Transcripts For SFGTV Our City Our Home Oversight Committee

Approve. Member rajeo. Yes. And chair williams . Aye. All right, so we are adjourned. It is 4 33 p. M. Thank you, everyone, for sticking with us and well see you tomorrow. Thank you. Bye, everyone. See you tomorrow. The meeting is closed. Just want to notice we didnt have. Can you call the roll . Im going to read my script first. This is held by web x modifying requirements for inperson meetings during the coronavirus disease emergency. This committee will be convening remotely until the committee is authorized to meet in person. Public comments will be available on each item. Each will be allowed three minutes to speak. Comments during the Public Comment period are available by calling 14156550001. Again its 14156550001. Access code is 1469968636. Then pound and then pound again. When connected, youll hear the meeting discussion, but will be muted and in listening mode only. When the item of interest comes up, press star 3 to be added to the speaker line. Speak clearly and slowly and turn down your television or radio. You may submit your Public Comment by email and it will be forwarded to the committee and included as part of the official files. Please note this meeting is recorded and will be available at sfgovtv. Org. Great, member andrews . Here. Vice chair dantoni . Yes. Friedenbach . Here. Haines . Member haines . I see. Let me move on. Member leadbetter . Here. Member miller . Here. Member nagendra . Here. Chair reggio . Here. I see a thumbs up. Great, we have quorum. Welcome everyone to day 2 of the our city, our Home Oversight Committee retreat. Were going to Public Comment. Is there any Public Comment at this time . Members of the public who wish to provide Public Comment on this item should call 14156550001. Access code, 1469968636. Then pound and then pound again. And if you havent already done so, press star 3 to line up to speak. Wait until the system indicates youve been unmuted to begin your comment. You have three minutes. Checking the list now. There are no callers. Thank you. Well move to item 3. Discussion on analysis of gap Tropical Storm in the Behavioral Health system. Well hear as it relates to gaps. A review of mute your line. As it relates to people experiencing homelessness and gaps and possible action by committee in response to the item. I want to say the Mental Health sf item, supervisor ronen was supposed to be here for that, but called to another committee hearing. Were going to postpone the Mental Health sf presentation and well get to hear from dr. Nigussebland and others for the first presentation. Ill turn it over to dr. Nigussebland. Will you send me the most, so i can share. Thank you so much, chair williams. Im pleased to be here. Its nigussebland, so youre very close. Thank you very much. We have the director for Behavioral Health services, Marlo Simmons. And well be jointly presenting marlo will be sharing an overview of the Behavioral Health services. Ill be updating as it relates to the mayors efforts. And then well conclude with thoughts about opportunities for continued investment in our services as it relates to people experiencing homelessness. Im going to turn it over to director simmons to begin the presentation. Welcome, director simmons, thank you for joining us. Can you hear me . Great. Thank you, dr. Nigussebland, for starting us off. So our request was that we provide a little more detailed information about some of the financial picture and specific programs and talk a little bit about some of the gaps we know exist in our system. I imagine there probably will be a followup and more detailed data that will be requested around specific areas. I think as i go through especially the first few slides, people will have a sense of how complex our system is. And so if a request for information, say, where are people discharged from a program is made, well need to know very specifically about like what type of program are you talking about . What kind of discharge . So there is a lot of detail that we need to discuss so we can get you the data that you need. So ill go to the first slide, please. Thank you. Actually, im sorry. Can we go to the slide before that . Perfect. So well go through some of the b. H. S. , dr. Nigussebland is going to go through the Mental Health reform work and then well start to talk about how that all folds together into a future investments were recommending. So next slide. Ive gone through some of this at the last presentation i made, but to provide very brief framing for people, again, our system provides services along a broad continuum from prevention, Early Intervention, all the way through locked facilities and placements in State Hospitals. People come in to our system through a lot of portals of entry. One of the challenges we have in the system is that there are certain gaps in the number of services we have, so we know we need more intensive Case Management, we need more residential treatment beds. We know that housing for the people coming out of the program is key. We know that people have a hard time navigating the system, so were building in more support and structure for people to navigate the system to get to the right door at the right time. And then to move through the levels of care as they make their way toward recovery. And just as a reminder, in addition to delivery services, Behavioral Health Services Within the public of health, we operate two plans. We manage the medical clients, the medical care plan and the disorder system which is a different medical care plans that add to a lot of the navigation complication. Then we have our Health System where were delivering services. And then our Health Promotion and Early Intervention services are also very complicated network, which we believe we can leverage to do a lot of the work that we hope to get done over the next few years. Next slide. My internet is a little bit slow. So if you think about the triangle that was on the previous slide, that is really an oversimplification of our system. So im going to go through some of the Mental Health services we have and then a range of Substance Use services we have. And again, those systems primarily because of laws around privacy, how the funding comes down to the county, and the structure of the different managed care plans, the link between Mental Health and Substance Use, we have been working on integration for the last 10 years, but there are a lot of barriers and were far from an integrated system. But we know that even though, for example, Mental Health sf is called Mental Health, Substance Use is a huge issue and were working to develop Program Proposals that address Substance Use and really focus on a Harm Reduction approach. On the Mental Health services side, we do the outpatient programs which are more traditional, therapeutic services. Intensive Case Management and sole Service Partnerships. And thats an area we know we need additional services. We have about 200 people waiting on waiting for the services right now. So we need to expand those. Crisis services. Again, were building a Crisis Response team which well talk about later. And we have kind of range of ways where we interact with people that are in crisis. Residential Treatment Services range from 90 days to 12 months. Private provider network, individual providers that generally do outpatient services, but theyre individual private providers to provide services. The acute Inpatient Services provided at the hospital. And then longterm care is where we have folks that are placed in state care or longterm State Hospital stays or other subacute locked facilities. Next slide. So youll see that the Substance Use disorder set of services is as robust. Weve done work over the last few years to really build out a more robust system. Having to follow a lot of the state