Ohlone land. As steward to this land, the Ramaytush Ohlone have never given up their land, we benefit from working and living on their homeland. We wish to show our respects by affirming their soverne rights as first peoples. Thank you, commissioner guillermo. Our next item is approval of minutes of september 19th, 2023. You have the minutes and i have reviewed them, if there are no amendments, can i have a motion to approve. Motion to approve. Public comment. And i dont have my script with me, but i will note that we always take folks that have received accommodations first and then we move to those accommodation. I see one hand, at the moment, were only taking those who have received accommodation for me. Please unmute that person and well give them three minutes. Caller hi, commissioners, this is patrick shaw, code a a. Please begin. Caller thank you. These minutes were at the chair me and others have continually raised the issue of what the Commission Long term plans are to prevent another reoccurrence. It appears that the commission, advise contract, when it expires in 2024 for a period of time. I think thats accordance to minutes for finance and committee. When commissioner asked if that contract was going to be extended again. Im wondering are they hiring for renewal, 10 Million Dollars each and every year in to reports payable is that . The plan . Is that your mission to laguna honda . Thats the only comment. Any questions or comments, if not we go to a vote. All those in favor . Aye. Opposed . The minutes are approved. The next is resolution honoring honoring lisa goldman, we have dr. Navina babba to present on this. The mic. Doctor lee has contributed to the health and well being of San Francisco for over 34 years. Her career has been multiple parts of the department, most relaoent heading the office. Through her previous presentations, dr. Goenld has to the department. Which has brought up the strategic. What i most appreciate lisa is her ability to quickly set the current state, understand the problem and develop counter measures. I have personally learned so much from her and will miss her Clear Thinking to complex issues and articulate the path forward. I wish her the best in retirement. I wanted to take this moment to extend my gratitude for contributions and years of service. And i will read the draft resolution before you all move forward to take action. Where as lisa golden have served the city and county of San Francisco over three decades in making tremendous contributions to the align tra taoej i can initiative and continuously improve the performance, where as dr. Golden has held several dph positions including medical director of ocean park center, medical director of Quality Improvement for primary care and most recently for dph Promotion Office. Where oversaw the task of developing this Strategic Plan and coordinating the complex implementation of the plan through the department, where as through her work developing and overseeing the promotion al office, dr. Golden create thed infrastructure that makes improvement employees daily work. Every new employee is oriented as central part of dph work and throughout the department. And where as dr. Golden convene with the dph executive staff every quart tore discuss performance across dph. Where as golden served as in multiple roles during covid from the first month of the covid pandemic emergency response. She also lead response, in our most congregate settings, she was both during the Pandemic Response to transition response back to the department operations. Where as dr. Golden is known for her innovation, creativity, and always being able to volunteer to address issues at the dph. Where dr. Golden leaves a legacy to support and improve the lives of all san franciscans, she will be dearly missed at the dph and communities. Resolve that the San Francisco honors lisa goenld for her Outstanding Service and leadership and wishes her well in her retirement. All right, before we go into any Public Comment or commissions or director of course, we will need a motion to approve the resolution. So moved. Any Public Comment . Seeing no Public Comment, folks online, were on item 3. Resolution honoring lisa golden, press star3 if you would like to make a comment. I see no hands. Well begin with dr. Colfax. I want to great dr. Goldens dedication. As you heard from resolution, she has done tremendous work and ive had the pleasure of working with her for these last few years and really so deeply respect, her wisdom, her patience and her consistency as dr. Babba had described, embodying lean principles and one of those principles is going to the work that is actually being done to observe and to ask questions. And there is a lot that goes in the department, and dr. Golden was instrumental in ensuring that in crisis, in complex situations, in situations where improvement need to be made, was instrumental in being a key resource in helping us think through, how do we develop a structure, how do we develop outcomes to improve, how do we ensure that we adjust as more information comes in. And how do we ensure that were always in mythology. I knew dr. Goldmans way were successful when people were asking how did that work. From doing test sites and vaccine sites on the ground to the covid dashboard, dr. Goldmans leadership was instrumental. Most recently she has deployed her team to laguna honda and moving forward with the recertification and all the improvement there. And these are things that are sustainable, and thats the thing that i really value so much about dr. Goldmans work. These are not shiny objections, these are things that get embedded. And she is, she is subtle and yet very powerful in ensuring that cultural change around Quality Improvement and sustainability takes route and forces across the department. So thank you, dr. Golden for your incredible leadership. Thank you, director colfax. Commissioners, any other comments . Commissioner chung . I was just going to say, i still remember when i first started, when i got appointed to the commission, thats when the dphs implementing the lien principles, sxifs asking the same question, i said how do you turn that into a culture. You can say you want to improve something and how do you make sure that everybody that comes after, would pickup the same type of practices. So i dont, i cannot picture that to be easy task. And thank you for like doing all the work and congratulations on your retirement. Vice president green. First of all, your contributions have been remarkable. When commissioner guillermo and i were first training and leading seemed overwhelming. And it was taught to us the way you distilled it, your ability to take complex concepts in terms of all the covid work that dr. Colfax just discussed but all the lien principles, it was overwhelming yet we were able to understand it. And every single time, we were at the jcc at the county, we see the benefits of all of your contributions. I dont think we can express it enough, because the kiezens and all the way that the lien has improved care for patients and for all the residents of San Francisco. Its the backbone and it could have gone so off the rails without somebody like you to shepherd this complex way of dealing with a Massive Department to the point where we are today. Which is so incredibly successful and critical for all of the achievement that weve seen. So we are so appreciative, well really miss you, and you make great choice nz sweater colors. [laughter] thank you, and dr. Goldman en, i would like togolden. When i first came on the commission years ago, learning about the principle, it was a very important part of that how this large complex Department Works and how the principles are infused across the entire department. Sxif no doubt that in addition to your work and leadership during covid, that your work in the kiez en Promotion Office put us in the country. Sol grateful for your work, really transforming along with your team, the culture of this department and put ing us in a very strong direction and really having us prepared for what was, unprecedented crisis where you were so engaged too. Thank you so much for your leadership and for your work and i would like to offer you an opportunity to say a few words. Before we vote. Hopefully to other agencies as well being spread. Thank you for that. I feel very privileged to have been been able to work across the department can so many incredible people and across other agencies as well. I feel like its a privilege that one does not always get in the department, so i really really appreciate that. And the fact that there are opportunities to build a career here, to actually develop oneself and to have a variety of different, activities, responsibilities and work. So thank you very much. I really wibbler the department and the Health Commission all of the best as you continue to do the good work promoting the health of san franciscans. Thank you. Thank you, i think we can go to a vote now. All those in favor of approving the resolution honoring dr. Lisa golden. Aye, opposed . Thank you very much. Mr. Secretary, do we have a photo . Okay, moving. Would you like to take a photo . Yes, lets do that. Commissioner can we get up to the front of the spending time up here in the dais, that almost felt like a field trip. Okay the next item is general Public Comment. At this time