[roll call] >> all right. having a quorum, the next item on the agenda is the approval of the minutes of the health commission meeting on june 1,

2021. commissioners, having reviewed the minutes, do we have a motion to approve or any amendments? >> so moved. >> second. >> before we go to a vote, is there any public comment on this item? >> person on the public comment line, please let us know if you'd like to make comment on item 2, which is the approval of the health commission june 15, 2021 minutes. raise your hand by pressing star, three. no hands, commissioner. >> can we have a roll call for the approval of the minutes? >> clerk: yes. [roll call]

>> clerk: great. the item passes. >> great. the next item is the director's report. dr. colfax? >> good afternoon, commissioners. grant colfax, director of health. there are a number of items in the director's report. i will highlight a few of them. one is on that on june 17, mayor london breed declared by proclamation that juneteenth will be recognized as a legal holiday for all city employees. this declaration took effect immediately, and the city observed the juneteenth holiday

on june 18, 2021, and i would encourage all the commissioners, if you haven't already done so, to read the message about juneteenth day from our director of health equity, dr. ayanna bennett. june just finished, and it was pride month. there were a number of activities that were commemorating pride month across the department. limited somewhat due to covid, but a number of things are described in the director's report. i was pleased to participate in a citywide panel of lgbtqia + city employees talking about our experiences while working with the city as members of the health department. and also, i'm pleased to say

that it's laguna honda participated in the celebration by bringing bingo back. just wanted to point out that, as well. there are a number of issues around covid-19 in the director's report with regard to vaccination efforts. we will cover that quite a bit in that update, so i'll leave it to that stage of the commission meeting to talk about some of these in more detail. happy to answer any questions that commissioners may have. oh, and happy to say that we've had quite a bit of press, and the links are available in the report. thank you. >> thank you, dr. colfax. do we have any public comment? >> clerk: persons wishing to make public comment, press star, three. no comments, commissioner. >> thank you. commissioners, any comments or questions for the director's report before we move into the

covid-19 update? okay. seeing none, we'll go to our next item, number 4, for discussion, which is the covid-19 update. back to you, director colfax, and to dr. tenor, as well. >> yes. thank you so much, commissioner, and commissioners. just to add that i will be providing a brief overview, and dr. tenor, who leads up our g.p.a. covid task force, will be providing more details. dr. tanner joined on us response in the spring 2020 as we were pulling all the stops out to mitigate the effects of covid-19. she recently joined the department. i'm pleased to have her on board. she's an outstanding leader, and she'll be providing more details after i provide this overview.

next slide, please. so we've been relatively well off in san francisco with regard to covid-19. we are starting to see an increase in covid-19 cases, and again, i want toemphasize this increase of 107% does give us some concern, but to indicate that these are relatively low rates compared to where we have been, just to remind the commission, one, we expect rates to continue to go up as activity increases across san francisco, across the bay area. we still have, unfortunately, thousands of people eligible for vaccine who are not vaccinated, and again, we obviously have people coming in and out of the city, as well. just to put this in perspective, at the peak of our

surge, in december, our rates were 142 per 1,000. that is a steep decline, and i do expect this number to increase despite san francisco's relatively high vaccination rates, and i'll go into this in a little more detail. next slide. right now, despite that increase, we haven't seen an increase in hospitalizations yet. we hope that the hospitalizations will remain relatively low. we expect them to remain relatively low compared to case rates as they were prior to the vaccine rollouts. there will likely be some increase in this, and i'll get you -- that to you in a minute, but also, lag rates in increase in cases by a couple of weeks, so we would expect to see an increase in the number of

hospitalizations, and we are monitoring this very carefully. the other thing is the reproductive rate, which is shown on the right side of this slide, and in our region, it's pretty consistently above one. so that means that the virus is spreading, that every person infected with the virus, slightly more than one person is getting infected. next slide. and you'll see this. this is the reproductive rate over from april of -- 1 to june of -- sorry. it should be april of 2020 to june of this year. that's a misprint on the bottom of the slide there, so april of 2020 to june of 01. you'll see our reproductive rate, which was pretty low relative to where it has been.

after the winter surge, it's steadily climbed up. so i think it's prudent to look at what's happening in the united kingdom. we are somewhat higher in san francisco with regard to this, and you can see that in the u.s. as they've gradually increased activity, they haven't fully reopened yet. that's still going to happen, as far as we know, in a few weeks, that cases have dramatically increased. starting in late may, cased have dramatically increased, certainly much higher than we are in san francisco. they are at 40 per 100,000. and hospitalizations have increased, as well. but i just want to emphasize that yellow curve on the graph. that's for the whole country, and you can see about 300

hospitalizations for the whole country, and the death rates remain extremely low and among people who are fully vaccinated. so this increase in the u.k. has contributed to the delta variants, and we expect -- as you'll see, we expect this to be an increase that we're experiencing also due to the delta variant. next slide. so this is looking at the delta variant, and i apologize. it shouldn't say india variant on this slide. this is the delta variant, and you can see that we know -- that the delta variant has been increasing in its prevalence throughout the spring in our region, and it's been more than doubling every two weeks. so we now believe in san francisco, in the bay area, that it accounts for a

plurality of cases and will be the vast majority of cases potentially in a few weeks. next slide. so vaccines are a way out. the vaccines provide good coverage from the delta variant, and the seven-day running average of 1100 vaccines being administered, down from our peak. we're working hard on vaccine hesitancy and addressing concerns that people have, and dr. tanner will go into that in more detail. right now, we are administering about 400 doses per day. that's, again, dropped significantly, but that would result in about an increase of coverage at our population level about 1.5% per month, and i think the -- vaccinated

population comparatively to the rest of the united states and to most other countries. we are much -- in much better shape of all residents in san francisco. 67%, over two thirds of the population, have received full vaccine coverage with a second

dose. of those, more than 12 years of age, so those eligible for the vaccine, we're nearly at three-quarters, at 74%, and then, our most vulnerable population, we have relatively good coverage. i will say, though, that you can see on the box that is highlighted here, we still have people here that are at serious risk of acquiring delta. it's that difference between 791,131 and the 647,039. so while the percentage is good, there are still a lot of people that are at risk. i think the delta variant is basically the covid that we were dealing with last year on steroids, and i just can't emphasize enough that we're

stressing people to get vaccinated against this variant. the astrazeneca, moderna, and johnson & johnson vaccines are all available here in san francisco and are extremely eligible against the delta variant. we're doing everything we can to increase these rates. we're certainly not resting, satisfied with these numbers, even though they're better than most community across the nation. this map shows the concentration of new covid cases in the first two weeks of june of this year. basically, the bluer -- yellow to darker blue, that represents

a higher percentage of covid in those communities. you can see particularly in the bayview, visitacion valley, potrero hill, and mission bay. these inequities continue, and you can see that our weekly case rates, san francisco overall, it's per 10,000, but you can see in san francisco overall, we -- for the month of june, we're at 4.8, and then, you can see the differences by self-identified race ethnicity on this slide, so it's something that we're working hard to address with many

community partners and systems. next slide. vaccination rate by age. as is continuing to be reported across the country, we have fewer cases in the 25 to 34 age range in particular who are receiving the vaccine. you can see that blue line is vaccines administered by age, and that group lags our vaccination distribution other than the younger age group because they're not eligible to receive the vaccine, so

reaching out to this group as well as 18 to 24 is key, although we're going to continue to do everything we can to reach out to these groups, as well as they're particularly likely to have poor outcomes due to covid-19. you can see these figures have not changed much since the last time i presented to the commission. we still have a lot of work to do so get certain percentages

commensurate up to the other cases. next slide, please. and then, i wanted to close my part of this presentation with the modelling that dr. maya peterson has done since the beginning of the pandemic for us and just to provide some scenarios. again, this is coming off that fall-winter surge, but model makes a couple of assumptions, that the delta would be 75% by

july, perhaps even sooner. the delta is 50% more transmissible than the b117 variant. it's not a matter of scientific debate, it is. this model is assuming that it's 50%, and that our activity, our contact rate as the tracers call it. so assuming no waning in immunity and no increase in

contracting of the delta variant, we would show an increase of by peak by early november of this year. however, we can get into some more challenging situations where there's waning immunity, and also, delta is twice as transmissible than the b-117, and the hospitalizations peak significantly. now we believe it's too early to tell which of these scenarios could potentially be unfolding right now. we're watching the situation very carefully and consulting with our infectious disease experts locally and across the

region. these assumptions are based on some data that we have now, but it's not concluesive, and we're still waiting to see over those next few weeks in particular as we watch the u.k., israel, other countries with relatively high vaccine rates, what's the consequences of the situation that we're in and are going to be in in the fall are. next slide. so i think that -- yes, that concrudes my part of the presentation, and commissioner bernal, i didn't know if you wanted me to take questions now or wait for dr. tenor. dr. tenor will be adding considerable depth to the overview i just provided. >> dr. colfax, let's do questions now, and commissioners, if you have any questions or comments, please indicate so by raising your hand. we have commissioner chow? >> thank you, and thank you,

