes, is i. >> it's mostly a welcoming spa space. it's urgent health services, den detail, behavioral health and meeting with benefit's councillors and housing. it's not a hang-out. >> or where crisis teams would bring someone?

>> conceivably, they could if there was an urgent medical need. >> certain medical need, right. ok. well, that's that's page and here are my other questions. there was a bed's analysis and came up with a recommended bed increase and budget or administrative kind of feasibility analyses and just what they've determine the it would take to clear out the wait times and make sure that we

don't keep people in jail who don't need to be in jail. it was skilled nursing facility beds and board and care beds and mental health residential treatment beds. so my understanding is that this budget includes some of those beds this year?

>> it would fund all of those bedses just described and in addition -- >> but not in this first year, right? because there's been talk about feasibility and timing and identifying them and bringing them online and i just want to make sure i'm understanding. if the tax reform doesn't pass, none of the essential beds that are required to clear some of our waiting lists and to be able to deal more humanely with folks, right now, in our current universe wha, i will have to rut my colleauges in november or december with a supplemental appropriation to try to do something around locked beds. ,right, because it's totally dependent on the tax measure? >> right, on the tax measure

passing for these beds. the own exceptioning the hummingbird beds, which were identified and that has been underway. they are partially taking it time. >> but the beds are recommended in the bed model and so it would be for a portion of this year, at least, 31 locks of acute treatment beds and 13 psych skilled facility beds. and that gives me a lot of heartburn around totally dependent on the tax measure passing and i think that i'm glad that we're trying to get those beds actually funded.

and one question that i have, though, is that i have heard and would love to figure this out over the next week or so, that we right now spend a lot more than we budget on locked subacute treatment beds and skilled nursing facility beds and i don't know if that's true. do you happen to know if that's true? >> we budget for a certain census and we have people coming and going and for the last several years, we have used a higher proportion in those categories. we have always been able to balance that to make it work and

we're constantly reevaluating that mixture in our budget. >> well, it hasn't worked in the sense we have had incredible wait lists. but it's worked for some. it wouldn't be such a win to take this beautiful bed study and simply move our budgeting practises more in line with our actual youth, but still not increase the actual number of beds that are available for the people who need them, which could be a thing. , depending on how we handle it. i want to understand that a

little bit more and if i could get that information. i think we're meeting with supervisor ronen maybe on monday and it's possible to have that information, that would be great. >> we saw this every year and we want a net gain, right? >> we don't solve, because i think the bed study compares and looks at wait times. it's looking at how many beds do we have and how many are we short and so we have a gap based on what we're spending but we have an even deeper gap to budget. and so, the additional money that's been put into the budget to deal with the bland bed study may actually just get us closer to what we're currently spending and may not dress the bland bed study at all. so i don't know.

that's what i want to think about over the next couple of days. and because i want you to have clean budgeting but i really want you to buy more beds. and so, then the other kind of somewhat of a similar question -- again, we're talking about expanding this crisis team and i really appreciate the work that the department has done on this and the proposal for the four teams and i think supervisor ronen and i have a shared interest and i'm imagining -- i hope colleagues will agree that we want to build on that. but i do recall -- i want -- and of the next few days i would like a better understanding of how the crisis team fits into what we are already doin

doing? this is similarly an effort rely on expanding ems6. i want to understand how that has grown and how those ems16's are used. also, how the mobile crisis team relates to this and any other, you know, outreach that's happening now because i think supervisor ronen and supervisor hainey and the whole board's intention is for a game changer that really changes the experience for people who are in crisis on the streets and really changes the experience of people in san francisco who are seeing people in crisis on the street. and the question of whether it's to be 24-hour, but i think it needs to be at a volume that is great enough that is actually impactful and i'm a little

worried that the increase that happened last year -- again, it's been a weird year, a very weird year. but i know ems6 does great work and i know they're doing things that are saving the system money but gettin getting help to peopo otherwise wouldn't get it and the ems6 folks are just amazing in what they do. pouring on another couple of dozen people into this system, i just want to understand a little bit more about how it will get us to game changing. and i also agree -- and i look forward to talking more with you. for me, each of us is seeing different things in the mental health sf center and what it will provide and we have overlapping but not -- different priorities with it and

overlapping priorities around that. for me, it's very, very important that there be a place 24 hours that these people who are interacting with the crisis teams or em6 or mob mobile crisr anybody surrounding people in crisis knows there is a place to take someone that isn't false. i would like to talk more about that. so last year, we talked a lot about the investment and dual diagnosis that was a big deal and we thought it was a really kind of a break-through, important thing that we were doing these 55 dual diagnosis tests and then we didn't for reasons that i think are understandable, because we were working with the nonprofit and the nonprofit was looking for real estate and those 55 beds didn't happen. but do we still there's think

there's a tremendous need for dual diagnosis beds. as i read the study, the total needs they found was 20 mental health residential treatment beds which maybe could all be dual diagnosis beds, but that's a very different -- it seeps ses like the conversation was different a year ago from the study and i'm trying to understand how to reconcile those two. you don't have to answer that. >> doctor, can you respond to the supervisor's question? >> i'm going to ask you to take that. >> thank you. good afternoon, supervisors. and i think my first reaction is that we need for our entire system to be dual diagnosis. we have a lot of opportunities for integration and there shouldn't be as many limitations one way or the other. and the continued need of dual diagnosis beds can be addressed by improving capacity on both sides of the mental health and

substance abuse system and really based on how the beds' investment goes this year, exploring how well we're meeting that nee needs a it needs to ben ongoing conversation. >> i think it would fantastic with $11 million we could solve our needs for beds. my suspicion is we probably need 55,000 dual diagnosis bed exposa similar increase that the bed study shows and i think the right way to do this is to make these investments, see if it's enough and probably need to do more and then do more the next year, god willing, budget permitting. which is another reason not to wait, but to get going. and again, i have a lot of concern what happens with this investment if the tax fails and

it cannot be that we get to november and the tax reform fails and then we're done with this. like, i i hope that my colleagu, even if we go along with this plan to rely this heavily on the money that we hav we have a com. i don't like reopeningening reon the middle of the year. but this is something we should reopen, because we will be making a decision not to fully address this two years after the audit, and after discussing the same issues for years and years and years and we have a framework now that everyone agrees on. and we can't wait. and so my last question is, why is aot still a pilot?

are we doing any more with this money in the budget? >> i think it's been a pilot in that the staff -- those particular staff that we're talking about are going from temporary -- we're doing a pilot to permanent works and so the aot model is going to be integrated in all of the work we're doing around the office of coordinated care and compliments very much that level of the critical care management, that they are going to be a part of that team. >> is that money -- i mean, the money in the budget, is there any expansion in aot there or keeping going what we've been doing? >> it is keeping going what we've been doing, but definitely all of what we've learned from the model, what we've learned works will be incorporated into anything new that we're doing under the coordinate auspice of coordinated care. >> ok, those are my questions.

thank you. >> thank you, supervisor mamdelman. supervisor walton. >> thank you, chair fewer and doctor and to the entire team. does the new budget provide funding for treatment beds, particularly after the two million was readjusted in the mid-year adjustment plan? >> dr. simmons, you had some perspective on the daybeds. can you comment, please? >> i think there are more studies that need to happen. one possible idea is that within the bed count, we're including, i believe, that it's 20 beds for the 12-month residential, that we could make a portion allocated, which could be a dual diagnosis model based on what we

have already developed and that that would reduce capacity from, you know, the adult serving system and we would need to study that more, but we could address tay through the existing budget proposal. >> and so could or would? i could walk out of this meeting right now. i mean, could or would. >> my understanding, we haven't specifically identified a specific number of beds for tay in the beds that are proposed.

>> i know you've said we had problems in the past locating beds for tay. why wouldn't we carve out beds for tay knowing we've had those issues in the past? >> well, i think we certainly could. it's just a matter of how much neglect do we want to have in the beds we find, given we've had historical challenges. but we could do that in this budget, as well. >> i hope we are able to address that. and how much revenue from the overpay executive tax, if we are fortunate enough to pass it, would be allocated towards filling the behavioral health vacancies? or have you explored that yet? >> i can speak briefly to that, supervisor walton. the co tax proposed from the november ballot is not assumed as a revenue source with the budget in front of you, to the extent that it did pass, it

would be subject to future decisions by this body as to how to appropriate those funds. we'll send estimates regarding what the different taxes on the ballot would be worth and we're they're included in the budget or not and so i'll have that information in your hands shortly. >> got it. you can see i'm trying to and ba little proactive, if possible. the mayor's budget introduces an $11 million grant program in dph and do we know what those funds are going towards? >> greg? >> sure, supervisor walton, we are putting together a grant program that is focused on

individuals who have made a contribution through the city option program into a medical reimbursement account. we've had a lot of conversations ourselves and through the san francisco health plan that administers the program to help them gimp the circumstances with covid and the dollars for a number of reasons are only available for withdrawal for medical expenses under the tax codes and this is an attempt to use dollars from within the city option program to provide grants to those that can be used for any expense related to what's going on with covid that's not necessarily a medical expense. so it's one of the set of

programs that would collec we'v. collectively been working on who are out of work. so up to a $500 grant program for those accounts. >> and those would be administered through the sanfrancisco health plan. >> thank you. and does this budget that is proposed right now provide for increased testing in the black community, pacific island community, latino community and all of the populations where we see increases in disproportionate amount of folks who have contracted the virus and have a high number of cases? >> for covid-19, specifically, yes. it includes an expansion of testing specifically to test in communities where there's the highest rate of covid-19 for this upcoming year. >> and along those lines want

are your strategies to address covid-19 pandemic in these same communities of color? >> well, one of the key things with regard to testing is that we have a mobile testing strategy where we go and follow -- we go where the virus is. right now it's largely concentrated in the southeastern part of the city. so, for instance, we've implemented two mobile testing teams that are cable of doing 250 additional tests a day each and those are being deployed to the southeastern part of the city and we will also establish a permanent site in the southeastern part of the city, hopefully by september and so that will dramatically increase to test in those neighborhoods in addition to the current testing options that are

available. (indiscernible). >> do you know what those services are? >> we can certainly provide that and again, i don't know if dr. hammer or dr. simmons would talk about those programs but we can certainly get you the amount of dollars that are allocated to those programs. dr. hammer or simmons, do you have more information progra

programmatically? >> a lot of our juvenile judgment investments and partnership with the justice system and we have specific investments we make and we hold the work order for the program which is over a $4 million program that is directly related to violence supreme court and so therand our populationspecific y intervention, they all have elements that certainly are related to preventing violence, which is a big public health concern. >> yeah, it would definitely be great to know the specific investment, particularly looking at the budget for spy and seneca, understanding the youth are involved in the juvenile system and, as you know, with

mental health sf and our focus on more healing center practises, specific to populations that need support and look at mental health differently from a cultural standpoint and would love to know that. thank you. >> thank you. >> supervisor, thank you. >> president yee. >> yes, thank you, chair fewer. and thank you for all of the questions from the other supervisors. we've talked about mental health quite extensively and i think what missing from me is that we haven't really spoken much about the mental health needs of young people, younger than tay. and i spoke about mental health

needs for -- well, meaning the preschoolers, already, and i know we can work on that pretty well outside of the public health system. department.

