Transcripts For SFGTV Government Access Programming 20240714

Of consumer one who receives Substance Use services, and to permit a consumer who is an employee in the health or public or private agency, and who does not have any influence or authority over any financial or contractual matter. Concern the employee or the employer to be appointed to the commission. Chairwoman thank you. And we have andy mullen here from supervisor stephanies office to present. Good morning. Thank you for holding this hearing today. Im andy mullen. Im here on behalf of supervisor stefani, who holds the board of supervisors seat on the Mental Health board, and she unfortunately couldnt be here today. And many of the members are here for public comment. The legislation before you today is fairly simple. It makes three proposed changes. Im going to sort of discuss them just in order of importance. The Mental Health board is a fairly unique body in that it has been around since 1956. And it puts a majority of its seats for consumers of Mental Health services or family members of consumers of Mental Health services. Which means it puts people directly in this system in the drivers seat. Because the Mental Health board has been around for so long, some of the language, i think and we would probably all agree is a little antiquated, its conception of what Mental Health is and the services is. The first thing it does is expand the definition of consumer, which are a majority of the members, either directing or through their family members, to in clues include substances abuse treatment services. It also esplanade expands the eligibility of consumers to hold seats. Previously there was pro bingprohibition of ployment. Employment. The consumers are now waived. They could just have to excuse themselves if they had a financial conflict before them. Thirdly, it proposes renaming the Mental Health board to the Behavioral Health commission. That comes because the word Behavioral Health as you all know is an umbrella term that includes Mental Health and Substance Abuse issues. Our conception of this has changed a lot since 1956, before all of us were born. This is now meant to be more inclusive of the work that they do, which is interface with the department of behavioral Health Services under d. P. H. , and report out and advice those departments and those employees on these matters. With that, these changes come to you directly from the members themselves. And many of them are here to speak about the personal importance of these changes to this organization. And im happy to answer any questions. Chairwoman i had a question about and this is for you or any of the members of the Mental Health board, where the term consumer comes from. It brings up the idea of someone who is buying something. And im just wondering why patient or individual isnt used as opposed to consumer. That is such a good question. I have no idea what the answer is. Chairwoman i was figuring some members of the Mental Health board might be able to answer that. Do you want to answer that . Thank you. Hi, im helena brooks, staff to the Mental Health board. Im trying to remember when consumer came in. It probably has been eight or nine years. It came from clients requesting that. What could say it is consuming Mental Health services and Substance Abuse services, but it was clients not wanting to be referred to as clients or patients, was my memory. Chairwoman i appreciate that. I just always it just never made sense to me, so i was curious about that. Thank you so much. Are there any questions . No. Well open up this item for public comment. Any member of the public who would like to speak . And thank you so much to the members of the Mental Health board for being here today and for serving on this body and for all of the advocacy you do on behalf of this community. It is so appreciated. Good morning. Good morning. Thank you. Im john sanders. I cochair the board, and i hold a consumer seat. And just to give, i gues guess i guess to underline one of the reasons were requesting the change is historically there has been a divide between Mental Health and Substance Abuse disorder services, leaving consumers basically leaving consumers no choice but to choose between cooccurring disorders. If they go for treatment for one, theyre often excluded from one or more programs based on having Substance Abuse for one or Mental Health issues for the other. Again, with Behavioral Health being more inclusive in addressing both, Mental Health and Substance Abuse disorders, the name change would align us not only with other california counties that have transitioned in this manner, but it also helps us when were with programs that are seeking funding. Oftentimes there is that same divide between Mental Health and Substance Use. And when we have these integratitintegrative services,t pushes them to gain funding for those sources. [buzzer] chairwoman thank you so much. Good morning, chairwoman ron nan and members of the committees. My name is terry bora, and i have been on theMental Health board for fouryear. The change has been gradual, i would say, over the last three years. There are now 11 commissions that are called Behavioral Health, and there are 32 boards that have used the name Mental Health Substance Abuse. I think that this gives the public more reason to