Transcripts For SFGTV Government Access Programming 20240713

Good morning, my name is heavier and i am with Community Housing partnership and jobs with justice. We work with Supportive Housing residents who were formerly homeless and the people in our building have severe medical needs that require many trips to the hospital and lots of them that i have worked with have to go long distances to get their care. We have several buildings that are in very close proximity to the new van ness facility and i have heard of little to no enrolment in that facility, which would be a lot easier for our residents who are disabled. Also, as far as the outreach to the tenderloin residence, the people in our buildings and the tenderloin atlarge, as you know , a lot of their first languages are not english, and its almost impossible for them to be able to take that step without some really serious and intentional outreach on the part of cpmc. A lot of times, to keep people enrolled and to have them get the medical need that they deserve, we are relying they are relying on our residential case managers who are not familiar with the Health System, were having to scramble and figure out this paperwork that they are not familiar with, but they are the ones that are having to take on the job that cpmc should be doing as far as outreach and enrolling people. So i ask that the commission make the changes that are needed to hold cpmc accountable and to do what needs to be done. Thank you. Thank you. Next speaker, please. Hi, my name is sylvia. I work at van ness. I was here last year and i will say hi again. One of my patients told me to say hi for you because he had breast cancer. Once again, im talking about short staffing. Once again, we want arbitration and we will never go back in there. But i am here to give you a story, a reallife real life story of my experience on the floor. Right now, i am taking 13 patients because my doctor put me on modified. That is the only thing i take his 13 patients. Not 50, not above that because of my ankle that is really hurting. So i am working in pain, but one thing, the night shift is always short. Overall, it is short staffing, but what i do is check the patients, if they are breathing, and things like that. I walk around. If anybody wants to go to van ness, the tenth floor is too big i am the only one who has a short hallway, 13 patients. To make sure that when they arent drug, to make sure they are breathing and things like that. Our code blue, since we moved in there, is skyhigh, in my opinion , because i am grading them because they are grading me and i am grading them. I am doing 100 and 10 of my time to make sure my patient is safe and breathing because they are on drugs, heavy drugs, medication. If i dont do it, my legs will hurt. My patient will die. And it is so bad for my heart and my mind when my patient dies i see a lot of them in my years since 2003. Im asking again, i am crying here and asking again, we need more staffing on the floor. Thats it. Thank you. Thank you. Next speaker, please. Good morning, commissioners. I and the union rep and we represent workers at cpmcs davies, pacific, and van ness campuses. I heard a lot about talk about numbers, and it looked good from cpmcs account. They were doing everything on the up and up. I want to tell another side to that. They said they hired so many people. I would like to ask the question of where . Because i represent the tax, i represent the food service workers, i represent the p. C. A. , i represent pretty much everybody but the nurses and they are all shortstaffed, even Central Distribution departments that deliver cotton balls around nurses, nurses cant even get cotton balls because they dont have the stuff to actually delivered those. I wonder where are all of these people hired . Probably in management. The Food Service Department has like 12 managers just to manage one shift, the day shift in the kitchen on any given day. That is probably where all their hiring comes from. Speaking of the subacute, i would like i dont want to spoil anybodys hopes, but i dont think that they will ever have adequate staffing in the subacute because they dont have adequate staffing anywhere. Cpmc does not have any intention to actually comply. We have an open grievance right now because the contract, the cba obligates cpmc to keep an adequate level of casual per diem employees. We have an open agreement because they actually have none in most of the departments. Absolutely zero per diem employees, and as of recent, they may have hired probably about three, and i know because i watched the Staffing Levels there, so hold them accountable. I would like to speak about the spirit of this agreement. I would like for this commission to hold them accountable to that spirit as well as make sure that this is adequately staffed for the patients and workers alike. Thank you. Thank you. Next speaker, please. Good morning, my name is jennifer. I am one of the nurses from st. Anthony medical clinic. Im here to provide a few comments about the challenges our clinic has had in enrolling new patients. We welcome the partnership that we were invited to enter with San Francisco health to provide cpmc as one of those options for our patients. Since the other option was San Francisco general, when we presented just the options to our patients about which Service Provider they can choose, most of them were very familiar with San Francisco general. When we talked about cpmc, a lot of them did not know about cpmc or where places were located. So when we had to explain to them where they would have to go to the lab, xrays, specialists, it was very confusing for them. It was easier for them to choose somewhere like San Francisco general where things are centrally located and where they are much more familiar with the services. One of the other challenges that we had was that last year in 2018, we lost three of our primary care providers. Two of them moved out of the area and one of them retired. Since then, we have had staffing challenges and have had different per diem staff coming in and out of the