Transcripts For SFGTV BOS 20240703

Hillary ronan, chair of the committee. Im joined by vice chair supervisor mandelman and supervisor walton, our clerk is stephanie cabrera. And id like to thank jason goldhammer at sf govtv for broadcasting this meeting. Madam clerk, do you have any announcements . Yes, thank you. The board of supervisors and its committees are now convening hybrid meetings that allow inperson attendance and Public Comment while still providing Remote Access and Public Comment via telephone. Public comment will be taken on each item on this agenda. Those attending in person will be allowed to speak first. Then we will take those who are waiting on the telephone line for the public call in number is screening. Sorry streaming across your screen. When connected you will hear the meeting discussions, but youll be muted and in listening mode only when your item of interest comes up and Public Comment is called those joining us in person should line up to speak and those on the telephone should dial star three to also be added to the speaker queue. If you are on your telephone, please remember to turn down all listening devices that you may be using. Alternatively you may submit Public Comment in writing in either of the following ways. Email them to myself. The homelessness and Behavioral Health select clerk at stephanie dot cabrera at sf gevorg or you may also send your written comments via Us Postal Service to our office in city hall at one doctor carlton be goodlett place room 244 San Francisco, california. 094102. Finally, the soul action item to be acted upon today has been requested as a Committee Report and will appear on the board of supervisors agenda of october 3rd, 2023, unless otherwise stated. Thank you. Thank you. Can you please call item number one . Item number one is a resolution authorizing and approving the director of property on behalf of the department of homelessness and Supportive Housing to negotiate and enter into a sublease agreement. For 312,000ft s of property owned by the California State Lands Commission and leased to the California Department of parks and recreation for the citys continued use as the bay view Vehicle Triage Center at Candlestick Point state Recreation Area for a term of two years, commencing on or about january 13th, 20 2024 through january 12th, 2026, for a base rent of 312 per year authorizing the director of property to execute documents and make certain modifications and take certain actions in furtherance of the sublease affirming findings under the California Environmental quality act and finding the proposed sublease is in conformance with the general plan and the eight priorities of planning code section 101. 1. This file has been requested as a Committee Report. Eight members of the public who wish to provide Public Comment on this item should call the public call in number. Scrolling across the bottom of your screen when prompted, enter the meeting id and then press pound twice if you have not done so already, please dial star three to be added to the speaker queue. The system prompt will indicate that you have raised your hand. Please wait for the system to indicate that you have been unmuted and you may begin your comments when we go to Public Comment. Thank you. Thank you. And we have emily cohen here from the to present. Sorry good morning, chair. Ronen. Good morning, supervisors. My name is emily cohen, Deputy Director at the department of homelessness and Supportive Housing. And im joined by andrico pennock, the director of property with the department of real estate. Should there be any questions about the merits of the lease here before you today is a resolution that authorizes and approves the director of property to enter into a new sublease agreement. Rent for the parcel at candlestick state Recreation Area that is owned by the state Lands Commission and currently leased to the state department of parks and rec to support the continued use as the Vehicle Triage Center for an additional two years. The current term ends in january 2023 and we are requesting a new two year term that would extend the project to end. In january 2026 sorry, 2024 to 2026. The new sublease has an annual base rent of 2 to 312,000 that will be funded through prop c, our city, our home dollars that were allocated in this years budget. The Vehicle Triage Center has been operating for nearly two years under the leadership of urban alchemy and many of the urban alchemy team are here today. The Program Provides 24 hour staffing. We also contract with the Bayview Hunters Point Foundation to provide on Site Social Services and Case Management support to the guests by or sorry, by bvb and urban alchemy work to connect guests with a variety of social services and do the basics of intake Case Management, benefit navigation, wellness checks work to ensure that folks are assessed for housing connected with health care and public benefits. Use the demographics of those that we serve at the Vehicle Triage Center generally reflect the population of people experiencing homelessness. But you will see here that we actually serve a much higher percentage of latinx people and a higher percentage of African American people. The we have received a lot of questions about permanent power at this site. This has been our biggest challenge to operating the site. So did want to speak to it right off the bat. This timeline on the screen reflects the key milestones related to our work to secure permanent and interim power at the site in november 2021. Public works received initial pga contract for this program, which has been identified as a covid related priority as it was related to the launch in january 2022. We had not received timelines for pga permanent power on the site in june 2023, and public works worked with the sfpuc to submit a new application to pga. And we anticipate hearing back from pga next month in october with more information about the timeline. Given the delay with permanent power up to the site in spring 2022 and public works began exploring interim Power Solutions and this included submitting an application to baaqmd for generators to provide interim power while waiting for the permanent power from pga. That application is still pending and we have not received permits. I did want to give some context related to vehicular homelessness in San Francisco. Our point in time count from 2022 found over 40 nearly 4400 people experiencing unsheltered homelessness in our community. Community 24 of those folks were found to be sleeping in vehicles. Either Passenger Vehicles or recreational vehicles. In july 2023. So very recently we did a citywide count. We did a citywide count of tent structures and occupied vehicles and found over a thousand inhabited vehicles across the city over 500 of which were identified in district ten alone. We know that the Candlestick Point neighborhood has a high concentration of People Living in their vehicles. An and therefore really makes sense to prioritize that neighborhood for services from this site. The site is currently serving 46 guests in our current capacity of 35 vehicles and actively connecting guests with vehicle repair, Health Care Services and a wide variety of services, including Housing Options. I also wanted to speak a bit to cost. This has come up in our certainly youll hear from the bla on this item and did want to give a little additional context to the cost here. The cost per bed per night of this program is most appropriately calculated by the total guest capacity on site rather than the vehicle capacity on site. As these services as the meals, the Case Management are provided to the to the guests. This does not include in my estimates here, do not include the annual lease cost, which in the first iteration of this project was free. In the second iteration will be 300,000. We have a 50 guest capacity in 35 vehicles currently, which does give us a 232 per guest per night cost. This is slightly above what we pay on average for other noncongregate shelter items. But when we get the Fire Suppression system in place around the new year, well be able to increase capacity to 120 guests in 81 vehicles, and that will bring the cost per person per night down to 95 per person per night, which is much more reasonable than what were currently seeing because of the artificially low capacity based on the lack of power and Fire Suppression systems and that wont include the 300,000 lease, which would be on top of that. And i am happy to take any questions you might have. Thank you. Thank you. And before we go to questions, if we can hear from the vla, good morning. Nick menard from the budget legislative analysts office. So item one, this is a resolution that would approve a sublease with the California Department of parks and recreation for the city as a tenant to occupy by the Candlestick Point state Recreation Area. The lease is two years starting in january 2024 and has an annual base rent of 312,000, or 1 per square foot. This is similar to the existing lease, except that the city is now paying rent at 1 per square foot, whereas previously early the city had committed to providing approximately 845,000 of Law Enforcement and Parking Enforcement services in the area and consideration of the lease. And at the time, the board approved the current lease, the plan was to have an initial capacity of 78 spaces and then expand that to 150 spaces that current lease or the proposed lease still allows for up to 150 parking spots Going Forward. And as you know, as we do for any lease, one question we ask is what . What is the property going to be used for . So in this case, theres two this is being used as a Vehicle Triage Center. There are two contractors providing services, urban alchemy and bayviewHunters Point foundation, urban and we detail in our report that their performance on the existing grant agreements, which in general both organizations have performed. And there was a finding in that urban alchemy his clients, their exits to housing were below target. There was a you know, in the agreement theres a target to have at least 50 of the guests have a positive exit out of the site. They only achieve 25 in that year, which is similar to the Vehicle Triage Center that the city used to operate at in san jose avenue. And we also note that Bayview Hunters Point Foundation is one of two nonprofits on elevated concern status due to fiscal and performance monitoring issues that were identified as part of the comptrollers fiscal citywide performance monitoring review. But they appear to be making progress on some of the findings that were identified last year. So if you turn to page five of our report, youll see that the total cost of this program for this fiscal year or next fiscal year and the following fiscal year. So for the for this year and the next two years, the total cost is 12. 2 million, including the cost of the lease and the Service Agreements that does not include the 4. 5 million that has been spent to improve the site. So thats simply operating costs and when we look at if you if you look at the existing site capacity, the Department Just noted, its actually less than what was originally reported to the board a couple of years ago. So they currently have space for 35 vehicles. Uh, but the cost of operating the site is about 5 million a year, right . So that ends up being about 140,000 per spot. And i think we can measure it by spot or we could measure it by, by the number of people in each car. But i think no matter what whatever denominator you use, its still expensive. Its still expensive relative to the Vehicle Triage Center that was operated on san jose avenue, its still expensive relative to other homeless response interventions. And just to kind of put some scale on this, i just looked at it in agreement that funded five buildings of Supportive Housing for 464 units of Supportive Housing. That was 9. 5 million, right . So thats less than double whats happening here. So i think that this the cost per unit will become more efficient, though if they can increase capacity. Right. And it sounds like theyre on the path to doing that. Its in talking to the department, one of the constraint thats on the capacity is, is the permanent power. And i think my understanding is that theres a lot of uncertainty about when thats going to happen, because theres even though theres an agreement in place with pge and we know from our other work, it can take years for that construction to actually take place. So i think that theres a lot of uncertainty here, you know, and that is for that reason, we are recommending that the board request a, you know, the department has capacity to do this this year, but they could come back during the budget process in june with options for you all about lower cost models and what the cost and benefits of those models would be so that you guys can have a policy discussion about whether this is the appropriate funding level given the sites existing constraints at that time and the outcomes from the program. Um, at that time, uh, you know, but you know, operating a Vehicle Triage Center is consistent with, you know, the administrative code that the board created, chapter 119 to operate a Vehicle Triage Center. So its for that reason and its a below market rate lease. So for that reason, were recommending approval of this resolution to approve this lease. Thank you, colleagues. Any questions . Supervisor mandelman. Uh, thank you, chair. Ronen and thanks. Thank you for the, for the presentation. And im going to im planning on supporting this item. I do think it makes sense. I think the bellahs recommendation to get an update in 2024 makes good sense as and i do. It does sound like the costs should come down , but i also think. I guess my question about this this because this the vehicle of folks living in their vehicles issue is big, broad, thorny, challenging, not just San Francisco, region wide and. The value of the money spent on this project i think has something to do with whether we have an overall strategy or thinking about what were going to do with this population. And its a little bit outside. I have a beef with you all, which will take up an item to about shelter and transitional housing versus long term permanent housing in San Francisco. And whats the really Long Term Strategy . But this is kind of a whole other set of issues of folks, folks who have some sort of housing of last resort. But its not exactly housing. Uh, and what we see is the trajectory for those folks. Once, you know, if we bring them into a vehicle triage sense, thats not its not an rv park, its not a traditional place where folks live forever. Or maybe you are going to have folks anticipating having them there over the long term. But im just wondering how the Vehicle Triage Center kind of or if we have more than one fits into an overall strategy around people who are living in their vehicles and then secondly, it feels like a problem that cries out for a Regional Response since there you know, land is scarce everywhere, but it does seem like there are people who could sustain, maybe sustain themselves over a longer term if they if there were more rv parks of sort of the traditional kind. And so i dont know what kind of conversations may be happening at the regional level about this this need. So those kind of two questions, what do we see as the where are we aiming to get the people who are going into these Vehicle Triage Centers to . And whats our success in getting them to some something that feels like a more stable, permanent situation and. Then how are we addressing this regionally at all . Thank you. Supervisor through the chair. I think these are excellent questions and things that were grappling with. As you all know and noted, that vehicle based homelessness is a challenge up and down the west coast and something that many, many communities are struggling with. And certainly we are no different here. And id it has been challenging for the department to address because as it looks and feels a little bit different than the traditional homelessness that weve developed an expertise in working with and its a very, very diverse population community of folks living in their vehicles, some who i have talked to who have said, this is my home. I want a safe place to be where no ones going to bug me and give me parking tickets. And im cool. And then other folks who have said, you know, this is not sustainable. This is not where we need to be in their interest in housing. And so having a diversity of options for the communities, incredibly important, ensuring that we are making housing offers so for those folks who are eager to be indoors and eager to be out of the vehicle, we want to make sure we have options. And i just looked at some refreshed data from our Program Monitoring of this project, and it looks like 44 of the guests last year moved out to positive exits, whether that be housing or like a moving in with friends and family. So really strong outcomes for this for this project, but also knowing that thats not going to work for everyone. For some folks, these are their homes and they want to stay in them in a healthy and sustainable way. So i do think there is a larger policy conversation to be had about subsidy ized or low cost rv lots like there are in other parts of the country. And what that could mean for our Housing Stock and out of curiosity how does that 44 positive outcomes i mean it sounds pretty good. How does that compare to traditional shelter about on par . Its a little bit higher, actually, than weve seen. And i need to look at the data because i just saw a quick email about it to see how that breaks down. But it is far better than what sort of we initially anticipated that outcome to be. And do you have of i mean, i know psa is theoretically the and we can get to this more in item two but do you have a figure on positive outcomes exiting psa . I could get that data for you in that time. Thats fine. You know, many folks dont exit psa. I know most people dont. But im curious if we i mean, some somebody we do look at exit destination and i think i have that those notes for my next presentation. Great thank you. Thank you. I think well open this up for Public Comment and then i think both supervisor walt and i will have more questions. But right now we can open that. Madam clerk, if we can open this item up for Public Comment. Yes, thank you, madam chair. Are there any members of the public who would like to make Public Comment . For item number one, please line up to your right remote public column. Members, please dial star three to be added to the speaker queue for those already on hold, please continue to wait until the system indicates that you have been unmuted. Good morning. You may begin. Thank you. Good morning. Im kelly and i live in district nine at and i work with the stop poverty toes coalition and. Im very, very happy that i have five seatbelts in my car and four of them were filled this morning with folks who are coming here from the candlestick Vehicle Triage Center. So talking to people, i realize how important it is for them to know that theyre not going to get towed. There are so many people who are living in their vehicles that thats thats just a daily constant number ing fear that theyre living with and being in the Triage Center allows them to gain stability so they can start working on their goals, whatever their goals might be, whether its getting a job, getting working to get into Supportive Housing, no matter what their goals are, it helps them to