contact our board if there are certain situations that they would like us to look into. It also expands the facilities that we can monitor. Which i think is a good thing. The public needs to know that our board, our new commission, is there to serve them. So i think this is a good thing. I know in the scheme of everything that youre looking at, it is not addressing homelessness, it is not addressing tenants. But even shakespeare said, whats in a name . So this is an important change for us. Thank you. Good morning. My name is richelle slota, and i serve on the Mental Health board. Sandra fewer appointed me. I am in favor of this change because it improves clarity and consistency for our message. And thats the heat of it. Heart of it. It is not a huge thing. It is a little thing, but it is an important thing. Thank you very much. Chair ronan, supervisors, my name is greg betor, and im, too, a member of the health board. As ive been on the board, i have noticed a fine line between Mental Health and Mental Health Behavioral Health and then Substance Abuse. Theyve all been put under the same umbrella, and i feel that as we move on and progress, the term behavior would probably encompass, one, similar things that were working with, and i think my colleague just said, we dont do much housing or the things you guys are dealing with, but i feel that the change in name would give us a little more flexibility in the things that we do. Thank you for your consideration. Chairwoman thank you so much. The next speaker. Thank you, and good afternoon. My name is iddelle wilson, and im a native of San Francisco. I love our resourceful city, it is the most city in this world. We have the best services you can possibly get. You cannot get anywhere else. Renaming our board from a board to a can commission is very important because somehow when it is a commission, it seems a little more important. Im not saying that boards arent important. Please, dont nobody go back and say i said boards arent important. But when youre a commission, people are oh, youre a commissioner, oh, how are you . No, im just kidding. It would be very important. Im in support of everything my colleagues had to say. Im not going to repeat it. Im in support and behind all of them. Thank you so much. Chairwoman is there any other member of the public that would like to speak . Would you like to speak again, soon to be commissioner . Alana . Do you want to say anything else. That didnt take up your time, sorry. Im not a commissioner. Im just staff to the board. Chairwoman oh, okay. I want to make clarity on two of the items, the one about consumers who are employed by the department being on the board. That is actually a state regulation that was not in the original administrative code because it came bou about about two years ago. And the third item about our role with the Mental Health services act was also added by the state. So, any other questions . Chairwoman thats all. Thank you so much. Is there any other member of the public that would like to speak . I was just wondering if any of the consumer groups might qualify, kind of, as lobbyists if theyre selling any kind of material, like needles or what have you to any of the programs, and then theyre sitting on the i dont know, in effect, who is on the commission, but i mean speaking in generalities. Using one example that i can or one item that comes to mind. I was just wondering, lobbyists sitting on the board as consumers. Chairwoman thank you. Seeing no other members of the public who would like to speak, Public Comments is closed. I just wanted to really give a shoutout and a thank you to the members of the Mental Health board, soon to be the Behavioral Health commission, it would appear. As many of you know, ive been working very closely on these issues and on a proposal with supervisor matt haney. We were going to come and speak to you about it at your last meeting, which was unexpectantly cancelled, so ill really looking forward to the opportunity to speak with you all. I will say that Mental Health assess also recognizes the integration of a Substance Abuse illness and Mental Health illnesses as being very similar and oftentimes people have two dual diagnosis. Most providers say it is a rare day when they see someone with just a Substance Abuse illness or just a mental illness, and not a coincurring diagnosis. So this makes a lot of sense to be changing that name. I also have to say that im very excited that you will now have an official role in oversight of our Substance Use programs in San Francisco. You know, most of those are run through health 360, which i think is an incredible organization, but i do believe they need some oversight in terms of both the switch to drug, medical, in terms of Funding Sources for their services, and the number of vacant beds there are in the facility every night. We know there certainly is not a lack of need for those beds in our city. But somehow, whether it is procedures within the organization to get into those beds, or the type of programs that are being offered, there is a mismatch in terms of what is going on there. Because the fact that there has been as many as 70 beds vacant in a night is up to the level of an outrage given what we all see, the suffering we see in the streets every day in San Francisco. So the fact that this