clinic, and with different schedules. We have been trying to maintain the panel of patients that we have and provide care to them, which doesnt always allow for new patients to join because of our access. In terms of recruitment, we have been trying to recruit new permanent care providers and we are also contending with Different Centers and organizations that can maybe offer more bonuses or bigger salaries then we can, unfortunately offer them. We still strive to provide the level of care that we always have, but we have been faced with a few challenges in the last couple of years. Thats all i have to say. Thank you. Next speaker, please. Kim tell villani, San Francisco labor council. I am deeply saddened. I feel like this is the greatest issue of all time. I dont even know where to begin one, cpmc has not fulfilled its obligations, and despite the boxes that you all check off. I work one block away. My old office looks out at cpmc van ness. When i pull my car out or in of the garage, there is a tent city right there exactly one block. In fact, the smokers from cpmc smoke in the same alley. There is a tent city. Theres lives that could be taken care of cpmc a block away. There is no excuse why they cant be taking on more. We have been here, we have testified. They can hire navigators, they can partner with Community Housing partnerships who have residents in their hotels. Tenderloin housing, for example. But cpmc chooses not to do any of its because they really dont want to do it. They are perfectly fine sending more and more people to San Francisco general on a taxpayer dime and it limits the capacity of San Francisco general. I need the commissioners to really holistically look at the Health System and make the private hospital, cpmc, do more. This is a sad, sad day. When you walk out of here, there are people without health insurance. That is not an excuse. They need to do more. They can do more, they are choosing not to, and we are letting them get away with it. These are the options. They are fairly simple options. Either you are for the people or you are with cpmc. Cpmc has failed. We have seen the deaths that have occurred in the subacute unit. They really dont care about patients and we really need to hold them obligated to do more in the city. It is disgusting and we should not allow them to continue to do their Business Model this way. A look at st. Francis, they do weigh more and they are just a few blocks away. You have the ability to make them do more, the question is, will you . Thank you. Any other Public Comment on this item . Okay. Public comment is closed. I will defer to my copresident as many of these issues are healthrelated, and then we will provide comments. It is now in the hands of the health commission. The commit are there commissioners who wish to speak on this item that have questions yes, first of all, thank you to the staff of the Planning Department and also the department of Public Health for your excellent presentations as well as for everyone who stood up for Public Comment today. I would like to dive a little deeper into the question of providing services in the tenderloin, the medical services. I know we are looking at this presentation and it is looking very similar to what we saw last year. Some of the numbers are confusing, so i would like to give the opportunity to clarify it because going back to what corey said about the spirit and the goals of this, it is not really just about the numbers, it is about the people, it is about the lives. Particularly when you are looking at the tenderloin, it is lifting up and bolstering services that are available in the tenderloin with the organizations that already exist in the neighborhood. When you look at some of this data challenges, which, of course, are legitimate challenges, these are things that could have been anticipated if you are looking at patient choice, that is something where you could do more outreach to the communities of people are more aware of the services that are available from cpmc. You are looking echolocation of services that make it more complicated for people to take advantage of whats available at cpmc. There are ways to address that as well. And then of course, staffing challenges for some of our nonprofit partners. That is something that can be anticipated as well when youre looking at the cost of living, the cost of housing, and the cost of soaring rent of nonprofits were trying to serve people in our community. I would just like to ask and also applaud them for stepping up and taking on some responsibility, but this looks very similar to the presentation we saw last year, and while we hear there are plans to put together a path to sustainability, we really want to ask more pointed questions about what those plans are and what has come from those discussions, so i dont know who is best suited to answer those questions, but those are ones that i think we would like to hear addressed. Thank you, good morning, commissioners. Im emily webb and director for Community Health for the bay area. I appreciate the question an opportunity to clarify. This is an example where i think cpmc has made some efforts towards the spirit of the agreement. The letter of the agreement said if there was not an mso with the tenderloin serving base by december 31st, 2015, then cpmc was to meet the obligation for additional lines through our existing partnership with northeast medical services. We hear the communitys concerns about wanting additional primary care options in the tenderloin with a pathway to hospital and Specialty Services at cpmc, hence we forged the contract with Saint Anthonys to provide that option to patients. As has been stated, we also have a clinic and three other independent primary care providers that contract with cpmc as the in network hospital. Although this challenges that have prevented the Saint Anthonys number from growing to 1500, despite actually quite a bit of funding and inkind effort on my behalf and my stuff s behalf, we have worked with the community and a whole host of partners to provide access to cpmc with primary care