Transcripts For SFGTV Government Access Programming 20240713

That plan the city of San Francisco its own cultural competency training. The population in San Francisco is different from much of california. A cultural training would not be adequate to help provide the Compassionate Care necessary for the population of San Francisco. Second part of comment is related to what came up earlier. I work at a Retail Pharmacy nothing breaks my heart more when they come in to pick up the medication and they dont have the insurance papers. It takes days. They are homeless and they have to leave the pharmacy after 14 hours and dont get medication. They might be without de beat esmedcase and we cant find them to get the updated information. If we find the insurance we cant provide them what they needed. It is almost like the efforts of the Healthcare Providers are almost gone to waste because they dont get the therapy that they need. Than thank you. I am jennifer. I have multiple comments. Regarding cultural competency, i heard statements about linguistic competency. In recent bargaining dph changed the way that they compensate staff when they offer services to clients in the native language. Staff are discouraged from speaking in the native tongues because they are not compensated for it. Staff are told do not speak the Foreign Language unless you are certified that is appalling. Regarding icm. I have to say thank you for talking with staff. When the criteria for step down was developed, it was not developed with any input from staff. If we change the way we do things to expect it to work we should not rely on consultants or those of the administrators we need to talk to those doing the work and touching our clients on a daytoday basis. There was a moment where we mentioned stabilize, adults who do not stabilize. This brings me to the arts. The clients who are users of services in a high way need more care for a long time. This is a severe illness. When beds at the arf are closed we are not able to stabilize people to maintain the stagization. Stabilization. We negotiated with the mayor and came to an agreement about if arf. There are 23 beds vacant and 54 beds lost right now. People are evicted from the man or, from the aurora home and from 54 are evicted, homes are closing with 23 vacant beds and are not allowed to move people. I do know why that is. These people need a home. Thank you. The thing that strikes me as essential pieces to puzzle with 4,000 people is the intensive Case Management. Basically doctor sung said they did not increase capacity for intensive Case Management. Thing whiteled down the waiting list and some could go to other places but they had to increase the caseloads. Doctor bland tells me 4,000 people, 90 dont have intensive Case Management. There is a critical absence of staff. I heard a lot of acronyms and aspirational starts but i didnt hear about when these 4,000 people are going to get taken care of. It sounds like at the rate we are going they are not going to get taken care of unless you get more staff and you really do it. It is very discouraging. Thank you. I have deanna law. I am deanna long i work for the San Francisco Community Clinic Nonprofit Community Health Centers throughout San Francisco. We specialize in providing culturally competent care in different neighborhoods. I just want to call out two things. That doctor bland and could fax mentioned that i was happy to hear. One is emphasis on the Behavioral Health work force. You there are those with an emergency medical bill. Ab1611 would protect these patients against the emergency surprise bill. Thank you. That is all the speakers i have. Is there anyone else who would like to speak on these two items . If not it is in the hands of the commission. If you have a question or comment please identify the presenter to address that comment or question to. I think i dont actually have a question at this point because i think that the initial presentation on the challenges facing our Behavioral Health services was extremely comprehensive. I thank the doctor for taking on the role of the acting director to move forward with as much progress as you have been able to do. I think that the key thing she has laid out and doctor bland identified was not so much the identification of the problems because those now have been very well elicited and certainly the doctor has helped summarize the issues that we are facing especially as you look at the homeless. I think the doctor has broadened that to say and the rest of our population needs a certain amount of support and health. We have heard the issue of cultural competent, the need clearly of language capability, the challenge of being able to actually meet the client. I dont think to say we are not going to say that. Any door wherever would come in and now we are also looking at how we can outreach and try to meet them where they are. I understand that we may go outside the doors to be able to bring them in at whatever location you are with your diagram, for example, but we need the outreach. This has been a very good discussion about how we are facing behavior health. I think the doctor for the next four or five years is saying that we may be looking at a change of even the entire process of both mental and physical health if the States Program about medicaid is actually carried out. Going through a number of hoops yet, but she is warning us again and that fits fairly well with the rest of our presentations this afternoon in terms of all of the possible changes and even the Planning Commission issues of what to do about facilities. I think that only shows the