dr. colfax. although the last slide, it only had one line, so i don't know if we were missing it or whatnot, but it indicated that there were xs for projected hospitalizations, there were only one line, but the indication was clear. i'm wondering if the cases are going up and you have a breakdown in terms of how many were or were not vaccinated, and is it within that vulnerable age range is normally -- i mean that you have shown that has not been vaccinated? so i think that would be of some interest. and secondly, if we were only vaccinating at about 400 per day, it would take us about 375 days, i calculated, in order to get those people vaccinated. so what are the outreaches to try to increase beyond 400 a

day? >> yes. so dr. tenor is going to cover that piece in more detail. in terms of the cases by vaccination rate, i've asked the team to analyze this, and we will be doing that analysis particularly with regard to hospitalizations and deaths when we have more deaths due to covid-19, and we will be bringing that data back to the commission. i would expect that we would have profound differences based on the data that we're seeing some other parts of the world with regard to infect rates and hospitalizations and even more so death with regard to people who are fully vaccinated compared to people who aren't fully vaccinated. there's no reason that we wouldn't see that. so we are seeing that, and i think it's going to be what's so, so key. we have such a high number of

vaccinated people that we need to look at the rate of covid-19 in the vaccinated versus unvaccinated region. and finally, in the slide from dr. peterson, that graph did show the peak scenario under no waning immunity, and also the waning immunity gets us into high numbers of hospitalizations, but that was, as you pointed out, that graph wasn't shown on the slide i just showed. >> thank you very much. >> commissioner green? >> yes, well, thank you for this information. i guess i had two questions which maybe will be answered. the first, i'm really curious as to what resources we're

evaluating to assess waning immunity? obviously, we've got individuals who are very early, and we've got our older population, at least, has proven to be more vulnerable to the delta variant. i'm wondering when we might understand that and when immunity is waning. and then, i guess the correlate to that is the number of sites and the hours at the sites have shrunk considerably. some test sites are congregated appropriately in the areas where we've had the greatest case rates, but there's a swath in the northern part of san francisco where it's difficult to get tested regularly. i'm wondering if we're going to miss spikes and if we're testing people, as they're being tested, we inquire about

their vaccine status? city test s.f. really has very few easy to access, especially for working individuals, easy to access work sites? >> yes. to answer your question, i will refer to dr. tenor because she has information on that. i think dr. tenor is really going to focus on the vaccine efforts, but we can get you that information, as well. in terms of the waning immunity, i think there's considerable on going discussion in the scientific community. one is waning on going immunity from vaccines, and the data that i'm getting from talking to infectious disease experts, the numbers for these vaccines

are being sustained, and that they're very, very strong. i think with regard to normal immunity, in san francisco, that's where, paradoxically -- no, let me correct myself. with regard to natural immunity, there's a question of whether people have been infected with so-called wild-type strain, whether they will be at most risk for delta, and i think that's being looked at more carefully. i think commissioner, in answer to your question, we are continuing to consult with infectious disease experts both at ucsf and other academic institutions who are literally watching this hour by hour, and we're in very close contact with them, so it's still unclear how long the immunity

with natural immunity and vaccine immunity will last. but the c.d.c. strongly encourages people to get vaccinated, and the bottom line is we need to get as many people vaccinated as quickly as possible, and if people were potentially think he that we had -- thinking that we had such a high level of herd immunity because our vaccination level was so high, i think the variant overrode that argument in san francisco. >> thank you. >> dr. colfax, i have two questions. do we know what percentage of

people who had received the first dose are either not receiving their second dose or significantly delaying that second dose? i believe 42 days is the outer limit is when they would be effective and spacing them apart? >> i don't have that number to report to you in real-time, but we certainly can calculate it. and it has been -- it has -- across the country, there is a certain percentage of people who unfortunately are not returning for a second dose if the second dose -- when a second dose is required. obviously, we know that the johnson & johnson vaccine requires one dose, and with the delta variant, how important it is to get that second dose and reaching out and being as flexible as we can to ensure that people receive a full dose of a vaccine regiment, but we

can certainly provide that number at the next meeting, commissioner. >> and if it's significant, it would be good to know the extent of our ability to reach out to people that have reached out for that first dose but not the second. as we look at the increasing case numbers of the delta variant, how are we approach that as we saw much higher numbers in the african american community and latino vaccination rates? what are we doing in that regard? >> so as part of the sustained efforts, we've been working to provide low barrier access to

vaccines in areas most affected by covid-19, and we're doubling down on those investments. dr. tenor will go into more detail on those. in fact, moscone will close july 14, that those are not seen -- those are not mechanisms where we're going to get significant increases of people or residents to get vaccinated, but from our mobile teams to our community neighborhood sites to our clinics to our pharmacies to our roving teams, we're doing everything we can, and dr. tenor will talk a little bit more about this. but we're also holding events and going to events that are not necessarily vaccine oriented in focus, and we also understand in conversations with community members that it's going to take multiple

touches and multiple conversations before people would potentially get a vaccine. some people are going to want to talk to a health care provider. some people are going to want to talk to a family member, some people are going to want to talk to a trusted family member who received a vaccine. but it's also going to take sustained investments, and that's exactly the system that we're creating in this task force going forward. >> thank you, dr. colfax. commissioner chung? >> thank you, dr. colfax being for that presentation. i want to take you back to the -- dr. colfax, for that presentation. i want to take you back to the reporting of the media because every day, there's something knew that came out from the media that partiallien stationalized the issue that

just, like, you know, raised concerns about, like, other variants, and, you know, the pros and cons of wearing masks for children under the age of -- partially sensationalized the issue that just, like, you know raised concerns about, like, other variants and, you know, the pros and cons of wearing masks for children under the age of 12. >> it's exactly that. it's hard to breakthrough and emphasize how important these vaccines are and how good these vaccines are, and i think that's also being lost because on the -- you know, things that

are not really central to saving people's living and preventing -- lives and preventing them from getting sick.

>> emergency operations center is a citywide body that's run by the department of emergency management, and each of the bodies has a response. obviously, because this is a pandemic, we're one of the largest d.o.c.s. as we were working through that response, it became very clear that this was a citywide universal big picture problem, and we needed all hands on deck so that we could streamline our efforts moving forward. we moved into that structure in july 2020, and then, around march, as we started coming out of the third surge, our vaccination numbers were improving. we moved into this transition state. so the bulky behemoth structure

of covid command wasn't really needed anymore as the pandemic had changed. so it's moving from this citywide, big picture, across the board response so -- to what we were just seeing that dr. colfax just highlighted, where pockets of areas were not getting access to vaccines or sufficient access to vaccines. we're starting to see pockets of disease pop up, and the behemoth structure of the covid command was, in some ways, more challenging than -- than the -- as nimble as we needed to be moving into the next phase. so in april to last week, we were really in a transition structure, trying to figure out how we could parse out the

elements of the response but still making sure we were working within the city structure. this is still a citywide response, but wanted to make sure that the different elements of that response were working in the most efficient way. so over those couple of months, we were teasing out what each department would do, what we needed to maintain, and also, how do we maintain readiness in case things start to get bad again? and then, as of last week, we moved into our e.o.c., overreaching coordinating source, and then a structure command that can be set up in a matter of days, depending on the response.

at this point, we -- while we need to manage the responses for covid, we're also recognizing that we have other important health issues that we need to focus on, and the goal of our task force is trying to figure out how we can efficiently manage as much as possible and keep those -- that transition back to normal function in the back of our mind while still dealing with the pandemic. so with that in mind, and the robust vaccination program that we're very proud of, that has

changed the response that we need to do. so our vision is that we need to reduce covid-19 within our community. the thing we were worried about in the beginning, which is having a lot of people die, having a lot of people get very sick, overwhelm our hospital systems and our health care systems and even potentially to the collapse of health care systems which we've seen in other areas across the globe, so we want to make sure that that's becoming less of a threat. and also, we're looking at long-term consequences of post covid symptoms in milder cases. so some of these areas where covid -- our numbers are still going up, although even though, our hospitalizations may not be going up, those people that are getting infected are at risk for post covid syndrome, and we want to make sure that we're minimizing the impact that covid has on our community.

