Transcripts For SFGTV Government Access Programming 20240713

The adult residential series. Today it is part of the three presentations laid out by president loyce. We will be addressing some of the needs of the Public Health services. Then at the next meeting we will have a presentation which will be an overall of Behavioural Health programs in the department. In addition, i would like to on behalf of the commission, welcome commissioner suzanne gerardo. She has been the chair of the San Francisco Families First five commission and the founder and trustee of the demerlac academy which is serving underserved children and families. You certainly bring a lot of credentials to the commission, and were very happy to have you. Would you like to say a few words . Yes. Im very happy to be here, and i hope with my background in Mental Health, Behavioural Health, as a practising psychologist, im not just an administrator, i see families and adolescents daily. I look forward to being part of the planning, program, and solutions as the department of Public Health moves forward. So i welcome the opportunity to serve the city. Thank you. Thank you. Welcome, commissioner. The second item on the agenda is the approval of the october 1, 2019, minutes. Okay. After having a chance to review, do we have a motion to approve . So moved. Second. All in favour . Aye. Minutes approved. Thank you, commissioners. Item 3 is the directors report. Good afternoon, commissioners, director of health for the county and city of San Francisco. I also just want to extend my warm welcome to the new commissioner. You were just sworn in about 45 minutes ago and getting right to work. Very much appreciate that. It is with the spirit of the Health Department that we get right to work in solving problems. We are so excited to have your wisdom here to help us figure out how to do it better across the department, but especially with Behavioural Health. As you know, as we talked, theres a lot to do in this area. Im very excited. The Health Department has done big things in the past and we will continue to do big things with your leadership and the rest of the commission. Thank you for being here and look forward to working with you. Thank you. So the a couple of other things in my directors report that you have in front of you. Very exciting announcement from mayor breed with regard to launching the urgent care s. F. Initiative. This is a bold vision to expand our Behavioural Health system, just focus on the people who need it most and for who our system of care is currently failing. It really is about focusing on the 4,000 people that our director of Mental Health reform has identified as the most in need identified by their being homeless, suffering from psychosis, and also Substance Use disorder. The initiative reflects input from community partners, medical providers, and other clinicians, is informed by data and evidence, and i think most importantly reflects the publics passion for addressing this issue. At the end of the day i think from a Public Health perspective and just in general, this initiative will save lives and it will address the Behavioural Health crisis that were currently seeing on the streets. The mayor is proposing, among other things, an expansion of 1,000 beds in our Behavioural Health system from residential law facility to boarding care facilities. Thats a 50 expansion in terms of what we already have. The initiative is built around four pillars. One is creating a more coordinated system of care, reinforcing and expanding our outreach efforts and further creating no barrier and lowbarrier care. Two is strengthening and expanding our treatment options. So our programs the programs that work are expanding, and we have new innovative programs being launched and eliminating wait times for care whenever is possible. Three is strengthening our Behavioural Health Care Workforce both in Civil Service and our community partners. We know that recruitment, retention, and Career Development is a challenge for people and this will make sound investments to make that work. Number four is ensuring that people have access to Housing Options to help aid them in their recovery. Another key component is ensuring that we have evaluation and monitoring systems. So we develop feedback loops to learn what is working. We develop a system to learn whats working and adjust for whats not. We know that recovery is possible for people who have Behavioural Health issues. We know the system is working for most of the 30,000 people who are already in our system. I think its important and well timed for the department to start thinking beyond that number of people and look at where were failing. We need to expand and have the resources to do better using evidencebased ways. From helping San Francisco to addressing the aids crisis, weve done great things and im confident on this initiative and the support of you in the public, we will be able to move forward. A few other things on the directors report. Im proud to announce that mayor breed and a few other supervisors announced the adult residential facility that we talked about a couple of weeks ago at commission. Im pleased to say theres a balance that we agreed to where there will be a continuation of the adult residential facility. The final state after april 2020 is we would be running 41 beds in that facility and maintaining 29 lowbarrier hummingbird beds. In the interim, five people will be moved, provided its clinically indicated or they agree to move to other facilities, to