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Present. Joy have script to read and we can move forward. Welcome at this time october fourth San Francisco Healing Commission meeting it is being held in hybrid foradmit in person room 300 broadcast live on sfgovtv and available to the via web ex call 4156550001. Before we begin like to reminds all present and attends nothing person all health and safety protocols add hered to. This includes wearing a mask covering your nose and mouth any time you speak. Failure may result in removal from the room. We appreciate your cooperation with requirements in the interests of health and safety. Note that there is a hand sanitize are station at the front of the room. I have a Motor Vehicle in case you need temperature we welcome the public during comment period. There will be an opportunity for general Public Comment at the beginning and on each item on the agenda each comment is limited to 3 minutes. If you like to comment on the line call in and listen or you use the web ex link they are real time the sfgovtv link sometime there is is a delay to make sure you get your hand up in time use web ex or call inform Public Comment will be in person and call in. The commission will take comment first from people in person and then from people remote. Those in person should submit a card to me. And instructions for call nothing remote found on page 4. To access closed captions hover over the live stream the cc logo will show and click on it. Note that city policies with federal, state and local law prohibit harassing conduct against others during Public Meetings and not tolerated. Public comment is permitted on matters went jurisdiction of the Health Commission. Thank you for joining us. Thank you. Thank you to offer the Ramaytush Ohlone land acknowledgment. Ramaytush oholone land acknowledgement the San Francisco Health Commission acknowledges that we are on the unceded ancestral homeland of the ramaytush rahmytoosh ohlone olonee who are the original inhabitants of the San Francisco peninsula. As the indigenous stewards of this land, and in accordance with their traditions, the Ramaytush Ohlone have never ceded, lost, nor forgotten their responsibilities as the caretakers of this place, as well as for all peoples who reside in their traditional territory. As guests, we recognize that we benefit from living and working on their traditional homeland. We wish to pay our respects by acknowledging the ancestors, elders, and relatives of the Ramaytush Ohlone community and by affirming their sovereign rights as first peoples. For folks watch being we rearranged the agenda we have pan taftic presentations today and we loaded them to the front of the agenda. Well begin with our next item which is general Public Comment. This is the time to make comment on items not on the agenda. Not on the agenda and i want to note in in case you make comments about laguna honda that is listed under item 7 the directors report. Any comments should be med there. Any comments about lug luge under item 7. I will stop you if you are milking comment about that item that topic on this item. I will read something. At this time members may address the commission on items of enter to the public went jurisdiction of the commission but flot on the agenda. Each member may address for up it 3 minutes the brown act forbids discussing any item not on the agenda including during Public Comment. Each individual is allows one opportunity to speak per item. You may not return to read stimulates from others not attention. Written comment can be sent to the Health Commission. If you wish to spell your anymore in the minutes you may so during your comments. All right. I see a person on the line with their hand up. Let us know you are there. Yes. Excuse me patrick. Yes. Go ahead you have 3 minutes. Thank you. Although laguna honda is Kitchen Floor. As i noteded luge looking comments at the directors report this is general Public Comment. Why this is not im sorry go ahead. It is in the about the closure plan. Anything with laguna honda will be on the directors report. Why no, no, no. It says. So we will move on that is the only Public Comment for that item. Commissioner. Thank you be secretary morewitz. Our next item is hi very close update we have doctor hyman scott and Nyisha Underwood and cohen. Welcome thank you. There is 3 of us will present today on the report. I will do i control the slides. It controlled remote say next slide and she will move it. Im hyman scott a physician in San Francisco department of Public Health work at hiv i will gift update on behalf of my colleagues from the Epidemiology Group and getting zero on the steering committee. Great. Am we will discuss the hiv epi screening prevention and Care Services through the 21 epi report and touching on the initiatives we have to address the disparities that will highlight in the report. We talk about hiv getting to zero and the Community Health Promotion Health access pointses as well as the disease prevention and control program activities. Will so, as you see in this slide, what we track are Testing Services and these are in medical facilities from january 2020 to march of 22 you see that we had a steep drop off during the shelter in accomplice and that has rebounded and exceed 2019 levels so what we dont have here okay. And so we have had rebounds in our testing and medical facilities but have in the seen the same rebound in our Community Testing cites yet. This is the main component of the report this looks at number of hiv diagnose we have seen. So new diagnose decline. From 2019 levels in 2020, we had lore number of case but a concern our testing declined. And the previous slide and saw a slight increase this year in 2021 from 138 to 160. And that hiv deaths have gradually increases since 2016 and hiv causes continued to decline real seen deaths over dose increasing and over all in san front we are about 15, 600 People Living with hiv and over 70 of those individuals are 50 or older and almost 40 are over 60. The rates of diagnose by gender and race are here, you see these are adjusted for population. The highest rate is among black men in San Francisco at 77 per 100,000 followed by latino men and seen a sloit up tick in latino women. And which is in the equal to black women in San Francisco. And that the over all rates on men of all races have been stitial since 2019 and we have seen the changes among women who are black or africanamerican and latina in San Francisco. And we also look at populations this includes race, ethnicity and risk factors for acquisition this is number of cases not rates. This is not population adjusted. The largest number of case were latin x and followed boy white individuals and people who inject drugs is also increasing. And among our Homeless Individuals and we had largest increase in women and sixtyfour come paired to 2019 levels. We evaluate causing of death. You see, on the far left hiv causes continued to decline. So it is in 2009 and 12 red. 2016 in blue and 2017 to 20 in grey the deaths declined under 30 . Now accidents increased. This does include over doze and in the most recent time period made up 17 of deaths this occurred amongst People Living with hiv. We monitor close low linkage to care after diagnose. Stheez are each year from 2017 on the far left and yellow to 2021 in purple. And looking at over all number of diagnose how many are linked to care within an among after the diagnose in 2021 with 94 an increase from the 2020 levels and close to when we had in 2019. And we look at biosuppression, 612 months; that is stable from last year. And decreased from 2019 levels. We are hopeful we will improve in biosuppression rates. And this is a sum row that looks at different populations. And just to orient you the 2019 is in blue. The 2020 is red or orange and 2021 is in yellow. And you can see the average for each those years 2019 it dropped from 75 to 70 and had a rebound to 72 . We have several populations and women, African Americans, young people and people who inject drugs and nonu. S. Born individuals below the biosuppression average rate in San Francisco and our important population for focus for treatment engagement and care. In this is a slide that looks at housing status. People experiencing homelessness. We look at numbers come paired to nonhomeless on the far left. If you notice in the upon 2021, 95 of people who were not homeless linked to care within a month and had a significant drop in 2020 to 83 . Viral suppression rates are lower. Compared to 80 and versus 50 to 60 . And then receipt of care dropped dramaticically in 2020 for People Living with hiv experiencing homelessness and not near for people who are not experiencing homeless knows in the same viral suppression all People Living with hiv and those when received care we have the large gap in our care out come. I will give a brief update before over to my colleagues. Getting it zero we rearranged our Priority Areas and activities to focus on these areas of need within our city. And at the top of our efforts are centering Racial Equity tow attain health out come for all of San Francisco. These other categories this we focused on. People sprngs homelessness. Rapid initiation of viral therapy at initiation and reengagement. Age and drug over doze interventions. I highlighted topics we are focussed on in the next year. Including preventing stis among individuals living with hiv or using prep. Looking at new ways to use antiviral therapy and intfwrat it to Health Access points and Community Programs to have a descent rollized access to option for treatment. Specialize protocols for restarting individuals rap ird low on therapy. Looking at as people age given the major living with hiv are over 50 and will be over 60 soon. We want to focus effort in making sure we have services that meet the needs of our population as they age. And looking at drug over doze prevention. A stake holder engagement and huwe will move forward to support safe Service Within the citys Harm Reduction strategy. This is a snapshot when we are focussed on this is a list i will not go through all you have the slides and if there are questions i will be happy to answer those. And then another thing we have been try to maintain communication role time as we track what is happen with covid and now with mpx reduction in access to service in many of our communities. We have done town hallos covid and hiv treatment and prep. We have continued to update our website to keep a Clearing House for information and listed the updates and resources we posted and in bold at the bottom. Maintaining our engage and want communication around hiv, covid and mpx. All right. I will turn it over to my colleagues. Thank you, doctor scott. Hello commissioners my name is Nyisha Underwood upon im the quality improve am manager in the Community Health equity and he prosecute Motion Branch. Im the acting manager for our ending the Epidemic Initiatives and i lead the development in writing of the Health Access point. Today i will talk about the Community Program this is we have that are addressing the hiv, help c and sti disparities. Y received funding from cdc as a part of the National Ending the epidemic hiv Epidemic Initiative a 10 year aimed at ending the hiv epidemic by 2030 and sf keep added goals of e eliminating help c. As well as rusing stis we call it ending the epidemic rather than ending hiv epidemic. Plan is built on Strong Foundation of principles and have yous you see listed here. This plan is a living document. And tell dive the implementation of hiv, hepc and hiv prevention over the next 10 years. We are in the third year of ete. And the plan is linked here on the slide. Thats the website to the link. For the plan. So the populations that ete prioritizes are black africanamerican, latin x. Transwomen, people who use drugs and people who are experiencing homelessness and people with incarceration experience. All of the activities and ete are status neutral service. Which means that anybody regardless of hiv status is entitled to receive comprehensive care and support. Some of the other activities listed here are the mobile contingancey management the equity competence prosecute Motion Branch. This Program Funds the sudden fran aids foundation to provide street based out reach and interventions for people experiencing homelessness and people who use drugs. Focus is also on communities who smoke and inject and or inject fentanyl. The other resources offered for the program are incentives over dose Prevention Services, on going counciling and drug Testing Services. We also have expanded access to prevention care through home testing program. Take me home. And then there are texting remindsers for city clinic enrolled prep patients. This texting platform alighthouse patients to know about new resources such as the new lab based home testing program. We also have focus Community Engagement through community grants. We funded several, 7, Community Based organizations called, caps. That provide meaningful dialogue to the communities. All the priority populations that are talked about in the beginning. They advise dp heart attack on delivery methods and funding. One other thing we were able to do through the capps was provide 50 ofh on delivery methods and funding. One other thing we were able to do through the capps was provide 50 of funds to compensate the Community Members for their expertise and time. Jot other activities is Regional Planning across almeida county with east bay getting to zero and San Francisco getting to zero and we are doing this to increase the prep access regionaly. Lastly, i will talk a bit about the Workforce Development opportunity through chilly. The Community Health leadership initiative. D ph is using this to hire, recrew and support staff on the ete prior population. They are learning Racial Equity competence Health Equity and Harm Reduction. Im sure you heard