a huge focus is really to reduce these inequities and reduce public severity and access to services. as dr. colfax mentioned, the inequities that covid exposed have been prevalent throughout the pandemic, and we have been watching them very closely as we're learning how to manage this disease and this pandemic. and so these inequities are really a key focus of our response moving forward and how do we actually address these and reduce them and protect our populations that have been impacted the most by covid? so we have several mechanisms that we are focusing onto achieve this mission and vision. so, obviously, vaccine is the

most important. so we have worked very hard to make vaccine as widely as possible, and at this point, all of those who are interested to come to a point to get that vaccine have received that vaccine. now, we are in that last mile of those patients who, for whatever reason, of the population, has something in the way of their getting a vaccine. whether it's a structural barrier, whether it's a lack of information, whether it's fear, whether it's concern about the vaccine, whether it's, you know, the fact that they work the night shift and can't get to vaccines. whatever those issues are, we're trying to figure them out and make sure that everybody in these scenes has the opportunity to get vaccinated. at the same time, we are also recognizing that these same communities that have the lower

vaccination rates have higher rates of covid. unfortunately, those rates are still allow, but we want to make sure that we're -- fortunately, those rates are still low, but we want to make sure that we're concentrating mitigation efforts in these communities. and i will talk in a minute about the testing question and how we're trying to improve low barrier testing to those communities. we also, throughout this pandemic, have seen the importance of engaging our community partners and really using sound community engagement principles, so we want to make sure that our communities -- that we understand what the challenges are that our communities are empowered to address those where they're able; that we were supporting them when we need to, and that we're working with them to, again, understand what those barriers are so that we can understand the best way

to bring down those barriers. and the additional step is monitoring these covid variants and indicators of waning immunity. so there's several different groups that are sequencing these variants so we can understand what kinds of variants are dominant in our communities. we have a specific set of information on patients, where those outbreaks are centralized because the variants that are prevalent and the variant mixes are important for us to understand how we need to approach these patients. for example, as you guys heard for the delta variant. it's obviously much more transmissible, so it's a bigger threat. as that variant takes predominance, and we estimate that the variant will become the dominant strain not only in

the bay area but around the u.s., and that's going to, again, impact our numbers. also, watching for waning i community, so looking for cases in vacuum -- immunity, so looking for cases in vaccinated people. cases in vaccinated people are a little bit easier to measure. with an efficacy of 96%, that means that out of -- fewer than out of every 100 patients who get vaccinated potentially could get covid, but are our numbers scaling higher than that? and to the question about whether we're seeing the numbers -- the vaccinated -- whether we're seeing numbers in vaccinated or unvaccinated, as dr. colfax mentioned, but just as a gestalt, the numbers that

we're seeing, are they vaccinated or unvaccinated? if it's a new variant that is vaccine resistant or is this a variant that we've seen before, and maybe we have waning immunity, so those are our signal functions, and they're the flares that go up and kind of signal to us that we have a problem. and the last key element in our response is the resurgence of cases. we have a lot of disaster service workers now that have a whole new skill set after 1.5 years-ish of working on this response, and they have expertise that we don't want to lose and we want to make sure, i believe, as commissioner

chung has said, that we're ready to respond faster and better and that we're learning the lessons from this unprecedented event. so making sure we have trainings, making people can practice the things that they learned moving forward. this is a bit of a busy slide, and i apologize for that, but it's intended to give you the lay of the land as the task force. this is the overall with the department of health and the department of emergency management, so they're not specific functions of the e.o.c., but they're a lot of the functions that the e.o.c. plays, and that's coordinated across the city. over in the orange boxes, that's the task force leadership group. the city has the task force leadership triad.

there's myself, panjeet, and charles, and [inaudible], my other half, we support the task force closely. but then, our leadership direction is dr. colfax, dr. baba, dr. phillip is our health director, and the human resources department. so that team is really steering the task force. the blue boxes below are the elements of the task force. so our sections are in the dark blue and the functions are in the lighter blue. this is important because as we were talking about this focus

on these highly impacted communities, as we scale down our staff as we should in this -- in this time where

things are a -- [please stand by]. >> and so our community engagement teams are working on that. we're building up a neighborhood -- a neighborhood -- neighborhood -- what's the word? neighborhood expert, so we have people working in these neighborhoods to understand the communities, understand what the barriers are, and understand what people's concerns are and the best ways to work with those communities

to try and get those numbers up. and then, also, i think thinking about how do we get low barrier access to testing. and then using contracts to help expand our teams? our staffing has gone down as we've moved into this new phase, and so we're really trying to be as efficient as we can with our resources, so using some contacts to try to expand our capabilities. also using mobile teams to bring them to people where there are. by being within those communities, getting to understand, to know the communities, and getting to understand and develop relationships with the people there, we're hoping, and our feedback from our community partners, has been that as people feel more comfortable and as we have repeat visits to those areas, we anticipate that people will feel more comfortable getting vaccines,

and empowering the community in vaccine efforts is a key part of our strategies. so testing has been a challenge throughout the pandemic, trying to figure out how to get testing to people. we have a city college site -- sorry, the city test site. and mamany cases, those were -- they were used by a subset of the population that were not necessarily -- it wasn't a great way to get into all of the different communities. obviously, getting into all of the different communities requires a lot of staff and a lot of different resources, and how do we balance that? one of the ways we try to balance that is making sure that we have community access sites so that people can get there during off hours. and then, a final element of this is we were really trying

to explore some of the employment care testing and really trying to make that -- those types of tests, the more rapid tests available to populations so that we can extend our research. we are also working on a request for proposals for a single course vendors that can do vaccination and testing so that we can expand our reach. so the goal is this is more of a grassroots approach, and what we're doing is working with our community partners to figure out how we can do this in the most efficient and effective way possible, so that's really the focus of the task force moving forward.

the other caveat to this is while we are doing very well in san francisco, much of the world is not. there are countries in the world where i have received more than they have, so my two shots are more than the entire country. and the concern for that is as covid continues to -- you know, while we're learning about covid, it's learning about us, and while it's replicating and increasing pockets of disease prevalence, the risk of another wave is high, so we are racing against time, and we are doing the best that we can in san francisco to make sure that we are as protected as possible, but we also have to keep an eye on the global view and what's happening in the rest of the world, so we are watching that very closely and watching as these potential variants come out, and also watching, as dr. colfax mentioned, and other

countries, to see -- and other countries similar to us to see how their response is compared to us and as their cases tick up or their hospitalizations tick up, what's their implications compared to us. finally, with all of that, i just want to highlight, you know, we're hoping for the best, we're preparing for the worst, but i just also want to take a minute to celebrate where we are and how far we've come. looking back at march, and i was working in the emergency department and communicating with my colleagues -- i have several colleagues that i worked with in an outbreak in west african in 2014-2015. we were texting book as we were learning about what was happening in new york and terrified that that was going

to happen here, and then, seeing our spikes in covid cases. we had other other situations with the fires and getting people vaccinated and also making sure that they are rolling out in an equitable way. and now, we can take a breath. while there is a lot more work to be done, we have one of the most successful vaccine campaigns in the world. we have one of the lowest death rates in the u.s. we don't want to rest on our laurels, but i think we need to take a minute, this is due to the efforts of a lot of disaster service workers, of our frontline health care workers, our leaders in san francisco that made tough decisions early on and continue

to make tough decisions as we move forward. and i just -- i think that everybody worked together to make this possible, and i just want to take a moment to celebrate that. and then get back to work, so that's all i have for you guys today, but i really appreciate the time, and i appreciate allowing me the opportunity to speak. and if there were other questions that you guys have or questions that i didn't get to in my excitement for sharing our work with you, please let me know. >> thank you, dr. tenner. i believe you did address almost all the questions, but i'm sure there are some new ones. before we go to the commissioner questions and comments, do we have any public comment? >> if you'd like to make public comment on this item, the covid-19 update, please press star, three to raise your hand. no hands, commissioner.

>> thank you. commissioner giraudo? >> thank you so much. thank you, dr. tenner, for that presentation. it was very, very helpful in understanding the -- the start and the road to the finish line, so to speak. my question is at when there is the okay for the 12 and unders to be vaccinated, do we have a vaccination blitz plan going forward? >> thank you very much for that question. it is really a key part of trying to get as many people vaccinated as possible in the

city. one of the -- our vaccine team is working very closely with our communities. we also have a max the vax group that is a group of students and youngsters that are working to try to get out the word and do a little bit of prework, actually, in educating their peers about the vaccine. they have some of the most fun campaigns. they've come up with some really cool stuff, but also, we're working with pediatricians. we know that it's one thing to make a decision about getting yourself vaccinated, but many parents who had their problems getting their vaccines for themselves are a lot more hesitant when it comes to a two-year-old, so making sure that in the sense that every door is the right door for vaccine throughout the process, we have to make sure that the resources are there for people to get educated and to ask the

questions that they need to ask. so it is a bit of a broad swath, you know. some of it -- we are doing some work with some of the summer camps and things right now, so depending on when those vaccines get approved, we'll be reaching out to all those different elements of community. >> have you partnered with the san francisco unified school district as well as daycares just so you can have a blitz? >> yes. we have a group that works very closely with san francisco unified school district, and so we are having discussions with them about the best ways -- because obviously, we would love to work with the schools on this.

the discussions are on going, and they have been for a little while. we are trying to engage all of our partners that have contact with children that could help us. thanks. >> next, commissioner green? >> yes, well, thank you for that really uplifting positive conclusion. you said it so eloquently, and we all feel the same way, that there's been so many really valiant people, including our citizens who have done such a wonderful job to get us to where we are today. i was really curious, talking about our outreach. what kind of research were we doing with things like focus groups? i see a lot of patients, and i am very concerned, as you articulated, that a lot of parents are worried that it's fine for them but it's not fine for their children, and one of

the examples that have come up in misinformation is infertility. i do worry that there's that kind of thought, and of course, i've been quite surprised at the number of presentations that i have who are afraid it's going to hurt the baby and have declined, but i think now with the delta variant, i think trying to expression the -- the urgency, given the level of contagion, but i think it would be helpful for all of us who contact our friends, our families, as well as providers of health care to have some guidance -- i think there's some things in the new york times, how you talk to children about vaccine hesitance.

