Competency training. The population in San Francisco is different from much of california. A cultural training would not be adequate to help provide the Compassionate Care necessary for the population of San Francisco. Second part of comment is related to what came up earlier. I work at a Retail Pharmacy nothing breaks my heart more when they come in to pick up the medication and they dont have the insurance papers. It takes days. They are homeless and they have to leave the pharmacy after 14 hours and dont get medication. They might be without de beat esmedcase and we cant find them to get the updated information. If we find the insurance we cant provide them what they needed. It is almost like the efforts of the Healthcare Providers are almost gone to waste because they dont get the therapy that they need. Than thank you. I am jennifer. I have multiple comments. Regarding cultural competency, i heard statements about linguistic competency. In recent bargaining dph changed the way that they compensate staff when they offer services to clients in the native language. Staff are discouraged from speaking in the native tongues because they are not compensated for it. Staff are told do not speak the Foreign Language unless you are certified that is appalling. Regarding icm. I have to say thank you for talking with staff. When the criteria for step down was developed, it was not developed with any input from staff. If we change the way we do things to expect it to work we should not rely on consultants or those of the administrators we need to talk to those doing the work and touching our clients on a daytoday basis. There was a moment where we mentioned stabilize, adults who do not stabilize. This brings me to the arts. The clients who are users of services in a high way need more care for a long time. This is a severe illness. When beds at the arf are closed we are not able to stabilize people to maintain the stagization. Stabilization. We negotiated with the mayor and came to an agreement about if arf. There are 23 beds vacant and 54 beds lost right now. People are evicted from the man or, from the aurora home and from 54 are evicted, homes are closing with 23 vacant beds and are not allowed to move people. I do know why that is. These people need a home. Thank you. The thing that strikes me as essential pieces to puzzle with 4,000 people is the intensive Case Management. Basically doctor sung said they did not increase capacity for intensive Case Management. Thing whiteled down the waiting list and some could go to other places but they had to increase the caseloads. Doctor bland tells me 4,000 people, 90 dont have intensive Case Management. There is a critical absence of staff. I heard a lot of acronyms and aspirational starts but i didnt hear about when these 4,000 people are going to get taken care of. It sounds like at the rate we are going they are not going to get taken care of unless you get more staff and you really do it. It is very discouraging. Thank you. I have deanna law. I am deanna long i work for the San FranciscoCommunity ClinicNonprofit CommunityHealth Centers throughout San Francisco. We specialize in providing culturally competent care in different neighborhoods. I just want to call out two things. That doctor bland and could fax mentioned that i was happy to hear. One is emphasis on the Behavioral Health work force. You there are those with an emergency medical bill. Ab1611 would protect these patients against the emergency surprise bill. Thank you. That is all the speakers i have. Is there anyone else who would like to speak on these two items . If not it is in the hands of the commission. If you have a question or comment please identify the presenter to address that comment or question to. I think i dont actually have a question at this point because i think that the initial presentation on the challenges facing our Behavioral Health services was extremely comprehensive. I thank the doctor for taking on the role of the acting director to move forward with as much progress as you have been able to do. I think that the key thing she has laid out and doctor bland identified was not so much the identification of the problems because those now have been very well elicited and certainly the doctor has helped summarize the issues that we are facing especially as you look at the homeless. I think the doctor has broadened that to say and the rest of our population needs a certain amount of support and health. We have heard the issue of cultural competent, the need clearly of language capability, the challenge of being able to actually meet the client. I dont think to say we are not going to say that. Any door wherever would come in and now we are also looking at how we can outreach and try to meet them where they are. I understand that we may go outside the doors to be able to bring them in at whatever location you are with your diagram, for example, but we need the outreach. This has been a very good discussion about how we are facing behavior health. I think the doctor for the next four or five years is saying that we may be looking at a change of even the entire process of both mental and physical health if the States Program about medicaid is actually carried out. Going through a number of hoops yet, but she is warning us again and that fits fairly well with the rest of our presentations this afternoon in terms of all of the possible changes and even the Planning Commission issues of what to do about facilities. I think that only shows the dynamic process that healthcare is