Transcripts For SFGTV BOS Public Safety Neighborhood Servic

Thank you the board of sprierdzs are convening hybrid meeting allowing in person and Public Comment and Remote Access and Public Comment via phone. Equal access is essential when take comment as follows. Will be taken on each item. Those in person will be allowed to speak first then those on the phone line. For those watching 26, 28, 78 or 99, and sfgov. Org the Public Comment number is streaming across the stream it is 4156550001. Again, 4156550001. When prompted enter the id access code 2486 793 5172. When connected you will hear the meeting discussions and muted in listening mode only. When your item come and up Public Comment is called those in person lineup to speak along the wall to your right and those on the phone dial star 3 to be added to the queue. If you are on the phone turn down your tv and listening devices. We will take Public Comment from those in person first and go to Public Comment phone line. Alternateively you may submit comment in writing e mail to myself the Public Safety and Neighborhood Services clerk. Or via mail forward to the supervisors will be forwarded to the supervisors and send written comments via post office to city hall items acted on today will appear on the board of supervisor agenda of november 8 unless otherwise stated. Call item 1. Item 1 a hear to provide an update on the fiscal year 202021 proposition t. Treatment on demand report and requesting the departments of Public Comment adult probation, sheriffs department. Da department to report. Member when is wish to provide Public Comment call 4156550001 then access code 2486 793 5172 press story 3 to enter the queue. The system will prompt and indicate you raised your hand wait until you have been unmute exclude may begin comments when we go to Public Comment. Thank you. Thank you, supervisor mandelman for calling for the hearing on the annual prop t on demand report and your leadership on the crisis in drug addiction and over doses in our city the floor is yours supervisor mandelman. Thank you chair mar and members my apol joes to you and the audience for my tardiness. I want to thank the departments that have been so giving of their time. D ph, public defender i want to thank the coalition for engaging and Service Providers health right 360 and aids foundation. I said these before but they bear repeating. Treatment on demand is more then and there a quarter century old in San Francisco. We declare third degree our policy in 26 years ago and yet near low 3 decades later it does not feel like we are there. And even worse, it does not feel like we exactly know what the gaps are and what providing meaningful treatment on demand in San Francisco would look like or cost. Meanwhile, parallel opioid and methamphetamine epidemics impacted lives with over dose deaths sky rocketing 478 . Treatment on demand properties in 2008 are due by february first of each year. The notion is that the treatment on demand reports impact behavior in this belling the mayor will think about them as she crafts her budget. The board of supervisors think about them as we look at add back funding. And pass the budget in the summer. This will be my third hearing since taking office in 2018 when we started, it seemed clear d ph had not taken reporting obligations seriously and had settle in the a habit of submitting 12 page reports that found the department was meeting the treatment on demand goals that of the ends and no need to talk further. And no one d. Since, i do think the reports have gone from bad to better. But i still think there are unanswered question bunkham minot be asking all of the right questions not guilty first accomplice. Reports may need to be rethought Going Forward. I am concerned we dont have a clear process for america unmeted demands despice the ordinance requiring each report to have assess sdpment plan to meet the demand. I have follow up questions about the wait times in the report and how they are with the experiences prosecute voiders and Community Organizations and folks in criminal Justice System connecting people with Service Every day. I look forward to hearing about partner efforts and to dig in any discrepancy between what folks are experiencing and what is reported in our treatment on demand report. We need to understand just how many we are losing as a result. Without the data an analysis how much more are necessary seems hard or impable and we will tread water while the system is this years report this is good thingful highlights several opportunities improvements more residential step down services and treatment for Spanish Speaking clients and people with dual diagnose and in custody and injustice involved clients. Butt report does not measure the extent of the gaps for the subpopulations much less propose policy or budget changes that would close those gaps. Supervisor steph no and i joined supervisor dorsey in requesting upon departments Work Together on a comprehensive plan to end street level drug dealing and right to recover. I Department Supervisor dorsey effort in this area. But i think that the experience of treatment on demand suggests the ways in which the directions that go out to departments do what i think is a reasonable and personal thing to assess need, come up with plans to close gaps and report back