i'm curious to know where we're pulling best practices and what advice you can give to help us all crack that code? >> thank you. you hit the nail on the head. i think that really getting that information out to people is really important, and we have done quite a bit with -- with outreach to the different communities. we have done focus groups. i think some of the focus groups, they said we don't want to keep doing focus groups, but we have been doing targeted interviews with groups, as well. and some of the things the vaccine team have been working on, they have a program, coffee with a doctor. because one of the things that we have heard both anecdotally

and in researches is people doing studies on -- where do people get their trusted information from? because i can -- you know, i can talk all day along with how wonderful i think the vaccines are, but if you don't have a relationship with me, you may not know or may not trust me, you may not believe me, and so a lot of the data that we're getting is people want to hear from their doctors or they want to hear from doctors about this, and that's a bit challenging, given the speed that we need to roll this out at. but one of the things that we are doing is we have had a few training sessions with physicians to say, how do you answer these questions, especially the one about the fertility question.

i heard that on a facebook post, and then, it comes everywhere. so giving physicians and nurses the material to talk to their patients about -- physicians and clinicians the material to talk to their patients about this. anything goes, no question is a dumb question. whatever you're concerned about, we're going to give you the information that we have, and so i think that's been one of our key tactics for trying to get information out there from the providers. the other corollary for that is

having trusted community members with the community trust that the community relies onto be able to work with some of those community members to also give them the information so that they have resources, they have some vetted information that they can go to in their communities that they are really concerned with. and also, this is the scary thing especially for parents. i don't have children, but i know -- when you're thinking about things, health and how you're going to approach them, that it gives you pause. and i think for those of you -- i'm fortunate in that i can

read the literature. i eat, breathe, and drink this every day, so when my sister calls me with questions, i can answer them, but not everybody has access to information that's accessible to the public. >> thank you so much. >> thank you. commissioner chow? >> yes, thank you for this wonderful presentation. all through this whole pandemic, our city government has been able to draw people together and now to get into the next phase, and each of the phases are fascinating. i very much appreciate the discussion on trying to reach the young, and there has been so much information, of course,

about the potential problems that some of the young have faced, and as you know, the adolescents recently. i'm hearing the same that there is a hesitancy to subject because we're already dealing with two people, right, in this age group, really. -- to subject them to a possibility of longer term, or even short-term illness. i understand that you could have a meet the doc thing, but they're not always as -- we're not always as expert as you all are and don't necessarily have the right answers, but we have the same questions. so i'm wondering, as i think commissioner green was noting, if we also get fact sheets out and so forth, if we could turn

the media around to sort of actually give this instead of scaring people all the time to doubling or tripling the rate or something like that, you think it would be very helpful, something like that. i think with the resources we have, we're going to run in with more resistance, even, with the under 12. i'm hearing that already, and 12 to 18, and that they're not vulnerable, and that if it is, that's like a cold, and that's sort of the answer they all have, and then, they're concerned about the long-term. so i think additional education from a really trusted source, which i think this department is, could be really helpful, but that's just a suggestion.

the other workday, as you were stating, a lot of times, you will be asking your own doctors. as we said before, although logistically, it may be quite difficult, but it would be okay if the doctors in, their own offices, were able to give the vaccines once they convince somebody they should actually get it rather than throwing the next step, now you can't even go to the mass vaccination places. we'll have to find a place for you. i know that cal stats has put out some grants to practitioners and apparently up to $50,000, but i wonder if we're doing any outreach, then, to our segments in the private,

solo, and small groups. the rates seem to be up to 70 or 80% that are coming back? -- do you know anything about the cal vax program that you might want to promulgate more because i don't see it getting to the people that you want to get it to? >> thank you very much. i don't know much about the cal vax group, but i'll look into that. i think our groups are working with the different systems.

we are relying on our partners to vaccinate their patients. they will have the relationship to be able to answer questions, but also, it's going to be very important that the patients who have primary care providers can go to their providers and get vaccinated, and again, we will be focusing on that last mile and trying to get to those patients that might have a harder time getting in to be vaccinated. but yet, supporting and make -- yes, supporting and making sure those providers -- we have a lot of resources to what providers and partners can do. >> and like i said, i don't know too much about the cal vax grant.

i understand that, actually, applications were in in august, so if somebody in the department really looked into that and see that was useful for you. i guess my last question is more i know you've established a lot of good relationships with the neighbors, as you said. as you move into this new structure, is it going to change where, in the neighborhood with regard to a or b or c, and now, all of a sudden, it's become box x or y or z or are these relationships going to continue as we move people around? because those relationships are very important for everybody right now? >> yes, they are. we are working to maintain the structure. katy tang has working with us so far and has done some

incredible work in helping to build those relationships. we don't want to be changing forces mid stream as we have people with those relationships moving forward. so what we're trying to do is rather than completely disconnect from the other -- you know, there's a new person or a new group that's coordinating with us, what we're doing is working to bring those groups together under that structure so that those connections are easier to be made. for example, our coordinator is a really wonderful woman named jackie mcclay, and she has been one of our community branch leads. so we're bringing in her to oversee -- she's very good with operations, so we're bringing her in to oversee our medical operations, and she can link in

with some of the c.d.o.s that she's worked with in the past and with katy tang on those community partnerships. really, the operations are there. those are the things that we need to do to try to minimize the spread of covid and minimize the impact of covid, but there's community and relationships, those are universal. it's a relationship building that we are -- we're working on for covid and for vaccine but also for all of our public health measures moving forward, so the focus, obviously, right now, and the most important thing we need to do is vaccinations. these relationships, i think we're really trying to build the health of the community moving forward, so these relationships are going to be key, so we're trying to not disrupt those with this transition. >> well, i do want to thank you, you know, for the work that you've done first in the emergency room and getting through that search and all,

and now actually as part of the city's efforts to really make this a long-term program so that we can respond in the future, and your dedication to that is certainly worthy of our -- and thanks for your work. i'm looking forward to further reports showing how this transition's going, and we're getting to that last mile. thank you. >> thank you very much. >> thank you, commissioner chow, and thank you, dr. tenner. dr. colfax, did you have something you'd like to add? >> well, i'd just like to add my gratitude for dr. tenner for her leadership during this pandemic, and also just clarify with regard to the delta. those are national data from

c.d.c. as of june in california, the delta variant accounts for about 36% in cases compared to 34% for alpha. and again, we believe that the delta now represents a plurality of cases if not the majority, and if it's not the majority, it will be soon. from the federal level, we were hoping that the f. -- we are hoping that the f.d.a. will provide full approval to the vaccine soon. some people say they're waiting for that full approval, so they'll be on the emergency operation. others say it won't make much difference, but that is a milestone from a regulatory perspective that could address some of the vaccine hesitancy issues, but again, it

[inaudible] who are working hard not only on managing all these pieces, but it's a huge operational list in terms of the transition, so just to emphasize that challenge going forward. but with dr. tenner and others in the lead, i'm confident that we're in good shape. >> thank you, dr. colfax. and i'd like to associate myself with all of the gratitude that you've received from dr. colfax and the commissioners and extend it to your entire team and also take a moment to reflect on how effective san francisco has been in addressing the pandemic and really taking some pride for that, your work and the work of every single employee in the department of public health. the mayor, our community partners and community of san francisco for everything that they've done to get us to where

we are, so thank you, again, for your excellent presentation, and we look forward to further updates. >> thank you so much. i'll take that back to my team. they will really appreciate that. >> all right. moving onto our next item is general public. >> clerk: there is no public comment. >> thank you. item 6 is a resolution to recommend to the board of supervisors to authorize the department of public health to accept and expend a gift of perpetual software licenses in the value of 59,999.40 from the

san francisco general hospital foundation. and we have bruce oceana, director of telehealth and interpreter services. >> and greg wong will be presenting today because bruce is out of the office today. >> all right. thank you. >> [inaudible]. >> thanks. we wish him well and a speedy recovery. >> [inaudible] earlier today due to shipping fees, so that was excluded, and we are asking for a gift for software licenses in the value of

59,999.40 for the san francisco hospital foundation. >> mr. wong, commissioners, i'm sorry to interrupt mr. wong. commissioners, i've told mr. wong that we can't change the resolution just because something has come through administratively, but you all can provide it through a motion. so mr. wong, could you say the amount again, and then i'm going to encourage commissioners to say that in a motion to approve the resolution. >> thank you very much. the value is $59,949. my apologies for the inconvenience. >> no inconvenience at all. i believe we would need a motion to approve the resolution and then someone to offer a friendly amendment,

correct? >> yes. yes, sir. >> do we have a motion to approve the resolution? >> i'd so move to approve the resolution. >> second. >> second. >> second. >> great. are there any amendments? >> i would like to propose an amendment to the amount of the resolution to read $59,949. >> thank you, commissioner. >> i second the amendment. >> okay. and that's acceptable to the mover and secondary, which i believe are the two of you, as well, correct? >> mm-hmm. >> yes. >> okay. great. do we have any public comment on this item? >> if you do have any public comment on this item, please press star, three. there are no public comments.

