>> this is tuesday, april 20 of the. would you please call the roll. >> commissioner bernal. >> present. >> commissioner green. >> present. >> commissioner christian. >> present. >> commissioner chow.

>> present. >> commissioner giller month. >> she is on another meeting. >> members of the public we are switching the order of the agenda a little bit particularly given the events of the day. we will begin with the director's report. director colfax. >> thank you, president bernal. i want to start the director's report by acknowledging what a difficult day this was for our city and country as we anxiously awaited the verdict in the derek chauvin trial. justice was served. there was a statement a few hours ago i would like to read it speaks eloquently to this moment and what we need to do as a society to put an end to

senseless violence. i quote from the mayor. it does not bring back the life of george floyd. it can't replace the years of his life robbed from him or memories with his prepped and family. the tide is turning in this country. although still too slowly towards accountability and justice. 11 months ago the world watched as the officer kept his knee on the back of george floyd's neck for 8 minutes and 46 second, it felt like an eternity systematic justice was on plain view. the country and world erupted in protest. we are months removed the need for action is as critical as ever. this is about more than prosecuting the officer who

killed george floyd that is an important step. it is about restrucking how polices is done to move away from the use of excessive force, shifting responses to nonviolent calls away from automatic police response to something better equipped to handle the situation. reinvesting in communities where it has been nearly impossible for people to try. changing who we are as country. that is what we are trying to do in san francisco. our street crisis response teams consisting of paramedics and behavior health specialists are the first responders to mental health calls. our dream keeper initiative redirects $120 million to improve lives of black youth and families through investments in everything from housing to healthcare to worke forcer training and guaranteed income. our sustained efforts to reform the police department resulted

in 57% reduction in instances of use of force and 45% decrease in officer-involved shootings since 2016. while this tragedy cannot be undone. what we can do is make real change in the name of george floyd. nothing will bring him back we can prevent others from facing this in the future. that is the work we need to do. ongoing, challenging. if we are committed we can make a real and lasting difference in this country. end of quote. i also want to echo a few points from a letter i sent to staff yesterday in anticipation of a verdict. these are experts from that. blinking an end to racism acknowledges the proximity in the workplace and home. when it comes to public health

in particular, racism colors the experiences of our patients and affects health outcomes. it takes the infrastructure of communities. shapes resources we need to be healthy and well. this pandemic has exploited our economic divides and disproportionately impact the communities of color. racism is a public health crisis it is our duty to dismantle systems that prevent people living full lives. events like these are traumatizing and difficult for many. especially black african-american colleagues. i want to encourage everyone to be gentle and do whatever is necessary if it means taking time off. this past year is extraordinarily challenging. i have been humbled and inspired how we have come together to push through these difficult times.

this time is no different. we must continue to support each other. thank you, commissioners. >> thank you, director colfax. i certainly for myself and on behalf of the commission want to associate with the leadership of mayor breed and you, director colfax. truth and justice did prevail. now the time for healing. there is so much work to be done to dismental the racism around us. it is particularly fitting today that we are hearing an update from the street crisis response team, it is critical in san francisco for what we are doing to reform and reimagine policing in our community. we are grateful to hear that presentation today. we want to echo your statement, director colfax how we need to be there for each other, how difficult and traumatizing this

experience has been for not only our team and our family within dph but throughout the community. people do what is necessary to take care of themselves and that we support everyone within the department and the community. thank you very much. we can continue with the director's report. >> thank you. the director's report i have many details on covid-19 updates. we will be presenting that after the minutes are read. i did have a couple announcements. just to say that the mayor announced on april 13th the least of a site for drug sobering center. this is something that is continuing to be a co-focus of

the department because of the covid-19 pandemic. we are delighted to release 1076 howard street for the first sobering center in san francisco as we continue to strengthen behavioral health system. a note to the commissioners on that. announcement that is wonderful for the state and for the individual and for the health department. sad to see this individual go. christine shador, acting director of population health division has been capped by governor newsom to be the deputy assistant director for the california department of public health. outstanding opportunity for christine. as you know she has been a pivotal part of the department,

key leader in. >> commissioner covington: respo >> commissioner covington: -- . she has outstanding resume and i think in addition there is an incredible mentor to many of us in the department supporting the work around health equity. i am sad to see her leave the department. she will be bringing her skills and her commitments and inspiration to the state and will continue to support us in that way. congratulations and best wishes to christine as she moves on to the state. that is my director's report. thank you. >> do we have any public comment?

>> on the public comment line please press star 3 to raise your hands for the director's report comment. i don't see any hands. >> commissioners, any comments or questions on this portion of the director's report before we move to the minutes? commissioner chow. >> i want to personally thank director colfax for the letter that he sent out to the department employees because i think that struck the appropriate phone for the health department. grateful for the mayor's statement and for our department it was nice the director actually was proactive and i am hoping our employees will appreciate the sentiments there

and we will all be able to follow-through and continue to respond to the news of all of our population. thank you, doctor colfax. >> thank you, commissioner chow. commissioner guillermo. >> i want to add my thanks to director colfax and the mayor for their statements ready to be shared with the public and with the department today. i am glad it was the statement and not a different statement that would have made a mockery of everything that we believe in. my gratitude that we were able to hear these statements from

you. i also wanted to take the opportunity to congratulate christine and really i am very pleased. as some of you know i have known christine since she was out of grad school since i was her first employer out of grad school. hopefully that helps the trajectory of her career. i can't take credit for everything she has been able to do. i am glad that san francisco now has so much representation at the state department of health. it really does go to show what we have all been able to achieve and how much we have to be grateful for in terms of leadership of this city and this department and its leadership.

it is nice to know we have friends and colleagues up there at sacramento. >> thank you, commissioner. commissioner christian. >> thank you, president bernal. i want to thank doctor colfax for his letter and his statement and also to thank the mayor for her comments and her leadership. like everyone here, i agree with her 100%. this is a very sad day as well as an important day, obviously. maybe there are people not feeling so sad. what i feel is that mr. floyd is not here. there is no reason under the sup, no, just reason under the sun for that to be true. the question of justice is a hard one.

representative corey bush wrote on her twitter feed that justice would be mr. floyd being alive today and what we get today is the beginning measure of accountability. i think that is true. we had a jury in this case that did their job and were intelligent and truthful enough to see what the evidence showed them so we can be thinking of all of the justice we can have at this moment. very limited measure. for this horrendous situation to continue to repeat itself is something that we are all have on our shoulders to do what we can to stop it, including whatever changes in policing in

the country that are necessary, not simple reforms but deep changes. my heart goes out to everyone, especially mr. floyd's family. he should be here today. a friend said course corrections are possible. justice happens in the heavens. let's hope that is true. >> thank you, commissioner. i don't think any of us could state it better. thank you very much. not seeing any other commissioner comments, we can move to the next item where we will go back to consideration of approval of the minutes from our previous meeting. i do know we have amendments. before we go with head with amendments. mark, do we want to move as amended or should we move and

then hear amendments. >> yes, on page 2 of the minutes commissioner green asked me to strike an extra buy-in the third paragraph. two words by, by. commissioner christian asked me to take out the summary of dr. bennett's comments and include her comments verbatim which i did going bank to the video. those are the two amendments before you on the copy that is hosted and also that of the minutes i sent to you. >> all right. seeing those as the changes to the amendments to the minutes,

upon reviewing the amendments and knowing -- the amendments do we have a motion to approve. >> so moved. >> second. >> any comments? >> public comment on the minutes of april 6, 2021 meeting raise your hands by pressing star 3. i don't see any hands. >> with the motion and second we can move to approve. >> roll call vote. commissioner bernal. >> yes. >> commissioner green. >> yes. >> commissioner giraudo. >> yes. >> commissioner chow. >> yes. >> commissioner christian. >> aye. >> commissioner chung. >> yes. >> commissioner guillermo. >> yes. >> minutes are approved.

