Transcripts For SFGTV Our City Our Home Oversight Committee 20240711

Approve. Member rajeo. Yes. And chair williams . Aye. All right, so we are adjourned. It is 4 33 p. M. Thank you, everyone, for sticking with us and well see you tomorrow. Thank you. Bye, everyone. See you tomorrow. The meeting is closed. Just want to notice we didnt have. Can you call the roll . Im going to read my script first. This is held by web x modifying requirements for inperson meetings during the coronavirus disease emergency. This committee will be convening remotely until the committee is authorized to meet in person. Public comments will be available on each item. Each will be allowed three minutes to speak. Comments during the Public Comment period are available by calling 14156550001. Again its 14156550001. Access code is 1469968636. Then pound and then pound again. When connected, youll hear the meeting discussion, but will be muted and in listening mode only. When the item of interest comes up, press star 3 to be added to the speaker line. Speak clearly and slowly and turn down your television or radio. You may submit your Public Comment by email and it will be forwarded to the committee and included as part of the official files. Please note this meeting is recorded and will be available at sfgovtv. Org. Great, member andrews . Here. Vice chair dantoni . Yes. Friedenbach . Here. Haines . Member haines . I see. Let me move on. Member leadbetter . Here. Member miller . Here. Member nagendra . Here. Chair reggio . Here. I see a thumbs up. Great, we have quorum. Welcome everyone to day 2 of the our city, our Home Oversight Committee retreat. Were going to Public Comment. Is there any Public Comment at this time . Members of the public who wish to provide Public Comment on this item should call 14156550001. Access code, 1469968636. Then pound and then pound again. And if you havent already done so, press star 3 to line up to speak. Wait until the system indicates youve been unmuted to begin your comment. You have three minutes. Checking the list now. There are no callers. Thank you. Well move to item 3. Discussion on analysis of gap Tropical Storm in the Behavioral Health system. Well hear as it relates to gaps. A review of mute your line. As it relates to people experiencing homelessness and gaps and possible action by committee in response to the item. I want to say the Mental Health sf item, supervisor ronen was supposed to be here for that, but called to another committee hearing. Were going to postpone the Mental Health sf presentation and well get to hear from dr. Nigussebland and others for the first presentation. Ill turn it over to dr. Nigussebland. Will you send me the most, so i can share. Thank you so much, chair williams. Im pleased to be here. Its nigussebland, so youre very close. Thank you very much. We have the director for Behavioral Health services, Marlo Simmons. And well be jointly presenting marlo will be sharing an overview of the Behavioral Health services. Ill be updating as it relates to the mayors efforts. And then well conclude with thoughts about opportunities for continued investment in our services as it relates to people experiencing homelessness. Im going to turn it over to director simmons to begin the presentation. Welcome, director simmons, thank you for joining us. Can you hear me . Great. Thank you, dr. Nigussebland, for starting us off. So our request was that we provide a little more detailed information about some of the financial picture and specific programs and talk a little bit about some of the gaps we know exist in our system. I imagine there probably will be a followup and more detailed data that will be requested around specific areas. I think as i go through especially the first few slides, people will have a sense of how complex our system is. And so if a request for information, say, where are people discharged from a program is made, well need to know very specifically about like what type of program are you talking about . What kind of discharge . So there is a lot of detail that we need to discuss so we can get you the data that you need. So ill go to the first slide, please. Thank you. Actually, im sorry. Can we go to the slide before that . Perfect. So well go through some of the b. H. S. , dr. Nigussebland is going to go through the Mental Health reform work and then well start to talk about how that all folds together into a future investments were recommending. So next slide. Ive gone through some of this at the last presentation i made, but to provide very brief framing for people, again, our system provides services along a broad continuum from prevention, Early Intervention, all the way through locked facilities and placements in State Hospitals. People come in to our system through a lot of portals of entry. One of the challenges we have in the system is that there are certain gaps in the number of services we have, so we know we need more intensive Case Management, we need more residential treatment beds. We know that housing for the people coming out of the program is key. We know that people have a hard time navigating the system, so were building in more support and structure for people to navigate the system to get to the right door at the right time. And then to move through the levels of care as they make their way toward recovery. And just as a reminder, in addition to delivery services, Behavioral Health Services Within the public of health, we operate two plans. We manage the medical clients, the medical care plan and the disorder system which is a different medical care plans that add to a lot of the navigation complication. Then we have our Health System where were delivering services. And then our Health Promotion and Early Intervention services are also very complicated network, which we believe we can leverage to do a lot of the work that we hope to get done over the next few years. Next slide. My internet is a little bit slow. So if you think about the triangle that was on the previous slide, that is really an oversimplification of our system. So im going to go through some of the Mental Health services we have and then a range of Substance Use services we have. And again, those systems primarily because of laws around privacy, how the funding comes down to the county, and the structure of the different managed care plans, the link between Mental Health and Substance Use, we have been working on integration for the last 10 years, but there are a lot of barriers and were far from an integrated system. But we know that even though, for example, Mental Health sf is called Mental Health, Substance Use is a huge issue and were working to develop Program Proposals that address Substance Use and really focus on a Harm Reduction approach. On the Mental Health services side, we do the outpatient programs which are more traditional, therapeutic services. Intensive Case Management and sole Service Partnerships. And thats an area we know we need additional services. We have about 200 people waiting on waiting for the services right now. So we need to expand those. Crisis services. Again, were building a Crisis Response team which well talk about later. And we have kind of range of ways where we interact with people that are in crisis. Residential Treatment Services range from 90 days to 12 months. Private provider network, individual providers that generally do outpatient services, but theyre individual private providers to provide services. The acute Inpatient Services provided at the hospital. And then longterm care is where we have folks that are placed in state care or longterm State Hospital stays or other subacute locked facilities. Next slide. So youll see that the Substance Use disorder set of services is as robust. Weve done work over the last few years to really build out a more robust system. Having to follow a lot of the state regulations and state rules, but a similar kind of path youll see in the triangle as we have prevention programs really being aware of Harm Reduction is the best approach to doing Substance Use services. We also need to do screening to identify people. The helping people with medication assisted treatment. Its one of the more well known and something weve done a lot of work over the last couple of years to expand access. And we also do medication assisted treatment for alcohol use disorder. Withdrawal management. So in a similar way to Crisis Services on the Mental Health side, detox and Sobering Center are similar kind of crisis programs where ideally people wont need level of care and we want to prevent utilizing care at that level. And then we also have outpatient and residential. We have very few beds in our system that are technically able do both, but we know moving forward we need to build programs and have that capacity. And then residential stepdown is a relatively new model where for us in San Francisco, where we recognize that a lot of people coming out of residential treatment, being discharged to the street is not a way that youre going to help someone maintain their recovery. And so we know that in fiscal year 1819, we were stepping down about 27 clients per week who were leaving residential treatment and being discharged to the street. So a residential stepdown is a merging between housing and treatment. Its a place for someone to go so youre not discharging them back to the street. Next slide. And so this is a slide i shared before, so again ill go through quickly. We do sole age range from birth to death. One of the takeaways from this slide, Behavioral Health Services Already serves a large proportion of people experiencing homelessness. We see that number is even higher in the Substance Use treatment system and then it even higher percentage is up to 71 for people who are served in both systems. So we know kind of people who need multiple services have complex needs. And we want to make our services more available and accessible, make more of them, but also really need to focus on making sure the services are effective and helping people to achieve their treatment goals. The next slide. There was some requests for information about the demographic information about the clients that we serve. So this is an overall picture. Again, you can tell, imagine from the list of Mental Health and Substance Use services, that we need to be very, very concrete about which kind of datapull we want. And so we look forward to working with you to get you the data you need. So the Mental Health clients, this shows excuse me the breakdown of gender identity and then across the board ethnicity breakdown of people served in both systems. So youll see that there is an overrepresentation of africanamericans in our system relative to the population in San Francisco. Definitely a population we need to serve more effectively. The next slide. So again, there was a request for some kind of breaking down more of what number of people were serving and which time of program. We definitely have different ways that we can cut the data, but this slide shows for some of our kind of big service categories, the number of unduplicated clients that are served. And we our data of this status of peoples housing certainly has opportunities to be better, but this kind of gives a general sense. Again, youll see when you look at services in Substance Use, withdrawal, those services you think of as higher level of crisis, were seeing a higher percentage of people experiencing homelessness in those populations. But then when you look at our outpatient programs, you see a much lower number, which can mean lots of Different Things, but i think its pretty clear to everyone that access to these services is a challenge. And something that we need more lower threshold programs to better integrate services into places where people already are, such as Supportive Housing sites and shelter and more access on the street and in dropin programs as well. Again, just trying to tell the story of how complex our system is. I have a few slides on of the financing. If we want to talk details, we have to talk about exactly. B. H. S. Has 40 Funding Sources from federal level, state level. We have work orders from many different city departments. We have grants. So if you can imagine, you know, that we have 127 contracts with 89 communitybased organizations, and those communitybased organizations operate over 400 programs and those 400 programs are funded with 30 different Funding Sources, trying to figure out what exactly people want to understand about our system, its a complicated story to tell in just one presentation. But we can definitely get into more detail. We have 800 Civil Service staff that are funded by Behavioral Health. About 200 of those are that report into Behavioral Health, theyre part of the contracting system, the fiscal system, i. T. , all of the enabling organizations that are part of their Business Office and other parts of d. P. H. Next slide. So this is a quick overview of the money picture. So youll see on the left that our Mental Health services for adults and older adults is the largest portion of our budget. We have a childrens Mental Health system which is about 87 million and then the Substance Use disorder system, which represents about 16 of our budget serves all ages. Mostly adults. But does have some Prevention Services for children. About 86 million. The next slide the next chart, the pie chart, shows the different sources of funding. And some things are rolled up, because again having 40 things on a pie chart makes it difficult. So this is a big picture. Youll see that the prop c funding is going to be a very large percentage of the b. H. S. Overall budget and a lot of work still to be done about how that funding is going to be allocated. Next slide. So this slide shows a little bit about how one thing about our system, is that we, the Civil Service system, the cityemployed staff, operate about a third of the programs that we services that we deliver. And then we contract out about twothirds. And so this and what this slide is a little bit funky because the propc up here, this 18 , its included in here because it is money that we will expend over time, but it isnt yet clear because were obviously working on the details of what percentage of that will go to Contract Services versus Civil Service. So this slide ace little bit funky, but if you do a revenue and expenditure slide, you want the two pie charts to match. We included that just because of revenue coming in. And we need to start planning for these expenditures. And one note about the contracted services, all of our Substance Use services are contracted out. And on the Mental Health side primarily Civil Service provides outpatient services. All of our other than what happens at San Francisco general hospital, all of our other level of care is provided through contracts as well. So our contracted partners are a critical part of our system. Next slide. So there was some question and interest in knowing more about our outcomes. And, again, im hoping that people will have taken away that we need to know exactly which programs do we want to know about. I wanted to provide an overview that we do track different performance metrics. Some of these we do better than others. And there is opportunity, i think, across the board to improve what we track, how we track it, and how were reporting out and being accountable for the use of public funds. So we currently track access to care. We do have clinical outcomes. Ill talk briefly about those tools on the next slide. A lot of what we track is required by medical. I think i said this in the last presentation, that medical, much of the system is medical funded and with that comes a certain level of Regulatory Oversight and hoops that are often times by the clients. So the flexibility of new funding coming through Mental Health sf and propc are very exciting opportunities for us to do the more competent care we know is needed. These are assessments about needs and strength that are done when someone enters treatment. And 612 months with regular intervals and we can look at these for most of our Clinical Programs to understand if people are improving in these measures. The pediatric symptom checklist is used by the system. Thats a parent tool. So the parents are measuring or indicating how they think their child is doing in treatment. But we have a state database, called the Data Collection, that is used by all of our fullService Partnerships, which are a big bulk of our intensive Case Management programs. And then the Substance Use system is required to submit data into the cal system. So we can pull data from any of these metrics for many of our programs. So, again, more detailed data to come as requested. Next slide. So, one of the things we understood about the goal for the retreat is to really start to identify the gaps. And so i wanted to share just briefly one of the gaps we know exist is this intensive Case Management. And we have seen that intensive Case Management and full partnership are pretty much interchangeable, but that this is a very effective model of care. We currently have the capacity to serve about 1200 people, but we have a long wait list right now. It was Getting Better before covid, but because of the vacancies of staff, its up to 200, many of you will be familiar with ucsf citywide and we were able to partner with them in the last 18 months on a new intensive Case Management linkage program, called the Crisis Response team. And focused on people experiencing homelessness. They were in the last year served 74 points when they started working with those clients 97 lacked housing. So this is just a quick snapshot of some of the outcomes we tracked. So we got everyone assessed by coordinated entry. 29 people have moved into permanent housing. 