calm down and to blend in with the community. Theyre yeah. And as far as im concerned, we need lots more Vehicle Triage Centers in the entire city, including the west side, for sure. So um, im really hoping that you agree that there should be a two hour. I mean, a two year extension. I understand its. Its expensive. And really what peoples goals are is to have traditional support of housing that is, you know, thats what we want with the coalition on homelessness and with ending stop poverty toes. So at any rate, thats my story. And im im going to encourage people to come on out your next speaker, please. Good morning. Council my name is charles keener. I live at the Treehouse Center there that youre voting on. Um, the only thing i really got to say is, is if i had found this place to be able to stay there, i would probably have about 15 or 20 tickets for failing to move on time for the street cleaners. And that was just one of the things. I mean, ive been out there on the streets where first thing i got to worry about when i wake up in the morning, where am i going to use a restroom . You know, that same difference here. I just got through stripping out the inside of my, my, my rv because as well, we got a rat problem up here. Theres a lot of rats around there. We got to take care of them. But i had to find out how much damage was done to my house. And the only way i could figure to do it was to take everything out of it. So. So what i did and if we dont get the extension and thats the way itll be leaving, i guess. And i dont i could probably support the walls and stuff to hold it up, but it aint going to last very long. If i got to move it, i got to put put things back in it to hold the walls up before before i can even think about moving it and its going to take more than a couple of months. You. Yeah thank you. Thank you for your comments today. Next speaker good morning. My name is mark. Not i live at the Triage Center, you know, and if it wasnt for this place, you know, i would probably not have my rv. Id probably be back on the street living on the street. And for me, it helps me out because ive had medical problems and theres other people in there that have medical problems. And for the most part, it makes me feel safe that i have someplace to go, that my vehicle is not going to be towed because it doesnt run. And they have people coming through there that are helping me to get it running. So that i can move on. But i cant do nothing unless i get my health back in order. And theyve helped me with that as well. Now get me to my appointments. A lot of things. Theres good parts and theres bad parts to this thing and i see more good in it than bad. So for me it helps me because im safe there and to move my vehicle, i couldnt do it. They would tow it. And then what do i have . I dont have anything. So for me, this place, it works. And we do. We need more of them. Thank you. Thank you for addressing the committee today. Are there any other speakers here in the chamber . I would like to speak to this item and please do line up and then youll just go through once the previous speaker finishes. Okay. Okay. Hello, my name is juan ramos. Im with coalition of homelessness and im a temporary organizer with them. Today i will be translating for oswaldo. Hi, my name is oswaldo and im if you could, if you could hold on for one one moment. See pueden esperar queremos doblar el tiempo para puedes hablar durante dos minutos y puedes traducir durante dos minutos. Could we just restart the time and give four minutes . Sure would you like me to say that again . Oh, look, were just. We just want to double the amount of time so theres time to translate and. Okay, so were just going to start over the clock with four minutes. Oh, okay. Thank you so much. Yeah, no problem. Okay. Gracias okay. Hi, my name is oswaldo and i just first off, firsthand off. I want to say thank you for everyone whos supporting us. Because its very important for me to be in a safe space. This joe biden la la la. Because part of my experience, i was living in a bench in the streets and its very difficult and hard because. You dont have secure city, you dont have food. There was days that i would go three days without eating, without drinking anything. Era La Experiencia de la. And there was some days i didnt have experience sleeping outside in the streets. So there was days where i didnt know when i would get my next shower and. Maximo tiempo puedo nos agora and i feel like the time or the extent of the lease would be very helpful for us tenants. The ones that are living there, because if not, we would be very hardly affected by the situation and in my opinion, again, it has helped me in a lot of ways that no one can ever imagine. Si quieren pueden ser los dos microphones por favor. Para se puede. Escuchar bien si si para el discussion. Uno para cada uno. Gracias okay. Gracias. A pues de nuevo repetir yo estoy todos los recibiendo la ayuda estamos muy agradecidos porque es dificil vivir en la calle inseguro de anteriormente cuando empezar a la vida de homeless es dificil porque no tienes no sabes de donde la comida de nos dan podria ser todo desayuno escena chaguo todo tenemos todo pero hay perdon so he repeated some of the stuff that he said, but again, hes just thanking for the placement that there are right now because without them they give, they provide food, they provide a place to shower as they please in the estoy muy contento en el lugar de seria todo in his part. He just want to say that it would be really good if you guys can think about the extension, the lease extension, because it would be very helpful for him and for the others living there too. And thats all. And thank you. Gracias. Por su comentario next speaker, please. Hi good morning. My name is alda. Im going to try to speak in my in my way to english is not that good, but im going to try to do my own words. I was a homeless for like eight years. I was living sometimes in a car when i got the money to buy one. So after that i come out, tried to commit suicide. I was in a program i come back to the street after that and i was able to buy my trailer, right. And it was very hard for a woman almost 50 years old to live in the streets. But two times i was almost getting robbery and people tried to get into my childhood when i was in the streets to be in the triangle is very safe and if you take us this thing for us, as me as a woman that dont have a stable job and the economy is getting worse and we most of us, we unable to pay our rent even a minimum wage. So we dont know the future because the economy is getting very bad. I dont have a really good job right now. My hours are cutting. They offer to me to move out to a place. But i was thinking if i cannot pay my rent and the future, what i going to be. So i going to come back to the streets. And i dont like that im going to place and touch your hearts and you can give you that extension. What we need to be safe and keep going to the goals. Maybe in the future, all of us, we are going to be successful people. But i need you guys help us to commit the goals to everyone. Thank you. Hi again. Um, again, my name is juana ramos with the coalition of homelessness. And i just want to be here as an advocate for everyone living in in this situation. There is. Its a tough one. I used to be homeless. One of my friends that i was close with was living in an rv. Um again, i never had like the full on experience, but its something really hard and to be homeless and then for them, i feel like this gives them an opportunity, gives them hope. And if you guys take that away from them, where do they go . And then you guys also have to look at the bigger picture. Now people are theres homelessness is increasing and if you guys evict them, where do they go . Were were we can prevent homelessness. We can prevent certain situations. But then you have talking about a lot of, you know, 30 or plus more. So thats 30 plus more in the streets. Its so i want everybody to look at the bigger picture. Try putting your guyss self in their shoes and have some empathy or try to empathize again when this its a hard situation for them and i feel like the extension the lease would give them time to find a job, get more to be sustained, to be sustainable. Sorry and again, i was one who struggled and was homeless, been in different programs. But when you go somewhere or some place you dont have a job, youre struggling. And especially when you have kids to provide for food, childcare, etcetera, its pretty tough. So again, i just want you guys to be open minded. Try to empathize with them and please keep it in mind and hopefully you guys approve this extension. Thank you again. Next speaker, please thank you for your comments. Good morning. My name is javier beaumont and im an organizer with the coalition on homelessness. I want to thank you all for bringing this on the agenda today. Im just pretty much echoing whats already been said about the importance of safe parking sites and this specific safe parking site. Im excited that the that we have an opportunity to renew this lease. And i appreciate like, you know, how candid you know, the analysis of the budget was in this but you know, were a big money city and this is a big money game when were talking about whether people are housed or not. So and what we heard in like some some other analysis, too, from hsh is that, you know, if we if we stay on the ball, that we can make it less costly if we expand it. Right . So i think its kind of a slam dunk in that way. But but i cant help but think about the meeting that we had at the sfmta board not too long ago where were begging, begging the communities are begging for a safe parking site for the people who live around the lake. Merced area. And now we actually have one. I mean, we actually have one in candles stick. And i think its a Pretty Simple ask for you to keep it going. And then in the absence of long Term Solutions, this is something that i think is very straightforward and something that we might take a little bit of a hit at first, but its more important that people have stability and that theyre able to have comfort because they deserve it. And so i in conclusion, just want to say i support the extension of the lease and thank you for your time. Thank you for your comments. Next speaker, our oh, my name is nathan king. Im a director of residential with urban alchemy. Ive been at the vctc since day one, and i think its a very strong community. Its not just a program. The amount of compassion and empathy that ourselves gives bayviewHunters Point and even the guests show each other like i think its a very important thing to have. And also the amount of safety be like, its not you cant feel safe living in your car, not knowing whats going to happen through the night, but to know that were at each gate and we watch 24 over seven to make sure that you can have a good nights sleep, i think thats one thing you should look at and keep aware of. Thank you. Thank you for your comments and for the next speaker. Please adjust the microphone so that you can be hear clearly. Thank you. Hello everyone. My name is louis reed. Im a director over at the vtc in and im also a native of that community for 53 years and not only do i see the progress thats working for the community , im a part of trying to make it work even better. We go outside, we clean up the outside of the safe site at candlestick and make sure that we try to keep it as clean as possible for whoever comes through. They want to go through the park just want to come through and sightsee from different areas of walk of life. So we do everything in our power to make sure that theyre safe, that their sleep. We understand that a lot of people feel like this is like a nuisance, but its really been a great help and they have been real great at keeping their Community Together as a family. Its like a lot of people in the beginning didnt really care. Like for the program. But as we progressed and as we came along , we then housed over 14 families. We still in the progress right now of housing more families into housing. I think its a great program. Um, we have seen numbers grow, like you just heard from some of the guests. We have clients, we have theyre, theyre very, very in tune with what they have. Theyre mindful. They respectful. They dont go outside the community. We now see a bunch of kids, is utilizing the parks more around there now that they dont have 100 rvs just surround the park. They have animals. These animals need to be cared for more. And we have people that come on site like twice a week to see to it that their animals get the same care that they get. Nobody goes unnoticed. Nobody goes unfed. And i really believe that this extension will really, really be a great support not only for the community but for them as well. Thank you, guys. And yall have a wonderful day. Thank you for your comments today. Mr. Reed, may we please have the next caller or speaker. Apologies hi, my name is keisha escudero and im the director of Program Administration for the Bayview Hunters Point Foundation for community improvement. And the vtc side at candlestick is one of the sites that i govern. Were subcontracted to provide Supportive Services. Case management to the clients, and weve been there for a little over a year and a half of close to a year and a half. And we have seen a tremendous increase in, in first of all, when i mean by by in a lot of the clients, the clients at the safe sleep sites from my experience are the resisting not to not going to congregate you know, shelter living. Um but they have proven themselves if they have their own individual space that they can make stain and they can sustain. Uh, so ive seen personally the increase of the buy in and the support of services is a gamut of Supportive Services that are being offered and that the clients are receptive to. As far as medical, dental, housing, vision and dmv, i can go on and on. Pet support, but i dont want to go too far into that because one of my case manager here is here that is providing that Actual Service like louis mentioned, im a native of San Francisco. Ive been here 54 years and ive been in the field right here in this city 23 years. And ive seen us evolve to this point. So my thing is that if you can have favor in your hearts for us to continue this program because we are saving lives and it is working, its not a long Term Solution, but we need a little bit more time to break through that resistance. Thank you. Thank you for your comments today. Next speaker, uh, good morning, everybody. My name is craig martin. Im a case manager for the Bayview Hunters Point Foundation and like my director was saying, my boss, im also a fourth generation san franciscan. So this is touched me personally. And to see these clients and work with them every day. Some of them were resistant in the beginning, but once one found housing and found out how positive it changed their life, every body jumped on ship and was like ready to move out. It takes time. It takes patience. But were also working with each individual person. We have the sf food bank that they pick up every thursday fresh groceries, fresh vegetables. We also have a repair mechanic thats on site today working with the clients, trying to fix their rvs, get them ready for repair for clients are moving with their families. We just have to finish with the repairs. Working with the financial Justice Department , waiting for that to finish. And also just touches me personally because as a kid growing up walking through the streets of the bayview, going to candlestick and seeing how bad it was with the rvs and then driving through and also walking to the park with some of the guests and also just being in the community. Thats craig. How do we get in the vtc . Were trying to get more people in. So like i see the change, i see the growth in the community, but it takes more than just us voices. It takes you guys and everybody else behind me to support this community and it means a lot to me personally because its my city. I care about these people. Theyre not just my workers. Theyre like my employees. Theyre my friends. Theyre my family. So i really hope that you guys find it in your hearts to extend the vtc site. Thank you. Thank you. Next speaker. Our good morning, everybody. My name is otis hughes for urban alchemy at bbc. Yeah this program really, really works. The people behind me, theyre supportive towards us as far as weve been supporters of them. They help us around there as much as they can. You know, theyre like a family. This program is working so much that i hate to see it closed down. I hope its within your heart that you keep it open as long as you can because they need this. We need this because we all bond together. I could be homeless just like them. Be in a situation like that. But unfortunately im not. And they helped me. They helped me be a better human being than who i am. And, you know, like i said, theyre like family to me. And if you can find in your heart to keep it open, i really, really appreciate it. Thank you for your comments today. Next speaker. Hi hi everyone. My name is pamela gilmore. I am the Deputy Director for bayviewHunters Point foundation. Im here just. To just to ask for an extension for this project. We really need to finish what we started. Great work is being done there. The value we talk about the money and thats incredibly important. But the value to the community, what would happen if these people were in their vehicles, on the streets . Its just the impact to the community is way worse. Having a secured site that is safe where there is food , there is a sense of community there and urban alchemy and weve all joined together to support our fragile, our brothers and sisters who are experiencing extreme sensing, fragility in their lives at this time. Um, and given a little bit more time this relationship, this partnership, this service, this preparation action for providing support would definitely be short term. And we will achieve the goals that were set out to do. Thank you. Thank you for your comments today. Miss gilmore. May we please have or sorry, are there any other speakers here in the chamber that would like to speak to this item . Seeing no additional speakers here in the chamber, well go to our call in line where we have ten callers with five in the speaking queue. If you are on the line and would like to speak to this item, please dial star three. Now to be added to the speaker queue. Mr. Kawano, may we please have the first caller. Good morning. My name is Timothy Allen simon. I am a native of San Francisco, raised in the ingleside. Ive lived in the bayview for close to 25 years. We im also the president of the candlestick Heights Community alliance. We oppose the Vehicle Triage Center. And i think the Financial Data brought forth by the budget analysis gives one of many reasons why also we should point out that there was no California Environmental quality act, proper filing or deliberation on this site at the cost could actually put the residents in permanent housing. This is close to 13 million over a two year period. It is. And i want to remind our board of supervisors and thank you for this opportunity to speak is that district ten is the only district currently that has a Vehicle Triage Center after two years, we have brought this to the attention of ms. Cohen over and over again. The facility that was in district 11 was only 6 or 7 months. It was cited at a space that was already permitted for construction. So i think