this is probably a big issue where mental health services are needed because so many kids consider suicide and stress. so can you talk a little bit about whether that has come up to your consciousness to know that we have to deal with that and i know we haven't talked about it much, but there's a lot of urgency around mental health. i'm still planning to bring that around after budget. and so hopefully, maybe you have other answers that you don't have any anticipations today. a. >> thank you, president yee. certainly we have a

long-standing children and youth program that dr. simmons will talk about and we can get you further information. i will say that given this unprecedented pandemic that we're in, we are starting to see really mental health effects of people, long-standing effects of the pandemic of people who are very pivotal development stages and have to be thought o about n our system of care. i'll turn it over to dr. simmon for additional information and we can follow up with you next week or in a different briefing for your pleasure, supervisor. thank you. >> i appreciate your question, supervisor. we definitely would need a lot of time to talk about our full range of chattahooche children d family services and we have a

lot with the foster care system and the homeless response serving children, where we try to make our services as available as early as possible and we know that -- and i'm glad you raised dys, because we know most mental illnesses emerge in that period and it's important that we're there to intervene as early as possible. we have an investment in sfusd and we're expanding to middle school expose we're doinschoolss in response to stabilized families, to respond to crisis more actively and engaged i engo make sure our services are present in after-school programs

and we would love you to tell you more. we understand about the importance of that age in particular and families are important because anyone in our system is part of a family at some point, regardless of how they identify or define that. so we know that work is important. >> i appreciate that. and i don't want to say there's no services. there's just a lack of services. i mean, again, just using this as an example, i believe we have two mental health personnel oveh over two thousand kids and it's not enough. if we can find ways to strengthen that piece. i'm a strong believer to catch things as early as possible, to give our youngest the best chances to succeed instead of

waiting for everything to be acute. hopefully, there are others on the board because i won't be around that long to advocate for that to happen and to strengthen. and yeah, i'll look forward to hearing any additional information you might have. thank you. >> you're welcome. thank you. >> thank you. so i have a comment, if you don't mind. oh, supervisor ronen. i just wanted to take you back also in what supervisor yee said, that i think that through our own assessment to the sfusd, students self-testify and many asians contemplating suicide as young as middle and i think that's a silent population around mental health services partnership want to emphasize

tharound that in the asian community and i feel there needs to be much more support to our asian communities. this is what we have heard from health councillors in our schools is that asian parents also don't understand the seriousness of student's stress levels and how they contribute to a high stress level and we've had suicides. parents don't want it to be called a suicide, but there have been suicides and i think that it is really not being addressed to the level it should be, but my question to you today is, i see that you have -- on page six, advanced equity in our workforce and racial equity, black, african-american health and then, i gets guess, we've hd

conversations about this and drt mortality rate and black infants are more likely to die in their first year of life than white infants. in california, the birth outcomes are more pronounced and in los angelos, black babies are three times more likely to die than white babies in their first year of life and a rate of nine.six for 1,000 in contrast to the white rate of 2.1 deaths. and so i have to ask you, with almost a $3 billion budget, what resources are putting to this problem? i think it has been persistent and has been consistent in our population. and so, what are we doing to address that? i know there was a grant and

that is inadequate and an insult. what are we doing to combat that? i have fought this many times for the mayor and i've spoken to you about it. i've spoken to many healthcare professionals about it, but i want you to know, also, in the public health realm of folks, people have said to me, what are you doing about the black infant mortality rate? san francisco is among one of the worse in the nation. and that is really, i think, inexcusable when went are one of the wealthiest cities in the u.s. thank you. answer, please. >> thank you, chair fewer for the question and the preterm births among black african-american population has been a key focus of the department and one of the focuses as part of our black african-american health initiatives. you mentioned the dula access program and we're continuing to work to expand that program and we are working with the human right's commission to execute

the abundant birth project which would take out -- not take out, but it would expand beyond the very specific medical interventions that have been historically focused on to make improvements in realizing that their broader contexts with socioeconomic aspects are likely driving these poor outcomes and while we focused on improving the direct care, access to care for families, that may be necessary but not efficient. working with hrc, this would be a pilot program that would provide cash stipend to women who are expecting and shortly after giving birth, to support their needs and to allow the flexibility for them to decide how to use those resources for the needs that they have at the time. and so it's an innovative

program that we are hoping to execute and have budgeted for, as well. and then we continue to have our state perinatal equity grant, which allows us to continue the programs around addressing the needs of women at risk for having suboptimal outcomes in terms of birth. i'll last dr. hammer talk more about the maternal child's work we're doing, as well as dr. bennett with some of the work on thele equity side of that. dr. hammer. >> yes, i'm going to turn it over to dr. bennett. the perinatal equity work is a shared initiative between maternal child adolescent health. dr. bennett has been the executive lead on that from the

office of health equity and i'll ask her to speak on that. >> hello, i'm having the worst wi-fi problem and i'm hoping everyone can hear me. >> we can hear you. >> so ththe office of health eqy has been working in different departments because we need wide-ranging work in in area. maternal adolescent health has been one of the biggest. the two in the budget right now are the income supplement program, which dph is contributing to, but is also heavily supported by philanthropy and pent to be, me,

really, a test for concept and see the outcomes with configurations in their community. the other is the dula program laser-focused on african-american and specific islander moms. those are the groups with the worst outcome and they do work with latin x but that's a different program and they are meant to be partially funded by the program and heavily funded by philanthropy, making these to some degree, versing them as organizations, hopefully, in the community and i think both have been fairly successful in rounding out that funding and we're starting to see outcomes from at least birth from the dula program and the income supplements and we'll able to get started some time soon. >> i'll be really frank. i think that this cannot just be relied on grant funding.

that this actually has to be a part of our general fund money. this is where, i think, i want my tax money to go and, actually, i'm a little appalled that a supplement income, a stipend, in effect, is not going to solve the issue. it is much deeper than that. and i think it is related to housing. i think it is overall stress and i think it relates to employment. i think it's all about living conditions, even before pre-pregnancy. i think that it is much more than the dula program and a stipend program. i think that this actually takes a huge amount of committed financial stream and this is where the general fund dollars should go. i don't think it should be on grant money. i don't think we should be

relying on philanthropy. this is our responsibility and this is where we show a commitment with our general fund dollars to actually these births. i think that it is much more than that, i have to say that this is an issue that has bothered me the whole time i have been in office. i've seen very little action and i know that it is an issue that is not just directly in the house of public health. although, it is a huge responsibility of public health. it has to do with all of the supports. i just think that when we talk about san francisco being one of the most progressive cities in the united states and we allow this to happen, that this is not only an embarrassment, it is actually absent of a moral

compass to solve this program. we are not talking about a lot of people. we're talking about about a group of people where we know there are disparities in their health outcomes already. when we talk about reinvesting $120 million to the black community, this is where i want my money to go. i want to say as a taxpayer, four generations in san francisco, this is where i want dedicated fund dollars to go because i actually think this is something we can solve. if i didn't believe that it was something we could solve, then i wouldn't be so insistent about it. this is why i think i'm so

passionate about it because i feel that the investments have to be strong and investments have to be constant and they have to be there every year and we can build on it and we have to hold ourselves accountable to the outcomes. these moms, it is not just at birth, right before better but it's after birth, the second year and third year and if we want these outcomes, it has to be duly funded through our general funds and not through philanthropy and not through a grant. so i know this is a bigger issue and you have spoken -- i mean we've had you here for a long time, but i just ed thi just hat because i think it's really important and i want it to be under radar and i want it to be on the radar of the supervisors that will remain here, that this is something that we should

dedicate or general fund dollars to and the best practitioners and the best staff and a dedicated staff that we can get to follow this initiative until we're actually seeing some really positive results and then even after that because this should not happen in san francisco. i just wanted to say that. i think you've answered my question. i just felt like i had to say it. this is my last budget year and so i wanted to make sure my colleagues on budget know and that they will follow it. and then i have to ask you, mr. wagner, you have 1,158 vacancies in public health. and why do you have so many vacancies and do you have any general fund higher that are pending that have not been hired that are going through the hiring process now?

>> thank you, supervisor fewer. so on our vacancies, you have the report from the budget and legislative analysts and this is a conversation that tends to come up each year at budget time. and so we have a number of annual salary ordinance positions and then we have a salaried budget which is less than the total of the annual salary ordinance positions by quite a bit and so our budget assumes that a large number of those positions would be held vacant. if we were to fill all of those one thousand positions, we would overpand by $140 million. so we just don't have the funding in the budget to fill all of those. >> so my question is, why are you keeping all of those

vacancies? why do you keep those positions then and why are you not giving up those positions? i could say 100, maybe or 200, but over a thousand positions to be keeping vacant is ridiculous because you will never be able to fund those. if you're telling me consistently year after year, you haven't been funding them, why are you keeping those vacancies? the second part of the question, do you have any hires out of general fun dollars but in the hiring process not hired but budgeted in your budget? >> so on the first part of that, why the positions are there and some of the answer is the second part of your question. and so, it has accumulated over time when we take budget reduction and comes in the form of attrition savings versus the position.

we often ask for that to retain the flexibility for our programs to use different types of positions and they'll have more of a men of positions to choose from to meet the needs that they have over time. but as you point out, we have positions that we need to hire. and we have some critical areas where we are trying to fill. we often spend our salary budget, but we do so partially by using temp dollars, by using overtime and in some cases by supplementing with registry, particularly at our hospitals and so, we do have a significant number of positions that we need to fill and some of those big areas that we're focused on are nursing, where we are trying to fill our permanent nursing position so we can reduce reliance on per diem and another

large area that we'll focus on over the coming year is behavioral health for the reasons that we've spoken about today and we have gaps in our behavioral health system from challenges, from recruiting and hiring process. and so the answer is a combination of two. we do have those vacant unfunded positions, which is a structural thing but we have a big need for hiring particularly to get people in those clinical positions in the door and to decrease our reliance on overtime, on registries and get permanent people in those positions where we'll have more stability and longer tenures and better patient care as a result. so those are a couple of the big areas we're focused on and our ability to hire is one of the

key strategic initiatives for the coming year. do you have physicians in the hiring process that you have not hired yet? >> yes. >> how many do you have? >> we have several hundred. i don't have that figure in my fingertips. >> so you have several hundreds in the queue now that have started to engage in the hiring process. is that correct? >> correct. >> you haven't furthermorely hired them and they're not employees yet of the county and city? >> that's correct. >> you have several hundred and you don't know how much it might be but probably in the millions of dollars. is that probably correct? >> yes, although a lot of those dollars would go to replace spending that is occurring in the registry.

so you have -- so what i don't understand, i think, is the number of holding over 1100 vacant positions. (please stand by).