board will be soon to be commissioned, and will be overseeing and forgetting out what is going wrong there, and how can the city intervene to make sure that is not the case is a relief to me. I wanted to thank you all for your extraordinary work. I cant wait to meet with you all and talk about Mental Health assess, and how were really going to be hopefully very shortly a model for the nation on how to achieve genuine Mental Health parity in the city. Perhaps we can finally do that in San Francisco and then sprayed it to the state and the rest of the country. There is a lot of work and advancement happening in this field. I certainly hope that San Francisco will be on the forefront of moving that forward and i very much look forward to working with all of you. Thank you for bringing this forward, supervisors stefani and mandelman, and thank you to the commissioners for doing all of your extraordinary work. I look forward to getting to know you much better shortly. With that, is there a motion . Supervisor mar . I just wanted to echo your deep thanks and appreciation for the Board Members and soon to be commissioners on such an important body here in the city. And thank you for all of your work and leadership on these critically important issues that connect to so many other important and challenging sessions that we are dealing with as a city. I would like to make a motion that we move this forward to the board. Chairwoman without objection, i move it. Mr. Clerk, are there any other items . That concludes the meeting today. Chairwoman thank you so much. The meeting is adjourned. [meeting adjourned at 1 11 mayor breed thank you all so much for joining us at ward 86 at San Francisco general. Sorry to keep you all waiting, but there are always so many exciting things happening in San Francisco. Today we are really here for an important milestone, the release of our annual numbers of new hiv h. I. V. Infections. While it is still challenging in terms of talking about some of the issues that so many people in our community face, we know that the work thats being done by so many amazing people right here in ward 86 in San Francisco general and other incredible organizations which ill mention shortly will truly help us to reach what we know is a goal that we all have, and that is getting to zero h. I. V. Infections in San Francisco. I am just really delighted that we in San Francisco, since the 1980s, have been at the forefront of pushing for innovative ways to change policies, new sciences and technologies to help us get to this milestone that we are so excited about today. We are showing progress, real progress, in fact. In 2018 for the first time ever, not only have we dropped diagnosis by 13 , but we have finally seen this number go below 200 for the first time ever. That is significant. [ applause ]. Mayor breed its progress that we should all be so proud of. This shows that when we Work Together with the community, with our policy makers, with our Public Health experts, our nonprofits, we can truly make a difference and save peoples lives. Im particularly proud of the department of Public Health. They continue to show their commitment to innovative and groundbreaking health solutions. I also want to thank ucsf and getting the goal coalition and all of those with us who continue to show their commitment to addressing this issue as well. Even though weve reached this incredible milestone here in our city, we know that there are still disparities that exist, specifically by race and ethnicity, by age, by gender, and, sadly, by housing status. These disparities highlight the work we have to do to continue to get to zero and really trying to remove the barriers, the stigma, the discrimination, so that we can truly end new infections, which is our ultimate goal. In fact, in 2018, africanamerican men had the highest diagnosis rate. Africanamerican women also had the highest diagnosis rate. Fighting this should be our focus and we are taking steps to do so. This week the department of Public Health will launch a competitive bid process where we will allocate 8 million in additional funding to Community Organizations primarily serving the africanamerican, latino, transgender and substanceuser communities in order to strengthen the work that we are already doing. [ applause ]. Mayor breed we have programs right here at ward 86 that others will talk about to really continue to help those that, sadly, we know are homeless. Just last week, we announced our new initiative to help those suffering from Mental Health and addiction who are homeless on the streets. This initiative, our heal our city initiative, will help us to serve, treat, and house those living with h. I. V. And help prevent new h. I. V. Infections. Again, i want to thank everyone here today who is doing work, including dr. Graham cofax who has been an advocate and working in this field for so many years, your incredible leader of the department of Public Health. I want to thank the positive Resource Center for their work. The San Francisco aids foundation which had an incredible event and continues to raise money to invest in this effort. The transgender law center. Aids legal referral panel. The lgbt center. All of the leaders of the getting to zero coalition. Your work is truly appreciated and the value of what you do makes a real