dynamic process that healthcare is undergoing. What i i see is one of the Biggest Challenges to try to answer these needs is really what is it that we are going to be able to have as a work force and it goes back to i think our Health Network was talking about. The real challenge right now is we are going to have all of these ideas, some of which are going to need immediate implementation to help the homeless, to help those who actually also have other Mental Health programs that are not homeless but need the same help because some of them are also on the streets. They are not getting the care they need. How many are not going to be able to be from the Homeless Population in the intensive care they need. Where do we get that . We heard from the Community Consortium they have trouble and we have heard that, i think that is really one of the Biggest Challenges. I understand with the new director of Human Resources we need to identify people or we cant put them in a system and we have to accelerate how we work with identified personnel, potential personnel because they will go elsewhere. The identification of personnel and keeping them going is almost as critical as looking at opening the new hospital or as we were looking at the personnel for management of the epic program. I see that as a lesson that i have gotten today that is a real challenge and how our director is going to be able to work with the different well what opportunities they are going to have. I could ask the director what he view views as a way to move on this and what we might look for in terms of implementing what are very nicely developed and certainly well thought out ideas. I am sorry are you specifically asking about the work force . Yes, we cant identify personnel to carry out the programs that we are working on, we are not really going to move the needle. This is something that is for Michael Brown in the back now, our new hr director i talked with nim within his first hour of starting laying out a plan to focus and recruit on these positions. Going back to your comments, we have a proof of concept with regard to hospital skill. It takes considerable resources to do that, right. If you look at what mayor breed has talked about as increased investments in the work and we need to talk across the different stakeholders including unions and Civil Service to provide incentives for people to come and stay in the work. We have been looking at things to have more opportunity for people to stay, other incentive programs as well. We also need to create a culture of excitement with h. I. V. Having reengaged in the h. I. V. Clinic there. There are people that worked there for years. I think they could get compensated better in other places. They are Mission Driven and inspired. I think many of our Behavioral Health team are committed to that. We need to expand that perspective in our culture that people can be shown to make a difference in that way. It is a combination of focus, data, priorities and making sure that this is a priority and people are supported in moving that forward. I would repeat that. Also, shifting the culture with regard to where we call a difference when we do epic. Many in the room were major contributors. It was a heavy lift, but we did that lift when we addressed the h. I. V. Epidemic, we found a way to do that. Key is those were not issues just one part of the department, right . That was not the only job of a director within the units or section. That was a Department Priority and resources were brought forward to do that to make a difference. This problem didnt happen overnight and we are not going to solve it overnight. As you saw with the Behavioral Health network we are making structural changes to have a road map to go forward starting now and into the near future. One final comment with jeff. In regard to the work force. It is very important that work force be able to not just have the knowledge and the credentials. This is where i think unless we do that we dont reach equity. We cant answer the disparities. Whether it be because of a cultural issue in terms of working with africanamerican communities or with some of our other Foreign Language speaking communities that we are able to also work with that. I know that is the real challenge. It is very important for us to be able to answer the disparity especially for a fairly sizable part of our population. Thank you. I would make a comment that for the first time in many years i have been a part of the system i see a cultural shift in the Government Entities in relationship to the community that we have been serving all of this time. What we need to do is continue that cultural shift in the government and cb o community so that when we deliver what has been presented today that those communities, those cb os and the Department People are invested in and committed to doing the work because without that shift, we will be having this conversation next year and i do not want to have it next year. I want to also suggest that because it was so explicit in doctors presentations we understand where we are going now we have though create resources and will to get there. I thanks you both for the reports that were educational for me as well. Other comments. I would echo that. You have done a very comprehensive job of identifying the population. Of course, the challenges of the work force and the aspects about the population that is so critical. I wonder if you collaborate a little bit how you envision the Behavioral Health services working to the goals. Do you have any targets . I know there are some about how long it takes to house people, what