open up a 14bed hummingbird that would last in april. People would be moved from that hummingbird to other hummingbird options and we would reopen to the state of 41 beds. Really pleased that we were able to come to some agreement. I think the staff input and the collective problemsolving let us move in the right direction. The governor just another key piece of news in our rapidly developing Behavioural Health field, the governor signed sb40 into law which helps strengthen our conservatorship and will help more people in what i consider lifesafing conservatorship. We will be able to help people for up to six months, provided they meet a number of criteria with regard to what these bills regarding we see the multiple offers of care. So we are working on this. A work group has been established. We expect to enroll people starting the 1st of the year. Those are my key updates. There are a number of other things in the directors report, but in the interest of time and with the respect of the commissioners, i wanted to stop and take additional questions of what i mentioned and answer any questions that answered you in the report. Commissioner green. Thank you so much. These are wonderful announcements and wonderful news. Do you have any sense for when the plan to reopen the rf beds might actually occur . Is because we have to address the Patient Safety and quality care issues. I think it was uncertain when we could accomplish that and if you had a sense of that Going Forward. The current state of the r. F. Needs improvement. While we dont think at this time any patients are in acute danger, we think things could be better in terms of strengthening our quality of care. Ive asked for a root cause analysis Going Forward to determine what are the staffing, what are the resource, what are the cultural issues that we need to fix in order to improve that. I think one of the key things that will help us understand that better is the working group that this agreement reached. So there will be a working Group Problem solving on a wide variety of issues while we continue to make significant improvements in the r. F. Going forward. The thing is, the r. F. Is not closing. We will have the r. F. As we in the interim between the final state. We will have the r. F. Afterwards, right. So we need to continue our current efforts to make the r. F. Better, but this working group that will be meeting soon and establishing a process for root cause analysis will really, i think, hold the deeper answers. In april when were ready to go to the 41 r. F. S, hopefully, well be able to do that in a way that is optimal for patient care. Thank you. Other questions . Okay sorry, dr. Chow. Im actually quite excited about the Mental Health plan, first of all, because i think it offers many specifics that are really right on the ground. It addresses our workforce problem, allows us to have resources to do what the mayor would like to have as the program for our Mental Health and substance disorder. So its very specific. Do you have an idea within this is there a time frame that some of these will be coming on that we could also be monitoring with you in the Mayors Office . Im glad theres an outcome component at the end, but as some of these come online, would we get an update on these . Now were going into these other units or were in the course of hiring this or were now working. I know were going to talk about the wholeperson program today. So thats one element. Im wondering if we sort of have a map of how were going to work with this, knowing that these details are still in flux probably. As we get more specific, it would be really helpful to understand the road map of this. You certainly put together, and so have with the supervisors the adult facility use and you have a timeline for that, which i think is really good. It would be nice to know how we would be looking on, as best as we could, what we would be expecting in now called urgent care San Francisco. Is that unreasonable . So absolutely not, commissioner. Just to also provide a little more perspective. Urgent care s. F. Is really a continuation of things the mayor has already started investigating in. If you think about the hiring of the director of Mental Health reform, if you think about the mayor investing in new Behavioural Health beds, around increasing the transparency of care around our beds and what i asked for i asked to prioritize is a Data Analysis to identify exactly who we need to help. I think urgent care s. F. Has been with us, we didnt call it that, but its been with us for a while as we moved forward. When we looked at the data around the 4,000, for instance, only 10 of those currently have an intensive case manager. Theres no way we have the tools right now to help the people on the street that we need to help. We are doing really good things with case management, were doing it with some people on the street, but not nearly enough. What this vision does is sets a ro roadmap forward for the types of investments we need to do. Were starting with the 230 that we identified of those 4,000 that have been prioritized by the department of health and department of homelessness and housing. Youll hear about that with the wholeperson care presentation. Wholeperson care is the operationalizing of our work with those 230 that really reflects i think the Broader Vision of what urgent care s. F. Is trying to do. I dont have a start time for these additional investments. I do think that thats a conversation thats going to be happening at the Mayors Office. The