its hypocritical that the board of supervisors continue to use bayview Hunters Point as the only or default location for Vehicle Triage Centers. There are large swaths of land throughout San Francisco that could provide this service as well. We have pleaded for equitable distribution of Vehicle Triage Centers throughout the city and county of calif and have been consistently denied. This should not be renewed. Currently there are illegally transmitting diesel particulate into the Alice Griffin community. Bret hart playground, gil morgan park and for the interruption. Thank you. I apologize for the interruption and for having to cut you off. But we are limiting each caller to two minutes today. Thank you for your comments today. Timothy alan simon, may we please have the next caller for. Hello. My name is russell maureen and i live in visitacion valley. Little hollywood. Im also a native of San Francisco. I grew up in the bayview. When i was a baby, my first house was up on griffith street. So overlooking Candlestick Point area. Its not working, folks. I mean, its been two years at and somebody said today, well, if you give it a little a little bit more time, the price is going to go down. The cost is going to go down. When does that ever happen to San Francisco . Its going to go up. Youre not going to find a cost saving just because youre bringing in more folks. It should not have been in a park in a public park in candlestick park. Its an open space. This is not the space for it. Im not entirely against the idea of a vtc, but this is the wrong location for it. Find another location, not in a public park. Public parks are for enjoyment. Triage. Lets stop calling it a Triage Center. Its not triage. Triage means you come in, you do a quick assessment. You treat it, you move it on. This is not this is basically your warehousing, folks. Youre keeping them there for a long term. And the path outward doesnt seem to be happening. I think miss cohen said 44 of folks had a positive outcome when they left. But how many of those folks are actually numerically not a percent actually landed in housing in a unit. Its less than ten. This place is housing less than one person per month. Ill say it. Im blessed. I have a home. I have a mortgage. Its costing more per site. Theyre more for a site there than my mortgage is in San Francisco. Thats the numbers were dealing with. Theyre its costing more. The household birx in the vtc than it costs for the majority of san franciscans to pay their mortgage, which is not cheap, as we all know. Its been tried. Its not working. Youre going to pass this today. Its going to go to the next level, put some guardrails into this. Come back when you come back for the interruption, come back and really have some hard questions. Apologize for the interruption. The speakers time has elapsed. Thank you for your comments today. May we please have the next caller . Good morning. My name is joy jackson morgan, executive director at third Street Youth Center and clinic, also a Second Generation bayviewHunters Point, native. I was part of the original Community Group that advocated for the Vehicle Triage Center. After walking in the streets every week talking to folks in their vehicles. That was triple parked along the candlestick expressway during the pandemic. Folks kept saying like this is my home. As ms. Cohen spoke to and other folks who are in line there and i want people to look at this issue, too, more so as a multi sector problem, right . Its not just an hssh problem. Its not just the homelessness. This is also a Public Health issue, which was also costing the city. There was a lot of Public Safety issues along that before the Vehicle Triage Center was opened. I want to remind people like a baby died out there. There was multiple meth labs that exploded. There was illegal water manifold is happening. So there was public Property Damage that was happening in that community before the Vehicle Triage Center occurred. Theres just noise issues. And now it has been contained. I also want to remind people that candlestick state park offered this 2 of their parking area. Its not in the public park area. Its in 2 of their parking area. They offered it as a solution, not that the city went to them. So this was a Community Effort at a multi departmental effort with there was a lot of trash that was happening every single week along the area. So when you think about the cost cost that it took, not just hcis budget, but all these other sectors and what it would cost for towing and storage of these folks, property interruption cost, joy jackson, morgan again, apologize for interrupting, but each speaker is limited to two minutes and your time has elapsed. May you please have the next caller. Hello im a baby resident and im calling in opposition to renewing the rtc and a lot of the points ive been raised in opposition i agree with. So ill just add a couple more. A couple people talked about the bigger picture. Yeah, lets talk about that. The bayview has not solved the problem with the dtc. Theres only 35 to 49 vehicles at any given time at the dtc. There are still hundreds of People Living in rvs around the bay area. Theres still fires still happening. All of the things that we experienced before the dtc are still in the bayview. Yes, theyre not along the Hunters Point expressway now. They have been distributed to the rest of the community. So i really think about what is the role of the board of supervisors in this. Yes is to have sympathy. Nobodys asking you for not to provide Homeless Services and connection to housing. What were asking is for sympathy and fiscal responsibility. The 15 million to get 15 people housed in the duration of the dtc is that fiscally responsible . Further we talk about environmental pollution. There has been no power at the site for two years. How can you even think that theres going to be power in the next two years . Again, fiscal responsibility. These are no good contracts for urban alchemy that and bayviewHunters Point foundation received. Does that mean that theyre going to get also no bid contracts Going Forward and there is no plan . We dont know what the plan is to help people in the community that live in rvs. We need to have a plan. This cannot be blindly extended. Thank you so much. Thank you for your comments today. We currently have 13 callers with three in the speaking queue. If you would like to speak to this item, please dial star three. Now to be added to the queue. May we please have the next caller. Hi, i am also a bayview resident and also a part of bayview hill neighborhood association. So i also called in to share my first. Thank you so much for your work. Right. The second part of it is like, i totally supported two years ago. However looking at the results and the execution, i do not believe it is the right solution. I totally understand. Like, yes, there are folks who need help, but we cannot keep throwing money in the toilet like this is a fiscally irresponsible project where you are not even using the money to bring a more sustainable permanent solution for these folks. Its clear from two years of execution on that this solution is not working. Why are we renewing it for next two years . What is the what are we expecting to change here . Are we going to keep doing this . So this is where my biggest concern is. Like, if we have the results right in front of us, we should be looking at them and hold us accountable for them and think about what can we do better in future. The current results do not support extension of btc and again by no means we are saying do not help these folks. We are saying help these folks by coming up with more, better permanent solutions. We should not be doing like right now. There is a damage to public park property. There are multiple incidents for that. Like you are welcome to go talk to the park officials. You are not screening people coming to vtc. Sorry anyhow, i totally oppose extension of btc at this moment. Thank you. Thank you for your comments today. Next speaker, please. So so this committee that was formed on homeless onus and Behavioral Health select committee, you need to go to the site and see things for yourself. So we have people here, you supervisors and some departments. Get the money and you your favor. Some an entities who are not from San Francisco. So but they are here trying to teach us a lesson. I dont know what type of lesson the director of Environmental Justice advocacy. You supervisors know so you have not gone to the site. And the adverse impacts that its creating to the people from double rock and the people who park their cars. But the caps are even increasing further down. So you guys, you know, are pathetic. This is a state park. Why dont you go to mclaren park . Why dont you go to golden gate park. You supervisors are kicking the can down the street and encouraging certain entities who are not from here. They are from l. A. Compton. I dont know where are giving them jobs and a few shout outs from the community. Watch for this program. Think twice before you go forward or you will get into deep trouble. Thank you very much. Thank you for your comments today, mr. Dcosta, may we please have the next caller. Next caller, please. Seems like thats an unintended line. Yeah, maybe we go to the next line, please. Hi my name is jesse kotowski and im calling on behalf of the Housing Action coalition, the Housing Action coalition believes in providing more housing at all levels, levels of affordability, including temporary shelters for people experiencing homelessness. We support the department of homelessness and Supportive Housing efforts. San francisco is in desperate need of housing, and this project has already helped almost 100 guests and has the potential to help even more of our most vulnerable residents. We support interim Housing Solutions such as this and are proud to support hshs efforts in Candlestick Point. While we all know while we all know this isnt a permanent solution to our housing shortage and homelessness crisis, we need an all of the above approach, which includes projects such as this to help the people of San Francisco. Thank you for your time and we look forward to continuing to support this project as it progresses. Thank you for your comments today, jesse. We currently have no other callers in the queue, but were going to return to the unattended line and see if they are available. Now hi, lucas williams, attorney for candlestick Heights Community alliance. Im going to address the issue, which is particularly galling that were still talking about this two years later. But the project is clearly not exempt from sequa. Its located in a state park, a state park that was founded to support Environmental Justice. Its the centers within 1000ft of residences, including alice griffith, and it has no power and its not going to have as as blah noted, as a supervisor noted, its not going to have power for the rest of the league. So how is it going to get power, Diesel Engine . Thats what theyve been using for a year to date. Theyve emitted hundreds of pounds of diesel particulate matter into a neighborhood that has the worst diesel pollution burden in the entire state. So its if the city had done review when this project was unlawfully approved, two years ago, all of this would have come to light. It would have been it would have been Public Knowledge that the site doesnt have power and is not going to have power. Making matters even worse, the parking lot is located directly on top of soil, contaminated with toxic chemicals, and thats extremely problematic because the city is again unlawfully conducting excavation activities right now that are releasing toxic chemicals into the air that the residents and the community are breathing. I think its ironic that that supervisor walden hasnt said anything yet. Its surprising to me because he is on record opposing the diesel generators, interrupting. Yet here we are again, a member of the committee individually. Please address the committee as a whole. Thats all. Thank you. Thank you for addressing the committee today. We have one caller that has joined the queue. May we please have the speaker . Hi this is Jennifer Friedenbach calling from coalition on homelessness. Speaking in support of this project. Um, just want to note that it has been very difficult finding safe parking sites. This is a great form of alternative temporary housing for folks that is really badly needed as weve seen a huge rise in the number of people who, um, san franciscans who cant afford rent, uh, economic pressures, retirement. Et cetera. That are living in rvs and so having a safe place to park where you have access to water, to food, to showers is really important. I recognize the, um, it is, it has been an expensive project. I think that it encourage trying to figure out how to take the cost down. And that said, if we lose the site, we have nothing and nothing to work with. Um and also encourage its pg and es fault that the electricity is not going on. And so that should go on and when it does, well be able to really bring down the per person cost. And thats been a delay thats been on pg and ease shoulders. So im really encourage you to support this project. It is an incredibly important part of our temporary shelter system. Thank you. Thank you for your comments. And while we check if you are on the line and intend to speak to this item, please dial star three now or well take this as our last caller and give you a few moments. Again, that is star three to raise your hand to be added to the speaker. Queue okay. Seeing no other callers joining, may we please have this last caller. Hi, im definitely in support of Housing Options, but i have to just ask a practical question on the numbers. Were talking about getting the costs down to 100 a day per person, 100 a day is 3,000 a month. That is the average price for a one bedroom apartment, one bed, one bath apartment in San Francisco right now. And its well above market rate for a studio. So, you know, if were looking to get people housed to get people stable, why are we as a city not just spending the money on renting available studios for these for people in need . I you know, as a taxpayer, i want the best bang for my buck and i want the best quality of service that were providing the people. So if we can spend and 2000, 200, 2,500 a month on a studio, to me that seems like it would be a step up from someone who is for stuck sleeping in a car or a van. Why not take that money and put them in an apartment, get them in actual home for the same cost to me, that seems like that would be a win win all around rather than just throwing more money at a half hearted solution that maybe has power and isnt really giving as much benefit to those who are living there. Thanks thank you for your comments. And were checking now to see if there are any other callers in the queue. Okay okay. There are no more callers in the queue. Thank you. Public comment is now closed. Supervisor walton, thank you so much, chair ronen. And first i want to just start off by saying that pga is evil. I do want to thank everyone who came out today and everyone who did call in and i want to start off by just stating that prior to opening of the vtc, we had an extremely untenable situation in the candlestick area. Dozens of vehicles occupied by individuals and families as well. No Restroom Facilities, no showers , no coordinated services, blockage of roadways and trashed trash and waste. Also added to the issues and i know this firsthand because i drive by there pretty much every day. I live in the area. I walk in that community and so i know the issues we had to deal with at the expressway when we opened the emergency Vehicle Triage Center due to the flooding, these conditions immediately stopped. Then we opened the vtc closer to the candlestick area and these conditions continued to improve. We cannot allow a repeat of what we saw in the area and the vtc most certainly helped change that dynamic. The goal is always permanent housing, but we also have to have Short Term Solutions to major issues and be nimble when we see Major Concerns in certain areas. And the resolution to that has been the Vehicle Triage Center. Theres much more work to do in terms of placing people in the permanent housing, but most certainly the vtc has improved and proved to be a meaningful short Term Solution and community to those that say why here, that that is because this is where we see a high level of individuals and families living in vehicles. This space allows us to make needed connections and provide services easier without the vtc even more vehicles would be in residential areas and that would not be receiving the proper cleanup that would not be receiving Restroom Services as connections to housing and medical support. And this is a reality that we cannot support going backwards. I we have a responsibility to keep communities clean and safe. And this provides a combination of both. While we try and address one of the biggest issues that we have to solve here in this great city. This is an expensive endeavor, but it will be more expensive and we cannot afford the alternative of leaving the unhoused and house, quite frankly, to fend for themselves and although we do have some concerns and have seen little opposition, we have received overwhelming support of the Vehicle Triage Center. There are areas across the city like by San Francisco state and lake merced, that would also benefit from a Vehicle Triage Center. So in order to avoid what weve had in the past, not only at the candlestick expressway, but also in other areas in the same community, we have to address this. What we are dealing with, and this provides a safe space and alternative for folks who have been forced to live in their vehicles and on the street. So a continuation continuation of the vtc is most certainly a must at this time. I do want to thank hsh for their work in community on this, as well as urban alchemy, not just for their operation of the site, but also for their professionalism and care and working with the residents at the vtc and also residents in the surrounding community. And i do want to thank the vla for their analysis and for their recommendation of approval. It is most certainly important that we as stewards of taxpayer dollars, do everything that we can to save resources, and there is a plan in place to, of course do that in the future. But we cant ignore that some solutions require a short term response so that we can make life easier for everyone. The Vehicle Triage Center does that and has done that. The alternative would be much worse, even for people who disagree with the Vehicle Triage Center. And sometimes we have to make hard decisions in leadership. But living in the area, seeing the improvement and understanding what has happened since the Vehicle Triage Center has been in place, i 100 support this extension and will continue to work with community, of course, to mitigate their concerns as we move forward. Thank you. Thank you. Supervisor walton, for your support and leadership of this important, important intervention. I first just really wanted to thank all of the residents who came out. Its so meaningful to hear from you directly. It it really puts puts a human face on how important this this this Vehicle Triage Center is. And its not always comfortable to come to city hall and to tell your stories. But i just want you to know that every time you do it, i cant tell you the difference. It makes for me personally to hear from you directly. So