regulations and state rules, but a similar kind of path youll see in the triangle as we have prevention programs really being aware of Harm Reduction is the best approach to doing Substance Use services. We also need to do screening to identify people. The helping people with medication assisted treatment. Its one of the more well known and something weve done a lot of work over the last couple of years to expand access. And we also do medication assisted treatment for alcohol use disorder. Withdrawal management. So in a similar way to Crisis Services on the Mental Health side, detox and Sobering Center are similar kind of crisis programs where ideally people wont need level of care and we want to prevent utilizing care at that level. And then we also have outpatient and residential. We have very few beds in our system that are technically able do both, but we know moving forward we need to build programs and have that capacity. And then residential stepdown is a relatively new model where for us in San Francisco, where we recognize that a lot of people coming out of residential treatment, being discharged to the street is not a way that youre going to help someone maintain their recovery. And so we know that in fiscal year 1819, we were stepping down about 27 clients per week who were leaving residential treatment and being discharged to the street. So a residential stepdown is a merging between housing and treatment. Its a place for someone to go so youre not discharging them back to the street. Next slide. And so this is a slide i shared before, so again ill go through quickly. We do sole age range from birth to death. One of the takeaways from this slide, Behavioral Health Services Already serves a large proportion of people experiencing homelessness. We see that number is even higher in the Substance Use treatment system and then it even higher percentage is up to 71 for people who are served in both systems. So we know kind of people who need multiple services have complex needs. And we want to make our services more available and accessible, make more of them, but also really need to focus on making sure the services are effective and helping people to achieve their treatment goals. The next slide. There was some requests for information about the demographic information about the clients that we serve. So this is an overall picture. Again, you can tell, imagine from the list of Mental Health and Substance Use services, that we need to be very, very concrete about which kind of datapull we want. And so we look forward to working with you to get you the data you need. So the Mental Health clients, this shows excuse me the breakdown of gender identity and then across the board ethnicity breakdown of people served in both systems. So youll see that there is an overrepresentation of africanamericans in our system relative to the population in San Francisco. Definitely a population we need to serve more effectively. The next slide. So again, there was a request for some kind of breaking down more of what number of people were serving and which time of program. We definitely have different ways that we can cut the data, but this slide shows for some of our kind of big service categories, the number of unduplicated clients that are served. And we our data of this status of peoples housing certainly has opportunities to be better, but this kind of gives a general sense. Again, youll see when you look at services in Substance Use, withdrawal, those services you think of as higher level of crisis, were seeing a higher percentage of people experiencing homelessness in those populations. But then when you look at our outpatient programs, you see a much lower number, which can mean lots of Different Things, but i think its pretty clear to everyone that access to these services is a challenge. And something that we need more lower threshold programs to better integrate services into places where people already are, such as Supportive Housing sites and shelter and more access on the street and in dropin programs as well. Again, just trying to tell the story of how complex our system is. I have a few slides on of the financing. If we want to talk details, we have to talk about exactly. B. H. S. Has 40 Funding Sources from federal level, state level. We have work orders from many different city departments. We have grants. So if you can imagine, you know, that we have 127 contracts with 89 communitybased organizations, and those communitybased organizations operate over 400 programs and those 400 programs are funded with 30 different Funding Sources, trying to figure out what exactly people want to understand about our system, its a complicated story to tell in just one presentation. But we can definitely get into more detail. We have 800 Civil Service staff that are funded by Behavioral Health. About 200 of those are that report into Behavioral Health, theyre part of the contracting system, the fiscal system, i. T. , all of the enabling organizations that are part of their Business Office and other parts of d. P. H. Next slide. So this is a quick overview of the money picture. So youll see on the left that our Mental Health services for adults and older adults is the largest portion of our budget. We have a childrens Mental Health system which is about 87 million and then the Substance Use disorder system, which represents about 16 of our budget serves all ages. Mostly adults. But does have some Prevention Services for children. About 86 million. The next slide the next chart, the pie chart, shows the different sources of funding. And some things are rolled up, because again having 40 things on a pie chart makes it difficult. So this is a big picture. Youll see that the prop c funding is going to be a very large percentage of the b. H. S. Overall budget and a lot of work still to be done about how that funding is going to be allocated. Next slide. So this slide shows a little bit about how one thing about our system, is that we, the Civil Service system, the cityemployed staff, operate about a third of the programs that we services that we deliver. And then we contract out about twothirds. And so this and what this slide is a little bit funky because the propc up here, this 18 , its included in here because it is money that we will expend over time, but it isnt yet clear because were obviously working on the details of what percentage of that will go to Contract Services versus Civil Service. So this slide ace little bit funky, but if you do a revenue and expenditure slide, you want the two pie charts to match. We included that just because of revenue coming in. And we need to start planning for these expenditures. And one note about the contracted services, all of our Substance Use services are contracted out. And on the Mental Health side primarily Civil Service provides outpatient services. All of our other than what happens at San Francisco general hospital, all of our other level of care is provided through contracts as well. So our contracted partners are a critical part of our system. Next slide. So there was some question and interest in knowing more about our outcomes. And, again, im hoping that people will have taken away that we need to know exactly which programs do we want to know about. I wanted to provide an overview that we do track different performance metrics. Some of these we do better than others. And there is opportunity, i think, across the board to improve what we track, how we track it, and how were reporting out and being accountable for the use of public funds. So we currently track access to care. We do have clinical outcomes. Ill talk briefly about those tools on the next slide. A lot of what we track is required by medical. I think i said this in the last presentation, that medical, much of the system is medical funded and with that comes a certain level of Regulato