33 are in the pipeline to housing. And then weve gotten 26 people linked into ongoing intensive Case Management because this program was designed to stabilize people and help them get connected to housing and ongoing care. This is a very successful model. And we just need more of this. Then we need better coordination and linkage also. Next slide. So, i am going to hand it over to dr. Nigussebland now to talk about Mental Health reform and then ill come back toward the end to share a little bit about our recommendations. And the other thing i want to say, i know there is a lot of interest among the group about the financing and the budgeting for the proposals were putting forward. And my understanding is that our budget team is coming to your meeting on tuesday to present. And so there will be more information on specific budget things, but dr. Nigussebland has a lot of great information to share. I will stop talking. Thank you so much, director simmons for that overview of the system of care. And i want to say, again, hello to the Committee Members as well as to the chair. Im anton nigussebland. Today, im going to be talking to you about giving an overview of our update about the mayors efforts toward achieving Mental Health reform, which includes some aspect of Mental Health San Francisco. Next slide. So Mental Health reform and the work that we started in 2019 is highlighted in an annual report which is posted on the website and has been shared with the Committee Members as background material. The work began in earnest in early april of 2019 and was further advanced by the Mental Health San Francisco legislation which we now know code fied certainly aspects of people experiences homelessness. And then there are Improvement Initiative was the department of Behavioral Health services focusing on things like timely access that director simmons referred to. But what is the commonality between all three of the areas is the focus on the target population. A Health Approach directed to people experiencing homelessness and Substance Use issues. For the population, we want to increase their access point and the number of hours available for service. We recognize a key need for better care coordination and offering more Case Management. Then lastly, expanding opportunities for Harm Reduction both through the policies and service sites. Lets go to the next slide. So im a physician. Im a psychiatrist and an addictions psychiatrist in terms of training. I spent my entire career on the safety networking with Health Systems in Northern California facing significant challenges in meeting the Behavioral Health needs of their populations. I accepted this appointment at the request of the mayor with a great amount of enthusiasm and excitement to be able to bring fresh thinking to bear on how do we align our services in a way that meets the needs of people experiencing homelessness . How do we align our Behavioral Health services in particular . Next slide. Starting this work, our team of individuals took a very deliberate approach to engage with our Service Providers, those frontline providers. I want to give a special thank you to member andrews, you may recall that he shared so many reports from over 10 years ago of our system of Care Community leaders both in the community as well as the communitybased organizations and our Civil Service providers to talk to these same issues. So we started by looking back to understand what were the conditions and the recommendations that were initiated back in 2009 . And you may remember sharing that report with me. And looking through over 10 years of surveys of our system and linking. There are a couple of additional reports i want to highlight and reports since 2019 that are not listed here. But i do want to direct your attention to the Behavioral Health report which was the most system recentwide survey initiated by the community. And that was released in 2019. Very helpful overview incorporating perspectives from our c. E. O. And the academic community. And since then, our report was also released. I was fortunate to have conversations with jinny in 2019 and it was released this year. There are common themes throughout all of the reports. One of which is a focus on care coordination, increasing opportunity for intensive Case Management, expanding field base services, optimizing the location of services through colocation. Creating databases and tracking systems. Expanding reduction housing with the focus on alcohol. And then lastly, expanding our datasharing opportunities for improving our care coordination efforts. Lets go to the next slide. So our team started out by establishing clear vision. Both our clients and system of care. For our clients, we recognize the importance of developing a system of care with low barriers to access and welcoming environment that meets their needs. And then fort system of care, we wanted to ensure that our system of care continues to be granted in evidence and form that reduce harm and officially deliver the services to people experiencing homelessness. Lets go to the next slide. So there is specific goals associated with these visions. One of which is, unifying our services and Service Providers. Advancing equity by addressing Health Disparities among this vulnerable population. Identifying systemic opportunities for improvement in our system of care. And then lastly, making sure that we continue to apply a datainformed approach in asentence cess assessing and implementing all interventions. I want to talk about the population for a moment and the approach we took. I would describe this as a population Health Approach. That we identified the most affected individuals among us. We began to understand their distribution of their disease, particularly their Mental Illness and physical health and needs. We looked for patterns of care that were inefficient toward improving their health. Ultimately, were going to be making recommendations for how to improve those in the community. So in terms of identifying our target population, we worked with the departments wholeperson care team using their database. And assessing our data within a single fiscal year, 2018 through 2019. Looking at every one within the system of care experiencing homelessness. These are individuals registered within the department of protective housing, or the department of public health. And we identified 18,000 individuals in that fiscal year who were present in either of those systems or both that were experiencing homelessness. I need to point out this defers to a point in time for that same time period. And that is just a different methology for the point in time. Its a snapshot. We looked for anyone with contact in the system of care that identified as homelessness from our data point. Now, among those 18,000 individuals, we began to apply filters for severe Mental Illness and Substance Use and Mental Illness and those experiencing homelessness. And thats how we arrived at the 4,000 individuals. On the far right, you see a smaller circle identifying 237 people enrolled in the wholeperson care initiative. That was a initiative launched in september 2019 based on the resources we had available at that point in time within the system to begin meeting the needs of the 4,000 that were most severely affected among the homeless population. So the Mayors Office made investments into coordination and services for those individuals, releasing tremendous results. Im happy to talk about those in a later discussion. But i can say at this point that 80 of those individuals among those 237 are now housed or in stable residential treatment settings. Lets go to the next slide. So im thinking and considering the health needs and challenges of this population. One, as i pointed out earlier, everyone here is experiencing homelessness. But they also have severe Mental Illness, such as schizophrenic. We look for evidence of cooccurring Substance Use issues, including opioids, cocaine and stimulants. There are interesting finding that developed. One of which, 95 of the people in this cohort, among this 4,000 with the cooccurring homelessness, Mental Illness and Substance Use, have alcoholrelated problems. Now alcohol doesnt get as much attention these days, but it is the most commonly used substance of abuse in the world. Some people say cigarettes, but in terms of Substance Abuse, alcohol is commonly used and accounts for a significant amount of medical morbidity. 41 of the individuals are receiving care in fragmented care. In and out of emergencyroom settings which does not promote services and linkage into services. When we found issues around equity. 35 of the individuals are black and africanamerican where they only make up 5 of our population in San Francisco. Not only was this population from a psychiatric and Substance Use perspective, but theyre medically ill. 74 of the individuals have a chronic serious medical condition. Things like congestive heart failure, renal failure. They have also spent time incarcerated in that same fiscal year. 28 of these individuals were in jail at some point. If they were in jail, they were in jail average two times during the course of a fiscal year. Again, fragmented care. Lets go to the next slide. So in terms of assessing our impact on this population, our team applied resultsbased accountability framework for looking for what types of outcomes would we expect for our residents were to make an impact for the population . We assessed the baseline and then we started making projections about what impact to expect over time. Youll see that on the right of the side, based on interventions that we recommended and you can see those in the oneyear update. First increasing the percentage of the target population who have been assessed for housing at baseline. Only a third had been assessed for housing. Had gone through the assessment to be considered for housing placement. Second, increasing the percentage of the target population retained. In other words, moving them away from fragmented care into a continuum of care that supports them staying in the community. Only half of the individuals at the time from the baseline were enrolled in those services. Number three, reducing the percentage of the target population who use urgent and emergent services. This is a indicator of efficacy of Case Management and coordination of services. Measured by scores by Mental Health and Substance Use assessment tools. And then lastly, increasing the number of these individuals who are placed in permanent Supportive Housing or other longterm placements. And we included the cumulative number here in fiscal year 1819. It was only 248 individuals. This is where we should be aiming in terms of targets over the next two years. The next slide. This slide depicts our oneyear key milestones. Starting with the loss of the initiative as i mentioned in 2019, at that time we also the Mayors Office offered funding to increase the hours and availability of the behavioral access located on howard street. Increased access to Overdose Prevention through naloxone kits. We launched the citys first website to find treatment, where you log on to the site, you will see where there are open beds within our system care and the steps necessary for a client to access those beds. We developed a model for the citys first drug Sobering Center as recommended by the Methamphetamine Task force by london breed. And that model was planned for implementation in the early part of 2020 and the planning came to a pause as with most things as a result of the coronavirus pandemic and the order for shelterinplace. Weve expanded the use of telehealth prior to the coronavirus pandemic. And even now by increasing access, by giving individuals access to smart tablet devices. So a care provider uses an ipad. We completed the first optimization project. One of the most common questions was how many beds do we need in our system of care . What number of beds will help us smooth our flow and achieve minimum wait . We took a datainformed approach to assess this situation and come up with a clear recommendation for how to optimize the number of beds in our system. And that report was released in june of 2020. We planned the pilot launch of the first street Crisis Response team. That team was the first team that will go out at the end of this month, in just a few weeks. I will point out this team is, based on the cahoots model, but with the San Francisco version of that. And that we have licensed clinical providers and we have incorporated the expertise of peer support counselors in doing this work. These teams will be going out working and helping meet the needs of people in crisis who are on our streets. They will complement the work that is already ongoing, conflict of Crisis Services which is the designated team for the teens and adolescence. This is one of the key recommendations from the community Behavioral Health commission. And in our reviews, we found such a high prevalence of alcoholrelated problems among the population, during the coronavirus pandemic, San Francisco had the opportunity to test alcohol and i can say that weve seen significant benefits from the individuals enrolled in this style of programming both from a Harm Reduction standpoint, but also retaining them indoors when they needed to, when the coronavirus was at its worse. So people who needed to be in isolation were able to stay there safely with the service in place. Lets go to the next slide. This slide, im going to talk for a few minutes about. I printed out a question that was asked to me about how many beds are needed in our system of care . Thinks the first analysis and the kwirs quantitative analysis of this type for the state of california. We looked at our system and looked where were bottle necked. We know that having bottlenecks are associated with negative outcomes and has significant financial impacts because people are receiving care but not optimizing their health needs. Here youll see a summary of that report on the summer. And you see here the bed categories for the identifying there were needs for additional investments. We see the recommended bed count increases. The total amount 117 beds. Im happy to report this modest bed increase based on our systems data was supported by the board of supervisors and its funded in this years budget. Now, i need to point out that when doing this type of work, the power comes in repeatedly doing it. At least on an annual basis. So i made recommendation force the Health Department that this process be repeated. You see on the far right, the cycle for how we go about continuing optimizing that supply by repeating this study. Then lastly, its important to acknowledge for every new bed investment, our system of care must also be preparing a longterm housing placement for these individuals. Otherwise, they will stay in the treatment system when they no longer need to be there and they need to be back in the community. Lets go to the last slide. So in terms of looking ahead for what this team will continue focusing on over this year, we are continuing to look at the needs of the 4,000 who are most severely affected among us. Were developing the bed placement tracking system. We made some steps toward that and we want to advance that work with more realtime bed availability information being available to everyone. Expanding and integrating the Crisis Response system. I talked about the Response Teams and the drug Sobering Center, but we also have recommendation force the development of a new s for the development of crisis diversion facilities. These facilities would meet a special need in our system of care between the Urgent Services of Psychiatric Services and the 14day stay services of units, offering a 72hour stay for individuals who need a bit more time to recover. And then lastly, expanding the options for telehealth and telepsychiatry. We have deployed our tablet devices. Theyre available at organizations, including the tenderloin. Lets go to the next slide. So im going to now turn it over to director simmons to conclude the presentation. And thank you so much for your attention. Thank you, dr. Nigussebland. Its helpful to i hope its helpful for the group to understand how much thinking has gone on and many of you have been involved in the thinking over the last 10 years. And many of you have been involved in the thinking and planning that dr. Nigussebland and his team have focused on. So im going to share some emerging recommendations that we, as a collective, from d. P. H. , including the Mental Health reform and others, really based on needs that we understand, gaps that exist in your system, a lot our system, a lot of work that has happened with partners. And one of the things that im excited to see, is that there is at least for Behavioral Health, an emerging vision for how were going to address there is the task force, prop c, Mental Health sf. There are so many groups that are invested in seeing Behavioral Health services improve. So i think what im going to talk about is the beginning of that improvement. Obviously, there will always be things that people will want to add and discuss, so thats what i understand the next few weeks. And then when we Start Talking about the budget specifics next week, im sure well have lively conversation and need for more data. Next slide. So the legislation itself calls for overall, it calls on Behavioral Health to improve access, coordination, quality outcomes, accountability. Its a very broad mandate, but there are specific things that the legislation calls for. So it calls for an office of coordinated care, Mental Health service center, new beds and facilities and new street Crisis Response. So the next slide. The other sorry no need to go back, but the legislation itself wants for our system to improve, but we need to start to prioritize work to improve services for people experiencing homelessness as well as people who are coming out of the criminal justice system. Unfortunately, there is too much of an overlap there. In thinking about how do we pull all of these pieces together and many exciting opportunities with new revenue, were organizing ourselves around these principles that are here. Really we need to better make people where they are and make it easier for people to access