mayors been very clear that shes looking for resources across a number of different entities to support this initiative, but regardless this work is going to continue in this direction in the principles i laid out. Once i have more specific information about if and when or when i should say Additional Resources will be brought forward to invest in this, ill be happy to bring it forward with the commission. As well as an operational roadmap. I think that is key. Again, weve done these things before. We will do it here, and im excited to share the next steps with you when i have those. So i would imagine some of that would be showing up in the budget for the coming year also, right, in terms of the 202021 program because these are new programs that were not part of the twoyear plan . I certainly think that is one of the several mechanisms by which resources will be brought forward to support the department doing this work. Thank you. Other questions . We can move on to the next item. There was no Public Comment for that item. Item 4 is general Public Comment. I have not received any requests, so we can move on to item 5, which is a report back from todays Public Health committee meeting. There were two presentations. The first was from derek smith. We got an update on some of the initiatives of youth and adult smoking, some of the different approaches, pricing approaches, reducing exposure and accessibility. We also got an update on the flavored tobacco ban and some of the enforcement measures there and some Additional Information as we tackle youth vaping. That presentation is Available Online if anyone is interested in taking a deeper dive. We also had a presentation on h. I. V. Health services, where we looked at a lot of the progress thats been happening in San Francisco in these last few years since we heard from them last, with regard to having people obtain and maintain care. We also got an update on the centers of excellence, as well as other progress thats been made, of course acknowledging that there is still a lot of work to be done, particularly with regard to the africanamerican community, and particularly transgender women of color. That presentation is also Available Online for anyone who would like to see more. Shall we move on, commissioners . Yes, please. Item 6 is a resolution honoring dr. Susan sheer. We have dr. Sheer right up here up front. Thank you very much. Actually, yes, her supervisor is going to say a few words. Oh, great. My name is wayne noram. I am the director of arches. I am here today to ask the Health Commission to honor dr. Susan sheer for her many years and many contributions to Public Health and h. I. V. Epidemiology and surveillance. So i believe that dr. Cofax also has something to say. So, dr. Sheer, susan, i want to personally thank you for your contributions to the department. We met each other i think my first day of work in 1998. I just want to express my deep appreciation. You are a very humble person who does not have a lot to be humble about. I think your work in the department really extends not only to improve the lives of People Living with h. I. V. And members with h. I. V. Living in the city, but also across the country and across the world. We have to mention that you have published in international journals, youve done groundbreaking research, youve supported an Incredible Team of folks to do the work, youve mentored many epidemiologists and scientists. Youve led a life that im grateful for and personally very impressed by. Thank you so much for your work. I hope you will enjoy your retirement. I also hope, as we work to get to zero and your leader in the getting to zero campaign, that you will stay engaged in some way. Best wishes for you to spend more time with your wonderful family, who also do great things in their own way, but i think its because of your support of the department that well miss you the most. Thank you so much for everything that youve done and for your amazing team of people. Dr. Sheer, may i also some of us want to say a few words as well. First of all, thank you so much, dr. Sheer. For my time here on the commission but also for many years before, youve been one of my heroes. For someone who has been living with h. I. V. For 30 years and someone involved in the Advocacy Community and the service community, your work has been extraordinary. Every time you come and see us here at the commission, it always gives me hope and reminds me of the amazing work that has been done by you and others for decades in creating the model of care in San Francisco that became the basis of the ryan white care act and the groundbreaking research that has been done that has put us on course to be the first city in the country to limit h. I. V. Transmissions. Of course youre i didnt realize that you started as a volunteer in 1989. That was even a year before we had the ryan white care act. Your work has been groundbreaking and it has given hope to so many people. I think i speak for the whole commission in expressing our gratitude for your best wishes in the future. I know well be seeing you as well. I just want to say that while the other commissioners took all the words out of my mouth already, but having known you for so long and all your work and thanking you for helping to create an that my Community Feels safe and comfortable enough to see care and your brilliance working in this department. And, dr. Sheer, before you speak, we would like to vote on the resolution. Thats passed. Thanks so much for those kind words. When