Shared but not heard sometimes. I really hear you and the more we look at the data the more we see prioritizing seniors and people with disabilities is crilesh. The mayor issued a executive director on vision zero reaffirming our commit in august and the item that has a lead on is doing what you are describing for a deeper dive of analysis for seniors and people with disubltds and youth. We did a survey of organizations serving seniors, people with disabilities and youth this fall and we broke our survey account and had to subscribe because we had such a good response. We have over hundred responses. [inaudible] leads our safe streets for Seniors Program as well. Ona i dont know if you want to say anything about your workshops. Would you like to come up and make your comments so wethank you. And identify yourself. Anna [inaudible] with the health department. We have done about 16 to 18 presentations at different Seniors Center across the city on high injury corridors including the ones mentioned in the mission, central latino and the one at Mission Neighborhood center and we heard that tradeoff issue between wanting to be safe but also the issue about bus stop removal and funneling the nrfshz back to mta to incoperate seniors concerns. I doment want to add we heard from one of the seniorsenters it was a Spanish Speaking only presentation where the seniors requested automated cameras in the mission and why we didnt have that and had to explain we dont have state approval so that is something we are also taking back to mta. Thank you mpt commissioner chung. Thank you for the presentation. There are two things i think it is new year so st. Is fresh in my minds. Every time when there is a new year there is always at least one fatality that is related to like driving under the influence so this year we know that somebody like lost their life to like the same reason. So, are we also tracking to see you know like, if like driving under the influence is one of the factors and the other one i think because there is state law that is going into effect now that we cannot touch our cell phone in the car, so do you think that will have a huge impact to what vision zero . Not in the top 5, driving under the influence is a leading factor and fortunate the state does provide a good amounts of funding for du i enforcement that the sfpd gets avenue year and they do a good job routinely implementing enforcement for du i and we alsothe office of Traffic Safety grants are coming up this month and sf as a part of vision zero will aprive for a distracted driving Enforcement Campaign as well so think both of those things will be up included in the next strategy. Thauj. Did you have a question . Kind of but i dont thinkthe other one is i watch a lot of news. I dopt do any of those things, i dont touch my phone in the car. The other one is when someone having a medical crisis while they are driving and it seems this year we saw more incident that somebody was have agstroke or heart attack and cost a injury to pedestrian related injuries recollect so what kind of message can we give to that because that isnt something you can put a stop sign or like you know a yield sign to control that . I think that is a really good question, it is a challenging question i think for vision zero for me, it kind of fundamentally boils down to how fast is the person drivejug are you driving. Because two people walking and bumping into each other doesntwe dopt have a report of fatalities that i know of. So, i think it is thinking about what alternatives in the city like San Francisco where we have so many people on the streets and know walking has so many Health Benefit physically and mentally as well as cycling and the environmental impacts of driving, how can we better create better alternatives so more people are out of their vehicles and the consequences of a medical incident wouldnt necessarily be death. Thank you. I had two questions, one was, from the information that you are getting from other jurisdictions and it is really sad the numbers continue to go up but that could be a number of factors. But are there factors there that we should learn from and you could describeyou didnt bring any hear but you can bring it next time in terms of Lesson Learned. I would love to do that. The vision zeeree network i was looking today issued a great Lesson Learned from 2016 on the website what they learned from different jurisdictions. The importance of community engagement. I was encouraged and thij their themes are consistent with our action strategy. This was more a observation because we have so few like 31 deaths, is there a change in the composition of where these were . Are they still in the high incident areas . Well 234clude a full analysis of that otour 2016 year end report. We find the High Injury Network is still quite predictive of where we see severe and fatal injuries but we are thank tooz the work that [inaudible] epidemiologists is doing thinking the police and Hospital Data we will update the High Injury Network and better understanding are there corridors dropping off. Are there hot spot said coming up and doing more work to understand that. Maybe you can sort of [inaudible] at the next meeting. The last was simply a observation that i had made also similar to what commissioner shan chez had. On the streets that are wide are there [inaudible] people can stop at . It is not always clear that you could or should stop at those between the lights. Embarcadero is one that very often you cant make all the way across as you rush to the ferry building. It is not really always clear the median stream is the comfortable spot you are supposed to stop at and i would imagine van ness is similar and some of the others, so