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 su