to us. Can end up not playing out the way folks had intended. This is what happened with treatment on demandful San Francisco recovery is treatment on demand on steroids and impacting all departments but i think we need to continue to get treatment on demand right if we make further progress. So e policies and plans are not enough am change requires focus from both branches of government, departments and public. And so that is why i call for these hearings and why im grateful for the partnership of the city departments and our providers. Our firsts presenter unless anyone has things they want to say. I believe i wanted to note for the presenters and you that because we have so many presentation in this hear and Important Information in discussion i think we are asking each to limit presentation to 5 minutes and madam clerk will have a timer on this to help reminds us. Thank you. D ph is up first. Im doctor comings the director of Behavioral Health service and mental healing sf at department of Public Health. You have a cold. I do. Recovering. First, thank you chair moore and vice chair stefani, melgar and our gratitude to supervisor mandelman for calling the hearing. This it is a topic this is extreme low high prior to me personally. I have a long story of providing Clinical Care to people with Substance Use disorder and have been working over the last decades to improve system of care and access to care in order it save lives and support peoples recovery. We will aim to answer your questions and look forward to your on going conversation. I want to really extend our thanks to profound low to the partners both who will be offering testimony today as well as others in the city who i have come to know. We are aim to be i department receptive and engaged with feedback aim to improve as we go and grapple with the difficult but person issues. Next slide. From the legislation i want to level that the as we understand the from the luthe d. Public health min tain fro and low cost medical Substance Abuse services and residential treatments with upon demand. So, in this presentation, i hope to cover who we serve, the services in San Francisco, funding for the services, cast and time liness of services and accomplishments and opportunity for improvement, next slide. Im rushing a bit. First let mow call attention to national data. Answer address the question how many access Substance Use services nationally. This statute National Survey on drug use and health the government conducts. Y we know among people with Substance Use less then and there 10 need treatment receive it. And most people with sud at the time of the survey dont foal they need treatment despite the presence of the disorder. And this is a major gap. This we aim to address. Strengthning a continuum of care you see here. Which aims to deliver services consistents with the persons as we call and you see at the bottom of the slide stage. Change. On the right side looking at the bottom line stage of change as action or maintenance. Folks interested in the moment and making change in Substance Use or other Health Behaviors and maintenance refers to people who have achieved those change and maintaining them often referred to being in recovery. And you can see botch on the continuum of care, that we offer Treatment Services to folks in action or maintenance phases suchs residential, out patient treatment. Medication treatment. Sober living environments. On the other side of that continuum first calling your attention to the bottom line. Precondition temmrigz this refers to folks who might be using substances and not really thinking about making a change. Those are some of the 90 of people with the Substance Use not currently in care. And important low, dont perceive the need or foal they need care. How do we approach those folks clinically, systemically, we offer Engagement Services both to prevenn them from dying in the moment, keep them alive in order we work with them to increase mote vision for change. Some of those Services Include over dose prevention, syringe access cites moving long this to counseling for people who might want to make a change temperature is important to set the stage like this because in measuring or aiming to measure need and gaps we know we need to attends to people across that continuum of behavior change and offer services in a time low fashion that can meet their needs and move them along the change continuum how many with Substance Use disorder Access Service in our Health Network d ph funded or directly run clinics. We see among San Francisco Health Network in 2021. The number of people we know about in the San Francisco Health Network numbers about 11,000. And the number who received a subSubstance Use Disorder Service is 40 . Should i pause. Yea. If you can pause. Supervisor melgar has a question. Jul want to do this. The question on the slide you had about the numbers is this individuals or is it visits . Meaning. An individual has several of those . Im sorry the number of people, people. Those are number diagnosed. Yes. Thank you. And should i continue im happy to continue to take questions as you might make sense to hold them. Got it im accumulating my own. Next slide. The next slide illustrates the Substance Use services in San Francisco where we deliver care and services. And present