>> we will go to the covid-19 update with dr. grant colfax. >> thank you, commissioners. grant colfax, director of health. i will be providing a brief overview of where things stand with regard to the pandemic. albert will present plans with regard to our transition as we continue to address the pandemic in the city. also, we continue to re-open. with regard to cases and deaths of covid-19. we are at 35,816 diagnosed cases. i will point this curve is very level starting in february of this year. our numbers continue to be relatively steady. that will become more apparent

in some of the slides i show in following data. sheer it is. covid-19 cases plateaued. you can see purple which shows the cases per 100,000. on may 15 of last year to april 15 this year. you can see the purple line dropping dramatically. red is march 2, orange march 24. we barely missed the yellow yesterday. you can see that purple curve is corning to that yellow. the california yellow tier. that purple line averaging just above the yellow tier level. what is hopeful about this you can see since we have gone to

the red tier with more activity for a six week period we mained steady number of cases. it is relatively low to where we have been before. next slide. in terms of population characteristics. not a lot of change here especially since this is cumulative. cases are reduced dramatically. we wouldn't expect to see radical here. racial ethnic disparities continue. age group more younger people are infected with covid-19. we are looking at more recent cases diagnosed to see if this is proportion at young people infected with covid starts to increase now that we have high vaccination among those 55 and

over. this will take time to change. over the last couple months the case distribution by age to see if there is a shift in the age of diagnosis. the key health indicators. our hospital system indicators the first three on the slide remain in the green relatively robust. case rate in the yellow 3.8. relatively stable. testing numbers these are steady now between about 4500 to 5200 tests per day on average. this is consistent with the reduction in testing after the holiday and reduction in testing overall in the state and country. we leveled off at 5,000 per day. the numbers are good and p.p.e. supply is at 100%.

this is hospitalization curve. you can see the sharp increase in the spring and leveling on the far right of the slide down to level that we were in the interval between summer and winter surge. then having to go back to the beginning to seek the levels of hospitalization. within the healthcare system as of today we have three covid positive positive patients it is a radical shift from a few months ago. the mean age of hospitalized patients dropped over time. it is reflected with vaccination rates of 65 and over. those were the first populations we prioritized and were eligible for vaccination. blue tots represent the average

of hospital patients. april 14 that average age of hospitalization dropped to 45. lowest we have recorded. >> in terms of vaccinations, san francisco residents 64% of people eligible for the vaccine have now received at least one dose. we are making very good progress there. 42% have received or completed a series two doses or one shot johnson & johnson vaccine. our vaccine administration is currently at 10,400 day rolling average. this has gone gown somewhat from 12,000 average per day. not due to the j and j. it is decrease in supply from

the state of moderna and pfizer. the state redoesed the supply by -- reduced supply by a third over the past week. we expect that to continue for two, three, four, weeks. we have capacity to do over 20,000 vaccines each day in our city. you can see what we are basically putting into arms what we are getting. we are also expecting -- we recently made everybody 16 or over eligible for vaccine in san francisco. we expect that cdc and fda will allow 12-15 to be eligible for pfizer. we are awaiting trials from moderna if that would hold true. in terms of the johnson &

johnson vaccine pause on april 13th. we followed fda and cdc guidance with regard to distribution and administration due to initial reports of six cases of blued clots with -- blood clots from women who received it. this is an extremely rare he haven't. -- event out of 7 million doses. started within two weeks of the dose. we have administered in the city 33,000j and j doses, a malsnub over 800,000 vaccines in san francisco. we haven't had any known events. we issue provider alert with regard to what providers and patients should look for in terms of the extremely rare

event and difficult provider with symptoms shown on the slide. we do not expect the pause to have any realtime effect on our vaccine efforts. we were receiving very little j and j supply. the week this was put into place out of 10,000 vaccines we were eving only 500 j&j. those are on hold. because of our relatively higher moderna and pfizer supplies it was a pause in the j and j created minimal disruption in the vaccine effort. we are watching to see what the cdc and fda do with regard to lifting the pause. hopefully more vaccine supply as soon as this pause is lifted and as soon as we can get more moderna and pfizer into our

system. >> these numbers already to put in context. in san francisco our numbers are higher than the u.s. overall. 39.5% have received at least one dose. a quarter of people have been fully vaccinated. you can see the california numbers here. we are somewhat higher in the california numbers. i mentioned 800,000 we have put in arms. i talked about the challenges we are having. nevertheless we are on track to have 70% of eligible residents receiving at least one dose of vaccine by the end of april. that is good news. we are running ahead of schedule before this decrease in vaccine

supply was announced by the state. again, we are on relatively good sitting with regard to needles into arms. >> you probably heard this. we have continued to expand the orange tier activities as our numbers remained low. the acting health officer modified health orders to allow more increased activities. we didn't allow everything allowed understate orange locally. we have expanded. there are some exceptions here. we are basically in full state orange now. you can see most of the modifications we are increasing capacity of certain venues. i think that is it.

i will defer to the chair if you would like me to take questions now. >> without objection from the commissioners we will have the doctor go next. >> give you 30 seconds to switch presentations.

>> as they presented in december, in july of last year we transitioned to a unified command structure with three unified commanders from d.p.h., h.s.a. and others. that took us into early march or late march, thereabouts when we began to shift into the transition state.

we are not calling it a boc and you will understand in a second. this phase will continue on for a bit and then we will continue the transitioning of current covert response that is managed and coordinated with the command centre back into the public health department as well as other departments when this transition begins. next slide. the high level goals for the transition planning process is we want to make sure we are using a phased approach. it isn't a single date, july 1st, and suddenly we have a full transition back to city departments. it will also be guided by milestones that are grounded on hiring resources, transition timing, triggers and et cetera. the work that is guiding the

transmission will be over time, as well as grounded by outcomes. so the new normal, as we are calling it, living with covid within the department, while also maintaining response operations. when these services return home to d.p.h., we still have ongoing response and what it means for the zuckerberg and the general hospital, behavioral health and throughout the department. there is a lot of expectation both internal and external from city departments. their business industries, schools, as well as residents who are in our neighborhoods in terms of covid response and in terms of how we transition and how that will impact our residents throughout the different neighborhoods. there's a lot of expectation management to make sure people understand what that means to them.

support the reopening of local governments and schools. that is front and central right now and it will be ongoing for a few months. and clearly communication is the big part of this and managing the expectations of internal and external. internal is not just the ccc, but throughout respective employees who are currently in the command centre. some of who will be returning in some -- they have been activated for more than a year. it is a big shift. one day we return home to the regular operations. there is a lot of critical communication that is part of the planning process. next slide. i won't go through this because dr. covax has already covered this. it has already been updated. things are getting better, which is why we have some flexibility in terms of time to do good

planning. next slide. it is also a budget alignment in terms of right now. this gives you a sense of the different realms of the deep, intends to work of understanding what resources we have and managing our covid response and what resources we will need to manage the ongoing response based on service-level assumptions that we anticipate of maintaining or not maintaining. we will not go through them all, but commissioner greene had raised the question earlier in terms of the presentation. they -- they are profit resourcing options in the budget function. greg will present more on may 4th to this body in terms of the final mirror's office and the approved positions. the full resourcing options are ongoing activation of dfw that

would come from d.p.h. and not to d.p.h. agencies, there is a current assumption of 50% of activated staff will remain activated on july 1st. twenty-five% will remain activated october 1st and zero, they would be no additional activations from january 1st 2022 and beyond. it is not final yet. it is awaiting the mere's office approval. that is our proposal to manage the resources needed to maintain the ongoing response. the second options are we have contracted a number of services over the past year and a half or so. some of whom will continue to support our ongoing response. the third option, we also hire a number of temporary positions as part of the covid response. all of whom will continue on to support the response and then the fourth option is really what

is going to be in the new fiscal year budget in terms of the approved temporary positions to support this response. there are also some operating assumptions to inform our planning to get to the resources needed to support that. the assumption is we are now -- we're not planning for a surge. meaning we are planning for at the highest yellow status in terms of cases per 100,000. we are also not planning for boosters vaccine as needed. we are also not planning for variant impacting the vaccine effectiveness that might require the booster vaccine. we are also planning the assumption that at least 80% saturation of adult vaccination. clearly there will be pediatric vaccinations that will happen later this year that will continue into 2022. we are budgeting for that but we are not budgeting for boosters

and that variant impact on the vaccine. it doesn't mean we are not planning for those. what we are planning for in the base budget and we will do planning in terms of what the resources that would be needed for that and the likely path to support that demand will be further reactivation of staff since hiring staff and the dollars available would not be fast enough. next slide. additional reasons in terms of why transition now, as i noted earlier, every department is asking the staff to return because of opening of libraries and schools in the lake and also the current covert command centre structure is very resource intensive. is a structure that is not sustainable for the long term as a disaster response. as well as the liberal dfw is a getting pulled back. this is the most challenging, a delicate dance of balancing

these while we are still asking for ongoing activation although it is not 100%, though it's still a sizable number of july and october and beyond. we are working through all of those as part of the planning process as well. next slide. it started april 5th. there are some real concrete specific changes already. as i noted earlier, the command structure had three unified commanders. right now, as of april fifth, that structure has shifted to no longer with commanders, but directors as the point person shepherding and leading this transition process until we completely transition into a department specific structure. it is spaced. i will not get into the specifics of that.