i just wanted to really thank you for coming out. I also wanted to just ask, like, either emily or or Deputy Director cohen or director sherry mcspadden to come up. And just if you could explain, because i think its not its it makes when you when you break down the numbers and also, i wanted to thank the bla for the really, really great job on the report. And when you break down the numbers, it it its so shocking. And i absolutely truly want to ask you to fulfill the recommendation of the bla and when we get to the budget process to come to us with options for bringing those prices down. And yes, pga is evil and a big part of the problem, but but im wondering if you can explain why we just dont rent, you know, market rate studios and move everyone in because thats what you immediately think when you see these large numbers and i know its not that simple. And so if you could just respond to that that Public Commenter who made that suggestion. Absolutely thank you. Chair ronen, i really appreciate this question. Housing is cheaper than shelter for it always has been. I mean, that is one of the biggest arguments in support of a Housing First model because you are not paying for some of the auxiliary services that that our company, a shelter, especially like a Vehicle Triage Center. But but in generally speaking, a shelter is going to serve for people a year and the housing unit that may be less expensive live on a night by night basis is likely going to serve one person for the rest of that lease. And i think thats where the big cost difference comes in, is if a shelter is functioning properly and moving people out into long Term Solutions for individuals, for couples, for families, lives are going to be impacted by that one shelter bed each year. And if the shelter continues on for years and years, that one bed has had a tremendous impact. Housing is a game changer, right . We know this. Housing is the answer to many peoples homelessness, but its going to serve that one person for as long as that subsidy continues. And so can pairing the two on a per night per person basis. We do it because were comparing costs of interventions, but it is a little misleading. I do also want to speak and appreciate the opportunity to talk about why this particular project is so expensive, and in part its because of the pga challenges. You know, but just as a note, when we you think Vehicle Triage Center, youre like a parking lot. How expensive can that be . But when you get down to it, we need to rent or buy a shower. Trailers bathroom trailers, because even though folks have rvs, not all of those Restroom Facilities are functional hand washing stations. We have a Potable Water tank so folks have access to clean drinking water. We have blackwater pumping for folks who do use the facilities in their rvs because theres no power. We dont have refrigerators or freezers on site. So we have freshly prepared meals delivered to the site daily, which is very expensive. We have wifi and camera infrastructure, which we have at other facilities as well. Laundry service, because there is no power at the site to do our own programmatic and client laundry. We have solar lights operating on and we have the rental of an office trailer and storage as well as insurance and other infrastructure. So these temporary sort of what i think the general public and for good reason, you think a parking lot how much infrastructure can there be . Theres a lot that goes into making it a safe, dignified location. And those costs are expensive. Thank you. Appreciate that. While im at the mic, i also just wanted to thank supervisor walton for his leadership on this from really well before day one of this project and really appreciate his work in community and with this project. Thanks thank you. And with that, im wondering if, uh, supervisor walton wants to do the honors. Thank you so much , chair. Ronen, i would like to of course, move this forward with the positive recommendation to the full board of supervisors. Great. And if we can have a roll call vote. Thank you on that motion. Vice chair mandelman. Hi, mandelman. I member walton walton. I chair ronen i. Ronen i. This item passes with three eyes motion passes unanimously. Thank you so much. Everyone who came out. Madam clerk, can you please read item number two . Item number two is a hearing on the department of homelessness. Apologies. Pardon if you can, please exit the chamber silently so we can continue the meeting. Yeah thank you. Can you please exit the chamber silently so that were able to continue . Thank you. Item number two is a hearing on the department of homelessness and Supportive Housing Strategic Plan to understand how the Department Prepares its approach to homelessness as far as available beds in the system, whether permanent or temporary, the number of available openings on the waitlist for each program. How the department maintains its coordinate entry system with the number of individuals awaiting for housing and those who do not qualify for housing and how to impact the Strategic Plans implementation action will have on street conditions over the next five years. And. Hello pardon me. We are still continuing the meeting. If we can please exit silently, we continue reading the title street conditions over the next five years and requesting the department of homelessness and Supportive Housing to report members of the public who wish to provide Public Comment on this item should call the Public Comment number. Scrolling across the bottom of the screen. When prompted. Enter meeting id and the press pound twice. If you have not done so already, please dial star three to be added to the speaker queue. The system prompt will indicate that you have raised your hand. Please wait for the system to indicate that you have been unmuted and you may begin your comments when we go to Public Comment. Thank you. Good morning, director mcspadden. Good morning. Good morning, chair. Ronen. Good morning, supervisors mandelman and walton. Um, appreciate the opportunity to be here. Happy friday. And so i just wanted to start out by going over our Strategic Plan. I dont think weve had an opportunity to present it here to you and then well be here. I have actually my whole exec team either online or or in chambers here to answer any questions. So the plan was developed in 2000. In 2022 and on into early 2023 and was issued in april of 2023. It will be the guide for the department of homelessness work from july 20th, 23 through june 2028. So five fiscal years. So moving on to our Guiding Principles. Through this plan, the city has embracing guiding certain Guiding Principles in our approach to ending homelessness. And these include leadership and guidance from people with lived expertise Housing First and housing focused collaborative relationships, and shared decision making. We want it to be data driven, obviously, and then ultimately we have it rooted in common sense. Our long term vision is a city that is advancing Racial Equity and housing justice, that is ensuring no one experience homelessness, and that is ensuring everyone has the housing and other Community Supports they need to thrive. We have three core values guiding this work. First is to focus on equity and justice. The second is to focus on quality, to improve the services we deliver. And this plan isnt just about expansion. Its about making our Current Systems work better, including improving systems flow and better integration of other with other systems. And weve developed this again with a lot of help from the community and a lot of people who have lived expertise of homelessness is and then its about encouraging innovation in our approaches and our systems as so one of the main reasons we believe this plan will be successful is due to the development thats centered equity, Community Engagement and systems modeling to develop this plan, we focused on equity with active Community Engagement that centered and compensated people with lived expertise. Our Community Engagement and Stakeholder Input processes were implemented in partnership with people with lived expertise of homelessness, including the recruiting and leadership of Community Liaisons to design and implement engagement activities, surveys and focus groups with people with lived experience. This input sessions with provider organizations, Community Leaders and stakeholders representing neighborhood groups, merchant associations and the Business Community and the general public and facilitated planning discussions with the strategic framework advisory committee. The local homeless coordinating board, the our city, our home oversight committee, and other entities, and our our commission wasnt seated until may and so that actually happened after the release of this plan. We also reviewed and considered many other relevant existing plans and reports to identify issues, strategies and activities that have already been prioritized and are being implemented within the community. And we focused on crossdepartmental coordination and planning to identify priorities and objectives and to develop and align strategies and activities to ensure that the Strategic Plan truly represents a citywide plan and that its multidepartmental and its not just sitting with our department because homelessness touches all of us. Find we relied on system modeling to help determine how much of which kinds of housing and services interventions are needed to make an impact on homelessness in San Francisco, including developing a baseline model using the best available data regarding needs, pathways and scale of Current Investments and interventions, and projecting impacts of different investments or other policy and practice changes and to inform, goal and target setting for the plan. So just moving on to the Top Priorities of people experiencing homelessness or with past experiences of homelessness. These include improving Housing Options and making it easier and faster to get housing improve the shelter and Case Management systems, adding more shelter beds, improving Mental Health services , ensuring equitable Program Access and service access, and providing more Job Opportunities and expanding outreach and improving training for outreach workers and case managers. So while weve made some important changes in our approach in this plan, theres also continuity in that it builds in that it builds on our success. To date, weve expand prevention, shelter and housing in a way that has reduced unsheltered homelessness by 15 over three years, as was shown in our last point in time, count San Francisco is one of the only communities to decrease unsheltered homelessness by double digits. And this correlates directly with the increased investment in evidence based prevention, shelter and housing. And this slide here demonstrates the significant system expansion over the past few years. So our Strategic Plan, five year goals there, five main system goals in the home by the bay plan. First is to reduce the number of people who are unsheltered by 50 and reduce the total number of people experiencing homelessness by 15 to i is to demonstrate measurable reductions in racial inequities and other disparities in both the experience of homelessness and the outcomes of city programs intended to prevent and end homelessness. And then the third is to actively support at least 30,000 people to move from homelessness into permanent housing. So for is to ensure that at least 85 of people who exit homelessness do not experience it again. And then five is to provide Prevention Services to at least 18,000 people at risk of losing their housing and becoming homelessness homeless. These five system goals provide clear directives for the whole community to focus on, to not get destroyed, parted from and to know when were veering off course. But we also want to emphasize that there are system central system level measures to understand how the system is delivering on its core responsibilities in our system and partners for fulfilling their core roles is to reach these system goals. The city will expand the homelessness response system and focus on the five strategic actions on five strategic action areas. So the first part of the work is expanding our homelessness response system. The availability of Housing Assistance is the ultimate factor that drives progress on homelessness to reduce the number of individuals experiencing homelessness, we plan to increase the number of housing slots available, increase the number of prevention slots that we can use , and then to further decrease unsheltered homelessness, we need to increase the number of shelter beds these needs are captured in the Strategic Plans expansion targets. We started to make progress towards these expansion goals in the 23 to 25 Budget Approved by this board in summer of in the summer of 2023. In the last years budget, we received approval to invest in 1650 additional slots of prevention, a net of 594 shelter, new shelter beds and 355 housing slots marking a significant progress toward expansion goals. And then with the investments in this plan, our data modeling has demonstrated that we will achieve the 50 reduction in unsheltered homelessness and overall decrease in total total homelessness over the five years of the plan. So system modeling has also made it possible to project the costs of expanding the homelessness response system. With this additional housing and services, the city estimates that this expansion will require more than 607 million in additional funding during the five year time frame of the plan and more than 217 million in additional funding annually thereafter, increasing with inflation over time to sustain the new investments. As these Financial Resources are not yet secured. All the although the fiscal fiscal year 23 to 25 budget started to make these investments marshaling resources at this scale is going to require increased and ongoing funding commitments at the local level. Aggressive advocacy for and leveraging of new state and federal funding, strategic and coordinated philanthropic investment and accountability to ensure that all dollars are effectively deployed to achieve the desired outcomes as. To achieve these goals, the city will also need to strengthen operations and outcomes across the entire system with five key action areas for each of these action areas. The plan draws on relevant recommendations provided by people with lived experience of homelessness and lays out and prioritizes objectives and strategies that we will pursue to advance these action areas. Im going to go through each of these, each of these in depth in the subsequent slides in the area of enhancing system performance and capacity, well focus on building nonprofit provider capacity, i. E. Enhancing performance and accountability, strengthening the quality, diversity and utilization of data, improving alignment of city wide strategies and resources. Is implementing a redesign and equitable coordinated entry system in the area of advancing Racial Equity and housing justice. We will focus on equity and justice focused data and analysis, Collaborative Partnerships and shared decision making, internal and external equity focused Capacity Building and nonprofit sustainable city activities, and then empowering the leadership of impacted communities and people with lived expertise. The coordinated entry, the coordinated entry redesign work started in 2022 with an evaluation that identified some key areas for reform. Some overarching themes include the need for more transparency, more standardization, better training, and more Community Involvement in the system. Re design work went from september 2022 to april 2023, when the redesign workgroup finalized their recommendation actions, their priority action areas include investing in staff, diversifying options for access points, clarifying messaging and improving the quality of services. Received the third phase, which started in spring of 2023 and is ongoing, is the actual redesign itself. The coordinated entry redesign committee was seated in august 2023 with 24 Community Stakeholders and two city staff. 65 of the folks have lived experience of homelessness and this group will work to implement the recommendations as. An and then in the area of improving our response to unsheltered homelessness, this will be embedding an expanded shelter, services and resources within in outreach efforts, crisis interventions, shelters and transitional housing programs will be addressing the health behavioral, health and Services Needs of people who are unsheltered. We will be connecting people who are unsheltered directly to permanent housing and addressing Community Impacts and neighborhood concerns. Is part of the work. This is an area where the citywide nature of this plan is key partner hours at the department of Emergency Management and other agencies are central to coordinating our work through the creation of our plan. We were able to convene stakeholders to unite around a shared vision and strategy for our multidepartmental response to varied conditions and crises on our streets. The agencys shown on the slide here represents some of the many agencies we work closely with. The department of Emergency Management has started to take a more active role in coordinating the citys response to unsheltered homelessness in recent months, with their coordinated street response work. Were looking forward to continuing to partner with them. And then additionally, our systems expansion of adding 1075 shelter beds is key to meeting the needs of People Living unsheltered. We currently have a capacity of over 3100 shelter beds and units, as the board has requested. We mapped out our shelters with a visual of current vacancy rates. Hopefully you can see that on the slide. Our shelters have very high occupancy. We need more resources to offer people to get them off the street. Our shelter occupancy rate generally hovers around 90 to 91 overall, but resources for adults are far more utilized and less available as of september 20th, the adult shelter system had an occupancy rate of 94, and there was and there were 467 people on the shelter reservation waitlist for beds at three adult shelters, taking referrals from that list , adding this crucial shelter capacity will be a key component of system expansion with improved system flow. Increasing successful and stable entries into housing. Our first objective in this action area is to improve access to and ensure low vacancy rates across the citys permanent housing portfolio. The plan seeks to do so through speeding referral and placement processes, innovating and improving housing, navigation and placement services, and strengthening low barrier and housing. First approaches as as a request. And this map shows the location of our site based permanent Supportive Housing and the vacancies per site that make up our current 9. 