a lot about the last couple of months and as well as i of course today a colleague presented on contracts but the other things that we are doing is that we developed a framework called the Health Access point. The contract start date for them are january 1. Of 2023. And they are a one stop shop of services for several population this is we are funding. I will show that next. It is to provide the goal of the Health Access point is it provide ensure that all of San Franciscos have high quality of care and treatment and attain optimal health. One of the things we did with this rfp would be intentional. About address being equity competence focusing on the populations that have the greatest disparities in hiv, hepc and stis. Half of the funding went to the black, africanamerican and latin x population. Something else different is that we are intgreg grating the testing will be provide across the 3 diseases and increased emphasis on hrm reduction and over dose prevention and the other services that we are requiring the healing access point to provide. We are have Health Access points for each of the populations listed here. The last program i will touch on is opt in the out reach prevention treatment and integration for reaching people experiencing homelessness. I like to acknowledge my colleague in the back approximate who leads these efforts for tip and if there are questions directly related this program she can answer those for you. The 4 main components of this project are collaboration and coordination. Hiv, heshgs he pc and out reach and linkage to the San Francisco aids foundation hepatitis c Wellness Program n. Collaboration and coordination piece, our communities the commune Health Response Team Partners with the foundation, glide and street medicine and provide treatment in bay and the tenderloin and other districts and testing mot modalities at Navigation Centers the treatment Linkage Center and encampment. Some of the testing modalities are they do door to door testing. Pop of clinics and health care and out reach and throughout out reach the out reach engagement efforters prioritized as encampments throughout the city and this it is also a way that the San Francisco aids foundation recruitings for their h cv Wellness Program. They are able to enroll people and get them on treatment and also track how many people have been cured. Hepatitis c. I will turn it over to my colleague Doctor Stephanie cohen thank you, ms. Underwood. Good afternoon, commissioners. Thank you nyisha and hyman. Im stephanie cohen, director of hiv and sti prevention in the Disease Control branch and the medical director of San Francisco city clinic. I will share updates around our work in clinical hiv prevention that focuses on addressing disparities you heard in our epidemiology summary. One of our core roles in the disease prevention and control is to ensure patientings diagnosed are offered Partner Service s and linked to prevention treatment and care. We do this with our link program. Linkage integration and comprehensive service. This table shows out come from our links team for patient who is they provided Navigation Services to in twenty 20. Links provides navigation to People Living with hiv who are not in care. Among 53 homeless living with hiv that received services from links. People who at the time they began engage with links had not had a viral load in over 6 months or a high viral load 62 achieved viral suppression. 12 months after they began working with links. These other out come we hope to see with our links work and is a way to reach populations not engaging with care. The cdc rescuing niezs the importance of disease intervention specialists, the w force this make up our links team. And we receive other jurisdictions, Supplemental Fund to support our Disease Intervention Services workforce. We are using that funding to build a program, radar. Building reserve for accelerating disease responsibles. This program is there to strengthen this core backbone of our Health System we call saw was crist kag cal during covid and the monkeypox out break. What this group has done is helped develop curricula and learning opportunities for our dis. Who have many skills that i have to learn when they come in the work in order to succeed at their job. You see this learning pyramid with core skills, content knowledge and the type of expertise can special casework need to perform this healthing function. You see in the core skill section we assure our dis as cultural competency in working with the populations impacted by hiv. We learned in working with the gis the team lead in supervisors need support and professional development as well and radar has tude a community of practice of the dis supervisors to ensurety Group Leading the team has the skills than i need including skills in management and on boarding and training and in preparing for surge and out break response. And assuring that Health Equity is the center of all of the work. Additional role in hiv prevention ensure that providers in San Francisco are skilled in providing hiv services. We do this through our provide are consultation, trinning and Capacity Building program. And this is an important effort to make sure that all of these strategies and hiv prevention from froesz rapid art to best practice in w with people experiencing homelessness throughout our Health Care System. And the last year, we really focused on working with clinics and provideers serving the populations who were not seen the decline in hiv that we expect and hope to steel. We have focused work on street medicine and Shelter Health and done things integrating point of care and sti testing in the Navigation Centers and shelter in place hotels and worked with the opt in team to support the encamp am health firs and wing with nyisha and the cbos as they come on board so far they offer integrated hiv and sti testing. We provides Technical Assistance in systems change support throughout the San Francisco Health Network system of care to implement best practices and prep in screening. At core cites castro and mission and jail house and the chipy clinics. And another critical function is to ensure access to Sexual Health service at city clinic and center of excellence in Sexual Health. Advance through this on the slide. We do at city clinic provide services with the approach, you can keep it advancing the bullets here. I will highlight a few interventions in the left year including integrating immunation and m pox. Try to scale up as much as possible our over dose rehappening vebz services and in may and june when m pox increased we served a center of excellence in diagnose, testing, treatment and vaccination. Advance the slide. You can keep advancing the slide and one more. So a couple of other highlights for city clinic the last year we launched the rest of the d ph medical records system. We also have been a site for controlled trial on exposure [inaudible] doctor scott mentioned will be an emphasis in the coming year. In terms of integrating hiv Prevention Services we have a number of quality improve am projects and other projects to opt myself hiv prevention care at city clinic. Lastly, you heard much about prep today and over the years but prep conditions to be a tool in our hiv getting to zero efforts and again am advance through the bullets. So this continues to be aye an evolving field there are new tools on the horizon we have improved access with the primary agents for now generic. We have options for dosing for prep. We have an oral option for renal insufficiency and a long acting injectable option fda approves for prep. Together in getting to zero we are working to ensure all the prep are made widely accessible in San Francisco and particular low the populations we see gap in prep use and see slower declines or increases in hiv diagnose and that it is as you heard women, transwomen. Homelessness and inject drugs. So this is a summary slide. Again you can click through until all the bullets are there. In summary, we saw improved rates of hiv test nothing 21 and testing rates are not quite back to 2019 levels. Over all diagnose declined 8 compared with 2019. We have seen high levels of linkage to care and viral suppression and evidence of improve ams over 2020 levels disparities in homeless knowledge highlight the the trepdz in doctor scotts presentation. And you can advance. Our efforts across our branches are to ensure we have anning Proctor Gamble approach that is equity focuses and stigma free and low barrier access to hiv Prevention Services. Thank you and we are available for questions. Barrier access ton services. Thank you and we are available for questions. Access to hiv pre services. Thank you and we are available for questions. Is there are Public Comments. I note that i made a mistake about the person making general Public Comment welgo become to you after this item is over. So you can make your comment. Folks on the line if you like to comment on item 3 the hiv update press star 3 now to be recognized star 3. I see no hands from the public, secretary morewitz i cannot see commissioner hands through my display. Commissioner giraudo . Commissioner giraudo. Thank you. Excellent presentation i really complement you on your work and just to all secretary morewitz a concise presentation. I have follow ups on slide 15, eta and eat that you presented about the activity. Im wondering what that time line to be emplimitation of the activities is . And will there be condition cree data on the number served and program recorded . I have another question. Next slide which guess long on slide 16 on h ap who will be responsible for collecting the data . Cbo or dph . Commissioner giraudo in terms of slide 15, on ete. So, we are in the third year of ete so the activities have been going on for 3 years now. We are we do collect data. We do reporting through our federal fundsers. And in terms of i think the question was number of people served . Im sure that im not well versed on everything we collect through each the ete activities but im sure we can pull did thea on number of people served through each activity. It is just they were you know excellent activities but i would just be curious on in your implementation hop how many would be served. I will try to get that data for you. Id appreciate it and then on h ap, who is responsible for collecting the data . The cbos are required collect dastasm we created Performance Measures for each standard of Care Services. We are also in the process of creating a Data Management system so our cbos track when we need them to track. Great. Thank you. I appreciate it and i do like datsa. Thank you very much. Why thank you. Commissioners chung and chiou. Commissioner giraudo i want to share with you that i have requested for them to come and present to the population and health committee. In the future when they have more data. Thank you. I appreciate it. I have one question inform the spirit of like competitiveness, i think this you know like every city in the United States are raising to the end the epidemic. In reference to the rest of the country, where are we in terms of our progress and completing the goals set for 2030 . Excellent question issue commissioner chung. We have a friendly competition with new york state. I think we continue to see a decline in the number of cases. Proportion of change is pretty similar to 2 other jurisdictions in the country. There is over all like slight decline in number of cases but San Francisco, sealings, boston and new york are places where we have seen changes. I think we have seen largest over all decline in the last 5 to 7 years in number of case compeers to other jurisdictions. Whether it is a populations are different policies. Other things happening in communities are differentful bithink we are we would like to see a lark larger rate of change and disparities not a part of our epidemic but need to responded to them. We are making the efforts its ensure well is equal implementation of programs. And we are tracking, reporting and responding to these disparities and change in populations that are impacted. Thank you, doctor scott. I recall with earlier data from a few years ago San Francisco seen a decline in one year that equalled the nationed with decline of 5 or sick years . That was the communities to reach now we have the disparities that persist. We have a lot of w to do moving ahead. I did have a few questions. Commissioner chiou. No, thank you. And thank you for this excellent report. Why commissioner chung can you get closer to your microphone. Thank you for an excellent and convoois sighs report i was wondering about 23 things. One we have looked at the half contract today and will look at is this as a commission. And so is that part of the hiv project or and if so is this part of the zero project or where does that fit within our department results. It is a multiplicity of organizations of Department Services and so is it focus from you know starting from hiv . Thats my first question. Trying to get a place am. You had mentioned this there was a team that i pictured was out in make sure that people are involved with the hiv testing. So, we have mull pull teams going out. Solar and other street team usa, do they in any way you know conflict or clan rit with each other if somebody come and wants to and could be possible hiv for your team call member if they needed this order. I dont know how this works. I picture i bunch teams out there. And just wondering than i talk to each other. Thirdly, was one in regards to on your side 14 and ending of all epidemic of the epidemic in the community in the city they had coordinated with help v3 in order to try to reach populations that were [inaudible] im wondering if there is a space here and obviously this is that could be asian issue and than i are not a large number of asian hiv cases we then reach out to those who are arab yen at high risk and also are