For a number of years and weve all tried different ways to deal with the most vulnerable populations. The fact that youre able to bring these agencies together and have also the force of the citys structure to say the agencies will Work Together has been part of the challenge. I had several just sort of clarifying questions. If we looked at the opportunity amongst the 17,600 in the surveys you all have been doing and perhaps i need a clarification in the coordinated entry assessment, on the 11,000 that are on your red lane, are those people who have chosen not to take it or theyre people we havent reached out to . It could be both. Okay. Because the system that we have integrates all the information from the emergency room, these could be people coming in quickly and exiting the city. So the 2,400 people who have not been assessed who have a history of psychosis and Substance Use disorder, the lower left, those are going to be the people we prioritize with the Homeless Department to get assessed. Now that we have this sort of tacit agreement that this is how were going to prioritize people, what i hear is music to my ears. Has he been assessed yet . If not, lets get him assessed. So it is all paths are going to go through this filter. Then we have 5,266 folks who did go through that process somehow did not get prioritized. So the director and myself will be working with the Homeless Department to figure out how to get them reevaluated or rethink this or have an ability to do a secondary assessment. Maybe its possible also that we begin over time to think about how to prioritize people without expecting them to sit through a 20minute interview. So there may be people that as we Work Together and finetune this, i would say a year from now we will figure out how to get folks assessed and prioritized in maybe an alternate way. I read that while were working at the 237 level, we think there may be another 3,000 or so who might, in fact, use this type of process in order to improve their lives and be able to treat them too. Were working together from the street to home. The 3,735 is the 4,000 that you hear about rounded up. Right. No, thats very good. I think that helps at least define for me what youre looking at and what this is a cohort of. Then i looked at the street to home, but the home ends at the Navigation Center. We know that the Navigation Center is not a permanent home. What are we proposing as item 6 . Because ultimately a year goes by and we will now have used up a year in navigation, right . So well, 6 would be home. So that would be getting to their home and the right, safe place. I see. We need to have six there. It looks like navigation is the no. Sorry. So thats a visual problem there. The Navigation Center is probably the path to getting them to the home. So the 1,000 people who got prior we saw that were serving them, we assessed them, we prioritized them, the 1,000 people doesnt necessarily mean that the other folks are not vulnerable in any way, but what it says is its a very complicated department of homelessness with h. U. D. Methodology for how many beds or homes they project to be open with some sort of like how you book a plane, they assume people will drop off, which is true, some people have dropped off. Thats where the 1,000 comes from. Good. Thank you. Im looking at a client standpoint. We have a nice chain thats put together to integrate and understand the client, often it seems to me the client actually responds better if there is sort of an individual that they feel is their advocate or their person or their doctor or their is that how were going to also be assigning that somebody will sort of be your key contact and someone that in case you go into crisis, have an issue where you would like to pick up the phone, there would be somebody they could talk to . There could be an individual assigned point person. Yes, some of them are already engaged with an intensive case manager, some of them with Case Management through the h. U. D. Team. So there is a commitment that we will have a streettohome plan for 135 of them, go find them and find out what they really want and what their real needs are because we dont have enough information about them. Thats where the highintensity care team is critical to get those folks. The other folks, there is a commitment through the Center Agency that they will prioritize Case Management of some sort. So we have the navigation case managers who will help them navigate through it. If they have a higher case manager, this navigator might not be necessary. If they have an intensive case manager, that might be a different route for them. The idea is who is the person and how do they get from here to there. You have a twopronged approach and some are already in a relationship with their case manager. Youre thinking there are 135 that you really need to work with and decide what they need . Right. Very good. I guess lastly id like to know what wed think would be a good way to be able to track how this is coming if this is such an important program. What would you all be suggesting in terms of a follow up and at the right time . Do you think six months would be good to bring Something Back as to where we are . Does that make some sense . We show up anywhere and talk to anyone about and we can talk for ever about it. Okay. Id leave that to staff to schedule. Commissioner green. Yes, thank you. This is incredible, the work youve done and the effort youve put into this, very optimistic. I was wondering whether you could tell us a little more kind of what commissioner chow was asking about when you think youll be able to gather data. Especially on some of your outcomes. For example, you can put people in housing, yet whats your benchmark for how long they stay there . I think that new england journal article said there