percentage would be housed in certain period of time. That is not part of Mental Health. Are there any new targets you have developed that you think you can reach in the near term . I also notice i think there are 800 people right now working within the Mental Health system. Have you thought about how you u can redeploy these people to the top of their licenses, incorporate remote providers, which is a huge opportunity for us, where you are going with that. Where within the system you expect to find did leadership and creativity to move along in these paths you have outlined . Thanthank you for the questi. I am going to invite doctor sung the invite the second half of the question. I was assigned for two years to complete in survey to make these recommendations. It is important to acknowledge with in the two year timeframe there are many recommendations that our team is working to help the Health Development develop a framework for implementation we wont be present to see them did deployed. With respect to the work force, it is important to come back to the Community Members comment. One of the key investments the mayor agreed to make is to supplement the number of intensive case managers. We have a target and goal. Right now we have one case manager for every 17 clients. When people have complex needs like the 4,000 based on our success in the department, fullservice partnerships is one case manager to every 10 clients that requires more people, more case managers and also resources to recruit and retain. In thinking about the outcomes i have been pleased with the support and collaboration with the Deputy Director of support services looking at developing clear outcomes for the intensive Case Management services across the board. As pointed out earlier the system has been very closely focused on compliance and regulatory measures which are process measures. We are now taking the shift to ask the difficult questions about what where the actual outcomes associated with the interventions. We think about care coordination and particularly for intensive Case Management, what is happening with Housing Status . How much do they spend time in jail . Are they engaged in meaningful activity . Are they engaged in physical and Mental Healthcare consistently . The baseline measures. We are pleased to have the partnership to assess the Case Management services at that level. I would like doctor sung to respond to the second half of the question. Thank you for the question. I think the question was redeploying staff . Yes, because we have to meet the needs of the changes moving forward. How do we deploy them . What will it lookalikes . We need to fill the current positions. That is one of the challenges. We prioritize this and i appreciate the partnership as well. Thinking about what is it going to take to hire staff and keep staff . What they see is you know what happens when you change staff, there is a loss of connection with clients. They have to learn. They get burned out if you have a one to 17 caseloads and they leave again. It is a cycle. The shifting will have to happen at the same time. Does that make sense . Thank you. Thanthank you, doctor sung fr your Service Today and as we go forward. Would you like to economic in . I would like to know the commission has lost quorum. This is an informational session. Would you like to check in about if rest of the agenda . Yes, we have two other items the Fourth Quarter report and the office of compliance and private seize annual update. I would request that we move those to a meeting in the future. I am making that request to my colleagues up here. If there is no objection we will do that and i will have mark schedule it for us. I agree. We have agreement. We will move those items to a future meeting. You can consider adjournment at this point. You are unable to vote because you are not a full body so the meeting is adjourned. Good night. Mr. Clerk please call the role. role call we have a quorum. Mr. Clerk, would you please read the Consent Agenda . Items 24 considered routine. Not planning to present. If a member objects, they can be considered separately. Any questions or comments on the Consent Agenda . Any Public Comment on the Consent Agenda . Seeing none, can we have a motion to approve the Consent Agenda . So moved. Well take that without objection. Mr. Clerk, please call the next item. For the first can we take a role call for the first vote . For the consent . Yeah, we have to do role call for each one . Yes. role call . We have approval. Mr. Clerk, please call the next item. Item 5, recommend approval of the tole exemption and this is current. Good morning. Good morning. inaudible . On the Treasure Island Mobility Management Program tole policy and affordable programs. For folks watching, the background is that Treasure Island has a Development Agreement that would bring it from home to fewer than 2,000 residents today to more than 20,000 people in buildout over a period of 15 through 20 years and the challenge that we need to addres address is the growthd traffic that could mean for the bay bridge. So the traffic generated by the development is projected to double and that could mean as many as 60,000 trips on and off the bridge each day, about a quarter of the bay bridge volumes. So the Development Agreement approved in 2011 included a Transportation Plan that would address this challenge, both minimize the new traffic generated by the development, by vehicle traffic, a as well as provide alternatives getting off the island by transit. Its a transit first plan and it would include new Regional Transit, ferry and bus transit