i was deciding whether i wanted to be an epidemiologist or not, that i landed as a volunteer here at the department of Public Health. That was just a stroke of fortune that im thankful for every day. Ive had amazing support and colleagues. As what was said we worked together for many years. The commission has just been wonderful. I really appreciate the oversight, the questions, the pushing of the ideas and the topics. Its just been a really wonderful experience. What id really like to do is recognize the amazing h. I. V. Surveillance team. Basically anything ive accomplished has been with their support. They do the heavy lifting. Their collecting the data, coding the data, cleaning the data, entering it, analyzing it, and then i get to stand in front of you and present it. They make me look good, make my job easy. I want to recognize them and thank them for that. Please stand. [ applause ]. Dr. Sheer, would you come up this way and shake everyones hand. [ applause ] [ cheering and applause ]. Commissioners, the next item is the wholeperson care, shared priority launch. The second person is wholeperson integrated care. Hi, commissioners. Thank you for welcoming us today. Im going to im the director of whole person care. I havent seen you for a while. Nice to see you. Welcome. Im going to be talking today along with dr. Hallie hammer about some of the work that were doing around trying to think more innovatively for the people we serve who are experiencing homelessness on the streets. So im going to talk about the interagency shared priority launch. And dr. Hammer is going to follow he and talk about the whole person integrated care that were working towards. Its not moving forward. The there. Whole person care, as you may recall, i was here about a year ago, whole person care is a medical waiver. It is so can i get this whole thing on the screen there . Whole person care is a medical waiver started in 2017, will end in december 2020. The department of Public Health services gave money for counties to address vulnerable populations. Counties were invited to apply for innovation for their particular vulnerable population, and San Francisco chose adults experiencing homelessness. Part of the deal was that we were to work in across agencies to address the social determinants of health in order to improve healthcare. We are paid to deliver services that medical doesnt pay us to do, we get money for sobering center, medical respite, care coordination, housing services, for assessing people to prioritize them into housing. So all these services, about 36 million a year to San Francisco, half of it is a match. I am going to talk today a little bit about what were doing now with whole person care. These are our departments. Department of health and homelessness are the coleads with the state. Included is benefits to the department of Human Services, aging and Disability Services aging and adult services. And then e. M. S. Services through the fire department. In addition, we do a lot of work with ucla and we can talk a little bit about that. Three prongs. What we need to accomplish by the end of december 2020 is how are we going to come together and think from an interagency perspective how to prioritize the over 17,000 people that between the Health Department and the Homeless Department touch who are adults experiencing homelessness. I am really excited to say we have achieved that. I am going to talk a little bit about how we got to that. Once we establish what our priority is, now we need to agree how we are going to gather and address that population. The interagency shared priority launch today we will talk about as well as the whole person integrated care. Those are two ways significantly different innovative ways we want to address the population. The first is a coordinated Care Management system that integrates data from 15 different datasets. Weve had that from 2005 which all the data im going to share with you came from that system, could not know these systems without integrated data. Im not going to talk about where we are and where were going with new technologies, but i will be back to talk about that. We have touched and served over 17,000 people in a 12month period. They either showed up is and said in an emergency room that theyre homeless and we record them, or were on the streets and seeing and observing that theyre homeless. Of those folks, the doctors asked me of those folks experiencing homelessness, who among them are suffering the most from psychosis and cooccurring Substance Use disorders. Using that data, we were able to identify almost 4,000 people who have a history of being and psychosis in their background and also cooccurring Substance Use disorder, which includes alcohol, cocaine, opioids, or stimulants. Thats about one in five of the individuals who have that history. Of those folks, most of them, 80 of them, are getting their care in emergent and urgent fashion. 95 of them have had some history of alcohol use disorder, but only 6 of them have utilizing the sobering center. 