this just highlights the progression of those activities over time. next slide. key milestones, at a very high level, it's guiding the transition planning process budget. there is an important word here which is versatility how are we prioritizing these services? we want to ensure other covid response stories. we need to implement those in order to mitigate the spread of the infection. there are functions in areas where they don't belong to a

distinctive department uniquely. they cut across departments work across the current structure. and we just want to make sure we have clear disability and capture the needs of these so they don't end up just getting falling through the cracks when we assault the execution of the transition. we are seeing a critical factor of the milestones and one of the key steps to when we can transition, making sure we have the staffing identified and the needs of the budget. we are also doing temporary hires against the greatest need so we can sequence the hiring to support the transition because it will be over time. reassigning dfw, that is the ongoing activation, as well as prioritizing department priorities. this is leveraging external

resources and contracts and hires as additional resource options. next slide. this is an example of the job classes that have been posted by d.p.h. these are the top priority ones that we determined to be critical in supporting the current response as well as the eventual response when they transition back to d.b.h. in addition to this, there are several classes that have been posted and those lists are available for hiring once we confirm the position, in which

role, and in which area that we can begin recruiting or interviewing from that list. dr. green also had a question in terms of other areas in terms of -- i want to bring up also there was a hiring manager that had been assigned to each one of these job classes, as well as coordinated through d.h.r. so that there is clear accountability in terms of who is owning, which recruitment, which classes, how many f.t.e. is in that class. next slide. previous slide. thank you. this is what the transition state looks like.

a couple of key functions that is within the unified command structure before april 5th as part of the command system structure. i will call the vaccine as an example. there is so many significant components related to isolation in hotels, and the rooms that are critical in order for us to support the transition requiring the residents to be rehoused. data and virus tracking is the intelligence at work to in form how we plan and organize. we want to make sure we have complete visibility and that will make sure we have anything in terms of what we need to know and the biology of the virus and the muni -- and the variance et cetera.

there is a lot of information that we have continued to push out to different neighborhoods and districts and industries. and equity and community are other critical pieces that are pulled out. and that light blue box is the department operation in a post- transition state of how we would intersect with the eeoc which will be administrated -- ultimately the data attracting the virus wilful back into d.p.h. once we fully transition into a state. next slide. this is a busy slide. i have spent a minute here just to orient you in terms of how he got to this process. the big box on the lower two thirds of the slide is what we will be shifting into once we begin the transition process. we are not calling it a d.o.c.

in a traditional structure. it's a task force. this is a hybrid between the traditional structure and the current structure. so in the orange box in the middle, that is the body. it's a task force leader reporting directly to dr. koufax as the director of health. informed by a policy group on the left and dr. phillips to continue to form out the policy decision. the task force is similar to the operations section of the traditional structure. and the blue boxes on the bottom are mostly operations, logistics on the left there. the logistic branch will completely disappear once we

fold that into the material management supply chain because ultimately that is the unit and programme that will run the logistic part of the ongoing response. so once each one of these boxes goes to full integration into d.p.h. department -- a programme unit centre or division, then these boxes will go away. and in the green boxes, it just shows the correspondence and coordination as the eeoc structure, the joint information and communication jake as well as the eeoc structure. the pinkish orange, i can't tell what color that is, my apologies. on top of other workgroups that are critical to support the transition planning. this entire slide is the transition planning governance

structure to guide decision-making to ensure alignment, coordination, information sharing across different groups that are doing the work. some information his are critical input points for other groups to inform the planning, the timing and sequencing et cetera. those groups are the human resource groups that the new director is leading. the equity and community engagement group is leading that to make sure equity is front and centre in our ongoing work so it is not a one off. we have many doctors who are all part of the critical group to make sure we can fully understand what the impact is and fully integrate from a workflow of people and processing data system perspective and a similar group of ph.d. his that we are now starting to work with, as you

heard earlier, will be leading the department. there is a body that meets weekly that puts up to two groups. one group is the six-month strategy group. and then the right side is maryellen and adrian that are called to the transition management team. that is the governing body for the transition planning. once we fully transition, it will be the task force. once we completely immobilize the entire city from the covid response, then it will go back to edp eight -- d.b.h. structure. next slide. a well. this slide -- this slide will be

useless because there is no text here. i will walk through each one of these boxes. it is quite colourful. my apologies. i will start with the purple box. this is just an example of how we are planning to take each work group through the planning process. the purple box starts with the data model projection. there is great work in terms of really understanding how much saturation of the vaccine, what is the impact of the variant currently, et cetera et cetera. that is driving our ongoing service needs when we transition. next to box up is the eeoc service. we have just completed that as part of the budget planning work with each branch to say, what do you think we need to continue to do come july, october, and january of next year? based on those requirements grounded on the data that the

advanced planning team has given us, how much resources do you think we need to manage that service expectation? and then the third box is the heavy lifting work, which is the deep dive of each group to make sure we understand who is currently supporting the area, how many of those people are actually going to be leaving by july and who is remaining, what is added to that list of people from a hiring perspective, so that we make sure we build that hiring into the transition to allow us to say we already transition for this area or we have not because we don't have the resources there yet. part of the work of the due diligence is there are a lot of workflows that have been created to support the covid response and command centre. when they transition back, there is going to be some adjustment there. we need to make sure those changes work and that they can be fully integrated and incorporated to support that

change. as part of that there is also systems and data that we need to understand. and i think in terms of data and systems, there is a number of new clinical systems that we have either acquired contracts for or created to provide the data and information that is needed to inform. we have to understand all of the people, process, system, and data that are critical to support the transition integrating back to home units. and the fourth spot is because it is risk mitigation and assumptions, because with planning, based on the operating assumption i stated earlier, no booster, no variant impact, 80% saturation in adults and no surge. what if there is a search? we know there will be one. how high? hopefully how small? how high that is, when that is, we will certainly translate into

what we have budgeted for, but we will have to get ahead of it. once we have finished planning the transition based on the base budget and the workflows and triggers, we need to develop contingency plans for the risk should they happen. what resources are needed, what will be needed to add quickly, how will they be staffed through gsw and having those hard conversations with eddie took -- other departments to make sure everyone understands that because we are not budgeting or planning for that and then the fifth one is specific transition recommendations. once each work group works through those, obviously the f.t.e. and the contract dollars have been confirmed. but there were a number of other areas that are not be confirmed that need to be defined. the clear triggers, the transition, the timing of the transition, as well as the sequencing. some functions are easier to transition early then later. other functions cannot

transition until the very end because those are ongoing needs and we need to see the sequence of those properly to ensure critical dependencies are done first so other functions can then transition with full support. we need to now say this is our implementation schedule. we start july 1st, or whatever that date is. we had to follow the playbook and the plans as we transition over to whatever the base is and then the pop up is, i call it a policy and change application. once we establish these transition plan details, we need to make sure we understand are

there any policy impacts that need to have external impact? some of that will come up in the lower boxes as each age group identifies lower issues. these will get escalated to the body so these decisions can be formalized or decided to give back to each work group so we can use that as planning assumptions or planning decisions. as well as the change implications. whatever change that we are identifying will clearly need to translate to communication plans, supporting staff that are transitioning back or that are staying. this gives you a high level in terms of the critical steps that we will take as each group works through the specific plans. next slide. i think this is the last slide. this gives you an example. i thought this was a fascinating contrast. both pictures is the centre.

this is the low level. the left side was thousands of pallets of logistics supplies. and the right side was what was moved as part of a transition process for us to have a high volume area. those are the two images. that is the end of my presentation. >> thank you. before we go to commissioner comments or questions, mark, do we have any public comment on either portions of the covid-19 update?