thanksgiving slide because we often think of Substance Use treatment as one thing. Which is residential treatment. And thats where everyone stops their thinking. You see, on this slide of multiple tiles there are multiple locations for the deliver of sud treatment as well as Risk Reduction and Harm Reduction services. You see the cites of delivery. Additionally, in those cites we deliver multiple services in combination and independently. We deliver psychosocial, individual and group counseling. Contingencey management. Cognitive behavior therapy. Medication treatments or interventions. Then other service which support people moving through habehavior change continuum. Assessment linkage and service and a halvinggation. Housing support and deliver prevention related services to youth. Funds from this following sources see them listed here from general city funds to federal and state dollars. Et cetera. Next slide. Describing on this slide the treatment capacity and service that are available in San Francisco. I want to call and this was the subject of last years conversation in part, call you were attention to the fact we are delivering Substance Use related treatment and other service in when we call the special care system. Meaning the it behavioral aretha and increaseingly other sectors you see toward the bottom San Francisco Health Network primary care. Whole person intgritted care and Community Partner and prevention and out reach. Wee look at occupancy rates. What you notice is only the residential programs because that is the easiest to measure in terms how full they are at different point in time. This past year was complicated because of covid and sometimes losing staff or out ill. Sometimes having to shrink capacity. You see there the occupancy rate of different types of services and we aim for them to be in the full to get people this and out in a timely fashion. Next shows additional kiensd of Residential Care or place based care not included in our formal treatment on demand but intendsed care for people with Substance Use out of a variety of levels of severity. You see some of those additional capacities there. Next slide. The listing kind of service including community access. And other medication, which is for alcohol use disorder, contingencey management. Expanded distribution including a new expanded work taken on by d ph. And treat over dose Response Teams started a year ago. All of these services contribute to the upon continuum of care andune are serving folks who may be at a contemp lative or prep phase and in the red or interested or even needing of more formal or Residential Care settings. I want to present to you 2 graphs one is our treatment admissions through 2021. These are admissions to left lanesed Treatment Programs. And when you will see here, is that there has been a decrease in treatment admissions we talked about this left year for a number of different reasons. Covid, back a few years ago with transition to med kale and standard who is is eligible for residential treatment. Some of the folks needing housing were not eligible for formal treatment and important low we are increaseingly offering low barrier and lower threshold care and care cross multiple sector this is is illustrated boy this slide unique clients receiving in San Francisco. It is also goes by the trade name sabox one treats opioid disorder. You see an increasing number on the dotted line on the bottom increasing number of patients by year. These are data from the state so we cant over lap them with our systems of care. But this reflects an over all approach in treatment and getting people treatment in i time low fashion in multiple settings you see well is a more than 3 fold increase in the last decade. Finally or using our data and we are improving our ability to measure timeliness of care determined wait timeers time lilyness of killer in formal Treatment Programs. And management we found less then and there i day wait time to admission. Over all 90 day residential, Methadone Program of less then and there a day with capacity. I want to point out this does in the reflect timeliness to access of other care settings we are increase to improve primary care and street based care and so forth. I know this area is we, this is our data to the best of our ability to measure it. We do engage with stake holders and get feedback and find ways to improve where there are exceptions or whether experiences or contrary to our data. I will end with the left 2 slides. Next slide. I want to rerowel what i believe to be our major accomplishments in the left year. We taxicab new service at the minna project in collaboration with colleagues at ap d and soma rise. We were successful, we believe in incorporating Spanish Language service there. We have more work to do. We also have been aim to expand service for people with dual diagnose. We hear and than loud and clear. In some of our new services the minna project vicktory whys accomplice we aimed include care for people with dual diagnoses and plan for additional beds. Expanding residential step down and expect them to happen in this coming were. And urn taking a hospital referral improve am project aim to decrease the length and gentleman of time with referral to accomplicement within 24 hours. In terms of gaps you know we completed this report and t