the members of the public may address the commission on the items on the agenda. With respect to agenda items, the opportunity to address the, each member may address the commission for up to 3 minutes. The brown act forbids, including those raised in. Patrick, this testimony is about items not on todays agenda. So please dont cut me off. During the board of Supervisors Committee as a whole hearing on september 26th, Roland Pickens answered a question from from supervisor Rafael Mandelman to present a report from Behavioral Health working group during the Health Commission meeting in october. About the plans to create additional Behavioral Health and Substance Abuse treatment in San Francisco in including, recommendations to expand Behavioral Health at laguna hospital. And since there is no presentation on this topic today, and mr. Pickenss report will be presented in october, did that report on october 10th or the 2nd full Commission Meeting on october 17th . Members of the community deserve to see, this board and its eventual recommendations. So we can consider the importation of whatever recommendations are presented about bifurcating and Long Term Care nursing patients, against Behavioral Health patients who have had no substance additional treatment that created in long term settings. They just meet those to but you shouldnt be robbing peter to pay paul by reducing the availability of traditional nursing facilities at the ex tense of San Francisco out of the county who need traditional Long Term Care nursing facilities. Thank you. Time is up, great. Thank you. That is the only comment under general Public Comment. Okay, our next item is the directors report, director of health. Good afternoon, good afternoon, commissioners. Im here to provide the directors report. Items, ill gl through them quickly and answer any questions if you would like a deeper dive. Glad to announce that dph announced the staff board, of the most resent Data Available in overdoses. And her update later today, doctor will provide more information there. Im also glad to give you an update on laguna honda to join our executive team as our new directors of nursing. Theyre tracy brown and Michael Collins who have remarkable careers in healthcare including extensive experience in Long Term Care. At laguna honda, they will have roles that are essential to restructuring the organization that we have created in our transformative work to turn laguna honda na a world class nursing facilities. Also please to announce that as of october first, San Francisco was one of the first 7 counties in california to implement as a Community Recovery empowerment, care act, also known as care court. The care act which passed the state legislature and signed by the governor last year, provides Community BaseHealth Services tho to resident who are living with schizophrenia and other disorders. Participation in the program is voluntary but were hopeful that that we can provide tho those not currently in care. Also wanted to announce that Health Coordinator for San Francisco san mateo and oversee Newcomer HealthRefugees HealthAssessment Services which is funded by the refugee and you can read more details in that item. And Community Partners including day that the lara sa one of 15 teams of rising Public Health and Community Leaders around the country to participate in the inaugural cohort. And this is supported by the number organizations and really pleased that they were selected as rising leaders for important program. We have now plateaued from the data we have and hospitalizations are even going down slightly and im pleased to say that regard with the updated vaccine, it took more time that we would have liked but we were able to secure vaccine for our publicly funded sites. Were encouraging every one for whom the vaccine is recommended to get that updated vaccine. So i will stop there and answer any questions from the commission. Thank you. I see two hands, and again we start with the folks who have received accommodations. Three hands, and given permission and accommodations. Jamie lets start with caller 2. Caller its patrick again, were encouraging that laguna hondas two directors of nursing tracy brown and Michael Collins have finally been hired. There is still no word on hiring federal director. Laguna honda paid invoices to the medical director for this and two on completion. Presented and 10,000 for a total of 46,000. That hiring laguna medical director. Did you receive invoice number 3 and 4 from berkeley Search Consultant . Or an additional 46,000 for the medical director. And hiring, mr. Collins for the director of nursing conditions. What were the two total cost of hiring, to two directors of nursing . Were they placed by berkeley Search Consultant or another search firm . Thank you. Thank you very much, jamie lets go to caller 7. Caller hi, this is dr. Lisa calmer, i asked for accommodation but i dont think i received your email. Dr. Palmer, i gave it to you before the meeting, i apologize in my tardiness in getting back to you. Caller thats okay, im just really nervous in getting admissions restarted and post political and economic pressure to have patients to laguna honda in order to serve the flow at the General Hospital. We do need more Behavioral Services and, a lot of, people that need services have. Have aged. People whos behavioral is uncontrolled, really cant accommodate it safely in a congregate facilities with frailed disabled and elderly people. And we really need to know, that mistakes have been made in the past are not going to be repeated. And i think, this was such a big part of putting the whole place into chaos. And clinical manager who were obedient and not competent. And i worry that not being able to attract the medical director is because of the unknown around this, the politics of being forced to agree to admit patients that are danger to themselves or others at laguna honda. And so i really would like you to be very transparent about this. And how laguna honda will be protected in its mission from the patients that are danger to themselves and others at laguna honda. The challenge of adequately Care Planning without without breaking regulations is once theyre in the nursing home and have all the rights, is also almost impossible. And its going to lead to more jeopardy if were not, if there is not a real realistic plan to not repeat history here. And we need services for these people, but not we need to not sacrifice laguna honda. Your time is up. Thank you so much. Thank you. Jamie, please unmute the last caller. Hi caller, youve got three minutes, let us know that youre there. Caller yes, can you hear me . Yes, begin. Caller interestingly enough, my concern is similar to dr. Palmers. I dont think there is been merely enough public discussion of the impact of the slow project on the seniors disabled resident of laguna honda. And possible adjustments or eliminations of that unsuccessful branding of population. What is the plan . Thank you. Thank you. Le there is last comments for this item, Public Comments. Commissioners any comments or questions from the directors report . All right, thank you, dr. Colfax. Our next item is gift fund, this is an action item. We have lilly conover, chief Financial Officer to present. Thank you. C. F. O. Laguna. In your pact today, you should have the budget first actuals from last year and the budget for upcoming or the current year. So im going to walk you through those two documents and then im happy to answer any questions. So for fiscal 23, which budget you approved last year, we had 21,000 in revenue for the year, most of that was in trust. We had 3000 in cash donations and 500 in in kind donation, which was a donation from the garden club of st. Francis which is some clothing and toil toiletry item. We had therapy, art our part art with elders are back in full swing now that we have opened up and opened activities up to the residents again. We have not moved with outing but were start to go see more outings happen than in the last few years. Those are kind of due to timing where we received request towards the end of the year for the wish list, the covid related support. Just going down a little further, i want to note the rehab program. A lot of the spending there is for a program that we call mollys fund which is Adaptive Technology and then were merging a couple of categories for the budget for next year. So the total for fiscal 23 was 20 3000 which was less than the budget but were hoping to open up a bit more, open up the outings and other activities and we were not quite there but we hope to this year. Thats enough for you. As we dover year, we review budget line items, we have them weigh in on which programs we want them to increase and add and remove, so all of these add items have been approved by that committee. So were increation the art, activity Therapy Program this year. Were increasing, were hoping to increase our given how much cost has gone up over the past couple of years. So we got that approved this year. And just given the year over year, ambitious target that we have. We reduced by 30,000 by this year. We will begin to have more outings and the gift fund balance is well still over 2 Million Dollars. So were funded for this year and future years of programming, im happy to answer any questions. Thank you, ms. Con over. Before we go into