>> i don't see anyone on the comment line, commissioner. so there is no public comment. >> president breslin: thank you. commissioners, any comments or questions for dr. colfax or dr. you? okay. >> thank you. thank you for your presentation. i appreciate the answer to my questions. will we be doing updates as we go along the transition to the commission? [indiscernible] >> i would defer that. >> we will be providing updates as part of our regular covid update we will keep that

commission updated. >> thank you. >> unless the commissioners would like to see more. we will do more at your request. >> thank you. commissioner green? [indiscernible] >> and how much effort will be needed in order to not only make these various transitions but all the contingencies that might be involved. i guess that i am really interested in hearing about the progress because i think most of us probably with think that at some point boosters would be needed and what is really impressive is how this department and the city in general, the mere's office pivoted so rapidly and did such

a terrific job when we were confronted, very suddenly, with this virus last year. and some iteration could happen again. i think we would appreciate an update. i want to acknowledge this is a tremendous amount of work you have undertaken on top of everything else. i am very impressed by the thinking and if there is any way we can support you making these transitions or pivoting back as needed in the future, we would be very honoured to do so. it is remarkable. i just wanted to express some gratitude. >> thank you. >> thank you. >> thank you, commissioner green. we also see ourselves with your comments. thank you. commissioner kristin? >> thank you.

i do want to thank dr. colfax for doing this sexual orientation and gender identity -- [indiscernible] -- thank you for sharing that with us. >> thank you. commissioner ciao? >> thank you. it's almost hard to say the thoughts on this because it is much more than that. i don't think anyone of us realize how complicated it was easy to see how you built, it was not easy to do. it is amazing to see the considerable steps being taken to do this transition and it sounds like it ultimately gets back to a norm of some sort and

i think that is amazing. i do think it would be a very useful thing to understand as you hit certain milestones when it would be appropriate not just as a general comment as to what we are doing, but perhaps to describe some of that, particularly, i think as you move from the post transition state to the boxes that you have in which the departments come together. i think our staff and our officers can work out how we could receive an update that also might be able to inform where some of the key boxes get responded to and i consider it

particularly, in the first transition state, as you were going through those boxes, in some way it would be important to understand how we are progressing housing, for example, and what is happening and, you know, then how does that finally dropped down into our final boxes? if we took several large topics like that, obviously with joint information we understand and equity is getting really good reports on how equity is occurring, but i think, would like wave data and virus trucking, i think the areas of housing and the reopening were topics we have not taken up, except for the recent and hopeful orange plus that we have gotten into, and i think that's

the type of updates that is helpful for us. i do wonder in the box, and this is just a small plan, you've got vaccine operations. but what about all the testing operations that are going on? you have data and virus tracking, and i'm not sure how we are continuing testing and which box does it go into? i am sure it's in here. i wasn't quite sure how we would do that. the second question related to the next jar which was, as we are working through this, you have the policy group still involved within the department, or is that just an external

group just like it is in the post transition, and therefore, that is where the intersection with rest of the department will go? otherwise, it looks like a direct line that goes to a department, but it says ccsf. small things, i would appreciate perhaps a light on those two topics. >> yes. great questions. it is a very astute observation. the policy group is what they are reporting to the department policy level. it should be outside of the big box. your first quest -- question in terms of the previous line, the

blue boxes, this one i want to bring to your attention. the reopening and the rehousing pieces of the ongoing transition structure that is in place now. they are not being managed. part of the transition management team, we are primarily leading the health functions and services in that transition. the testing question that i thank you also asked is there are a number of other functions of contact tracing and case investigation, outbreak management are all examples. the assumption is they are not being called out is because those functions have been

relatively stable because we are no longer in surgeon we have been doing those services and functions for over a year now. we have operating processes as well as escalation structures and status structures within the current new version of this ecc so we don't need to call those out. they will continue to support the covid response. we will continue to manage them and coordinate and deal with escalations accordingly with areas. it's because there was a determination that these areas require a lot more focus and visibility and even to some degree, resources to make sure we can stand to those up and continue to operate them during the transition phase, which is why we are helping this holdout. i hope that answers your question.

>> it does. i appreciate that. i appreciate you are going to be heading this because you did such a great job with our epic transition and i am sure that was in preparation for this. d.b.h. is a very large part of this whole response. i really do appreciate how well you have been able to describe to us this extremely complicated, but a very important part of making sure that the transition and going to the new normal, so to speak,, is actually very transparent. thank you. >> president breslin: if i may, in regard to the policy group

that you astutely raised, with regard to that structure, that is an advisory group to problem solve issues across the country. we want to help inform that group of well -- about what it shows. we will fix that on the charge because it is misinterpretation of accountability. >> thank you very much. it is amazing how much work has gone into this, and the thoughtfulness to bring us into a very organized fashion and for us back into a new normal. thank you. >> thank you. are there any other commissioner comments were questions on this item? i do have one question. where did all that stuff go when it got emptied out? >> you don't want to know. someone to laguna honda, doc,, i don't think a lot went back --

we are planning to figure out a way to send these to a warehouse and which vendor to help us manage this inventory. >> thank you for that excellent presentation and thank you to the director. we can move onto the next item of discussion which is the report back -- general public comment. >> there is no comment. it's good to note it for the record. >> thank you. our next item is community and public health committee update, which meant just before this meeting. >> thank you very much. we have a few topics for presentation and discussion. the first was the public health accreditation plan, which was

from 2017. which is the companion or the driver of the community health improvement plan from 2019 and the community of the community health needs. so within the plan there are four target areas. food insecurity, access to care, which is the process that people needing care with h.i.v. next is active living and that is focused on decreasing the traffic jams at the end of san francisco. particularly the pedestrians and the fourth is healthy eating, which is focused on decreased sugar consumption. one of the presentations was

excellent. we had a number of questions and one of the concerns and questions that she answered going forward is the continued communication between the department itself of these different priorities and the community interaction as well as d.b.h. and everyone buying into moving these forward throughout our system. that was topic number one that we discussed. the second one was the primary care behavioral health that dr. hope presented on and what

this is, and i'm sure all of the commissioners no, is the integration of behavioral health into our primary care clinics and within the clinics is a behavioral clinician and a behavioral health nurse. it is for handoffs, particularly from the primary care doctor. the downside of what is going on right now is the vacancy rates. there is, in the supervisory structure of the programme, there is a 70 2% vacancy rate. and within the primary care clinic, within behavioral health, there is also a

significant vacancy rate of health workers and clinicians that are needed. they are working closely with the human resources department in recruiting, in posting positions and hopefully many of the positions will be posted by the end of the month. it is a concern because the services have always been offered to the primary care clinics in the integration of behavioral health. it has been a model of care and it is a continuum for the needs of the patients from, you know, the pediatric group, to the adult side.

so it was a very informative presentation. hopefully they will be able to return. it is such a crucial programme in the department in our primary care clinics to give us an update on hopefully how the positions are being filled and how we are able to get up to where we have been in the past. one of the components that has been very hopeful as a result of covid -- they are hopeful it will continue with telehealth. the no-show rate is down 10% for appointments so telehealth for behavioral health will

continue. i must say that both presentations were extremely responsive to questions that commissioners had submitted prior and it was very hurtful -- helpful in our understanding of both of these presentations. that his report. >> thank you for the update -- that is my report. doing public comment on this item? >> it's all online. there is no public comment. >> commissioners, are there any questions or comments? seeing then, we can move on to our next item. it was carried over from a previous meeting. our apologies for having to

delay this presentation. however, it is particularly timely given the verdict in the case of the murder of george floyd and the very important acknowledgement that the mayor had given to the street crisis response teams and her statement regarding the verdict and how it is critical to the efforts that san francisco is undertaking to reform and reimagine policing. we are taking a leadership role across the country. again, apologies for the previous delay and thank you again for being here today. we are looking forward to your presentation. >> thank you so much. truly, no apology is needed. it is really timely to be here today. i'm very glad to be able to share this programme. let me go ahead and share my screen. okay. is everyone seeing that okay? perfect. great. again, i am here to talk about the three -- street crisis

response team. i'm with the department of public health with behavioral public health services. our team is a close collaboration with the fire department and i'm co- leading that effort the fire department. today we have an opportunity to give a little bit of background around how we got to the street crisis response team being implemented, a little bit about our planning and our process moving through this, as well as our pilot evaluation plans and early pilot reports from the first four months of implementation. of course, as we have discussed today, and this is a very important conversation that has been needed for many years as we know, there is a very important opportunity right now across the nation to think about reform in

a number of different ways. of course, looking at the behavioral health system and the opportunity that the legislation affords us, as well as the commitment to police reform and mayor breed has been a very strong advocate and ally in this and had a statement around this in december of 2020 specifically calling for a team like the street because -- crisis response team to respond to nonviolent instance in the community. there has been a number of different processes that have been occurring across san francisco and conversations around that. just two to name. i know conversations are having in many different forms and places. two of them are to discuss alternatives to policing and as well as the coalition of mental health processes to discuss alternatives. when we started to embark on imagining and envisioning what a street crisis response team programme would look like, we really reflected on these key

elements of crisis system. of course, we know there needs to be someone to call and this team really focused on the place of someone to respond, but we know that even with someone to respond, an important part of this work is to look at our entire system of care and the continuing of services to people have a place to go where there is no wrong door into treatment and it is something we strive for as a system. we know there are a lot of opportunities for growth in our system to do this. so how this alliance with other mental health s.f. initiatives. and of course,, to link individuals to ongoing care so we can mitigate any future crisis and support individuals to remain safely in the community. as we started thinking about the programme, we wanted to think about what the goal was. and again, focusing for this programme on what an alternative to policing response would look like.