undergoing. What i i see is one of the Biggest Challenges to try to answer these needs is really what is it that we are going to be able to have as a work force and it goes back to i think our Health Network was talking about. The real challenge right now is we are going to have all of these ideas, some of which are going to need immediate implementation to help the homeless, to help those who actually also have other Mental Health programs that are not homeless but need the same help because some of them are also on the streets. They are not getting the care they need. How many are not going to be able to be from the Homeless Population in the intensive care they need. Where do we get that . We heard from the Community Consortium they have trouble and we have heard that, i think that is really one of the Biggest Challenges. I understand with the new director of Human Resources we need to identify people or we cant put them in a system and we have to accelerate how we work with identified personnel, potential personnel because they will go elsewhere. The identification of personnel and keeping them going is almost as critical as looking at opening the new hospital or as we were looking at the personnel for management of the epic program. I see that as a lesson that i have gotten today that is a real challenge and how our director is going to be able to work with the different well what opportunities they are going to have. I could ask the director what he view views as a way to move on this and what we might look for in terms of implementing what are very nicely developed and certainly well thought out ideas. I am sorry are you specifically asking about the work force . Yes, we cant identify personnel to carry out the programs that we are working on, we are not really going to move the needle. This is something that is for Michael Brown in the back now, our new hr director i talked with nim within his first hour of starting laying out a plan to focus and recruit on these positions. Going back to your comments, we have a proof of concept with regard to hospital skill. It takes considerable resources to do that, right. If you look at what mayor breed has talked about as increased investments in the work and we need to talk across the different stakeholders including unions and Civil Service to provide incentives for people to come and stay in the work. We have been looking at things to have more opportunity for people to stay, other incentive programs as well. We also need to create a culture of excitement with h. I. V. Having reengaged in the h. I. V. Clinic there. There are people that worked there for years. I think they could get compensated better in other places. They are Mission Driven and inspired. I think many of our Behavioral Health team are committed to that. We need to expand that perspective in our culture that people can be shown to make a difference in that way. It is a combination of focus, data, priorities and making sure that this is a priority and people are supported in moving that forward. I would repeat that. Also, shifting the culture with regard to where we call a difference when we do epic. Many in the room were major contributors. It was a heavy lift, but we did that lift when we addressed the h. I. V. Epidemic, we found a way to do that. Key is those were not issues just one part of the department, right . That was not the only job of a director within the units or section. That was a Department Priority and resources were brought forward to do that to make a difference. This problem didnt happen overnight and we are not going to solve it overnight. As you saw with the Behavioral Health network we are making structural changes to have a road map to go forward starting now and into the near future. One final comment with jeff. In regard to the work force. It is very important that work force be able to not just have the knowledge and the credentials. This is where i think unless we do that we dont reach equity. We cant answer the disparities. Whether it be because of a cultural issue in terms of working with africanamerican communities or with some of our other Foreign Language speaking communities that we are able to also work with that. I know that is the real challenge. It is very important for us to be able to answer the disparity especially for a fairly sizable part of our population. Thank you. I would make a comment that for the first time in many years i have been a part of the system i see a cultural shift in the Government Entities in relationship to the community that we have been serving all of this time. What we need to do is continue that cultural shift in the government and cb o community so that when we deliver what has been presented today that those communities, those cb os and the Department People are invested in and committed to doing the work because without that shift, we will be having this conversation next year and i do not want to have it next year. I want to also suggest that because it was so explicit in doctors presentations we understand where we are going now we have though create resources and will to get there. I thanks you both for the reports that were educational for me as well. Other comments. I would echo that. You have done a very comprehensive job of identifying the population. Of course, the challenges of the work force and the aspects about the population that is so critical. I wonder if you collaborate a little bit how you envision the Behavioral Health services working to the goals. Do you have any targets . I know there