care and reduce some of the hoops that we currently have in place. And then also provide more locations for treatment and respite. Im going to walk through a slide for each of these. And then well come to the end and we can answer questions and engage in whatever conversation you all want. So meeting people where they are. This is knowing that we need to expand outreach. We need to go find people. Most of the folks that are on the front line of the homeless response system now know who needs help. So we dont need to put a bunch of boots on the ground to find people, we need to partner with the front line. We need to put Behavioral Health services in the shelters, integrate teleHealth Services to expand our reach. We also need to do Transportation Services to get people from point a to point b so theyre successfully connecting. And the street Crisis Response teams are an important part. We know too many people are in crisis on the streets and not getting access to care when they need it. And we also know that too many of those situations, the police are the ones that are responding. So our hope is that the street Crisis Response teams, again, one going live next month and up to five more by the end of june, are going to replace police who are currently responding to onthestreet crises and will be able to actively engage those people in care. We know we have a huge problem in San Francisco about harm caused by Substance Use. And had a huge spike in overdose deaths, so we see strategies that include expanding naloxone distribution, getting more of an easier access and spreading Harm Reduction practices and investing in those to be spread across the homeless response system. And for our Behavioral Health services to be more oriented to Harm Reduction approach. Of course, there is a lot of barriers to access to care. And so one of the things and this is one of the cases about Mental Health s. F. And our work moving forward that i am most excited about. For those of you who are familiar with the work weve done with transitional aged youth. Over the last few years with Behavioral Health services, we hear loud and clear from pretty much anyone in the community, they know a client that needs help and they cant get the client to the right door. The client goes and are told theyre not at the right door, not at the right hour. There are so many challenges just accessing services. And we have found with the tay work, weve created a system that helps people get to the right level of care when they need it and its going to be more culturally congruent than randomly going to a program. And someone who goes to psyche Emergency Services 42 times in two months and never gets connected to care, the office of coordinated care is going to build the infrastructure so were identifying those people sooner. We have people who are part of a system to alert others that they need care and that theyll be able to go out and do a lot more active engagement. A lot of the Data Collection that we do now that needs to be improved is going to be supported through the office of coordinated care and we also know that training and development of our workforce is really critical. I will add that the training for the workforce includes training for front line homeless response staff. So people working in Supportive Housing programs, people who are working in the dropin centers, they need skills also. So our workforce includes all of those people. Were working with stakeholders in the Implementation Working Group for Mental Health s. F. To really figure out what model of program should look like and what problems were working to solve through that center. We do have a new Homeless Research center that will be opening and that is going to have a lot of supports built in, but also have primary care, there is going to be a lot of great ambulatory Care Services and that is being done in Close Partnership with street medicine and the whole integrated care team. So that will be a great resource. And then next slide, please. And so we need more. More of many things. Im sorry, the one thing about the other thing that the office of coordinated care is going to be charged with, is, again, making sure we have the right number of the right kinds of services. So the office of coordinated care will be charged with getting more intensive Case Management slots, expanding Case Management across lower levels of care to be more accessible. And then this last slide is really about providing more locations for treatment and respite. And a lot of this is based on, the Data Analysis that the Mental Health team has done and just very well informed set of things that we need. So the drug Sobering Center, again, we had the meth Sobering Center ready to go and then covid hit. So we need to come back to that. The managed Alcohol Program that dr. Bland discussed. More residential stepdown beds. Because discharging people to the street is not recovery way to go. Low barrier residential treatment. Were looking at a model that would not require medical hoops. Dual diagnosis and super low thresholds, so this will be an exciting program. We know we need more locked and psyche beds. More Mental Health residential treatment. More board and care. We have money to increase the rate as well as purchase more boarding care. And that price urgent care that nigussebland talked about, so we need more places to bring people as the crisis teams connect with people. We dont want to just have door, we want to have other places people can be brought. That may be the last. Just the thinking ahead and really being sure that all of these activities are integrating. There is a lot of people vested in Behavioral Health being better. A significant number of the groups are focused on people experiencing homelessness. And we have yes, a lot of opportunities to leverage input from different groups. And then this is just the final that is reiterating the vision that dr. Nigussebland already shared. But really focusing on people experiencing homelessness, Getting Better access to services that are more impactful. So that is the end of our presentation. And we are available for questions and discussions. Great, thank you so much for both of those presentations. Im going to go to actually Public Comment before we turn it over to our committee. So is there any Public Comment at this time . Members of the public who wish to provide Public Comment on this item should call 14156550001, access code, 1469968636. Then pound and pound again. If you havent already done so, please dial star 3 to line up to speak. A system prompt will indicate you have raised your hand. Please wait until the system indicates youve been unmuted and you may begin your comments. You have three minutes. There are no callers. Thank you. Im going to member nagendra. Hi. I just wanted to thank dr. Nigussebland and Marlo Simmons for a really helpful presentation. Especially, i think, helping us understand, one, that sort of the plan. I think that the i think one of your slides had flow optimization and how investments actually get to the targets. I think that could be a really good way for our commission to be think being, kind of, you know, how were also trying to create those things for optimization and how investments will get us to our targets. I think those equity principles, transparency, accountability, really resonate. I want it say that i think the piece about sort of helping us connect Mental Health sf is interpreting and implementing. That was a helpful connection to make. I wanted to know, there is one slide i think that talked about creating permanent housing. Every investment, youre talking about housing outcomes. I wanted to hear more about is that something youre working on in the department . How is that sort of coming together . Thank you so much for that question. And with respect to housing, youre absolutely correct. Its an interagency effort. The problem with homelessness and Supportive Housing is that the agency primarily tasked with making housing placements, weve been partnering with them in a monthly meeting to align resources to meet the needs of this population. Weve had a couple of successful projects, including assessments to be done in clean clinical settings as opposed to expecting them to go to the Navigation Centers or their main site. That was one of the major initiatives. The other aspect of that has been equipping case managers also now to be able to offer those interests to their clients. I believe that Case Management, one of the key outcomes has to be placing those individuals into housing successfully. If were going to make these investments into the care. In terms of other things happening, when you look at the Coronavirus Response, weve been tracking what percentage of the 4,000 are placed in shelterinplace hotels. I think there were challenges there. The challenges were particularly from the federal level in that when the cdc opened up the tier for vulnerability, they did not acknowledge the role of severe Mental Illness and Substance Use challenges as a Health Vulnerability for coronavirus. And now we have extensive amounts of data about the impact of coronavirus on peoples Mental Health and Substance Use needs. So our city moved to move people into these hotels and Wraparound Services, so were tracking those individuals and talking with h. S. H. Now about how to prioritize among those, among the 4,000 in the shelter in place hotels as they get moved into housing and ideally do not return back to the community. That is the commitment from the Mayors Office at this point. That these people will be placed in a safe setting. Thank you. Can i ask a followup question . That was extremely helpful. There is prop c funds have 25 for allocated to Mental Health and im trying to get a sense of how a couple of things. One, how some of the work that youre doing, can any of the dollars be used for housing . I think thats a question for the commission too, in terms of attaching for example, if were going to Case Management bed for every case every treatment bed, is there a way to think about Housing Resources to help that person exit homelessness as well while receiving services. But also knowing that is not under the purview of one agency. How does medical billing fit into what what can be covered and not covered . I know this is a complicated question, but im trying to understand where we can go to medical for things that we then can use flexible funds we have in other ways . So on the medical front, there are many things that were talking about funding that can leverage medical dollars. I think we also want to be very cautious in being able to use flexible funds when we need them. Because we dont want the medical requirements and all the hoops that come with that to be the reason people arent getting into care. And i think that becomes an opportunity and its not easy to figure out, how do you it boils down to how are Electronic Health record is going. So we have to do a lot of work on that, but we definitely want to bring in every available dollar. And im glad that you asked that, because i think there are so many opportunities to leverage Different Things that the more we, as a city, have a clear vision around Behavioral Health and really take kind of collective impact approach, that everybody can see their vision and support the vision, rather than silos. And sometimes we set up siloed based on funding streams. Were leveraging medical, but we want to avoid hoops. Thank you so much for the question. I wanted to point out the reason why we emphasized the role of housing is because my son is joining me the reason we emphasize the housing is because at any point in time 75 or more of the people in the residential programs are people experiencing homelessness. And so we have to be very thoughtful as we expand the treatment site, expanding opportunities for people to exit treatment to go back safely into the community. And then the second thing that ill point out with respect to funding, we were all excited in 2019 about the new medicaid waiver proposal. As many of you know, in light of Coronavirus Response at the state level, that has also been put on pause. But there is one key aspect of that, its a component of the recommendations for Mental Health reform, which is supplementing Case Management services is needed so we can better offer client engagement. I do believe that San Francisco should be making investments so that our intensive Case Management services are consistent. The difference being we have partnerships which are the Case Management services with certain supplements offered. And then we have nonfull Service Partnerships. I believe that we should be using our citys funds to standardize that so everyone gets the same level of services. Because we demonstrated in San Francisco, when you offer individuals full Service Partnerships or Case Management services, with you get solid outcomes with individuals spending less time in jail, the emergency room and theyre more likely to be housed. We know what works. We need to make the investment to standardize that approach across the board. Thank you so much. Going to vice chair dantonio. Hi, thank you so much for the presentation. It was super helpful and just a lot of things that i learned today. I have a few questions. Several questions around the intensive Case Management piece. So if its possible, if we could go over what the intensive Case Management looks like, number one. And then also just as far as the numbers. 40 of people who are accessing intensive Case Management not through Behavioral Health, 40 are homeless, correct . And there is currently 200 Homeless People waiting to access that service. So i just yeah, i guess you could possibly explain about what intensive Case Management entails. So i kind of want to see where the other 60 who are not homeless accessing. And in terms of funding through this program, is it going to serve everyone, not just Homeless People . How are we making sure we prioritize them . And like what is going on right now that there is 200 people waiting and only 40 of Homeless People are served. I know thats a lot mixed into one, but i think theyre all kind of interrelated. Dr. Nigussebland, do you want me to start and you can add . Yes, thank you. So, the intensive Case Management model of care is really kind of an everything it takes level of Case Management. Its not always done exactly to this model which dr. Nigusseblands point about needing to standardize is so right on. But the model, the idea, is that it is usually teambased care. So you have a psychiatrist, a clinician, a peer, a nurse, all working with a group of clients. Youre going to be providing them with Mental Health treatment. Locational services if they need that. Help getting access to housing. The full Service Partnership of intensive Case Management includes a little better access to some Mental Health service funded housing. It also includes flex funds. So if someone wants to get a job and they need a bike to get to work, the flex funds can pay for the job. So it really is focused on helping someone to build the life they want to build and doing whatever it takes. The case managers are very mobile in the community, meeting people where they are. The most significant thing about the i. C. M. , is that the case loads are way smaller than youd have in like outpatient therapist or case manager who could have 50, 60, 100 clients. The intensive Case Management model right now is generally about 17. We believe thats too high. A goal would be between 10 and 17. And so thats the model. So really if you need therapy, you get it. You need medication, you get it. And ideally, it stabilizes people, gets them on their trajectory for recovery and they would gradually step down to an outpatient program. One of the challenges is the outpatient programs, because they have very little Case Management support. That step from i. C. M. To outpatient is sometimes too big of a step. So a lot of the outpatient programs are like, we cant take someone coming out of i. C. M. , because we cant case manage. We need to build case manage capacity. In outpatient, the more i. C. M. Would be focussed on that flow from i. C. M. To outpatient and back up. Because we know recovery is a cycle. We currently have 1200 intensive Case Management slots funded. We have shown to be very, very successful. And there just is such a high demand for that level of care, that we have about 200 people in the waiting list. We have a few vacancies across our programs, but its really just the demand is high. We also have people who are again not being able to be stepdown when theyre ready. So everything is connected to everything which is why i keep talking about flow. Because even if you build enough i. C. M. Programs, you need people to start stepping down to have the flow. And there are 200 people on the wait list. I dont have the number of these people experiencing homelessness. And then the 40 , its usually for Behavioral Health. When someone comes into the program, its usually when we mark the box about their housing status. And so ideally, people who are in i. C. M. S may have been homeless at the time of entry. But the i. C. M. S are very active in getting people housed. So that number hopefully will go down. And then the last comment ill make, just in thinking about, you raise a really good point. We want to prioritize people experiencing homelessness. And we also need to remember that our system is serving people who are medicalel that have specialty Mental Health or specialty Substance Use services. So those are not a level of need that could be served in the primary care program. You know, or going to a Therapist Office once in a while. These are a very, very vulnerable population. Many of whom are at risk of homelessness, have experienced homelessness, have come in and out of incarceration and so it really drawing a line between who is homeless and who is not in a medical safety net specialty Mental Health system is something we have to be really careful about. Because