was a pretty impressive percent that stay there one to two years. Do you develop your targets in some of the areas youre looking for outcomes, targets for avoiding e. R. Targets and quality of life. How long do you think you will get data and assessing the data. And correlating that with the center not opening for two years and with the staffing you may need to be successful as well as the physical placement for individuals. I gather the Tipping Point opportunity is great, but im not sure how all the timing of all that fits together. Can you elaborate a little more on that . Because it seems like you could be facing barriers with regard to the staff that could both give inadequate care for the patients as well as the placement. And then what about, given those things and the potential funding issues, where you think youll be able to really give back information, you know, on your 237. We dont expect you to boil the ocean, but it would be interesting to know what you think. I would say that the 237 we will have the dashboard that they were creating in about a month. Theres about 29 of the folks who have already been housed in it. So we are trying to, together, get them from here to there and figure out what is stopping them from getting from here to there. The real difference here is that health is showing up and saying that we are there to figure out how to get them services that its a housingfirst model, but is there something that they need before they can get in or after they get in to keep them there successfully. So i cant say one, we need to know more about the 135, but all the 237, except for three unfortunate folks whove already passed, all the 237 folks have had they say, i want housing. They showed up somewhere and said, i will answer your questions to try to get into housing. They are definitely motivated to get there, but theyre also experiencing psychosis and theyre not necessarily always regulated to be able to get from here to there. So were trying to figure out how to do that and what level of care is needed to help them do that. I dont know if we can say right now that were going to house all of them. Certainly we have three months before we start and get reflective about is this the right approach to it. So i dont know that i can safely say how many of them will be housed. Can i go so far to say half . Maybe. Did i answer all your questions . Im curious to know more about the data you plan to gather, when you feel you might have some results. And again, whether you feel there will be barriers in terms of staffing and actually physical placement that might slow down your progress. So i think what youre getting at with the whole person care funding ending in 2020 and our target date to open the Homeless Health resource center, which will be the clinical home or hub of whole person integrated care, that will be in late 2021, so within the next year. I mean, what this really does is it i dont want to overuse the word foundational, but it lays the foundation for us to be working together across Clinical Services to determine what the need is for people showing up to urgent care repeatedly, but they might have one of the Street Team Members or the hot case manager working with them. What it does is brings people together to develop a care model so that theyre actually coordinating care for these folks. Were starting now. Weve already started this work, so were already starting the case conferencing and then working across these existing Clinical Services with the whole person care team on the shared priority list. Thank you. Director cofax. I want to thank both dr. Hammer and ms. Martinez for their incredible work on this and just to emphasize that the literature shows that people suffering from these conditions with support and not as much support as some of us might think is necessary can be housed. I think one of the wonderful aspects of ms. Martinezs leadership is shes brought in a number of researchers and clinicians from ucsf, several of them leaders in this field to bring in a healthbased aspect to this work. This is an effort thats going to be saving lives Going Forward. I mean, the specific when we open hub and how that happens are important pieces. I want to emphasize we are doing this now and Going Forward. This is really a continuation of our modernizing our system of Behavioural Health care in response to data so we make the investments Going Forward to get those people in the housing and get them the Wraparound Services we know they need. Thanks. I wanted to add an example of that, commissioner green. So just as an example of this sort of working across previously disparate services is we have a psychiatric nursepractitioner from the Behavioural Health access team who now basically has jumped and is embedded working with the street medicine team. Thats just an example of bringing our staff together who all touch in different ways this patient population, these patients, these individuals theyre not all patients, and connecting them to services. So he has in a expertise that he can assess people on the street and is an expert in access and how to access our services. So first of all, ms. Martinez, dr. Hammer, i would like to associate myself with the comments made by fellow commissioners about your excellent presentation. Thank you. Since youre nimble going back and forth on slides, i had questions on three of them starting with this slide here. I know our focus is on Behavioural Health and Substance Use disorders now, but noticing on the slide that 74 have a serious medical condition, 12 h. I. V. aids, 35 hypertension, 4 renal failure. Skipping forward three slides to this slide here and looking at the coordinated entry assessment, im wondering at what point do these factors enter into prioritizing people for housing and other things . Because