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 serving them, we assessed them, we prioritized them, the 1,000 people doesnt necessarily mean that the other folks are not vulnerable in any way, but what it says is its a very complicated department of homelessness with h. U. D. Methodology for how many beds or homes they project to be open with some sort of like how you book a plane, they assume people will drop off, which is true, some people have dropped off. Thats where the 1,000 comes from. Good. Thank you. Im looking at a client standpoint. We have a nice chain thats put together to integrate and understand the client, often it seems to me the client actually responds better if there is sort of an individual that they feel is their advocate or their person or their doctor or their is that how were going to also be assigning that somebody will sort of be your key contact and someone that in case you go into crisis, have an issue where you would like to pick up the phone, there would be somebody they could talk to . There could be an individual assigned point person. Yes, some of them are already engaged with an intensive case manager, some of them with Case Management through the h. U. D. Team. So there is a commitment that we will have a streettohome plan for 135 of them, go find them and find out what they really want and what their real needs are because we dont have enough information about them. Thats where the highintensity care team is critical to get those folks. The other folks, there is a commitment through the Center Agency that they will prioritize Case Management of some sort. So we have the navigation case managers who will help them navigate through it. If they have a higher case manager, this navigator might not be necessary. If they have an intensive case manager, that might be a different route for them. The idea is who is the person and how do they get from here to there. You have a twopronged approach and some are already in a relationship with their case manager. Youre thinking there are 135 that you really need to work with and decide what they need . Right. Very good. I guess lastly id like to know what wed think would be a good way to be able to track how this is coming if this is such an important program. What would you all be suggesting in terms of a follow up and at the right time . Do you think six months would be good to bring Something Back as to where we are . Does that make some sense . We show up anywhere and talk to anyone about and we can talk for ever about it. Okay. Id leave that to staff to schedule. Commissioner green. Yes, thank you. This is incredible, the work youve done and the effort youve put into this, very optimistic. I was wondering whether you could tell us a little more kind of what commissioner chow was asking about when you think youll be able to gather data. Especially on some of your outcomes. For example, you can put people in housing, yet whats your benchmark for how long they stay there . I think that new england journal article said there was a pretty impressive percent that stay there one to two years. Do you develop your targets in some of the areas youre looking for outcomes, targets for avoiding e. R. Targets and quality of life. How long do you think you will get data and assessing the data. And correlating that with the center not opening for two years and with the staffing you may need to be successful as well as the physical placement for individuals. I gather the Tipping Point opportunity is great, but im not sure how all the timing of all that fits together. Can you elaborate a little more on that . Because it seems like you could be facing barriers with regard to the staff that could both give inadequate care for the patients as well as the placement. And then what about, given those things and the potential funding issues, where you think youll be able to really give back information, you know, on your 237. We dont expect you to boil the ocean, but it would be interesting to know what you think. I would say that the 237 we will have the dashboard that they were creating in about a month. Theres about 29 of the folks who have already been housed in it. So we are trying to, together, get them from here to there and figure out what is stopping them from getting from here to there. The real difference here is that health is showing up and saying that we are there to figure out how to get them services that its a housingfirst model, but is there something that they need before they can get in or after they get in to keep them there successfully. So i cant say one, we need to know more about the 135, but all the 237, except for three unfortunate folks whove already passed, all the 237 folks have had they say, i want housing. They showed up somewhere and said, i will answer your questions to try to get into housing. They are definitely motivated to get there, but theyre also experiencing psychosis and theyre not necessarily always regulated to be able to get from here to there. So were trying to figure out how to do that and what level of care is needed to help them do that. I dont know if we can say right now that were going to house all of them. Certainly we have three months before we start and get reflective about is this the right approach to it. So i dont know that i can safely say how many of them will be housed. Can i go so far to say half . Maybe. Did i answer all your questions . Im curious to know more about the data you plan to gather, when you feel you might have some results. And again, whether