there are so many Vulnerable People that were serving that could be homeless tomorrow. Because their Mental Health issues can get them evicted. How were going to define that is an important thing. Just a followup. Thank you for that. It was really helpful. I definitely see that last piece that youre talking about. Im wonder federal governmentin plan in place to prioritize Homeless People . Basically prioritize Homeless People in looking at programs i guess id like to see the breakdown, like, of people accessing those services, like, more numbers. Like specifically around Homeless People accessing these programs. Or people that we consider to be at risk. Just because propc is funding for homeless programs, so i want to make sure that were talking about this with at least for me im feeling like im not understanding the whole picture, really understanding the people who are not considered homeless who access the services, help me to understand the Homeless People who access it too, that makes sense. Yeah, i think we can get you more detailed information about clients enrolled in intensive Case Management. I would say when we start to build new intensive start to buy new intensive Case Management slots, we have to look at who which programs currently serve, you know, the greatest number of Homeless People experiencing homelessness, who is doing the better job of serving that population, so we start funding in the right place. We also need to think about when were doing assessments and referrals, where are we taking referrals from . Are we working as much as we on the street, with the hot team, in Navigation Centers . We need to be responding where we put our assessment and placement functions matters and can help us target the populations. And we know people coming out of residential treatment, coming out of the hospital, where would it put those types of referral things in places were not seeing people experiencing homelessness. So we would be biased in that way. Not sure if that answers your question. No, no. That was a great answer. Thank you. All of your answers. Ill go to member friedenbach. Youre muted. Thanks so much, dr. Nigussebland for the presentation and director simmons. I just so really helpful. I guess part of what i was looking for and im confused why were having supervisor ronen present on this, because all of my conversations with her, she says she doesnt know. Can we get a breakdown on what it is that you guys are planning on spending that are program monies under propc that the way that it was presented to us by the Controllers Office, it was Mental Health sf. I still dont know what that is. I have no idea. And it looks like almost all of the money is already spent on items that we have no idea what they are. So we need to know what it is that is being planned specifically. Exactly how much per item. And we need to then weigh in and decide if that is a priority or not. I know for me, you know, as one member of americaning many, im going to interested in funding things that make a substantive difference in peoples lives in terms of stabilizing them in a bed, in terms of moving them to permanent Supportive Housing. And a lot less interested in what i call gobblygook stuff, that from an unhoused persons perspective, its like bureaucratic. I mean, unhoused people, ill give an example. Theyre not too fond of coordinated entry. They see it as a way to basically deny them services. And spending millions and millions of dollars to tell people theyre not eligible for services. And what they do want is a place to live. What they do want is a residential treatment. What they do want and people do in terms of the Case Management step, i definitely like that, but the way that its you know, i think we were thinking about it as something that follows people into housing and make sure that people i mean people with severe Mental Illness, lets face it, theyre not making their way through coordinated entry and into housing for the most part. I know youve been doing stuff to fix that, which is awesome. If they do manage to make it through the entire crazy bureaucracy where youre not even allowed to barely bring an advocate with you. Youre supposed to provide a bunch of paperwork and all this stuff. And going through all these things. Ive worked with people on these housing placements and its absolutely insane. If they do miraculously make their way to housing, the level of care theyre getting is not where someone with severe Mental Illness is going to be able to make it. Theyre going to end up back on the streets. Thats what we found in revolving door. I think there is a piece where the intensive Case Management can follow people into housing and help make that happen, but i just im a little eager to see kind of like the black and white dollars and cents about what was being thought of so we can think of that stuff. Im super interested in, you know, weve we had care on the last list, but id like to see the cost of buying the care facilities and creatively having a new model for care that is sensitive to services and has that beautiful communal living that can be really positive. And i know that, for example, visa manor is for sale. And they have room for a ton of people. So i want a dollar amount. Those are kind of my comments. Thank you, member friedenbach. I know controller rosenfeld wanted to be here, but pulled to another commitment for the board of supervisors and theyre pulling all those numbers together. So hell be putting request to delay the next meeting so they can get all the numbers together, about but thats all depending if were available as a committee. I wanted to add that. Member leadbetter . Good afternoon, everybody. Its good to see everybody. Really wonderful [indiscernible] a couple i think slightly different to it, but looking to this and but the exercise was eventually going to get to [indiscernible] kept coming up, this is how we maximize. Struggle for providers and clients alike. [indiscernible] if there were housing. The Navigation Services are only so great great if they were with housing. So i would really like to ask and answer for each dollar spent here what are we doing to solve the housing problem. And so i think thats a how well and i saw that in the tools, very cool. I like that a lot. I think thats kind of what were asking for on the homeless side. And i think i guess my question there was similar to asking about these care facilities. Its clear we can spend Health Dollars on acquisition we have on the on the housing solution. And our system has been struggling mostly medicalbased dollars on housing because we all know this causes a problem. So i would love to hear a little bit of how you guys are that and maybe [indiscernible] what you bring forward for the housing dollars. Thats what were doing. Share a little bit of in terms of where youre thinking as far as [indiscernible] director, did you want to respond . I was thinking dr. Nigussebland would jump in, but im happy to respond, too. There has been so much work and thinking around the beds that include the housing piece is critical. I have to ask you to restate the question. I was a little challenged because i wanted to be respectful of your expertise, but can you restate the question for me, please . Sure. I think how can i say it more succinctly. How do we know that its going toward maximum expenditures . So, Case Management is important. [indiscernibl [indiscernible] this will be the [indiscernible] dollars are. If you [indiscernible] and maximum housing is what im calling it. I will say that in our approach using the data from our system of care to identify our bed capacity needs, that approach was done irrespective of whether someone was housed or not. Meaning people need this level of service, how many of those level of service do we need to meet the demand for those services in our system of care. I also pointed out that 75 of the people in those services are experiencing homelessness. So one could defer if you expand the services, more homeless would be receiving the right level of care. Whats interesting about housing is as i pointed out, the Supportive Housing is an agency with the primary charge for developing new housing placements. So d. P. H. Can be very helpful with providing data and information about the Actual Health needs to be able to construct a program that would be able to provide adequate services so that people can stay housed. I think thats what weve been trying to do recently in terms of data sharing agreements and how we transfer information so they can structure the services appropriately. Now, the reason why intensive Case Management is such an important thing, when you look at the 4,000. When you look at the 4,000, only 10 of those individuals have intensive case managers. Meaning that the definitive service with someone with severe Mental Illness and issues most of those individuals are not receiving that service. And so it was very intentional to say we need to expand i. C. M. Slots and we need to expand those slots to meet the need of this population, which was bolstered by Mental Health of San Francisco. And the emphasis on expanding intensive Case Management to achieve ratios. And as director simmons pointed out, were functioning at ratios of 17 to 1. The last thing ill point out from a what is the data tell us . The team may be interested in the at home study based in canada and five different provinces where use a housingfirst approach and compared housingfirst with Mental Health services and housing with Case Services and it was astounding with what people achieved. Even if they used substances, they stayed housed for longer. So i. C. M. In the context of housing can be an effective intervention for many individuals. Its a lesson from the canadian athome study. Thank you. I want to emphasize im full supporter of or provides that [indiscernible] about the important levels. [please stand by] [please stand by] i think we have opportunities to explore new models in housing which may not work for everybody and we have step down housing and looking at medical certified treatment and then housing and theres more opportunity to have housing beyond what were currently doing and we need housing. Its not effective. I think its clear they need more of our support to successfully house people. This gives an opportunity to build things as a team in way that i dont think has existed before. I think you hit the nail on the head there and so theres a conversation about housing and [indiscernible] [aud [audio muffled] that optimization [audio muffled] im hopeful [indiscernible] thank you so much. Thank you. Im going linda miller and then we should move turn the item to have a good amount of time. Member miller. Thank you. And thank you for the presentation. I have two questions. Im not quite sure how to get into this but the question i keep asking myself over and over and over is as the demand grows for Mental Health professionals and psychologists, is there enough supply . I just graduated and i know every single field theres a shortage of psychologists and Mental Health professionals and everyones projecting a shortage and Mental Health was more of a taboo and now its being accepted and everyone is recognizing the need to have Mental Health professions working inside the system. Im wondering with the demand coming out is there enough Mental Health professionals and appropriate enough Mental Health professionals because ive been in a lot of situations where you have someone not appropriate to the population and it can be very triggering for people and create more problems particularly because Mental Health professionals tend to be in a position of power and their stories count more and people can feel like theyre not being heard and be trigsered more. The second thing i wanted to ask is were talking about different models. Now, i cant say ive been around every block but ive been around a few. The Navigation Center and now the village. So me i can say from experience at least 95 perhaps all of our guests would wen fit from Mental Health therapy and why arent there therapists and Mental Health professionals just stationed in those places. We know just about everybody who has experienced severe trauma before they get to the streets is definitely why theyve experienced living on the streets is trauma. We can have a line going around the block and when you embed the Mental Health people inside the living facilities they may develop relationship that can also benefit from warm handoffs of people they already have relationships with and not as stigmatizing as going to an office or chasing someone down to an appointment and have noshows and all that stuff because ive done Community Therapy too two years ago. It seems to me if were going to start designing systems with Mental Health needs in it, put the Mental Health people where the people are. You have the shelter and if there was somebody coming on a regular basis or stationed there, i know we could have people to feed them regularly. Im not sure where that is in the system or why it doesnt exist but i wanted to add my two cents. Thank you. I wanted to under score the conversation and we want to make sure theres a pathway to housing for people and i hear what were hearing is having them connected. This isnt a question you have to answer now but juan to think about which is what is needed to have a more housing plan for folks and what does that look like operationally and what does it mean other than better integration with the housing and homeless system. Its a question id like us to have an understanding better. If i may add a couple comments. To your point the maximum is where the office of coordinated care so critical. Because youre talking about people going from point a to point about and unless theres a village supporting those data systems and training and process and procedure those two silos are never going to talk to each other. You should have a housing plan as they walk in the door. Within a week you know where that persons going to go and if you dont have friends in the housing world working actively with the Treatment Program that bridge isnt going to happen. We have to build the pathways and thats what we havent done in the office of coordinated area wont let us do is think about point a, b, c, d and what is the path all the way and thats not easy. Weve had pockets of success and where care is important. That has to be someone said its not behavioral house or housing, thats the point is its about pulling all the resources together to help people have successful outcomes. Were moving towards that as a city. And we have not the same kinds of all shortages of Mental Health professionals and were aware of disparities. We need to do better on retrutment and we have pipeline programs that we put in place over the last 10 years to boost and do better recruitmentment in the pipeline programs and the other thing ill say is when the shelter in place start the initial reaction was ill provide this in every hotel and then we ended up having people sitting around and its a model that emerged the people in the hotels to have a basic understanding of Behavioral Health so they can call help when its need and what Mental Health needs. Its not always a licensed clinician. You can have a welltrained peer doing support and identifying people when they need help and get them the right kind of help and to be flexible with what that is and the coordination is very important. I dont ever think well have enough bodies to put people at the ready at all these sites but theres so many things we can do to coordinate Different Levels but step zwaej of aur cashing staers and and the thats what we are focussed on. Thank you so much. Im going to move us to item 5 and well have time for discussion but i want to thank the doctor and director simmons for this amazing presentation and great conversation about connecting to systems and i appreciate the presentation and ill move us to item 4 which is developing and Decision Making framework. The committee will discuss the goals of the ocoh legislation and identify common values and priorities for Decision Making and develop a framework for the way of proposals of opioid funds and ill lauren it over to law ill turn it over to laura to facilitate. I think when we worked with the chairs on the agenda, we wanted to make this a bit of a retreat and pulling out your thoughts and ideas and helping you all get to know one anothers perspectives a little bit better and create a shared Committee Information of the goals of the work understanding of the goals theft of the principles and the goals youll have moving forward. This is more of like the typical touchyfeely retreat type content a little bit. Ill structure it so everybody has a chance to share and ill have a structured process to give everybody a chance to give at least one idea and then well have more opened discussion to weigh in on the shared information a little bit more. One we get through the values and principles and structure your thinking around your understanding, the next item will pivot to talking more about all the things we heard over the last meeting and a half and that will be the next item. Now that we have a shared understanding of our framework, how do we want to prioritize and what do we need to dig into more and understand better and laying out a process and work plan for yourself on how you want to touch on all these issues moving forward. Thats coming up next and setting the stage for what well be working towards. Im going to share my screen and do like a visual note taking. This is my version of a float chart. Well use that. Well take notes and make sure everybody sees the information together. I really miss having markers to write on the board with but well do our best. So just starting off i think we had thouths of what the goles were to make sure we all are together and have the intended purpose of the fund and the committees goals and general brain storm. This is from the legislation that created the committee and the ordinance