>> chair fewer: department of public health, during this covid, you've had to pivot and protect all of us, and i just want to say we are completely grateful for saving all of our lives. i think at this time, because

we're looking at a deficit, we are looking at things that we can save money that we would not normally think about. so you might just think about hiring, but what we're worrying about is could we save money in the first year, the fiscal year, and the following fiscal year. okay. i don't have anymore questions. i want to say thank you very much. i know this has been very long. you have a very large budget, and you carry so much work. i think supervisor ronen has another comment, but i just want to say thank you so much sharing so much information and answering all of our comments. thank you. supervisor ronen? >> commissioner renne: ye . >> supervisor ronen: yes. and i noticed that dr. bennett wanted to say something, so i

wanted to give her a chance. >> chair fewer: oh, i'm sorry. >> i just wanted to clarify, for both of those programs, the doula program, both of them are the results of a really close collaboration of multiple city agencies and the health plans all working together over the last several years, so the funding for those programs is not normal. the doula program is something they're advocating for getting those services covered in insurance and medi-cal.

the stipend programs hopes to be a reformulation for a way we give funds in our other programs, and so both of them are meant to help us develop longer standing changes in the programs. >> chair fewer: we are compiling a list of community groups, and so many african americans are asking for doulas. i think when you have a $270 million budget, $250,000 isn't that much. >> supervisor walton: d.p.h. can do more, i think. >> chair fewer: yeah. i can't leave this off without

emphasizing how important that is. so thank you -- >> supervisor ronen: sorry, chair fewer. i just have one other question, and if you could just summarize and keep it short, and we can talk about it later, but dr. grant, i'm just wondering if you can tell us how you feel about this request to remove sheriffs from general hospital. >> so thank you, supervisor. and judst to clarify, there hasn't been a formal request to remove the sheriff from zuckerberg san francisco general hospital. we're in the early part of the process, and i think what we're looking at with our director of

safety and in collaboration with the community and the sheriff's deputy is envisioning a safety of care and looking at where law enforcement would be needed in some of the areas. we're very early on in the process. this has been an ongoing discussion at zuckerberg to some degree, and we're bringing some of our primary care into the discussion, but that's independent of any budget discussion at this point. it's simply premature to speculate on any of the financial implications of that. >> supervisor ronen: okay. okay. thank you. >> chair fewer: thank you. now we're going onto homelessness and supportive housing, which is -- thank you very much. >> thank you, supervisors. >> yeah, thank you very much.

[inaudible]. >> chair fewer: at this time, we also have one trailing legislation, so at this time, mr. clerk, can you call item 4? >> clerk: sure, chair fewer. item 4 is resolution approving the fiscal year's 2020-2021 and 2021-2022 expenditure plan for the department of homelessness and supportive housing fund. members of the public wishing to make public comment, call

415-655-0001 and enter meeting i.d. 146-169-8090. press pound, and pound again, and then press star-three to enter the queue. >> good afternoon, chair fewer and supervisors. i'm gigi whitley. before the you is a two-year expenditure fund for the homelessness and supportive housing fund. so similar to in prior years,

this is really funding a component of our housing first program, especially particularly for homeless and formerly homeless individuals on county assistance programs or c.a.p. the expenditure plan before you totals 19.410,283 million in both years of the fiscal year, and as you can see, the h.s.c. doesn't cover the whole fund.

this is consistent with prior years of the budget, and we ask for your support. thank you. >> chair fewer: thank you very much. any comments or colleagues from my colleagues about this item? if not, let's open this up for public comment. mr. clerk, can we call for public comment, please, on item number 4? >> clerk: yes, madam chair. operations is checking to see if there are any callers in the queue. operations, please let us know if there are any callers that are ready. if you have not already done so, please press star-three to be entered into the queue. if you are waiting for public comment thus far, we will be taking that after all the departments have presented. for those already on hold, please continue to wait until the system indicates you have been unmuted. mr. qu, please let us know if there are any callers commenting on this resolution for the department of

homelessness and supportive housing fund. >> operator: yes, i have callers in the queue. i will unmute the first caller. >> clerk: thank you. >> clerk hello, caller? caller, we can hear you. >> so supervisors, the whole day long, i've been paying attention to the various elements and the supportive measures, and we all know that

housing and those who are homeless are adversely impacting quality of life issues in san francisco. and so again and again, we see that, in the past, we've had blueprints to address the situation, and we're not making progress. in fact, some of our other states do well, and we don't do well under same program that is being utilized. now, i've been noticing we lack

people of color who can give their expertise. for that is linked to cultural measures that we don't want to address, and that he had las to implicit biasness, and so i'm stating in this two minutes -- measly two minutes that i'm given, that our hearts have to be in the right place if we're going to address homelessness and supportive housing. thank you very much. >> clerk: thank you for your comments. next speaker, please. >> hi. i think i pressed the button for h.s.a. can we speak on the topic yet?

>> clerk: no, we're currently -- yes, not yet. the public comment for the budgets for the various departments will be the next public comment after this one. >> okay. >> clerk: when we do open it, but yeah, it may be a while. next caller, please. >> hi, i'll call later again, for the next public comment. >> clerk: thank you very much. operations, next speaker, please. >> hi. this is -- hi, this is marty regan, and i'm asking the board of supervisors to keep h.s.h. budget whole. this is not the time to cut

services for most vulnerable populations in san francisco. it's time to be bold, it's time to use reserves and get our arms around the most vulnerable people in this city. regarding homeless youth, these are people in our city who are often hit the hardest in economic downturn. the youth of larkin street, 45% of our youth lost their jobs and significant wages just this year part of the covid impact. they are often left out of bold plans from the city, and we're concerned that this'll force them deeper down the road of homelessness. we're asking for a prevention lens, and we're asking for a racial justice-social justice lens for the most vulnerable youth, criminal impacted youth, youth of color, lgbtq youth who are disproportionately

overrepresented in this city. they have potential, they have assets, they have strengths, they have resiliency. we need more housing. we need more specific youth housing options for them. we need bold, creative vision for workforce, and we need to look at our homeless population as assets to the city to help us all rebuild. they have an equal right just like the rest of us and a place in this city to help us discover from this, and i thank you for your time. >> clerk: thank you, miss regan. just as a reminder to the callers who may be on hold, we are taking public comment specifically on the resolution expanding the plan for the department of homelessness and supporting housing fund. if you wish to speak on h.s.h.s

funding as a whole, that will be coming towards the later part of this meeting, and you can press star-three to take yourself out of the queue. but for the next speaker, operations, please queue them up. hello, caller, we do hear you. hello, speaker, we do hear you,

but turn down your t.v. this is your go. >> operator: madam chair, that completes the queue. >> chair fewer: that completes the queue? >> clerk: yes. >> chair fewer: public comment is closed. i'd like to make a motion to refer this to the full board with a positive recommendation to be heard in the meet be on september 15. could i have a roll call vote, please. >> clerk: on the motion to refer this to the full board with a positive recommendation to be heard on september 15 -- [roll call] >> clerk: you have five ayes.

>> chair fewer: thank you very much. and now, we'll start with the presentation on the budget of homelessness and supportive housing. mr. hahn, you have the floor. >> good morning, chair fewer, and supervisors. i'm natalie stuart-kahn. i use pronouns she and her. i'd like to thank the city

partne partners who worked tirelessly on this budget proposal. i'm having a technical difficulty. h.s.h. will continue to lead with our values of compassion, courage, and common sense. central in those values is equity. it is imperative that we recognize that the root cause of homelessness is the lack of affordable housing, but for people of color, the root cause of homelessness is systemic racism. this budget and this moment gives us the opportunity and indeed the mandates to continue to push even harder to reverse the impact of that racism by equitably housing our unhoused black and brown neighbors. h.s.h. has, for many years, incorporated equity principals and practices. as the department formed, it began with naming racism as a

root cause of homelessness and participating in raefesearch o the topic. our new coordinated housing system prioritizes people on housing based on topics like incarceration and homelessness. by prioritizing people based on need, pardtnering with communiy based organizations to maximize the organization of marginal groups. h.s.h. have demonstrated our department's commitment to equity, and there is much work to are done. but we will need help. creative partnerships with philanthropy will soon allow us to access consultants. the mayor's budget before you today proposes an addition to hire for an equity manager, our

only staff person focused entirely on this topic to keep equity centered across all of our work. our d.e.i. committee leadership team, staff, and partners are poised to make huge progress on equity as we embrace the significant expansion envisioned in this budget, but we will have to hold ourselves accountable. this is one of those historic moments, and we need to rise to it. focusing on the budget, h.s.h. proposed budget totals $50 million in 21 -- fiscal year 21 and $60 million in 22. h.s.h. budget is growing by 131% each year with record expansion to route homelessned

homelessne homelessness. of the 33.9 in general fund growth that you see here in 20-21, the majority of the funds are allocated to new programming, including $23 million in one-time housing acquisitions, which are matching funds for the state home key, which will allow us to on board new permanent supportive housing as well as $8 million for covid response for safe sleeping costs, covid costs, and shelter space and staffing that are above what fema will reimburse. mayor breed announced her recovery plan on adults because senior adults have higher level of acuity and vulnerability for covid. as you can see, if the puzzle pieces and funding streams

unlou unlock and come together, san francisco will see an increase in housing needed for the elderly. 1,500 new units of permanent supportive housing represent the largest expansion in 20 years, and this would be on top of the robust mohcd pipeline which includes permanent supportive housing for adults, family, and t.a.y. the planning aligns to the advances family goals of not exiting anyone to the shelter in place out on the streets. despite the tremendous expense of these hotel and the risk of not maintaining their funding. not everyone in a s.i.p. hotel

