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 FranciscoFamilies 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 HealthCare 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 a