said with the analysis is the intention to hows 4,000 Homeless People and fund needle assistance and rent subsidies to keep residents housed and Substance Abuse services to move the citys most severely impaired individuals off the streets. Thats a big bucket of intention for the fund. I wanted to give a followup chance to unpack that and give your perspective on what you see as the primary goal of the fund and the committees work. If theres anyone that would like to start by sharing maybe well start with the chair who rarely gets to speak. If you have questions for the member and there was a presentation around system models and what is used in other cities and if anyone wants to use questions during this time we can do that as well. Looking at this makes me want to not wait for folks to enter into crisis and how are we going about this process in an up stream way. Thats the part around Legal Assistance and rent subsidies but thinking broadly around that especially with the last presentation from the Behavioral Health systems and looking at the homelessness bucket and wanted to think in that way about it and of course lifting up the lived experience from the presentations that we had yesterday and other reports we have seen. I want that to be a core part of how we look at this work and obviously theres a way folks are flowing through the system that its not getting us where we want to good. I dont think its as simple as the 4,000 and 1,000. We have to think much broader than what im seeing here. And i cant see the hand raised because of the way the screen works so if you would like it wave your hand i can see it better. I saw brett go before debbie. Thank you. Building on what the chair said, i often think about for those that know im associated with p. R. C. With Wraparound Services and a significant continuum of crisis care through Supportive Housing for about 270 beds across San Francisco. P. R. C. Has the opportunity to provide hiv services as well. One thing i see and this is why where its a heartbreak the consistency of the inequality and over representation of the Behavioral Health and hiv and frankly the black African American report that continues to come out on an annual basis. The high common denominator is people who are depending on who you ask, 5 to 6 of the population and represented in all the key areas which is incredibly difficult and fru frustrating and incongruent with the philosophy of San Francisco. Im struggage with struggling with that and we often talk about the Racial Equity lens and a want to make sure its just not a platitude and cache phrase. Its clear some of is this by default and by design. Thats my first piece. The second piece i wanted to say with all due respect to all the conversation were having around housing and im glad im signature here to provide Emergency Assistance through to lack of services, for everyone on the call i know you just dont have a house. We know that. We have jobs and those jobs have health care and they have many other things that wrap around support services and we benefit from every day to keep our lives moving forward i would not want us to be and i dont want to hear about having a job and having meaningful employment and giving back to society and things that exist right now that we talk about it from a broader perspective because to share the point, we cant wait for people to fall into care. I dont want to build into care that only have down Stream Services and all weve done is not paid attention to the up stream and allow for a steady diet of people to to fall into disrepair and disenfranchisement which a lot of the state and local programs are structured. Though were talking about how we think about what is needed for a person to feel full, whole and complete. Thank you. And its a way to address disparity and the whole person need and get people housed. Cool going after you two. 1,000 other things. So i think i just wanted to expand also on what chair williams was saying about going upstream from in terms of not waiting until people are in crises or experienced a lot of damage because theyve been homeless so long. Also, going up stream in terms of age. We have a system that also for lack of a better term discriminates against younger people the way its set up. Children and youth and our families have young parents. Its about acuity and things emphasized once youre older it means were not going up stream and creating a situation where younger people are having severe negative consequences of experiencing homelessness to then decreases their opportunity opportunity for the rest of their life in terms of trauma and things they experience. I wanted to broaden that up stream piece of things. And representation on African Americans, i think we should be explicit and what were doing is not equal access but disproportionately larger for African Americans. If were going correct the inequities we cant just say well take mur sure African Americans will have equity and we have to be intentional and we have to be explicit and well have a larger proportion of African Americans served to make up for that historical piece. And i really like maximizing housing and i think for me the way id frayed phrase is we should prioritize the initiatives that have a tangible impact and are able to make it feel more tangible. I want to agree with the job and community and Economic Development and i think we have this beautiful opportunity to incorporate that into the new system were basically building. I think about when youre creating housing you can get union cards for folks unhoused and when youre creating new programs you can make sure theres Capacity Building so within the program theyre able to hire folks that are able to take on jobs and if theres a building out of the capacity necessary in training dollars and all that to make that happen. Though we didnt specifically fund job training within prop see if were seeing it as an innovative shelter or Health Program etcetera that could be done well as well. That was a lot. Integrating whole Person Services those noted as part of your purview with the fund and more emphasis on how it disproportionately provides services in our system. I saw a member. Well go i think and echo those. Theres a mention of prevention and employment and meaningful connection to employment. I just want to talk about that and we were talking about we have the buckets we know and heard a lot of information and is helpful information about all the different kinds of Department Plans and budgets and it feels like we have to think about how to evaluate all these different plans. [please stand by] how will the investment end Mental Healthness and employment and housing or how will that get us to the whole so theres a rational intentional way were funding and it feeds into clear outcomes that we can track, track progress against and so the public where the funds are going and where we making falling short so we can inaudible four months and say we werent able to purchase that moment and for when things arent working out and we need to change our funding strategy. So in other words, i think im repeating myself but the commissioner having a comprehensive plan and also so that we have something that were holding that we kind of all share so we can start evaluating things. That talks more about a work plan and sort of thinking through how you structure your work moving forward and so i would love to hold that thought and it keeps us in the space of thinking about values and goals that we have and then bring this back and this sort of proposal of creating a framework for how the Committee Structures its path forward and the next item. Im sorry, if i could respond to that too and i think meaning like a larger, i definitely that im also talking about a work plan but sort of a level up from that is sort of our Strategic Vision using our goals so we can set outcomes and goals and figure out what the work plan is to get there and we dont have those goals to reach yet. , create a vision for the of the funds of what you want the impact of this specific fund to be on San Francisco and cry eighting a process to work towards it and measure the oversights function on it. So, you were next in line. I definitely grow with the comments and want to lift up the disproportional and its heart break to go see that from a black women as well and wanted to figure out how we can address that and be really intentional about that and we have to looking at both of these systems and the older representations so we want to second that and i am thinking about the housing plus jobs plus healthcare piece and being a Workforce Development provider and being a Community Space for house less folks and just wondering the magic that happens there that folks really get connected and whether its taking classers being in programs and they get to have that engagement. I think that makes me think about just Community Space and folks can be where its not just going to be housing but creating space for folks and to have a community. In the space where theyre not stable and they may not have housing and they have that community so theyre thinking about that as well and im thinking about also social capital and how that plays into this as well and just i want to lift up the issues around the 24 hour intake and what we heard from homeless prenatal programs and just pregnant people and families with Young Children and folks with Chronic Health meets and i want to put that in addition to the black community which will probably be called to, yeah, we have confirmed to me and yeah, its just really loves a conversation were having. Great. So, thinking of the fun a way way to support Services Available more broadly and more deeply and member haines. Can you hear snow. Yes. Ok. Cool. Its so great listening to everyone and im excited about the portion to put in all of our wonderful ideas. It was great hearing with in terms of jobs and housing and those are the onetwo combinations and im speaking for myself and my personal experience and the things i would like to add to this list is when i experienced poverty and homelessness and in some of the target demographics that were speaking of being a person of color and lgbtq and what made me successful supportive infrastructure and this is what made me successful because i was able to access it from my friends network. Were an mazing city of San Francisco and we build some of this support infrastructure because housing takes time and i know that the process of our goal but things that dont take so much time to build would be additional access to showers and it was great to hear theyre different on that and we always know that bathrooms in San Francisco are a big issue and in terms of getting access to that 24 hours a day in addition to the hours and one of the things that got me to add and organizations and that i know that i learned homelessness and from a woman who had a child that the city only had two organization thats were providing storage and not 24 hours which is what i would like it to be but in that storage opportunities, you could not fit a stroller so 24 hours access to storage. And its bathroom and large reand a place to charge my phone and that made it easy for me to navigate between what i needed to do and successful in my own homelessness situation and it needs to be a Committee Leader in addition to all the work that im doing with you all. So i would like to figure out how we can build those resources and make it accessible in each of our districts in San Francisco and making it easier for people to not have to troy to go all the way to district 6 where the majority of the services are being provided and people should access it in their local neighborhoods where theyre experiencing their situation. In that support of infrastructure i think that ive heard a little bit and i would love to hear more in the work we want to do in the future is transportation, like it is a pain in the butt to break down an entire living situation and a house or apartment which ive done more than once and to secure those personal files and things that you get access to a job and the precious belongings, clothes that make individuals be able to have that sense of confidence and selfrepresentation where theyre going for jobs or other opportunities where they need to keep the positive experience and being able to get those items from a to b to z whether you are couch surfing and its really expensive. I had to break it down and i dont know a lot of people who can manage that when they have a home and when you dont have a home and you have its difficult because were trying to address that. To have Community Space thats allow people to get some education and framing opportunities and allow those Mental Health services and professionals to provide triage to navigate people and the quality of their resources that are available in the city from different partners or city agencies so it would be wonderful to be someone with that and we heard about those things and i know that there are the wealth of people on the streets who are a small family and a father or a mother and a family that includes a pet. I want a pet. Im looking forward to getting a cat in the future but im supportive to make sure that for the parents of children that some of the funds can be dedicated for the children to get their supportive programs and Educational Programs and Child Services or pet service zoos that the pets can as they deal with the situations and i was just talking to home girls and she was in one of our sros and shes shelters and take care of that and that adds stress onto the person who is dealing and out of the systems that we have available and this is supporting that has helped people feel comfortable and i was on the Advisory Committee and we focused on housing and homelessness and this is under mayor ed lees term in my short time on that committee, we talked about having a single support platform where all the services from non profits in city could be integrated and im not sure where they left off with that because ive never seen a single loot form in multiple language and for our work and effort or the general resource use for the individuals to experience the situation it would be nice to have the single platform that people can go into help them navigate all the of the different resource providers the housing opportunities and Educational Opportunities and Mental Health opportunities and supportive childcare and test support and the infrastructure and triage Access Points across the city and i help that mental work through our efforts and so those are a couple of ideas that i wanted to throw into organizing that and. Thank you so much. So we heard a lot of some support infrastructures and as well as some services for families and children and i saw member ridge yo, next, goals that you understand sort of for the funds, your perspective on that . So the immediate thing is maybe the obvious and i think brett reminded the chefs today dont only look at covid impact but we have to look distinctly at the covid impact right at the beginning of this, im concerned about 2,300 people if i have the number correcting and having to lead and i very much want to know what the plan is at that point and be helpful in terms of saying it that it seems right or what elements of it and maybe we need to attend to further and i dont have a sense of how were going to be able and how the city is going to be able to do that with the housing slots that are available on the housing opportunities available right now and shelter and related programs that appeal to me to be insufficient and i think what we can do is give the experience of everything lodged in going back to the street so thats a very significant point to me as we also work on a longer term plans and i having been in the work a a long time, in no way discount the importance of all the other elements of the employment, the Economic Development and the meth Health Services and i guess im a huge believer is all of us are inHousing First being the issue and our focus is to be really. I could say easily affirming ought things. The third thing is we have to Pay Attention to capacity, system capacity ex building that. Weve talked from the equity point of view and making sure that we spoke about some concern on where did we find some of the folks we need to hire and i know when i was there theres always a challenge. How do we develop that workforce so i think we need to be confident that the tempts dealing with this are precipitation attention to that and we have to be concerned about cost factors in that and we cant low ball those costs and i think that you can expect in the past weve done in shelter and minimum wage in expect people to sustain work in that way so i think wages of very important in this and its great inequity of wages in our community and even in the fields so sometimes the inequity between the Public Sector and the contracting and is significant and we to make sure or encourage in an oversight to say if theres going an element of development of housing or development of shelter or the way that issues theyre funded at quitly in order to sustained and that organizations can keep on going with what is needed. I heard a lot about focusing on prioritizing Covid Response how we add a cove response to settings and the priority and thinking about the provider networking sustainable when wages. Were talking about a lot of these goals and we are also talking about and were get something of that out of some of your responses and i know we havent heard from everyone yet. I want to bring out some of that context if you want to share more about specifically any other priorities that are coming up or some values around the how this committee decide to use the funds that you want to add into this mix, we ca we can enta gret as well. We heard Housing First and sort of like principles of longterm solutions versus short term and principles around looking up stream for example and how we prevent homelessness and how we work on