choice in the neighborhood. I think it is important to note that while there are acknowledge challenges that you heard from Saint Anthonys, we are working with multiple providers in the tenderloin to be the Hospital Partner and to serve about 2600 residents that have home zip codes in and around the tenderloin. Just a quick followup, when youre talking about path to sustainability and efforts that are happening now, what are you anticipating you can accomplish in the next year to fully meet the spirit and the goal of the agreement . Yeah, the effort with Saint Anthonys, i think our perspective is because we have multiple primary care providers, that can refer patients to cpmc, we are meeting the letter of the agreement and the spirit of the agreement, which is to allow tenderloin residents to have access to the hospital that is newly in their neighborhood. What we have done with Saint Anthonys is we have done quite a bit of work with them. They used to be a free clinic. They now accept reimbursement and we have funded them to get access to federal dollars for the health care for homeless grant to join the San Francisco Community Clinic consortium and to begin to contract with medical. That did not exist prior to our building this relationship with them. We funded them towards that effort, as well as provided Technical Support and guidance. We have also funded them for outreach efforts pick we believe that them having people in their dining room and out in the neighborhood and they have quite a few programs around staff recruitment, they have a wonderful Security Guard Training Program in the neighborhood, that those staff are better suited to engage with the neighborhood. We funded them towards that effort. Those are just some examples of the things we have done, and they also have had a leadership challenge and staffing challenge which plays into the ability to grow the partnership. With respect to the acknowledgement of the great work that is done by the folks at Saint Anthonys, the next time we get a report back we would like to see the results of some of these efforts and see that even more enhanced with Saint Anthonys and organizations in the community. Okay, thank you. Thank you. Commissioner child . Thank you. I have reviewed the document and its easier to review them as we sit here in these years, but it also becomes, i think now a real opportunity now that both hospitals have gone into operation. And we look for the future, and as i think much of our apostate public testimony spoke of, we then to need we then need to see how these hospitals actually meet the needs, not only of the Business Needs of cpmc and their desires to be more than just simply local and Community Hospital, but as the opportunity , as a city, to take to make use of these as providers for the residents. So most of my comments really, at this point, dont relate so much to how well you have come to check the boxes over the past , but what we would look forward to in the future. That is, for both hospitals. So as i am reading, i am reading the smaller one first, and we think cpmc for coming and stepping up to the issue of providing additional and patent inpatient and Outpatient Services for that district, which were, if it were not there , would certainly have overwhelmed general even more. That was a Real Community need. But as we see that the hospital is a Community Hospital in that sense, i think some of the areas that were in the d. A. , that really should then be those which the communities able to access, and that was one reason it was put in there. I believe that it appears that we have gone quite well in terms of moving a Diabetes Program. And i am somewhat concerned, but i think the d. A. Might be able to cover that even though it has been transferred out of the hospital, and no longer really within the realm of the Health Commissions purview as a service from the hospital, it still does, i believe, remain under our d. A. , and that we should be able to take comfort in the coming year as to what the Diabetes Program has been. So i would look forward that staff would be able to provide that to us in an x youre working with cpmc as to now a mature Diabetes Program with at the new hospital. I think the last speaker also brought up the question of the senior programs, and the senior excellence with both the ace unit and with outpatient programs. I think its our opportunity for the coming year to then ask that as part of the report, it is not checking off the box that you have those, but that the commissions be able to understand what has actually occurred, how many people are being taken care of, how many were from that community, and, in other words, to understand not just a quantity, which would be nice to know, but also the quality of the work that is going on. I would say that i am looking forward to a coming year and we could see the fruition of the reason these buildings were built. They are not built there just to be buildings, they are not built to just become Tertiary Centers for a very large system, they are built also for our community i think our new van ness avenue campus, we should see and, thank you, i guess it was just last weekend, and i understand that you have just opened up the new van ness campus, that you brought us data in terms of who are being served with in the system . That is helpful. That is demographics that we can then compare in the future as to what is going on, and i think an additional amount of demographics should also then indicate what is the demographic in regards to our zip code use from the tenderloin. What is the percentage that are now able to use and do use the hospital. I think that goes also to the clinic and yes it is not so necessary that we get the 1500 as an m. S. O. Or as a group that cpmc has sponsored, but that we see that what these efforts are, in fact, show that the communities using the hospital. So whether it be by way of the clinic, by Saint Anthonys, by the three independent practitioners, i think the key question is, county people are actually using van ness that are from our tenderloin . That, obviously