will qualify, will need, or want housing. these populations and individuals have become possibly more invisible during covid due to the presumed lower risk of covid, but beyond covid, vulnerable families and others are becoming homeless because they aren't able to say in their doubled-up environments. it affects our families and young people quickly. this budget proposal maintains an investment in prevention and diversion, and we need to continue to work with our family system providers to be able to spend their money faster than ever. looking at the sources of funds for the mayor's plan, we know

there are many key financial assumptions that need to work in our favor for success. these are shaded in the table in front of you. these include fema reimbursements continuing until july 2021, unlocking prop c, and of note there, we have only considered one-third of the allocation of prop c funding which would be governed by the prop c committee, leaving two thirds of the prop c unprogrammed for family, t.a.y., prevention, and mental health. other key assumptions include c.a.r.e.s. hud funding, personal care, creative philanthropy already happening, and additional state aid. this provides a deeper dive into the adult enhancement. not yet mentioned by me is that the mayoria budget does continue to provide for the operating cost of the vehicle

triage center pilot, which will require deeper dives to understanding homelessness. on the next slide of critical importance to our system of care is that the budget propsal has to existing reduction to services or programs for our c.b.o. partners. these individuals and programs work tirelessly each day on their frontlines, and they have stretched themselves time and time again during this crisis. the mayor's budget does allocate funds into other navigation center projects for transitional age youth and 95 for the bayview community. this also does involve belt tightening for h.s.h. so we can ensure we are continuing to expand and that we are using every single dollar efficiently. it cuts funding for hsoc

vehicles, and it moves one system funding off of the general fund to allow for other commitments, including critical operating positions. finally, this slide articulates that the mayor's office has recently unfrozen our hiring, and we are very grateful. after four years, this month, h.s.h. will have a fully staffed h.r. team for the first time ever. this courageous team will allow us to support the continuing framework of rapid rehiring. we have lost of support of h.r. for covid due to a work order, so we will need the increased input. we will continue to rely on c.s.w. resources. the mayor's plan also imagines a small right now increase in

f.t.e. specifically focused on the race equity position we discussed, facilities, and other matters. if funding like prop c unlocks, the mayor's budget imagines some commensurate funding. thank you for your time, your commitment to san francisco's unhoused neighbors, and making san francisco a shared neighborhood for everyone. [inaudible]. >> chair fewer: do we have any comments or questions from my colleagues? supervisor walton? >> supervisor walton: thank you so much, chair fewer, and thank you so much, director stuart

kahn for this presentation. i do have a few question. the first is what is the allocated budget for t.a.y. homeless services? >> i won't -- thank you, supervisor walton. i will tee up and frame that answer, and then if gigi whitley can provide more context, we will do our best. so as you know from your role in advanced planning, supervisor walton, the existing budget for h.s.h. is not being cut, so we have an existing t.a.y. budget which will remain, and we are deeply grateful for that. we know many other departments are needing to cutback significantly. it imagines an increase for the t.a.y. navigation center. more importantly, we are close to drawing down all of our money for the government rapid

funding project call rising up. what is not in the proposed budget, supervisor and supervisors, is the t.a.y. money that would be allocated if prop c unlocks, and that is what we are beginning the advanced process on now with our t.a.y. community. in our existing budget, i will turn to gigi whitley to see if she can provide anymore details or content. >> hi. through the chair, gigi whitley. our baseline project is $63 million. it doesn't include the 880 for the navigation center. the mayor's invested $10

million in the rising up project. that will be exhausted at the end of 20-21, so we're looking for hopefully to the unlocking of prop c and other allocated t.a.y. funds. the prop c funds would be about $73.5 million over the two-year budget. >> supervisor walton: 73.5? >> correct. >> supervisor walton: and isn't rising up, the goal to keep about $40 million in that pot? >> i can speak to that, gigi. thank you, supervisor. so that's a $35 million public-private partnership allocated by mayor breed and sort of seeded by mayor breed.

there's $17 million left to be raised by philanthropy. and as gigi noted, if prop c unlocks, we would be able to seed more money. rising up is sort of a heading home to sort of double down our investments in t.a.y., and what we're really excited about, supervisor, thanks to the partnership led by larkin, we're starting to see our rising up for t.a.y. program, and that is getting up to speed now, and we're going to need it now more than ever. i don't think it's exactly accurate to say it's going to be a lot of money, but it's something we're going to need to invest in very soon, either philanthropically or otherwise.

>> supervisor walton: and does the rising up plan [inaudible]. well, we have to make sure they go somewhere from safe sleeping villages, and what's the plan for that? i know we're doing some best planning work on that, and does the budget take into account where those unhoused folks go? >> thank you, supervisor. so all of the covid -- i'm going to group the safe sleep with the s.i.p. expansion for purposes of answering your question. so all of the expansion related to covid, they have been in these s.i.p. hotels. the entire thing needs to unwind through this expansion in permanent supportive housing, rapid rehousing, diversion, and shelter.

but safe sleep is a safe space to be right now, so -- and i know many of your colleagues have you have a real interest in safe sleep. safe sleep happened to san francisco, and we have a lot to learn about it. what we have learned is that it provides a stop be place for people to be, for their cortisol levels to come down, a system that has failed them, and a ticket to home ward bound, and maybe a chance to stay there in their community, safe from the street-based elements, but not yet safe from rain and smoke. so what we want to do is use it as part of the system flow. what the budget imagines, to speak to your question,

supervisor, 100 safe slots, ramping down later. everyone has to go somewhere. no one can be exited to the streets, just like the s.i.p. hotels. we can maximize the resources, meaning reduce the cost per person of a safe sleep site, learn from the remarkable work across the city, and have a little bit more with the same amount of money. >> supervisor walton: and so just from your response, because i want to just make sure that we always compare apples to apples. >> yep. >> supervisor walton: and when you talk about the locating permit housing, rapid rehousing, shelter, where does either a, securing more hotel rooms or even the purchase of fall under in your categories? >> thank you. so as you know, we are continuing to ramp up the s.i.p. hotel rooms.

those are not housing, they are shelter. they do not have the same rates, unfortunately, so -- and they are more expensive than permanent supportive housing. so thank you for the tee-up to this question. the acquisition of hotels or other properties in the city falls into the expansion of permanent supportive housing, the 1,500 units that i talked about. for example, with the project home key application that you all approved or with prop c funding coming on-line, and we, along with our partners, are gearing up to rapidly acquire, hopefully not have to fix up very much. and i want to make this clear, we are hearing from building owners, hotel owners across the count city who want to engage and partner in this. we need to maximize and ensure that we have the best facilities at the best rates. >> supervisor walton: i have a

lot more questions, but i'm only going to ask two more because i know i have colleagues on here, and they may ask questions. can you tell us what h.s.h. is doing to address the unhoused black population in this city? >> yes, thank you, supervisor, for the question. this is going to be the moment to work harder on this topic. it's no longer sufficient for us to declare this in our principles. the 40% unhoused population who are black and the 5% housed population is an unacceptable proportion. the status caused by systemic racism as presented earlier in my presentation, supervisor, i

think you know this most, that our communities have suffered. first, every single decision at h.s.h. and every single policy needs to be looked at through an equity lenses. we need to get better at that. that requires further training for us, further training for our partners. we need to include and advance the voices of lived experience, the voices of leaders of color across our c.b.o.s, and our own voices in our organization. those are sort of the cultural underpinnings how we make uninformed decisions. practically or from a project perspective -- and i know we cannot project manage our way out of this, we need to course reentry and reevaluate it over and over and over again for

equity. study shows when coordinated entry -- if you are black in san francisco, you are a little bit more likely to receive permanent supportive housing through a coordinated entry assessment than if you are not, but we would like to see how much more that can be done within fair housing law, and there are many things we're learning from our own national colleagues and from our own creative thinking. i'm really excited about the house blacks initiatives and housing opportunities that are happening, and i look forward to that partnership. >> supervisor walton: housing entry has been the problem, and it's been how can we keep black

people from receiving the help that they need? you can't just blame the laws that are in place. it has a lot to do with people who makes the decision in who goes where. which brings me to my last question is will hsh guarantee that members of the h.o.t. team with culturally competent in certain communities and allow individuals to come out and decide who has a voice and walks on their streets? >> supervisor, i want to thank you for drawing this to my attention, again, a couple of days ago. i think what we can commit to -- first of all, i want to balance that, you know, the hot team is a nonprofit provider.

it is sup vised clinically by civil servants, but the vast majority of h.o.t. teams are nonprofit providers. we could potentially look at resources and training as we bring them to our full system of care. i would love to talk to you further about how to engage with community about, as you said, who comes out and walks the streets. when i've been out in the bayview with the h.o.t. team, i know their dedication to that community, and your community is tell us we must do better. >> supervisor walton: correct. and my community is specifically telling me we want different people, service providers. and again, under the latest assessment we've had, folks and community. and just for my clarification or my knowledge, doesn't d.p.h. hire h.o.t. team members? >> sorry, no. our nonprofit provider hires them.

