Transcripts For SFGTV Government Access Programming 20240713

Okay. Item number four. Item four is the approval of possible modifications of the minutes of the meetings set forth below. The regular Meeting Minutes from september 12th, 2019. Are there any questions corrections to the minutes . I move the minutes from the september 12th, 2019 meeting be adopted. Second. Any Public Comment on this item . All those in favor of approving the minutes signify by saying aye. Aye. Any opposed . It is unanimous in favor. Will all right. Item number five. Item five is a general Public Comment on matters within the boards jurisdiction. Do we have any Public Comment this is the time to come forward if you have any questions or concerns about something. Please come forward. Hello, my name is jason and i am from ucsf. Currently vaping and ecigarettes are still widely used and there are many programs in place that offer Preventive Health care screening and Mental Health care consultations. What are your thoughts about implementing or expanding the Tobacco Cessation program . That is a good question. Could i ask our director about that . Im sorry. I have only heard part of what you were saying. Yes. What are your thoughts about implementing Tobacco Cessation programs . There are many preventive screenings currently in place, but there is none for tobacco use. We do have Tobacco Cessation programs, correct . Through the health plan. Yeah,. Through the wellbeing program . What was that . Maybe you could come up and say something. She is mentioning that the newer Tobacco Cessation Program Addresses vaping in particular. Let us do an assessment with the health plan on whether that is currently the case. I imagine that it is but i can affirm that with the health plan , but, yes, tobacco is one of the leading preventive measures that we can do and we will take a look at that. Thank you. Thank you for bringing that to our attention. Thank you. Any other maybe we could find out if our own Wellness Program that we operate deals with tobacco or not. I heard you say no. I am not clear that is the case. Yes, currently we have Tobacco Cessation programs through our health plans. We currently do not have anything that we offer directly through the wellbeing program. We used to when we had one of our counsellors here probably about five years ago who went through a particular training, Tobacco Cessation training that she did offer to city employees, however, when she retired a few years back, we did not actually supplement that by getting an additional person trained because we felt, at that time, the health plans were able to meet the need. It wasnt tobacco specifically, but as abbey indicated, we have to do an assessment on the vaping case. What im worried about fake being is is it the same addiction or different addiction it is also an addictive disorder. There is a collective concern about the uptick of teenage utilization which is exactly what the sales of Tobacco Products target. Then you get someone who is addicted for a long time. I think it is a very valuable thing for us to check into and report back on. I think with the report back weekend maybe assessed if there is something that needs to be enhanced within our own program and to our own employees that we can assess that when we hear what the health plans are doing. Okay. I just read that another person died from it in california here. I think it was around this area or something. All right. Okay, any other comment on this item . Seeing none, Public Comment is closed. Item number six. Item six is the president s report. This report is given by president breslin. I have nothing to report at this time. We can move on to the Governance Committee issues. Item seven is the approval for the initiation of the Health Service board annual selfevaluation process regarding the fiscal year of 2018 through 2019. This will be presented by Committee Chair scott. Thank you. The Governance Committee met earlier this week to review both the Health Service Board Evaluation form, as well as a timeline that is proposed working in strong cooperation with the department of Human Resources, which is really the administrator of this survey. After reviewing the survey itself, we agreed that the survey that was used last year should be used again this year, and that the timeline would start this friday with the notification to Board Members or the selfevaluation and to continue on for about two to three weeks to allow members to complete the selfevaluation, and then we would come back in january with a the report of the results. So that is a broad timeline. It is outlined in our terms of governance that we do this annually, and this is, i believe , the fourth year we have conducted a selfevaluation of board activities. With that, i would like to move that the recommendation of the Governance Committee, that for the selfevaluation form and timeline be adopted. I will second that. I have one question. During the Governance Committee meeting, somebody brought up the issue of being a unable to assess the new Board Members. I dont believe we ever added on an extra item for that. Did we . I will defer a bit to the secretary, but my understanding is that we have not done that. We have tried to maintain consistency with the prior administrations survey, and that Board Members who are not able to assess any particular item or area of the survey are asked to complete that in the comments section of the form. That is correct. I have the same concern, particularly around the orientation since most of us have not be reoriented since the last