are some about how long it takes to house people, what percentage would be housed in certain period of time. That is not part of Mental Health. Are there any new targets you have developed that you think you can reach in the near term . I also notice i think there are 800 people right now working within the Mental Health system. Have you thought about how you u can redeploy these people to the top of their licenses, incorporate remote providers, which is a huge opportunity for us, where you are going with that. Where within the system you expect to find did leadership and creativity to move along in these paths you have outlined . Thanthank you for the questi. I am going to invite doctor sung the invite the second half of the question. I was assigned for two years to complete in survey to make these recommendations. It is important to acknowledge with in the two year timeframe there are many recommendations that our team is working to help the Health Development develop a framework for implementation we wont be present to see them did deployed. With respect to the work force, it is important to come back to the Community Members comment. One of the key investments the mayor agreed to make is to supplement the number of intensive case managers. We have a target and goal. Right now we have one case manager for every 17 clients. When people have complex needs like the 4,000 based on our success in the department, fullservice partnerships is one case manager to every 10 clients that requires more people, more case managers and also resources to recruit and retain. In thinking about the outcomes i have been pleased with the support and collaboration with the Deputy Director of support services looking at developing clear outcomes for the intensive Case Management services across the board. As pointed out earlier the system has been very closely focused on compliance and regulatory measures which are process measures. We are now taking the shift to ask the difficult questions about what where the actual outcomes associated with the interventions. We think about care coordination and particularly for intensive Case Management, what is happening with Housing Status . How much do they spend time in jail . Are they engaged in meaningful activity . Are they engaged in physical and Mental Healthcare consistently . The baseline measures. We are pleased to have the partnership to assess the Case Management services at that level. I would like doctor sung to respond to the second half of the question. Thank you for the question. I think the question was redeploying staff . Yes, because we have to meet the needs of the changes moving forward. How do we deploy them . What will it lookalikes . We need to fill the current positions. That is one of the challenges. We prioritize this and i appreciate the partnership as well. Thinking about what is it going to take to hire staff and keep staff . What they see is you know what happens when you change staff, there is a loss of connection with clients. They have to learn. They get burned out if you have a one to 17 caseloads and they leave again. It is a cycle. The shifting will have to happen at the same time. Does that make sense . Thank you. Thanthank you, doctor sung fr your Service Today and as we go forward. Would you like to economic in . I would like to know the commission has lost quorum. This is an informational session. Would you like to check in about if rest of the agenda . Yes, we have two other items the Fourth Quarter report and the office of compliance and private seize annual update. I would request that we move those to a meeting in the future. I am making that request to my colleagues up here. If there is no objection we will do that and i will have mark schedule it for us. I agree. We have agreement. We will move those items to a future meeting. You can consider adjournment at this point. You are unable to vote because you are not a full body so the meeting is adjourned. Good night. Im going call this meeting to order. Welcome to the november 5th, 2019 meeting. If youre a member of the public and want to speak, there are forms to fill out or speak into the microphone. Please put your cell phones on silent. I want to thank sf move tv. Gov tv. Foul well start with a role call. role call . The first order of buz of bus is Public Comment. Any Public Comment . Seeing none, Public Comment is closed. Noapproval of minutes of october 15, 20 2019 and october, 2019. Do we have approval . I raise a motion. Second. Any Public Comment on minutes . Seeing none, Public Comment is closed. Missione role call . The minutes have been approved. And next agenda item is a report from our executive director wyland. Thank you, president. Good evening, commissioners. So this evening one hav, i havef update for you, but i wanted to circle back on our annual retreat and just do a little afteraction with all of you here. And also let you know well revisit the Mission Vision and values at our next hearing on november 19th, is the idea. And that would come as an action item, where it would, instead of being discussion only tonight, we cant vote on the Mission Vision and values in their draft form but we could do that at the next meeting and we should just to memorialize it. Via email today, i sent you a link to our google accounts to is that you could access the documents from review them and make suggested edits if you have any. And i would love for you do that if you have any interest to over the next week, so that we can prepare to bring this to a hearing. And so, in you