you feel there will be barriers in terms of staffing and actually physical placement that might slow down your progress. So i think what youre getting at with the whole person care funding ending in 2020 and our target date to open the Homeless Health resource center, which will be the clinical home or hub of whole person integrated care, that will be in late 2021, so within the next year. I mean, what this really does is it i dont want to overuse the word foundational, but it lays the foundation for us to be working together across Clinical Services to determine what the need is for people showing up to urgent care repeatedly, but they might have one of the Street Team Members or the hot case manager working with them. What it does is brings people together to develop a care model so that theyre actually coordinating care for these folks. Were starting now. Weve already started this work, so were already starting the case conferencing and then working across these existing Clinical Services with the whole person care team on the shared priority list. Thank you. Director cofax. I want to thank both dr. Hammer and ms. Martinez for their incredible work on this and just to emphasize that the literature shows that people suffering from these conditions with support and not as much support as some of us might think is necessary can be housed. I think one of the wonderful aspects of ms. Martinezs leadership is shes brought in a number of researchers and clinicians from ucsf, several of them leaders in this field to bring in a healthbased aspect to this work. This is an effort thats going to be saving lives Going Forward. I mean, the specific when we open hub and how that happens are important pieces. I want to emphasize we are doing this now and Going Forward. This is really a continuation of our modernizing our system of Behavioural Health care in response to data so we make the investments Going Forward to get those people in the housing and get them the Wraparound Services we know they need. Thanks. I wanted to add an example of that, commissioner green. So just as an example of this sort of working across previously disparate services is we have a psychiatric nursepractitioner from the Behavioural Health access team who now basically has jumped and is embedded working with the street medicine team. Thats just an example of bringing our staff together who all touch in different ways this patient population, these patients, these individuals theyre not all patients, and connecting them to services. So he has in a expertise that he can assess people on the street and is an expert in access and how to access our services. So first of all, ms. Martinez, dr. Hammer, i would like to associate myself with the comments made by fellow commissioners about your excellent presentation. Thank you. Since youre nimble going back and forth on slides, i had questions on three of them starting with this slide here. I know our focus is on Behavioural Health and Substance Use disorders now, but noticing on the slide that 74 have a serious medical condition, 12 h. I. V. aids, 35 hypertension, 4 renal failure. Skipping forward three slides to this slide here and looking at the coordinated entry assessment, im wondering at what point do these factors enter into prioritizing people for housing and other things . Because as we know, housing stability contributes to Better Health outcomes, whether its someone with h. I. V. And adhering to their regimen, Blood Pressure monitoring, sticking to a diet, those things are very important. Does that come into the Assessment Tool at all . Yes. And also skipping forward a few more slides to the outcomes, is there anything in the outcomes that youre measuring when it comes to Health Outcomes when it comes to these other conditions people have . Good point on that last question. I would say that when i first looked at the coordinated entry Assessment Tool, i know all of the 6,000some people who have been assessed and all the 1,000 of those people who were prioritized. So essentially what i did is i looked at what the data said. Did they assess a pretty good representation mix of who we know are experiencing homelessness . Yes, on every single count, the representation of the people in the jail, also the people who so like 25 of the general population have a jail history, about 25 of those assessed had a jail history. I looked at about 14 or 15 of those vulnerabilities, and all of them were very well represented with the exception of psychosis, and that makes sense. Then i looked at who got prioritiz prioritized and it was significant higher. One of them was medical. So significant higher of those who did get prioritized showed up. So their tool is identifying through the questions they ask, which does ask about some medical conditions, are identifying and prioritizing them and the way we wish to see it with the exception psychoses, and we will be working with them. Also, i believe i had seen a previous presentation getting to zero on this Assessment Tool. Do i understand correctly you dont draw the curtain all the way back on what the criteria are because sometimes someone whos working with an individual client, for example, might coach answers to advantage somebody in the yeah, i think that there was a lot of suspicion around whether or not the tool asked the right question, did the right ranking, whatever. What i have experienced is that is sort of set aside. When i said no, i validated the how many people were assessed, representative, and their vulnerability, and i don