i would talk a little bit more about the data we looked at the type of cause we landed on responding to the initial pilot phase. our goal for the programme is to provide rapid, trauma inspired responses for individuals who are experiencing a behavioral health crisis in a public setting, that otherwise would have been responded to by law enforcement and that we can reduce any unnecessary contact with the criminal justice system or law enforcement, as well as any unnecessary emergency reviews. we had a pretty ambitious timeline fragmentation. we know how important this work is and as many things were during 2020, this has impacted and our planning was impacted by covid and thinking through what changes needed to be made to be able to implement this programme during that time. but we launched our first team at the end of november. this team was focused on the tenderloin area. again, as we look into the data,

i will share that i am sure it is not surprising, but this is where we see the highest volume of calls relative to the geographic area, which is why we wanted to first initiate the programme there and provide services there. our second team launched in february of 2021 and this has been posted -- focused on the castro and mission area. which is the second highest volume of calls for geographic area. and our third team just launched at the beginning of april, which is focused on the bayview. i will say this is a little bit different in terms of starting the programme in the bayview because relative to other geographic areas in san francisco, the bayview actually has a low volume of calls that go through 911. and as we were looking at this from an equity lens, we recognize this doesn't mean there is less need in the bayview, but that we know that having a 911 call and a response that is typically police, communities of color and

communities like the bayview may feel uncomfortable calling law enforcement or calling 911. so we are not seeing the same volume of calls, but again, from an equity lens, wanting to make sure we were implementing their that the relationships in the community understands the need and knowing that the less volume of calls in terms of our goal is to launch an additional three teams. i can talk a little bit more about that timeline, but in total, at the end of the fiscal year, our plan is to have six teams operational which will allow us to provide citywide 24/7 coverage. sinnott all six teams will be operational 24 hours a day, we will be able to have coverage throughout the city while working on keeping operational at the highest peak times of the day when we see the high volumes of calls. this is just a brief slide about the budget overview. as i mentioned, this is a close

collaboration with the fire department. this includes the budget for the 16, and the staff to provide ordination and follow-up support. i'm sure you are familiar with mental health s.f. legislation which includes offensive coordinated care and the crisis response team has dedicated responses to require follow-up for all individuals that they come into contact with. that includes the staffing for this. it also includes programme supervision, management, our evaluation, which i will talk about in more detail. and of course,, staff training. i will note that staff training has been a very important part of this process. we worked with an external trainer who has expertise in crisis programmes to provide a week long training for the teams that we are implementing, which helps us collaboration -- what helps us with collaboration

across the team. making sure people have similar experiences and understanding of doing crisis work before they launch. we are also launching an equity training for this team. as we have discussed here today, equity and having a lens not just in the implementation but also having a programme navigating in the community and building relationships and the impact of the programme is incredibly important. we want to make sure those conversations are central to our work. to talk a little bit more about who is on the team or who is in the vehicle responding to the calls, before we launch the programme we had a number of conversations with other jurisdictions across the nation thinking through what the best mix of staff would be on the rig for us to respond. what we landed on is a community paramedic being provided by the fire department and the community paramedic is able to address emergency and medical

needs and supervise triage for that. community paramedics have additional training to support individuals and collaborate with our providers and support individuals who have behavioral health needs. they are a great fit for this. we also, through the department of public health, are providing a behavioral health clinician and a peer specialist. and just to highlight, part of the intention of having both of these on the rig, again, each team member plays a vital role in the operation and being able to support the whole person and the needs of the individual. i mentioned a little bit about the role of the community paramedic and being able to address and triage for any urgent medical needs and as an example, we have had situations where they were doing a quick check of the vitals and someone had uncontrolled blood pressure and was able to be transported to the hospital. it would have gone unmet. so able to avoid a critical

medical emergency. that behavioral health clinician is often seen across jurisdictions in this work. and of course,, is incredibly important for addressing significant behavioral health needs. they are able to initiate involuntary or calls if that is indicated. and has additional expertise in supporting individuals. as an example, we shared early on in the programme the team had contact with an individual had recently been the victim of a rave and was able to provide a very trauma informed response in real -- in supporting that individual who had a very violent and recent and three of complex trauma that required that clinical lens. what is unique is it is not something in other jurisdictions. as you know, in behavioral health services, integrating peers and individuals with lived experiences in this work is incredibly important to us. we are already seeing that this

is a vital part of the programme. not only does it help us reflect the experiences of the individuals that we are serving, but it allows us to meet the needs of the individuals in a different way. to give an example, we had an individual who had gone to the hospital and had a negative experience and felt that this is a traumatic experience being transported to hospital via an ambulance and working with behavioral health clinicians, so they kept running away from the team and was very wary about the community paramedic and behavioral health clinician. it was the peer specialist was able to engage the visual and -- engage the individual and treat them. so having this three-member team has been incredibly valuable and important. of course, having three team members has its own unique challenges, but i just want to

say we have an incredible team and a great supervisory and management team across the different programmes that have worked collaboratively -- corrupt -- collaboratively together. it's very exciting to be part of this project. we had dedicated capacity through the office of coordinated care. this team just launched on the fifth, as long -- as well as with our bayview team. this team includes clinicians and soon to include peers as well to provide a linkage and follow-up coordination. our goal is to meet with all of the individuals that the team has had contact with. and in a short couple of weeks that they have been operational, we have already had great successes in connecting individuals to ongoing services like intensive case management or some of our other low threshold case management programmes, residential treatment, et cetera. we have three teams currently operational. each team provides 12 hour coverage, seven days a week, but

our goal is, by the end of the fiscal year, we will be able to provide 24-hour coverage seven days a week. our goal is to ensure geographic coverage for all of san francisco and to promote equity and he very mindful about how we are implementing the programme, particularly in communities of color and making sure that we are building those relationships. that this is not something we are doing to their community, but partnering with their community to support individuals. so reflecting back on the slide i shared in terms of the importance of the struct -- of the crisis. prior to implementing this programme, we thought through the best way to do this all. and this being calling law enforcement, cited in our pilot phase that the best thing for us to do would be to respond to 911 dispatch calls that can be diverted to this team. we are having ongoing conversations about having an

alternative number that is not mine 11, respecting community it -- communities and individuals who are not comfortable dialling 911. that is something that we are considering and looking into. we have certainly heard that from community members that that is the need and that is something that is desired. we know these 911 calls or otherwise responded to by police and it was important for us to work to divert all of these calls away from law enforcement. i will say, in addition to responding to 911 calls, the team is not waiting for calls to happen. they are driving around the community, engaging with community members and if they have an on view or if they see someone in distress, they are also responding to those in need. we're also working with some of our other city agencies and partners to make special calls, or if they are encountering someone in need, rather than calling law enforcement were calling 911, to be able to refer to the team. and as we are adding more teams

to our portfolio, we're looking at ways to expand that and support our communities in different ways. so just to look at this flow, this is a little bit of what we have talked about. an individual would call 911 if they saw someone in distress. we know these calls are already going through 911. if there is not a behavioral health need to, the department of emergency management or 911 dispatchers will continue to deploy the police department or fire departments. if there is a behavioral health need to, but there is violence or a weapon involved, that will continue to have a police department and crisis intervention team response. and as i'm sure all of the commissioners are aware, the comprehensive crisis team has a specific team of individuals that work closely with the crisis intervention team to collaborate on these calls and

situations. and as we are looking straight crisis response team flow on the fire right, these are situations where there is a behavioral height -- health crisis in a public setting where there is not current violence. the team response to these types of calls and there is a couple of opportunities here. in some situations -- and must -- in most situations, these calls are resolved in the community. what we see in other jurisdictions is 70% of calls are resolved in the community. meaning an individual doesn't need to be transported to another location. our goal is always to support individuals who are willing to go into a treatment programme or to transition to a shelter, for example,, so our team, we have worked hard to collaborate with our different partners and they are making direct referrals to some of our programmes and social services and transporting them there in the vehicle if they individual is willing to go to them. in all of these situations,

staff are providing to support people to mitigate future crisis. i know one of the foot came up for my question is raymond training for and are they -- what kind of treatment -- training are they receiving? we're looking at types that have existed and so we are sitting into an existing structure. and the department of emergency management has been a great partner in thinking through what are opportunities to collaborate, the questions are -- and the standards they are asking so work doesn't look different for dispatchers. what the difference is is having another team to deploy to respond to these types of calls rather than law enforcement. and so you will see -- let me walk you through this a little

bit. i know it's a lot of information. these are different types of calls that we look into that may have a behavioral health component. let me start on the far right. these are well-being checks. these are coded as 910 calls. you will see on all of these columns, on the left-hand side is more of the teal color. those are priority calls. that is where there is an emergent response needed. so this could be that someone has a weapon or there is a violence or there is a critical medical emergency that needs to be responded to. be priority because need a response, they are important, but don't need the same level of emergency response. so for well-being checks, you see they are travelling -- there are travelling 9,000 priority a calls. roughly 18,000 priority think calls. this is a huge volume of calls. what is challenging about the well-being checks is there is a very big continuum of what these calls are. some may be for someone