survey. So if we dont answer the question, then is the survey not complete . We have to answer the question in the comments and say, please ignore my response to question number whatever and whatever . Essentially, there are further guidelines that will be emailed to you all tomorrow, but we are asking every question be answered. If you select neutral because you feel as if you do not you cannot answer it in any other accurate way, we ask that at the end of the section for that grouping of questions, you explain the neutral responses in a sentence or two sentences to give context. And then the neutral will be discarded . No, it just basically is ensuring every answer every question is being answered. We still have the same number of questions from last year without altering the survey completely by giving six response questions we did not want to alter the survey. We may have to cook to may have to consider the results as we start and not compare them to the previous years. I can tell you, speaking as an individual, if im going to change my answers to some questions because of the neutral option where i feel there has not been anything that applies to me in that question. So there will be some changes, but you will just have to contend with the account if you are not going to ignore it. But you will also have an opportunity to comment about your neutrality or why you didnt respond. They are doing the analysis. Okay. So it has been moved and properly seconded. Is there any Public Comment on this item . Hearing and seeing no Public Comment, we are ready to vote. All those in favor of the item as presented, signified by saying aye. Aye. Opposed . It passes unanimously. All right. We are back into regular board matters. Number eight, please. Item eight is the directors report. Thank you, good afternoon, commissioners. I would like to begin my directors report by acknowledging the passing of the c. E. O. Of Kaiser Permanente. Im sure many of you have read the many accolades of bernards contribution contribution to healthcare. I know i didnt have the opportunity to work closely with him, but i know many who have, and people who worked with him since he was a medical records clerk all the way back. So he is a very revered and, as i said, the accolades i dont know in my memory of ever seeing a Healthcare Executive receiving the types of accolades that he has upon his passing, and it just speaks highly to his contribution. I did want to acknowledge that. I know their archives a representatives representatives here that may have additional comments. Good afternoon, i am from Kaiser Permanente. I thank you for the opportunity to say a few words about our very highly esteemed chairman and c. E. O. Of Kaiser Permanente bernard thyssen. I come up with a heavy heart. We started our careers around the same time. He was with us for over 30 years and has been our c. E. O. For the last six years. He was passionate, a passionate leader. Not just for the people, but also for our members and in the healthcare industry. He was an advocate for a lot of change around pharmaceutical companies and challenging them on some of the costs, so he was very active and really believed all people should have access to healthcare. And very committed to the wellbeing of the community. So reaching out and trying to help the communities that we serve to be healthier and have a healthier lifestyle. He was an amazing visionary. I can tell you, being an employee of Kaiser Permanente, what i experience. It was a visionary with a really big heart. If you ever had the opportunity to talk with him, you felt that. He always felt like he was a friend. We are going to miss him greatly we are confident with our interim c. E. O. , greg adams, who worked very closely with bernard he has a lot of experience inside and outside of kaiser. We are very confident that his work will continue to move forward in this organization. I will share with you there will be a viewing of his body that is open to the public on sunday in oakland. It will be from 11 00 a. M. Until 3 00 p. M. For anybody interested it will be at the oakland rotunda, 300 frank all applause in oakland. Thank you for this opportunity. Thank you. If i can make one comment as well. Having been in my professional career at Kaiser Permanente, this is to remind the audience that kaiser is a three like its tool. It is a Nonprofit Health plan and a nonprofit hospital and it is a medical group. He was the c. E. O. And head of the Nonprofit Organization which was the health plan and hospital system. Speaking as a physician, one can see throughout my years on the board some of the tensions that can occur between physicians and health plans and physicians and hospitals. I would say that he was a true partner in working with the medical group and furthering goals, so i know that the physicians share the extreme fondness and loss of the leader of the other two thirds of the stool. But to make sure everyone is understanding that this partnership, as you can tell from the press, is always tense in healthcare delivery. He managed to really show that there is a way forward. And for that he could also he should also be recognized and modelled in all health plans and medical groups. I would only add to that the reason why i am in San Francisco is that i was recruited by bernard to serve as a Vice President for h. R. In a prior structure at Kaiser Permanente called the golden gate service area. I also have a personal relationship with him through a professional mens organization that he and i are members of. Both from a professional and personal