able to test for [inaudible] of trying to have us as an hepb free city. Thank you for an excellent presentation. Thank you, commissioner chiou. Dwroo hello, commissioners. Miosis to see you. Commissioner chiou i can responded to your question regarding the integration of the h ap and where they set with the getting to zero goal. Health access point is integrated wrap around service that focussed on hiv, sti and he pc services. And it sits on the continuum is that the goals in alignment with getting to zero goals. Getting to zero ratings stilling in and getting to zero hiv deaths. Off the programming and activities and service that are embed in the our h ap will contribute to the city goals and cross collaboration with ending the epidemic goals. We have 2 big major strategies. Thats where the h, ps fit in this large conditionium. Can you introduce yourself. And where you sit im nicole trainer Community Health and ecwrit and he prosecute Motion Branch and new budget and contracts manage. Thank you. Rachael will responded to the question regarding hep services. Hi. Commissioner chiou. My name is rachael i go boy nova. The combaft building liaison for the Community Health prosecute Motion Branch and part of chrt Community Health response team. In terms of the collaborative w this chrt has done with our d ph teams, typically that looks like the chrt team collaborate with various Different Teams with d ph include out of street team [inaudible] and Shelter Health. Harm Reduction Therapy Center and cbos such as glide and San Francisco aids foundcasion for people who use drug s and deal welcome homelessness the work serve people had use drugs and sprngs homelessness in shell in place sight in 2020. I helped coordinate and motionalize the different efforts of hiv, sti testing this has evolved over time. So within 2021 that has a majority of that collaborative effort encompassing providing service in shelter in place cites as the cites [inaudible] have basically broken down over time, a lot of that work mobilized to collaborate with city clinics team tom do hiv excuse me. Diagnose hiv positive [inaudible] and to um support those who um, have tested positive at um private sros. Um, this definitely became an issue in the winter of 2021. Where we tried mobilizing as a Health Department to provide Testing Services buzz we found out there was a cluster of transfells of color in this sro and as a response we taken the best Harm Reduction in the community to address had cluster because of the majority of the people that were hiv positive remember transand fell in people who use drugs. So thshg cluster was not able to be served in the sro because it is a private sro not within the shelter in place cites but because of the hard work and the collaboration that links does with the community, we have been able to identify the inform act turned a brought range of testing events in 2 different shelter in accomplice cites we provided Different Services that collective low included not only hiv, he pc testing but distribution and covid rapid testing. As a result we were able to the find one period hiv person had was transand woman of color this informed the wrap up of detail of the june 2022 where we closed out with the [inaudible] project with them. Upon encampment healing fair we reached community and collaborated with the tenderloin links center. There is a lot of different moving parts and Different Team usa. I think with glide and the aids foundation if not for you Community Relations it was not for the Community Collaborations work would not be well define exclude shaped and commune driven. Thats where im seeing where the work guess how this is tie in the with work with d ph. Thank you. I am still [inaudible] which one can inneract with the asian population and also screen them for hepb . And commissioner chiou to clarify you are talking about if the h ap folk dos this or Something Else . I dont care, we are going to be reaching the people and looking and and the he pc and b are you know within this same range of trying to e eliminate both and if we are dealing with the arab yen population we are doing testing if i can retake the town to be able to test for those who are still [inaudible] then and there that would be helpful for this population as just asking if this was within the scope of time to extend being a site for all and being be a [inaudible]. Thank you. Right. Thank you so much commissioner chiou and to respond, we have a healing access point that is funded through alliance Healing Project that focused on the Asian Pacific islander community. We also will be connecting them to our contracted services at the ending the he pc epidemic and you all aprufed i condition transact for our hep b services we will connect all 3 of those services with the h ap and cross collaborate rigz and testing for he pc and b but basic services and all are funded under chip. We will have strong intinauguration. Thank you very much secretary morewitz commissioner chung. [inaudible]. And i would imagine would include hepb screening . Anyway. That is what my reaction when commissioner chiou asked this question. I think this from all [inaudible] presentations when we see is the importance of structure intervention for those hear not housed and the viral suppression rate is different. Out there [inaudible] are these h ap s trying to get to are the ones we funds also authorizing the social determinenants. Yes they are designed to address that and social conscience of individuals, which is why the standard of care the requirements of standard of Care Services in the h ap not only include the Drug User Health services or hiv compossiblies butt basic needs. So this basic needs component is crucial. It was implement friday the community voice. Community wants to walk in a facility to get basic needs are there to address social conscience. Food security, housing, employment. Especially for those who are experiencing homeless knows. And to add to your first question the San Francisco Community Health center, yes than i are one of the Fund Agencies and primary population is transwoman focused on color. But believe the hepb and hpv will be intgritted for the different populations. Thank you. Other hands. No other hands i had a few questions. I apologize. Commissioner guillermo. More of a comment and one that i noted in the finance Committee Given this the h ap s are a new model. Wrap around services and focused a populations to the extent this we are going to be evaluating and monitoring the role out of the model begin nothing january and gwen to commissioner giraudos emphasis on data, i think that both on a qualitative basis and a dave collection fact base you, it would be grit to make sure that we are collecting the data that is similar not questions are asked boy the commissioners but over all in terms of the efficacy in the issue this is men arising from this model of care. It looks promising. Because the Capacity Building built in to this this it would be incumbent to monitor this in a sort of creative and supportive way so we get the most out of what is being invested in the service. Given this is a new model. Thank you, i had a few quick questions we are looking at the difference of 20 then and 2021. 2020 was anomaly. One thing that toed out with last years presentation i dont have it with me. We did see some not insignificant reductions like retention in care and viral suppression among white people in San Francisco living with hiv but the same out come among African Americans are are were stead and he im wondering correct mow if im wrong. I wander if well is anything we learn exclude when the causes of some of those reductions might be and huwe motorbike able to take when we are learning to help improve out come for after can american in San Francisco. Social ice ligz . Issues around lack of access to care stilling in within the community. Did any of this toed out for and you anything we learned from that . Thank you. Great approximate question and may be doctor ask the you can chime in. I think it is come plex to unreceivel the trendses. Hayou presented are possible explanations. I think that the safety net system really worked to sustain cob newt of operations during 2020 and does serve many of the communities of color you highlighted. Within links, there was a need to prioritize. Because many staff were deplayed to covid or disruptions in the workforce. So i think our prioritization were communities with same out come and people were in care and taking meds at home but in the coming in for viral loads buzz they could not access the Health Care System or concern body coming in a brick and mortar clinic. This looks like potential low could look like someone was out of care but home taking med and were in the getting labs done. We see different potential things affecting different population upons different low. It is part to fin down. Do you have other thoughts to add . The only addition i say is that we do monitor hiv out come in the white system this is a safety net and their out come are better then and there any other system. And their providing resources and care for people experiencing disparities. Africanamericans, lettin x, there is a system around that, this is important and the groups that were a part of that were really quick to come back into in person visits to do out reach to advocate for the Care Services and essential services to restart very quick low. I think those other efforts that were implemented that sort of helped to support those communities. And you know, i think it was also we were lucky that they did not drop more than hawere already there. We were all fearful and thankful low the care systems as you sa in the h ap, to create men of those components and outside of the hiv realm that work well in our system. Thank you and testament to the work of staff and community partners. Thank you. I have another easy question compared to that. Looking at slide 3 hiv Screening Tests. What is the distinction between when you electric at the average Screening Tests did refer and Community Testing . How do you make that distinction . So i would think about a Screening Test if you go to see your care provide and go to the lab to get your blood drawn for hiv versus going to foalsom or castro street fair and getting your test outside in the communities. Not connected to a provider visit. You know there is the San Francisco aids foundation has a mobile van idle for 21 2 years there has not been same Community Events happening secondary to covid. That is know example of a place where Community Testing happened before 2020 and is in the really happening since. Great. I think we expected over all rebound for 2022 when we see that. I wanted to thank you for an excellent presentation. Concise and it is i presentation i look forward to every year we are grateful for the progress made. And thank you for your work and like to recognize director colfax. Thank you. I wanted to thank the presenters and it is impressive to see the progress this is made. A few points stand out in the history in terms of our effort in San Francisco. One is the disruptive reallocation of funding. This is important to highlight that was not an easy thing to accomplish. Approximate it was disruptive in a positive way. Increasingingly true intinauguration of service. We talked about it and i think your work shown it is not only taking root but blossoming in ways that were not possible before. The integration that every door is the right door in this situation. And emphasize the knowledge that is something that is that we promoted in the department with hiv and other stds. Exciting break through studies like [inaudible] and the fact we can take something that is being submitted for publication in a leading scientific medical journal. And the same time figure out how we will implement this discovery, inspiring and emphasize to the commissioners the team did not highlight this as much as i think it reflected the w they have done the strain the pandemic and of course m pox on top of that all the work in a time of competing needs and priorities as far as the diseases are concerned i dont think we could have anticipated. The leadership in hiv and stds but the work in covid and m pox as well. Thank you. Joy like to echo director colfact much has been asked. Your team with mounting and crisis after crisis. And you have risen to the challenge. We understand the cost of this and the extra strain. Thank you for continuing to do excellent work and deliver great of services to the people of San Francisco. Thank you again. We will go back to our one caller with the general Public Comment. Why yes. It was my make the version of the agenda that is out to the public says laguna honda hospital and Rehab Service closure plan. I apologize i will unmute you. I apologize gwen and i got 3 minutes on the clock to make your comment. Are you there. Why before you start i am here. Buffer start the clock i think you should relax your presumptions about whether Public Comment is going to being addressing the closure plan before you rude low cut someone off. So you can start the clock now okay you got 3 minutes. Although lhh replace am project is mentioned. No information has been provided. No audio. I got in interrupted by automated message. My hand had been raised. Please, continue. No information hen provided of the project time line or whether the project is already completed. What is the budgeted dollar amount to replace the Kitchen Floor . By report the freezer in the kitchen and broken down for months. And laguna honda may have had to rent freezer trucks parked in the parking lot. And the freezers have been replaced yet. What is the amount to replace them. During the remrigsment project a vender will presumable low be required and hired to provide food and meal deliver tow laguna honda residents that meets state standards including men use for appropriate diets, [inaudible] variety of and cultural and resident preferences. Has a vender been selected . Had is the status of the entire Kitchen Floor replacement project f. This commission choses in the to answer today you should draez the issues at the lhh team meeting on october 11th. Why thank you thank you for your patience and sorry for my mistake. Thank you, call and secretary morewitz. Next we have the office of Health Equity frupt doctor ayannea bennett. Welcome. Nice to be back and see you. Glad to talk about the issues but want to assure that you even though i was not here to do this report the work has continued it is not an important and everybody is dedicated and i can tell you about when than i have done. The report today is going to cover a few areas and i chose them because they are time markers and things we are doing on going. Im not going in depth of the differents w we do that in the future it it is because it has been awhile you want you to have a mark for the program. I have been empowered, mark. Over vow we will go over the over all goals and plans for 2022. We do them annually. We will be looking at those goals and meching new ones for the beginning of 2023 on an annual calendar to match action plan calendar. That is on the calendar year. We will talk about the action plan activity specifically. We will talk about challenges. There will be many. There have been some to talk about and a fourth thing i did not put on the agenda which is to talk about the resolution that you all did in 20 twenty and where we are with those activities. I want to start with the context of what the office Health Equity does and irrelevant it it is in the the office it is the vision and shape of equity as a concern for the department. We really think of it in the 4 areas. I have added separated out things that were lumped together before it looks a little different because that is the way the staffing and w is shaping out. Equity culture and the Awareness Training we are doing. 