having put in some of the streets even a median stop, im wondering if that is part of the education that could go on and think this also impacts seniors and all who walk slower. It isnt necessarily to try to make the end of the next street but you might just get partly through and wait for the next one. That may be part of education. Those stops be made more clear as somewhere you could really be pedestrian friendly stopping at. I think that can be a part where there is feeling you should get all the way across the street. So, that was just a observation and whether that was something other places have fond or we could be clearer. Now that we take the effort of putting the the medians are seen as important to service that 23u7ckz. Function. I think those are good ideas to tell people you dont have to rush across, you cant in most cases. Otherwise i think we will look for wrd to your presentation of the strategies you have at our next meetding and we will take up the resolution that you will be proposing. Thank you so much. Sorry, commissioner loyce. Yes, you mentioned in your report you do not count suicide as a part of your vision zero. Im wondering sp there Data Collected on suicide in relationship to the traffic and where is that data deposited and it will be helpful for monetal health sunch services we look at that as a issue. You dont have to have a answer today. When you said that it struck me that it doesnt make sense to add it here but it needs to be somewhere. I think that is a good point and something that we have discussed with respect to institutionalizing the protocol and getting more into detailoffs the fatalities raised other issues. Thank you. Thank you very much. Thank you. Our next item, item 8 is assisted out 237 patient treatment. Aot. Thank you. Let me know if you need help getting there. I think im okay, thank you. Good afternoon and happy new year. Angelica [inaudible] director of outpatient treatment and pleasure to give you a update. I want to start out the conversation by reoriented to what assisted out 37 patient treatment is. It is outpatient treatment aot and not something new to the united states. The First Program was 1972 in washington dc and 44 states currently have existing aot laws, but they do vary greatly from state to state. In california aot became part of our law as Assembly Bill 1421 passing in california in 2002 becoming part of our welfare and institution code. It was a recommendation of mayor lees task force and adopt bide the board of supervisor july 2014. At that point a implementitation committee was convened of Diverse Group of stakeholder tooz talk how to implement aot in San Francisco which well talk about in more detail moment airly. My primarily responsibility of the director up to implementation is insure our community is aware how we implemented aot and conduct strake holder training. I conducted 63 stakeholder trainings to hospital, the jail, peer organizations, peer advocacy groups, patient rights, family groups and anyone interested knowing more about aot. We implemented the program in november 2, 2015. Assistant outpatient in california is rirfed to as lauras law based only laura wilcox. What is unique about the law is adopted by each county and not a mandate to adopt. It is a new tool in the tool belt to support and assist individuals with severe melthal ilmss and families and communities where they live. What it is is the goal of getting ahead of a criseish and supporting individuals with severe melthal illness not engaged in treatment, have a history of treatment non compliance and on a downward spiral. What the law allows in certain circs is allow the individual to participate in the treatment and utilize the black robe effect by the court to leverage someone in the care. In the case of aot, this is Civil Court Order and if somebody 12349 compliant wa 2r50e789 plan they are not held in contempt or arrested and not sent to the hospital unless they meet the 5150. A long term goal is reduce negative outcomes such as reducing hospitalization, incourseeration and victimization. These are counties that have aot programs or adopted programs in the planning implementation in california. I would like to note San Francisco has besxh a leader in the conversation as aot and convened and hold a Conference Call quartly to discuss challenges we are facing, tools for engagement and successes to learn from other counties. The Substance Abuse and Mental Health service adminlstration named aot as a Evidence Based Practice provided feedback for a study on aot and support other counties adopting. How is San Francisco different and how we implemented aot . While this is required by law to offer multiple opportunities to engage someone in voluntary services recollect San Francisco took it step further to make it is a part of our Health Safety so allow 30 days of engagement before filing a court putension but on achberage allow longer than that around 60 day squz that shows the erftd to engage in voluntary services and utilize the court order and petition process as a last resort. San francisco insured we had a care team which is multidisciplinary melthal health team that consists of a director which is psychologist and myself, peer specialist and family leize on. These are unique to San Francisco but many other counties in california followed suit and what we do is embody the principles of recovery and wellness and insure the services are commune tee based individualized and strength based. Move toog discussion of what we saw in the first year of implementation. Again, we started the program november 2, 2015 so this covers november 2, 2015 to november 1, 20s 16. We had 214 goals one 06 chs information only where a individual wanted to know about what aot is and 108 were referrals. 