standpoint, he was and had been a friend of mine throughout my early career here in San Francisco in Human Resources until my leaving kaiser in 2001. I will miss him personally and professionally. Thank you. Thank you. Turning to the directors report , in the packet it highlights the highlights included are the decision not to release a request for health plans for plan year 2021. As the board knows, we have been monitoring the marketplace and it continues to evolve. There are one of the things that has occurred since we last met was the announcement of the settlement with sutter, and that settlement will not be public until late february, early march of next year. It is possible that it will have impact on the market here in San Francisco. So that is one that we are anxious to see what the settlement entails. We are also continuing to serve the development of the can be product and watching the sutter product develop. We will be coming before the board again in december to talk about the member focus groups that we did throughout the month of october where we did a significant number of listening sessions with the members to understand their current experience and to get their input regarding their questions and concerns about possible models. Going forward it was very informative. I have reviewed the polemic area results and have the draft final report on my desk unread at this point. I am anxious to call through it go through it and make the presentation to the board in december. We are also in the process of updating the Strategic Plan based on the activities that have occurred over the last year and, again in december, plan on reporting out in the form of the annual plan and Strategic Plan update simultaneously, since they are so interlinked. We are anxious to do that. We have done some initial assessment about accomplishments for this year, and as always, when you take the time to do a look back, is always amazing how much you get done. We are pleased about that and we will be looking at those areas that perhaps we didnt accomplish and understand why. It could be that there were dependencies or sequencing that we needed to recognize or give more time to the Strategic Plan. It was written over a threeyear period and was quite ambitious in the number of activities that were suggested to accomplish some of the goals. We will be reporting that out to you in december. I will, at the conclusion of this directors report, stand at the podium and give to you the results of the Employee Engagement survey. I will defer on that for now. Also as a followup to an earlier meeting when the care coordination presentations were done, we had a breakdown in communication with kaiser and have given them the opportunity to put together a presentation on complex care coordination which be which would be more comparable from what you heard from the other plans. That is in process. There have been some investigations into some of the issues that some of our members are experiencing. We want when they choose to buy a concierge service, but it is not required to be a one medical participant and it is precluded from positions to charge an extra fee, but it is considered an ad on option that members may choose to charge. As we become aware of any of these situations, we are better able to investigate. We have heard it mentioned that there was some issues with some providers. We have communicated to them at large. But as most of us know, it is very difficult to correct a problem when you dont really know where it exists. I really do encourage the members to advise h. S. S. When they have questions or concerns about their plan coverage. We do hold that information, the privacy of that information and would protect the member from any procedures and retaliation that they maybe fearful of. I would encourage people to talk to us. Can i ask . Yes. Two questions. I guess there are two parts to this topic. One is that the one medical. So when you just walk into one medical, because they are everywhere, the front windows now say they are associated with dignity and the healthcare system. There is one in west portal that i walked by. So our potential patients given a sheet that alerts them upfront what the fee schedule will be and that they are, maybe at risk for paying those fees depending upon their health plans . I dont know how this works. Someone is nodding yes. So they are given one they walk in the door. It is my understanding, at least from their website, that you can join and pay a fee on the website. What is not clear is we have done some secret shopping and tried to understand where the confusion might be. I think one medical in their general marketing practices do advertise a membership fee and they state it is for their extra attention and concierge Type Services and receiving appointments. What our plan is, particular with the ma p. D. Is prohibitive if you are under contract. I dont know how every one medical Office Brooke operates in as far as informing members, but it is important that if you are a member that you dont have to pay the fee. Okay. So that is evident to our members, how . How do they all remember this day today when theyre walking down the street . It is fairly to folk typical. Once they determine youre not there for an emergency, the next thing they ask is for your insurance card. Again, we need to continue to ensure that when medical is following these procedures and assists the members should they require assistance. Okay. The second item has to do with tolling. We have talked about these additional fees on other occasions. So what i