impact, as we can see by the numbers that were presenting here today. It is something that we should be proud of. And yes, the work and the investments will continue to be made. This is a milestone for our city. I want to thank each and every one of you for your work and advocacy to get us to this point. With that i want to take this opportunity to introduce a champion in this effort. This and so many other issues that we need to address in San Francisco around Mental Health reform and others, supervisor Rafael Mandalman has been an incredible force in addressing this issue as well. The supervisor for ward 8, supervisor mandalman. Thank you, mayor breed. Thank you for your tremendous leadership on this and so many other issues. As i walked in today, i had a couple of thoughts. One is every time i walk into ward 86 i get a little bit ver clempt because of the amazing work that has been done here for decades and then the amazing work that continues to be done to chart a new path to actually get us to zero. I am such a fan of dr. Gandi and of all the folks who gave me a tour early this year or last year, i dont remember when it was. This is an extraordinary place. Walking in here and seeing this collection of the citys Public Health talent, i am just we are very, very lucky. [ applause ]. Yeah, they deserve some plaza for the work they do each and every day to keep this city healthy and make it healthier. This report has fantastic news. Dropping under 200 reminds me a little bit of 20 years ago, 21 years ago at this point. I am old enough, as some of you are as well, to remember when the bay area reporter had its first no abyss issue. Now we are trying to get to the next step of no deaths and no new infections. To the folks who conceived that several years ago and have been pushing for that goal, i want to extend profound thanks and congratulation on the success that weve made. Some of the data i mean, my aide got me some of the amazing statistics. Overall in the city, 94 of the People Living with h. I. V. Are aware of their infection. That is an extraordinary number. That is not true in the rest of the country. You know, there were no children under the age of 13 were diagnosed with h. I. V. Since 2005. Babies are not being born with h. I. V. In this city. That is an extraordinary accomplishment. We are getting people tested. We are getting folks into treatment. That is how we got closer and closer and closer to zero. That leaves the bad news in the report that were going to hear more about, which is the persistent challenges and, in fact, the increasing rates of infection among africanamerican, latin max, folks on the street, folks struggling with Substance Use disorder, and Mental Health issues. I want to thank dr. Cofax and mayor breed for the creative thinking they have brought to that issue. We know we will not get to zero until we get a handle on really getting care to the folks on the streets who are living with so many challenges, who you see every day in ward 86. I think what the mayor has recognized thank you, madam mayor for recognizing it it is going to require crossdepartmental collaboration, nonprofit government, private actors all working together to really solve these challenges. Everybody can do their part. Here at ward 86 youve come up with a popup, Innovative Program to give folks the care they need. They dont have to make the appointments. They come in and youll wrap around them and give them everything you can in each of those encounters you can. Monica gandi moved out of this ward, so im not happy about that. Im happy youre still in San Francisco. All of you who have gotten us to this milestone and going to get us to zero, thank you so much. [ applause ]. Mayor breed thank you, supervisor mandalman. Now to talk a little bit about the report is the director of the department of Public Health, dr. Grant cofax. Thank you all, today. Its great to be back in ward 86. I worked here for over a decade and im looking forward to returning to the clinic to be a clinician as well. I experienced, as with many of you, the grief and the sadness and advances that weve made with h. I. V. I started as a medical student and weve seen the progression that weve made and the progress thats been accomplished. Whether youre a community provider, a clinician, a researcher, a member of the press, i think the legacy teaches us that it takes a collective vision, a collective effort. Prioritysetting, and understanding what are the priorities in the system to help us do better. Thats the San Francisco h. I. V. Model. Thats our homegrown model that got us here today with h. I. V. It will get us to zero. Getting to zero has the departments full support going forward. I think as importantly is the San Francisco model for what we do with h. I. V. Will also be the model for how we address what may seem like intractable Health Problems today. Think about where we were 20, 25 years ago. Think of where we started. Who would have thought were getting below 200 . We still have much more work to do. We must be bold. We must be innovative, both and h. I. V. And with Mental Health and with Substance Use and with addressing the intersection between health and homeless. Speaking of both vision and innovation and getting us to where we need to be, one of the key people in this city whos doing groundbreaking