>> supervisor walton: thank you. >> just to clarify, they did used to be part of d.p.h., and they are hosted at the d.p.h. building, but they are a nonprofit provider. there are many street medicine providers that often get merged with h.o.t., so it seems like you and i should sort of break some of this apart together so i can understand more of what we need to do. >> supervisor walton: definitely, along with community. >> yes, sir. thank you. >> clerk: apologies. madam clerk, before we continue, would supervisors haney and preston, noted present at 4:01, we have now been convened as a special

meeting as the board of supervisors. >> chair fewer: mr. clerk, what is a problem for me is that people are not coming up on the queue, so i'm sorry, i'm going to ask supervisors to raise your hand. supervisor mandelman? >> supervisor mandelman: thank you, chair fewer. thank you for coming to talk to us today, director stuart kahn. we're going to have publicly a conversation that we have privately frequently and -- i mean, first of all, actually, before i go there, i want to express the great gratitude that i have for you and the folks in your department who do extraordinary work who i think do not get the credit for the extraordinary accomplishments and achievements that san francisco has made in housing many, many, many, many, many folks who did not have homes.

it is unsatisfying, i'm sure, to some of my constituents, to hear, but in fact with those hundreds of millions of dollars that we spend every year, we keep 8,000-plus folks out of supportive housing into a more independent living situation, do a tremendous amount of outreach, and have done super extraordinary work over the last month in limiting the spread of covid-19 among our unhoused population in promptly shutting down -- shutting down shelters, congregate shelters when we became concerned that those were going to be on places where covid would spread among vulnerable people. in standing up, i think a relatively unprecedented number of hotel rooms for a city of our size. i think there are a number of

things that this city can be proud of, and before i say my criticisms, i'll just say that. >> supervisor, thank you very much for that. we deeply appreciate it, and we're proud of the work. >> supervisor mandelman: and folks in h.s.a. and d.p.h., and it's a shared -- >> right. >> supervisor mandelman: all of that is great, but the wonderful things i just said do not reflect the feeling i think of many of our constituents who think the city is a complete disaster in how we manage homelessness, and also -- are somewhat incongruous with united nations findings, and the general reception, that the united states and around the world, we're doing a terrible

job managing homelessness and dealing with homelessness. to my mind, one of the things that we've talked about, one of the reasons maybe for that failure is san francisco does not do a great job in taking responsibility and planning for the rest. we do a great job -- not a great job. for a city and a country that has abandoned its commitment to very low-income people and housing very low-income people, we make a real strong effort here in san francisco to try to get unhoused -- housing people who are unhoused and to solve the housing problems. but for people who don't have a shelter bed, permanent supportive housing unit, hotel room in the time of covid, people outside that sphere, we sort of say to them, implicitly to them and the neighborhoods in which they're going to try to find shelter, you guys are

on your own. and then, unhoused people -- this has gotten particularly acute during shelter in place, but it was a problem before, and before i was a supervisor, i spent a huge amount of time and my office's time, what do we do with these unhoused folks? we played a game of whack-a-mole, and the block that has come to experience encampments or people make more and more noise until the city finally responds, and maybe some get the funds that we're talking about, and others get disbursed. maybe a few days or hours later, i will hear from people where the new encampment is happening down the block. and it seems to me that

ethically, legally, in lots of ways, we need to have some kind of plan for rests for the folks -- that other set of folks. and i think that, actually, this board of supervisors, even before i was on -- i mean, not this board of supervisors -- boards of supervisors have pushed for some kind of comprehensive response that would allow us to enforce our laws and also allow us to be guided by the principles that in san francisco no one should have to camp in public spaces and no one should be allowed to camp in public spaces. i think supervisor campos, and the cause was taken on by supervisors ronen and haney, perhaps the cause of navigation centers for all would meet the need; that if there was a navigation center in each district, that we would make a play for enough beds or serious

placement that taking care of the rest would happen. mayor breed talked about building out 1,000 shelter beds in her first term. some folks have talked about duplicating new york's right to shelter. but in general -- and then, during shelter in place, my colleagues on the board, the board has unanimously said, and i personally don't actually know how feasible this is, we should get a revolutionary ordinance, 8,000 hotel rooms, 15,000 hotel rooms, to bring relief to the homeless and our neighbors. i have gotten no point that there is a plan for the rest, a place for all, from the administration. so i have pushed, others on the board have pushed for some

version of safe sleep at another cut at this. would it be possible to set up safe sleep sites, and have enough of them, that we can offer people a place to be that is not the sidewalk that they happen to be on? this has worked to varying degrees where it's been tried. i think everett was tried, but it was not, and i think there are a number of reasons why it was not terribly successful. i think supervisor preston -- i'll let him speak for himself -- but i think he thinks the haight has been a relative success. there has to be some other plan

to deal with this issue of being -- having enough spaces for folks that we can offer one to all in encampments. you are not the entire policy center around us. you are just part of a team, but this doubles down on getting shelter for a portion of the homelessness and actually spending a ton of money and time and resources on the rest.

i'm done. >> supervisor mandelman, yes. we have had this conversation privately. i appreciate having it publicly. i think it's layered. i'm very pleased in san francisco that we live our values, and this really focuses on housing to health care. families in new york stay homeless for the entire first part of their children's life. i think it's a valued conversation, and we continue to live our values. you are correct, that this is -- it's entirely with me. what i will say about shelter versus housing is that you can

spend as much on shelter as you do on housing, and so shelter, when supervisor haney and i talked about this with -- with his really courageous legislation around navigation center, it was sure, this is terrific, and we will not expand housing. so what about everybody else? i will not get out of my lane and talk about fees or camping, but i will say i'm really interested in the idea of what safe sleep is teaching us about the idea of what people need. we know that people who are experiencing homelessness on the street are increasingly wanting in ways that sfriurpri those that even talk to them every day. i think i talked about this with all of you: it's very

expensive right now. we need to bring the cost down. the reason assiit's expensive because if you have an empty building that already has water and bathrooms, it costs less to repair that than an empty parking lot. we need to look at other communities marshally that look at increasing the role and responsibility of people -- nationally that look at increasing the role and responsibility of people that living there. that is absolutely part of what we're trying to figure out, and i welcome that conversation with any supervisor who wants to talk about the space in their neighborhood. we absolutely need it to be larger, and where people are. so we have this sort of geographic equity challenges. we need to serve people where they are.

i think the plan for everyone else, supervisor mandelman, what i've said to you privately is i'm not willing to surrender the idea that we cannot end homelessness and make it rare and brief in a period of time. i've pushed on this, your constituents will be happy to know that i've pushed very hard on this. i'm concerned if we say go over here, first of all, over here may not want them there, and that community will be impacted. secondly, if you go over here, and there's no support, there's no security, there's no resources, that a fire will start; that we will have danger on our sort of dime, on our own -- on our own recommendation. you would then counter that that is what is happening now on the streets of san francisco, and i would agree with you, so we have not solved this. based on our conversations, i have asked our consultants to research nationally the idea,

beyond safe sleep, what are communities like us doing for safe places, and what have they learned what has worked and what has failed? before covid -- i will close with this. before covid, safe sleep on the west coast was failing in many, many locations, with some very special, unique circumstances, and we were able to bring those lessons to san francisco, working with expert providers, our partners across the city who set these sites up urgently but expensively. we need to talk about whdiscu talking about. i know a research memo is not enough, but i will get the answer for you. >> supervisor mandelman: i appreciate you engaging me with this, but i think we need to. although i appreciate your

desire to see san francisco end homelessness and/or make it rare and brief for all, we do operate in an ecosystem that is dependent on actions taken by the federal and state governments, and we will continue to feel their failures in san francisco. and i do think that the city is simply not asserting spnt for something doesn't keep us from being responsible for it. there are terrible things happening in encampments right now. i witnessed somebody emerging from a tent the other day, and the fact that these sites are not city run doesn't make the city not responsible for them, and i hope that we can achieve something that is better for that. the only other question that i want to ask you about sort of relates to -- it relates to the

plan to build out 1500 new permanent supportive housing units i believe over the two years. we've had a conversation about this. i just want this to serve as notice of a publish. the criteria for getting into the s.i.p. hotel, while it's been a little unclear and has been malleable, depending on covid-19, it has become a tool for particularly challenging encampment situations. there's been interplay between those two goals, but that does leave out youth, families, and it is -- and folks -- and people who i think need particular attention because they're particularly

vulnerable: trans women of color, for example. and i just want to -- i believe this is on your radar -- i know it is, but it shouldn't be that our plan for more permanent exits from homelessness post covid are determined by the steps that we've taken during covid and the need to, you know, keep people from -- we do need to keep people from moving from hotels back to the streets, but we also need to have housing options for youth, families, trans folks, and i just want to make sure we are mindful about that. >> yeah. through the chair, i just wanted to make sure i'm aware of that and what we need to do. the reason -- we don't know

who's in s.i. pichp. hotels. we know who they are, but we don't know enough information on them, are they vulnerable? so yes, the s.i.p. team is outlooking for vulnerable individuals, and the hsoc team is out there, looking for covid individuals and offering them s.i.p. rooms and covid rooms. we have a flexible array of services and interventions for people, so yes, that's why it's working, supervisor mandelman. [please stand by]

>> we need to do advanced planning in real-time now and it will allow for more housing that will be targeted at transitional use and it will allow for more targeted -- for example, the rising-up initiative which i discussed with supervisor walton could be an interesting place. we could double down on rapid rehousing and prevents for families and say we need this array of families. and so i'm eager to learn from the community the way we were do around adults what the needs are

so if and when that funding comes to us and the committee forms thanks to the controller's staffing, we're ready to go and anybody who has people you would like to invite to the conversation or if you would like to have input into that family conversation, beyond the providers that you talk to daily, i would welcome that input. thank you, supervisor mandelman. >> thank you, director. >> supervisor hainey. >> thank you, chair fewer. and thank you director and to the budget committee for allowing me to crash this party. this is obviously a very important issue and set of budget questions for my district and for our whole city. i had a question about the cost of each of the different types of beds that really would fall into our covid response.

your presentation says that we're doing $179 million investment to cover 2600 hotel rooms through june of 2021 and 15.1 million to support a 200-bed shelter, which is 75,000 per bed. is it accurate that the hotel rooms are actually cheaper than new congregate rooms? >> so let me frame that question and then, miss whitly can help me with specifics. so approximately -- and supervisor, these are fantastic questions and the driving of our budgeter. it's so valuable but as you heard me talking about, it's not reimburse the by fema. so the hotels, when i last looked were $250 a night, kind of loaded, right.