discussion, is there a motion to approve . Second. Any Public Comment . Does anybody in the room want to make comment on this item . All right, anyone online . I see no hands. Okay, commissioners any questions or comments . Seeing none, all those in favor. Aye. Aye. Opposed . All right. All right, approved, thank you. Our next item is Behavioral Health services update. We have dr. Hillary kunings who is our director of Behavioral Health, to present. Welcome dr. Kunings, good to see you. Good evening, good afternoon. Thanks for having me. If you can so it can catch the sound of your voice. Sorry about that. So im very happy to be here, members of the commission. Dr. Colfax to give you an update on our resent activities in Behavioral Health. Next slide. Ill spend some time on the following agenda item, ill also thank you for your questions, ill try to inter grade into my presentation, some of the responses to your questions. Ill be first sharing some updates with care court, updates from our Residential Care and straement efforts, over to response and importantly cal aim and our current transition to epic our new Electronic Health record. Next slide. As you heard and new initiative, our govern created through legislation entitled sb1338 as you also heard from dr. Colfax, we in San Francisco are part of a first part of cohort of counties to implement care court starting yesterday. With l. A. To follow shortly and the remainder of the counties in the coming year. Competition thats include members, members providers, or what is being called reference, this includes our assisted outpatient program, conserveship. If the person is eligible and the person will not engage voluntary in care, the participating will receive a court order care plan with up to 12 months. This is for people with psychotic disorder due to schizophrenia, and other disorder. So those who have a disorder without a psychotic disorder, would not be considered eligible for care court. This is intended to be a less restrictive alternative to other forms of court engaged or court mandated treatment. It is intended to be less restrictive for example, and conservativeship. The govern and state have proposed should be a way to engage folks early and prevent further development of crisis or further complications from the illness. We still have uncertainly about the number of people being referred to. We have estimated Health Services data, that there may be between 1 and 2000 people eligible in San Francisco. They will all likely not all be referred and certainly not all at once. I got ahead of myself. All will be participates in a approach, l. A. Will be coming next month. They will are expected implementation by december of 2024. We have been aiming to educate community members, you can see that we have had three resent meetings including a town hall in august. The San Francisco superior court held a town hall Public Meeting in the middle of september. And this is not upcoming but there was a board of supervisor hearing last week which was publicly accessible. Next slide. Next slide. I wanted to update you on the proposition c, and Mental Health, expanding our range of residential hair and treatment in San Francisco and for san franciscans. The bottom line is that we have an intended plan of opening 400 new Residential Care and treatment spots. As of now, we have opened 350, so we are closing on the remaining obligations. And working hard to get those opened. You can see at the bottom right hand of the slide, the categories of beds that are we are still working through. You asked the question about how full our beds are and resent news about the beds. These are beds that are all staffed and available just to clarify one of the questions. We also have published and other places that are beds vacant vacancy and occupancy is about 85 percent depending on bed type. There is variation across bed type. Best practice is not aiming for 100 occupancy. Because then of course, when somebody needs a bed, its full or a particular service. Some of our service right side fuller than others. Some are held for particular populations, for example, pa ri natal care. There was a setting in our management program, foxz coming in were not always admitted. Further this is a relatively new program and folks presenting for care at that level, draw management, may not always be appropriate whether because theyre too sick or im going to use air quotes but maybe have medical complexity and other complexity that makes them appropriate for different level of care which they are then referred to on to and linked to very closely. So i want to mention that, as an incorrect data point that got circulated very widely on the basis of some information that we had shared with the board of supervisors. And just want to correct it for all of you. Changing topics to next slide. As all of you are aware, compared to 2022, we did see a flattening of overdosed deaths from 2021 to 2022 and unfortunately, we are seeing an increase, there are 563 preliminary overdoses deaths in San Francisco from january to august 2023. This is about 40 higher than that period last year. The manl or the of these deaths volve fentanyl Something Like 80 of them, fentanyl as you know is a potent opioid that is being either mixed into the drug supply both locally and nationally. Or, drugs are being sold as fentanyl and being sought after by folks with Substance Use disorder. Like other jurisdictions, were aiming to address this very serious epidemic and i wanted to share with you some of the things that weve been able to accomplish, certainly since we last met and some over the last year. Next slide. I wanted to share with you some of the progress that we have made inter ventionz. These are both clinical inter intentions happening in treatment programs, and interventions happening in lower barrier setting or in primary care settings. And interventions happening in and around the streets in San Francisco. As part of our approach, through Mental Health sf, we have opened a significant number of beds that really address the specifically these are beds also known as recovery beds and silver housing. Theyre intended for folks coming out of residential treatment. They can stay here for up to 24 months. Receiving outpatient treatment while having a safe place to stay. Theyre expanding something called contingency management with four programs in our Substance UseDisorder Treatment programs. Contingency management is our interventions with people are given an incentive for healthy behavior. This is the most affective treatment we have for people with stimulus use disorder. Under medical reform in california, were able to use medical dollars in a pilot passion to fund these programs which have been historically excluded from medical. Additionally and you can see the next three checks, we are working aggressively to expand hours of service. In some of our programs, were really looking to create models where this is not just Business Hours but evening and weekend hours. We as you have heard from my colleagues, Maria X Martinez which have opened is partly and importantly serving people atrisk of overdose and were working closely to incorporate treatment and Risk Reduction services there like distribution of noloxan. You also have heard about our specific post Overdose Response team that are particularly geared for people experiencing homelessness. Were aiming to reach people after a non fatal overdose and specifically fatal overdose. Sing slide. We also know that people atrisk of overdose, maybe socially isolated and may not have the skills to respond to overdose. In this game, we work to open a drop in space with low barrier therapy for people experiencing homelessness to reduce their risk of overdose. Were working aggressively to saturate communities with information and availability of nolaxin. I know youve read the slides the various ways in which we have done that. He will mie light, we have Overdose Response training to recognize overdose and respond with naloxon. And its on the next slide. We have had an overdose recognition response training which has been taken by more than 5,000 in order to reach people atrisk and give people the opportunity to respond. Next slide. You heard from dr. Colfax that we launched a dashboard to track on what is happening in terms of death, overdose, non fatal overdose, morbidity and to understand the extent where were getting into the hands people, such as naloxone and getting into a chair to reduce the risk. You can see the screen shot in front of you. I want to turn to our overdose. We know that African Americans have more than five times risk of overdose risk compared to other san franciscans. Were work to go establish more engagement and partnership with new Community Organization and leaders and black lead and black serving organizations around Overdose Prevention and access to treatment. You can see some of the partners that we have working with closely, we have connected with a total of 25 black serving organizations, we have trained more than 180 people, in Overdose Prevention. Also working deliberately across our own organization, that should be officing of Health Equity as well as in Behavioral Health diversion inclusion. And we really are aiming to make this a whole department and bhs effort. Next slide. Another population that we know is that elevated risk. Our folks who