5 vacancy rate. Weve already started to do some of the work by implementing strategies to speed up placements and reduce vacancies in recent months, weve implemented a new unit refusal and participation protocol to encourage efficient placements. Weve also expanded the role of case managers to include document readiness. We completed the unit level inventory project, a large infrastructure overhaul to include all Housing Units in our main data system. The one system we now can much more easily track which units are availablend more easily match clients to appropriate units. Weve also started the direct placement pilot where people are placed directly from the street into housing our street to home program. With these initiatives. In addition to the new Housing Resources coming online this year, we are confident that we will reduce the level of vacancies in our permanent housing portfolio. And then finally, in the area of preventing people from experiencing homelessness. This will focus on expanding Prevention Services to serve 4300 additional households. Well be strengthening our current Homelessness Prevention and eviction Prevention Strategies and targeting enhancing housing problem solving for people at the very cusp of homelessness, thus creating an expand supply of affordable Housing Units that can prevent households from experiencing housing instability and crises, and developing upstream Prevention Strategies that better prevent people from experiencing housing crises and risks of homelessness. The San Francisco emergency rental Assistance Program, or erap, is a major tool in San Franciscos citywide prevention strategy. Its jointly administered by the department of homelessness and Supportive Housing and the Mayors Office of housing and community development. Erap launched in spring of 2021 as a covid 19 Relief Program rent Relief Program for people who could not get support from the states rental Assistance Program when the States Program closed in april of 2022, the San Francisco expanded eligibility for the local program in september of 2022. The program stopped accepting applications due to a backlog in february of 2023, after processing the backlog, the city reopened the program as a steady state program, i. E. No longer in response to covid 19, with more targeted eligibility requirements to focus on prevention for households. Most in need without being overwhelmed administratively. Hsh partners with seven Homelessness Prevention providers that offer erap assistance in 20 2223 hshs seven providers dispersed. At 9. 9 million in financial assistance. To 1440 households. And then hsh will lead the development of annual implementation plans and regular reporting on our progress. We will use these primary accountability mechanisms listed on this slide to ensure that the city as a whole is accountable, is accountable to making meaningful progress toward achieving this plans goals and objective, and to inform refinements to strategies and activities in the future. So our public reporting process progress is partnering with people with lived expertise and then, of course, our Homeless Oversight Commission in. And that gets us to questions. And i want to reiterate that ive got many members of my all the members of my exec team either here in person or online to help with the questions. Thank you. Thank you so much, supervisor walton. Thank you, chair ronen, and thank you so much, director mcspadden. I do. I do have a question just in terms of if we look at a slide nine and look at the second goal and im wondering how are we going to achieve with this or without prioritizing, prioritizing housing, without race and without prioritizing housing with people who are disproportionately homeless. Oh, so the Racial Equity goal . Correct so weve identified a lot of categories where we need to improve in those areas and again, we really listen to people with lived expertise of homelessness. Weve tried some strategies more recently, like with the emergency housing vouchers, for instance, and some of the youth housing weve done where weve really been able to work directly with neighborhoods and work with the organized actions that are experts in serving communities of color, queer communities. Et cetera. And we have found that that is a really successful way to increase and advance Racial Equity and other types of equity in our system. Does that help answer your question . I mean, i think were. Go ahead. I mean, it definitely addresses it. But is there a way to make it concrete that we can prioritize people who are disproportionately affected by homelessness and put that in policy . We have been using certain proxies to be able to do that legally, and we can certainly put some goals in in terms of the numbers of people who are disproportionately affected. I mean, we definitely track that and we talk a lot about it in each of our programs. And how and how were doing it. For instance, in the emergency housing vouchers, how were doing a very good job of that. So i think we can set those goals and make them really clear. Sorry if its not really well laid out and i know we cant use race, but most certainly we do have an astronomical number of folks disproportionately affected by homelessness. Absolutely. And race is just one piece of it. Right and so it would seem like we could carve out something concrete that would help us achieve our goals. Yes, we can. Thank you. Supervisor amendment. Any questions . As well . Maybe a couple comments and maybe a couple questions and my comments. I want. To will not be surprising to the staff from i think they know that i fundamental disagree with the direction that i think the department is taking in a host of ways. And i want to also say that i have enormous respect for the folks who are working in that department and who are leading that department, because i think youre working really, really hard and doing a lot of good things. I dont believe that this Strategic Plan is a roadmap to make meaningful progress on conditions in our on our streets and in public spaces over the next few years. And i believe that ive said this before. I believe that for a number of reasons. I believe it because the 50 reduction in unsheltered homelessness as as presented in this plan and thought about in this plan depends on more than half 1 billion of additional spending during that time and then continued increases in spending above inflation Going Forward. And i dont know where that money is going to come from this. You have described that this plan is based on Housing First and housing focused principles, which have been guiding the citys homelessness response for at least the last 15 years. And i think without it would be it would be wrong not to acknowledge the important successes of that strategy, the lives that have been changed, the people who have moved indoors, the people who are in housing now and would not otherwise be, but for the billions of dollars that this city has spent that has not led to what san franciscans expect it, which is usable public spaces and the under prioritized portion of the immediate transitional exits from the street that would be paired with a broader encampment response across the city is a great failure, in my view, in this plan, and it will be a problem for the city Going Forward. And if this were coming to me for a vote, i would vote no. So saying that out, the other concern that i have in this, you know, again, it its consistent with what the city has been doing. Its probably consistent with maybe the direction youve received. Im not sure. But you know, housing is the priority. Three other priorities include expanded shelter include expanded Mental Health and other services to support the people who are in who are currently in psh. Thats an other priority. I would reverse that. I would say that an important that a key goal in any plan Going Forward should be to increase the resources that are available for the people who are already in ssh because those buildings, many of them are tremendously challenging to manage. There are people who are falling out of that housing. There are people who are in that housing who are struggling with their neighbors, who have tremendous needs and challenges that are not being adequately addressed. So not to be the meanie here, and i dont think that my views are actually shared by necessarily a majority on the board, but i am i just i think were off track here. So with that, a couple questions. Just maybe more on like sort of tactically how the department is thinking about some issues. There has been talk about i mean, the mayor made an announcement earlier this week about, you know, testing folks and then requiring participation in in in treatment for. Folks who are on gay who are substance using. It seems to me that if were going to do that and were going to have folks potentially going away to you know, residential treatment and then coming back to buildings, we need to do a far better job of having buildings that are supportive of sobriety than we do now. And i know there has been some talk or think ing about spaces that are more buildings, that are more supportive of sobriety than the ones we have now. And i know adult probation has done some exploration in that regard. And im wondering what the your department is currently thinking about converting portion of buildings or New Buildings or are we going to have some spaces for folks who want to be in sober spaces to support their own sobriety . Okay. Theres a lot there to unpack. Supervisor so first off, thank you for your comments and i understand that that we have a difference of opinion about this plan and that said, we also know that we need more shelter. And part of what drives what we can do is, is the funding. And so when you look at the funding and the and the homekey funding thats come down from the state and ohio, you know, that actually forces our hand a little bit in terms of how we think about our priorities, because we want to make sure to take absolute advantage of all the funding and shelter is actually a little harder to fund. And as as Deputy Director cohen has pointed out, is also more expensive and so were trying to balance all of those things at once, you know, and make sure that we have a robust system that meets people where they are. And thats obviously a challenge in San Francisco. So i think the so to your other question, yes, i mean, obviously, we are very much in support of what the mayor has announced this week and what our colleagues at Human Services agency are proposing to do. I think that what we believe is that people do need choice. So this year we should be we are planning to stand up a sober, sober living building so that people who want to opt into that would have the ability to live in a place where theyre where people are committed to that value. I think, you know, we know that not everybody is ready for that at any time. And we do believe that Housing First is really the right way to go. So and so were but we are looking at that model and we certainly have worked with adult probation and others about what best practices are around that. So well continue to having those conversations. I just one last thing is that well go ahead and ask your question. I just lost my train of thought. Im sorry. Sorry how many units are in that proposed for that building . 150. Okay. Well that thats sizable. Yes its a its not nothing. Its not nothing. And is there i mean. Well, well see how that works. But if it works, it might be interesting to try to convert other buildings. Were still in the early stages, but yes, its going to inform us a lot on kind of how we want to think about our whole system. And then how about the need . I mean, weve had this massive, relatively massive expansion of while we have lost residential boarding care and while we have seen no significant, uh, im not sure if weve had any expansion in locked in locked facilities. So the only thing we got for people with severe mental, often the only thing we have is h. And for my suspicion is that there are some people who are in these buildings who dont actually need all the services that are available or may not need that forever. But theres it is also my strong suspicion that there are people in our buildings who need a lot more than theyre getting at. And how is the department thinking about getting that . Yeah and so the first thing i want to say is that this actually is a really high priority for us. We need to be supporting and supporting people in buildings. I wouldnt say its other. Were were having to work on all of these things at once. The theres a National Conversation going on about this very thing because this is what everybody is running into, especially in cities across the country. And we are really well, very well aware that there are some buildings and some residents in our buildings who are who need a higher level of support. Weve been talking with our partners at the department of Public Health about this and part of the reason that we have this plan and shared goals in our plan is really because we know very well that is not our area of expertise, but it is the is. And we need to work really closely with them. We have some great models, you know, 1066 mission, for instance, where for all of the services have come together to really support people, to live in age, in place, to have disabilities and be supported. I think we need more of those as we move forward and we really need to Pay Attention to the acuity that were seeing both in the buildings and on the street. I mean, its you know, there are a lot of very ill people out there. And were seeing the ages of people on the street really rise. So we know that people are older and yes, we arent the assisted living or the Residential Care system, but that there isnt enough there to support. So there are some really good models of ways that this is being done, both in San Francisco and outside of San Francisco. And were looking to replicate some of those. We have a new one coming online actually, this year based on a model that we learned about in oakland and have been planning with the San Francisco health plan and anthem to get going this year. So were very much aware of that. All right. Thank you. Thank you. So i want to appreciate all the work that went into this. And i want to appreciate what i think is a very honest Strategic Plan. And i think that thats something that we have not had in the past. And i, i like supervisor mandelman find the goals to be underwhelm coming, right. That we want to increase this unsheltered homelessness by 15 and by 50 and people experiencing homeless by 15. But i think that you are being honest that even with a very ambitious addition all amount of money to raise to achieve these goals that these are possible where where i differ with supervisor mandelman and have a question for you is what are we doing wrong at the same time as i think this well thought out, well balanced, really mystic plan thats ambitious because we have to find all this money that we dont have. What are we doing. Wrong to change the status quo . Right. And what i mean by that is, is there an effort to do a serious effort to organize with your peers all around the country . Because what were facing in San Francisco, we are not alone. Youre new Deputy Directors coming from los angeles. Its far worse in los angeles. I know that because im from there. And every time i visit my mom, im shocked at the where and how many encampments there are on the streets where ive never seen them before. This is true in every major city across the country. I just went to a National Conference in saint louis and every single city and even smaller cities are experiencing the same that we are. What is the effort to get the federal government to Start Building Public Housing again . Because lets be real, thats the only way were going to seriously end homelessness is, yes, we have a large budget, 14 billion, but the amount of that budget that is tied to fixed expenses that we cant cut out mean that we dont have as much ability to move around money as wed want. And we also have to balance our budget. Unlike the feds, theres just never going to be a enough money for San Francisco. So on its own to end homelessness in our city. While all cities all around us, you know, are dealing with the same thing and dont have the budget we have. So its super frustrating to me that we ever pretend like we could fix the issue on the streets. And thats where i would ask almost my colleague, supervisor mandelman, you disagree with this, but what would you do differently to solve the situation on the streets . Because even if we built enough shelter to house the 4000 unsheltered people on the streets today, hey, were going to get a whole new wave of people because were not going to spend money on preventing new homelessness in San Francisco. That means. And were also going to get people from out of town because this is a national problem. This is a statewide problem, and no one city can fix it. So where is that work happening to say, to be honest with the public . And thats what i like about this report, is its actually honest. Its saying we cant fix homelessness in in in San Francisco. We cant stop street homeless in San Francisco because well never have enough money to do it. So if i would love to hear from supervisor mandelman, but i want to give director mcspadden an opportunity. To respond first. Okay. So supervisor, i agree with you. I think this is a it is a national problem. There are a lot of conversations that are going on many different levels. I mean, you know, from governors offices talking with the federal government about states needs, certainly u. S. Mayors talking about this and sharing their own experiences with each other as as the director of the department of homelessness, im a member of the National Alliance to end homelessness leadership council. I spend a lot of time with that group, both sharing experi ences of what were seeing in the cities and counties and even rural areas that that we work in. And we do a lot of advocacy on the hill with that group around these very things like we need more Affordable Housing, whatever it looks like. Right . We need that. This is ultimately an Affordable Housing issue, too. But you know, we also do a lot of work with the us inner agency, council on homelessness. Weve had a Good Relationship with them. You know, those are things we are doing all the time. But its, you know, im just going to interrupt you for one second to say, but i dont hear you say every time. We cant fix homelessness in San Francisco. So unless the feds make housing a priority again, i dont hear that anywhere. Its not just you. I dont hear it anywhere. I dont hear the mayor say that. I dont hear my colleagues say that. I dont hear you say that. I dont hear other cities or states saying that. And i think its time to be honest about that, because otherwise, with every i think this is an honest plan for once, i think its one of the first honest plans weve actually gotten. But what i dont hear and i and i think this is a failure from leadership everywhere is saying , lets not lie to you, people of San Francisco, that are that are up in arms because the amount of tent encampments there are all over our city. I dont want to lie to you. I want to tell you that until your congresspeople, until your president starts investing in Affordable Housing and subsidized housing for the people of this nation, were not going to solve this problem because we can never afford to do it for the nation. In our one city of San Francisco. And i never hear that. I dont hear it anywhere. And because of that, we set up these expectations that were going to constantly fail to meet for the people of San Francisco. And you have people like supervisor mandolin saying its your fault. He disagrees with your strategy or, you know, and we have all those people saying it, but but the truth of the matter, its not mayor breeds fault. Its not your fault. Its not my fault. Its not super mandelsons fault. Where are the feds . Theyre the only ones that can truly solve this problem. And they have wiped their hands for decades of serving the needs of the people of the United States of