53 of the individuals we had contact with. Well discuss in more detail but as we discussed the program is based on a law so many individuals do not meet the strict eligibility requirements, however all the contacts were able to talk to the poren and provide support and provide information about resource squz the best pathway for treatment. This gives a ovview of the number of referrals we receive each mupth. The first month of impmentation we had 30 referrals which is not surprising. Most were from Family Members and Family Members are a long proponent adopting aot in San Francisco. Since that time it leveled off and on achberage we have 9 referrals a month. Looking at the number of court orders in total in the first year of implementation we filed 7 core petitions. Two of which were extensions of existing core putensions so only 5 individuals that we putensioned the court to order into treatment. The result of those are three resulted in a settlement akbrument where the individual agrud to work with us, three Court Ordered to participate in Outpatient Service and one withdrawn because we were unable to contact the individual. In total 60 percent of the individuals we had contact with accepted voluntary sunchss. The number of core petitions filed is lower than in other counties and speak tooz the uniqueness of our program and care team outreaching kwl engage individuals in voluntary services. Looking at who made referrals, as you can see Family Members and treatment providers counted for most referrals made and total account for 8 seven percent of the referrals. We also received furts from adults libing with the individual and parole agent. We had 8 referrals made by [inaudible] only certain individuals with report to the program but in all the circumstances we were able to work with incaller to figure another person in the individuals life who is qualified requesting party and can make the referral so there wasnt anyone that missed out on the opportunities offered by aot. In regard to the location of refrlts, most originated from San Francisco county accounting for 74 percent of referrals and neighboring counties. One thing we didnt anticipate is we had a lot of referrals out of state and made by Family Member jz aconted for 9 percent of the referrals. These were Family Members contacting us who luchbed ones traveled to San Francisco who had severe mental illness. Mubing to demo graphics who we were working with, orient avenue wn to the graph you are seeing, the top graph which is total referrals we received. The orange graph is who we saw in the program and the teal graph is individuals Court Ordered. Across the board for individuals referred recollect seen and core petition was filed we saw predominantly male. Age of referrals for individuals referred and seen, the age group is between 26 and 45, however we saw a sligetly higher skew for individuals with core petition filed and that fsh 36 to 45. In terms of ethnicity, you can see that we had a Diverse Group of individuals referred to us, however, for individuals referred, seen and core petitions filed were predominantly caication and African American. Wanted to take a couple minutes to talk about reliminary outcomes from the first year. The average length of time we worked with each individual is 124 days or 4 months with a average number of two contacts a week, but this fsh as frequently as 5 contacts a week dependent on the needs of the individuals we are working with. Again, i think it speak tooz the level of intensity och the individuals we work and even if somebody agrews to vaulden volunteer services it takes time to stabilize them and continue in long term care. 40 percent of individuals reported a history of homelessness and 36 month prior to aot contact and at the time of discharge we had 65 percent of individuals housed. Again, 60 percent of individuals accepted voluntary services and time of discharge 62 percent of individuals connected to long term Case Management service. Part the requirement for aot is provide a annual report to state department of minuteal health and that is a may each year. I believe you have a copy of that report see the first report delivered to the state may 2016 and there was a small period implemented, the data in the report is primarily qualmitative, however, 2 gabe gave a great opportunity to provide information from participants as well as Family Members and other support persons and how we can improve our program. Happy to report 100 percent of participants surveyed reported feeling hopeple hopeful about their future and respected by the case manager and staff is trying to support and engage in volunteer services. Feedback from Family Members reported increase awareness of resources and service in San Francisco, however, not surprisingly did report frustration in the limited amount oaf information we could share with them due to confudenchality laws and not able to require someone to traik psychiatric medicine. I had a opportunity to do Data Analysis due to negative outcome. Commissioner chow, i know you wond ered about the 36 month prior so have data regarding the year prior. The reason we use 36 month is that is what the state department of healthal health requires. Psychiatric emergency contactss, each individual had a average number of 7 contacts and the 36 mujt leading up student sth contract with us. Since that time we how shown a reduction in pef contacts. We look at the year prior individuals had a average of 4 contacts and that is less than 1 currently since 6789 what we did for the comparison for the Statistical Analysis and compared the daily average so we look at everything on the same scale. So, the significant r