>> thank you. are there any questions or comments from commissioners? seeing none, we can move onto a roll call vote. >> clerk: okay. so i actually have [inaudible]. >> okay. [roll call] >> thank you very much,

supervisors. >> thank you very much, mr. wong. okay. our next item is an update from the finance and planning committee. the chair of the finance and planning committee, commissioner chung. >> good afternoon, commissioners. the finance and planning committee met today prior to the commission meeting, and we had approved the recommendations of the contract report and four contracts for the consent calendars for the commission to approve, and we also have heard the presentations for the d.p.h.

third quarter revenue and expenditure report, and we had really robust conversations really looking at, you know, you know, like, how, you know, to support smaller organizations and clinics to sustain themselves, you know, with, like, so much to consider. and also, we also had conversations about, you know, like -- you know, like, the issues of health equity. when is, like, investing in a contract that seems pricey too pricey, and we had decided that, you know, like, some of these, we could do that in the population health committee, you know, to have some of these presentations, including the presentations for the -- one of the programs, which is, like,

for pregnant women and for recovery services, and we thought that it might be of interest to have -- to hear full presentations about the program at the population health committee, and maybe we would include other programs such as the one that commissioner christian had suggested, which is post partum depression, and hopefully, commissioner giraudo will agree with that and put that on future calendar. >> all right. then moving -- do we have any public comment on this item, secretary morewitz. >> yes. would you like to make public

comment on the public finance and planning committee? no question. >> all right. any questions from the commissioners on public finance and planning committee? all right. seeing none, we'll move onto the next item, which is the consent calendar. back to you, commissioner chung. >> all right. so presenting to you, commissioner, the consent calendars for the full commission approval. >> do we have a motion to approve? >> i'd so move to approve the consent calendar. >> second. >> we'll have a roll call vote. >> i'll start off with any public comment on this. >> please press star, three if you'd like to make comment on the consent calendar. no hands, commissioners, so i

can move on with the vote. >> thank you. [roll call] >> the motion passes. >> thank you, secretary morewitz. our next item after the consent calendar is item 9, which is for action. it's the proposed relocation of felton institute to 1663 mission street in san francisco. this is part of the prop i process, and we have michelle ruggels, part of the d.p.h. business office, presenting. >> and i just realized, this is

a discussion item. you will take no action on this item. this is the opportunity for the public to make comment on this proposal. >> so this is a discussion item. miss ruggels? >> hello. good afternoon. >> hello. >> okay. so my office is responsible for ensuring that the department of public health meets its obligations under the department's good neighbor policy, and d.p.h.s good neighbor was policy in created in response to citywide legislation, which we refer to in shorthand as prop i, in the admin code, which is a way for residents and concerned residents to bring [inaudible] to change in use or a significant expansion and to be able to bring concerns to an

approval body before a project is approved. so for us in the department of public health and typically for the health commission, your approval action is of a contract that funds a project. in the case of today, what the felton is doing is proposing to lease two suites in a new site, and they're using existing dollars, so there's no contract subject to approval, like the last time a few weeks ago, where you approved the funding for a new drug sobering center. so my intention is to present to you the felton institution's proposal. what they're proposing is to move to two suites in 1663

mission street. these programs are moving from three different locations to the two suites. they have four forensic programs that are going to be relocated together and then one children's program that will go into a separate suite. specifically for d.p.h., we'll have a memo packet that goes through a lot of this, but any way, to be in compliance, really, our requirements are to do public posting of this project, which in this case, it's not quite seeming like a project, but it's treated the same way so we can hear all the concerns. the [inaudible] signage posting at the site where they're proposing to move. we have a certain number of days -- we have a certain number of days where the posting has to occur. and then, we're obligated to

two mandatory meetings. one which was held today, and one at the health commission. sometimes we do more meetings, but the obligation is two meetings. so we had the first meeting on june 3, 2021, and we met the posting requirements in 15 days. we completed the posting requirements on may 25. and initially, in the posting -- if you do a posting you don't have to do a mailing, but felton institute did distribute fliers to the residents surrounding 1663 mission street. and i think i just want to clarify, it was my staff under the direction of tom mesa who's the director of business compliance and his staff, so i'm reporting out and i want the credit [inaudible].

so anyway, we have our first meeting, and there were 22 attendees, including staff. so it wasn't -- anyway, it didn't generate, like, the drug sobering center. felton institute, their facility's director and their c.f.o. really presented a powerpoint slide, outlining the details of what the programming would be, their clientele, and their intent to lease the two suites which total 81,000 square feet, and there weren't any questions or objections raised or really any comment. and so because of that and because of the attendees, 22 people in total, we didn't have

a community meeting, which met our threshold. if there's outstanding questions, we'll keep holding meetings to get some answers, but in this case, there wasn't. so today, we are here to bring this to the health commission. i believe that felton institute staff are here also if you have other questions, as is tom mesa, the felton staff about the project but specifically about the lease or anything, and then i think that's it. the other thing is i believe it was commissioner green that sent a set of questions which we provided back, not just till today though, so it's stuck in your e-mail, if you didn't see it, a grid. one of questions was why, and the top five zip codes of the clients that they served, and

so that's included in the attachment. so it was less information about the specific programs themselves, but from the felton institute, representatives are here if you'd like to ask those questions or know more. >> thank you, miss ruggels. before we go into commissioner questions or comments, do we have any public comment? >> anyone on the line, if you'd like to make comment -- actually, i think you're a staff member for this, but if you have public comment, you have two minutes to make public comment about this item, please press star, three. no hands, commissioners. >> okay. commissioner chung? >> well, i just wanted to make comments that this is a [inaudible] from the past because this -- this buildings has the histories of, like, being useful to other programs

like the substance abuse programs before d.p.h. merged it into behavioral health, and i happened to be working there there 20 years ago. i can't believe it's 20 years. and more importantly, the other convince den -- coincidence, mr. oceana would be able to present, he was the director. that would be a very happy coincidence. >> thank you, commissioner chung. commissioner green? >> there's good karma in the building on top of everything else. i just had one question. with the zip codes and so forth, these are such worthy programs, i just want to make sure, especially for the on side components of -- on-site components of these various components, there wouldn't

be -- [inaudible] do you have any questions about that for the current participants? >> my opinion poll, i think marvin davis -- >> i've unmuted mr. davis so he can speak. >> well, good afternoon, or good evening. this is marvin davis. i'm the chief financial officer here at the felton? great question? one of the things that was actually advantageous for us in moving to this location was actually the proximity of the clients we serve, and we're -- you know, and transportation. so, you know, we are -- we currently have locations, the sites are actually -- i mean, the programs are actually in locates further up van ness and one in the mission? and so yes, these are definitely better locations for

serving our clients. >> excellent. thanks. >> thanks. >> commissioners, any other questions or comments? this is an item for discussion that will come back to our next meeting as an action item, so thank you to mr. davis, thank you, miss ruggels, for your presentation. >> excuse me. may i enter -- actually, it won't come back to you, this item. this item is done after we move onto the next item, just so you know. it contains one item, one-time public comment. >> thank you for that clarification. our next item is item 10, also for discussion, san francisco department of public health behavioral health services and mental health san francisco update. we have dr. hillary kunnis to

present on behalf of the department. welcome. [inaudible]. >> oh, hello, angelica. >> hello. >> dr. [inaudible]. >> hello, commissioners. thank you for having us. i'm -- as you indicated, dr. hillary kunnis, is the director of behavioral health services and mental health services. i'm joined by my colleague, angelica almeda, and we'll transition into a presentation about the street crisis response team. and i did get some of your questions from during the day today, and i'll try to integrate those into the presentation. next slide. so i'll be briefly providing an

introduction, sharing with you some recent highlights as well as some progress areas in mental health san francisco, including some hiring updates and some bed usage, and i'll then transition to angelica and in addition to speaking about the street crisis response team, she will be looking at our health equity impact assessment. next slide. next slide. so i thought i would just start by a few more words about me. i know that you heard about me at the march commission meeting and that i was joining d.p.h. at the end of march. so i, as all of you likely know, i transitioned from new york city where i was at the

new york city health department, and just hearing the last presentation, appreciate the challenges here as i was deployed to work on covid for most of my last year in the new york city health department. i have been very busy getting acclimated here, meeting with, of course, staff at d.p.h. as well as a variety of providers, which is still very much on going, as well as meeting with community members. i think as you all know and as i have been learning more deeply is that the great number of new investments in policies, [inaudible] as well as the important legislative work of mental health s.f. the other observation that i'll just share with all of you is all of this work is very much happening locally but also nationally and certainly was

part of my experience in new york city is our reform work is really happening in the important context of the anti-racism and racial justice movement that is happening nationally. the current overdose death crisis, changes in policing practices, and histories which i learned well in new york city and i'm learning about here is underresourced and disinvestment in community behavioral health services that has really gone on for many decades. and all of us in the behavioral health services are growing our intention for the behavioral health care system and its reform. next slide. next slide. so i wanted to kind of summarize where we are and where i think we are going in