and include expanded muni service and also include onisland options, getting around onisland, including a circulator shuttle. The plan also included tools to discourage driving, especially during peak periods, called for a congestion tole for driving on and off the bridge and for parking to be paid and bundled from your residential unit. The revenues from those parking fees and tole fees combined with transit fares, transit pass purchases and developer contributions would be the Revenue Source for the new reginole transit. ReluctanRegional Transit. We need to raise the revenues to pay for the new Regional Transit and other onisland services. The transit would be a very robust Transit Service level by buildout. A new bus service to and from Treasure Island that doesnt exist and a new Ferry Service in downtown San Francisco. Muni service would expand including a new route. It would be paid for through the city general fund, through the muni budget but new onisland circuit shuttle and eastbay bus service would be paid by Treasure Island revenues. Fountoday we bring to you what e expecting would be a first in a series of actions to address matters of tole pol sil policy e not yet been decided. We are bringing before you to support the current residents and we expect other remaining matters of policy to come before you over the next several months through the spring. So those include supports for current workers, lowwage workers and for future low income residents of the island who will move on to the island in the future. And weve gotten to this point based on outreach, so supporting the current residents was highest priority that we heard through outreach feedback. We did travel demand modeling of what the effect on travel patterns would have, how many trips are we talking about, financial projections, what would bwould it take to provides benefit. We found on that, its feasible to exempt the securit current rs and we project only a modest effect on the travel demand patterns and the revenue need, which ill explain more in a moment. So the action were bringing to you today to exempt the current residents from the tole and we would need to determine some implementation specifics in the future. So we will need to adopt toll system business rules and we would need to include implementation specifics of how this program is administered and enforced and these are things like the benefit will likely require the use of a fasttrack transponder and well need to work with tita to set up a registration, eligibility and registration process for folks to receive it and things like the total number of exempt transponders, we nod need to identify that maximum number to prevent abuse of the system. Thirdly, we recommend to revisit or sunset the program at the midpoint of development and there are two points at which we know we need to take a step back and evaluate the programs performance. The first evaluation points is at the threeyear mark, so the legislation calls for us to present an evaluation to the California State Legislature no later than three years after the program begins. We are here, also, recommending doing the same at the midpoint. There is a funding need that weve identified would be required to keep the Transit Services whole and provide this benefit. Of course, that the amount of the funding needs depends on what the toll level is that is ultimately adopted but if were looking at a range from somewhere between a total of eight a half to 20 million through buildout divided by six years, which is the most critical point in the programs financial stability. Its about 1. 4 to 3. 4 million per year over a period of significancsixyears, the first f the program. Were could look to a number of different sources to fill that and we could look in program so the programs we have authorized, which are the parking fees, the toles that would be paid by future folks, not the current residents and transit fares and past purchases or nonprogram revenues, outside grants, city and regional partners or other sources. So the schedule going from here, we know we have more work to finish on remaining matters, including supporting lowwage workers on the island and supporting future lowincome residents who will move on in the future. We will complete that outreach and the Technical Analysis of ideas to do that over the next few months and expect to bring back to you the remaining undecided areas of policy in the spring and that would include the toll levels, the toll rates, the hours of operation and any programs to support the other populations that we have identified. So reminder of what the action is before you and please let me know your questions. Great. I certainly a number of statements and questions, but can we open it up to Public Comment first so that can help us to shape some of the points we might want to bring up. So anyone who wants to speak can come up. You have two minutes. Better talk fast. Good morning, supervisors. One thing i wanted to ask rachel, the slides you were just showing, can we get those . Yes. You will see that im sorry, im steve stalone with Treasure Island wines and a member of the Treasure Island organizing committee. One of the reasons you will see that our contingent here today is smaller than usual is that we didnt even know about this hearing until we got an email friday night on a threeday weekend. So that left us very little time to be able to plan and get here. Wabad optics, one would hope trying to encourage democratic support and input that people would have gotten an opportunity to be here. We have a couple of things we would like to say about the issue