america. That cant afford housing. And i just want to hear that from everyone in leadership, because if we dont hear that, then theyre going to blame whoevers in power. And its not that persons fault. Right its the fact that we have a federal government that has decided to leave america regions out to dry when they cant afford housing anymore. I agree with you. I want to hear you say it more. I want to hear. I want i want say it a lot. To be honest. I want the prolog of this report to point that out. But i also would love to hear from my colleagues, supervisor mandelman well, ill jump in line only because youve asked asked for. Yeah. No, i mean, i think that i mean, we may not i dont know. I mean, im not going to speak for the mayor. Im not going to speak for other colleagues. I very much believe that the homelessness crisis we have in california is the result of, you know, a half century of failed federal housing policy and the abandonment of cities that goes back to the 50s and 60s and underinvestment not just in i mean, i dont think the solution is to throw is for the federal government. I mean, throwing a lot of money at homelessness would help throwing a lot of money at housing for poor people would help. Throwing a lot of. Thats what i mean. I know. I think theres no disagreement. No disagreement on that point. I think, like i reach a different my view, too, is very much rooted in the idea that no San Francisco cannot solve homelessness and plans that are predicated on the idea that we as a municipality can solve homelessness s are going to fail. And so in an environment where we dont have the resources to do what we would like to do, which is solve homelessness, how do we triage . And i think we are doing too much of trying to solve homelessness and not enough of the triaging of people whose homelessness we cannot solve. And so what i would do that is different from this plan and would require for this board or the voters to change how we spend proposition c dollars. As an example, i would dramatic increase spending on shorter term immediate exits from the streets. I would and this is something youve worked on or through the chair to the chair that the chair has worked on. The notion of Navigation Centers was we cant solve everybodys problems in San Francisco. Lets get folks in. Lets figure out whats going on with them. And then only a small number of them will ultimately end up maybe getting housed in San Francisco. But well well we will work. We will we will swallow this whole problem. We will make it. The citys problem, recognizing that we cant solve the homelessness of all of these individuals. But only by embracing the whole problem of our sidewalks are we going to be able to create the change that i think your constituents want. My constituents want. And this is not a plan to do that. This is a plan to try to solve homelessness. It is not a plan to try to triage as many people as we possibly can. And get as many people as we can off of the sidewalk, which is which is what i want. Youre now just going to director mcfadden witness a debate of supervisors. But what what i would say and where were not as far apart on this as you think i think if i were the director of the department or if i wrote prop c, i probably would spend more money on shelter than than we currently are. But what im saying is, is if you dont prevent the new homelessness from coming into the system, then then youve got more people on the streets right . So were between a rock and a hard place. Whether we spend a little bit more on shelter than we do on permanent Supportive Housing and prevention or we spent, you know, i mean, its in a way, if you dont do all three, i dont know that youre youre going to youre going to have better street conditions. I honestly dont know that you are. And that there is like for example this plan. One thing that i do find compelling and that i worked on during the budget process with you all was that we are actually on the path to end youth homelessness, which is a big deal in terms of preventing adult homelessness later on. So i think we could we can argue about the details, but ultimate we, the people of San Francisco , are not going to be satisfied no matter if we spend a little bit more on shelter than we are on prevention or or vice versa, because were still going to have this problem in the streets, just like we have all over the country, not just its not a california thing. Its everywhere. Its a national crisis. Its a national problem. And so for me, i just think were were were were debating locally, you know, and the press makes it out to be this big difference of opinion where ultimately its really not about its the fact that whether we spend a little bit more on shelter or a little bit more on prevention, were still going to have street homelessness because the feds have washed their hands of their responsibility. So i will i will just say that if you want to Say Something, director paton, feel free. Otherwise im going to turn it over to supervisor walton to get into this discussion. Supervisor walton thank you, chair. Ronen you know, first it should be 100 clear to everyone, and i know its not the only way to really address homelessness and all the other ills that we have economic we are to address the systemic issues that lead to poverty and without strategies and plans to do that, were going to continue to go in circles and 100 agree with supervisor ronen, just like our regional transportation issues, right . Were not going to solve them locally if the state or federal government dont step in and bail out transportation, which by the way, is affected across this country, then we will have major problems with our transit entities. And thats the same thing with homelessness. And youre right, we dont see scream and yell enough about the fact that we cant solve this locally. And the government, the federal government particular needs to intervene in. And ive been trying to not have these debates about imaginary policies at this time, but most certainly we do have colleagues that keep bringing up these imaginary policies in meetings. But i do find it i, i dont understand how you can say that throwing money at housing for poor people would would help. And then also say attacking people on welfare and most certainly guaranteeing more people will be out on the streets. I dont understand how if a main priority is to try to address the encampments, try to prevent encampments, try to keep people from most certainly what it seems like the nuisances that that constituents deal with, then how you could support policies that would most certainly make that worse. But it you know, that conversation will continue but over my dead body will that actually become a policy . But yeah, i guess we i guess we have to have these conversations about imaginary proposals because theyre out there. Yeah, i have to. I have to echo you, supervisor walton and just say it was disappointing to hear you say director mcspadden, that you support not taking away peoples limited funds. If theyre on welfare and poor, if they dont submit to whatever it is this imaginary half baked plan that theyre supposed to submit for them. I was shocked to hear you say that. And it really it really disappointed me. Ill just ill just put that out there. I dont know if you want to respond or if ill ill ill turn it over to supervisor mandelman. But i was i was shocked and disappointed and i have to put that out there. And i, i dont know that we want to get into a discussion about proposals for reform, but but since its come up to be clear, and i dont think ive i dont think i or anyone else has expressed a lack of support for folks who are on welfare. I i was a medical kid. I think that , you know, poverty and addressing poverty has always been one of my motivating factors in being in Public Service is the proposal, as i understand it, that is emanating from the administration and is not really our topic today, but is not to take away housing or shelter from people who are using drugs that are likely to kill them. The proposal is to take away the cash and not to take away the cash. If folks are participating in treatment, it is an incentive to participate in treatment and to avoid dying of overdose s, which is killing people. And if folks are using meth or fentanyl, the likelihood of dying from that is great. And i am interested in seeing if Public Policy interventions can get folks into treatment. Theres no requirement that people be successful in efforts to achieve sobriety. The requirement would simply be to participate in treatment. One of the problems we have in h is that we put people into these buildings and the and the s the services are entirely voluntary and so i think mandating services is not a bad idea. And if this and if the way to do that is through the payments, im down for it. I dont know how you cant if you take away someones cash and they have housing, they cant pay their rent and are going to be displaced. So i dont know how you cant say those two things are related that is untrue. The rent will be paid. The cash will not be delivered to the person, to the to the to the rent will be paid. The rent will be doesnt affect the housing for our residents. That that proposal would not affect the housing for our residents. Okay. So how the people will feed themselves elves and every Everything Else to stay healthy. It is it is then up in the air. But thats good to hear that really they will participate in treatment that could save their lives. Um, did you want to respond, supervisor mcspadden, the supervisor, director of hispanic. I dont want your role. Thanks no, i dont actually. I mean, that is not our proposal. Its actually the proposal of another department. I dont really want to comment except to say that my understanding of that proposal is it would not affect the housing of our residents, the Housing Status of our residents. And that is important to us. Yeah, thats good to hear. That is good to hear. I am happy about that. The rest of the proposal is disgusting, but i am happy to hear about that. Okay. If theres no other other comments or questions, then i will open up this item for Public Comment. Thank you, madam chair. Are there any members of the public who would like to make Public Comment for item number two here in the chamber . Seeing then well check our call in lines where we have nine callers with one in the speaking queue. If you would like to speak to this item, please dial star three now to be added to the speaker. Queue for those already on hold, please continue to wait until the system indicates that you have been unmuted. May we please have the first caller. So supervisor users stick to the agenda, stick to the agenda for some of you. Supervisors came here from i dont know what planet. So you all dont know what the hell youre talking about. The department of defense. And thats the federal government built thousands of housing on potrero hill. Hunters point, other areas in San Francisco. Who do you think they built it . The federal government. So now we want to go to the federal government. When we have a budget of 14. 6 billion and we cannot do justice to our people. And we have supervisors who are rambling on about utter nonsense. This we cannot rely on the federal government to do everything for us. We are the fifth or the fourth largest economy in the world. California we can afford to build housing for everybody in San Francisco. So so you supervisors do not know how to do a needs assessment. And as for the presentation, thats a good thats a long presentation and i have nothing against the presenter because ive known her for a long time, but shes been given difficult assignments so that she can deliver to the city. And the city is not supporting her in the right way. Do not blame the federal government. Our city is a corrupt city. You know that. You know how many people have been indicted and some of you supervisors will be indicted soon. They are in the pipeline. So dont be rambling about this. That and the other thing the federal government has done its of its duty. I apologize for the interruption. Each speaker is being allotted two minutes today. Thank you for your comments. Were checking to see if there are any other callers in the queue and there are no additional callers. Madam chair. Public comment is now closed. Um, i would like to make a motion to declare, heard and file this hearing if i can have a roll call vote making on the motion to file this as heard and filed vice chair mandelman mandelman i member walton i walton i chair ronen i ronen i. You have three eyes that motion passes unanimously. Thank you so much. Madam clerk, can you please read item number three . Item number three is a hearing on plans to implement the Community Assistance recovery and empowerment. Otherwise known as care court by october first, 2023, and requesting the department of Public Health superior court and department of homelessness and Supportive Housing to present members of the public who wish to provide Public Comment on this item should call the phone number scrolling across the bottom of your screen when prompted. Enter meeting id, then press pound twice if you have not already done so, please dial star three to be added to the speaker queue. The system prompt will indicate that you have raised your hand. Please wait until the system indicates that you have been unmuted and you may begin your comments when we go to Public Comment. Thank you. Thank you. Supervisor mandelman, did you want to Say Something before we turn it over . Super briefly, just context for this. This committee had a hearing on a court back in april and heard what the what the different departments that were going to have to figure out how to implement care court in San Francisco were thinking at the time i think we conclude in that hearing that we wanted an update closer to the time when care Court Implementation would begin. It is supposed to begin october second. And so i think we wanted to hear from and again on how things have evolved over the summer, how theyre feeling about about what theyre going to be able to do, what impediments theyve found, what funding they might particularly through things like Bridge Housing, what kind of resources they may have been able to identify and track whats whats going on. So we have first dr. Angelica almeida from dpi. And we also have here who will be participating in the presentation, i believe. Thank you. Good morning, miss almeida. Good morning, supervisors, and happy friday. And i believe we have slides at honors pulling up for us. Great. Thank you so much. Very much appreciate the opportunity to come back to talk about our implementation of care court. And of course we could not be closer to when our implementation is as we are looking forward to implementing on monday and the court receiving petitions. So next slide please. So for today, we wanted to do a brief overview and reviewing information regarding care court where we are in terms of implementation and what well look different after october 1st when care court formally goes into effect. Next slide and so with that, we wanted to remind everyone in terms of the conversation regarding care court, how we got to be here today. Care court was created through legislation, senate bill 1338 care court is unique in that it allows for Court Ordered treatment for individuals with serious Mental Illness, particularly individuals who have a schizophrenia spectrum diagnosis, who are not engaged in care and are deteriorating in the community. Its meant to be upstream from other restrictive options like conservatorship or assisted outpatient treatment. But ultimately, while care court prioritizes engagement and voluntary treatment, what can happen is that the judge can ultimately order somebody to participate in a treatment plan in the community. This does not allow for involuntary medications or involuntary treatment in any way. But what really leverages is a symbolic way to the court to support somebody to engage in treatment , which is frequently called the black robe effect. So one thing thats important to note is this is also not an acute intervention. While individuals will be working with will have serious needs. This is not for people who otherwise need to be served in a hospital setting from when a petition gets filed to when we might have a court order in place is at minimum four and a half months. So it does take time for the Court Process to work through. Next slide, please. So just as a reminder of what the care court criteria is, it requires that an individual be over the age of 18 and have a diagnosed case of schizophrenia or other psychotic disorder. Again, is not engaged in voluntary treatment, is unlikely to survive safely in the community or is deteriorating where we suspect the individual will require hospitalization or more restrictive services in the future. The and we have to show that a person is likely to benefit from the program and that this is a least restrictive option to ensure the recovery and stability in the community. Next slide. I know we spoke about this at our last hearing and just to say we of course, get a lot of questions of how this looks different from other programs. And i recognize what is challenging thing and frustrating in some situations is we often have these programs that serve narrow parts of the population and that we try to puzzle together to provide as much support as we can in the community. And yet we are Still Limited in those interventions. So we wanted to highlight in terms of our Civil Court Proceedings how these differ. So we have care court and then moving to more restrictive assisted outpatient treatment and ultimately conservatorship, which of course were anticipating some major changes to conservatorship. And the definition for grave disability in the future. So just to highlight how care court looks different from out and conservatorship out im sorry, care court is unique in that it allows referrals from family members similar to out, but allows referrals from family members and First Responders. And thats a unique part of the program. The other piece thats unique is that care court calls out the ability for the judge to appoint a supporter in somebodys case, a supporter could be a friend. It could be a peer or somebody else in the community that the person trusts. But the idea is that this is somebody outside of the treatment system who actively participates in conversations around what somebodys care plan would be and what kind of Treatment Services they would participate in in collaboration in with the respondent or with the person whos been referred to the program. Um assisted outpatient treatment. Again becoming more restrictive requires that there be negative outcomes before somebody can refer to the program. So care court is really again meant to be upstream. This idea that people dont have to be getting worse before we help them get better out requires that somebody have two or more psychiatric hospitalizations or jail contacts where they received Mental Health treatment and the three years preceding a referral to out and of course, when we look at conservatorship , which as we know has come from the lps act and has not been modified in significant ways since 1972, require hours that somebody meet that very high threshold of grave disability. Conservatorship is our most restrictive of intervention for individuals and does allow in certain circumstances the ability to administer involuntary medications and to for somebody to be placed in involuntary