that context. as you all know and has been really wonderful to learn more closely is the very many innovative services and programs that are here in san francisco. there's really tremendous infrastructure within our clinical system with some mobile capacity with a lot of new crisis and residential services that have been either recently launched or coming soon. there remains, i think as we all know, an urgent need to expand our engagement and services to some of the folks who have the greatest need and who are the hardest to reach. so we are aiming for equitable outcomes for san francisco. san franciscans, we are aiming to create parent treatment that is consistently available, flexible and accessible and

truly responsive to the hardest to reach and hardest hit people. we are doing this by continuing to reach people increasingly where they are and removing barriers to care. we are building culturally response can i have care that is equitable -- responsive care that is equitable. we are collaborating across d.p.h. and san francisco. we are transforming our program to a managed medi-cal program, and we are very attempting to developing capacity to respond to urgent new issues as part of the public health department and at the behavioral health subject matter experts. when we're aiming -- and we're aiming to build a system that is outcomes oriented. next slide. as you know, we are the safety

net system for san francisco, and we've served more than 10,000 clients in the last year, and i'll also note that we are a largely a self-serving system with the vast majority of our clients over age 26. i'll also note that a disproportionate number of san franciscans accessing our services are unhoused. next slide. as part of what my team has been doing over the last year, and i saw that in the last presentation, you heard about our division's equity action plan, and just by brief summary, i wanted to share with you some of the progress in that area. we -- our team identified that the behavioral health services staff members are most likely to be black, african american,

latinx, latino, latinas than the people using our services and that culturally congruent behavioral health systems are not equitable across our systems of care. we have enhanced and are working further to enhance staff capacity to work equitably by building equity infrastructure in behavioral health services, build antiracism leadership skills from staff wellness and conducting regular exit interviews. we are proceeding deliberately to increase our recruitment of black african americans, latino, and latinx staff, particularly leadership and particularly clinicians.

we are trying to come up with new initiatives and new work, and here on this slight in front of you -- slide in front of you are really just some of them. covid, as occasions, as it is in primary care, the opportunity to conduct more virtual care, which is happening now in many clinical and street-based places. it represents new opportunities to change the way we do business and to look at new business as a way to further engage people and [inaudible] behavioral health resource. we are committed to deliver more culturally congruent health practices. we applied for and received

state endorsement for one of the mhsa -- what's called innovation projects to deliver tailored care to african american san franciscans. we deliver mental health care to those sheltering in place and homeless shelters. [inaudible] can be delivered. we are also moving forward with what i put together [inaudible] and low threshold care that happens in places that can be flexible and broad. two examples are hummingbird valencia, which is now open, and i know the commissioners have heard about the drug sobering center to be opened in the fall. we have also had the

opportunity to expand more crisis and mobile response centers. the children's health crisis, which is under seneca, which is open to all kids being served in our behavioral health system. this is really in addition to our children's mobile crisis teams, which operates 24-7 to all children of san francisco. as the commissioners know, we also launched the street crisis response teams in november, and we'll hear more shortly about that. next slide. next slide. i think as the commissioners have also heard a great deal about mental health s.f., i wanted to just speak a little bit more detail about our progress there. as you know, the confluence of mental health reform, proposition c, and mental health s.f., are really all

working confluently to move this reform and expanded behavioral health service agenda forward. next slide. as [inaudible] with mental health s.f. consists of several areas that have been legislated. we have operationalized this internal to -- internally at sfdph to internal domains that you can see here. note that the [inaudible] domain was not part of the mental health s.f. legislation, but we have formed an internal working group or domain to address that. as you all know, mental health s.f. is focused on people experiencing homelessness along with serious mental health or substance use conditions. next slide.

we are building out office space and undertaking stakeholder and community engagement. i'll just mention, although our mental health services center, which is to the top right box

of your slide, again, we are undertaking hiring in preparation for expanded and weekend hours which will enable us to conduct assessments and link people to care in more hours of the week. so important to really engaging and providing people the care they want and need. next slide. this graph -- graphic, which might be a little hard to see on your screens, but i hope you all had a chance to review these, this really described our specific new beds and facilities part of the work. we will be expanding behavioral health treatment capacity for residential or place based care by 400 new beds. this plan was guided by the mental health reform work that

produced a bed optimization report as well as san francisco legislation and stakeholder input. two of these are already open, hummingbird valencia, with capacity for 30 people, and the managed alcohol program in connection with permanent supportive housing, for a total of 20 beds. the next set of beds that will be coming on-line, you can see there will be opening this summer, so very soon. next slide. another aspect of our work is utilization. we aim to keep bed utilization at about 85%. the reason is we want to have beds available in real-time as

people need them. we know that we are continually striving to do better in this regard. i'll just note that one area, which was particularly low is the specialty residential beds. these are beds that we particularly focus on different populations, and therefore, we sometimes end up leaving them at lower occupancy than some of the other types. next slide. finally, as all of you surely know, hiring is at the center. we need to -- so the chart in

front of you, i think it collapses the kinds of positions that we are hiring for mental health s.f. into groupings so we are able to prioritize the work. so for example, in group a, we use our managers and directors who will then go onto lead hiring and fill in for some of the other subsequent positions ranging from health care, health educators, clinicians, and analysts and so forth. next slide. simley, this is a little more detail, and -- for the behavioral health services -- similarly, this is a little more detail, and -- for the behavioral health services network. this gives you an idea of the different positions that we are

hiring. they're merely the totality of the positions that we are hiring. there's some more to fill in on the mhsf side which will come at the next update. some of our challenges, which was a question that we did receive, relate to waiting to some of the lifts. we were very excited that one of the lifts for our behavioral health clinicians is expected right around now, and following that, we'll be able to move forward with those 2932s. next slide. and before i turn the presentation over to angelica, i just wanted to make a comment other two other questions that i received from the commissioners. one is having to do with

childrens services and particularly for kids experiencing homelessness. there are a variety of children's services available both in our navigation center as well as in our children, youth, and families section. we know that access to childrens services is something that we're working on improving. we do have some really model programs that work with families doing family therapy as well as family work that's happening in the navigation center with children and families. i also got another question about [inaudible] and parenting people, we have a number of specialty programs you saw in the -- one of the residential

programs as well as the residential step down program does have dedicated space for parents and families together. some of our other programs have special tracks that work close with the -- if the child is a client or patient also works with -- has capacity to work with the parent. there are some very exciting programs and access can and should be improved. and before i turn us over to angelica, i just want to acknowledge anton bland, who i know the commissioners are familiar with, and as i have gotten started, am aware of the important and thoughtful work that he led and very grateful for his passing on many of the things he had been working on to me as well as our team here. so to you, angelica.

>> thank you, dr. kunnis, and the commission also joins you in thanking dr. bland for his contributions to this effort. we would like to ask, what's the impact of positions being unfilled both in terms of your capacity to do the work that needs to be done but also the toll that it takes on your existing staff and having to cover work in multiple positions as you move forward in trying to fill those roles? >> so we have an extraordinary team is what i have learned. people are dedicated and hard working and indeed have been carrying an awful lot, and i have been absolutely

prioritizing hiring because i think it -- that is what the staff there great burden holding multiple responsibilities and makes us slower than we would like to be. [inaudible] it's fair to say, and so i hope as we bring other folks on board that we will expand our capacity. i also want to acknowledge that covid has taken a toll both on our staff, many of which -- many of whom have been deployed, i think appropriately, to help with the covid response, which has been so important, and that is also another element of stress, and we are excited in moving into a next period, and deployed staff are returning to their home

departments. >> thank you, dr. kunnis. i see that we have two other commissioners with questions. i would ask whether they would like to ask their questions now or hold until the end of the full presentation. commissioner christian? >> i can hold. >> okay. commissioner green? commissioner green? >> yeah, i just -- i can hold. >> okay. thank you. all right. dr. almeida? >> all right, commissioners. i'm excited to give an update on the street crisis response team. this is in direct response to the mental health s.f. legislation. it's also very much part of mayor breed's commitment to police reform and looking at alternatives to a police response to individuals

experiencing a behavioral health crisis in nonviolent incidents. the human rights commission alternative to police response and the [inaudible] the goal is to provide rapid trauma informed response to adults who are experiencing a behavioral health crisis? our primary goal is to reach individuals who are experiencing these crises in public spaces? of course, we are looking to reduce law enforcement encounters and to reduce any unnecessary emergency room use. in designing this program, we know that there are a large volume of calls that go through 911, and so we decided that our primary goal, because those are calls that are responded to by police currently were that we wanted to divert all of those calls away from law enforcement, and i'll talk a little bit more in a second about the types of calls that

we're responding to. but we're responding to 911 calls and have a team of individuals that provide therapeutic deescalation and support, and also importantly, we know that we need to address crises as they're occurring, but also using this as an opportunity to support and serve individuals after a crisis to mitigate their risk of future crisis. so we have dedicated capacities through our office of coordinated care, which is our first piece of the office of coordinated care to launch, which is the first piece of providing supportive care to individuals. our goal is to reach every individual that had contact with the street crisis response team. so, again, in terms of our response, we're responding to 911 calls that are coded at 800-b calls. just to highlight, 800 calls are police calls that are coded as mentally disturbed persons.