will easily compare to what was at pacific, because that was quite far away and we understood that, but that , in fact, we should be able to see that a fair number of people from the tenderloin would find that services at the new van ness of a new are really accessible and are those which the Community Embraces and finds it just as convenient to use, even more convenient than trying to take the buses or whatever transportation in order to get to general or up to st. Francis, which is now a little further away. I think that would show that the citys partnership with our cpmc organization actually has benefited the residents of our city, which i think is the purpose of the d. A. Those would be my requests. I might also add that it is a small one, but on the Senior Center that says that we are going to have an Advisory Board in the community, im hoping it is a mistaken comment that the community Advisory Board only meets once a year, because that wouldnt seem to be adequate input on the part of either the community or cpmc in terms of dialogue regarding the work of the Senior Center. Aside from that, i will conclude my remarks. Thank you. I would like to echo what the other commissioners have said, thinking you for your excellent presentations, and also to the public for your very insightful comments. I think, you know, my concern is that there are literal stipulations for the d. A. And then there are mandatory statistical reporting demands, but then theres this whole issue of how this translates into engagement with the neighborhood. Quite honestly, i spent a lot of time reviewing these documents and i find information quite opaque. I cant quite extract from this information what you are really doing to outreach the community. When i look at cultural competence and competency, i think of the entire realm, including making tenderloin patients feel comfortable entering the doors of that numbness. It is an imposing building. The van ness entrance closes promptly at 5 00 p. M. , it is up a hill to get to the emergency room. I mean, it is an imposing structure. Even beyond anything you might say, there needs to be a lot more sensitivity to how you can really welcomed the residents that are within footsteps of the buildings themselves. The other thing that i think is really important is how you do explain your footprint. The hospital tours for the pregnant patients say that the labor and delivery unit is actually at 1100 van ness not 1101. Even your efforts to help patients that are planning to have care at cpmc are not coming through your website they are not coming through. Your website is very confusing and even to patients who have used the services at cpmc before the other area is senior care. We understand you have these programs, but we dont have any idea who really participating and what the demographic is. Now you have been open for about a year plus at mission burnell, and 10 months at van nuys, i would like to see the next time we meet, real data, real demographics about the ethnicities, about the language, about the insurance coverage, and about the charity care that you are providing at your two different sights in these various programs because that will help us better understand that you are really meeting the spirit of this agreement, not just the stipulations of the agreements. I too would like to add my voice to a my colleagues have said in relationship to the comments from the public. The report from both cpmc and the department of Public Health and planning. I want to make sure were clear that equity is an issue, and we need to demonstrate equity, or you need to demonstrate equity in terms of the populations that you are serving. This is a great piece of paper, except i cant read it. The print is really way too small. Next year, in march, for those of us who wear glasses and still cant read it. The class information is critical and essential. Whats more critical and essential is the notion of equity and access to these services, and i understand what was presented in terms of Saint Anthonys and the issues and concerns that you have in relationship to acquiring new patients, we can, and you should do better. With that, i will defer to my colleague, the president of the planning commission, for their comments and questions. Thank you. Commissioner koppel . Thanks again to staff with all departments involved. A lot of things going on here. I appreciate your time to clarify everything. I wanted to address the workforce issue. More so on the temporary side, the construction and building of the projects. I would kind of be out of order if i was necessarily speaking as far as the longterm Permanent Employment at the hospital, but before being appointed to this position, part of my responsibilities were overseeing projects like this and meeting with the general contractor and their employees along with city build and trying to connect all the dots, at San Francisco residents building important San Francisco hospitals, ideally taking the bus or bicycling or walking to work, and as far as im concerned, cpmc is more than compliant. They have exceeded what would what was actually possible. A lot of this has to do with timing. This wasnt the only hospital being built at the time. Ucsf, mission bay was wrapping up, and ideally those residents and workers, everything was timed perfectly when mission bay would be completed. Those residents were transferred over to General Hospital and building the new trauma center, so after that was nearing completion, those workers were ideally going to move right over to van ness gary, and there was about a year hold up. A lot of the residence, apprentices and even in the office workers, even had to go somewhere else and work for that year, and then be transferred over later. They were a hiccup or two on the front end of the project starting on times on time, and that threw a wrench in moving people from hospital to hospital, but let me also say this is a very important sector in our city. The Healthcare Industry when it is not there, you notice. And sometimes certain things can be taken for granted. We typically