Treatment Court or locked psychiatric facilities. Next slide, please. As we talk about what to expect as of next week, weve done a lot of work around population estimates. Just to note, theres no significant changes from the last time we had this conversation in. But we looked at this in a couple of different ways. We looked at this at a population level of how many people in the community on average have a schizophrenia spectrum diagnosis. As of those, how many people we anticipate will not be engaged in services. We also looked at the Mental Health population as well as lps , conservatorship, and again, different criteria. But we looked at this in a couple of different ways. Ucsf California Policy Lab did an analysis specifically focusing on individuals who had had psychiatric Emergency Contacts at zuckerberg San Francisco general hospital. So again, a more narrow population, all of that to say it is really hard to predict how many people may meet criteria are best midrange estimate is between 1 to 2000 people may meet criteria. In San Francisco. That certainly does not mean well receive petition on all of those cases. But ill talk a little bit more about how we are working to support petitions being filed with the court. Next slide, please. So the petitions can be filed with the court in a couple of different ways. Any of the eligible reference can petition the court directly. We have also set up a consult, an email address. So for individuals, First Responders, other treatment providers, family members, whomever might want to consult on if somebody is appropriate for care court, they can reach out to the department of Public Health. Well review somebodys case and determine if somebody meets eligibility. And ultimately the department of Public Health can become the petitioner. In all cases, the department of Public Health will be responsible for evaluating an individual, determining if they meet the care court criteria and providing recommendations to the court. So in all cases, the department ultimately becomes the petitioner. In these cases, we are, of course, preparing to leverage this new tool. Again, while a narrow population, it is a significant one and we look forward to also leveraging these tool and filing petitions with the court directly. Next slide, please. As we delve into the role of what the department of Public Health is responsible for, in addition to being the first point of contact with an individual investigating a case offering individuals voluntary services, the department of Public Health will be supporting an individual to enter into a care agreement at so where they voluntarily agree to participate in the program. And the Court Continues to monitor their progress or providing services to individuals is once a judge has ordered them to participate in treatment. But there is also this has called out in the legislature but a priority to support individuals is to complete a psychiatric advance directive similar to a Health Directive where if an individual deteriorate, its in the community. We have a plan in place for how they would like to be treated if they receive psychiatric Emergency Care types of medications they have negative responses to. Et cetera. So it gives an opportunity for them to have agency should they deteriorate and require hospitalization in the future. Next slide. Ill say San Francisco, of course, as a cohort one jurisdiction is leading the way in many circle instances, were providing a lot of consultation to other jurisdictions. A lot of other jurisdictions are building their models, similar to how San Francisco is. And just to share our model is really based off of our success and experiences with assisted outpatient treatment. So how we have decided to structure the team is the department of Public Health will have a Behavioral Health Services Team that includes both clinicians and peers that will be supporting that engagement and investigation. And then individuals will receive treatment throughout our portfolio of services, but primarily through Community Based organizations. This is very intentionally done because we want to separate intervention with the court out from where and how people receive services. It allows for individuals to maintain that relationship and rapport with providers because our goal is of course, that people continue to engage in services, whether theyre Court Ordered to participate and not and certainly after a court order has ended of course, in terms of services, again, individuals will have access to our entire portfolio. So this can include Case Management and intensive Case Management, medical support, peer support. It certainly Community Based outreach, residential treatment, crisis services, Substance Use disorder, treatment, etcetera. Next slide. In terms of treatment planning, we of course have done a lot of work to plan for the implementation of care court, including the Bridge Housing grant, which ill speak more to momentarily. And this has been really integrated with our work around Case Management expansion include investing in additional Case Management opportunities and of course weve had conversations around challenges weve had with that in our Case Management hearing, including the critical staffing shortage. We all know exists, particularly with Behavioral Health providers. Certainly in San Francisco, but across the state and nation. We currently are working very closely around expanding our Current System for residential treatment and we have 350 of the 400 targeted beds open and we look forward to continuing that, including keeping the care court population in mind to ensure that we have the appropriate services to support the population. In terms of concerns , i know we spoke about this at our last hearing as well, but just to say as as we were talking about while difficult to predict how many petitions will receive and the population in particularly with staffing shortages that we are experiencing, we anticipate that without additional investments from the state, the demand will exceed our current capacity to serve individuals calls, particularly because whether a person has private benefit s or is a recipient of medical or not, the department of Public Health is responsible for providing all that support with the court and investigating a case and liaisoning with the court as somebody participate in the program. This also means that there might be times when theres the risk of displacement of individuals who are otherwise waiting for treatment or are higher acuity because of our responsibility to serve care Court Participants. And thats something that were going to be keeping a very close eye on. And the other piece thats built into the legislation is we have to provide notice to individuals several times throughout the process and have multiple hearings before we get to a court order. Unlike the aot, it does not allow us to move forward with any hearings without the individual present. So particularly for our Community Members who are unhoused or transient, they refuse to come to court or we are unable to locate them, to serve them. Were unable to move forward with court orders. Next slide, please. Is in terms of the Bridge Housing grant, this was a grant that we were successfully awarded. Its 32 million over four years. This is something that is prioritized for care Court Participants, but is not limited to care Court Participants and something that were partnering very closely with the department of homelessness and Supportive Housing to implement. One important thing to note about Bridge Housing is that it does not allow us to fund permanent Supportive Housing. It is meant to particularly enforce or reinforce our transitional housing or short term Housing Options. So through this, we are looking to fund temporary shelter, emergency stabilization units, board and care patches for individuals who require that level of care supporting Co Op Housing and congregate semi congregant and non congregate shelters as well as transitional housing opportunities. Next slide please. So again, the length of stay in Bridge Housing is meant to be from a few weeks to a few years. So an emergency stabilization room, for example, might be 30 days or less, whereas a boarding care somebody might stay for a longer period of time. Were able to use this funding for navigation engagement and outreach. So in addition to physical beds that people will be able to stay in, this is also reinforced or providing Additional Support to our workforce by adding additional hot outreach workers and Behavioral Health support team members through the department of Public Health to ensure that when individuals are placed in any of these programs, whether it be a shelter or an emergency stabilization unit, we have the Behavioral Health supports in place to ensure their success in those placements. Next slide. We wanted to take an opportunity to highlight our partnership up. While individuals are not required to be experiencing homelessness to qualify for care court, we anticipate that a high volume of individuals, of course , will be experiencing homelessness when theyre referred to the program and have worked very closely with our partners at the department of homelessness and Supportive Housing to ensure that we have a really tight workflow in place for how to support these individuals is just a couple of things to note here is that we wanted to ensure that we are able we know that these are individuals who are not engaged voluntarily in services and we wanted to ensure that we were able to appropriately assess and move people toward towards placement outs without restrictions around coordinated entry or people not being willing to complete the coordinated entry assessments independently. So the dpa team will be completing these assessments on behalf of the individual. And if an individual enters into a care agreement or is Court Ordered to participate in treatment, theyll be prioritized for housing opportunities and of course serve as opportunities through the department of Public Health. Were going to have regular case conferencing with the department of homelessness and Supportive Housing to ensure for individuals that are experiencing homelessness that we are identifying a pathway for those individuals calls. In some situations it may be that they have to stabilize in an emergency stabilization unit or a shelter, for example, because of their risk of overdose. But the goal is to move them towards permanent Supportive Housing, whether individuals are moving into the department of Public Health resources or resources, we want to make sure that people have the Wraparound Services is that are Community Based to ensure their success in those placements long term. Next slide. I i touched on this already, but just to reiterate again that our department of Public Health team, as of monday will be investigating cases and moving cases forward. Well also be consulting with individuals to determine if people meet criteria for the program and filing petitions directly with the court. As people move through the process. We of course, hope many individuals will accept voluntary services and will be able to connect them to care through our Community Based organizations. As and when people are Court Ordered to participate in treatment, well make sure that they have the appropriate Services Available to them next slide. So in terms of whats happened since our hearing in april, which is hard to believe that it was that long ago, weve been doing a lot of outreach and engagement to prepare. In addition to developing the workflows that we were just discussing. But weve provided a town hall for our Community Based partners and providers. Weve met with First Responders to provide information about the program and identify how they can flag for us individuals that theyre concerned about in the community so that we can review their case. Weve participated in a panel through the superior court, and weve had many other internal presentations and updates through the Health Commission community Behavioral Health Directors Association on and conservative partnering with the conservators office, etcetera. So weve had frequent meetings with many different partners to both discuss how the collaboration will work and how people will flow seamlessly through our system, but also to think about how we move forward with filing petitions and consulting with cases as of october 1st. So next slide, please. And speaking of october 1st, that is upon us. While the program goes into effect october 1st, that is of course, a sunday. And so individuals will be able to file petitions with the court starting on monday, october second. Wanted to provide links to the Court Website that has information for forms that need to be filed to file directly with the court. And again, on our previous slide, we had our email address. If people would prefer to reach out to the department of Public Health for consultation prior to filing, court will be heard on mondays at 575 polk street at and we look forward to both filing petitions directly and to supporting individuals. So of course we have no idea what to expect as of monday, but we are prepared to receive petitions from the court to start investigating those cases and to move forward with filing petitions and outreaching individuals to again, hopefully engage individuals in voluntary care through this process, but if necessary, to serve people through the Court Process as well. And with that, next slide of course, i recognize that this is a lot of information. And as you can see, a lot of planning has gone into this implementation. On monday and happy to answer any questions that you may have. Thank you. Supervisor madeline. Yeah. So thank, thank you for all of your work on this and thank you for the presentation. Im still trying to figure out like sort of the logistics of how of how this is likely to work. So you mentioned in your slides as potential reference is the petitioner. I mean, theres a broad theres a relatively broad set of potential petitioners that is not just correct. Can you talk about that . And yeah, absolutely. So there is a very broad range of people who can petition directly with the court. So and this is unique. So a couple of things can happen. So First Responders, family members, hospitals, existing treatment providers can all file directly with the court. So they could go to the Court Website, download a petition, complete the petition in treatment providers can complete attached Mental Health declaration with that and file directly with the court and those situations. The court would review the case for prima facia evidence and if the judge believes that they meet prima facia evidence, they send that case over to the department of Public Health and then we provide a more robust Investigation Report and ultimately we determine that the person meets criteria and file a petition with the court, we become the petitioner. At that point, we also, as the department of Public Health, can file petitions with the court so people can we can file cases that we are working on or cases that we identify through our best Neighborhoods Team or through our multidisc Culinary Team meetings, through other collaborations that we have or individuals can send, even if they can and are allowed to file directly with the court, they can send cases to us to review and we can become the petitioner from the get go. In either situation, the department of Public Health being the petitioner, moves things along a little bit faster. Its one less step. But the department of Public Health ends up being the petitioner in every single case that moves through the Court Process is you, you, that and that is that is by agreement with the court, i guess, or i mean, is that in the legislation . It is in the legislation. So so, so someone files a petition, a paramedic files a petition with the with the court that then goes to if you have to grapple with whether to continue to pursue the petition, if you decide not to, what happens like does the court review that or or no, i mean, the court ultimately has to be the one to dismiss the case. But that would be that would and potentially youre in a fight with somebody about that in a i mean, its going to be interesting. This is not it is interesting. I had actually i had sort of thought about this a little bit like out where i mean, the reality with aot is it very rarely ends up in front of at least as San Francisco does it it almost never ends up with, you know, an involuntary process. Its sort of its just another way of keeping track of some high needs individuals. And its done through out and but its largely voluntary. This is largely voluntary, too. But it seems a little more a little less under the control. All of in that there there are going to be these petitions coming in from from lot potentially lots and lots of people. Well see how it plays out. And then that presumably is going to create challenges for your for your workload that are sort of as yet unknown. An and potentially could be bringing in. Id also thought that this might be sort of self limiting in the sense of like you know, who does who does get around to. But actually that list of people in front of the court, it could be quite large. Absolutely could be. You know, the 1000 or 2000 people that youre anticipating our most ambitious beds plan, which has been guiding our build out over the last like four years, is 350. Well its 400 beds, 350 of which have been delivered. But most of those are not beds for people with for with schizophrenia. Right. Or with the i mean, the presume this is target aimed at people who have skits phrenia or a schizophrenia like illness is most of the beds are not necessarily for people with those types of with those types of illnesses. So there is highly likely to be an extraordinary mismatch. Or am i wrong . I would say its possible. Right. Its very difficult. Its very difficult to predict. Of course. And i would say in terms of our bed, you know, increase, theres a dual diagnosis beds. We didnt touch on this, but not a requirement. We suspect many individual goals in addition to schizophrenia will also have a cooccurring Substance Use disorder diagnosis. So of course theres those beds and how we can support individuals is and some of this, like you said, is while theres the black robe effect is largely voluntary. At the end of the day somebody has to be willing to participate in the services. And so there will also be not just a recommendation of what we think somebody would benefit from, but also what theyre willing to do and where theyre willing to be placed. And how then do we provide those supports to ensure their success, their, um, how much Bridge Housing money did we get . Its 32 million over four years. Okay and are you imagining that that will be used . I mean, you gave a kind of a everything basically. I mean, all the things that a lot of places. Yes. Yeah are you thinking that those are operating dollars or are you thinking i mean, could some of that be we have a pretty horrendous shortage of dual diagnosis treatment. We funded 3 or 4 years ago now opening a dual diagnosis Treatment Facility that i think is still not happened is the thought that is the thought that that some of this could get used for actual like buildings . Or are we thinking this is just more money for the existing systems or this is currently being used additional additional money, additional money to expand bed capacity that already exists in our system. So enhancing across the board and again, were limited. Theres