many situations are those that do not include active violence or weapons. those cases that do include active violence or weapon are still responded to by the police department. those require a much more urgent response, as you can imagine, and are termed a priority level. there's three team members. we are working in collaboration with the fire department to implement this program. the fire department provides the vehicle and a community paramedic. through the department of public health, we have a behavioral health clinician and a peer health worker, so three team members responding to all of these calls. i'll pause to shielt that the -- highlight that the behavioral health clinician and the health worker were based in community, so it is important to partner with community

health organizations to staff that. i'll also note that including a peer health worker in this work is something that's unique to san francisco although many other jurisdictions contemplating similar programs had talked about including peers about this in this work. commissioners, i'm sure you all know about how important it is to integrate peers and individuals with lived experiences into our response and interventions as a system, and so we have already seen how invaluable this is to include individuals with lived experiences, so very grateful to have teams with these people working on this. we also have teams and peers providing linked up and coordinated care for individuals. in terms of vehicle, this is not an ambulance but fire department vehicle that is able to transport people to

voluntary treatment locations, so they're able to take individuals to detox programs, shelter in care, just to name a few. if someone needs to or requested or is determined to need to go to the hospital, we transport them there. we currently have five teams operational, and as of this week, those teams are operational 12 hours a day, seven days a week. as you can see, each team is staggered so that we have full geographic coverage of san francisco. i'll also note pending the

finalization of the current budget, we'll have a seventh team that we'll be working on implementing before the end of this calendar year. and what we'd strive to do in having these teams is to look at a response for different communities and team that had a geographic relationship, driving around the communities, identifying people they may see multiple times or people that are in distress, but teams that can deploy and dispatch to different parts of san francisco, depending on where the need is, so really working on striking the balance. the first team that launched, the tenderloin and castro team, had the highest 800-b calls that we were responding to.

the bayview was the next team launched and had the third highest number of calls. we implemented there early on so we could work on building those community relationships and partnering with the community to meet the need. we understand that the bayview is a community of color that is disproportionately impacted by contact with law enforcement. so to share a little bit of updated data that we have, this is data through may of this year. so relatively, we have responded to roughly 1500 calls, which in the month of may, represented 37% of the calls being diverted from law enforcement to the street crisis response team. our response time has been fairly consistent since

implementation of the program but is roughly 15 minutes. in terms of calls that we're responding to, again, most of our calls are coming through 911 dispatch, but our teams are also active in the communities and are driving around, and we're not waiting for a call to come in. if we see somebody in distress, we respond to that. also to highlight that the team does carry narcan in the vehicle, and there has been times that they've seen somebody overdosing, they've been able to reverse those overdoses, and they pass out narcan to the individuals. we recognize that all of our outreach teams are important in responding to the overdose epidemic that we're seeing. we also have some individuals or cases that we've responded to that our partner agencies have identified as being appropriate cases for the street crisis response team,

including e.m.s. providers through the fire department, etc. so i mentioned that we had roughly 1500 cases that we responded to, which led to 857 contacts with individuals. what we have found in responding to these calls is that most of those calls that we receive through 911 are third party callers or individuals that are walking by and see a situation unfolding or somebody in crisis and call 911, but typically, it is not individuals that are with somebody or the individuals themselves who are calling. what this has led to is that there's a fairly large percentage of individuals that we are unable to locate when we arrive to the scene. the team does a lot of work to walk around, drag around, look around to locate the individuals that we're called about, but due to the nature of individuals in san francisco and walking around, that's

something that we're monitoring and striving to improve. 59% of cases resolve at the scene, and an individual was able to be deescalated and supported to remain safely in the community. just to highlight that this is consistent with what other jurisdictions have seen in roughly 70 to 74% of cases remain in the community, but what this ultimately means is that an individual can remain where they feel most comfortable and were able to provide -- and we're able to provide that intensive care for them. 17% of individuals did prior transportation to -- did require transportation to the hospital or care. 71% of individuals were placed on a 5150 hold and transported to the hospital for care.

17% of individuals are also transported to other locations for care, so really, that's bridging our entire system to support individuals, and if that person is voluntary willing to go somewhere, that we're able to get them there safely. i want to show you a little bit about the demographics of individuals that we've served in the program thus far. so just to highlight, and this is consistent with our behavioral health system that many individuals that we're serving are experiencing homelessness, and this accounts for 75% of the individuals that we've had contact with. in terms of ethnicity, most of the individuals that we served have either identified as white or caucasian or black or african american, but you will see that there's a large percentage that we don't have this information.

some of this is related to early impacts from the program, so over time, we hope to see this change. some of our mitigation ensure having better office coordinated care teams, which launched in april. months after our scrt teams launched, this launched. it's very important to us that we're not making assumptions about a person's ethnicity and that we're also getting that information directly from the person. if an existing record exists, we're able to pull that into avatar so that we have more complete information.

and in that effort to talk a little bit more about how the street crisis response team is addressing institutional racism, the emphasis is in direct response to an alternative to police where there's not a crime in process. each of these calls represent a diversion away from a law enforcement encounter. we also are working very diligently to address existing health disparities and our evaluation and just as a reminder, we have two evaluation projects for this program, one that are going to look at outcomes for individuals and looking at gender and ethnicity, so we're looking at this very closely to ensure that we're addressing individuals and any systemic barriers that prevent individuals from accessing the

care that they need. part of this also includes building relationships in the community where mistrust exists between systems and law enforcement. one thing that we heard very clearly from our community members, in particular the bayview, is to have another way to reach the scrt team. they've told us that they're not going to call 911 because it's another risk of police involvement. there's some regulatory hurdles that we need to get past in terms of having a paramedic on the rig and having to make sure that we're meeting all the dispatch requirements through the [inaudible] agency and we're hoping that we'll be able to address this in the future and have an alternative way to reach the scrt team. of course, we know that this is not the answer to everything, and our actions are more

important than training, but we do ensure that our teams have had sufficient training around racial equity and that these conversations in our racial equity work remain central to our response and our development of this program. and just to share a little bit more information about our health equity impact assessment, this is something that we worked to put together. a lot of this is what we just talked about, but just to provide some additional context that the scrt team is trying to address, weaponizing 911 against people of color. we know that that is something that many people contend with and reflects a population of calls that we're getting to the scrt team. also looking at the impact and overrepresentation of people of

color with law enforcement and those who are incarcerated and use of involuntary holds, and so those are things that we are looking at very closely as we go through this program. in terms of community engagement, we had many conversations with our c.b.o.s, other programs and city agencies, behavioral health programs, peer focus groups, and other community engagements throughout the implementation of this program, but having that voice and the voice of community in both orday-to-day operations -- both our day-to-day operations and also in the way that we're driving this program forward has been something that's central to our work and important. and in terms of addressing racial equity, we're focusing on this program being able to provide that trauma response that's health driven and not driven by law enforcement that can provide that therapeutic deescalation and appropriate link to individuals and that

we're providing community based services and connection to the community where individuals feel most comfortable. we know that the services that individuals feel accessing comfortable in their communities are the best way to support individuals in meeting people where they're at. again, having somebody who has that lived experience also represents a unique opportunity for us to hire individuals from the community who are able to have those conversations with people that they may have grownup with or known, so that has been a huge benefit as having peers as part of our team, so we look forward continues to have -- continuing to have that and enhance our collaboration with the community and having our community driving what this looks like. so let me pause for a question before closing remarks to see if there's any specific questions about scrt, and i know that there were some remaining questions for dr. kunnis, as well. >> thank you. before we move into commissioner comments or

questions, i understand that we do have someone on the public comment line, seeking to make a comment? >> yes. so i see a hand, and i'm going to unmute the person who's on the public comment line. person on the line, you've got two minutes if you'd like to make comment on this item, which is item 10. >> hi. >> hi. you've got two minutes. >> this is dina long from the san francisco law enforcement consortium, and miscomments are -- my comments are based on dr. kunnis' presentation? for many of you who don't know who i am, i represent san francisco community consortium, which is made up of 11 community health centers in san francisco. we also are the san francisco grantee for the federal health care for the homeless grant, and we have a mobile outreach van that works very closely with d.p.h. in serving homeless

people. you mentioned in your collaborations, i've been asked by my clinic directors to find out the practical way that mental health s.f. is going to serve our patients. in other words, patients that get their primary care outside of the d.p.h. system but need to link to the d.p.h. system if their mental health issue is beyond the capacity of primary care to care for it. we know that some of our contracts have contracts with behavioral health services but others don't, and there's been a lot of struggles in terms of really practically getting patients served in the community mental health system. it ranges from everybody having a mental health crisis being told to wait in intake for four hours to some of the transient

individuals that we serve -- transgender individuals that we serve could not be addressed by their preferred name. so we would love to have a meeting with you and we would love to hear how, in a practical way, how these linkages are going to be improved? thank you. >> thank you, miss long. as you know, in meetings, responders and commissioners cannot get back to you with questions that are asked during the public comment. however, everything is noted, and i'm hoping that everyone here from d.h.s. is noting that it would be great to have a meeting with all to reach out with you. but just as a rule, there is no back and forth on that, and that is all that we have on the public comment line. >> great. thank you, and thank you, secretary morewitz. we will take questions in the order that they came in, and commissioner christian, and

thank you for your patience. >> thank you, president bernal. first, i just want to take a moment to say hello to dr. kunnis, and i want to say i appreciate so much that you're here and the work that you're about to do. this is a general question that i've been having in my mind, you know, in the last couple of months, accept since we've been coming out of the pandemic and a different stage of it. how is d.p.h. being vigilant about monitoring and figuring out how to respond to problems and threats that are -- health wise that are developing in the community as a result of covid and the way that the pandemic has affected the community?