10 withins in communication. Workforce policy. Things that say what it is like to be here and whether or not equity sea prior or something you feel or do. The Capacity Building the skills training people we have the right people and they can do this work there is actual clarity about what the work is. And out come. Service quality out come so we impact peoples healing and ends disparities and the commune relationships to support that work. And foiblely the one i think you have the biggest investment in a key thing is acounsel abltd doe we have a plan and report on the out come of the plan what data are are we tracking how we make this up to standards of the rest of our work and not manage we do and give ourselves credit for without demanding out come. Our goals for this year fall in a few categories. We have data sharing goals to create dash boards in disparity report. Both of those will happen next year based on staffing the Central Staff is Data Management and that is just completing hiring there are lets of come peating priorities of the department but it it is done you in. We start dog that analysis soon. Get those out as reports and the dash boards up. We work with the executive lead and did thea leads to pick conscience or work this we wanted highlight. That spanned life span and the work what we want to work on and the indz indicators we have done that but they are not put up. Community based training. This year we wanted work on community and community engage. It is something we do a lot of but deponent necessarily have the rigor. Are we doing it enough and where. This is helping im help that was delayed from a thing i was asking leads to work on. To an Actual Department wide strategic priority. We are in the analysis stage wheny worry doing on a larger scale when we are seeing to response in the community this will result in some structurural changes rather than getting work started. Policy and training on respect. And w accomplice culture. I been trying to get this respect thing going for years it is must having long. We have done in piloting, piloted in one your now in another clinic. I think we have got traction here. Used introducing to get people match what they were hearing needed to go with manager training and other things to support us enacting it and we have done this. There is staffing and i think we are at a good point to move forward it is key. Key for adding ash countability to the goals around employee disciplines ands upon treatments we know we have and respective of basic thaing thing everybody understands this canning a grounds floor for us to have. And build the Racial Equity top of. Community survey tool. In the procurement stage. In that stage for a bit it is timed now i have the staff to dot analysis. We are now red to start that pilot process toward the ends of the year and be able to lunch that as a concern. It in the meantime we started to talk more about what kinds of data we want back from the community. So it initial low was a small project and now i think tell have i big are use case people are starting the lessons of covid we need actual data about what people want. The integrated Pipeline Program is on going. We are going to pilot something with dream keep are funding that is fund thanksgiving is coming from our Public Safety to used in Public Health and other areas we near precontracking. Have an rfp developed. We want to make sure we work with cbos and others already in this work. We are trying to finds partners take the youths we are not connected already rather then and there build Something Else. That is our definition of our problem we have in the played our role on going systems this exist. They will play its role and that is a better outcome and we will get there to launch toward the ends of contract the evenltdz year and launch next year. And the final one is we have been wing on the coming out per for [inaudible] to get it from the internal project it hen for years with good results. It did blossom to an entire Equity Program for the department. But it never did have as much of i community component. That was deliberate and that was a leadership choice. But it then needed move to a different direction. We are in the middle. I funded priority setting project. We think we can lunch that as an initiative to pull in partners. But more on the levelave city Wide Initiative with multiple partners in early of 23. Other healing systems on burden. Residents on burden to help and other things to make that a rich process. So. Spent time on mcgonigles to see when we are doing. I will do highlights at the top. We had our second mid year equity convening. Left year was the first that was a chance for directors to present about the equity work in their your. It was fit for the directors to do not the staff and a chance for them to report to the healing director about their work. It was meant to be an oversight meeting and functions that way. Thissier we expanded it. Every area participated. It was 2 hours that went very fast and packed. But we opened it to staff to either attends as a zoom meeting or to watch the recording. There were 245 on any given time online and we had more people watch it after. We are move to where it is move nothing a culture of the department that we expect you do equity work. Lots ask questions did in the know things were going on. We need that push for people to seek the information and seeking a way to be involve and i had think we are getting there. Pose to be i print report to go with that to go with last years that is delayed by staff. Ive lost a few people deployed or someone got another job and we have not replaced them. What i have done is hire analytic staff which is when i needed get going. I have them coming in and replace some of the reporting functions soon after. Another thing i think was exciting about last year to get storyd and pushed forward from it would have been 203 in our action plan and pull today forward buzz we knew other areas were not going to be able to be done and so we are setting Senior Leadership participation goals. Those 5 areas there. 12 hours of training over 3 years a community event. Attending the Equity Council meeting and sponsoring equity event in your your and mid year report. Those were yours they were asked to participate i collected if people did extra internal events or xr Community Events. Some got coaching. Some mentored manager in departments. Over all, most every area had an are bust participation. The one this was less was community event, this was proirm low our administrative staff. Finance, yours like that are hearder for staff and leaders to do those. We will solve that by coming community ambassadors. We have that contract is going out for rfp soon we should have more established activities for them to participate in when there it is a natural activity for their division. 61 people met every part of the standard. Of but almost everybody was everybody was off by one thing if they were at all. Role did the standardization i want today talk about, a project this started men yearsing on we have in the talked about it again inform 2016, part of prime, we had set data goals for rishl equity, racial ethnicity and language data. Which is when we call, real. Race, ethnicity and language this w group was put in accomplice we did not have good data and were missing lots of data or not able to trust some. There were training of staff. Sept reported the Gold Standard and then expanding when we called our intake. Instead of just having it be the races as presented to us we had all the different ethnicity and different w went in deciding huto go about this. We are showing you right here the top 1 and show you how to read this. I did not make the callers consistent top is race ethnicity. The vast majority of pep in the system have an identified race ethnicity. When we do is i will tell you in a minute. This is orange is asian in that group and blue is lettin x. You see they are 2 large groups. Grey is white and black is the yellow color at the top and the others are native hawaii and American Indian and native alaska and they are simultaneous but present. Languages not are matching up. Enlabor is 66 this is the preferred language. That includes lots of groups. Spanish was 19 . But that is 19 of the total, lettin x are 35 . It is 2 3s latin x and spanish as preferred language. Look like 19 but it is a big chunk of this group. Same for theishian languages it is about 40 . Preferred cantonese, mandz rain or chinese or vietnamese. Those are all tiny less than a percent but all together 12 and asian was 28 it is in the half but a substantial amount. Each group has people who need language service. We have most of our Language Services in the clinical areas. I dont think i dont think about what the evaluation hen in terms of sxaekz how well people feel they are served by it but that is something we need to look at. Just to give you a bit of detail what that means. So if you look at the side there, the that is an example of what it moneys to mark asians we dont ask for actual america asian t. Is anyone of the different ethnicities under this banner and roll them up in the data to mean when we have to report this as a single race. The same for native hawaii and Pacific Islander this allows you to get down to subgroups in the data. It means they get small and so in some cases annual data will not be sufficient it look at differences without a lot [inaudible] it means we have little populations which are a challenge in did thea. But makes it possible. Our intention is to for in it dot subgroup analysis when we do the disparity did thea report our Community Health needs assess am report in the next year. There are some internal inconsistency, federal guidelines have hispanic not hispanic as ethnicity and Everything Else is race that is in the how it is local low. Latin x it is i race it functions this way and then we have lots of ethnicity in that as well. So this means we are converting data from the way we collect it to the way who it is gave us the money andments it reported. We collect it in a way consistent q with our local standards. And most common is in our system is have a choice of them and that is in the clinical yours buzz the system allows per it. In the necessary low trough for other activities. If im doing a street fair i may not get this data if our interaction is glancing. Or if i get it i men dont have to get this full array the data is different in the department depending on the service we get. For the clinicals and the more involved services we spends more time with people, we have it down to the subgroup level. We are working on now and making that standardsization. The yours where it is not as common getting those to be standardized with the standard in heck and it is meeting that. We are doing policy development that should be our regular per of the offices work and has succeeded. Did a hiring guidance last year the Senior Leadership participation. Which was guidance in the first year and become more policy as we add elements this year. We talked about this the end of this year well evolve to full policy. We did a Senior Leadership hiring process for the the director of Population Health that has elements we are not working on to make more of a hiring policy and that includes a community panel. So we have community opinion. And other elements that i think will helpful and equity stimulate that we want to make policy across the department for this level and perhaps the next level of hiring. Afinity group policy has just gone out we got our first application hopeful low more the end of the month and story to use those as a source of information about when employeesment and the way to sdmemate people in group and experience for group who is minot feel they are represented. The last is Equity Leadership standard work. Takings the leadership standard and turns it to a standards for oversight for achievement people say what does it money to lead for equity. Trying