might be living in Supportive Housing. Folks in Supportive Housing, through some analysis having also found to carry an elevated risk of overdose. We are working closely with our fellow departments, in Supportive Housing as well as non for profit Provider Group network, increase communication and coordination and housing sites. Together we have inskauld, we are work to go train Supportive Housing residents and staff and overdose recognition and response. And another Innovative Program has been our ability to deliver morphine the medication to treat disorder, by our pharmacist now work withing more than 80 residents across 25 housing sites. The idea here is bringing treatment to people to promote their adherence and retention and care and of course reduce their risk of overdose as well as promoting health overall. And finally, on the overdose front, next slide, were happy to share that we were the resent awardee of a major center for Disease Control grant on overdose, called overdose to action. We have named as one of the 40 jurisdictions nationally to receive the funding and the first time and the first time in San Francisco. We will be using the funding to engage into treatment and improve data capture analysis on drug related metrics and trends, increase education of Healthcare Providers to increase describing and other affective medication. And well be able to Fund Additional efforts to work specifically with the black african communities and Supportive Housing. And then finally the next slides, you heard me speak about the contextual urging change for us. We are finalizing new rates for which we pay for service. And we are aiming to support providers through this intense transition which is changing the way we do documentation and care. Were strengthening our health plan as well as healthcare blue cross. As you know, when somebody has a severe healthcare, they come to us at dph as a managed care plan and as a provider, if they have a mild to moderate, they are cared for in the primary care context. Which have implemented and aiming to improve transition of clients between the behavioral system and in this case, general medical care system. This is really an Attorney Development as we integrate care across the system. We also have an opportunity under cal aim, to derive from additional funding for what is being called Community Support, you can see this in the second to bottom green. One example is that summer rise, our drug sobering center, one of the new efforts under mental sf, launched as a community or has begun to be part of the community. This is really enabling us under the fed med cal program to deliver care that is broader and more narrow bio medical care, which can be extremely affective but this allows us to address other needs to folks with severe Behavioral Health concerns have. And last slide, i want to just mention that we are hard at work, preparing to join this the rest of the network, on electronic called record called epic as you know. Were going to be launching, epic in may. Just allowing us rather than april as you can see here, allowing us more time to finalize current processes. Were currently in what is called the groundwork and adoption fades where we have subject Matter Expert from across Behavioral Health working closely with our colleagues in i. T. And across from the department to being able to implement epic again. Another really huge transition for the Behavioral Health system. We are happy to spon or our leaders and to help us grow and help us lead into this next phase. This is really an enormous and important undertaking that in my view holds a promise of helping us Work Together to become a better one Network System so that we can communicate about clients and patients and make sure we are coordinating and driving to good outcomes in their care. Next slide, i think that is. Happy to take questions. Thank you, dr. Kunings, before we go into questions or comments, well take Public Comment. Sure, is there anyone in the room that would like to make Public Comment on this item . All right, seeing none, i see one hand. Jamie, could you please unmute that person . Hi caller, youve got three minutes, please let us know that youre there. Hello caller, can you unmute the next caller, there is two hands up now. Hi, i just, i would like to clearer, can you hear me . Yes, please begin. Caller hi, its dr. Palmer again, i would like to a clearer look on how close we are to treatment on demand and can we talk about that to the tracking on the overdoses . How do we know when weve got petition services. Can you go back to the other caller and see if theyre there now . Hi caller are you there now . Caller hi, yes, sorry. I was calling in because in the last like nine mobssinger i tried to reach out for services for my son in San Francisco. I tried to bring the mobile help line, and he was turned away. By the time that mobile health came, he had already wanteding away. For me, as a parent, he has private parent, trying to get appointment with ucsf psychiatry was nearly impossible. Nearly a fourmonth wait. We first started off at General Hospital and he couldnt be seen as General Hospital because his xaourns is not contracted to general kopt hospital. And then i went to my general care and a lot of things had happened in between that time. Im hearing about a one connective, one connective platform that youre all creating. And my son is very young still, he should have been able to easily get help. Im letting you know, its not there in the private. And ucsf or General Hospital, they have a long wait. I want there to be some honesty about care and giving families more, when i brought him into the hospital, they wouldnt let me sit with him. They would not let me give information at first. I had to tell them im a hospital worker for them to Start Talking to me. There is things that can be done at the front end. And as a parent, i felt like i had no support through all of this. Thank you. Thank you so much for your comments. That is the last Public Comment. Yes, thank you for those comments. Commission, do we have questions for dr. Kunings . Thank you dr. Kunings for your presentation and again for all of your work that you and your staff do on behalf of san franciscans in need. My question, has to do with, the amount of contracting that we do with our partners outside of the actual network. How are we assuring ourselves that is a through the measurable outcomes that were looking for. Because a lot of what you described are great programs process points, expansion of services and you know, those kinds of things. How are we making sure that were making a difference in the individual lives, particularly as it relates to the vendors and the Service Providers that we have that are outside of our own Media Network . And particularly because we know how difficult its been for them, to hire, to recruit, attract, hire and retain the kind of skilled sthaf that is needed for this expansion of services across the whole continuium. Its not, its not something that i know that is easy to answer or even easy to mention, and hopefully through epic or some other, data coordination, were going to be able to do that. But what is the thought on that . I just, its a question that i think i ask often in terms of how were going to be able to make sure that we are going to have on going Sustainable Impact if were not able to attract the kinds of quality, providers and such to stay in the work . Thank you for your question, commissioner guillermo. I think both parts of your question are really important. One is workforce and we, we are both, government and our contractor providers, challenge to recruit enough Behavioral Health workers to fill all of our spots. I think there are a number of tactics to try to address this including within dph and with our colleagues at the department of human resources, better smoother, wider recruitment efforts. As well our Development Efforts which are largely funded by our state mental Health Services act. We graoe, i think that we all have more ideas and more thinking to even expand further as we are expanding services. And with that staff, sufficient staff, we have been challenged to expand ours as quickly as we would have liked. On the first question, in contract with that. To the sort of, one part i wanted to say that i think we are really looking forward to epic. In order to ease the reporting and tracking that well be able to do. Is know from may colleagues that we have been reporting as much less cumbersome than through current processes that we have. So one of the great appeals of epic, will be our ability to look outcomes more easily. We are in terms in measuring out, we have a lot of oversight by the state. We just finished one last week for example, is assessing in the case last weeks audit what impact they have on our clients as well as other health measures. So this is part of the scrutiny, appropriate scrutiny from the state in addition to our own, measures. I want to acknowledge opportunities for improvements. And i think in the fields as we have been in the faoefld Behavioral Health, getting measuring outcomes in our services, is kind of the work of the field that weve got to do that better and more clearly and communicate it consistency. It is very different than measuring people, for example Blood Pressure control or diabetes control which are measures