and that's helping people shelter in place and that's a valuable resource. shelter before covid was somewhere between 70 and $90 a night depending on the shelter and now that we are at 30%, 40% capacities and increasing to 50% occupancy for safety, that has become more expensive, if that makes sense. same rice, same price tag but per person, more expensive. the housing ranges between $50 and $90 a night and this is why housing is actually cheaper in some ways that shelter right now. and the villages, the resource rich ones are in the 260 range. and so, those are the price tags right now. is that helpful or is something more i can provide? >> yeah, that is helpful. are the congregate beds that are used as a part of the covid response, fema reimbursable like

the hotels are? >> they are to some extent and not all shelters have been repumped. and so i'll let gigi take the tough questions. [ laughter ] >> thank you, abigail and i'm actually going to phone a friend and call in the controller who is closer to the fema reimbursable and there's hsa staff that's probably on the line that will give a morquio me cojent answer. >> they're likely reimbursable but not likely. and this is one of the areas of ambiguity. hotels are clearly claimable and congregate shelter is questionable. and safe sleep is almost

entirely non-claimable, we're relatively certain. what i'm having a hard time understanding in terms of -- why would we use strategies that are more expensive and not reimbursable? why are we relying more so on the hotel rooms and not as heavily on the other strategies that seem to have more problems in their own way, more dangerous and in some ways less humane? i mean, i've been to the safe-sleeping slight sites and w them as a last resort, but a far less preferable option to the hotels as a place for people to be living and then if you put on top of that they're more

expensive, i don't understand -- and not reimbursable, why are we using these? >> so i can speak to the programmable piece and i'll let my colleagues speak on the reimbursement. hotels, as you know having worked there and sip hotels, as you know having worked there, are very critical for highly covid vulnerable individuals and they're also very expensive and it has taken every ounce of the dsw effort as well as ceo's increasingly stretching themselves to do it. and director roher and i are willing to speak to the limits of availability and the controller can speak about the limits of the funding. from a perspective of what we

feel and know that people tell us they need, some people want to come to a hotel room and many people do not want to be alone in a hotel room. we're reevaluating a roommate policy. and many people want to be in safe sleep right now and i agree with you in your evaluation and some people want shelter. we had, as you know, supervisor, a difficult time encouraging highly vulnerable ko covid folko leave shelters to come to a hotel. so what we know individuals experiencing homelessness, this is the number one that they teach you, meet the clients where they are and that's why we're getting these 90% -- 70% to 90% rates in places like the tenderloin. we are trying to balance that with what is reimbursable. so there's the need. there's what works and then there's what is feasible and

fundable. and so we're trying to balance all of those in this jigsaw puzzle that is the covid response. >> if i could, supervisors, sorry to interrupt the hsa budget process. >> you're very welcome. >> just a reminder on the reimbursement from fema, the non-vulnerable by fema definition are zero percent reimbursable and that is driving some of our sort of decisions not to house every homeless in a hotel because, you know, at 250 a night, it would be zero. and we're even frankly concerned about the reimbursement in general with the fema. i think ben can speak to this. they're strict about auditing person-to-person and that's driving a lot of that decision. >> i'd just had, supervisor hainey, this is why the mayor's plan and budget in front of you

and you know this and supportive is focused on housing. it is both affordable, covid safe and we have unlocking resources that are not things like fema which rely on the current occupants in washington to help us out. >> got it. that is helpful and i do think that it's important for folks to know because i think there's a sense, particularly with the safe-sleeping site or shelters that it's cheaper than hotels and hotels are the more expensive option and that's very much not the case. so for the people who are on our streets right now, i know there was a tent and structure count about a thousand or so, which was up from january,lying the, g

the many people not counted by the metrics. in this budget, are there things that focus on bringing them inside? what is the plan for those individuals, particularly if new hotels are not in this budget? how are we going to bring in the thousands of people who are out there now? >> so we started with -- before covid, we started with approximately 5,000 unsheltered neighbors in our community and as you've noted and supervisor mamdelman, we had to get our shelters rapidly and supervisor ronen's district in kind of an emergency mode. so some people went on to the street as a result of that and many, many people are out on the

street anecdotally and we need better data, newly during covid because of what i started talking about around families. they were staying with someone, they were doubled up and because of covid, they can't stay on so and so's couch any more. these are folks not living unsheltered. and so, we believe we were at a peak in people living unsheltered in may and that was when april, may, when the tenderloin when you live, i work, was in such dire straits. and the city kind of wrapped its arms around that community. and the beauty, i think, is very much restored and i'm greatful for that. i think we should talk to the department of emergency management and dem about sort of all of the people that are out there now. what i know is that a member of that team is that the plan is currently, you know, two to three resolutions of specific

encantments each week. i know you're in touch with them about what's your crisis and how we bring hstoc behind the tenderloin and the hot team continues to be outside looking for the most covid vulnerable to bring into hotels to invite others into shelter because that's the job of hsh is ending homelessness and that continues, but that won't solve the street conditions. and so, the plan is there are more hotels coming online. as you know, we are focused on the tenderloin and the mission, the bayview, thelma and castro and we need all of those resources available. the mosser of the resources th , the better the conditions in the passion of the colleagues who work there. and so the plan is to go back to resolution by resolution and i

heard hstoc talk today about 49 large inca49large encantments. that does not speak to supervisor mandelman's what about everybody else. the other thing we haven't talked about here and i believe talked about it with the department of public health, and i hope you will talk about with chief nickelson is the really bold plan around community paramedics for the psychiatric. so in my mind, there's three buckets, the hstoc resolution, the psychiatric emergencies that are either alarming or -- excuse me, the behavioral health, the substance use and psychiatric that are either alarming, upsetting or incredibly angering to those of us that live in sanfrancisco, depending where you sit and the everybody else.

so we are doing better in the first two categories and we need to continue to look at the third category. >> ok. yeah, i'm a little more than ae concerned about the fact that we have had some success in the last few months on relying more heavily on certain strategies like the hotels and that. there isn't a significant increase for those that would meet the need that still exists on the street. >> i think it would be useful to talk to the controller or door director moore before the costs. i gave you a ballpark and it doesn't need to be right now but that's one of the driving factors here. it's not that we don't all believe in the importance of the

hotels. >> such that we don't run into a home where 100% of the cost becomes a local one and that

will occur at some point and we don't know when. the budget assumes it will continue through june and i believe it's one of the reasons that the plan -- that the proposed budget reaches to is to try to complete the placement of people out of sips by that date. to the extent we climb to a higher target in the coming year, it creates some cost in the shorter term and creates a greater cost in the longer term to create the alternative placements for folks coming out of the hotel. and i don't know if that's helpful and clearly the choice is in front of you with the budget but those are the two cost pressures that i see. >> got it. ana couple of other quick questions i wonder if you could answer. i know there were some number of buckets of underspending from 1920 transitional housing placement, 541,000 and 598,000

and homeless reach over one million and why was there so much underspending and how are these carry-over funds used in the budget? >> yes, i will ask miss lee to speak to that and thank you for that question. >> through the chair, deputy director. i believe you're referring, supervisor to the bla audit, which identified a point in time and a projection of year-end spending. we were doing better this year in getting funding and contracts out earlier. covid hit and we certainly got

behind and i think the other thing you've likely heard from our nonprofit partners over the years is given what was at the time a very tight job market and certainly the high cost of living to live in san francisco, they were behind on their own hiring and having challenges, spending down their own budgets. and some of that projected fund balance was identified at the nine-month report and i believe there is additional projected fund balance from our department used in the final budget and that would be a question for the mayor's budget director but in general, if it is a fairly deminimum mus amount, most providers ask to carry that forward for one-time needs.

i think it's important to point out that some of what the report talked about really dealt with federal funds which we have certainly had trouble spending down because of the various restrictions on those funds. but more than that, those funds are often off-cycle and don't match the budget cycle and that needs to be taken into account. i'm happy to answer further questions about the audit. i didn't fully prepare to answer audit questions but happy to do what i can. >> i think it will be good because i'm sure this will come up around the bla report and having some response to some of the things that came up and i know there will be a hearing on that and i'll ask one last

question which is about housing subsidies which is, in this budget, i though there's a number of different housing subsidies that are included and which ones are new or expanded or at the same level? are there any that are growing significantly or added to or being cut back in some ways? i was having a hard time sort of understanding how each of the different types of subsidies are being either grown or reduced in the budget? >> san francisco has a lot of housing that is physically based and supervisor hainey, you've become an expert on this. we need flexible subsidies. we launched a subsidy pool after many years of efforts to make that happen and we were really excited to have subsidies that

launched the moving-on initiative which is part of our housing ladder and so we believe in short, median, long-term subsidies that allow people to move around the community, to sustain their exit to homelessness and that's a part of the array of services that people let us know that they need and miss whitly can hopefully speak to the specific budget questions. >> so through the chair, there are no reductions in any of our ongoing programs in the mayor's proposed budget, including ongoing subsidies. the budget does, through the mayor's recovery plan, account for 1 1500 new units of housing. as director stewart mentioned, 200 would mean throughou philanc

fund asking we're lookin and wee november ballot to understand the prevention problem somes, emergency subsidies, rapid rehousing and, of course, permanent supportive housing can be unlocked, not just for adults experiencing homelessness but families, families at risk of homelessness and then are traditional age youth. and that's where the expansion comes from in out budget and really, the budget is based initially on getting through the fiscal year with the covid expansion and the investment in project home key that the mayor announced and then to go beyond that point, similar to what you heard from the dph presentation, it's really reliant on that tax measure and then, you know, additional resources that would come to tru fruition if the

georecovery pond passed geo georecovery bond passed. >> anyone else? supervisor preston? >> thank you, clear fewer and committee members. thank you for all of your work and thank you, director fewer. let me just start by saying that i want to give some credit where it's due beyond all of us who are politicians or who work for the city to try to imagine where we would be look at these expenditures were it not for the vision for homelessness advocates going and getting prop c on the ballot and passed. and i won't put you on the spot to ask because i knew we don't have a lot of time. but i think we all need to envision how bad this would be in we did not have prop c funds which hopefully will be unlocked

following the this november. and i see the increases, the significant increases, over $100 million, as we talked about, coming to the department and i think we're all in agreement of the need to really tackle the homelessness crisis and address the tragedy on our streets. i do need to note as the d5 supervisor, that i'm concerned with how the decisions are made around what's a priority neighborhood and what isn't. i represent a district that i would say in terms of the spending here and the plans from what i can tell, this is kind of being left in the different and really, looking at the neighborhoods, western addition, we have a significant and growing homelessness crisis. and you know, you referenced a list of priority areas for the

upcoming year and i guess my first question is, particularly given the discussion of a racial equity lense? i'm not hearing anything about serving that area as a priority. >> supervisor, i assume you're talking about street as opposed to bringing a navigation center, but i'm happy to say a little bit more. i want to make sure i'm understanding your question. >> my question is anything. >> so you outlined the strategies and a number of neighborhoods that are priority neighborhoods. the philmore and western edition are not in there.

the only new thing has been the safe sleeping slights that was referenced but asking for those two areas which are increasingly impacted by homelessness. why is that not on a priority list and any plan in what you've outlined to address that neighborhood? >> thank you, supervisor preston, for that question and this is why i don't like to get out of my lane on street conditions. so the original protocol around priority neighborhoods for sip and other resources, which is in my purview was those neighborhoods based on where people were, based on hstoc evaluations and the point in time count. the reason this needs to be a dynamic, which i would encourage a conversation with director carol expect director of

emergency management who has been incredible partners on this and i know you all speak to them daily, to constantly reevaluate that. the reason that count was done recently, supervisor preston by hstoc was to specifically understand where people are. we though that people experiencing homelessness move around and we know that an encantment with two people in your neighborhood and is relatively ok can balloon very quickly to being not ok. and so, i would encourage that conversation and that conversation around priorities. you should wipe away what i said about those neighborhoods because i that is now dated information that hstoc has more data about where people are in the city. that was the original geographic. i'm happy to speak to where people go, the bringing them out of homelessness in your

neighborhoods. >> ok, well, i don't want to belabor this but i want to understand this. >> sure. >> to the extent there are priority neighborhoods and i understand it's dynamic and a lot of discussions that happen and it concerns me, who is setting that priority? there's a huge amount of funds and allocated to address homelessness along the strategies that you have outlined and there is some understanding and every time i engage -- and this is not specifically hsa but anyone in eoc, command center, trying to get clarity, there are clearly a set of priorities around neighborhoods served, populations served and who is setting that priority? is that you as the director of hsa? >> no. >> who is setting that priority? >> so again, supervisor, i would

encourage you to speak with the department of management. i know that's a frustrating answer. my responsibility is to make sure there are places for people and i also have a foothold in this because we oversee the hot team which is a partner to hstoc. the way those priorities are set are a combination and they're driven by data and i don't know what the department of emergency management will say, but several years ago, we had a whole data tool driving how we moved encantment when we able to end all before a massive regression and then covid. i think we need to be data-focused. you and i spoke about this yesterday. so we talk about where people are housed and unhoused in need and not where people are the loudest or have access to make that concerns known.