35 of them identify as black africanamerican. Weve always known that there is a high a disproportionate share of homeless adults who identify as black or africanamerican. If i find source data and say those folks experiencing in and out of homelessness for more than 15 years, that will go over 50 . That gives you some sense of the equity issue here. In terms of of homelessness and psychosis, weve known this is a fragile and medical condition, its very serious. We see 12 who have some history with h. I. V. aids, congestive Heart Failure almost twothirds, hypertension and many in renal failure. A very significant number. Aging, there are 113 of them who are between the ages of 18 and 24. Jail interaction and over 40 of them cycling in and out. Its a vulnerable population. Weve been working together on this population in one form or another since with Barbara Garcia in 2003. Weve known from a population perspective its very vulnerable folks out there on the street. For whole person care we engaged with 400 people to ask them what their priorities were. We did a summit with the department of Public Health and the department of homelessness and Supportive Housing under the leadership of roland and carie and together built this vision and designed the process that im going to walk you through today. For the interagency prioritization method, essentially, if you are familiar with the coordinated entry assessment tool, it was a tool that was designed by the Homeless Department last year. 17 questions. You sit down with a person for 20 minutes, ask the questions, you enter it in and it ranks them in terms of vulnerability. So we have endorsed that tool by the the department of Public Health endorsed it because we looked at the Historical Data and looked at who theyre assessing and prioritizing, and there was a proof of concept. We endorsed and adopted that tool as a way of prioritizing folks. We have added to it that individuals experiencing the psychosis and cooccurring Substance Use, its a way of ranking those folks. Im going to talk a little bit about that. So there are a lot of numbers here. Again, 17,000 unique people who have been experiencing homelessness. If you stay in the green lane there, 6,500, almost a third of the people have actually sat through that 20minute interview and been assessed. Of those, a thousand people have been prioritized, and of the thousand people 237 have that history of cooccurring psychosis and Substance Use disorder. Does that make sense . Thats how we got to 237 is following all those yess. Essentially what that is is we have two big departments, different perspectives, housing and health, who come together and say we agree how to prioritize folks for these services for permanent Supportive Housing. On the no side, there are still people who have been assessed and not prioritized with that health history. There are people who have yet to be assessed with that tool. Those two lanes, the director and myself are working with the Homeless Department to try to have a solution for that. How do we get this tool to people experiencing psychosis who maybe cannot show up and sit through a 20minute interview. How do we get the folks experiencing homelessness assessed by the Homeless Department . So now we have agreement of who is our highest priority. Now we are working in the midst of figuring out together how were going to respond to these folks. All those summits and workshops brought us to a number of things. One is the launching of the shared priority response, which ill talk more about today. Dr. Hammer will talk a little bit about the Homeless Health Resource Center. So let me talk a little bit about the launch. So before we started on the actually delivery of these services, together we came all these agencies came together and said what are our principles . We need to follow these. One is this prioritization process used to be who do you know and what are the workarounds from how the system isnt working . So this is now a process that was developed with this how can we be very transparent, do it fairly and equitably to prioritize people, even when we make exceptions, how can we be transparent on that . The pathway to the Services Needs to be clear. It needs to be adaptable to individuals. It needs to be hopeful. There needs to be a sense that positive change is positive. Then obviously the Racial Equity lens and that together because were doing this with all the agencies together, that we need only share in the success but also share the accountability. There are three teams working on the shared priority launch. The first one is an internal group of people. Whole person care is providing a lot of the structural support in helping us implement this. Thats the interagency project team. The interagency project work group are people from the Homeless Department, people from Behavioural Health services who are working together to go through the list of 237, where are we now, and where do we need to be with these folks. Then we have a group of folks who got together last friday for the first time who have the ability to unstick or unjam doors who can think from a systems perspective, who will be responsible for making sure that what were doing is actually aligned with all those shared principles. Well be bubbling up recommendations to the executive directors of these departments to say this is how we think we need to move forward. Theres a list of people and roles and responsibilities in your you can look at it more closely. So what our priority goal is that we health, housing, and Human Service together will adopt whatever it takes. Approach to place these vulnerable clients who are experiencing homelessness into housing or other safe settings. We will be developing a street to home plan for each of the 237. This is a one path, but essentially the idea is to keep everyone focused on what were trying to accomplish here. Its not to solve everything, a lifetime of im sure very complex psychosocial and medical issues. It is how can we together