that i was used in primary care. Im very committed through epic, and through data to get us there. I would say that were working on it and in some cases we do have it and in other cases, we have gaps. So if i can followup, i appreciate that lots of monitoring from the state and other resources that we have. Will San Francisco will be able to establish its own measurable goals or, bench marks around . Our situation is quite unique, right. And so, im just wondering rather than just, complying or being accountable to our funding sources, how to be accountable to ourselves. Thats also a great question, i think we do and want to set our own benchmark. I think we want to make them consistent with external expectations where possible. I think we is our dashboard on overdoses is example is this, are we getting more people into treatment . Are we retain to go have more people in treatment . Are we reaching the people who might be atrisk overdose with the kind of services that we know can be protective . None of those are exactly measured by the state by way of example but we intend to measure them by this dashboard as well as a still in Development Mental sf dashboard, very well welcome of specific recommendations as well. Thank you, and that would ally also to the partners that we contract with . Yes. Okay. All right, i look forward to hearing more about that, thank you. Thank you, commissioner guillermo. Vice president green. . Fm first of all, thank you so much for the progress that the progress that you and your team have made under your leadership, when you look at all the programs that have been put in place, this is such a difficult aspect of Public Health that were dealing with now, especially here in San Francisco with the overdose and Mental Health crisis. So were grateful for you and your team for what youve been able to accomplish. Now that we have the programs, we have cal aid and a lot of wonderful ideas and i know staffing can be an issue. But im kind of confused about points of entry. You know, the Public Comment of people that may be more disadvantaged of being insured than uninsured. One example that crossed my mind, for example how does relative who feels, one of their family members has schizophrenia and they may be homeless at this moment . How do we find them . And who makes the diagnosis especially in light of staffing issues . I wonder if you can comment in points of entry and in particular, the aspect that these programs will be most successful both accessible and successful in enrollment 6789 um, let me also acknowledge that we take a lot of calls and work with families and are families bho have private or commercial insurance. Do need to go through their commercial and Insurance Program and we are aware of wait list and some challenges there. We also however work with families helping to get them situated, whether its making a diagnosis or coordinating care. A few routes, one is our access line or b how and our Behavioral Access Center or bhac. The line is available for families to speak with to receive referrals and similar our Behavioral Access Center can do the same. If somebody enters into these pathway is looking for more help and referrals, for example, the homelessness. The next year and a half and office of coordinated care for people with complex Behavioral Health needs who might need either linkage into on going care helping to figure out where is the right level of care or what the right referral is can you also comment on what kind of opportunity we might have as there is been a few more arrest in terms of over drug use and what lessons we may have learned from our center in terms of that particular population, helping them enter the system. Of care. So ill just comment on, a city Wide Initiative called demac or the drug market initiative. And are under law allowed to be held for about four hours. Part of that Law Enforcement, lead program, every one is offered by the sheriffs department, offer referral to treatment or to services and in that neighborhood of course as i just mentioned our Behavioral Access Center which is open now 7 days a week including into the evening hours. I think one of the things that we have learned as well as the other street work, is folks, their top request is from us, from the city is shelter and having material needs met. And so even when folks clearly have a Behavioral Health challenge, it may not be in that moment that they are seeking treatment for their Behavioral Health concern. And so, i think one of the learnings here and sort of whether its been helpful for me to think about as an addiction medicine doctor, is thinking about a person stages of change. And for the person that clearly has a problem, they may not be ready to work around changing their Substance Use for example. This is very much what were aiming to do with our street teams which i did not so much talk about today. Being able to get people into care, into treatment whenever they ask and that is our goal as well as to coordinate with other agencies who may have other services at their disposal. We do have services especially in the overdose crisis, thank you so much. For transparency and getting to the heart of what is happening and the data is the basis for formulating our response. And of course this is alle happening with within the context, against the current of new substances. Sometimes that can lead to a greater overdose . Is there anything that we have learned from our data that has been surprising that has helped guide in that response and the gaps in that data would be helpful in formulating our response. Thats a great question, thank you. To know what is going on. Were working for example, with colleagues and Fire Department to and they, and to support us to get more realtime non fatal overdose data anticipating that if we see up takes either geographically or in time, that we will be able to respond in a more targeted fashion for example. We know that we, need more and intend to go look for patterns, whether its in geographic patterns or across social networks, this is the way that data can help us respond in a more targeted fashion. I think what is preokay fieg the feel in all of us is being able to detect emergence of new substances. This is something that we, as you mentioned, somebody mentioned sylocene which has enters the market in the east court thanks to the office of chief examiner, we are aware that theyre present in some folks who have passed from overdose. We have not seen yet the xilocene as a more prevalent substance in our community. Thank you. Thank you. Commissioners any other questions . Yes, commissioner chung. Thank you dr. For the presentation. What strikes me is one of the flies that correlates to post incarceration. One of the higher risk factor, it says here received inperson Mental Health and Substance Abuse treatment. So that would increase the risk of overdosing . Do we know why . Im just looking for your exact sentence. Oh, and sure. We, and the reason for this, is that, is that when folks are in situation where they have not used any opioids for perhaps not voluntary, theyre tolerance for their substance which is a physician thing goes down. So even a little use, can be, they can be as higher risk for overdose than had they, had not stopped using. This is a couldnonedrum. This is a challenge for all of us. Oh thank you. Following their release from incarceration. But that is a known phenomena, its also true that detox can increase risk of overdose. Somebody stops opioids altogether, if they have a slip or relapse, theyre more vulnerable to overdose than had their use conditioned. This is worrisome in the context of fentanyl where a small flip return to drug use can be dangerous and fatal. That is longish, thank you for the explanation there. Those number will allow me. And these are from thank you for that mark, or from north carolina, data. There is also data from other places around the country and, i dont believe that there are local data to that affect, just to clarify again. And then also to a finer point, that in San Francisco, we do offer treatment or many jails across the country do not. We are a leader in this, in San Francisco, thanks to my colleague and jail help. And we are very much unfortunately, the exception still. And upon release. Thank you. Commissioners any other questions or comments . Dr. Kunings, thank you so much for bringing this excellent presentation to us. We know that there are a lot of challenges and were grateful to you and your team to address them, and we look forward to hearing for. Thank you so much. All right, our next item is the vision zero update. Is for the present, nz sue, as well as jamie parks. So welcome, and the floor is yours. Good afternoon, im iris and im the lead ep meadologist for vision zero within the Population Health vision. Im going to be presenting the findings of our annual report and a as well give a overview data science initiative. Next slide. In 2014, San Francisco adopted vision 0 as a zero wide policy to end traffic related deaths. The vision right side concept originated in sweden in 11997. When they adopted a official road policy. Vision zero came from u. S. With washington state. To ensure that mistakes on roadway dont result in severe injuries or death. Trans formz available data into practice and timely products that generate and improve Decision Making towards sfmt as goal. The Police Department and office of the medical examiner should receive notification in a timely manner. And provides Community Support when needed. Next slide. Casualties are linked to their decision or hin, identifies the corridors for the most of the year and failed injuries in San Francisco or concentrated. In addition, we over laid fatality with equity prior to communities and found that 44 of fatalities occur in the community. Injury crash decreased and then pla tude xh vision zero was adopted. 