>> i'm not saying this is arbitrary but if there's a process and strategy here, it's not one that is apparent to the public or to this supervisor. but i'll move on. i have other question. and so, on the issue -- just to

ask a little more on the issues that we touched on a little bit about racial equity, talking about the street issues and western editions, let's look in terms of the resources. what is proposed in this budget to add capacity in the western edition? >> thank you. so this is the second half of your question, but it's much more comfortably in my lane. so, across the system of care, we have buckets of money if the key assumption unlock and if the controller releases funds, for example, that are on reserve, for safely -- we have shelter but those projects are quite spoken for in the budget and we have the continuation of things.

first friendship was this your neighborhood and we have replace ed this with a hotel in your community and then we have housing. where the safe sleep and housing will be will depend on where we find space at the right cost near folks who need it and so, you and i spoke yesterday about what that looks like during covid and what are the spaces that are cost effective because all of you have incredible boots on the ground that can help the department of real estate supporting us to find all these locations and so it's not allocated, supervisor, by district, that way.

>> there are no longer resources for drop-in and the resources that were in the philmore and i understand you can address plans to open alternate, but that was a resource that was available serving folk overwhelming or the african-american community, not exclusively in the philmore, but that resource was in the philmore and no longer available. i'm asking are there any new resources to increase the infrastructure and capacity to provide shelter in homeless people in the western edition?

the answer is that maybe through the profit c funds and that discussion will happen in the future, i understand. but what i'm trying to understand, is there anything specific in this budget proposal that is targeting increasing that capacity in the western edition in the philmore area?

we need to make a connection. when you close one door, you have to help people navigate to the next door. so there is not a shelter planned in district five or in the communities that you're referencing and there are buckets of money for permanent supportive housing expansion when there are buildings available for safe sleep when we find locations. we talked about a creative concept of a safe sleep location that ma maybe one day could cont to a shelter. those are the kinds of things we would like to partner with you on -- the reality is that there's people experiencing homelessness all over san francisco and they are disproportionately african-american and that's facts in evidence, yes.

we have to move through this racial equity. racial inequity. >> it may benefit the african-american people because of the disproportionate -- there's nothing specifically allocated to increase the infrastructure for serving homelessness people in the neighborhoods that i referenced. so i'm missing it.

>> i corrected that. i think you should speak to the department of emergency management about the street components. >> ok. but there's nothing in the current budget proposal or how these funds are allocated that would provide either a new shelter, a new emergency drop-in facility and i understand you and i are talking about these things in the district about potential ideas. but in those neighbors, nothing decided as a part of this budget to provide that kind of infrastructure for homeless people in the western edition or philmore? >> not to my novembe knowledge s budget. this location was ideal because it served so many neighborhoods

so effectively and centrally. and the decision that the mayor had to make to reallocate the resources because it would have been so expensive for a short period of time is a difficult one, i'm sure. we have that physical space and so i think -- we have retained that physical space and we need to look at the best use of it to help supervisor -- hayes valley, western soma and whatever the area of the castro is that comes down the hill there near the center. >> looking forward to partnering with you to make 33 goff a

reality and, you know, we're months delayed on that but hopefully we can do it. i wanted to go back to follow up on a couple of things that supervisor hainey asked about just on -- the 2600 searc sipp, how many of those are new to be acquired in 21? >> i'm sorry, the 2600, so we are at the number we're at today and that would be a good question for director roher and several hundred more still anticipated and then we reach the cap the controller was talking about financially.

>> about 100 still to be under contract and that will likely happen and might happen before the end of the fiscal year. >> got it. and if you were to add a

thousand hotels factoring in reimbursement, what would be the additional cost of that and would that be in the current budget? >> that would have to be, supervisor, in addition to the current budget. we built -- to keep in mind, the budget is the cost of the 2600 or more hotels, but it's the decant or exiting so it's almost a double cost. you pay the average, 250, fully loaded per night for every new room. because we are so committed to not exiting anyone to the street, that requires an additional solution on the back end and whether that's problem solving, rental subsidy and permanent supportive housing or whatever, so a double cost. the cost alone of a thousand new rooms just on that front-end is $250 a nighttime night times a d and take 25% of that would be

the general fund cost.

>> if we hit another surge and thing get much worse, we'll have to are recalibrate and readjust in terms of the need for hotels rooms or additional isolation. but right now, the plan is to begin exiting over the next 13 months, to begin exiting and complete exiting by the end of the 13th month. >> with the exiting not starting until after november. >> correct. it sounds like you're factoring costs beyond the fully loaded costs of the hotel room for people who have exited. is that right or not? you're telling me it's not just the cost of the rooms but the cost of after someone has exited

where we are placing? >> correct. >> in terms of total burden to the city, supervisor preston, the numbers that director roher is giving you is the cost per night of a hotel room. but once we bring someone inside, we're committed to placing them somewhere and so we have to fund an exit. but the numbers he's speaking about are specifically the hotel costs. >> and we get the reimbursement on the hotel but not on the subsequent place that the person has moved to next. >> that is correct. that becomes the expanded homelessness response system which has never been properly funded. bylaw.

>> if we added a thousand rooms, assuming maximum fema reimbursement, it would be $65,200 a night. or 1.87 million a month.

>> is there a pro jected cost for sleeping sites if if it's

doubled? >> supervisor preston, thank you, we spoke about this yesterday and this is where i think we have the most opportunity and work to do within the mayor's current proposed budget. the range of costs, like a safe-sleep village, which is a small site but has virtually no staffing is cheaper but less productive for the people staying there than a village. so the costs have varied widely across provider and site and so, as you and i talked about, it's just like shelter in that it needs to be an economy to scale. we want it large enough but not too large. and we are currently doing that analysis, crossing it against locations in the city. and so, you know, in our dreamland, we would have 120 folks to be able to say, we would have as our advocates have

expertly recommends, we would have residents involved in the work and we would have to figure out with those who set up the sites and the rest of the city partners how we can get that to be less expensive, the one-time cost. we need to bring food and security cost down. this needs to happen on every line item and so we need to work on that to bring that cost down. i can not put a number to it, publically. there isn't a number to it now as to what it should be. i don't -- we were not responsible for safe sleep when supervisor mandelman passed that legislation. i apologize that i'm not familiar where that number came from but i think many of us are surprised and concerned about the costs currently. and they started out in an urgent way, in the way they needed to and they need to get more efficient now. they must. if we can get them more efficient, we can get more of them, but i can't give you a

goal number yet. >> thank you. sorry, chair few officer. >> yes, i was just going to say, so i am following this conversation and i actually think that if you're saying they must be more cost efficient. is that correct? >> yes, they are very well run generally speaking and we're grateful. >> we're talking about safe sleeping villages. is that right? >> yes. >> so my question has always been, why aren't we using facilities that we know have bathrooms and toilets and water access already? why aren't we using sites that we know public buildings and can be adjacent to public buildings that we know already have toilets, already have sinks and already have water? if you're telling me that is the expensive part, why aren't we

using those buildings? so what is it? why aren't we doing that? because quite frankly, i'll just say we have public buildings that actually do have toilets and they do -- during the 1989 earthquake, we were able to set up showers in the hall of justice basement. so i just don't -- see, there is what i don't get. because i've been doing this conversation and i have a who've encantment and had a fire and i guess there's concentrated areas and you have concentrated areas you are working on because what your data tells you, this is the bulk of the most vulnerable people are living and when you look -- i think the frustration is also, there's no plan for these other areas that are experiencing growing homelessness and, also, there's to relief. i also think that -- so we have public buildings already that

have toilets, that have sinks and electricity and that have all that stuff and i just don't know why we're not using them. so if you're telling me it has to be more cost efficient, yes, i completely agree. why are we bringing water in? why are we bringing toilets in? we already have them. we built them with taxpayer money. they're not used now and all of these buildings are closed. why aren't we using them? we could have them in every neighborhood. we have recreation sites in every neighborhood that have toilets.

>> my head shaking was sort of, yeah, i agree with you, it's a bummer, we can't. when we started covid, my team

assessed literally hundreds of buildings to your point, supervisor. we want ones with bathrooms, an easy shower hook-up and we decided not to use rec centers because of the childcare sites and wanted to leave those open for other programming. we approached the school district and they didn't not want us to use their gymnasium.