the person in homelessness and so just sort of trying to draw those concepts out of those and that is the goals of the use of the fund as well and so just if theres things you want to share just integrated into your commentary around more principles for these values and further and how the fund should be structure or nice so i saw a hand from chair williams and i know we have a couple people havent yet shared. I have a correction to where it as leveraging community partnerships, its Leverage Community partnerships that build social capital and community and. Great, thank you so much for that. I have captured something and and understanding and and build the social capital and and communities, a sense of community. Its the meal. Yeah. We have such a great list already and like people had a lot of great points and just to see things that i want to add are making sure were sticking to San Franciscos definition of homelessness and we are trying on those folks and not just limiting ourselves with federal definitions and theres a reason that San Francisco has that definition and the funds for i want to make sure that not necessarily and its not limiting restrictions. And then, i guess that also ties into id like to see coordinated enter tree like if some of our plans are coordinated they would be more restrictive and more transparent because i feel like its something we heard multiple times and then that kind of goes in my next point which kind of spoke on which was around lived experience and really centers around people with lived experience and in that getting more presentations from people with lived experience and making sure that we are getting different voices like youth and women who have gone through the db system and and things who are a little bit more invisible and really getting some of their, yeah, some of their input and i guess that brings me to my next point which is talking about the data conversations that we were having yesterday and where i definitely agree with centers ourselves around data and i guess my one apprehension to that is like just not only focusing on that because i feel like sometimes we dont have a lot of data and just making sure that were also just hearing from peoples experiences and drawing from that as well. I guess sustainable longterm solutions for housing so, for me im more personally focused and ive seen more success in longterm solutions versus rapid rehousing. Especially for families for some people it would be successful so i would like to look at acquisitions of buildings and making longterm investments and Affordable Housing for the community. Yeah, just really looking at more peer to peer models of funding so similar to the original presentation. To do Like Community work basically its been really successful. So, yeah. Yeah. So, i guess just around the longterm solutions and this might be a less value centered and more like tangible things that im thinking of and id like to see us look at the cost to move up the pipeline and for housing coming online and do an imminent Domain Research project and make to see if theres any buildings that we could have for homelessness. Thank you. The defense of homelessness and not letting that limit understanding of people with experiences and then longterm solutions of a priority for you on strategies for the use of the funds as opposed shorter term. If also we could just add a little barrier and its a lasting value. I saw your hand. I have a value of being achievement and outcomes driven and ending homelessness. I think the conversations about system modeling planning is at its core a desire to be successful and dealing with wholeness and giving folks every opportunity to have a life of wellbeing and active care and and i think i also want to further and go back to the original of the registration and im not sure that the paragraphs would be the paragraph that i was full out if they were and and did he tell a plan in place and we can measure against. I think and its a lot of great thinking and on the community that is better than legislation and honor the fact that its here and grateful to that thinking and bring it forward a little bit. Were charged and doing these assessments, were charged to send a certain and im confused why they havent been here with us and i see anne is on here and im confused on that role and its has 50 or just having these and there is already great thinking around the tax and the floors or all the different expenditures that are a lot of what all the members were saying inaudible short term rental and when we have that lets look at it and see if its working. Were getting our housing within our Workforce Program so really we have this point and workforce and inhousing as in workforce income support i think its proven and acquisition we have is in the legislation and looking at different prioritizing different populations and its already inaudible being called out and families being called out and from shelter and it will be important to shelter and inaudible . Homelessness prevention. We havent gotten to talk too much about but its in here and i think its important for us to obviously the Mental Health team and then, you know, i think also to the value that were also charged with the Oversight Committee developing recommendations and developing unique assessments and allocations against this and called out our jobs to promote and facilitate transparency and this is the one that you ex tighted and empathetically and i know that and many people care and why this passed and it passed out of a movement and i think its there to keep that movement going and whatever we can extends, we have at this table to the very, very big sense of being involved and specifically how to do that and weve already gotten offers of additional funding, planning support, would have the transparency as well as the competency and here i echo all of the numbers that is not just cultural and they talk about it in the past and its hard of equity and we can use the model and the achievement asking and answer questions and its the target and disparity. So, for me, i would love from my personal experiences and near professional experiences and we also have a really understanding what the need is and hold back responsibilities seriously as the fund it is going to be the funds to tax everything out so we can look at that as a limited box or we can look at it as just the beginning where theres more and more interest and excitement and im excited about that. Great, so thank you. So really just like drilling into the legislation is important to you and pulling out all of those key sort of buckets and goals from the legislation as you are sort of basis for driving decisions. I want to recognize member i just want to say yes and the movement. Bringing up stakeholders to bring your thinktank of it, great. Member miller, you are the only one we havent heard from and i want to give you space if you share to care on your values or priorities and sort of what you see as the driving goals youd like to put forward . Sure. Well, you know, ive always said, im very pragmatic. All i care about is where the rubber meets the road. I think we a huge opportunity to create a system that can be copied in urban Centers Across the country. Recently i had a develop proposal so i have to do research and i was really surprised to see. I think it was like over 60 of unsheltered people are living in the state of california. So what does that say to me . I know there are a lot of natives here that are experiencing homelessness right now. I know that. Some of them are family members, friends, family members, people i grew up with and i can see that. There are people who are from here but i know that we have to be honest. Us who are on the coast, were having an influx of people coming in because of our temperate weather. So, you know, i work here in San Francisco but also in los angeles so i get to be in these different places where i see the frustration and how different people are grappling with this situation thats emerging and really no one knows how to deal with it but theyre very angry and the way that i see it is that california, los angeles, San Francisco, oakland, a lot of us are tasked with figuring this out for the rest of the country and while everyone else sits around in is mad about the situation. And frustrated about the situation. Its very few people who are actually sitting down and trying to figure it out. Im excited to be a part of this body. Im excited about the presentations because what i saw is that people have been doing a lot of good work for a long time and really thinking about this as long as we hit our mark. I think that theyve kind of showed us so what i think agreeing with what member said about having a higher vision, i think our vision is much higher than even San Francisco. And we kind of have to see ourselves as figuring out for another level and thats not something that is about us being boastful or thinking too much of ourselves but its just kind of what is before from being thoughtful about how to do this and not just reproducing the same thing and so one of the things i liked in the presentation yesterday, was when they show kind of where everybody is along the continuum and what the needs are in what the gaps are. So, if we know how much money we have, in each category, and we know what is there and we know how many people are in what situations, meaning, what kind of would work best for you for where you are right now and for some people. For some people its sro and shelter and some people its more longterm housing and some people its a bus ticket back home but us being able to provide and match people with their needs, the other thing that is very important, you can throw money at services. But if those services are not staffed correctly, and you end up with a lot of open beds and so i learned this in los angeles when they were looking at us to staff rros and one of the things they said to us, were talking about thousands and thousands is that a lot of vacancies because theyre so dangerous that people would prefer to live out in the streets. When we started to look into it in San Francisco, and so i think and also, some shelters and people feel unsafe there so i really feel like and that shows back to the point and my people make good money. They make good money so we can demand a certain level of service out of people and we get it and people understand. I staal my staff that you get paid the same amount of people and i expect you to treat every single guest, im talking about in the village in front of city hall just the same way as you would the w hotel and i can tell you for the most part, it works and we cant, the problem s. When were paying people minimum wage, you know, they dont sometimes female care about their jobs and a lot of times people dont and theyre just doing it for the money and its hard for you to hold onto it because theyre paying the same amount as bugger king and we really under value the people who work in these services and so, i think if we want better value than we have to start evaluating, i dont know if i want to say Service Providers but a lot people who are along the continuum providing resources for unsheltered people i think we need to look carefully at the quality so we can maximize it so people can feel safe and live in clean places and really have a place to start to come down from that cortisol high. That and also the transparency and i feel like we have to work it and when the mayor put that shelter in place order in and it was 500 tents in the den ter loin. This morning there was 27 tents in 11 makeshifts now i know there was a lot of federal money coming in and other money coming in. What that told me is we can figure this out. And we can figure it out quickly. Now we just have to be worked about how we do it and build strategic about how we do it so we can sustain it. So i know i said a lot. That was great. So, im just going to add a plus one up here. So, that model system that you are talking about how do we create that mold system that other cities row lion us to build for them and to leverage themselves and then having a targeted approach, target interventions that actual needs of clients and the quality of the services that are being delivered and we need to focus on that as well to ensure that were paying people enough to deliver highquality care to the vulnerable populations. And i want to get us to thinking through a shared understanding a little bit more clearly we have a mix of ideas and principles and values ask id like to have a conversation about the group about anything that sort of doesnt anything you wouldnt grow with is this create a sort of comprehensive list for all of you and there anything we need to add to the list or anything we need to kind of grapple with a little bit more and you want to adjust to make it something that you can agree with and so i want to guess us to a place of shared understanding there and any policing things missing this that are changes and member andrews and it wasnt sure if member register yo was leaning forward to speak or not. Thats what i saw. Can i just say, are we almost on item 5. We have some overlap in our conversations. So i just want to make sure that were. I will get to item five so im trying to wrap this but get up to a place where we feel solid about this content so we can pivot more fully to thinking about awestruck attitude process but i dont want to close it out with people feeling that this is representative their views. If that works. Go ahead. Do you want to speak first, ok . Thank you. So, i am trying to respond to your specific question and i dont disagree with anything that is here i think that our charge, you know, i think over all our charge is to prevent and end homelessness for san san franciscans as possible. Thats what were trying do that. To do that with transparency and accountability and data driven and outcome focused and centering equity and peoples lived experience. Im trying to serve a lot of what ive been thinking about and what im hearing. What we probably are going to have to figure out is, you know, theres so many great things on the table and we have a rare opportunity to look at all the activities and departments and plans and all the great work that is happening and really understanding what makes an impact in sort of creating that system flow from homelessness to housing and Housing Stabilization and what isnt working f so well but we have this opportunity to do something very bold that meets the need of the problems. So ive seen other communities get big amounts of money and i talked about the veteran system yesterday. We could, i think what were going to have to figure out is if we could have existing programs or start new ones and not necessarily big impact and im not saying those programs dont need help and im not saying you shouldnt think about that i just think we have to also think about this opportunity that we have to be, i guess inaudible as our value which is i think about San Francisco being one of the cities to have universal healthcare and im sure before that people say theres no way i would provide healthcare for everybody and i just think why shouldnt we be a city that say says a system wide rental system system or a housing care system that sort of helps people who in a housing crisis whether theyre about to help homeless access rental services and i know im making that simple but you know, i think that we have created large fragmented programs and systems because weve had to respond that way and so now we have all of these different pieces but its sort of, i feel that we have an ability on the commission to step back and look and think about what is a bold, sustainable solution with an ongoing source of revenue and it takes into account all the activities that are happening and really sort of tries to figure out the impact and im trying to say we have to be bold and figure out whether were going to be funding lots of programs or ream trying to make a few strategic impacts and think about how inaudible with holding up the ideas and expertise and stakeholder and more Community Buy ins and i dont know if its a Community Process or having Community Members and stakeholders or work groups but get us that buy in so sort of hold all of this together. So i saw member andrews next. Yeah, two quick things. I often think about in the clients that we serve here at prc, when we are done naming them as a patient or a client or a con sim of services, we think of a resident of San Francisco like we are and im thankful that were developing a system of care that is both considering up stream and downstream and considerations but i just always say when the person lose prc do they feel . Is there a level of selfefficacy and selfresilience and their name is gorge. Theyre not 1654 or theyre any persons client. I want to see success being that theres someway in which we are allowing our clients to be selfreliant and selfpossessed in a way that and the system of care, the two wall of care is the person no longer needs 2 and i just put that out there. The second thing i would just say is i really think that for a lot of work that were doing and were talking about coordinated entry theres a coordination of conversation and engagement that the city departments have to have and obviously its gph and hsh that are soontobe the leaders in this but i think its important for the city to work hard to develop that relationship in a way in which it ultimately wont be a barriers and for the unqualified success of this particular set up funds in the programming that is here so yes, maybe it needs to be and have ago understanding of what were trying to do with Workforce Development even though they may not be directly involved in 2 so i just want to make sure that those relationships are developed in strong and nourished and cared for and intended so we can really see the full promise of the work were doing here. Thank you member, im going to pause there after that and move us forward and since