here. Well, we understand that the Business Issues are not going to be addressed until another couple months or few months, whatever that is. And there is talk of an employee exemption and we think thats a good idea but theres two other points weve been raising for nearly a year now that have not been addressed or even mentioned that theyll be addressed, really and those are what happens to the vendors and our customers and bringing business to the island . I guess im going to leave it at that for right now. If you. Thank you. My name is jim morowski, owner of island wines, on the island for 12 years. Just following up with some of the meetings and outreach youve had. I want to touch base on one issue which was on october 24th, we had an outreach meeting to the businesses and nonprofits on Treasure Island. The day before the 23rd, we were sent conscienc community wt documentation from cta. This was not allow us to make a contribution to the discussion and we appreciate the outreach. Thats important but giving us 100 pages of documentation a day before a meeting is not great. I had an opportunity to look over some of the documentation. A couple things to point out. I appreciate the effort to try to accommodate some of the exemption on the residents and employees. However, looking through the documentation that was sent by us of cta, the development buildout is now pushed out significantly. Its actually now going to be two to three thousand units from 5 to 7 years out. So well have a long period where theres will be a limited buildout. And thats going to directly address the whole congestion issue. How much congestion will it be . And actually it was interesting to see that in the last five years of the documentation, andd this is page 12 of model assumptions, theyll build 5,000 units in the last five years. So my point is that if this whole toll and the Transportation Plan is to address congestion, the congestion issue is going to be quite a bit farther out, further than the developers estimates without getting into too much detail, i went to the Financial Model and asked for a Financial Model so the community can ask and look at what is the revenue and benefits and that kind of stuff. I got a great document with a lot of assumptions but still no publically available Financial Model that we, the public can look at. Finally, the challenge i had looking at the Transportation Plan is that its still very heavy on a few buses and were only on meeting 25, which has a poor performance. Its even up to 25, 27, its ac transit bus to the east bay, heavy ride on muni bay which is paid by for city funds and its a small ferry issue and thats only going to run up 227, it appears in the documentation. To have a few in the morning and evening on weekdays only and there will be no ferry during weekends or offhours. If youre putting buses on an alreadycongested bridge, how will this mitigate congestion . And why is everybody paying for five t to seven years for a fery system thats illdefined. Anyway, so ill leave it at that. Again, im willing to work with the staff and sfta and rachel, but again, that optics of fetting a lot of information getting a lot of information before a threeday holiday, optics are not great. It may go to the sunshine laws strictly, but again, we need more input on how these decisions are made and also more disclosure about what is the financial background of this toll and is it really going to mitigate congestion . Thank you. Hi there. Im a current resident with a few thoughts with trying to bring a different perspective. Were glad to see that people are listening to us and doing outreach attempts towards the community and so, i want to say thank you for that an, but going with the toll and revenue and things like that, just concerned about the businesses they do most of their business to people who dont live on the island, but we really benefit from them, right . We have two restaurants. And we have the wineries, which we enjoy, as well. But without if theres tolls deterring people from coming on to the island now, before residents are really causing traffic, and impacting the freeways, can the businesses survive for eight years until a bulk of the population comes around . And another thing i wanted to throw out there is what about an ad campaign and trying to encourage the visitors, the people that are coming to spend their dollars on Treasure Island to use Public Transportation or developing some kind of shuttle or something that really encourages them to use Public Transportation to get to the island . I know that doesnt help with your revenue, but if the revenue is only part of it and cob jerks is the real issue, maybe that would be useful. Thank you. Anyone else for Public Comment . Public comment is closed. I want to thank everyone who came out and spoke and i want to thank the ssfca for your outreach and for listening to the residents and for bringing this forward and for listening to us, also. Certainly in my time spent on the island, talking to folks out there, there is a tremendous amount of anxiety and concern about the toll, both from current responsibilities, as well aresponsibilityresidents ai think its clear we make a statement and commitment that current residents will not be paying the toll and that we are going to have a policy, i think, to evaluate in a number of years so they know for sure, for that amount of time, and then look at it, then, in terms of its performing. One of the things to be looking at is the Public Transportation system and how effective it is and how accessible it is for people. Theres a number of reasons why, i think, a toll on current