to get that down to pregnant this is concrete so people have a sense of how to succeed at it. We have a policy analyst that hire period done and we should come on board soon. Then well at any time fellowship we did not have this year we ended the last one the beginning and story a new the beginning of 2023. And that building on analytic skills and policy ajs and other yours that hope managers will use to change the way they do their leadership. Challenges. Racial equity plan has over 90 activities does not include health goals. It was focused on workforce as a proirm area. And that at the direction to the office of Racial Equity an important first your and in the manage we can do we are held to guarantee health of the city. That i think we were able top fwhans by waiting that firstier when we had a lot of attention. A lot of support from ore or knew we will be able to really achieve a lot and so if you look at the box 2021 versus 2022, 2021 had more actions planned. And includes things we had this accomplice we had a significant number of things a council, having leads. We did those things. It pulled actions forward from the other 2 years when we could. When something was delayed i pulled Something Else forward. We did a significant number of things. I will go back. Vacancy i think we are in the boat with the entire rest the country in that pulling back staff is hard. Losing staph we have competing priors. We managed that well enough and new goals createed replace them we were not planning on that but those became project had it was doyle do without the staff to passport of the i think the work continued just did not look like it was intended. The leads started workorth goals. There are things they need theyre all wanted the afinity group policy it got delay exclude started different grouches in their area. I dont think i think the equity ball is rolling fast enough at typeset point tell keep going when we have [inaudible]. I think we dem strit third degree. And everyone is stretched and equity skippable is a problem. I will say we have realist good evidence this is not as much a problem as in the past. We have more w this did not get directed by me or anyone else. So for example, all of that work with the differencial awards was initiated by them i helped but that was initiated by them it is a hurdle sometimes and that work, worked well and med a model for how they do the rest budget of you in their equity load with move forward. Primary care with Covid Vaccine tracking the offer rate and desegregating it by race was their innovation. I had no contribution to that and they went forward and we are table to show they could work on and correct. I do think that there is always a delay. But m pox equity was an issue quick low. Not because it is always but people looked right away and started to staff up any respond right away the next step we anticipate tell be there and build it in. We are very close. Our forecast for twenty 23. The third and final year of this rishl equity action plan it is redone every 3 years. Our anticipation from the office is this plan will be focussed on sdrekt services and up to us to integrate that with the w we set those 3 years. We plan that year to be lighter. Because things get delayed. There were 22 activities planned the lightest. We will move forward for may be upon 7 thing this is will in the get done this year. Perhaps more, this will give us a number we can get close to. The vacancies have been filled. I concentrated on analysis it helps guide us. We learn friday covid and everything theles we do our best work when we are data driven and guided and helps focus the work and helps to help the commune understand why we doo do what we do. The your vs leads a couple just just getting hired or about to post. And that includes operations, whole person integrated care gim a department they have an equity lead and jail house is adding somebody. This will be the entire department at that pointful Community Resources are developed we got training, consultant toward survey platforms they were all institute third degree year and become available in the early part of next year. We worked on in thissier and see the fruit next year. The 2022 [inaudible] to get more newscast Racial Equity action plan. We are about a third of the way through in terms of achieving all of the goals and 2 thirds away that is an okay match up. Some we defered 2023. If that they had a Data Analysis need i moved them to next year because i knew i would not get hiring done in time that is a third commolest and a third not complete. I think we will get to somewhere around 8 plus percent commolested leaving goals to the third year because we have thissier light, i think we have done a reasonable job i will not go over all. The afinity group on policy getting released was our Organizational Culture goal in goal 6. That has just happened. You have for the board the Health Commission the Health Equity Impact Assessment. Was dying for a staff fortunate lead it and we worked out with contracts and the Business Office they are moving one of their staph in my office. She arrived an among ago and will take that project with her knowledge of contracts and help implement how we will teach and then evaluate that program. So. I think we are upon in good shape for all of them. Thing i think we are clearly need to spends more time on and i think we all agree is the hiring and retention. Discipline and separation are up there. Both have been building projects. They either had major changeings of leader help or locked fundational staff they feel are in the midst of being reper seed. There it is an experience. Equity unit in hr created. Has a leader. Hiring staff. We had changes in the leadership of eeo and labor over the last year. So there have been things that have been elements that slowed us down but approximate terrible low forward motion. We over all feel okay. I do think that the focus for our staff is most 2. Society fact that they have been delayed can being painful for everyone. There are big problems they required a lot more under loyaling support it foal like we had a chance of doing an effective job. I think it is because a problem we want to fix it tomorrow buzz it is a big problem it taking more it do that. So, i think we reach 80 percent. Data driven areas next year and we are like low to show out come for everything we did now in the next 3 year cycle. Part of our next plan is how do you evaluate and sustain. All of those things. Retention, prosecute motion. Organizational and the boards and commissions we made the most progress. Develop and separation is data inspect and dont have an prescriptional data system. We had hand counts. Of things but it does not really give us the role time did thea we need for improve am. It is in accomplice and coming. Hiring and recruitment and discipline and separation yours we need to do the most. I wanted bring back the resolution in 2020 racism as a public healing crisis. That was we were part of a national ref lougz. The american Public Health association tracking it and from this point we did it swept the country and there are lots of them. I think that the one that you instituted has i bit more concreteness it was a list of directives. I will go over the directives and see where we are. Funding and staphing the office of Health Equity helped the staff increased from 5 to 15. And hired all the 15. I lost a couple but i think the upon ends of next year at full strength. That allows mow to have areas of focus. Analytics and reporting and that de feoeds the work happening in divisions and feeds the communities. They want to know when we know so they make their own decisions we are close to doing that. The group Health Disparity and improvements were just staffing that up and we have the commune Engagement Group those other 3 big areas of work. Train and w force Culture Group is the last one navery well with hr, this combines with the hr office of equity and he experience to make one large team. Cooperate and participating in the office of Racial Equity we are on going. We have a meeting to review the work coming up. Establishing measurable equity goalless we had a 3 reporter s or having an annual plan reporter 3 years ago. May be 4 at this point the plans have not been as concrete. A lot of them were about awareness or aspirational. You in we are getting more concrete part is a staff person with Quality Improvement training trying to make the goals mart. And more concrow and add met tricks. We will continue haprocess successfully there hen a change over in the staff person but i think we will move that on track. All the staff data. Client and patient data race, age, jendz and transgender and Sexual Orientation you will hear about Sexual Orientation and transgender data. The problem is the quality of the data and whether or not we have the systems to give us role time changes. We dont but we are getting them. We have it in the clinical embarrassed is use those systems and i described they have we dont have it as much for staffing. Special the joint conferences to talk about equity laguna honda. Both of them had leadership and are building teams that you should for equity. It has been consistently a topic. Under taking review of all existing policy and practices to understands barriers to achieving rishl equity goals. We have done this in co yours. Hiring and leadership and we have done it in key areas. Doing the review is going to take more to be a lot of policies. We are looking we now have a policy analyst coming on board dweel that but tell be directive. Where are the yours we think we have the biggest impact on creating inequity and he creating a legals of target policies for this person to look at. Using best practice the business use the equity lens for request for proposals. We have seen that w. It is in the policy for everyone and trin and guidance in the Business Office and finance is irrelevant just coming on board. But they will seal this in the next year or so bum developing the best practices has to happen within this unit they have only you in got the leadership. Will we are just making the requests to hire. And the left one is by january 2021, which was may be for you or 6 mobs after the resolution. Having a plan for the. Am experience of africanamerican staff. There is i plan, it is in the as specific as i like it to be in terms of our ability to really take on each situation as it happens. One of the things i think hampers us people dont expect their problem to solved we dont hear about things until than i already helped. I think that will get better now there is clear leadership for experience in hr and betters we move the respect policy and demonstrate enforce am of temperature what people are going to need to see. Now we dont have a system that function in this way. We have a plan around respect, around adding experience as the your in hr and developing interventions. Said plan we took it to meanwhile solutions we are mid process that one. What we need is to get data to set metrics to say, where are we with this. We have interventions like secondary review of develop requests. Things have happened. But wutd data i dont know how we are being at the moment. That is my last slide. Thank you. Doctor ben the. In your growing team for this excellent presentation. Secretary morewitz do we have comment. Person on the line if you like to comment on item 4 office of Health Equity update, press star 3 now. For item 4. I dont see Public Comment. Commissioners. Commissioner bernal im looking for hands of commissioners and i see commissioner giraudo. And then commissioner, there are more after. Okay. Grit. Thank you very much doctor bennett for this report. I will have a question and also a comment. The action plan of over [inaudible] is challenging with the vacancy and hiring issues. Are there activities, goal and time lines reworked in so that the implementation and data reporting needs do they strain the staff . Just correspond. That it is rushed meet a time line it might not be tluro and possible low more cursory to mote that time line in case they need to be rework said. I will first point out thank you for that question. They are in the equal low of equal priority. Right. So on that list is making sure we have diverse picture in our clinic and space. Absolutely we should do that. I dont think that is on combn anybodys list as high as the discipline disparity corrected. There are some we are going to do but are not really staff intensive projects and others are quite intensive. So there is a mix in there. We have been here awhile. I was anticipating we were going to have some delays. We have an advantage of started this before this requirement came out from the city we can say we completed a few of them off the bat or in process of getting to them. I think we were at an advantage we did not have 90 activities we had closer to 75 or something. And some of them we will have to delay and they are happen nothing one area and pred this to others. Not as a whole department all at once. Yes, i think it is realistic the way it is moved. I dont think we will see the results of the data based measures in the year twenty 23. I dont think we will see the results. We will do the activities and i think it will takiers to see those results. I think it is help happening we will see happens with staffing or the next emergency. This will get everybody become to make these work. I was anticipating delays. This was done in the middle of the beginning of covid. It was uncertain time and for the department of Public Health so we were unsure with had resources will be when we wrote it and so i left room to adjust. Great. No, thank you, i dont want to burn out standpoint. Not sure that it is avoidable. But it is i passion. For the people involved and i think it helpd that is true that people have been die to see change for a long time. There is something energizing. I think we are in okay