its 5 00 p. M. So away want to get to the last item. Its a value of collaboration and we said it before. Although weve organized along the way as we thank people from dph and hsh who i think would be our Public Sector collaborators but i think thats an important thing. We are not, i dont think, were an Oversight Committee and we recommend to the maybe and board of supervisors, were not solely tasked with this. We have to provide guidance, we have to provide values here and we have to be satisfied that the standards were met but i would also see we saw today and we heard yesterday as well. Definitely thinking at department shelves a shared task and so i just want to remind us on loin myself that collaboration and important part of and if i could say also i think a couple of our members have talked to the importance of collaboration and making sure that we here the community the community experiencing homelessness and with theyre in sight and guidance to us is i think also, our fellow members and communities and our neighbors some of who dont see it the way we do and you know, to be able to listen and to talk with them too and take that into account i think its along the way. Were not sole those carrying this burden for our community or this opportunity for our community. Thank you so much. So talking about that stakeholder process and we will as the collaboration across all different sectors to bring this vision together and so that is so much here and i would like to sort of, i want to summarize it all and categorize it and pull it together as sort of a document that sort of reflects your kind of values here. In terms of what we can do off line a little bit in the minutes, also to push this forward to not just make it a exercise but actually a process of in terms of the work plan that also broader than that i heard some interest here in creating a really clear kind of almost vision statement instead of goals or priorities and thats going to take a little bit more time but it feels like that can inform the work planning process as well to really dive down what are the goals of this committee and what strategic framework do you want to try to develop and how do you align your Funding Priorities to that framework and so and then measure and track it overtime so that sounds like a clear sort of way to one of my questions was how do you live these values and bring these items to life. It feels like that is one of the way that i heard in some of the discussions is do that to set clear goals and create a pathway forward for yourself and then measure and interesting it overtime and that gets us the values of transparency and accountability that other people mentioned. So thats next step will summarize all this information to get a clear view of it, not just bullet points but then well think a little bit more in the next item about how to what to prioritize first. What actions do we want to take. We have to talk through what is our plan moving forward and so well pull from this as we talk through the next item. Ill turn it over there to the chair or mary to get Public Comment. Im going to recognize also that i think a lot of us know that theres a hearing going on at the board of supervisors about the quid pro quo and inaudible . We have that outlined. Thank you and mary, can you s. There any Public Comment. Members of the public who wish to provide Public Comments on this item should call 415 6550001 access code 146 996 8636 and then pound and then pound again. If you have not already done so dial star 3 to lineup to speak. A system prompt will indicate you have raised your hand and please wait until the system skates you have been unmuted. Please note that you will have throw minutes. There are no callers on the line. Thank you. So moved to item 5. Which will also be facilitated by laura and the prioritization of gaps and work plan and the community will decision criteria to prioritize gaps and needs in the system and the committee should address through recommendations of funding and outline key topics in a work plan for future meetings based on the prioritization and possible action. What i want to do first is just to give you a framing of the work plan or the timeline were talking about. So here is, if you are a member from yesterday we had a quick slide where we talks about the framework for this meeting was understanding the current state and assessing gaps and needs which we heard all those presentations about and we are moving forward to think about how do we stage our work moving forward based on that information. So, one of the ways of staging the work or a key consideration for how you think about your work moving forward and how you want to align it to other city processes its the budget process and i think we have a sense of there are needs which is a weird kind of covidinformed situation and in a normal course of events, primarily the budget is done once a year and we kind of make as a city a budget for the year and this committee would weigh in on those expenditures and so here is just a quick overview in november, the mayor issued budget instructions and it kicks off departments to kind of develop their own submissions and give them to the Mayors Office and then the Mayors Office has it in their court and theyre working with departments to reshape that and kind of aligning their priorities and the mayor will release the budget in may or june for enterprise or non enterprise departments and try to understand and make adjustments based on their own priorities and what does it mean for the group . Laying out a proposed series of ideas for the timeline so right now we have needs that i plate out for november and sort of thinking through what are these Covid Response priorities we have that are outside of a normal budget process. And so then we will quickly november into normal budget process. Starting in the winter and you might as a committee decide to hear presentations, more presentations o. P. P. System models or under, use this time to create that set of goals and priorities and your approach that you want to use and outline how you plan to go forward as a committee so using that Strategic Planning timeframe could be one way to go and then by the time the departments are working through their own priorities for next year, theyll submit that to the Mayors Office in february and then that might be a good time to, when you have your framework established you have a sense of what kind of model you want to promote, what are your maybe gold ideas if thats the course you go down and you can hear presentations from departments on their priorities for the coming year and weigh those against your own framework so that would be in the march and timeframe when they might be ready to start that and based on theyre still working and thats a good, as i think what point the outside yesterday, this committee is charged to advise both the board and the mayor so this is the time when the Mayors Office has their budget in their hands and so this is a good time for you all the to begin weighing in on some of those priorities that are being establisheestablished by depart. I think you can hear presentations on their priorities and you can work towards issuing recommendations on that in the april or may timeframe so that would inform both the tail end of the mayors process as well as the start of the board process and so that might continue and it may continue to be shaped as the board hears things over the summer may through june. Theyre having their hearings so there may be sort of a staged process or something that you set up to kind of weigh in on the recommendations on the budget. And they use of the funds and so after that arc, you may decide to pivot towards monitoring function and you have an oversight function and so, you may chose to start hearing things on prior use of funds and you may want to start to test some of your models and only be the things were prioritizing lets get more data on that and on what has been done in those areas and that can be you may need to do some work on how you want to monitor and what you want to set up for monitoring sending and pivoting from there and i think starting to think about scoping that Needs Assessment which is required every throw years so, that having some time in the fall before the next budget cycle kinds of starts and you start to kind repivot again to weighing in on priorities and so this is just a proposal and offered to help give us framework and align it to some of the citys systems and certainly its adjustable based on the priorities that you may set as a group and we will flag that the kind of early november immediate needs or the Covid Response needs we have a as a system and i think that were keyed up to bring those spending plans, those current year release of funds and on a few of those things that youve been hearing the presentations about this time at the november meeting so we do have some proposed ideas and we worked with the chair and vicechair on and we want to see if that is changed and the next meeting is happening quite soon and so we want to make sure were clear on those priorities and then moving forward from that november regular meeting to december we can kind of start to pivot towards those other priorities that yo you are going to spend e minutes now flushing out and asking together before we move to priorities you want to or rethinking of this work plan and any questions on the slides . Well give you a go this time. You being jenny or julie . We can go back to slide 7 or slide eight, im sorry. We just did a long list a second ago. We need to pair it down to maybe four or five items and i know well do it. We need a coordinated set of goals and also some decisionmaking framework and having four or five items like these are the things when were looking at what we want to spend on or not, especially when we get into the emergency coming in over the next couple months it will be more reactive but from the proposed work plan timeline, we should be hearing presentations from departments on their priorities for the use of the funds before its submitted to the Mayors Office and march is going to be after and im really not comfortable with that. I think wed we need to have a clear early review and this is a particular problem with the homeless department. There has not been any kind of weigh in or accountability until after the decisions are made and its been submitted to the Mayors Office its not really true collaboration and its the opposite of collaboration so, id like to see that timeline bumped back. And then, i think you know, the may and june its may and i mean the budget comes out of the Mayors Office june 1st. I would like us to weigh in before they submit the budget to the board of supervisors and so, that theres, you know, all of these situations i think its beneficial to the department and the Mayors Office because they get the back cost later and hear our input ahead of time and its a more coordinated thing, so, those would be that would be my suggestion on the timeline is to push it back a month on each of those categories. I heard developing a clear decision framework which i think we can kind of get to through that winter month of planning and then kind of pushing the timeline up a little bit to hear priorities and proposals before the mayor received them and before the board received them. When you said winter, what do you mean by winter . I was talking about the decisionmaking on for this one the proposed, the november and december will be the current year priorities, right. And so im pointing at january and developing your approach. Yeah, yeah. Im thinking like so were going to get the Mental Health sf back and get the pain back and the recession thing and were using the homeless dollars to close the hole and the deficit by back filling money for expenditures that had money to pay for them and its being swapped out so this fund is being used for the recession and we need to look at those list of things and we needs to decide whether they fit into our vision or our principle thats why we need a criteria as we move in that should be the first thing on these november and december meetings is having like a short little, you know, i mean, i think actually cynthia sam arized it really well and the things that people were saying like theres four or five points we can look at as we are going through that list and we can go ok, bus tickets out of town, well you cant use prop c legally for funds for that but, they are using this things that dont fill outcry terria and theyre not things that make a tangible difference in Homeless Peoples lives, for example. We need to do that and we need to have something that were collectively agreeing to and is there things that there are essentially bureaucracy. They want to use it and that if it extend the 3 and theyre talking about coordinated care and they cant come oust Services Funds because its not actually something that is a direct service that is charge able to the prop c fund so we need to be able to do that so i think were going to need that for the november and december. I dont think it will be complicated but it will be easy and i feel like listening to everybody and were all basically on the same page and i didnt really, i heard a lot of consensus around in themes that came out that were tied together pretty easily. So just to summarize a little bit, it sounds like you would like to add an agenda item to the november meeting to confirm a list of key decision criteria perhaps that we can i can Controllers Team can work with the chair and develop before the meeting and so you can weigh in and kind of decide on that criteria and before hearing the proposals for a Immediate Use of funds for the key departments that are planned for that meeting. Yeah, exactly. Exactly. And im going to say i trust the chairs to be able to do that in a awesome way. Yeah. Ok. Any other thoughts or comments or feedback will the timeline or question about the timeline proposal. And then, we would pivot to thinking about maybe any priorities that kind of jumped out as being addressed in that plan sooner. I see julie so, im pretty sure this is supposed to go until 5 00 and im supposed to be at a retreat and i have to admit im feeling im backed in the corner right now about having to take the big responsibility of answering important questions for the city which is extending proposals in front of us before we have any governance. I the chair and the vicechair and im not clear how and we have a little bit wait a second, you know, its that weve got things to talk about here and so thats my immediate and how is it that we can respond rapidly to what this city needs and also working towards a longterm and this work plans is a very and deferential i think and timeline and i wonder if i feel like were being asked to, without being directly asked were being asked to say all the planning work thats been done and theres even more what we have done and you need to make the decisions on that and i think we have a different opinions on the committee about perhaps the system and efforts that becomes the modeling effort or the prop c funds that we have a measure against. Its hard to imagine how we measure against what weve put in front of us over the course of prop cs life and also measuring each time we have to show and give our recommendations and. Maybe we need to set up one of the how we will make decisions at the next meeting because we havent figured out the governance and so maybe we need to set up a Committee Structure that there is a Rapid Response and we would just subcommittee attempts to value a proposal that comes before and its a little bit maybe get some technical systems to represent and whether for proposals and and 48 million to buy a building. Has anyone done the work to evaluate is that the right building and we might need some Technical Assistance wrapped around that stuff. And i guess im thinking through subcommittees potentially which is a lack of response to get some of these and systems that maybe its professionals ordered by and it it can do the Community Process which is to clients and its just most effective when its focused with people with this experience thats what drives this stuff and gets to those Racial Equity outcomes we get to on accounts and think the professional sum or the and restore us in order to get us that and we have rapid Responsive Community assistance models that what im thinking of is like an impact subcommittee or a collective impact subcommittee which is our maybe we can invite people who are on our community to join that and that is the one where were looking at impact versus getting communication materials that moves people and are communicating what kind of progress theyre having and that sort of stuff. So that is sort of more of a approach and how its directing and its these things and and do this. So, the proposals to create more committees which would have to be heard later regardless because its not a agai agenizee at this about bylaws and the member, im sorry, can you just tell me how to pronounce it. Its ngendra. Ok. Thank you. And you have your hand raised. Im very going to echo what julie was saying just about one, yeah, i think we have and i dont know finance this is saying for the next meeting, it feels like we still have to figure out our decisionmaking process and i dont know if that is sort of where we are now. I know were trying to get through our priorities but, governance structure decisionmaking, i dont know what should come first because to decide on our priorities, do we need a decisionmaking process and not sure . The decisionmaking process and then i think the idea of having workloads or subcommittees that could do some of this work in between meetings with Community Members on them and could really help sort of add some capacity to not only the body but also again just expertise and for our thinking because i do think that we could use some of that so, i guess maybe also just looking at the time, is it something we can table for