show up and help these folks get from the street to their home . How can we help them stay successfully in their home . So there are many ways that they enter. Some go through pt vment subsidy some through the emergency room, inpatient, on the street. So we are working together with them to figure out these pathways. When this happens, who gets called next and how do we get them there . Whats different about this, because youve probably heard me come and talk to you about hums and other things in terms of our most vulnerable population, this is really different than anything ive been able to experience in the last 22 years and im really excited about it. One is that we are prioritizing individuals in an interagency way. There is no longer 14 lists, there is no longer, well, whos at the table to advocate for it, engaging were activating alerts in the systems. We have a single coordinator who has identified an airtraffic controller. For each one of the street to home plans, well be identifying is a navigator sufficient, do they need a certain case manager. We are developing what i think is very exciting, something called a highintensity care team. Ill talk a little bit about that in a second. With the street to home plans is integrated for each of the individuals and the resources of people coming to the table will be prioritized. This is based on evidence. Im not going to read all those. Thats for your reading pleasure. For the First Response high intensity care team is a combination of e. M. S. 6. They started in i think 2003 with neil singerlinni looking at high users. Its come back and been successful, but its also fairly narrow. Weve taken that success of that team and added a psychiatrist from the Street Medicine Team and added a case manager from the hut team and thats the interagency part of it. They will be the first responders. Those alerts will be put into epic and avatar and c. C. M. S. And the systems in the Homeless Department to say if this person shows up, you will be able to see that it says this is a shared priority client and its high priority for housing, health, and Human Services and to contact the highintensity care team. They will show up this is something that is new and has been asked for from the hospitals and the Emergency Rooms for years. When they show up, we need somebody to come because they go in and out, in and out, over and over again. This team will be available from 6 00 in the morning to 2 00 in the morning every day, seven days a week to respond. Im really excited about this. What we will be measuring with the help of the university of california evaluation team, well be looking at creating a dashboard. When i left my office, they were creating the dashboard to be able to see how many of the 237 have been housed or placed into a safe setting. Is the quality of their life improving. Well be using the Behavioural Health assessment tool, the ansa, for individuals to look at that score. We want to reduce avoidable use of the urgent Emergent Services and increase their engagement in more communitybased Behavioural Health treatment. And also to make sure that theyre increased in enrolment benefits, be it s. F. Advocacy or food stamps. 100 of these folks should qualify for the food benefits, and i think half of them have it currently. Were going to be evaluating the pilot itself. My team will look at how were working together in this intense focus so we can know how to sustain this. We will be evaluating it probably in february and then course correcting on it. Im happy to answer any questions, but i think ill turn it over to dr. Hammer and ill be back if you have questions. Thank you. Good afternoon, commissioners. Its such an honor to stand before you on this exciting day for Public Health in San Francisco and tell you about an Important New Initiative that were working on thats directly linked to whole person care and is an important part of the care Delivery System for the people that were just described. So why whole person integrated care . This is an idea which has been in evolution for over five years. As ill show you today, whole person care is specifically maria and her teams work to look at the data to gather data to help us coordinate care for this population. Is whats key to sort of laying the programmatic foundation and groundwork for us to be able to bring previously really disparate Clinical Services together so that we are integrated and coordinated in our work to serve this population. So what we have had in the d. P. H. Are Different Services which were developed to still perceived gaps, but not this overall populationbased strategy. So our urgent care services, Clinical Services in the Supportive Housing on the streets and shelters, but not really coming together to talk about individuals, to plan our services to take this populationbased approach. In addition, we had different clinical models. So everywhere from an episodics or urgent care model to see people when they come in, to more of a longitudinal model like we have in street medicine and shelter health. Also inconsistent coordination with Behavioural Health. So whole person care really provides this programmatic foundation that we needed to ground our work to indicate these Clinical Services. So basically what were talking about is these basically five different Clinical Programs and bringing them together under a new Clinical Service and ambulatory care called whole person integrated care. There is tom woodel and then also our permanent Supportive Housing nursing services. This