research, dr. Hyman scott of the Public Health department. Dr. Scott. [ applause ]. Thank you, grant. Thank you for inviting me to say a few words about some of the work that were doing, and the focus on really addressing disparities in our epidemic in San Francisco. Im a clinician here at ward 86. I came to San Francisco because this was the model of how you take care of people as they come. I think our focus on disparity has to focus on ensuring that we reach people where they are and that there are no hardtoreach populations. There are just hardtodeliver services and we need to rethink the way that we approach some of those services. I think popup is a great example of that. Some of the other street medicine and other opportunities to expand prep and treatment outside of the four walls clinics. Although my focus has been on prep and weve seen overall increases in prep use and continuation in San Francisco, we have seen lower rates uptake among black m. S. N. , for example, 10 in other race and ethnicities. In 2017, that was the case. In 2018, it does look like that gap is closing. Weve also looked at some of our data across our primary care clinics. It does appear when people start prep, they dont always stay on prep. The average duration on prep is eight months, despite continuing risk for h. I. V. Acquisition. We take care of individuals after they have been on prep and stop prep. Some of the barriers people have are related to access, costs, insurance changes, perceptions of risk, and discrimination. I think we really want to support people as they initiate prep in their communities, with their providers, to ensure that people who want to access prep can stay on prep. We also have a focus in ensuring that the systems in which people receive care particularly for prep and treatment are affirming places and that we address the structural issues, including Structural Racism that a lot of our san franciscans are experiencing in the health systems. So were really excited about the opportunities of these new efforts to really address these social determinants of health which are driving many of these disparities and preventing us from closing those gaps. I think if any city and jurisdiction in the country can do it, we can do it here in San Francisco. Thank you. [ applause ]. So thank you, dr. Scott. I just want to emphasize the focus on health equity. We must make sure we drive down the inequities that were seeing in San Francisco. Its been a privilege to serve under mayor breed and this is a priority of the Department Going forward. I also know we cant do this alone. The Health Department is a key piece of this work, but it also takes partnership. One of the great things of San Francisco is the partnership weve had historically with ucsf. Its my great honor to introduce a leader, an internationally known leader in h. I. V. Research. She really brought the model that was being used internationally and successfully. I was able to be part of those early conversations about whats going on locally and how do we turn the tide locally . What do we need to do . I think that key commitment of ucsf and the key commitment of professor Diane Havlier in her team, making sure were looking locally, she has been an amazing advocate. A key supporter of getting to zero. Shes going to talk a bit about her vision today. Thank you. Diane havlier. Its an honor to be here today. Im going to be talking on behalf of getting to zero. What is that . That is bringing people together from different sectors and communities with a common goal of ending the aids epidemic. It is built on the spirit of San Francisco because it requires collaboration, volunteerism, and action. So the report that came out just a few minutes ago is our report card. It is how are we doing in getting to zero with our goal to end the aids epidemic in our city. One of the logical questions is, what is the getting to zero contortiums response to the report . Many of the members of the Steering Committee here, we want to share with you our reaction to the report. We are pleased, but not satisfied. We are pleased because we broke the 200 barrier. Just to say that in San Francisco over the last five years, new h. I. V. Diagnoses have gone down over 50 . I dont know if you know this but in the United States it has become completely flat. We are pleased because people are starting treatment earlier. Many of them on the same day with a program that was pioneered in our ward 86. A couple of years ago this was simply unheard of. We are pleased because people from all around our country, all around the worldcom come to San Francisco and to this ward to find out what were doing and how we get results. What starts in San Francisco doesnt stay in San Francisco. We are not satisfied. Im just going to go back to the 200. Were not satisfied because we nearly had nearly 200 diagnoses of h. I. V. In our city, and its a preventable disease. Were not satisfied because of his disparities. Youve heard africanamerican h. I. V. Infected male, his mortality is more than half that of his counterpart. We have many disparities. Getting to zero, were making the strategy. What are we going to do about it . So lets start with we have a double down on these gaps that were seeing. What we need to do that is we just need to listen. Thats one of the things in getting