the next meeting and i know some of this is on this meeting and i dont know whap other folks are thinking but those are big things that we have to talk about and im not sure how much son our agenda today or what we can put fourth to our next meeting. Yeah. The electronic handout and i dont know. Yeah, i definitely hear the concerns and i appreciate the members point around developing really looking through the try terricriteria before we move ine weighing of what is going on, before we look into the weighing of different immediate needs and i appreciate that comment and having that happen at the next meeting. I also think theres nothing that pre includes us from setting up an ad hoc group of members to dive a little bit deeper into some of these other things to present the next meeting so if folks are interested, of course, being less than a quorum, we could do that and. We would have to agenized it publicly notice it and do all formal productions for that. I think what we heard from the City Attorney is that we can assign one member to go off and do research but as soon as we add multiple members, it becomes an Ad Hoc Committee essentially and we would have to agenized notice and do public process for it. Committee members individually could go off and create a proposal for governance structures and it seems like members maybe are interested in that. I guess i wonder if that governance structure is a bylaw and i think we were going to request folks to weigh in on the bylaws that were presented yesterday and one of the next steps were going to have was to have people kind of we sent it out as posted and to provide the red line comments and we can consolidate comments through the chair and vicechair to make sure that you use the document and bring that to a vote after the subsequent meeting and that would be for the next step for Committee Members and so, in terms of creating formalizing the governance process of the group through the bylaws and then i think in terms of agenizing the next meeting, that would be, you know, if its the intent of the next meeting is to create a decision sort of a decision brain work which we were gathering insights around building today we can do a similar process of consolidate tag information from today and pushing it out to members in a way that sort of is a proposal that members can then weigh in on and then the chair and voice chair can kind of make it the way you want it as presented for about essentially to say here is our decision criteria do you all agree at the subsequent meetings so i think that would probably be the most streamline process of us pushing out information gatherings and input cop sol dating it and bringing it to a vote at the next meeting. Just to get at the Committee Structure. If theres decisions about that that would have to be agenized through the bylaw so if you wanted to promote the creation of committees in that bylaw process where you are editing and providing feedback, that would be a good place to provide that feedback of what kind of committees you would want to incompetent great, we might get different option and well have to do our best to say here is what we think we heard from those things but, that would be a way to get get information abt the subgroups or committee you might want to. If we have the committee that i think we do need to hear from the hotel advocates and others about where we are and its time sensitive and so i feel like we can get that feedback around convenance and the ideas that came out and we still need to move forward with the conversation around immediate needs and i dont want to prolong that even and i appreciate the longterm planning and i just know that we cant wait given where we are with koe. Can i just Say Something chair, i just want to, and i totally grew with you and theres stuff we need to do with totals and stuff but a lot of what the city is talking about in terms of programs and used to its the bucket without Oversight Committee and frankly without really decent Community Process to decide what should happen and without a unifying vision and so im a little, its a little bit frustrating and i think this is Peoples Initiative and this was about put on a ballot because people were not happy with the way things were going with regards to this issue and we need to make sure that theres i just think feeling the city wants us to be a keep setting up these time lines to and i want to recommend we have more meetings and i dont think a monthly meeting will work right now. How are we going to get through the the 198 million of expenditures and be able to certify those in one meeting and so one Committee Members, i want us to think about that going out and having Community Input and if bev, if you had 70 million on Behavioral Health, what would you want to spend it on and have that facilitated and they come back with a list of recommendations back to the group and we have space to do that collaborative process so i somewhat disagree with ken on this. It is collaborative city and we have a responsibility to make sure that were carrying forward the point of the initiative which is the Peoples Initiative to put power in the hands of the people. Just a point of clar carrying i agree with you greetly. Which we should have that conversation before the meeting but im not saying you have to be as protracted as i heard from some of the other members. If the stuff theyre proposing is on going and it doesnt have a tangible impact on Homeless Peoples lives, we cant do more cool stuff with the bee heave areaal Health Dollars or some of the other things if its and prioritizes it. Yeah. Yeah. I dont know if anyone has some time. I think im hearing this and maybe i should take care and and i want to represent myself as one prolong pro tract and plan, ad nauseam, its not where my heart is in terms of works of planning it and its achievement and wanting to get that place and so thats, its my time to think how do we organize ourselves to work quickly and get ourselves up for the life and we also have to. And, the ideas, i think with this i hope that we talk about how we would work with that and spending time together and doing that and im happy to submit my fronts in the bylaws but i have that conversation together and do that and how in the sort it out what is a structure for us and its because the subcommittee has to be noticed it doesnt mean we dont have Public Notices are there or public representation and we have and why want to make things burdensome for us or inflectionn able but i want to take the time to put this stuff together a little bit so its not for 10 months and it will prepare to make very large decisions on the sentencing and the decisionmaking criteria and that is slightly confusing to me but i think were supposed to be having a plan in place with which we measure and make decisions and i know were working to get there and i like how what is that criteria that is worth 198 million. The 17th maybe off the table from what im hearing from the Controllers Office and laura, can you clarify this because the communication i got controller rosen field was that there was more time needed to get information . A little bit. So i think the request was theres like fine tuning the plan that the Controller Office is putting out a new projection report soon maybe im not sure exactly when but theres an updated information about one how much money is actually available in the ocoh fund based on revenues, new revenue numbers that are coming out shortly and then also, to kind of fine tune the Department Time to fine tune the funds so they can be more specific about what their plans are for the meet priorities and so the request was to push the next so by thursday or friday before the holiday week give you enough time to process and mull over the materials and then reconvene the following the 30th or the first to have the doug with the department to kind of answer questions and give you whatever information you need about those materials so that was the goal and i think that if you the intent is also so the recommendations their in the timeline or the process they would go to the board, the board has the fiscal year 2021 funds for the ocoh fund in reserve right now as does the Controllers Office so theres two reserves on the fund and so the goal would be to allow this committee to issue recommendations to the board in their december budget and finance meetings and so they can and hit something of those time lines so the money can start to be used for current near programming that is the staging is want to go give you enough information now and and give you time to allow you to review recommendations that the board would then be able to incorporate into their own decisionmaking at the present so theyre asking questions and separate reserves and to both the are we getting information on proposed expenditure thats have been to the prior when will that committee be . I believe thats on our proposed agenda that i shared or three items where there was an interest in bringing midyear relief of a reserve and and that was the resourcing expenditures and for the department of homelessness and Supportive Housing and sort of the immediate year needs for the rehousing work of as part of the planning for services requiring use of the funds and the third one is the expenditures about baseline so that notal sis that was completed around that would also be back. Those are three things that i think would be intended to move towards the board to allow release of funds. I see improvise that. Vicechair as well. Go ahead. So, is there a reason we couldnt split that agenda. For one thing when we meet we enter up going a long, long time and we have a lot. If the chair and cochair and i think you would speak of the three and you maybe shaping the criteria from the discussions that weve had. Lets say we met as planned next week, and i dont know if i think about a halfhour ago we were saying testifying maybe a good idea and it was a lot of Common Ground thats been discussed today and dont we have something tangible to work on in regards to that that would predate the controller coming back if the controller is going to come back like the 30th or the first so we have time to consider how we approach that inpersonally, i think it would be well worth our time next week meeting with the departments, meaning hsh, to understand further what the plan is in regard to renouncing the folks or placement of the folks in the units right now and if theyre plan currently in that regard includes using some of the prop c money thats also maybe thats clear to other people but not march and i havent heard what it is at all. If we put it off to december well have another fivehour meeting and that is i think we can split it. Some of the stuff would be ready to go by next tuesday. Thats what im going to propose or suggest. Im hearing, having two meetings in order to meet some of those time lines it might be a meeting that, a second meeting may need to occur before the standing meeting and its somewhat later in the month and after the board of recess so that would be a motelling on the 30th or the first to kind of hear these proposals with the information shared in advance and retaining the 17th meeting tuesday, to drill down on the decision framework and get agreement on the structure and have that be the priority for that session and potentially also hearing more contempt around the rehousing works, that would be forming the basis of the spending plan that hsh would bring subsequently. Im sorry, i think there are inaudible . Im not looking at them. I know its 5 40 so i really like member proposal and to that and vicechair was if the stack and he said exactly waves going twhat i wasgoing to say we needg someone and weve been going over and we have so much to talk about and we got delayed and we have all these things before that were having to deal with and at this think on going we should have two meeting a month and we can talk about it next week. If you can make that motion now. She can make that motion . We can move that . We have quorum. We do. We have quorum. Im not sure because i think im not sure thats been clear enough in the agenda to be noticed now and it may make cleaner sense to do it by the bylaws which specifies meeting per month so if you want to kind of incorporate that into that discussion that might be the do it. We would discuss governance in everything we could get that into the portion of these agenda. Ok. Yeah. We want to collect for it. Im sorry. Did you say we were talking about governance opt 17th of the bylaws. I heard we talked about criteria but are we talking about the bylaws . Into a clear proposals of bylaws to vote on so theyre notice. We have to notice the boy law discussion before you can vote on them and so, that is the proposal that you provide input on the bylaws which includes sort of how many meetings you have and how you structure them but, that specific boy law was the intention was to bring it to the next meeting with the validated edits and. Does that allow for discussion and decision if necessary . It would. It just needs to be noticed but then you could say wore going to approve it if we want to adjust here we can approve with those adjustments acknowledged. Theres no other member on staff that we can state what some of the recommendations are in terms of further 17th we should it sounds like people feel fine moving forward with the meeting on the 17th and having that being the extension of the conversations weve had over the next past two days and having another meeting to look at those back fill and some of the other pieces weve discussed. So thats what im hearing from folks. And i think thats what we should do and so, i dont know if theres any other comments on that . I agree. Extra meeting. I agree. Can i just clarify, so governance, the 17th is governance we can talk about the timeline of workgroup structure and well get information on the immediate funding needs so the line down plans and how and what funds are sort of general funds state and federal funds are being used in that and how to get there so put that information for the second meeting s. That right . So just to clarify that it was in what they shared yesterday in the array of fundings for that plan if they should know that a sap that they can drill down further but there was a slide showing the array of Funding Sources supporting the lands and if it sundays in a specific request of information to include and it would be useful to make sure the Department Responds to that. Yeah. I saw members and i think laura, me you and julia need to just meet and on sol date of what we have here and prepare for the 17th and the subsequent meeting. Its already 5 45 and i feel horrible for us going so long overtime. Im not clear what were asking of the department meaning hsh next week. Are we asking them to come and present a little more detail on what that plan thank you,. Thank you. I also want to put on the community that that is going to be a tough conversation. Its very politically charged and theres not a lot of information out there right now. And its a very hard goal for me to take on together and i just want to say that out loud and i know were all here to gro growo disagree go i went from early actions and not shot so, inaudible and its going to be a tough conversation. A lot of unknowns so. I saw member. Im just going to encapsulate the things we said in terms of the Data Tracking so we can track our progress what we planned to initiat initiate fort years cycle but inaudible . Based on everything that weve gotten out of this conversation were going to push for us to have the two meetings the 17th and have that followup meeting with the Controllers Office on the 17th it sounds like having some updates on the hotels and having a conversation about governance and folks just need to respond to the bylaws and we didnt get as much response to the survey for this retreat so please do that and in terms of governance structure and well have a conversation on that and also, back fill criteria i know we talked about that as well and moving into the 30th of november or the beginning of december, talking about those specific sort of where we are with some of the specific spending reserves and reserve allocations. Mary will be sending around the survey to get preferences on those couple days at the beginning of the week shortly, hopefully tomorrow. Today or tomorrow or some time soon. Tomorrow, thats a holiday. Ill send it up to get your feedback. So well get that done soon. Be responsive so we can get it into everyones calenders and get it locked in so that we can have that meeting. Be on the look out for that and for materials from me to be responded to as well. Also, its in your specific request around the data for hsh and what they need i have that. I know that that is, we can back italkabout it. They dont have the capacity but we can give them capacity if they need it. Ok. The other thing i just wanted to mention is the sip hearing so the departments presenting probably as we speak, and people can go online to sfgov and read the transcript and be more prepared for the discussion about how the sip funding is going to be spent. They also put out a written plan that people can look at that i can share with mary and if, i dont know what the proper procedure is but mary could share it i guess with the rest of the Committee Members. There say plan, a written plan that they have put out. Yeah. Well try and get materials gathered before the meeting so you all are ready to get that. There are specific Data Requests for departments and like anything we heard in any of the agenda items and either yesterday or today or anything on going and it would be good to send them through the Controllers Office just if we didnt get a questioned answered, we have a bottle up and make sure they get into the minutes so we can get the responses back to all members so if we can just send me and or mary and well figure it out any followup items that you are going to request from any of the