residents does not make sense right now. Theres not a significant issue with congestion on the island. The people who live on the island are not causing the congestion on the bridge and many of the folks on the island are low income or middle income and they have to rely on a car because of, i think, some of the gaps in access to Public Transportation that exists on the island right now. And there was always an issue that i had with this and that others, where no other neighborhood in San Francisco has to pay a toll in order to go to and from work, nor do they have to shoulder the responsibility of funding their own transportation system. We dont ask if you live in the tenderloin that you yourself, in addition to your bus fare, have to pay extra to be able to fund the system that serves your neighborhood. Puit was, to me, a huge challen. With that said, over the long term, when there is tens of thousands of residents, when there is a situation where we have a really strong effective accessible transportation system, i think we are looking at a different situation in terms of how to manage the peoples how people travel to and from the island. So i do think its really important that we make this decision today and are able to make that commitment and relieve the anxiety for at least the current residents around this decision. It was something that was very important to me and that i gave my strong direction to early on. So i appreciate that. But this is not the end effort conversation. We stilof theconversation. We need an informed conversation about whats happening with the businesses, with employees, with lowincome residents in the future, including those who are moving on to the island, what i think my view is that there are more exemptions and more things that need to take plays e and what were doing today is making this commitment to current residents and setting that in policy and this is not the end of the conversation. So when we do have a conversation about businesses and employees, i want too make e sure the outreach is there and that people know when were having the conversations at city hall and theres a tida meeting tomorrow evening and ill be there, as well and thats another opportunity to share on this and some of the other policy changes that are coming about. So with that, i have a question, but let me first commissioner walton. Thank you, chair hainey. I dont want to belabor the point and supervisor haniney said most of what i wanted to say but its most important we dont charge people just to get home. Were not doing that in any other area of the city, particularly our lowincome communities. As you know, i have Major Concerns about the future of lowincome families that will have to move to Treasure Island as we build Affordable Housing across the city and as we determine and select who lives where, there will be people who are going to have to move to Treasure Island, not even necessarily by choice. I dont think those people in the lowincome community should have to pay just to get home everyday. And so, i appreciate all of the work youre doing to try to mitigate that and understanding how that is equitable and i want you to know we see the work that youre doing on that. Im looking forward to continuing to flush this out, but appreciate everything that i see so far. I do real quick, supervisor hainey, number three, can you flush that out more in terms of when we say revisit or sunset exemption program, tell me exactly what you mean or intend to do with that recommendation . Yes. So we would need to look at the Program Performance relative to its goals and we have two specific goals from the Development Agreement, from the authorizing legislation, the 50 mochair goal and are we raising the revenue to fund the service . We will also want to add other metrics that arent given to us but are important. Like, are we meeting the Transit Service levels called for and are people getting the benefits that the Development Agreement calls for . When we talk about revisit, do we have say sunset exemption . Because even if we do an analysis at the midpoint or even later, other options are available to us. So do we have to say sunset exemption as a part of that . You can say revisit only without the sunset. I like that. I just wanted to make sure that was state. Thank you. Stated. Thank you. Absolutely and thank you, commissioner walson. Walton. I would prefer we use that language and not set any sort of sunset that happens automatically. A couple questions i had and one is, who is defined as a current resident . What are the definitions that were using and is there a cultofcutoff date . If you are in the sort of housing that exists there now, not the new housing. If you live there now, how do you define who those folks are and theres turnover because if somebodys roommate leaves and somebody else moves on, is it everybody who lives in the current housing . Right. So not in the New Buildings . So this is we do need to define this, and i would request this is something that in the toll system business rules, we need to create the definition there. But there are options. One is to provide a date, cutoff date, such as january 1, 2020. I think the question, then, will that capture everybody who we mean to capture . Or would somehow somebody who were intending to capture be not included in that and that would be unintended, so then what other provision can we add on to that to make sure that the people that were intending to capture are included . And bob beck from tida may have a suggestion here. Well, because it seems to me that the option is sort of to say if anybody liveshe