shape and getting diversified. Getting a more wide range nothing terms of race, ethnicity, age and parts of the department. People share the work more that meeting used to have 4 people and happened at my desk. It was intimate and grit now we cannot have it in person if we within become there are 30 people on that call. We have more hands to dot work than we ever have and have more in the next year. We near good shape. Thank you. If i get staff back. Thank you for anticipating our questions about staffing and impact of vacancy on the work and existing staph and the stricken that creates. You painted a good picture. Thank you. Something we are interested in we will do what we can to support your work. Runs a tight ship. Indee deed. I knew what you wanted to guest extra. Secretary morewitz. Commissioner green. I got condition fouzed and i wondered whether when we discuss third degree next. You might focus on the things you are prioritizing. I found the dance charts to be helpful as a visual to figure out what priorities you said. I gather a lot of the priorities will be set based on staffing. I have enjoy when presentations have been made in accordance to what you can achieve and you got your afinity groups and what are the deliverables you are expecting . And over what time frame. Men if we locked at a limited number of those thing and got a sense behalf is realistic in this has been the problem since covid and before. What could we see as realistic . I think for staph this gives them satisfaction and accomplishment. We have so many things we are trying to do. It is i dont know if you can poke to that. Just briefly upon because there are so many wonderful efforts. I would say sitting on the jc [inaudible] laguna honda and the county. Than i are doing a spectacular j. W. And their efforts in this regard and know that lost your team of leadership and guidance they are along and should be commended for the w they are doing. Could you just give a quick sense of when you think can be done you know if you were top present 6 machines from now what you think you would tell us and billsod predictions of staff it is difficult. I love to go from perspect you have getting more focus for it. So, i will say im not sure my predictions are as good as in the pas. 2 at laguna honda i have not anticipated as an accomplice to sends staff to the beginning of theier. Those projects will have it move to different people. But im hiring people to move them temperature it is going to be difficult. I tends to set aspiational goals. We got this work to do. And respond it thing fist they come up. Things come up. Ideally the w will not guilty be generated internal low. Pacific i lands are task force. W on workforce and we are doing a project. Those things have to have has to be recommend for those things. We are getting there, per low it about having staph to have a number of activities to keep things present for everyone. But i would suggest that it is mid year report as quick as it was. Deputy get i requested fooem people not to give neil the comprehensive but to pick a thing they were most proud of to talk about. It is too many people in 2 hours ken believe im saying just 2 hours but a bit longer. You get to hear some of what is helping. I think this is where the work needs to be in the areas where the patients are being touchd and staff needs to work when we are trying to do is give them the resources to do that. So giving them the communities survey tool is in the so i can do surveysilement to. A data nerd but it is irrelevant so this we get a different kinds of input for [inaudible] as they figure out had they should do around hiv or talk to cbos and get a consensus around what ways they need to hear about reallocation of funds. Getting communities voice is a thing im trying to offer. What happens with it . Is when we need about every two weeks. Im hoping will hear this more from them as a do their reports. What is it you are doing this is part of the Health Impact assessment will help us do. Im happy to do that to come become with more. I said this time i was doing a big over vow it has been so long since we talk said about that the big picture was. If you were to give us a preview of what you might come back saying you were proud of can you get, i understand what would you say off the top of your head. Why there is a lot of energy in the staff to really do things themselves. Im really looking forward it seeing when the affinity groups will do. I set aside funding for them. More if than i get more. Being able to see the speakers or cultural events or other things that changed the culture of the d. I think having near substantlies to the daily visibility of equity will chink thing and make people more, wear of their accomplice. Im looking forward to seeing what happens there. I think we are able to integrate equity in major project in ways we have not in the past. We are talking about mental healing sf and how we will dot out come and looking at that as a population level and surveillance. This moved toward data is going to have an impact. It is one of the most convincing things when i tucked about equity you know everyone has foalings but the disparities other disparities we should move toward the implementation more strongly. Looking at some of the goals that people set. And how much more condition credit they are. Dp being able to look at our agreed upon set of co indicators and talk about whether or not life expectancy, that is in the one but that take 10 years. Wlo we are seeing what we mode to see. A look at healing indicators and huwe will look at that data. Looking at had our staff is doing the direct work themselves they get to decide on. And then the left i say is the ways in which our leads are able to integrate the work across the department. We seen cross pollination. Black priority setting we are doing. That only matters if it becomes a driver for how our hiv group or environmental healing design their equity plans. They have equity plan this is is an established thing. You in this we have that we can start to talk about how we shape those to meet big goals. So that is the way in which each of those different groups will pick to contribute to what will be a more city Wide Initiative. Thats great. Thank you for this clarification. Thank you. Commissioner guillermo. Thank you. You know doctor bennett you answered a number of questions this i had in your responses to commissioner giraudo. Had i wanted to then comments and an appeal. You know we have priorized as a commission and department you know um the goals and objectives that are condition tain in the your office. And at least the 3 year plan implemented. And i appreciate you being realistic and honest about the challenges that you have encountered. And so i would just the appeal is that we finds a way to make it so you dont have to anticipate that you are going to lose staff to other departments, other concerns and crisis and such. When you are gathering steam here with now filling your analyst positions and the things you are doing the 8 to collect data and the progress and the upon buy in from staff. For us to worry about whether there will be [inaudible] with when it is you are trying to do is a concern i dont know where this appeal goes to. Because some is under your control and some is in the. I would like to make an appeal that you know if we want to be trough to when we are supporting here. That we if make it in in way possible for you to not have to anticipate a [inaudible] support resources than so that the activities you planned can be carried out as vicious as they are. On a timely basis. In continued greater support i would like to express. For where you are going and what you achieved and had you will continue to achieve the nextier for thissiers or this 3 year plan and as you plan for the coming years. So. I appreciate that. And i do feel im getting the support and i get asked about whether or not i can give a staff person to manage. And i want to explain why i said yes this time i killer about my plan. I want all the stuff on my thing to happen. But laguna honda and the continuation of that service is the most conscience kweshl equity question for the department the the moment t. Is in the necessarily in infrastructure thing like the stuff im trying to build combut lives impacted. The impact circle of the families. Those are actual peoples lives who who are going to be impacted boy inequity. I always try to move us to the point we are doing something people feel so we remember this is the ends point it is in the for mow to have my brill iant idea or yours happen. In the ends more people are alive or healthy or satisfied or mentally mr. Than before am when our system was favoring one group over another. In this case, that hospital is such a linchpin and such a force for equity for people who if it was not there, are not really able to take advantage of what little rest of the system we have. So. To me, it is a really person equity prirt that drafts on my list and this is when i can contribute to it and we need to i have somebody good the grievances. Seemed like a good place she could contribute i want her to do all my rfps but in terms of thing that the gets us to impact. I think she is making a big are impact at the moment. I think we are not where we wanted to be. But i dont think we are making less of an impact we are making more. As a member of the jcc i cant argue at all. And it just you know trying to keep a balance here of really supporting your logic and the need at laguna honda and by the way, from the report this is we get on how things are progressing with their their branch and your office at laguna honda, it irrelevant is a model. Everof the shgtivities that have been played out. And very, very help with the practice they have been making. But you wanted to have it on record we are supporting the resources and the progress this you are making. We have been a small core staff. For a long time and that has a way of adding vulnerability to plans that otherwise would not be there. As more hands come on board and i expect this to accel rit in the next 6 mogs that will in the be a problem if you have 5 people and 2 leave, there is only so much more you can do about this. Some things have to stop if you have 10 people and 2 leave it leaves room to redistribute. I dont have redistribution at times or space at this moment but i will get it and it is all is there trying to get on board. I have the seats i have not been able to complete them yet. We are move and thats where the priority needs be on agreeing to the point where there is sustainability. I like to under score from your exchange with the chair of laguna honda committee. That the fact of continued operation of laguna honda is a serious equity issue. Thank you and thank you to commissioner guillermo in the laguna honda jcc. One more commissioner, commissioner chiou . Thank you. And doctor ben the i want to thank you for it is amaing the vision you have and the vision we did in the see when the office created or when the resolution was written to develop this into a very powerful and Meaningful Department for us in the delivery of health care. I think we are dealing with a workforce issue as you said when we began many of the other city departments of course, were focussed on in terms of trying to respond to the mayor and the cities that concern. But this this was an opportunity that we developed Health Equity competence the name the office will get had made more concrow and it it is really difficult to think this we began with almost nothing including a no vision. And exact low to be able to tell us what you were going to do. And really xoit third degree what you are dog and have already done. I pointed out that both of our hospitals have actually taken this on seriously. And when we can irrelevant do. Now we can force down to the smaller units to able to really identify approximate be able on respond to everybodys real healing needs not on a broad basis. I know and we know in you have to get it down to the individual. And the vision you have is exciting and onliens tw years and you move today this far. I only have one or 2 other comments. One was in your relationship to the [inaudible] project and my only will comment there there needs a balance with commune input and a department guided response. And we than it was community input. Then lead to a principals for the department to responded. Will see they need to come to a consensus in order for thing its w im hope to see the perspective [inaudible] has been more successful then and there manage this we have been trying for 23 decades. And can be more successful if we get constructive commune input. I just point that out. Hopeful low we dont lose the gains that they had gotten us in the africanamerican community. I also am struck we will work on contracts. I wanted suggest this when we put in cultural competency reporter and there are many historical reasons why this happens. The intent of this was to try to drive a cultural competeny data looking at Health Equity and he not the general [inaudible] approach [inaudible]. Im wondering if instead of having this single line this appear on every contract which i dont think actually creates any equity and may choose contractors. If we could absorb that into what really is i think the intent of a culturaly comp 10 program, which is it has to address health and since you are going to have a contract. You might look at that and see if we and merge that requirement. And make a suggestion to our staff perhaps we could look at cultural competence in i way within the context we are trying to get to because it it is trying to get to the be able to be effective by understanding it this is irrelevant where i believe they inteblt of that [inaudible]. My other question was to ask, well. Make a comment that as you are looking at the language, i think what you mean as you described those that are less