understand you to say is the board is clear on this. Sometimes, and maybe other health plans positions who are also not as clear on this or members are not as clear, this is prohibited. This is clarification that when we get these complaints there is followup with medical groups or health plans . Yes. Along that point, if i may, would be possible to communicate to membership perhaps on the website or through members that have healthcare plans that would like to be able to shop around for physicians to give them a heads up to look out for these extra fees that may not necessarily be covered . I think we can take a look for our Communications Team as to what the information is that we give about the plans and on our website, and we can talk with the plans to see what they are staging stating. Thank you. I am still not clear. If they charged us fee, will we pay it . No. Okay. My understanding is that we have to pay this fee in order to belong. It is my understanding that that would not that would violate the contract. Is that correct . I am with united healthcare. So with the Group Medicare advantage p. T. O. , they are prohibited against their contract. If their conch if theyre contracted with our network, then they cannot charge the fee. Somebody can be on an individual Medicare Advantage plan and be charged the fee. It is their option to choose it or not, but there is no protection on the individual medicare advanced plans, but your group plan is definitely protected. So they can charge this fee, but it is not it is not against the law. Is up to the member to opt to pay that and it comes along with the fee. They can choose to pay the fee and take advantage of those additional services. It is prohibited if the provider is contracted with the healthcare. Second thing i hear you say, members may be telling them that are medicare options. They maybe saying medicares primary. It is hard to say. There are so many different insurances that these front offices manage. So to ensure that they have a clear understanding of the differences is a big challenge for them, but that is their business model. I think we have to hold them accountable for their contractual obligation. Having been in this service practice, it is possible that one medical is from a business standpoint but asked somebody to pay upfront and say that if you want us to bill medicare and see if we get anything back, then we will reimburse you. But of course, they wont. They certainly wont if they belong to the p. P. O. So members have that option, but usually lots of other providers charge that office the upfront. So you run it with cash or credit card or whoever you want to pay and then hope to get reimbursed by somebody. Yes, and this is a little bit different. To the general public, they pitch it as a membership fee. Right. I think what i need to do is have a conversation with one medical to be clear what the practices are and what they are doing to meet the needs of our clients. We need to look at the plants plans as to how many members we have under those that are using those services. It could be we do a direct outreach to those. You go there and you have your Medicare Card and it shows what your coverage is and what your copays are. Why would they be confused . Because they may be trained under the membership fees to be adjusted for everyone. This may be an exception. I dont know how any exceptions they accommodate. We were able to hire a whole bunch of folks to help us with open enrolment this year and other agents of services. I would like those that are here today to stand so the board can recognize. With open enrolment we have. With our Member Services team we have. [calling names] [applause] and we also have hired a new assistant health educator. There we go. [applause] thank you. We are very adequately staffed for open enrolment this year which is really great. It is like a trial by fire for an orientation for the team. Welcome aboard and thank you for helping us. The next item on the directors report is responses that marina wrote a very generously to a couple of technical and difficult questions, and one i wanted to highlight was the member feedback that Grady Ellison who is letting the Board Members know. I think we have deputized him as an investigator on the team. He was he has really worked closely with us to help identify some problems early on with our electronic enrolment. He was very helpful. It was a very hectic time for the department of technology, but we all overcame those barriers and it was really great to have a member so engaged with us in our services to identify issues early on and get them corrected for our membership. I thank him for that. I also, marina wrote a pretty robust response to some technical questions that you had that the phones be on the dashboard. I hope that we answered your questions. And thirdly, from the report, i will ask her to step up to the microphone. I just want her to read it into the record so the individual can hear it on the recording. On october 23rd to 2019, the main fax number stopped working, so i thank you can appreciate during these last days of open enrolment thousands of applications can be faxed in at that time. We identified that the issue was with the phone line and not the fax server or the software. We reached out to the Technology Partners and they just so completely understood our sense of urgency around that. They were able to get at t out to our premises and then they kept doing additional onsite troubleshooting with us as we looked at the fibra networks and the Telecom Lines and they were able to meet me