500 injuries on our city street. Next slide. Fatalities were relatively stable around 30 deaths annually with one exception in 20007. There was a 50 increase. Overall across transportation modes, pedestrians are most vulnerable road uses in San Francisco and act for a all majority in 2022. One person was killed while riding a bicycle in 2022, were seeing a sustained reduction in the number of cyclists killed on the streets since 2014. Bh we explored fatalities by age, in 2022, traffic fatalities were over represented among people age 45 and older. Each group had more fatalities compared to their representation in the city population. In contrast, asian and latino travelers were under represented compared to the representation in the total sf population. And for more information on fatalities by demographic, please refer to the most recently release fatalities report that is included with the presentation. Next slide. Adopted around the same time as San Francisco. Oakland has been adopted vision zero and long beach has not officially adopted vision zero though its had a plan since 2020. Fatalities increased across the nation. Many cities experience their highest fatalities accounts on record during the pandemic examine have remained in elevated rates in 2022, this was true in jurisdiction that participate in vision zero as well as those that dont. In 2019, less than 1 percent of fatalities or serious injuries were on segments. In 2020, that proportion rows by 7 percent. Next slide please. Starting in 2018. We analyze vision zero combination outcomes on only the two segments that it installed in 2020. We then use 2020 as a reference year because it experienced interruption of due to the pandemic. And keith street in day view hunters point. We compared 2019 outcomes on the street segment which in 2021 to estimate the difference and impact the project. Next slide please. Viewer collisions and significantly fewer injuries overall. And while we saw a descriptive in the number of injured. The total number of fatalities remain constant at 7 in 2019 compared to 2021. Next slide. These mindings align with the outline in the vision zero Action Strategy. Next slide. Our next major project is a collaboration with data sf to predict a model for severe injuries. Our hope is to combine data with multiple sources to exercise the likelihood of various intersections and street segments in San Francisco. To prepare for this work, information partners to modernize and centralize our data workload and systems for more efficient and robust analytics. Thank you very much for this opportunity to share the findings. I wish to give a big thank you to kevin morris who now works with San FranciscoPolice Department and his work has deeply performed the percentage here. Im going to hand off the mic to my colleague. At this, had you, iris and thank you commissioners for having me. Im jamie barks, i oversee the livable which includes our vision zero policy program as well as implementing a lot of the street changes that you see around San Francisco. Weve in a core partner since weve adopted vision zero in 2014 and i really appreciate working in iris. One of our Major Products is the vision Action Strategy which was adopted and produced for the Mayors Office in 2021. And a core to, core piece of the Action Strategy is the idea that vision zero requires a system approach. There is no zero that is going to get us to zero death. They do come from National Research that we looked into as were developing the Action Strategy . For the five main pieces, the five main components to getting to zero, we need to redesign our street and you can see about 30 reduction in crashes when we redesign our streets. We need a lot more than that as well. Key components, ill talk a little bit about our work on Street Safety cameras in a minute. We also need fewer people driving cars so we need to have a mode ship to behavior modes of transportation. We have a lot of people experiencing homelessness. And you know, thats a fundamental, there is one of many reasons why they need to address the housing and homelessness person. The principles that we use are, are, lets see. Next and as iris just described, pedestrians are over represented in our data. We know that theyre the most honorable people on our streets, particularly our seniors and people with disabilities and we can protect them at the places where theyre able to come into conflict with vehicles which is in that intersection. Next, when we talk about mode shift, we know that a lot of people feel unsafe biking or, you know, or using, and getting around San Francisco. And one of the ways is by providing close streets and space fas lts to use. Work very closely with our u. S. Fd colleagues and school colleagues. And then we have targeted program. Weve been working a lot on how we can recognize this at some point, most people are going to have to turn left. How can we make that happen as safe as possible. Next slide and next slide. That were working on, is a focus on mode shift and specifically, make iting safer and for comfortable for people to choose biking and out of rolling to get around San Francisco. Working into a program that really allows comfortable connections for families throughout. And, finally, were working on that we expect to bring to our board in the spring of 2024 for adoption and that will be the next generation of how we rollout, biking and rolling across San Francisco. Still dont know what we learned in the past few years. I have made a huge amount of progress in 2014, that we have learned a lot of lessons along the way. But we have learned a lot of important lessons along the way. A few highlighted here. We started off thinking that we had the money and resources in the time to rebuild every street in San Francisco and behind the network. That simply has not come to pass and far too expensive and time consuming where we have the resource thats we have to do that. Were going on wide street, and widening sidewalks, we really focusing on rolling that out as quickly as we can. When we adopt a vision zero, we thought that these vision cameras would be up and running and deployed by now right now. As it turns out, it took us this long to get to legislative authority. And its taking a lot longer and were ready to hit the road running, as soon as we can. And we learned how challenging it is to influence mode shift and, also how difficult it is to use to use Traditional Police enforcement to achieve the outcomes on the street that we want. There are a lot of challenges with Police Enforcement in terms of equity impact and the Police Department does not have resources right now either. So were looking at alternative of traditional Traffic Enforcement to get to that behavior. So, next slide. Thats everything that i want today share. I appreciate you having us. Thank you, mr. Parks. Do we have Public Comment. Yes, i do. And anybody else in the room that would like to make Public Comment. You can go after the speaker but commissioner will read that persons name. We have inperson Public Comment, lee anne chang. And ive got a timer with three minutes. When the buzzard goes off, please know your time is up. My name is lee anne chang and i focus on vision planning in San Francisco. It could not be becoming at a more needed time. Last year, 39 related deaths and occured and more than half pedestrians trying to cross the street. This year we lost a 4yearold child as well as 12 adults already. Today presentation shows that builts are affective in reducing bike and pedestrians collisions by a third. This is a step in the right direction. Built to be quick and inexpensive and incorporating basic infrastructure, that should be in place as soon as possible. Walk sf is also at an meeting hearing that just finished a few minutes ago, increasing to double down, on a plan that they have to complete quick build on 900 high injury, intersections by 2024. So the intersections that have yet to receive any improvements. This is low hanging fruit that they need and they need to get a back on track before the end line of december 2024. Soy want to thank and encourage the cities in continuing to Work Together to bring other life saving changes as well as an let i can project in order to make our street safe for all of moving around San Francisco. Thank you. Thank you, ms. Chang. And there are no remote Public Comment requests so thats the only comment for this item. Comments and questions, commissioners . Well ill go first. Im a cyclist and i cycle around the city. And i know that i deserve. What is the process of san first data viable later en fall. Okay, great, thank you. First oh al, thank you for en real clearing comprehensive presentacion and i think its eso impressive. E talked earlier antiusing data to i think this is excelente [captioner change] unlike its pretty clear where the data