see commercial buildings, residential, retail, and hospitals are a completely different type of building. They are so much more complex, they are so much more technical. We are not just installing simple every day features, theres different finishes, theres all kinds of machinery, technology, things need to be programmed, so it is just a feat that these projects to get finished and completed, and with the high numbers i am seeing on here, i am really impressed. I want to congratulate mr. Nam on his position and i feel really confident that he will be doing the right thing and getting all the right parties involved to sit down and get as many residents working on these jobs as we can. Thank you. Commissioner johnson . I just want to thank my fellow commissioners and thanks staff for this report. I just want to also echo that i think that the d. A. Agreements are so often both about what was discussed at the time of their forming, and also the goal and spirit of the agreement and really it should be focused on the evolving needs of the city and building a new and equitable and accessible relationship with all San Francisco residents. I am glad to see the report that came out this year did provide more detail. Especially i want to thank mr. Nam around helping us to understand what has been happening with the workforce and not only hiring an internship, but retention. That is where the rubber hits the road. It is great to see those numbers i would agree with commissioner greene that i think the rest of the report, particularly around community engagement, was extremely opaque and left some to be desired. I think there are some issues that were troubling last year that are still troubling this year. One is the issue of outreach to tenderloin patients. First choice, sure, people get to choose where they are go, but if theyre not choosing your hospital, you have a problem. Community outreach and Community Building is really about creating an ecosystem so that you are not just relying on one provider, but a myriad of organizations working together towards the goal of enrolment and retention of patients. Coming from a philanthropic background, that is how you do Community Back he outreach. You create and bolster an ecosystem. I am not seeing that ecosystem thriving. While i am hearing the efforts that have been done, and hope that next year there will be better outcomes, i think that theres more to do to shore up the organizations that you are working with, and working more closely with extremely competent organizations that are in the tenderloin that actually do know and have the skill of working with these populations and really keeping in touch with them, and making sure that they continue to engage. Along those lines, if you are not hiring social workers to support doctors and changing your culture to meet the needs of the community so that goes from everything from what your website looks like, to how people are welcomed, to very detailed plans around language and access to working with community members. We are also really concerned about, and still concerned about the issues related to the acute care beds. Our city desperately needs those beds and i would actually like to hear the end of my comments, what has happened with the patients over the last year . And what the plan is for that unit, and staffing. Im deeply concerned to hear again, this year, issues around lack of staffing, appropriate staffing. I absolutely agree with president woods that i think this is about equity and access and this is about making sure that your care is relevant, not just for the people who can pay for it, but for all san franciscans, and that will actually ultimately make your services viable in the long term being able to provide services for folks of all economic backgrounds, cultural backgrounds, and languages. That is the biggest challenge facing the healthcare sector as i see it, and i hope that you continue to be up for the challenge of really addressing those issues. Commissioner johnson, was that a question of the cpmc staff . Yes. Thank you. Good morning, commissioners. I am the Vice President of external affairs for sector. Commissioner johnson, we had a hearing last thursday, actually in the Public Safety committee of the board of supervisors to discuss this issue. Along with a presentation from staff around the work they are doing to address the citys larger problem, some of the information we shared last week around the issues of staffing and so forth, as you know, due to law and our concerns about privacy, theres only so much information that can be shared, but it is worth sharing that, first of all, the physician who spoke so ardently two years ago when there was pressure for us to transfer that unit from st. Lukes to davies has submitted a letter. We can share a copy with you giving his objective viewpoint of the care being provided in the unit. Staffing ratios are something that are mandated by the state and we are in constant compliance with those. They are posted weekly, they are submitted monthly, we also are regulated by the California Department of Public Health who have recently come through and done an audit of the unit and found there to be no concerns with the care being delivered there. Can you give a little bit more detail about what is going to happen with acute care beds and what has happened with the patients . I cant speak to whats happened with any particular patient. I think staff probably could, if kelly was here, could give a broader understanding of the type of patient who requires subacute care and what that means for their condition and level of fragility as a patient. Our intention, is agreed to with the supervisors and others last year, was that we would continue caring for that population that was with us at st. Lukes over at the davies campus and that is what we are continuing to do. Thank you. Commissioner fung . This is my first meeting on not only cpmc and the development agreement, but with some of the issues that have been brought forth. We have seen, and it is primarily technical analysis, i understand, some of the