outside Business Hours to resolve things as expediently as possible. And ultimately they diagnosed a loose wire in the basement. Isnt it always Something Like that . They were tremendous. The individuals were deeply invested in getting us back up and running. Im so very grateful for the expertise and assistance. Thank you to the department of technology. Thank you. Thank you, marina. So with that, i will transition to do a presentation on the Employee Engagement survey. I will go to the podium. Following my presentation, i have asked carrie to present to you a brief presentation on the e. A. P. Critical Incident Response is that the team has done for a long time, but particularly this year it has been quite a year. We had the opportunity to present this to the Mayors Department head meeting yesterday which is why i did not put it out in advance. I didnt want to usurp the mayor mayors viewing of it. They literally the only changes the fact that carrie will presented to you rather than myself. I will step to the podium. Okay. Do we have it on the screen . There we go. Okay. First and foremost, i would like to thank all the Staff Members that actively participated in this process. It is profoundly important as an employee that your voice is heard and thus we named it. As an organization, we are committed to survey results to create action plans to improve Employee Engagement on a continuous basis. We appreciate the opportunity to work with Talent Systems intelligent Talent Management consulting firms based in palo alto. Hs as a worked in partnership with its to review the 2016 total with approving the statistical validity and productiveness of the 2019 survey results. The survey went quite well and we thank you will be interested in the results. This presentation will cover the surveys purpose implementation and overview of survey scales. The survey resulting by scale and category and the themes that emerge from the survey and proposed next steps for Action Planning. The purpose is defined to the extent in which employees still who are passionate about the jobs and are committed to the organization and put discretionary effort into their work and are willing to refer. Engaged employees produce a greater output and a Higher Quality level and less engaged employees, and will stay with the organization longer. This leads to increased retention and organizational knowledge and reduced training and turnover expenses. The survey has a dual purpose during the strengths of employees in identifying areas of continuous improvement. Let me get on the same page here the survey was administered in august through september. They were a total of 52 items. Fortynine on a 15 rating scale and one multiple choice, and two open ended items. The double rating scale allowed us to look at effectiveness and importance. Fortyeight employees responded that as an uptick from the prior survey in 2016, there was a 90 Response Rate and a 96 Response Rate in 2019. The only persons who were not able to participate or were on a leave of absence. The engagement i want to clarify, these rating scales will be defined in detail further in the presentation. I want to note that its has been in the business of Employee Services since 1999. They stated in 96 Response Rate was the highest they had had from any organization. This excellent Participation Rate indicates a high level of trust. We had a small number of staff taking the survey for the first time, and the rest were experiencing a subsequent time, yet we had stability in our scores and above average, minimal downward trends and substantial upward trends reflected in the data on future slides. Slide five. Engagement survey scales. Items marked on the survey roll up into five scales. Alignment, fit, team, growth, valuing, with Employee Engagement being the outcome at the centre. These five categories represent action areas that drive or detract from Employee Engagement each of the five categories are defined on the righthand side of the slide. Next slide. Overall, results by scale, as mentioned earlier, the survey used a double rating scale showing its importance. They reflect how important it is to staff and how positively staff feel they support the focus area. The goal is to have minimal differential between the scores for each category. H. S. S. Had less than one point difference between the categories. We had a 1. 7 differential in supporting the category of growth, which is one area of focus for Employee Engagement Action Planning discussed later in the presentation. On the rating scale of one through five, scores of three or higher are above average for any organization. H. S. S. Meets this threshold across all categories. On slide seven, the Overall Results by category. The favourability score is this defined as the average of the respondents that rated agree or strongly agree on the survey items in each category. Increases in favourability ratings were seen in the areas of alignment, valuing, team, and fit. That represented the highest increase at 9. 