source right side coming from and the completeness of the data is relatively well documented. Police report is our main source of data. Thats why the past, since vision zero has been adopted weve been trying to link records with the police reports, with the, trauma registry at San Francisco general and with 911 calls, ambulance, operator, record, and other injuries reports. Weve been able to expand the number of injuries that we can report on. So the next report for severe injuries will be due out next year. Q1 of next year. Thank you, well look forward to the followup, i think it will be very informative, thank you very much. Commissioner guillermo . Thank you, thank you very much your report and i truly appreciate so the scientific nature of your approach to vision zero. And i think that that is, you know, everything data. I appreciate that. But i do have, some questions related to serve more qualitative aspect. The city is very dense city, dense with people, dense with traffic, dense with a lot of different things. So im wondering where that issue of density comes in to play not just in terms of the data cause i dont know how you collect that, relative to the things that you are trying to achieve in your goals. But, just as an example, in business areas in San Francisco, or even just in small neighborhoods of San Francisco is the city of neighbors, so geary or clemens street, for example, where you need to have deliveries and people coming in to shop that is are p going to be facilitated by a bike lane or uni. How does that serve the quality of life or the activities of daily living for a family, mom who has to go pickup her kids, buy groceries, make a quick stop at the market, there is no parking, cant take the bus, those are the kinds of things that i think that dont necessarily come show up in the data. And theyre not scientific in that sense. So how do you take those into consideration . It says, that the data really informs where we do project and where we focus resources but the qualitative aspect informs how we do the project wednesday we get there. But when it comes to this specific design treatment that we propose and whether we propose a bike line or removing or anything else, we do go through a in depth Community Process for our corridor process. And talk to stakeholders and figure out needs, you look at a corridor like the bike lane on va lenzia, we ended up with a unique design there because of what we heard, curbside load. So when we did take a lot of pride in our, our project is not looking the same city wide and that we to be taken into account what the stakeholders and what the stakeholders tell us we need. Sure, we dont get it perfectly but there is a process to make sure that we take into account more than Traffic Engineering perspective. Thats helpful. And i do know, that there is a Community Process of curious on how that comes into play with the data that you analyze. And it appears, drives a lot of the decisions that you make. So just encouraging, you know that type of sort of, inclusion, i guess, as we go into the future with all of these other projects, the quick builds and all of those kinds of things that are going to affect San Francisco again particularly because were such a dense city that requires so many different wake modes, of maneuvering and facilitating just as a said, daily Life Activities that are not just about the safety of pedestrians and drivers and such. Thank you. A quick comment about. Yeah. About differentiated risks. With traffic safety, you know, is the amazing if we could provide some estimation of risk for certain individual or type of individual. With the work that we have, that we do, we often look at things through the streets and talk about environmental risks because street segments dont really change very much. And in terms of the idea of exposure, you know, the idea of an exposure depends on density like you said. And we dont have good metrics on how to capture those often times. So, trying to get some inside about how we think about our quantitative aspects of our analysis. Okay, well thank you for your presentation. We look forward to the next one. Oh, yes, mr. Colfax. Yes, i want today express appreciation for the work and in including and especially the fellowship between the departments on this. For us it often requires that the Health Department, teams work across a different departments and for all sorts of bureaucratic, reasons that does not always happen, that it needs to do and im just really, i just want to call out that this is been a very important collaboration and in deed, its a model for across departmental collaboration around an issue that is important and part of both of the departments priorities. So, thank you every one for being just a great team, on only in the Health Department but to make the city better for every one. I concur can director colfaxs remarks. Thank you. Okay, our next item is finance update, we have commissioner chung the head of the finance for that. And there will be an item for consent calendar. Good afternoon, commissioners. The financial and Planning Committee met just before Commission Meeting. And we had, review one contract report, one contract report of which actually wanted to mention one of the contracts on the contract report will be pulled from the report and it will be reintroduced again in november and our next finance and planning meeting. And, hold on one second. And then there is two new contracts, you know, one with the mol simtack llc which is like a data company that we use to store. And its great to know, they have such a capacity that we were told. That we no longer need to warehouse any of the documents and it would be sitting on that, you know, on the in the system. So you know, it would be easier to access any of the information. And the, the other contract for for us to approve is the contract with richmond area services. And we heard, the dr. Conin mention one of those intervention. And its a newer approach tra taoej strategically in intervention. And because its so interesting, interesting enough that i had requested it to come back to the Population Health committee next year after fully implemented for a year and see what the impact looks like. So we get a better sense of like, what type of investment youth, what type of resells. So like a better way to put it. And then, we also spend some time to have some conversations around like how some of our contracts, are getting pretty complex and big with the same agency that we tried to make sure, like, that we have enough mechanism to monitor them. So that we can catch any red flags before they happen or provide the support that they need. So that they can continue to provide, like Top Notch Services to san franciscans. Thats it. May i chime in, commissioner . It may have been my middle age hearing but i didnt hear the name of Health Advocates being pulled. Okay, thank you dr. Chung, any Public Comment. I dont see any lands but in case you want to make Public Comment. Okay, moving on for our next item for action is our consent calendar. And to this constitute a Consent Agenda are considered routine by a single roll call vote, there will be no separate discussion unless a member requests discussion in which event the matter can be removed and considered as a separate agenda item. Back to, commissioner chung chair of the finance and Planning Committee. Thank you, president bernal. And as i mentioned earlier, were pulling the last contract on the contract report which is with the Health Advocate llc. And we introduced that in november. Which is the next finance and planning meeting. All right, so do we have a motion to approve the consent calendar . Motion to approve. Second. Any Public Comment . I dont see any public hands, we are on item 10. No comments or hands. Commissioner comments, all those in favor . Aye. Aye. Opposed . All right, the consent calendar passes unanimously. Next item, our secretary marks will give the update for the committee. Generously joined the meeting on september 29th, it was simply a open session to go into a close session so the credential report can be approved, there was issue with concern about folks using their credentials so thank you again. Thank you secretary and thank you commissioner guillermo to ensure that there was continuity. Any Public Comment on this item . I see no hands. Any commissioner hands or questions . Seeing none, we move on to other business. Any other business . All right, we have no other business. And i dont see any Public Comment any hands up on this item. Okay, then we can entertain a motion to adjourn. So moved. Second. All right, any Public Comment . Nrs no Public Comment on adjournment. Okay, [laughter] with no comments or questions from the xhitionzers, all those in favor. Aye. Aye. Opposed . All right, we are adjourned. Thank you, sf gov. Tv. Shared spaces have transformed San Franciscos adjacent sidewalks, local business communities are more resilient and their Neighborhood Centers are more vibrant and mildly. Sidewalks and parking lanes can be used for outdoor seating, dining, merchandising, and other community activities. Were counting on operators of shared spaces to ensure their sites are safe and accessible for all. People with disabilities enjoy all types of spaces. Please provide at least 8 feet of open uninterrupted sidewalk so everyone can get