expressing homelessness are having a behavioral health need in the community, and could range to a haven't heard from my grandmother and a couple of weeks and i am worried about her. this is an area of opportunity that we really need to delve into the data to understand what these types of calls are tell they can best be triaged to other teams. i know there is a lot of new conversations happening in the alternatives to policing conversations. these are not the cause that we are currently responding to, but it is an area of interest for us to understand more. in the middle you see the code 801 calls. these are persons attempting suicide calls. is roughly 3700 that are priority a. this is someone who might be actively harming themselves and they require an emergency response. very small number of these are priority be calls. i neglected to say that this data is from calendar year 2019,

so precovid. and we will continue to look at this data. i just wanted to highlight the timeframe. the calls that the team are focusing on our these mentally disturbed person calls, which are these code 800 calls. in 2019, roughly 4600 calls were these priority eight calls, which could be that someone had -- was currently violent or had a weapon. but there is roughly 10,000 calls that are priority be calls. our team is looking at diverting all of these calls to the street crisis response team where historically they would have received a police response. so we are requesting a lot of data in terms of the types of calls that we are responding to, how the team is responding to them, the amount of time it takes for the team to respond, i will delve into the evaluation more, but just to highlight, once we have all six teams operational, that is the goal for us to first work on moving

all of these calls away from law enforcement to the street crisis response team, and in fact, once we have all teams operational, instead of moving, having a police response, we will be to end emd protocol which will ensure an ambulance or paramedic will be a backup to the team, wears currently law enforcement is the alternative. that is a lot of information in one slide. in looking ahead and looking at our evaluation, just to say we know that this is a really important part of our community process and considerations as we are looking at overarching ways to have alternatives to policing in our community. we have had a number of community engagement conversations and processes, including focus groups with peer than individuals with lived experiences and more targeted

conversations with particular communities, but this is, of course,, an ongoing process. we're working on building public awareness, managing community expectations of what the team is able to do, what it is not able to do, and how that fits into the overarching conversations around alternatives to police, and building trust in the communities. teens are hopeful to be part of the fabric of our community ongoing. we are looking to implementing these and having the opportunity for them not just to respond to calls, but be part of the community and building those relationships. i talked a lot about our goals of addressing racial equity. we know this is not something that we can do with training around eight racial equity, but it's something that needs to be embedded and central into our conversations. just as a management team, but also how our team members interact with one another and how they interact with the individuals that we are serving. that is something we are looking at very closely.

of course,, in terms of addressing racial equity, when we look at individuals who are disproportionately impacted by the criminal justice system, how this team might impact of that and building those relationships and alternatives, and also looking at disparity in health outcomes in the work of our office has a system in supporting the bejewelled remained in their communities and receive the treatment that is needed and that they want. and, of course,, for a pilot devaluation, i will talk more about that because i know that was of particular interest. we are fortunate enough to have two evaluation processes for this project. we have a local evaluation through the company that is really looking at the types of calls that we are responding to, the outcomes for those calls, the length of time it takes to arrive at a scene and i will share a little bit of that data today. we were also very fortunate to

receive a grant through a foundation. that work is being led by dr. goldman. that is looking at the outcomes for individuals. that will give us a really detailed look around individuals who have repeated contact with the street crisis response team, how successful we are at connecting individuals services, and more importantly, how effective this is in supporting individuals long-term and looking at reductions of contacts with the criminal justice system, contacts with the jail, reductions in unnecessary emergency room use, and emergency contacts et cetera and have excess but we are with engaging in long-term services. let me transition to talking about our early pilot results. the exciting part about presenting a couple weeks later than we originally anticipated is we have moved back here. this is looking up at our first four months of implementation.

we had two teams operational at this time, including the tenderloin team and the mission castro team. i will share data from the month of march and then also the cumulative data since our implementation in november. on the top left you see that in march, the team responded to 256 calls. in total, they responded to 756 calls since the start of the programme, which represents a 19 -- 19% of the 800 are the mentally disturbed person calls that were diverted away from law enforcement to this team. the team, overall in the four months of implementation had a response rate of 15 minutes to arrive to the scene. most of these calls that they are responding to our dispatches from 911. they are representing direct movement away from law enforcement. at that accounted for 802% of

the calls they responded to. 13% of the situations they responded to where once they saw happening in the community. a couple examples or someone who is actively in health distress or running in the street yelling. has been a couple of those situations. they have also seen individuals who they were concerned about and were able to reverse overdoses. that is something they are actively doing. i will just pause to say that the team, having a paramedic on board are able to support that. they have narcan in the vehicle. they are also giving out narcan to individuals who are interested in that. mentioned earlier the special requests. that accounted for 5% of the calls that the team has responded to the beginning of the programme. while there were 756 calls that the team responded to, the team was able to have contact with 405 cases there is many situations where it is a

third-party choleric that we are finding or someone who doesn't know an individual, but see someone in distress and calls. and when the team arrives, they are not able to find an individual. we are working to close that gap so we have better success in engaging individuals. that is something we know will be ongoing. and looking at the outcome for the immediate contact with individuals, 53% of individuals remain safely in the community, meaning an individual is able to be ds collated and remain in the community and for us to support with ongoing care. 20% went to the hospital. this could be for medical or psychiatric reasons. some were transported to a behavioral setting. this could be a shelter, a shelter in place hotel, urgent care or a detox programme, et cetera. and roughly 10% of cases, there

was a 5150 that was initiated and an individual was transported to the hospital. just to highlight that, especially in the case of transported to the hospital, people can have multiple dispositions. so there is some overlap in these numbers as well. i will say for the office of court native care, because the status goes until the end of march. that team launched the beginning of april. it's too scene for us to have data about this ongoing follow-up after the immediate crisis, but that is something we are collecting data on and the team is documenting and we are monitoring very closely to look at that. we will have that in future reports to share. one thing that is important as we are looking at this is the client characteristics that we are serving. a couple of things to highlight. the first thing is in terms of ethnicity, most of the individuals that we have had contact with have identified as white or african-american black.

and while we don't have the housing status for everyone, many individuals, predominantly are experiencing homelessness, which is, again, which was anticipated for this project. i want to pause for a second to talk more about the ethnicity because i'm sure you will see we have a very large rate of individuals where we don't have information about ethnicity. we have a lot of mitigation strategies in place to address this, with something that is important for us as a team and in terms of equity is to make sure we're not making assumptions about an individual's ethnicity, but we are asking them this. of course, the team is doing that and they're very skilled in that and working to get that information, but we also know we are engaging with somebody at a critical time when they are in crisis. it may not be -- we may not be able to always get that information. we are hoping to pull the nation in from other systems if we know

individuals from other systems, including the hospital, but our office of coordinated care staff will be doing the follow-up for individuals. this is something they will be prioritizing as they are engaging individuals to make sure they are gathering demographic information so we have a more complete picture of who we are serving for this project. before i moved to questions, i want to share some additional information. i just want to highlight it is here. i want to share we had some client impact statements that the team shared, as well as alignment with other mental health programmes which i alluded to, but i want to highlight it is here. let me go back for a second. i'm sure there is many questions. this is a very exciting programme. it's hard to believe we have been only be doing this for four and a half months at this point, but it has been such a privilege to be part of collaborating with this team and the partners that we have and to be part of implementing this.