97 and speaks to our ability of onboarding the right staff for the right positions. Decreases in favourability ratings were seen in the areas of Employee Engagement and growth. These minimal decreases range between one and two . These areas are still considered important. Slide eight, Staff Members, we were assured anonymity and in responding to answer answering openended questions. Open ended question one. Open ended question number two. What are some of the opportunities for improvement in this department . H. S. S. Worked with i. T. S. To analyse scores for effectiveness , importance, favourability, and open ended question responses to identify overarching themes that lead to Action Planning. The three themes for the 2020 Employee Engagement action plan include collaboration, Employee Recognition, career, and Employee Development. Slide eight reflects the staff to do perspective on the current state of each focus area and future visioning for improvement opportunities. Slide nine, Employee Engagement Action Planning steps based on themes. Slide nine identified Action Planning steps in the areas of collaboration, Employee Recognition, career and Employee Development, and three themes that steph identified as being top priority for them. These Action Planning steps are a combination of improvements to existing h. S. S. Programs, processes, as well as new endeavours and collaborations that we plan to pursue within and across divisions. As you can see on the action plan and collaboration, were talking about the lean 101 Quality Improvement initiative which we reported out to you on several occasions and we will plan to continue to do so. We have recently had a meeting with the department of Human Resources to work with them in partnership on some improvements that we have identified. The lean training itself in that way and that way of thinking and working has been fully embraced by the staff. We intend on continuing to use that methodology for other process improvement and it will expand the opportunity for staff to develop skills in process improvement. Employee recognition, we will continue to diversify staff celebrations, support the culture of the person and wellbeing. We are developing an interdivisional committee tasked with developing an ongoing Employee Recognition program. And enhance employee performance appraisal process by incorporating opportunities for management to recognize and nurture professional development goals, identified by the staff. In the career and Employee Development area, we are looking at developing a Baseline Assessment of skill level by position and classification and use that analysis to enhance skill building pathways that improve effectiveness in the staffs roll and prime them with Transferable Skills for advanced position within or outside of the department. We are partnering with the department of Human Resources to provide refresher education on training and professional Development Opportunities that are available to the city and county staff, including career counseling and advisement. So throughout this engagement survey, we learned about our organizational strengths. Employees find that the work they are doing is meaningful. Employees feel their personal strengths are put to good use and the type of work that they are doing. Employees know how to contribute to the department and Division Success and they are highly committed to the departments mission and purpose. We also learned that opportunities exist to further support our Employee Culture of recognition for good performance , to evolve our staff in more process improvement projects that would support across collaboration and provide additional opportunity for ongoing learning and Skill Development that increases staff effectiveness and future professional positions within h. S. S. And beyond. As an organization, were committed to using these results for Action Planning that improves Employee Engagement on a continuous basis. We again thank the staff for the feedback. Any questions . I had a couple questions. Number one is, im assuming can you clarify whether a survey was done online and whether employees have the opportunity to do it outside the workplace . Was there access to the portal so they could do it privately at home or wherever . Yes, and yes. Okay, good. How long does it take on average to complete the survey . Ten minutes 12 minutes. And under Employee Recognition, what are the issue one of the issues that i think we all grapple with is how our members also acknowledge employees for their outstanding experience that they have had, and also when they are maybe have less than outstanding experiences. How does that fit in to the action plan for Employee Recognition, or is that an issue that is addressed separately . We havent discussed that. I think that is a really nice perspective to bring to the table and to look at it. I know we have a Strategic Plan and an effort to and we have the new phone system coming in and looking at how use salesforce and capture the nature of the calls are coming into Member Services. There is an obvious opportunity in working continuing to work to understand the roles that Member Services plays and how well they are doing. I think that is one area, and then soliciting member engagement. We have been doing it through a variety of special interest focus groups over the last year. We have done three different series of focus groups to speak directly to the members, but i do think that what you are calling out is worth consideration and we shared think through how we do it. I dont know if our managers are here that have experience of hearing some of the accolades we do get from our members and how that is shared with their staff. And then, of course, when there is issues that of performance, then the council needs to review it. This is from the 2016 survey. These are some remarks and sustained improvements. I commend you for undertaking this activity again, given the fact you have been here a little over a year and a half or so, but i think the inputs from the Management Team and the commitment to the managed team to support what you have identified is going to be