to zero, we convene people together, put the problems out there, have multisector discussions how are we going to work on this. We need to listen. We need to deploy new innovative approaches with tools that we have like prep. And longacting injectable therapy that could make it easier for some of our populations. And finally, the biggest challenge we are going to partner with the Mayors Office and all areas of San Francisco with the structural barriers to care. We know what those are, inadequate, gaps in housing, Mental Health services, and for Substance Abuse. Thats what were going to do. Ive been working in h. I. V. I came here in 1984 committed to the aids epidemic for decades. It is a conniving and very successful virus. I know that we can reach our goals. I just want to put forward for us who have been working in h. I. V. For decades, these are the questions of our time. Should we invest to end the aids epidemic . Can we end the aids epidemic . Will we end the aids epidemic . On behalf of getting to zero, our answers are yes, yes, and yes. We think we can do that because were San Francisco. Just look around here because were in it together. So thats what i wanted to share with you on behalf of getting to zero. So now id like to turn the podium over to colleague dr. Monica gandi who is the director of ward 86 and one of the huge structural barriers that were addressing is the Homeless Population and monica is going to talk about popup. [ applause ]. Its really an honor to be here. Just to tell you a little bit about the history where youre standing right now. We opened ward 86 in january of 1983. So this is the oldest h. I. V. Clinic in the country. Then across the street simultaneously opened an inpatient ward 5 b and 5 a. And many innovations in h. I. V. Care have come from this clinic. So a lot of the investigational therapies in the 1980s and 1990s were tested here starting way earlier than the rest of the country and the world. A rapid program, as diane mentioned, and a prep program. We know that many elements that are key to success for People Living with h. I. V. Are challenging if you dont have a place to live. That would be making and keeping appointments, particular set of appointment times, where do you store your medications and keep them safe, that theyre not stolen, safe sex, healthy eating. All of these barriers are amplified 100fold if you dont have a home. In addition to all these treatments we have here, we started the popup program and that was in january of this year. Im going to tell you about the popup program, but mention one statistic from this report that was released a couple of minutes ago thats so relevant to the popup program. Among people who are homeless living with h. I. V. In this city, the goal of therapy is 34 and among those who have homes is 74 . That is tremendous in terms of virulogic suppression. We aim to reduce that discrepancy in virulogic suppression rate. People who are living with h. I. V. And homeless are 27 times more likely to die than those who have homes. What does popup do . The people who were coming here were not just coming for the appointments, but for urgent care and to get food or to be warm for a minute or to come in for a minute. The idea was to have a popup clinic form around this clinic. Its like a popup restaurant where it is care that is designed especially for them. The popup clinic is composed of two or three designated m. D. Providers, a doctor, social worker, nurse, and nurse manager. It is a Certain Group of people who pop up around the patient, provide primary care, vaccinations, provider vouchers, food, warm clothing, hygiene kits. All of that is done in the context of no appointments. It doesnt make sense to have a tuesday, 3 00 p. M. Appointment, when youre living in an encampment. They can come any time of the day. If theyre a member of the popup clinic, our group forms around them and does this tenderloving care. It has been successful so far, and i hope to tell you about that in a later forum. There is no way that reaching this last 10 and these last 197 people and reaching the group that we need to reach isnt going to be resource intensive. It is resource intensive. But its worth the resources to bring all the innovation and care to this last group of people who need it. We hope its going to be effective and well tell you more about it later and thank you for supporting popup in ward 86. Mayor breed again, thank you to all the incredible nonprofit workers, organizations, and the folks right here at ward 86 in general for your hard work and commitment to get us to this point. Really proud of the work that you have done and also appreciative of the fact that you recognize that we need to be more deliberate in how we target specific groups that are disproportionately represented in these new numbers. We still clearly have work to do, but i do want to celebrate and appreciate the milestone set here today, because the fact is we got to a place that was not someplace that anyone ever thought was possible. Just like getting to zero, people were thinking, is that really possible . It is possible because of the work and the investment and what were planning to do right here in San Francisco. I cant think of better city to lead the way in this effort, and im positive that we will get to zero. Thank you all so