>> we're a city rich with resources. you looked at the school site and they said no and we just walk away? this is what we do? we don't go to the school board? >> supervisor fewer, i think -- and trans-team and the department of real estate have

been looking at every building, everywhere and we have some models for how this can work. with supervisor mandelman's mediation and encouragement, we had a really remarkable partnership with the school district at evert. it was short term and they believe school was opening and it was cost ineffective to stand up a site there only to close and other complications with that location. but there are properties and i think the school district has really shown remarkable partnership around the existing program which we are all thrilled is fully funded in the mayor's proposed budget which is taking care of families during this crisis in a covid-safe way. that started with parents pushing their school community and the leadership and that

principle and supervisor ronen and forgive me if i don't give credit to all of the incredible stakeholders, coming together and saying these are our families and even then it started with only being available for families in that school and there weren't enough of them and people pushed again and they got more comfortable with the idea of that use of space and now it's available to any family that has a child in the school system. so we have examples of how when we partner and we bring people experiencing homelessness to public facilities, the sky does not, in fact, tall down. fall down. the state gives this to us for a dollar. we have to do more. i'm agreeing with you, supervisor fewer and director roher, we have to do more of that and we have to fundamentally change the way we think about people experiencing homelessness and what they'll do to these facilities that are not being used. >> ok, so we've used the hall of

flowers in an emergency and why can't we use it again? >> that's on our list and a planned surge shelter for covid-positive individuals. we're in negotiation with a private high school for their gym angym and i don't want to rl the name because we're still discussing that with them. as you know, we looked at bill graham and always something about why we cannot. we approached the inciden interh council and the churches are too small and have programming. it sounds like i'm making excuses after excuses. i'm as frustrated as you and they keep doing exhaustive searches, looking at port property. >> othat's why we have the rv's

in supervisor walton's district. >> if it will help, i can provide you with a list of every site we have looked at and the reason it didn't work out and it's literally over 100. >> yes, supervisor preston, i see you anxiously awaiting to speak. go ahead. >> the response on that topic as well as a couple of other questions, but i don't want to interrupt. i know you were mid-flow on this issue, which i agree with you, i don't want to interrupt your line of questioning on this. >> i just want to say -- so we have the north court of city hall. i mean, i'm saw, no one is even there at city hall now.

>> what are you trying to accomplish. >> like for surge, we have the fine arts set aside for surge. and then we also have the hall of flowers for surge and when do we say that, ok, we can give it

one of the sites for surge but we can start to actually have shelter for people there? when do we say that? when is that point? >> that's more abigail's lane than mine because i'm the covid person. but that then becomes a cost issue which is why i asked who. there's a surge shelter that we have in the surge budget prepared for, but if you're talking about a longer-term shelter for homeless, that's a cost and that's not built into my budget or abigail's that is before you today. >> so we're saying that we can'f not finding sites or an issue of the money? >> supervisor, i was referring to covid sites. that's what my team is tasked what doing.

congregate sides fo sites for cd positive. >> supervisor fewer, before the crisis, we were slowly but surely making progress with things like 1925, 888 posts and 33goth. supervisor preston, you have been look for a space in your community for a long time. the department of public health was making progress in district eight. i think that was good and never, ever fast enough.

>> we want to embrace community and neighbors want to visit these hotels and bring food and supplies, but we need to keep the germs away. so i think you're exactly spot-on supervisor. director roher's team has been looking at every community which has a funding ability attached to it. when before we needed to find the money, the site and create community adoption. so if we could take even one of

those away, we could do more things faster. >> supervisor preston. >> thank you. just a comment and then some other questions, but on this topic, i just want to be clear because as chair fewer said, we have plenty of sites for the congregate or safe sleeping villages. to your point, i have -- when you say i've been looking for a long time in my district, it's not been hard to find sites our district or property owners and schools. that's not a problem and i want to be clear that, like, my sense and you can correct me if i'm wrong, we're making decisions around cost, a decision not to put more people into hotels or

safe-sleeping sites because of the cost of our commitment, which i think is strong and an important commitment that people don't commit those facilities on to the streets. and so, that's what is driving this. and i think it's important that we be upfront about that. to chair fewer's point, whether it's parks, whether it's public property, whether it's private property owners, and different apartments are ready to step up, whether it's a safe-sleeping site or solutions, i just don't think that's the limiting factor. i have to say their was told before i took office in december, i was hard to find a navigation center and within a month and a half, we've ha we'va property owner who was wanting to move forward. and so this is about how much are we going to spend to house people now and it's not even the cost of shelter now because as

supervisor hainey pointed out, the most cost effective solution so far is hotels and that many of those costs, not all, but for certain individuals, 75% of the costs are reimbursed and we're making this around the cost of when they exit and that's our limiting factor. not that we can't find the hotel rooms and not that we can't find the sites, right? we can, we could. we made that commitment, but it would be expensive and i assume it's not in the budget being proposed. but i'm a little alarmed looking at this budget when we have -- or the presentation when we have only 145 new tents proposed that say sleeping sites. my colleagues are reacting, as well, only another 100 hotel rooms does seem very much as assume scormuch, it'sdoubling df

supportive housing but not offering any meaningful solution or increased funding for the temporary things that would get people off the streets. >> supervisorsupervisor, there e 2,600 and probably more, because people share hotel rooms and they have increased the shelter capacity in san francisco more in the last five, ten years and a significant one in the bayview and lower -- excuse me if i could finish. moving for. the housing is not just healthcare but less expensive than shelter and safer. you said that the shelte shelter-in-place hotels are cheaper and that's not the case,

the housing is and permanent solutions where people have tenant's rights. separate from the values around that, that is also where thes these -- this is not a room but whatever this is, this room, are not going to be governing much of the money if it unlocks. much of the money is allocated by the voters already and if the controller releases it after the november election, it cannot replace fema money. so i hear what you're saying and i agree we need more of everything. this mayor's budget proposal offers the single largest expansion in housing. , in subsidies and potentially tay and family. and it continues to drive on shelter and sleep.

this is a part of the two-thirds not spoken for. we are also able to increase our investment in rapid rehousing, which is a fundamental exit to homelessness for families and tay in san francisco and need to focus as an exit for adults. we have to stop paying only attention to permanent supportive housing and the

beautiful but expensive shelter in place concepts. you're spot on that part of our exit not exiting people to the streets is that we have to think about the exit. it would be irresponsible. >> ok, supervisor preston, i am going to have to -- what i'm going to do, i'm going to invite you to keep staying with us and hsa is next. and so we are going to be looking at hsa's budget. i think that, actually, at this point, i have hsa left and mta left and the airport left and support level and then i have public comments and so, what i would like to do is -- supportive housing will come back to us. this is the only time they're

going to be here and i think they are scheduled to come back, also. so what i would like to do is move this along. this is our first sort of conversation with them around their budget and then, please stay with us because we are now going into hsa's budget discussion. i'm sorry that we have people that had called in at 10:00 to be on public comment and they were in the wrong line and they are waiting to give public comment, also, and most are from parent voices and i'm trying to be sensitive it will be after 9:00. supervisor mandelman, did you have another question? i see you in the queue.

>> we were making great progress to shelter-in-place and working with the public health department and if you look in the right way that street conditions had improved possibly over the -- i was thinking about the hummingbird site.

>> i'm not aware of a location or budget available in this proposal that focuses on 1925, 888 and we had to repurpose the funds for 33 which would have served five along with other districts. >> so not the fun funds for a d5 navigation center? >> yes, eliminated the fun fundr 33 goth. >> yes, and on the plan for homeless families, i wanted to ask if families can be included in -- you referenced a new

flexible pool earlier and i'm wondering if families are included in that? >> that's a terrific question and that's funded by philanthropy focuses on chronic homeless adults and creates a mechanism for a flexible pool which we would love to see expanded creatively to serve all playingpopulations and could lot with community with prop c funding, for example, because we know families want to be spread around the city and not in one location. that's a great question, supervisor. >> thank you. and then last question, just in terms of new people on the street, because this is something we battle with a lot of misinformation out there, you know, you referenced some of the causes of rising numbers in the streets, folks who are marginally housed and tight situations who had to move, i just want to dispel this.

a large number are brand new from elsewhere and do you know offhand, what percent of people on the streets are brand new to san francisco, who have moved here in the last couple of months? >> thanks for the opportunity to clarify that and i will be brief, chair. in the beginning of the pandemic, we saw an increase in peeping coming from elsewhere and, in fact, we learned and had to follow up swiftly, that people were released from institutions and jails with bus tickets to san francisco and that happens from time to time and there was a flow here. now we're not seeing a massive in-flow and we will not know a data-driven answer to that question until our next point in time count.

>> thank you, thank you, chair fewer. >> sure. please stay with us. hsa is next. miss abigail kahn, i'm looking at your vacancies and i see you have 19. this is something that i think has plague plagued your departmr awhile. do you have any hires pending right now but have not been hired in their general fund vacancies? >> i will let miss whitly step in a moment, but thank you for highlighting that and this is one of the benefits of of th tha audit without a full hr team and so we're grateful that our team is robust now. and the vast majority of our vacancies, a i'm looking at a chart now. the one thing i want to call the attentioattention for the board,

there is one position pending approval of the budget which a substitution to ensure that we have our equity manager helping us to do the work. deputy director whitly, can you speak to anything more specific related to the hiring? >> this is including a fine offer and background check and i have a breakdown to go over with you. >> the one positions, you're in the position of hiring all 19 vacancies? >> we have a number of positions held open for attrition or as-needed but we've been doing an aggressive recruitment over the year.

we're asking for an expansion around facilities and shelter, which we need to continue to manage this operations that are fully staffed. >> thank you very much and i just wanted to mention that we

are looking at vacancies, but we are looking at these positions that haven't been filled yet. and even if they're pending or close to being filled, they have not signed a contract yet and therefore, they're not employees yet and i think at a time of, further, but considering we're 1.7 million budget, we're looking to be the most cost effective at this time. >> our last three hires happen to be transfers from other city departments and we're considering to hire, we're reallocating within the city and trying to use our talented city staff efficiently by bringing them to hsh so thank you. >> we see you again next thursday.

so we'll see you next week and thank you and we'll see you next week and with that, we have hsa. we have now the department of human services with ingrid, also. and emily gibbs and emily kaplin. there you go, made it larger. and supervisor walton, are you still with us?

i'm going to ask the clerk he need to be excused. >> we can do that from the vote later on to continue with the items. >> thank you very much. here we go and the floor is yours. >> here we go, ok, supervisors, good evening. i'm the executive director of the human service's agency and so i will jump right into it and it's late, a long day for everybody and starting with just the overview of the human service's agency and as you know, it's three city departments with really one administrative foundation with admin support, department of human services of which i'm the director, the office of early care and education and ingrid is with us and the department of disability and aging services and miss mcfadden is here and i will kick it off with the human service's portion and then turn it over to my colleagues.

and so, just an overview of hsa, and i'm talking about all three departments. and as you know, we deliver safetsafety net service ands fod health insurance through medicale and placement providing the services to single adults and families and then, of course, a significant system of early care and education and then we provide protective services for children through our child protective services and adult through adult protective services and a whole array of services for everyone from birth to later stages in life. and as you see on the slide, we touch about 260,000 unique people in san francisco every year through one or more of our