critical over the next few months. So to the degree that you are committed to move in the direction, i commend you. Thank you. Okay. I would like to turn the podium over to carry carrie who will talk about the a. P. For managers in times of crisis. Hello. I am the manager of h. S. S. I will spend a few minutes talking a little bit about the presentation that abbey did yesterday. We want to talk about e. A. P. And a time of crisis in the service they provide to managers. We have three e. A. P. Counsellors their pictures are in front of you. Collectively they have over 50 years of experience and all three of them are licensed and f. T. E. E. A. P. Has two main core services. They have personal services and organizational services. Under personal services, they offer counseling and they do referrals, and her organizational services, they offer consultations, workshop training, mediation, and critical Incident Response. Today i will spend some time focusing on personal referrals and the organizations organization 20 around the critical Incident Response. E. A. P. , in regards to referrals, they actually do a lot of work when a member will call and have challenges on how to access Mental Health services through their health plan. They will actually help to navigate that system. They also have liaisons within all three of our health plans that provide them a direct line. So should there be an issue or a concern a member is having that they dont feel they are getting the right type of care, they connect with these liaisons through our health plans, and those liaisons can actually react very quickly. They also work to do a lots of collecting data to see what is working and what is not working, and that information is provided back to our liaisons to see how the health plans can improve the services and getting the right type of line of connection to our members to the right people. I will pause there to see if theres any question specifically about the referral process. Are the e. A. P. Team members all full time . Yes. So for organizational services, i will focus on critical Incident Response. A critical Incident Response typically is an event that overwhelms an employee when it comes to something that is not atypical to their Work Environment and theres actually two kind of pieces to this because we do understand that there is a large portion of the workforce within the city that our First Responders and that type of work is very typical. So please note we will talk more about responders a little bit later in the presentation. Some of those items you might see our work violence, workplace violence, death of a coworker or patient, or client itself. Death to a family member, natural disasters, Sexual Assault or even a physical assault. We would you find it, marina. We have seen quite a bit of an increase in regards to the Critical Incidents over the course of the last several years , so as you can see on the graph in front of you, it actually will show you that we have seen an increase by a substantial amount. We do relate this to very heavily being that the word is getting out there. That people know e. A. P. Is here for them and they are really able to utilize that service for them. So for this year alone, we have actually had 64 trauma responses where e. A. P. Has been called out to act and to provide support for individual employees and or departments as a group. In regards to the response, one of the things that we have learned through the process is not one situation is the same, so it is really determined by a case by case basis. However, there are some typical best practices that they move through as they are dealing with a department who has suffered some sort of a Critical Incident these would include an initial consultation. They have a point of contact within the department and someone who is of a higher level to get them engaged to talk about how they want to approach their group. They do an assessment, they will provide some sort of negotiation or agreement on how they are going to work with the department, and then they will work to inform and move forward through next steps. Some of the materials that they provide in the response is they do have some resource materials. Those are always on hand. Those are things they can give out immediately. They often will also come onsite to a department to do group discussions. One of the things that they have learned is by coming onsite, they have a lot more effective connection in dealing with the response when it is in a group setting, and opening up individual consultations through our office location. We have found it not to be successful to do individual counseling at the site location itself. That is also an extension of what they do offer, but they offer that at 1145 Market Street and then there is also a followup process. And depending on the engagement, the severity, the situation in which they are dealing with, the department, that feedback loop and the ongoing support can continue on. I will pause there. Are there any particular questions before a move into First Responders . Okay. We have started to engage with our First Responder group. As you know, First Responders to , every day, deal with a lot of trauma. These groups are your police, fire, sheriffs, department of emergency management, and medical examiner groups. These groups have collectively come together in partnership with us and we are really looking to address the needs of our First Responder group. There is some things that we are working on. Some of that is getting them in front of our health plan liaison to ask