as we know, housing stability contributes to Better Health outcomes, whether its someone with h. I. V. And adhering to their regimen, Blood Pressure monitoring, sticking to a diet, those things are very important. Does that come into the Assessment Tool at all . Yes. And also skipping forward a few more slides to the outcomes, is there anything in the outcomes that youre measuring when it comes to Health Outcomes when it comes to these other conditions people have . Good point on that last question. I would say that when i first looked at the coordinated entry Assessment Tool, i know all of the 6,000some people who have been assessed and all the 1,000 of those people who were prioritized. So essentially what i did is i looked at what the data said. Did they assess a pretty good representation mix of who we know are experiencing homelessness . Yes, on every single count, the representation of the people in the jail, also the people who so like 25 of the general population have a jail history, about 25 of those assessed had a jail history. I looked at about 14 or 15 of those vulnerabilities, and all of them were very well represented with the exception of psychosis, and that makes sense. Then i looked at who got prioritiz prioritized and it was significant higher. One of them was medical. So significant higher of those who did get prioritized showed up. So their tool is identifying through the questions they ask, which does ask about some medical conditions, are identifying and prioritizing them and the way we wish to see it with the exception psychoses, and we will be working with them. Also, i believe i had seen a previous presentation getting to zero on this Assessment Tool. Do i understand correctly you dont draw the curtain all the way back on what the criteria are because sometimes someone whos working with an individual client, for example, might coach answers to advantage somebody in the yeah, i think that there was a lot of suspicion around whether or not the tool asked the right question, did the right ranking, whatever. What i have experienced is that is sort of set aside. When i said no, i validated the how many people were assessed, representative, and their vulnerability, and i dont get those questions as much at all, actually. All right. Thank you. So in terms of the impact on their medical stability, i think that its pretty much assumed that we will be able to begin to address their medical conditions, but i think its a good idea to measure the impact. I would like to see that. I dont want to bombard you with more questions, but i think it sounded to me like eventually youre going to set some indicators so that you know how to measure the progress of the program and its hard to like, just being here and pull some numbers out of your head and saying this is the goal, so i totally understand that. Im curious about how you will be integrating Harm Reduction philosophy into the program, because, as you mentioned, these are clients with lots of different Behavioural Health issues. Some of them may need to access sobering center. Even as theyre housed, what type of housing would that be . That is another big barriers that a lot of them had challenges with is to stay sober while theyre housed. If theyre in facilities that are like only in the abstinence model, how are they going to be able to maintain . And also the other issue is how are they going to pay for the housing . I think thats the other issue that is commonly faced by this population which in my old days it was the program. If they dont have the money manager that sets the money aside, then its really difficult for them to exercise their own independence because of some of the cooccurring issues that theyre facing. So one aspect of the streettohome plan for everyone will be around benefits. So we are talking to our ssic program that was set up in the Mental Health department so we can get these folks into s. S. I. Advocacy so they can get the income that they need. I think the system Response Team which met again on friday is getting ideas and issues from the Provider Team that are working with the 237 and theyre developing their streettohome plan. Thats getting in the way of them getting there could very well be that they need a level of care in housing that we dont yet have. So thats a recommendation. It could be that they need a service where there are not enough slots. Thats a recommendation. It could be that we have slots, but being there tuesday at 4 00 p. M. Just does not work for this so there could be very many things that are coming to that system Response Team of people who are going to say this is the way we need to proceed. So do we need a different kind of service or a different kind of housing that we dont have . A number of the people have sex offender histories where we cant so what are the hurdles and the challenges of getting people from here to there . We may not be able to solve all of them, but we are trying to figure out what we can empower the Provider Team to solve on their own, versus where they need someone to unjam that, versus what needs to come to grant in the Health Commission and think about long term. Thank you. I think thats helpful. Commissioner chow. Yes, as we were looking at the serious medical conditions, i was just wondering how we were going to be connecting for these. Im sure youre going to have Substance Abuse programs and psychiatric programs. There are clinics that would be managing some of the worst of the worst. What would be the connections that we would be doing or encouraging . Would we actually be putting them into those or were going to have this as sort of a selfcontained medical system thats doing primary care and and im not sure then where some of the more serious issues requires secondary or tertiary consultation would come in. The integrated