>> sorry, i was on mute. >> no worries. >> did you say you had some additional things you wanted to present or is now the time for questions? >> please go ahead with questions. i just wanted to highlight what was in the appendix. >> great. thank you. i do have a few questions. thank you for this excellent presentation. my question specifically relates to the deployment linkage slide that you had put up. you mentioned that fiftythree% of the incidence -- crises are resolved in the community, but i think summer along the line you mentioned that other jurisdictions had had a 70% rate of resolving the crisis in the

community. are there other jurisdictions that have successfully launched a programme like this and what do you think might be the difference between resolving 70% versus our very initial experience in resolving in our community? >> i appreciate you noting that, of course, this is a small timeframe and there will be an influx very closely. in conversations with other jurisdictions, we are finding that the type of cause that our team -- that we have decided as a jurisdiction to respond to our more serious types of calls then what other jurisdictions typically do. so we are seeing that individuals have more significant needs and require transport either voluntarily to your facility or a small percentage of introvert -- of individuals who have to go to hospital for medical or

psychiatric reasons. >> right. and the other question was, in looking at incidents that are able to be resolved in the community versus those that require a linkage to a crisis facility or social service, i think that one of your appendices had discussed what those crisis facilities were and are those resources available in terms of crisis facilities or social services should you have to bring someone there to have the crisis resolved, and what would you project that needs our? >> i appreciate that. i think this is important to consider. it is an important part of our valuation which is to look at just the effectiveness of this programme, but the availability and the effectiveness of our other services and if there is opportunity or recommendations

to make services more available for individuals. is something we will be looking at closely. in terms of current programmes, we are mentoring -- we are partnering with urgent care, detox programmes, salter in place programmes and shelters. the follow-up support has been hugely beneficial. in many cases, individuals who had complex needs have gone unmet. we have not been able to find individuals. that has been a great support. we have been looking at other programmes that we know are on the horizon. we are very excited for them. we are partnering very closely with them.

we have had so much collaboration across the departments and across different parts of our systems and thinking critically about how these programmes and implementation of these programmes can make sure that they are able to be utilized in a very low threshold way. but some of the programmes are the drug sobering centre, which i know came up a little earlier today. and expansion of intensive case management, the stabilization unit and programmes like hummingbird, for example,. >> thank you. i'm just referring to the one slide. it makes so much sense. it's hard to believe this is not something we have been able to offer before. thank you for that. i realized i skipped over public comment. i only see one other commissioner comment. perhaps i will hear from commissioner chow and then to public comment.

>> this is a very exciting programme. you have may -- you may have answered some of these questions earlier. as you were discussing this, i have three different questions. are these individual clients or are they actually potentially the same clients, and in that case, are we keeping the special data that show the frequency of certain clients so that we have had -- we have had other circuits -- focused programmes before. how does that integrate with that, in case you identify the same people that have been identified as frequent visitors to the emergency service? that is one question. the second is that in the triage, it appears you were

taking only adults. what happens to the juveniles in crisis? i think certainly, you described you are trying to move away from a police backup to a fire department backup. i'm not exactly sure. i thought the purpose here initially was we must have a fire and d.b.h. response. that didn't happen. then you were talking about trying to eliminate that the fire department. i thought that might have been responding in the first place. >> i appreciate that. i will start with your last question. currently, these types are police codes that are used and historically they have been

responded to with a number one priority and the second priority which has been responded to by law enforcement. once we have all six teams operational and we are able to provide citywide coverage across san francisco and 24/7 coverage, that would be switching to an emergency protocol which will then have a team -- rather than police be a response, it will be an ambulance that is responding. that will be a big shift. again, we have diverted roughly 20% of calls away from law enforcement in just the front from months -- the four months we have been operational. we are confident that we will be able to cover these calls. we have paramedics on the rig. it was an extra layer of not

having police responding unless there is a risk for violence. is absolutely something we are tracking. there are some individuals that the team have had multiple contacts with. they work collaboratively with them. they oversee the e.m.s. six programme that works with individuals who are high utilizers of the medical emergency services.

we will have conversations to support individuals in the community. if someone is in crisis and repeatedly in crisis, working -- working on interventions to support them and doing it collaboratively with many of our treatment providers to make sure that happens and we have treatment plans for individuals that can be shared, so individuals can be supported and when possible, they virgin away from emergency services. [indiscernible] >> commissioner, i saw you talking, but unfortunately i didn't hear you. i'm not sure if it was my connection. >> okay. the other question was the protocol says for adults. what about -- >> oh, yeah. i missed that question.

for juveniles we have been working closely with the crisis service team. it has a team of individuals and designated partners to work with juveniles in crisis. if we encounter an individual where we received a call or the individual was under the age of 18, then we will medially contact our partners with the services and they will deploy the team to support the individual. >> okay. very good. that does not become part of the data that you will be able to show? it's sort of like part of the same system coming through either by 911 or on-site. and i'm just thinking, maybe you should also get credit for that and referring that to them and integrating those results because that would be part of the same nonpolice response.

>> i appreciate that. that is something we hopefully will have lots more data and great stories to share the next time we come to give an update on the programme. we will make sure that is part of it. >> it is one of the exciting programmes i have seen in all of these years that could really help and you have already diverted a large number of people that otherwise would have had a law enforcement intervention and i'm sure, you know, law enforcement probably appreciates not having to respond for cases that really aren't within their jurisdiction, but then requires the calling of our health teams. i commend you for that. i look forward to your next presentation and further excitement and how we continue to move out of that and into this. >> of course. and just to say, we are working

very closely with the police department and our law enforcement partners. it is an important part of this work. they have been great partners and we know there might be situations where we need the support of law enforcement in some of these calls and we have regular meetings with them to discuss how that collaboration is going. i think it's something we know is important to do. >> thank you very much. we really appreciate that. i am certainly appreciative of the work. it sounds like we can make some progress in helping these people and also avoiding the trauma of having a police officer for those cases that it is not appropriate. thank you. [please stand by]

>> and the fact that the team was able to realize this pilot under some unforeseeable circumstances is incredible and just to thank dr. alameda for her work to get this going.

>> marc am i correct that you do not see anybody in the public comment area. >> yes, sir. you are correct. >> thank you again, please extend the gratitude and the appreciation to the commission and your entire team we look forward to learning more about your progress. >> thank you so much. >> thank you. we'll move on to our next item. i just dropped my agenda, hold on. i'm at a standing desk this time so it's farther down to reach an approval of the appointment as the director of the san francisco mental health plan. we have dr. hammer. >> hello commissioners hally hammer, director of the

ambulatory care. it's a pleasure to present this resolution to you as director of the san francisco health plan. so i'll read the resolution and then ask for your approval. is that how we're doing this? >> yeah. and the commissioners will have the ability to comment before they approve just so you know. >> okay. great. and i'm joined here today by dr. cubbens. to and whereas mental health

care requirements kigs ent with the beneficiaries mental health needs and goals and where the california department of community behavioral health services operate in the city and county of san francisco and whereas the director of behavioral health services oversees and directs all client services for the san francisco mental health plan and whereas dr. hillary cummins has been appointed director of requires approval by the governing party and whereas the health commission serves as the governing body of the department of public health and

now therefore be it resolved with the health commission authorizes the appointment of hillary cunni as the director of mental health program for the city and county of san francisco. i hereby certify that the san francisco health commission of april 20th, 2021, adopted the foregoing resolution. >> thank you doctor. do we have any questions or comments for the commissions? do we have a motion to approve the resolution? >> so moved. >> second. >> okay. before we move on to a vote, do we have anybody in the public comment room? >> no one on the line. >> all right. we can move to a vote then. mark, would you please take the roll. >> sure.

[roll call] thank you. >> great. dr. hammer had mentioned we're joined by dr. cunnin. would you like to say anything upon this resolution which we are privileged to do? >> not. thank you very much and it's a pleasure to be appointed and i look forward to working with all of you. very happy to be here and to be doing this work. >> great. thank you and welcome.

okay. we can move on to our next item which is other business. do we have any other business? i see commissioner christian. >> thank you president bernal. i have two things. i was deeply unhappy able unable to be present, but i was glad before the meeting on the resolution and want to extend my thanks to commissioner guillermo for getting it going on the agenda and written. and, i was able to listen to most of the meeting, the tape of most of the meeting and so i

heard commissioner chow's comments and i was struck by the information that he was referencing particularly that the chinese people weren't permitted to go to the public hospital and that also authorization to build the hospital was withheld for quite some time and i was very glad that we were able to get that commissioner guillermo was able to get this resolution on the agenda quickly because it was vital for us to begin to get

this violent conduct in our community and the murders that had occurred historically and recently. i also think that it would be incredibly useful and strengthen whatever we say what we have said and what we might say in the future on the issue of discrimination against the people in what is now called the asian and pacific islander group. also, i was struck by dr. chow's continuing to need about the different communities and that are the different

ethnicities and language groups that are captured in this grouping. so what i would like to consider is i would like the commission to consider whether it would be useful and appropriate to amended -- open up at a future meeting, open up the possibility to add to the resolution in order to strengthen it and also, if we did that, it would give us additional time to think about whether they were other things we might like to add to the resolution that might strengthen it and bring it into even greater alignment with what our goals are and what our responsibilities are to act whether that is amending this resolution or having another resolution, i'm not certain, but i did want to bring that up as a possibility for future

business. >> president bernal: thank you, commissioner christian. i would refer to the sponsor of the resolution, commissioner guillermo. >> commissioner guillermo: thank you, president bernal. and commissioner christian. i truly appreciate your thoughtfulness and your consideration of the resolution and contributions to make it stronger. i do think that in -- i was thinking about it, you know in the haste to get something on the record, there were probably a number of things that could have been considered to strengthen this. one of the areas i saw were considerations around pacific

islanders. and so i wanted to make sure if we were able to strengthen the existing resolution or bring another one and to see where there are in fact other pieces of this that not only will strengthen the resolution, but might serve the model for other agencies and other jurisdictions and such what we have done here in san francisco. so i totally accept the consideration that commissioner christian is bringing forward and i appreciate it very much. >> commissioner christian: thank you commissioner. >> president bernal: commissioner chow, i saw you had something on the same topic. >> commissioner chow: yeah.