limitations in what we can use. The funding for in terms of short term placements. Right. So what would an expansion look like . What would you be giving me an example of something that would get expanded through. So an example is our ill use emergency stabilization units as an example. So these are single room occupancy beds that we have in our system. This is under the department of Public Health portfolio and these are meant to be like very quick, rapid. Were engaging with somebody, were like, if you participate in treatment, we can get you into a bed tonight where they have a private space to be and allows us to find people to provide that engagement to them. So itll increase our capacity there and like progress is an example of a provider of those, right or not, for the emergency stabilization. These are in Single Room Occupancy Hotels in a hotel. Yeah, but theres other like transitional housing and co op beds as well. Okay. So. All right. Uh, all right. And i presume that you are going to be thinking of amendments to suggest to the state legislature because it feels like were going to find all sorts of challenges and problems in implementation and already probably have. And theres going to be, i hope, communication about absolutely improvements to the program. We have we have regular meetings with the state and were very engaged in those conversations. And as you noted, through implementation and thinking through what that will look like. And i have no doubt next week well be learning a lot, particularly as a large jurist fiction implementing care court and amendments that we would recommend. I also sorry, i did have one more question. I mean, im imagining if this and again, its sort of ive been thinking of the aot model, but this is quite different from aot. But most of the people who are served through aot voluntarily served like youre doing a lot of work with these folks, that does not require a judge. Im imagining this could be somewhat similar. I mean, the judge is going to receive the petition on the front end, but once youre working with someone, the most successful cases, it seems like, are going to be the ones where its a voluntary arrangement. And you you may be having very little to do with the judge in in those cases. For someone where youre actually i mean, do you have a sense of like how many how many petitions you have a notion of the eligible population, then do you have a notion of how many petitions you might be pursuing in front of a judge . Because thats a multi month process . Yeah. And again, that similarly is hard to predict. Of course, what cases will come through, what evidence we have to move forward. And part of our triaging too will be while court is meant to be upstream, it may be identifying like this person actually would should be served by conservator ship now and has fallen through the cracks or would be better served through aot. So that will be some of the triaging we do up front and i think this will bring a lot of people to our attention in that may not have been on our radar people who may be quietly deteriorate in the community may be coming to our attention. So i think there will be that benefit. But the other piece that ill note that we didnt touch on, but as you noted, while this is largely voluntary, theres a ton of work in the background outside of the court dates and this has much more prescribed and frequent court dates than whats in aot, which again adds a complication of finding people to notice them that they have a court date to then get them to court or to appear in court on those dates . Thatll be a unique challenge that will have to face. Yes. But outside of that, the well, not everyone even being unsuccessful with care court does not automatically mean that youll meet criteria for conservatorship, however, creates a presumption. Right . If somebody is unsuccess full with care court, we are able to use that for evidence in a conservator ship hearing. If that occurs within six months and so it may be for some individuals this becomes a first step to receiving that higher level of care, particularly as we look towards january with the expansion of grave disability criteria with sb 43. Thank you. Supervisor walton. Thank you, chair. Ronen just a couple of questions so i can kind of understand how this is going to work out. How are we going to determine whether or not somebody is involuntary treatment, whether theyre engaged in voluntary treatment . I appreciate that. Supervisor certainly looking at if somebody has an existing provider and a lot of that will be a conversation with the individual and with the provider of how theyre engaged. I appreciate that because in some ways that of course, is a subjective determination, which is where us making our case that theyre not engaged or theyre not meaningful participating in treatment. Again subjective or anonymous. Exactly or and of course, a judge will have to weed through that information. Asian clients are have counsel in this process. And well have to make our case if its a contested hearing that while they have a treatment provider, they may not be engaged in services and lets say we find out they are in fact involved in voluntary treatment, how do we determine whether its sufficient. Yeah, appreciate that. So if they are engaged in voluntary treatment, this could mean that early on a case gets dismissed. And of course we can work with people outside of the Court Process to ensure that theres an approach match of what their needs are to what services they have, access to. Now you bring up a situation where potentially somebody is receiving, is engaged in services, but maybe they need intensive Case Management and they refuse to work with the intensive Case Management provider. I think thats really where we lean into our relationship with individuals and try to identify what their needs are, what theyre willing to work with to provide that and what we can add on to that. And weve had this come up in some situations where we have to overlap providers because it could be that theres that relationship that needs to be built and so well have to be strategic around that. I anticipate thats a situation thats less likely to end in a court order and is more about like how were creative as a department to support people. Thank you. Thank you. I part of me wants to ask no questions and then part of me wants to ask a ton of questions. Im just curious how many hours and how many staffers have spent time on on this do you have any idea . Gosh i dont have a good idea that ill say. Obviously, theres many of us involved across many different departments in this conversation in dr. Gonzalez, whos our cochief medical officer, and myself have been leads in implementing. And we have a small but mighty team working towards that. So its hard to its hard for me to say how many there are. Obviously, in the last couple of weeks, most of our time has been focused on care court as we look towards implementing action and we imagine particularly this first month or first couple months, the fall, i would say there will be a lot of staff time dedicated to this. What we saw with aot, which were fully anticipating with this new program excitement around it, therell be a lot of petitions initially that will need to weed through. Well probably see that fall off after the first couple of months as we really work with potential reference to identify why and ensure that were getting appropriate referrals. But we anticipate these first couple months are going to be very active and have a lot of staff involvement. And the reason that i ask that, and you know, i just feel like im wasting my breath in a way. But the reason that i ask that is because, as you know, my biggest critique about all these new programs is that we never implement fully the ones that come before them. And so our attention span, its like were all a bunch of children born with untreated, undiagnosed adhd, right . We are. Theres a sexy new program. All staff, you know, and you are someone who i have tremendous respect for, who is was already be hard at work putting together the program that came before it gets diverted from that. And does this new program mean i just wrote notes to myself and thought to myself, is this going to make a fun like any real difference because we already have out Mental Health staff, housing, conservatorship, drug court, Mental Health court, at least six outreach teams. We dont have enough beds for anyone. One especially dual diagnosis beds, which are important for this program. And i just i just wish i mean, you know, i agree. We dont have a choice. This is coming down from the state. So if we had a choice, wed probably my guess is opt out with no new resources really and say well stick to the 15 programs we already have that are not fully implemented that were in the middle of implementing. But you know, hopefully some you know, it just i dont want to feel totally defeatist because it feels like everythings coming crashing down at the moment. And we have to continue to do the work. And hopefully the excitement and the press attention. This program will end up helping some individuals who might not otherwise be helped. But i guess. Its a hard question to ask. Ill ask the question and you answer it how you are, how you will, and then well move on. But do you think in the long term that fundamentally care court is going to help help keep the problems that plague us in San Francisco in terms of Mental Illness, substance abuse, street homelessness, and, you know, the often overwhelm named and broken Mental Health care system that we have in San Francisco. Thats a big question. And ill say, you know how i look at it is, is this a panacea like, absolutely not. Like, will this provide an incredibly meaningful change to our system . Like it is not that nor do i think it was intended to be that. That being said, like i we certainly i certainly look at this as another opportunity to engage people. And i think well well learn a lot. And as weve talked about, like i think part of our responsibility as members of certainly of the state and as a cohort one jurisdiction is to provide real and honest feedback to the state about the challenges and limitations around this. I share the healthy skepticism around it. And certainly as we look at like youre saying, we have aot we have conservatorship like where and weve had dialog around how do we amend what we currently have to make it more meaningful with the shifting landscape we see, which i know that there are challenges around that. So at the end of the day, i think this is a different tool. It is of course complicated to have multiple tools that in some ways are blunt, right . That were trying to leverage. And as a provider, id say like, ill take any tool that i can get to try to make a difference is it ideal that theres so many . Like, of course not. And theres different complications with that. But every tool that we can leverage to support people has some benefit, at least for some people. But this is something we should absolutely continue to discuss and to advocate with at a state level. Thank you. Appreciate that. Can we now open this item up for Public Comment . Yes. Thank you, madam chair. Are there any members of the public who would like to make Public Comment to this item . Seeing no in chamber Public Comment, well go to our phone lines for remote public call and members. Please dial star three to be added to the speaker queue. For those already on hold, please continue to wait until the system indicates that you have been unmuted. May we please have the first caller . Hello. My name is john parker. I am a San Francisco resident involved in the process of providing care for people with serious Mental Illness for many years. I have a particular emphasis on those who become homeless. Ive had actually had conversations with many of the people involved in todays hearing over the last year. So ive been tracking this issue fairly closely. A little bit more background. Im a retired professor from northwestern university, was a global chief marketing officer for zurich insurance, was a partner at mckinsey. I also have extensive personal experience with addiction. 35 years sober myself as well as smi within my close family. My reaction to this hearing is i absolutely applaud this initiative. Im actually very optimistic about the potential for impact with a very targeted group of those people experiencing homeless who suffer from schizophrenia and they have a different set of needs that cant be met through housing, that is not tightly integrated with treatment and social support. My concern is how is this going to be measured and how success will be defined . Because you know, more than the capacity to which weve added, which is great, more than the ability to handle the flow, which is great, but he is how many people who need this are actually helped and helping as many people as possible should be the goal. Therefore, i suggest two key metrics to define success. One is the number of care plans were actually developed, and if there are 1000 to 2000 people that need it, we should really hope to get the 4 to 500. And then of those 4 to 500, how many are actually completed . And following up on the second metric, it might also be able to understand when its completed what that means for the participants and then happens when its not my offer. Id be happy to serve as an unpaid volunteer focusing on these metrics, building information around outcomes, crafting the feedback for the state. Id be eager to input from anyone on this call, and i will reach out via email to several of you, both on the board of supervisors and dr. Almeida, who ive spoken with you. After this call to get your thoughts on how to do this as well, because im just offering up im sorry for the interruption. Each speaker is being allotted two minutes today and your time has elapsed. Thank you for your comments. May we please have the next caller . Good afternoon, supervisors. My name is carolyn kennedy. I am a Community Leader in district eight and a leader in rescue. Im concerned that the housing and care model proposed for care corp participants wont enable them to complete their care plan successfully. The model that the department of Public Health has put together with the permanent Supportive Housing and no on site mental Mental Health staff is the model thats been failing us in many cases, too many cases Homeless Individuals with serious Mental Illness who received only 2 to 4 weeks of crisis residence treatment need a smaller environment. 10 to 15 people and more structured housing with on site support. Thought that support, by the way, doesnt need to be a Mental Health professional. It can be counselors. This model enables those with smi to stay on their meds and relearn the life and social skills needed to live independently. So i recommend that pilots, small Community Based transitional residential programs for care corp participants, several Long Term Service providers like Progress Foundation and formerly the baker places have run these Scattered Sites residences, and for many years these homes are located away from the drugs and the chaos that often lead to recidivism. So people with smi successfully live in these Small Group Homes with on site staff for 6 to 12 months after the residential stabilization treatment. With very low recidivism rates and with state matching funds, San Franciscos share of the cost of these these homes. Is 37 or 30,000 to 40,000 per person. So compare this to the average annual cost of psa at 47,000 per person, which doesnt include the cost of intensive case managers. And as noted by dr. Almeida, state funding new state funding is available for expansion. And the and thankfully, the department is prioritizing that 32 million state Bridge Housing grant for care corp participants. So this new four year Funding Source enables us to add more treatment capacity to meet the demand from care corp. Again, i advocate for to use these funds to stand up to Community Based homes with onsite counselors. Apologies for the interruption. Thank you for your comments today. Next caller. Hi there. Good afternoon, members of the board. My name is capital and i want to thank you for your time. Its an unfortunate reality that San Francisco, much like many other metro politan areas across the us, are grappling with a severe issue concerning Substance Use disorder and the city has seen alarming stats related to drug addiction and its profound impact on individuals in our community. While the care court provides valuable Treatment Options access to comprehend Services Like Mental Health counseling, Housing Support and Employment Opportunities remains, it remains limited to those suffering from a severe Mental Illness, including schizophrenia. We believe care court should be extended to a Wider Population of individuals suffering from Mental Health and Substance Use disorders beyond just those suffering from a severe Mental Illness. However severe is being classified. Therefore, we suggest the following to address the issue of limited access, and we suggest considering including a thorough assessment of other cities that are struggling with Substance Use disorder and forging partnerships with local nonprofit organizations and Community Resources to extend the range of services. By implementing these measures, the care court can evolve into a more holistic and effective program. Addressing the comprehensive needs of individuals with Substance Use disorder. This approach not only supports their recovery, but also enhances their chances of successful fully reintegrating into society as productive and self sufficient individuals. Thank you for your time. Thank you for your comments today. We currently have eight callers with two in the speaking queue. If you would like to speak to this item, please dial star three now to be added to the queue. May i please have the next caller. Hi, my name is Ashlyn Ferguson and im a resident and Business Owner in San Francisco. One of the questions i have is regarding the judges that are going to be used here. Im really disappointed with how the judges in San Francisco right now are actually handling a lot of the cases that go in front of them regarding drug dealers. Et cetera. Theyre letting these murderers back out onto the street. Are these judges going to get some special training to deal with the individuals that are going to go in front of them in care court . Because these people that are going in front of them are not villains. Theyre not bad people. Theyre just sick people. But if these judges are allowing the really bad people to get back out on the street, are they really going to even care about the people that are very, very sick and need our help . The second thing i wanted to address was the timing around people getting help. I personally have friends and family members who have been affected by Mental Illness and drug addiction and the outcomes have not been good. If they dont have the support that they need. Its just putting a roof over somebodys head doesnt fix the problem. It doesnt all of a sudden cure you. I have one friend who has some mental problems. She ended up living in a home, taking out all of the wiring, removing the outlets and unfortunately ended up dying because nobody was there to give her any help. Hello . Caller are you still there . Yeah did you wrap up your comments . I apologize. All right. Thank you. It appears they have completed their comments. Thank you for your comments today. May we please have the next caller