then and there 1 percent i assume is under the term chinese that you mean other chinese. Dialects. Because cant nose is already chinese. Mandarin is and that might be more present i know when you are thinking that would be present a lot of people speak many other dialects. Perhaps that is just to clarify that term. Lastly to ask you in the collection of the ethnicity what do you do with those who are of you know duo ethnicity . Um i dont think the best practice i will story at the lost question. I dont think the best practice wed out yet. In some cases, we take the marginalized group and include them in this partly buzz that is associate logically huwe treat people. You get which ever is the most marginalized and other time its worked to include them in both groups. And this is when you do an analysis. Not a pie chart but we are looking at something deeper. What is the impact of having this identity versus this identity. I dont think we have a consensus doing one of those. We do for our designation of latin x more of a race then and there an ethnicity if you america that you are in this group. There statute risk when you do this there are pep who are in twho different groups and impact the other groups. For the met per that has in the been shown to be true. There are in the learning numbers of folk who is might otherwise be innishian group or black. They tends to be white and mark latin x. We dont have a best practice and i locked i dont think we as an industry or a discipline settled on one of those. There are opinions, though. I personally like putting people in both groups if we dont add up to 100, so be it. That is in the our standard and can be confusion. There is debate going. Cultural competency, when we should get with the Impact Assessment is not a yes or no but do cultural competence but a few sentences if not more that says this is the disparity i will impact or i am intending it. Here are activities. And i didnt think those will impact this group. That im focussed on and then here is the metrics we will evaluate this with. Having this really more of a plan. Than a statement. And i think this is eflougz. Some point asking people to agree was the best we could do this was the level at which we were plan to get people aware there was a problem. And we are just storying it move them to out come. Had is when we have done as a department. Meching statements and taking training and then moving to but how will i change my budget. And we are getting there and we are moving our contractors with us. Thank you. That was [inaudible] also to try to get direct action we only had a half a person had was trying to [inaudible]. So with this staff of 15 i expect welbe successful. Thank you. Why your left question, i think feel fairly confident this we will not have a loss. Mobile homeum internal low by adding the external vis per low because we are not asking for pregnancy. We are asking forking participation. Which ask a different thing. It is a call not just to residence den its say when is your top of mind issue . But to a small are group to say, here is all the data. Here is where your disparities lie and ethnography we have done. Difficulties, here is some research about the interventions now talk this through. And then give the information that seems irrelevant havent if that process to the Wider Community to say this is where we ended up. One of the things we do is dont give people the depth of information we have. What do you want to dochlt did they know diabetes was high on the list or used to the fact people have amputation and it is in the top of minds as an if i canable problem. Giving the information and having a discussion where everyone is on the same page why it hen a long process. We are in good shape there not just direct us but this is with we are doing. Where do you want us to focus and the us is bigger. Someone from kaiser its the table. It is when are we going to do not just how the upon did the can move back and forth. We may not have the same capacity ends goal. We w on one thing and somebody else on another. Hsa on their thing. I think we all of the problems are complex they dont have to be collected impact if than i are in the we are not getting toot result that we think we are getting to and this is one i hope we will be able to do that way. Like the way we did with internal collective impact. Everybody had a role to play and tell have to be that way in the community as limp in the a become and forth conversation. Or a directive this we 39 but when pieces are you going to take cdo groups. Mental health providers. When is the role people will take not just when would they like us to do . Thank you very much. And i feel more confidence. Thank you, doctor ben thet is an enormous under take thanksgiving w is transfurthermorational for our agency and cullure and the way the staff responsibleses the w accomplice and the way San Francisco experiences our services and care. One thing we did not touch on and i wanted acknowledge is your support of this commission the resolution we passed about racism you were right was excellent and through the hard w of you and your seem and secretary morewitz, it described the disparities as they exist. Driven boy data and focused on out come and something we are proud to participate inspect and pass here. Thank you for your w and support in that as well. Before we close out. The topic i would like to recognize director colfax y. Thank you. I wanted thank you for your leadership in this w and appointing a structure to the work across the departments cross it in deep bo it. We have talked about equity forriers what is electric nothing systems is applying a structure that is maintained and ticking action and holding the institution and the people accountable for those actions and then documenting the out come. Appreciate you and your growing teams work in this and look forward to ensure the department meets the goals and meets the goal of the communitys we move forward toward improved Health Equity cross the city. Why thank you. Why thank you. I want it say, our staff and our community dont feel this yet. They do in spots. The cbos who do hiv with the black community when got more money than before. They foal it. But as a not an isolated experience but trans formation. We are not there yet there are people who that ared and said, what, and than i are in the wrong they are right. We did make a choice to build this structure because we had this fill a few times trying to get change. But that discipline delay the change. It is does. And those are peoples lives. Those are peoples grand parent who is we might have help prevenn get diabetes early and they did anyway. Or staff people who felt uncomfortable they left. So we are paying a cost for it and this monies we have to really, really commit to this changing things. In a deep way that will not disappear. So we are paying a price but hopeful leave get manage and all of you are helping it make sure that actually happens. That risk was worthy taking. Why not suggesting your work is done. I know. We acknowledge there is work head the ground w is lid in an effective way and thank you for this. Why thank you doctor bennett. We are going to delay our next item regarding data until a future meeting that will be announced in an agenda when posted. And move on to the next enemy which it is approval of the machines ever helling Commission Meeting september 20, 2022. Commissioners you have the minutes before you. Upon review if there are no amendments do we have a motion to approve . I move to approve the minutes. Second. Public comment . Person on the listen if you like to comment on item sick the President Trump of the minutes of september 20 of 22. Press star 3. I move to approve. To comment on item sick the President Trump of the minutes Public Comment . Person on the listen if you like to comment on item sick the President Trump of the minutes of september 20 of 22. Press star 3. Of the minutes of september 20 of 22. Press star 3. Commissioner grown. Yes commissioner giraudo yes. Commissioner guillermo yes. Commissioner chiou y. Yes. And commissioner bernal. Yes. Why thank you. Combr directors report. We have doctor grant colfax director of healing. Why thank you. President bernal. President directory report is in the commissions packet i will highlight and sum raise a few things in the report. Exited announce that we had released a road map to promote wellness and recovery with Substance Use disorder and d ph reled the road map drug over dose deaths. And building on progress made and prevenning the recovery of people had use drugs the planrous over dose in san front by 15 boy 2025. Reducing racial despairrity by 20 [speak very fast] and medications by 30 present boy 2025. Create multiple wellness hums people who use drugs to come in off the streets and connect today care special everybodies system the effective leaderships from the Tenderloin Center and new Community Center locations across San Francisco. Next years the plan will increase access to medication. And double the distribution of [inaudible] life savingant dotes. Really person plan and more detail in thes report and director and her team will return later to provide updates. Also wanted to tliet the San Francisco ems agency honored. The service honored with 2022 bronze practice, worried boyfriend initial association of county and City Health Officials temperature cell brits Health Departments for programs to meet the needs of their communities during the covid19 pandemic. The designation bronze practice demonstrates collaboration, dapable and program resilience. I think we will go oh. Not in the report but i want today highlight with laguna honda the laguna honda Team Continues to make progress toward our recertification goal. Really excited announce that in the key areas of quality improve ams, over this past week, all 13 neighborhoods in laguna honda were at 85 . On all the metrics and 7 of the 5 neighborhoods were above 90 percent in all 3 yours we are green and met criteria our expert consultants say are needed to be prepared for recertification. Great progress there. Andment toarc knowledge the w and at laguna honda and the laguna honda staff and just going to laguna honda this week and talking to people and presentlying certificates of appreciation to the neighborhoodses that met the green criteria, it is rable to see the enthusiasm and people embrailling quality improve am w our board and proud of the institution employmented to highway light that as well. And i think we will go to the slides for a covid and you want also a piece of m pox data graph i will use to center my m pox update. In terms of covid case. I will go to the hard copy of the slide. You see commissioners from this slide, our numbers from the last surge continued to decline 9. 9 cases per 1 huh human,000 below the 60 opinion 9 and the omicron surge. You see that the San Francisco pattern now mirror of the National Opinion dem nic case rates and ebbs and flows. Hospitalizations we stabilized between 40 and 50 people with covid hospitalized. That includes people hospitalized and fund than i have can i haved but in the hospitalized for covid and out of jurisdiction transfers. And this rate of low hospitalization includes 5 includes in intensive care and the remaining Hospital Capacity is robust with regard to 35 and, cute care of 20 . In terms of okay being and bofter administration. We are 86 of all residents received initial series. 75 percent of vaccines residents received within boft exert where are to 4 year they are lower 32 received a dose. 18 have come leasted an initial series. The numberers low relative to other age group they are higher comper se to the national average. Dpi think the next slide i will turn to m pox update. If i can get that slide. This shows our number of m pox cases in the city over time. You see this we are past our peek of numbers per day. Acounselling for the reporting delay you see on the right here. The numbers might gun i burch but there is i trend down. Really proud of the w that the m pox team done with this. At this point we have given approximately 32,000 initial dose of america pox vaccines. 