reaching out and not having been able to be here. and speaking to the resolution, it seems to me it would be very appropriate to strengthen it. then also looking at these resolutions to have a focus for the department and i think that could also help strengthen it and it would be if we were to reconsider the resolution to add to it and make it even stronger for our department as a guideline. so i'm hoping that i'm not sure what the mechanism is for the reconsideration. formally, maybe that's what we need to present at the next meeting in order to open it up or perhaps the president can order that we look at

potentially revising and then bring a potential revision that could be on the agenda i'm not exactly sure how this would actually work. in normal parliamentary we could have objected at the time of the minutes but then that would sound like we weren't happy with it. this is something that i think we all felt very strongly about. now the issue is how do we then be able to help strengthen it and what is the mechanism that would allow us to consider that? >> if i may jump in everyone, that is my job to figure out and that is not the weight of. that bureaucratic mechanism is not on you but you all consider to make the resolution

stronger, i'm happy to. >> president bernal: i'm pleased to bring the resolution back for further consideration at a future meeting giving the concurrence of the sponsor commissioner guillermo. commissioner christian, you had a second item you wanted to raise. >> commissioner christian: i had one more thing. i wanted to raise the request that we have at a future meeting, the report on the i guess this is now the time in the city where agencies and departments are meant to provide their data on sexual orientation and gender identity information that pertains to their work and i think we all know there was an article in the b.a.r. that was critical of the department of public health even as the article recognized

that we had just been through a pandemic that the department was, you know and still is responsible for and that turned the work of the city around as well as the work of the department as well as the installation as well as the bringing online of epic which is also a complication. be that as it may, we do have i suppose some information, maybe not what the -- what we would hope for, but i think it would be good for us to understand what we do have and what the department's plan is to -- is for moving forward and creating a mechanism where we are able to report the data that and collected and reported in the way that we need to. so if we could get, if you

would consider agendizing that in a future meeting, that would be my request. >> president bernal: we will work with secretary morewitz. do we have any other matters for other business? all right. seeing none. we can move on to the joint conference committee and other committee reports while the summary of the april 13th,la hospital j.c.c. meeting. we have commissioner guillermo. >> commissioner guillermo: thank you. and, just a brief summary of our monthly meeting on april 13th, i just wanted to recognize that michael phillips who is the ceo of laguna honda, normally, we provide the director's report, but what they have done is decided that, you know, as they are a team, a

very well integrated team of leaders at laguna honda, they have changed the name of the report to the executive team report. and so i just wanted to acknowledge that as something that i think michael phillips has sort of used to demonstrate how well they are trying to work together there. there's been a lot of turnover and a lot of issues and things that laguna honda has had to deal with over the last couple of years not to mention the pandemic. in this particular report, i just wanted to focus on a couple of things that as they highlighted and one is the work force over there at laguna honda. particularly the nursing workforce. in the chronicle when they were doing sort of a retro speck

tick on the pandemic was assigned to the covid unit. as sort of her introductory -- introduction to laguna honda and really cared for. many of the covid-19 patients that were there. and so i just wanted to acknowledge the chronicle felt worthy to highlight her and really did an excellent piece there that highlighted the kind of care that was being provided by all of the clinical staff and other staff, but particularly the nurses and sort of in light of that, every month, laguna honda recognizes the work team and for this last report, they recognize the nursing office staffers who

were really responsible for all of the coordination, scheduling, making sure everybody's in the right place at the right time scheduled for all of the neighborhoods there. and so, you know, they do everything, you know, coordinating who gets pulled into quarantine, who doesn't, and making sure everybody because this is a 24/7 facility and so wanting to sort of again, call out the team was the nursing office workers and then one last piece wanted to highlight not just for laguna honda, but also for all the nurses in our network that next month in may, may 6th to the 12th is nurses week and so i want to make sure we have an opportunity to recognize all of the work that the nurses do throughout the network and that since we may not meet or maybe

we do meet that week. but in any case, in case we don't, i just wanted to call that out. the last thing i wanted to highlight as an executive team report was a focus on a refocus on equity at laguna honda. there has been an equity counsel that was established at laguna honda awhile ago but it sort of had to be put to a nap for awhile during the focus on the pandemic and i wanted to let folks know, given our relaunched the equity council in april. and it's really the focus is to eliminate discrimination and promote inclusion and so i

wanted to make sure we as a commission and i wanted to make sure we were aware of that and recognizing also that the workforce at laguna honda is a large workforce of asian market and pacific islanders during the month of april, they wanted to address some of the violence that was occurring in these communities or at these communities and put in place a number of security measures as well as education efforts on behalf of the security safety and inclusion effort at laguna honda and so i wanted to recognize that the second thing

thafsz on the agenda was the laguna honda update and john grimes is the director of operations there. what they were able to go through this past year the low response of low numbers and no covid cases since january. you know, the high vaccination rates among the residents at 91% and among staff at 84% and just recall for you that there are upwards of 700 plus beds that are occupied at laguna in a honda at any given time. they had 91% vaccination is really a tremendous effort as well as 1,200 staff and to have

84% of that staff and open and willing to be vaccinated since we can't mandate it. and opening the clinics i think that's something we all should feel really good about particularly the history of laguna honda not just in san francisco but across the country. and then we did our normal sort of quality and regulatory affairs reports seemingly mundane, but very important given all the focus on the nursing home long-term care facility that is ramping up as a result of some of the things that have been uncovered during the covid elm epidemic.

so i just want to make sure that's a key focus of the leadership and in fact everybody there and then we had a presentation on the medical error reduction program which is something that it is always a concern making sure that we reduce the number of errors and the all the complications in the steps that are necessary to do that and really trying to employ new technology in doing that. and so, then, that was the bulk of the meeting and then in closed session, we approved both the credentials report and the performance improvement in patient safety reports and that's the end of my report. >> president bernal: thank you, commissioner guillermo. our next item is consideration for a motion to adjourn. we have a motion.

>> commissioner: so moved. >> commissioner: second. >> president bernal: all right. roll call. >> clerk: yes. [roll call] all right. that's everyone. >> president bernal: thank you, everyone. >> commissioner: thank you. reach out to folks that might meet before tonight. good night, everyone. >> president bernal: thank you.

>> we have private and public

gardens throughout the garden tour. all of the gardens are volunteers. the only requirement is you're willing to show your garden for a day. so we have gardens that vary from all stages of development and all gardens, family gardens, private gardens, some of them as small as postage stamps and others pretty expansive. it's a variety -- all of the world is represented in our gardens here in the portola. >> i have been coming to the portola garden tour for the past seven or eight years ever since i learned about it because it is the most important event of the neighborhood, and the reason it is so important is because it links this neighborhood back to its history. in the early 1800s the portola

was farmland. the region's flowers were grown in this neighborhood. if you wanted flowers anywhere future bay area, you would come to this area to get them. in the past decade, the area has tried to reclaim its roots as the garden district. one of the ways it has done that is through the portola garden tour, where neighbors open their gardens open their gardens to people of san francisco so they can share that history. >> when i started meeting with the neighbors and seeing their gardens, i came up with this idea that it would be a great idea to fundraise. we started doing this as a fund-raiser. since we established it, we awarded 23 scholarships and six

work projects for the students. >> the scholarship programs that we have developed in association with the portola is just a win-win-win situation all around. >> the scholarship program is important because it helps people to be able to tin in their situation and afford to take classes. >> i was not sure how i would stay in san francisco. it is so expensive here. i prayed so i would receive enough so i could stay in san francisco and finish my school, which is fantastic, because i don't know where else i would have gone to finish. >> the scholarships make the difference between students being able to stay here in the city and take classes and having to go somewhere else. [♪♪♪] [♪♪♪] >> you come into someone's home and it's they're private and

personal space. it's all about them and really their garden and in the city and urban environment, the garden is the extension of their indoor environment, their outdoor living room. >> why are you here at this garden core? it's amazing and i volunteer here every year. this is fantastic. it's a beautiful day. you walk around and look at gardens. you meet people that love gardens. it's fantastic. >> the portola garden tour is the last saturday in september every year. mark your calendars every year. you can see us on the website

so good morning everybody. welcome to george christopher playground. a playground that was dedicated by the way 50 years ago in 1971 by mayor's alioto and christopher. so we're so delighted to have

ou