much for joining us here today. [ applause ]. We just started in january. So at this point there is about 65 patients in the program, and we need to reach about 180 to 200 in our own clinic, let alone anyone who is homeless living with h. I. V. That we would like to reach with popup. Still a ways to go. Were doing this on a shoestring budget. [ indiscernible ] they did not change at all essentially. Last year was 33 and 70. We havent made that dent yet, yeah. Thank you. I meant to say that. So we had this goal of 90 reduction in five years, around 2020. So when we started, somewhere around 300. We have to get to 30. So we are the climb is going in the right direction, but in order for us to continue, were going to have to address what everybody talked about today. I want to emphasize, in the United States it really is shocking that the curve is flat. Okay. Thats because there hasnt been the investments and the innovation that weve been making here. [ indiscernible ] we will try. [ laughter ] [ applause ]. [ indiscernible ] so i think that you have heard during this press Conference Many of the themes from all the speakers, okay. So we have to be able to deliver care in a way that addresses the cultural the disparity that we have in population. Thats number one. That intersects with three things that i know the whole city is working on. Housing shortages, Mental Health services, and Substance Abuse services. I probably think wed all probably agree those are the main things we need to do going forward. [ indiscernible ] thank you for that comment. I just want to emphasize that the San Francisco department of Public Health shares the concern about providing traumainformed care. Thats been a commitment for a number of years. We strongly believe that you cant fully address someones h. I. V. , Substance Abuse, Mental Health issues, or in some cases their life on the street to get them into shelter or Navigation Center or housing without bringing a traumainformed approach to care. Thats a key part of what the department has been working on. Weve actually trained over 8,000 people in the departments and some Community Providers in traumainformed care. I also want to link the broader question of how do we approach the disparities in h. I. V. Infections. If you look at the Mental Health, Substance Abuse, the housing inebbingiquities, this about the system. If you look at the focus on the 4,000 and the same principles and issues around inequities, the same focus on data and driving down the numbers, it takes hard work. Sometimes we think, oh, there should be some fancy fix overnight and we should be able to reach into the sky and bring something. This is a 30year path for h. I. V. If we focus on the populations that matter the most. Invest in those resources, follow the data, and bring collective effort forward, we will be further ahead. We will be closer to zero, but also making progress in those tracks. Thank you. [ applause ] [ ] [ ] homelessness in San Francisco is considered the number 1 issue by most people who live here, and it doesnt just affect Neighbors Without a home, it affects all of us. Is real way to combat that is to Work Together. It will take city departments and nonprofit providers and volunteers and companies and Community Members all coming together. [ ] the product homeless connect Community Day of Service Began about 15 years ago, and we have had 73 of them. What we do is we host and expostyle event, and we were the very force organization to do this but it worked so well that 250 other cities across the globe host their own. Theres over 120 Service Providers at the event today, and they range anywhere from hygiene kits provided by the basics, 5 to prescription glasses and reading glasses, hearing tests, pet sitting, showers, medical services, flu shots, dental care, groceries, so many phenomenal Service Providers, and what makes it so unique is we ask that they provide that Service Today here it is an actual, tangible Service People can leave with it. I am with the hearing and Speech Center of northern california, and we provide a variety of Services Including audiology, counselling, outreach, education, today we actually just do screening to see if someone has hearing loss. To follow updates when they come into the Speech Center and we do a full diagnostic hearing test, and we start the process of taking an impression of their year, deciding on which hearing aid will work best for them. If they have a smart phone, we make sure we get a smart phone that can connect to it, so they can stream phone calls, or use it for any other services that they need. San francisco has phenomenal social services to support people at risk of becoming homeless, are already experience and homelessness, but it is confusing, and there is a lot of waste. Bringing everyone into the same space not only saves an average of 20 hours a week in navigating the system and waiting in line for different areas, it helps them talk, so if you need to sign up for medical, what you need identification, you dont have to go to sacramento or wait in line at a d. M. V. , you go across the hall to the d. M. V. To get your i. D. Today we will probably see around 30 people, and averaging about 20 of this people coming to cs for followup service. For a participant to qualify for services, all they need to do is