10,000 second dose. And irrelevant focusing also on events where people high risk go and reasonable at the folsom street fair we gave 10,000. It it is a large number i believe we did give 10,000 dose of m apply vaccine there and pleased the clinics there are supply and people can determine in come move quickly. M pox we are focusing on the issue. But the number for in the when they were and finally we are an adequate vaccine supply to meet demand. I say we are focusing on the point doctor bennetts last presentification wefect us on our system adjust to needs of the community and focusing on the needs to vaccinate the Latino Community vaccine rates are slower on going folk us and working with groups the well tino task fers to ensure that work continues. This is my report im happy to answer questions thank you do we have Public Comment. Why person on the listen if you like to comment the directors report press star 3 i see a upon hand. You are unmuted let us know you are there. I am it is patrick. You have 3 millions. [inaudible] informed the jct whether the second survey hen completed. L, h has in the informed whether applied yet. To cms to extend funding for caring for lug luge remaining 591 residents. When reimbursement endses on november 13th. When reimbursement source will be prosecute voided after november 13th . Similarly, the jcc has in the discussed an open session whether laguna honda submitted the cms reenrollment forms initial low planned for submission in mid august. And has in the discussed when cms first lug loug inspection survey by cdph scheduled for midseptember will occur. How far behind schedule is having the first cms reinspection conducted. I bla report third degree hma analyzed the first survey which rekosovoed the total of 39 on going deficiencies the board proirzs bla september 16th report indicated lhh was in the prep in the july to pass a cms recertification suri have in november. Doctor colfax updates on progress recertification was entirely too vague. Reimburse am end in november. Colfax rarms were meaningless. Thank you. Thank you. Questions or comments on the directors report . I dont see hands at this time. Thank you very much. Thank you director colfax. Resolution making findings allow teleconferenced meetings under code 54953e. This is the resolution this we pass every mnth to allow commission to hold hybrid or some cases virtual meetings. You have sewn this before. It is in your packet did we have a motion to approve . So moved. Second. Public comment y. No one on the line i will do a vote. Commissioner guillermo. Yes. Commissioner giraudo. Yes. Commissioner chiou. Yes. Commissioner green. And commissioner bernal y. Yes y. Pregnancy and planning mittee update. Secretary morewitz will defer this. Commissioner guillermo will give an update. Commissioner guillermo. Okay. And i will try to make this brief and efficient. You have the actions on the upon scenical dar that reflect the recommendations of the planning committee. The condition transact support included one contract which provides support to the department for regular reporting and reimbursement ref now opt miization services for medicaid and medicare a 5 Year Contract term. And00 autoother the next xoudz mow contract on the is for west Side Community mental Healing Center which the request of 10 Year Contract extension. Existing term. Which contract addition will be over 20 million dollars. And the next condition transact request the report is Progress Foundation and those are all Service Related to mental healing or behavioral health. Progress foundation an extension of the contract to 2027. Which is a for you year extension of the existing condition tract. For a total of new amount 120 million dollars. And the last contract is for special services which is an extension of 4 years for an amount of 20 million. These are contractors for services in place and an extension of those services for additional years. The next item on the agenda was a series of new contracts that are being asked to support the h ap program we heard about in the hiv update. So those are series of 7 new contracts with primarily existing contractors. Service providers recommended for action and the con7 in the left item was a report that on the impact of the tax. That put in place a now years ago and Good Progress on the decrease or at least reported the decrease in consumption of sugar drink in San Francisco. There has been an analysis and report this comper seed an front to richmond,ical cal in terms of a comparison city that did not have this tax and the significant difference in the consumption. San francisco relative to richmond, california the data that is collected is difficult because of where this information come from. But in an aggregate the data is pretty certain proof of the impact of the sugar tax the sugar tax impact and the nonprofits that have been granted funds from thiss revenue base of also indicated Good Progress with the target populations they are focusing on they serve and hoping for continued progress even as the tax base dksz bauftz success and impact the program hope to condition. This w and i um00 eye think we will be asking for um hopeful low a greater break down in the impact the difference impact of the um decrease in sugar consumption cross neighborhoods if this is possible. For populations even though show that because of the way the data is collected. And finds alternatives as a moneys to be able to target the Program Services and education meds to help for the 40. That was as far as as we got on the agenda. This was the agenda. And so. That sell the conconclusion of my report and i turn to the consentical dar that reflects the recommendations the committee made for approval. Thank you, commissioner guillermo. Is there Public Comment ownership commissioner comment before we move on the con7ical dar y. I see no one on the line and no handles from the commission. Why next is condition 7 calendar to commissioner guillermo. Yes, as i indicated the consentical dar contains the items i summarized that are recommended or approved for recommendation to the full commission today. All right. Do we have a motion to approve . So move approval of the consent second. I must have to a vote. Commissioner green. Yes. Why commissioner giraudo. Yes. Commissioner chiou yes. Commissioner guillermo yes. And commissioner bernal. Why yes. Why it is passed. Thank you. Why other business if tr is no other business we will must have on to our next item which is the joint conference commito report if september 27jcc meeting commissioner chiou. I am wondering, i dont trying to remember the sum row mr. Morewitz. I e milled you one if i read it to you and you comment on it. Yea y. Grit. The september 27, jcc meeting items including the report of the ceo and hiring and vacancy report and the robust potion update measures the hospital will be focusing on and tracking. Hoiring and Diverse Workforce and violence the measures the hospital will be wing on in the year ahead. During the medical staff report the committee improved the Laboratory Medicine rowel for spinal steroid injections in procedures revise medicine and Critical Care list and resunrise neurology privileges list. In closed session, proved credentials and if i canned fixed machines report y. I add that [inaudible] it was clear during the meeting we had. Thank you. Thank you, commissioner chiou approximate secretary merwits the next is consideration of going in clezed commissioner guillermo yes. Commissioner chiou. Yes. Why commissioner giraudo. Yes. Why commissioner grown yes y. Commissioner bernal. Why give us a minute to switch us over and clear now that we reconvened is there a motion to disclez or not any portion of the closed session. Move not to disclos second. Commissioner green. Yes. Why commissioner giraudo yes. Why commissioner guillermo yes. Commissioner ciao yes. Commissioner bernal y. Now you are at a consideration y. Motion to adjourn. So moved. Commissioner guillermo yes. Commissioner green. Yes. Commissioner giraudo yes commissioner ciao y. Yes. And commissioner bernal thank you all for a very looning long sfgovtv, bb. Long sfgovtv, bb. We spoke with people regardless of what they are. That is when you see change. That is a lead advantage. So Law Enforcement assistance diversion to work with individuals with nonviolent related offenses to offer an alternative to an arrest and the county jail. We are seeing reduction in drugrelated crimes in the pilot area. They have done the program for quite a while. They are successful in reducing the going to the county jail. This was a state grant that we applied for. The department is the main administrator. It requires we work with multiple agencies. We have a community that includes the da, Rapid Transit police and San Francisco Sheriffs Department and Law Enforcement agencies, Public Defenders Office and adult probation to Work Together to look at the population that ends up in criminal justice and how they will not end up in jail. Having partners in the nonprofit world and the public defender are critical to the success. We are beginning to succeed because we have that cooperation. Agencies with very little connection are brought together at the same table. Collaboration is good for the department. It gets us all working in the same direction. These are complex issues we are dealing with. When you have systems as complicated as police and health and proation and jails and nonprofits it requires people to come to Work Together so everybody has to put their egos at the door. We have done it very, very well. The model of care where police, district attorney, public defenders are communitybased organizations are all involved to worked towards the common goal. Nobody wants to see drug users in jail. They want them to get the correct treatment they need. We are piloting lead in San Francisco. Close to civic center along market street, union plaza, powell street and in the mission, 16th and mission. Our goal in San Francisco and in seattle is to work with individuals who are cycling in and out of criminal justice and are falling through the cracks and using this as intervention to address that population and the Racial Disparity we see. We want to focus on the mission in tender loan district. It goes to the partners that hired case managers to deal directly with the clients. Case managers with referrals from the police or city agencies connect with the person to determine what their needs are and how we can best meet those needs. I have nobody, no friends, no resources, i am flatout on my own. I witnessed women getting beat, men getting beat. Transgenders getting beat up. I saw people shot, stabbed. These are people that have had many visits to the county jail in San Francisco or other institutions. We are trying to connect them with the resources they need in the community to break out of that cycle. All of the referrals are coming from the Law Enforcement agency. Officers observe an offense. Say you are using. It is found out you are in possession of drugs, that constituted a lead eligible defense. The officer would talk to the individual about participating in the program instead of being booked into the county jail. Are you ever heard of the leads program. Yes. Are you part of the leads program . Do you have a case worker . Yes, i have a case manager. When they have a contact with a possible lead referral, they give us a call. Ideally we can meet them at the scene where the ticket is being issued. Primarily what you are talking to are people under the influence of drugs but they will all be nonviolent. If they were violent they wouldnt qualify for lead. You think i am going to get arrested or maybe i will go to jail for something i just did because of the Substance Abuse issues i am dealing with. They would contact with the outreach worker. Then glide shows up, you are not going to jail. We can take you. Lets meet you where you are without telling you exactly what that is going to look like, let us help you and help you help yourself. Bring them to the Community Assessment and Services Center run by adult probation to have assessment with the department of Public Health staff to assess the treatment needs. It provides meals, groups, there are things happening that make it an open space they can access. They go through detailed assessment about their needs and how we can meet those needs. Someone who would have entered the jail system or would have been arrested and book order the charge is diverted to social services. Then from there instead of them going through that system, which hasnt shown itself to be an effective way to deal with people suffering from suable stance abuse issues they can be connected with case management. They can offer Services Based on their needs as individuals. One of the key things is our approach is client centered. Hall reduction is based around helping the client and meeting them where they are at in terms of what steps are you ready to take . We are not asking individuals to do anything specific at any point in time. It is a Program Based on whatever it takes and wherever it takes. We are going to them and working with them where they feel most comfortable in the community. It opens doors and they get access they wouldnt have had otherwise. Supports them on their goals. We are not assigning goals working to come up with a plan what success looks like to them. Because i have been in the field a lot i can offer different choices and let them decide which one they want to go down and help them on that path. It is all on you. We are here to guide you. We are not trying to force you to do what you want to do or change your mind. It is you telling us how you want us to help you. It means a lot to the clients to know there is someone creative in the way we can assist them. They pick up the phone. It was a blessing to have them when i was on the streets. No matter what situation, what pay phone, cell phone, somebody elses phone by calling them they always answered. In officebased setting somebody at the reception desk and the clinician will not work for this population of drug users on the street. This has been helpful to see the outcome. We will pick you up, take you to the appointment, get you food on the way and make sure your needs are taken care of so you are not out in the cold. First to push me so i will not be afraid to ask for help with the lead team. Can we get you to use less and less so you can function and have a normal life, job, place to stay, be a functioning part of the community. It is all part of the home reduction model. You are using less and you are allowed to be a viable member of the society. This is an important question where lead will go from here. Looking at the data so far and seeing the successes and we can build on that and as the department based on that where the investments need to go. If it is for five months. Hopefully as final we will come up with a model that may help with all of the communities in the california. I want to go back to school to start my ged and go to community clean. It can be somebody scaled out. That is the hope anyway. Is a huge need in the city. Depending on the need and the data we are getting we can definitely see an expansion. We all hope, obviously, the program is successful and we can implement it city wide. I think it will save the county millions of dollars in emergency services, police services, prosecuting services. More importantly, it will save lives. Good morning and the meeting will come to morning, this is the budget and finance meet committing, im miss ronen and joined by ahsha safai and Committee Member chan. Our clerk is jali

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