i'm thinking specifically tonight about an article that's recently been written and shared with the commission about post partum depression during covid, and how domestic violence has exploded during covid and people unable to communicate their needs. so family violence and not just between intimate partners but children who have been exposed to greater levels of violence as a result of all of the effects of the pandemic.

you wonder what resources the department is thinking that are secondary or tertiary to covid itself but are in dire need of being addressed, especially when we're talking about equity and discrepancies in the system of care that we have -- the medical system and care that we have? but, you know, thinking something about post partum depression and the grave

effects that it has on the new parent's that's given birth, but also on this brand-new person. and if we're talking, and as we speak about and as we're concerned about addressing problems -- health related problems at their roots before they get worse than they need to be and especially among the most vulnerable of the most vulnerable populations that we've had, the newborn children, i just wonder how the department and the medical community is thinking about being vigilant about these newer developments and how we're going to be addressing them, given that there is a wonderful expansion in mobile crisis units of several kinds. is there thought in the department about how

community's needs can become more mobile, so this may not be anything that you have a lot to say about right now, but it's really important to understand how we're looking at these secondary and tertiary effects of covid and how we're dealing with them so that they don't become greater crises in the community? >> so let me just say a big yes to all of what you just said. in any disaster, this pandemic being one, there were both physical and mental health consequences, and this has been described in the literature, the scientific literature from new york, for example, post world trade center, about there being the consequences from the

point of view about the things that you just named. i'll just add also increased substance use is another manifestation. i am aware of increased mental health strategies, part of what we do to cope with disasters is to normalize feelings and reactions, and actually, people to proficient.

>> commissioner green? >> thank you for that insightful response. i do share these concerns because so many of these problems go unspoken in the way that certain communities don't want to call 911, there's a whole plethora of people

suffering domestic violence, women and men, that don't report it. what you were saying about linking mental health facilities to clinics where patients feel comfortable and clients feel comfortable sharing their most intimate aspects of this. i guess that was one of the questions that i just had, and you touched a little bit on this in your presentation, but, you know, for a long time, the intensity [inaudible] and, you know, we were presented, when margaret simmons was here, with these statistics of, you know, the dearth of those individuals, and establishing poor relations and doing the best that we can do to meet the needs.

it seems that is a component of it, so i was wondering if you could comment a little bit on how we're planning to expand that or follow through with -- it's great that we had the street crisis team, but there's a whole longevity component of it that i wonder that we plan on staffing. >> commissioners, let me actually see if [inaudible] can maybe make some comments on her approach of hiring and -- or let me turn to, in a moment, angelica. i will say i think a part of what you were getting at is challenges with the workforce and identifying people that can come into the behavioral health

field. nationally, hiring experts in behavioral health can be difficult because there are a diminishing number of people trained, and we are at d.p.h. working on a pipeline. additionally, there are also strategies to have multidisciplinary team work. we are potential providers with good training and support of many educational levels to help extend and expand the workforce. i also know that -- and i'll now turn to angelica because i think some of the recruitment that she's been able to accomplish to standup and expand street crisis response has been great, along with the

whole team behind mer. >> thanks, dr. kunnis. i'll also say that it's exciting to be in july because many people graduated and we'll be able to bring many staff on board? first, through i.c.m. providers, we have an i.c.m. academy which helps support long-term staffing and developing those skills, so recruiting and keeping people. the other thing i'll say specifically to some of our hiring through behavioral health in terms of civil service positions is that we've been able to leverage processes that allows for us to do group hiring, and i think this provides us with a unique opportunity to streamline getting people on board which makes a huge impact but also to be able to work across the department when hiring managers to identify where a candidate is the best fit for a position, which i think we'll also see

overtime will help us with maintaining staff long-term with the department? and finally, i'll just add with scrt specifically, having peer included in our work, i think it gives us a unique opportunity to increase skills that individuals have and individuals that are interested in going back to school, so this is more that long-term pipeline that dr. kunnis has mentioning -- was mentioning, but how we train people that are not masters level or doctorate level individuals, to come to our field as clinical providers. >> i mean, thank you. it kind of expands to what happened with the covid command center, where individuals really rose to the occasion, having not necessarily completed cath treatment, had the responsibility, so if we

can replicate that in this area and really have everyone practicing at the top of their licenses, it seems like we can expand availability and access, which is obviously so critical. thank you very much. >> commissioner chung? >> yes, thank you, and i want to thank both of the presenters and welcome dr. kunnis again. it's very exciting to hear as we're bringing so much of mental health together and looks like we're actually moving forward with some programs that will actually coordinate programs. so when it was mentioned that you were doing a partnership with johnson [inaudible] on the street crisis response program, it prompted me to look at the client characteristics, and then, i looked at other

criteria and data, and it seems to me that we should be maybe consistent in measuring the populations, and i hate to say that asian and other shows up again. and i recognize these are currently small numbers, but they're going to get bigger, and all of it will be bigger. i also am concerned that the multiple category, obviously, there's a lot of intermarriages, interracial marriages, and one could really miss that. as the numbers become more larger and as you're looking at making more uniform, the categories, you might want to actually parse out the multiple because this really is becoming a challenge for everybody,

right, to understand what's happening with that crew. i guess one last thing that i might ask, especially about behavioral health, is that i think one element was in the demographics is not being captured, which is the nativity or indigenous status. we know there are gaps between those who are immigrant and those who have been here fourth generation, and those are in all of our categories, so i think that might be another useful demographic as you're trying to parse down, and really, as you're saying, you're trying to get to the people and understanding who you're trying to reach. reaching an immigrant is different than reaching the third generation, even though

they might be the same demographic. importantly, i think if we can get the demographics right, and that's been a problem for years here, and then, we now have our, you know, gender and sex information and so forth, i think it's also important to know how to try to get the immigrant status and to also get the different ethnicities and categories of people certainly and especially in mental health. certainly, it's important to know the background as we're going to try to be most effective with our clients. so thank you again, for the presentation, the outline that

you put the road that you're going to be traveling really sounds exciting, and i think we all look forward to continued updates. the street crisis team, you're already making a difference with nearly 1,000 people who didn't have to have an interaction with police department when it really wasn't necessary, so thank you. >> any other questions, commissioners? seeing none, thank you so much, dr. -- dr. kunnis and dr. almeida, for your presentations. we're grateful to see the progress that has been made and the plans laid out for the future and look forward to having another update from you -- more updates from you at

regular intervals for the commissions. and again, welcome board. >> thanks. >> all right. we will move onto our other business. commissioners, do we have any other business? seeing none -- [inaudible]. >> and the next item is joint conference and other committee reports, we will hear a brief summary of the june 22, zuckerberg san francisco general j.c.c. meeting from commissioner chow. >> thank you. i'll try to be brief. we were able to review the a-3

safety presentation and as you know, there's been quite a bit of information on that, and the news article regarding the proposal and what's happened at the board in terms of moving forward. then, the other, i thought, very exciting process that we had was that we brought together all the different scorecards, and in one meeting, we were able to look at the scorecards and were able to put this completely as a whole and to see the great work that the hospital was doing in terms of quality of care. last -- not lastly, but we also importantly heard the joint county commission review, and we overall scored very well.

there was only one item that required that the joint commission come back, and the joint conference will hear a detail of how they are responding to all of the items that appears to have been a very satisfactory survey. we also then went and heard the regulatories of their report, our c.e.o.s report, how well h.r. was doing, and continues to really hit the marks that it needs. and we also, then, in closed session, approved -- oh, i'm sorry. before closed session, we had approved the community rules and regulations and the

pediatric service list, and in closed session, we did approve the credentials list, and i'd be happy to answer any questions. >> commissioners, any questions for commissioner chow? all right. and no public comment, correct, secretary morewitz. >> there's no one on the line, so there's no public comment. >> thank you. the next item on our agenda is a closed session. do we have a motion to enter closed session? >> so moved. >> second. >> and a roll call vote. [roll call] >> thank you to all the folks who presented.

we're now coming into closed session. you can leave the meeting now. i'm going to take 30 seconds to move us over now. folks in the public, we will be back.

>> either disclose or not disclose what happened in closed session. >> motion to not disclose. >> second. >> motion to not disclose. roll call. [roll call]

>> all right. thank you. >> and our final item is considering a motion for adjournment. >> i so move to adjourn the meeting. >> second. >> second. >> all right. [roll call] >> all right. thanks. good to see, everybody. it's been 21 days since our last commission meeting, and it's good to see everyone and department staff. >> thank you, commissioners. >> thank you, director colfax. >> all right. >> good night, everybody.

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