through. Sidewalk diverter let those who have low vision navigate through dining and other activity areas on the sidewalk. These devices are rectangular planters or boxes that are placed on the sidewalk at the ends of each shared space and need to be at least 12 inches wide and 24 inches long and 30 inches tall. They can be on wheels to make it easy to bring in and out at the start and the end of each day. But during Business Hours, they should be stationary and secure. Please provide at least one Wheelchair Accessible dining table in your shared space so the disability people can patronize your business. To ensure that wheelchair users can get to the Wheelchair Accessible area in the park area, provide an adequate ramp or parklet ramps are even with the curb. Nobody wants to trip or get stuck. Cable covers or cable ramps can create tripping hazards and difficulties for wheelchair users so they are not permitted on sidewalks. Instead, electrical cables should run overhead at least ten feet above sidewalk. These updates to the shared Spaces Program will help to ensure safety and accessibility for everyone, so that we can all enjoy these public spaces. More information is available at sf. Govt shared spaces. Youre watching San Francisco rising with chris manner todays special guests im chris youre watching San Francisco rising the rebuilding and reimaging and our guests the executive director of the Homeland Security and today to talk about the city and solutions and welcome to the show. Thank you an honor to be here. Lets a start by talking about people traeld dont consider that much the business programs what does the city need to have that. Most people think of homeless they think of people they see on the street in the tenderloin and many people experiencing homeless have not visible to the average person and a lot of those people are children or older adults and families that is what we see at the department of homeless on top of homeless among the black community we dont realize there. 40 percent of our homeless populationist with the africanamericans and only 5 percent of the population today the with the africanamerican and the same thing about the communities that over represent and we we try to make sure there is equity in the system and reaching the goals not seeing by the public as much we know that housing is essentially what Everyone Needs to thrive in the community. Quite correct some of the solutions often vulnerable or smaller scale how do we expand those solutions as we go about. A attended in the homeless he roman numerals seeing none, three interventions need presentation for the people experiencing homes in the first place and pouting are ways for people to get to permanent housing on their own and need shelter so really need all three of the intefrjz for people to assess one the things we often dont understand meet people where they are and sometimes did have the documents or other things to move into housing. They maybe waiting on Disability Income or themes so we have to be prepared to have things ready to use the sheltered are reality important. We know that ultimately preservation ask one of the most important toltz we can put into our systems if people dont have that mri better off for many reasons but way cheaper to have someone out of homeless in the first place and the permanent housing is a wonderful tool for many people cant get housing on their own and needed Case Management or other services to be able to assess the other part of their life employment and things. So the home by the bay plan can you explain the basics and how to address the needs . Sure the home by the bay the Strategic Plan the 5year plan to prevent homelessness i want to do what at mayors said homeless is not just owned by the department of 40e789s but the responded didnt has to include a number of stakeholders what that requires is really a collaborative approach were really continuing to work very close with the 0 department of Public Health and Law Enforcement or the department of aye. By linking to the voices of people exercising homelessness need to create programs without listening to the people experiencing and finding what is like for them to go through the system were not going to make that better and ultimately will not be successful. Your first goal really to produce inexacerbated in our system remarkably equity and also want to reduce the number of people experiencing unsheltered homelessness in 5 years and over all address homelessness by 15 percent your offer arching goals for us and some people said that didnt seem like enough or didnt seem bold enough to given where we are not just a a city but country wiring proud of that goal and look forward to implementing the work that it takes to get there and hoping will be can he have in 5 years. We are here the property interrupt trip to the lovely agreement can you talk about that and then maybe talk about how Public Housing will be a solution . One of the very exciting things about that building it accommodates names families in a neighborhood with Grocery Stores and transportation a little bit out of the tenderloin when we think of families with children finding places in the area that are enacted by homeless. So very again Community Space and actually have a partnership with the Housing Authority the Housing Authority has different kinds of vouches they have available and in case with the vouches we use those vouchers with the unit and help to cut the cost we have homekey dollars that provide money to the counties our acquisitions and able to leverage that. Can you you, you talk about the voucher programs how they help Public Housing and help landowners into the whole thing. Sure we have a few voucher emergency vouchers from the federal government during covid and dispersing those with the Housing Authority and the programs one they can help prevent people from 0 becoming homeless and people are in danger of becoming homeless with a necessity they can stay in the place they have and people are experienced homeless and in a shelter and kwobtd with the system the best way for them to find it themselves with the help of a case manager or a housing locate our that makes sense in San Francisco we will have a number of buildings in certain neighborhoods in San Francisco and a number of places in San Francisco we find people experiencing homeless across the decide but dont have an easy option with a number of neighborhoods so Emergency Housing Voucher Program we partnered in bay view and been successful in making sure that people from that neighborhood and that neighborhood kind of a proximity for people who have experienced homelessness with born and raised in bay view and, you know. Instead of putting them in a place across town a unit available able to work with them to find their units in the neighborhood eventually and we hope when lvrndz will see the value got a number of landowners buildings with a lot of vacancies we think that it is really um, helpful for them and hopeful for us we can Work Together and see the number of units in partnerships we can get people housed with a steady income from the rent. Thank you i appreciate you coming into here today. You know. This is great. Thank you chris appreciate that. Thats it for in episode and for sfgovtv im chris thanks fo item 50 is resolution calling on department of Public Health to provide medically necessary transition related care for transgender related people and remove restrictions. In 2012 gender health sf was born out of advocacy from Community Stakeholders and local leaders. Really as response to providing quality, accessible jnder aaffirming care for the most underserved. indiscernible the way i see it, there is two ways of folks we serve at our program. The first wave of folks who never imagined surgery access was accessible to them. Many folks who had to save money or par ticipate in underground economy to access the surgery outside the country. indiscernible really to make Something Real in terms of being able to connect with the gender identity and external indiscernible and so transform so many lives of many of trans folks who never imagined it was accessible to them. Now we are in the different era and time where transrights is in the social political and general indiscernible and now we are serving young folks to support them and making sure their gender identity is connected to who they are, so providing a space to support transfolks to live authentically and that is the goal to provide the level of care trans folks deserve. When it comes to access to healthcare, while we all believe in cost control and make sure we deliver healthcare in a Cost Effective manner, i dont think that cost is a reason or legitinate rational to exclude people from healthcare indiscernible colleagues i ask for your support. Thank you supervisor wiener. Colleagues on this item can we do this without role call . Same house same call, without objection the resolution is adopted. [applause] good afternoon, everyone. Being you call the roll. President ajami. Here Vice President maxwell. Here commissioner paulson. Here. Commissioner rivera. Hee yoovm commissioner stacy. Here you may make up to 2 minutes of remote comment by dialing 4156550001, access code 2592 330 0523. Note you enough limit comments to the item discusses unless under general Public Comment and if you dont stay on the topic you canni