specific questions, and then doing some deeper digging and research on how we can continue to serve our First Responders. Our e. A. P. Team is here for our managers. They are here for our employees, but in relationship to the services that they provide, we have a lot of our information where we do provide on our website. The slide you are looking at has direct contact information. We have an 800 line as well that people can connect to. And then this last slide really highlights some of the resources that we have available. They are very easy and one click away. Are there any questions . It is an impressive presentation. I dont know i could talk all afternoon about the trends and kind of Critical Incidents or whatever, but i guess the question i would have is how is your capacity . Do you have a sense of how your three managers are working overtime, or are they not working overtime . What is the assessment of this . That is a great question. We constantly have meetings about looking at priorities. We do identify that Critical Incident is a priority response. At times, we will meet to discuss what does that mean in regards to client load, how long are we pushing client sessions out further, and looking to address what other projects and work they are doing on, as you say, in addition to the Critical Incident and client responses. Theres a lot of other work they do do. Right now i would definitely say it is very tight capacity. I know jeanette is here and she is one of our e. A. P. Consular his and she can agree to that. There are three counsellors to do a lot of work for 45,000 employees. It is a lot. Could we use more . Absolutely to do the work that we are doing. Right now we are managing with what we have and we are reprioritizing where we need to. I will just follow up then. Thank you very much. It is very clear that you have some metrics. Is there anything that the board can do in reviewing those metrics or understanding better, you know, because obviously you are reprioritizing and you are reprioritizing to the two of need, and that is something that we should all be aware of in terms of how that is being determined and what we can do as a board. We have actually been in conversation and are starting to inquire outside of the organization as to what is the best way to approach the understanding of what the need is versus the vibe dont viability to respond. I think what we are noticing here is that we have a very strong and professional e. A. P. Team that has become widely recognized around the city, and therefore, we are getting an uptick. On top of, these are trying times. There is a lot of reasons why the demand for services is increasing, and i fully expect we will continue to increase. We are really considering how we go about perhaps getting an internal consultation to come in and help us project what our what we could and should be doing and seek the resources to do that. All things Mental Health are a priority in this administration, but the Mayors Office and i know when i did this presentation, several of the Department Heads were very gracious and theyre acknowledging how helpful our partnership has been because i think that is the way we have approached it. Either through the Department Head or their point of contact has had a very strong relationship with one of our counsellors who has gone in. In some cases when city attorneys were critically ill, prior to his death we were noticed and able to go in and work directly with the team there. Other times we learn about these things afterthefact, as you know. But it is clear that theres a very nice, professional recognition of what is going on. I think we will continue to see this rise. We need to develop a plan on how we need to meet the increasing demand. Thank you for doing the presentation. E. A. P. Is usually the group that is not recognized or doesnt give an importance until there is a need for it. Thank you to the aep e. A. P. Staffer the staff for the work that you have done. Outstanding job that you have done. Although thank you. What about retirees . The retirees currently are not eligible for internal e. A. P. Our e. A. P. Counsellors directly work with the active employees. Our focus with the retirees is to be able to provide their services through their health plan. So like that the Police Department and the Fire Department have their own behavioral the Police Department does, the fire does not. They have a peer assistance program. The Police Department has the behavioral science unit, which they do outsource their e. A. P. To an external vendor. So right now that is part of what these 51st responder groups are looking to do is actually collectively come together to be able to provide an e. A. P. Service similar to what the behavioral science unit receives through the Police Department for all five of those First Responders. [please stand by] yes, historically, and we were very aware of that situation. Suicides are up in a number of populations across the nation, and Police Officers are vulnerable, for sure. Im happy to hear youre working with the other yeah. Weve had some excellent conversations where were just really facilitating that, and i think its its important for, you know, as Mental Health becomes a more acceptable conversation and the stigmas reduced, theres just a lot of learning on what needs to happen on what services are available and who they help the best because theres a lot of misinformation out there about what Mental Health services cannot do because it covered everything from the homeless methamphetamine addicted person on the street to the off