come to the event. We have a lot of people who are at risk of homelessness but not yet experiencing it, that todays event can ensure they stay house. Many people coming to the event are here to receive one specific need such as signing up for medical or learning about d. M. V. Services, and then of course, most of the people who are tender people experiencing homelessness today. I am the representative for the volunteer central. We are the group that checks and all the volunteers that comment participate each day. On a typical day of service, we have anywhere between 40500 volunteers that we, back in, they get tshirts, nametags, maps, and all the information they need to have a successful event. Our participant escorts are a core part of our group, and they are the ones who help participants flow from the Different Service areas and help them find the Different Services that they needs. One of the ways we work closely with the department of homelessness and Supportive Housing is by working with Homeless Outreach teams. They come here, and these are the people that help you get into Navigation Centers, help you get into shortterm shelter, and talk about housing1st policies. We also work very closely with the department of Public Health to provide a lot of our services. We have all types of things that volunteers deal do on a day of service. We have folks that help give out lunches in the cafe, we have folks who help with the check in, getting people when they arrive, making sure that they find the services that they need to, we have folks who help in the check out process, to make sure they get their food bag, bag of groceries, together hygiene kit, and whatever they need to. Volunteers, i think of them as the secret sauce that just makes the whole process works smoothly. Participants are encouraged and welcomed to come with their pets. We do have a pet daycare, so if they want to have their pets stay in the daycare area while they navigate the event, they are welcome to do that, will we also understand some people are more comfortable having their pets with them. They can bring them into the event as well. We also typically offer veterinary services, and it can be a real detriment to coming into an event like this. We also have a bag check. You dont have to worry about your belongings getting lost, especially when that is all that you have with you. We get connected with people who knew they had hearing loss, but they didnt know they could get services to help them with their hearing loss picks and we are getting connected with each other to make sure they are getting supported. Our next event will be in march, we dont yet have a date set. We typically sap set it six weeks out. The way to volunteer is to follow our newsletter, follow us on social media, or just visit our website. We always announce it right away, and you can register very easily online. A lot of people see folks experience a homelessness in the city, and they dont know how they can help, and defence like this gives a whole bunch of people a lot of good opportunities to give back and be supported. [ ] shop and dine in the 49 promotes local businesses, and challenges residents to do their shopping within the 49 square miles of San Francisco. By supporting local services in our neighborhood, we help San Francisco remain unique, successful, and vibrant. So where will you shop and dine in the 49 . I am the owner of this restaurant. We have been here in north beach over 100 years. [speaking foreign language] [ ] [speaking foreign language] [ ] [speaking foreign language] [speaking foreign language] [ ] [ ] i moved into my wonderful, beautiful, Affordable Housing march 7th. I have lived in San Francisco since i was twoyearsold. Ive lived in hunters view for 23 to 24 years now. My name is vlady. I use titus and i am the resident commissioner for the San Francisco housing facility. From the very beginning, this whole transition of Public Housing and Affordable Housing was a good idea. But many, many residents didnt think it would ever actually happen. Its been a life changing experience. And im truly grateful for the whole initiative and all those that work on the whole sf initiative. Theyve done a wonderful job accommodating the residents, who for many years have lived in delap tated housing. Now they have quality housing. I was on a street where the living room and the kitchen and stairs. It wasnt large enough to accommodate. The children are grown. I had the accomplish of having a dishwasher in my home. I really like that. [laughter] i really like not having to wash dishes by hand. We still do it from time to time. The Mayors Office has been a real friend to us, a partner. We know that our city supports us. I love San Francisco. Just to be able to stay in my community and continue to help the residents who live here and continue to see my neighborhoods move into new housing, its been a real joy. Today in the omi in district 7 [cheers and applause] they say it takes Broad Strokes to make something truly incredible, people to enjoy and thats the message we have here today. Theres no better person to articulate the vision for advancing Economic Opportunity and equity in our city than our next speaker that is joining all of us and leading these efforts with us today and that is our mayor, london reed. Hello, lakeview hello