issues that are relatively new to me. It appears that i will need to study this pretty extensively if i am able to proceed in a thoughtful manner on future meetings. Just from looking at what was primarily on the planning side, it would be not as challenging as from the healthcare side. At this point, i will be studying it further. Thank you, commissioners. I agree with all of my fellow commissioner comments. Thank you so much. I did want to press a couple of issues and ask him questions. I agree with the font. [laughter] and i dont wear glasses for close reading, but it is a little bit challenging. I see that the patient demographic that was provided are for all campuses, and in thinking back to previous hearings, you know, especially as we heard about the issue of Language Access to the diabetic unit, i am wondering if we could have a more detailed, by Campus Demographic data, especially as, you know, folks when we rebuild st. Lukes were very worried about access within the eastern side of the city to cpmcs services, so i just wanted to see how that was in terms of the demographics as we know. We know the demographics are a big concern in the city and it tends to be different then in the cpmc main campus. So that is one, and then the other thing i wanted to ask was about hiring and resource hiring totals because i see that we are in compliance and doing well. I am wondering what this looks like in terms of race. So you provided data in terms of neighborhood and zip code, so we know that africanamericans have a much higher rates of unemployment in San Francisco, and this is an opportunity for folks, especially young people, to get skills to get in the door for this one project, but then those skills can be applied to other projects, and during an era where we have an extreme shortage of construction workers in San Francisco. We cannot meet the demand. So can you talk to a little bit about what the demographics look like . Thank you, commissioner. I am with city build. I knew that question would come up. Specifically for city build, our program has a 35 africanamerican demographic that graduates from the program. Is over 1400 since we started 14 years ago. Overall for construction, i did not procure the Demographic Data , but i provide a supplemental to provide that information for the commissioners, and then this specifically, that is what i was asking for from our office for the nd use post construction work for the operation. That is the other data i will be getting for the referrals and the placements that we have made for the operation of the various hospitals. Thank you. I would appreciate that data when we do this again. I think it is important. Thank you. Thank you. In my last question, that is for cpmc staff as it relates to the partnership with Saint Anthonys. I think that part of what commissioner johnson very distinctly said, always, is my worry, also, about creating an ecosystem by which people are attracted, but also once they walk in the door, there are culturally appropriate and welcoming services so that folks can be hooked on as patients. Im wondering what the plan is going forward. I understand that numbs was the partner who could fulfil the d. A. Requirement, but im wondering in terms of outreach to the Tenderloin Community specifically where they are not based, what the plans are for making that connection to the community and providing access and culturally appropriate access to folks. Thank you, commissioner. Emily webb again, director of Community Benefit for the bay area. We do work outside of just providing Healthcare Services in the tenderloin. For example, our Child Development Child Development centre on van ness, which provides Multidisciplinary Care to children with developmental and Behavioural Health delays is providing services at Saint Anthonys. We are also at schools in the neighborhood. We fund and work with dozens of communitybased organizations in the neighborhood, so through our Community Benefit investment, we do go outside of the walls of the hospital to try to make sure that we are meeting the needs of the community in the neighborhood. In terms of the services on campus, the data, which im happy to send you in a larger format, shows you that we try to recruit a workforce that is reflective of our patient population. That is really the number one thing from a healthcare perspective that helps with cultural, linguistic access to services. In addition, in the packet you will see we did an assessment of all of the cultural and linguistic access standards, and in the packet theres a detailed document that outlines what the consultant found, recommendations, and how we are working to address them. Theres a lot of Different Things that go into that, but it is in the Compliance Report that we submitted in may of this year thank you. Any other comments or questions . Okay. We are not taking action on this item, but thank you all for coming and we will see you again next year. We spoke with people regardless of what they are. That is when you see change. That is a lead vannin advantage. So Law Enforcement assistance diversion to work with individuals with nonviolent related of 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. Thank you for coming to the talent dance performance and talent show. [ applause ] todays performance and talent show. Public recreation has every bit of the talent and every bit of the heart and soul of anything that any families are paying ten times for. You were awesome. Meetings friday, here in room 400. San Francisco City hall. City hall is accessible to persons using wheelchairs and other assistive mobility devices. Assistive listening devices are available and our meeting is open captioned and sign language interpreted. Our agendas are available in large print. To prevent electronic interference with this room sound system and to respect everyones ability to focus on the presentation, please silence all mobile phones. Your cooperation is appreciated. The Mayors Disability Council Public Meetings are generally held on the third friday of every other month. Please call the mayorsf