very simplified organizational chart of the Health Network gives you some idea of where the services sit. Some in the transitions division, some in primary care, and then also working with programs that are located in Behavioural Health services. So the new whole person integrated care program is as i mentioned in a section of ambulatory care incorporates all of these services and brings together specialized staff who for years have been working across practice settings to Work Together to more effectively care for the population. Were really excited that, as was mentioned, we will be as were doing this programmatic integration work, bringing together our staff, our leaders, our clients to develop the care model, well also be planning for our new home in the Homeless Health Resource Center at 7th and mission. So here, next slide is a timeline that shows how weve gotten to this point, where, again, building on the work of whole person care, looking at our different disparate Clinical Services, and then given this exciting opportunity to team up with the Mayors Office of housing and community development, with Episcopal Community services, with mercy housing, with the homelessness and Supportive Housing department, come together and im sorry, as well as the h. S. A. In a new building where there will not only be housing, but also on the first and second floor this whole person integrated Care Homeless Services hub. So thats whole person integrated care. Im happy to answer questions. Commissioners, there is a Public Comment before we get Public Comment from former commissioner romagiey. Short people have to practice doing this. Good afternoon, commissioners. First of all, i just wanted to say to commissioner gerardo, welcome to an interesting time. Its a new era and were focused a lot on Behavioural Health because thats why were listening today. I just want to say welcome to it because today is a good day. Thank you for the resolutions on the arf because it really got us agitated. You did come together. Thank you. Now we need to move from here and what i want to say is its wonderful. Usually i come with lots of challenges and criticisms and whatever. Today is a day that i want to say thank you to ms. Martinez, dr. Hammer, and the whole team who has been working on this whole person care for years. Ive met with you and asked lots of questions and whatever. A slide presentation is not everything, so i do have some questions. Im going to leave that for another pay perhaps to understand it better. Thank you very much because from our perspective, from taxpayers for public safety, this is not trying to better an old way that isnt working anymore, no matter how successful it was in the past, but on a new pathway and taking evidence to bring to a new opportunity which always has a cautionary risk to it, but with monitoring and evaluation inside and out. So we want to thank you for that. We want to thank you for the leadership. We want to thank you for all the teams at the Management Level and at the frontline. I would just like to add that we would love you to also do Public Forums so we dont get so agitated because we dont know whats going on. We want to be a part of it because we are a part of it. We are a part of it as advocates, we are a part of it as past policy people, past consumers of your services, and current ones. We just want to be a part of it. We dont think its okay when you dont share with the stakeholders and the taxpayers who are bringing our part of the contribution to your work. So i want to thank you for that. On the jail, because im interested in the jails, i thank you for integrating a part of it. I notice that the jail is part of the service group, but i think also youre going to find that there are some real systemic issues in terms of immigration yes, immigration, but integration. I think maybe you want to look at putting someone on the Systems Group too. Okay. Thank you very much. Seeing no other Public Comment, commissioners . Thank you for the presentation. We in the beginning i also know about all the challenges to house the homeless especially those who have Behavioural Health issues. The challenge back then, and i anticipate this might be the challenges once theyre housed, they dont necessarily open the door for you anymore. So the issue of engaging them kind of shifted, but im glad to see that don nursing is part of the plan. They wont open the door for the case managers, but they will for the nurses. Glad to see its integrated and this is not just like one specific program, but this is a systemwide approach, you know, a new approach to things. So i am very hopeful with some, like, measured optimism. I look forward to hear your progress and the successes so we can celebrate with you on them. Thanks for your comment, commissioner. I would like to say one of the exciting things about whole person integrated care is bringing together these really different teams and giving them the forum to learn from each other. I completely agree with you, i think the don nurses have a lot to teach us all about engagement, opening doors, trust, and that continuity relationship that really is the cement that allows them to do such really effective work. Thank you for saying that. Commissioner chow. Yes. Thank you very much for actually helping to be so clear about what the whole person care project is and where youre all going. Some of it is probably driven by current events, but the fact that youve been working on this 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 se