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tv   BOS Government Audits and Oversight Committee  SFGTV  October 24, 2021 8:00am-12:01pm PDT

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if we continue with the current sogi standard and don't update it, we can -- it can lead to our sogi data becoming fractured. some departments can ask some questions and other departments will ask others and then it will be hard to compare the data and get a sense of the bigger picture. some other implementation barriers have been around capacity. so we see -- and i've seen different departments from my work. the departments need more support and collaboration from each other to resolve the issues they're struggling with and also to get support on training. so training needs have been really highlighted and while my office has provided some training and some departments have contracted with outside agencies, it still doesn't meet the demand. and then, finally, i just want to highlight the limited
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opportunities we've had so far for community input. we know that lgbtq organizations and communities are really invested in sogi data collection and it would be great to have that expertise and that experience to support our sogi effort the moving forward. so these challenges have also given us a lot of lessons and i think the -- they're great learning opportunities to move forward in terms on how to make sogi data moving forward. so my registers moving forward would be to develop an approach to create an update that can meet the current and future needs. identify additional capacity and work towards publishing accessible and meaningful data
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with lgbtq residents. and that's it for me. thank you for your time. i'll be happy to answer any questions. >> supervisor mandelman: thank you for your presentation today and for all your work with my office and me on getting ready for this hearing. thank you. so were we back to departmental and first up we have the department of homelessness and supportive housing.
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>> good morning chair. good morning supervisors. i'm a deputy director forcommunications and legislative affairs and you'll be giving our presentation today on behalf of the department. so thank you so much for having us. and for listening to this important discussion. i also want to extend a big appreciation to o.t.i. and powell for so much support and help. we have -- it's been a long road in terms of getting this data to the type -- to the quality we need to help guide our services and we're really proud of where we've come and we have more work to do. so i will jump right into it. this slide shows the data over the last three years. we've consistently served households, lgbtq households
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from the range of about 14% to 15% of the households receiving services from the homeless department. you'll see as the whole number of people who have received people have received has grown pretty dramatically by eight households over the past three years. we are aiming to serve 12% to 27% going to lgbtq households. next slide. we are -- you know, in the last -- we are really focusing on within our sogi data collection looking at how our services serve transgender and gender nonconforming clients and we've found over the last fiscal year that about 2% of households identify as transgender and 3% of the households served
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identify as gender nonconforming. and we have seen a steady increase in the number of transand gender nonconforming households that we've served. but this is an area we plan to do more work around going forward and is a great example of how this requirement to collect sogi data is driving our focuses. so we have done a lot of work over the past several years to streamline and improve our sogi data collection. we are now -- we now have data -- a sogi compliant data system system, which we did not before this journey. and we are now collecting this data across the homeless response system. this reflects many years of work, but we now have most of
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this data in our one system, our homeless management information system and are able to utilize this data more readily. as a result of expanded services and improved data quality over the years, the number of households reflected in this report has grown by over 5,000 since 2018, 2019. you'll see not only are we serving more lgbtq clients, we're serving more clients overall. so some of the work that we've done around data quality improvement you'll see reflected here, our goal is to continue to have all of this data into the one system and
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make sure all of the contractors putting data into the system have everything they need to collect it in a culturally competent way. so we did want to include some information about the covid interventions. particularly the s.i.p. hotels and the shelter system that we've built up in response to the pandemic. just over 13% of the households served in the alternative shelter system which includes the s.i.p. hotels identify as lgbtq+. we worked closely with o.t.i. and other community partners to identify people at higher risk of covid within the lgbtq community and refer them into the s.i.p. program. we also worked with dosw to place women both trans and sis
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gender women and so we're proud of the s.i.p. hotels to meet the needs of hily vulnerable homeless san franciscans. so the data is incredible and what it's helped us do is improve access. and we'll talk about this over the next couple of slides, but we expanded multiple programs. we are participating in the
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grand challenges and it helps us ensure we will be able to serve all existing homelessness. we have been able to provide training for staff across the system and really acquired lgbtq-specific providers to outreach to people experiencing homelessness to improve their access to our system. in fy20-21, we also continue to expand access. part of that was investing over $400,000 in coordinated entry services particularly for transgender and gender nonconforming youth expanding homelessness. we also partners with tjip and we have cultural competency to ensure we have problem solving
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at those access points. we are funding additional new rapid rehousing slots for survivors of domestic violence in partnership with the asian women's shelter which does have a specific program for serving lgbtq survivors we opened our first transitional age center. which was higher than we've seen in other settings for adults and youth. and, lastly, our next steps to continue to improve access, we across our system are opening emergency shelters as we move
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into recovery from the pandemic and re-opening jazzy's place at the delores street shelter is a really important priority and so we're moving forward with that with property opening, but also thinking about how we serve lgbtq adults and particularly lgbtq adults. we're also going to be undergoing a community needs assessment to ensure equity for clients of color and lgbtq clients to ensure they are getting access to problem solving prevention and housing services. we are continuing to invest resources in flexible housing assistance particularly for lgbtq who are waiting placement and providing sogi and cultural
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humility training across our systems. it's something we began a few years ago and we'll continue to expand across the system. and sort of lastly, we'll be excited we will be hiring shortly a chief equity officer who will be helping to drive the department equity work on racial equity and lgbtq equity perspective. so we really look forward to embedding equity at every level as well as in the work internally and externally from the department. so i will stop there and i'm valuable for questions. >> supervisor mandelman: thank you, director cohen. i first of all want to thank you for all the information that is in your report. i do think that yours is the department that is taking this
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mandate seriously and that is gathering and reporting data and that's helpful and it shows interesting things going on. i actually have a not sogi question, but the housing ladder program seems very interesting. also seems very sort of gestational. i was wondering if you can take a second to talk about the housing ladder. >> yeah. the housing ladder is intended to be housing that is -- continues to be affordable and subsidized for people who had previously experienced homelessness but no longer need the sort of intensity of service that is are offered at permanent supportive housing. so housing ladder is called step up moving on just about
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too or i guess just did re-open a new housing site at the abigail hotel which will provide over 50 units to continue to meet the affordability of p.s.h., but no longer leave those intentional social services. >> supervisor mandelman: great. i want to congratulate you on getting the chain navigation center open. i'm glad to see that done. curious about the designated lgbtq+ spaces in s.i.p. hotels. how does that work? >> so within the s.i.p. system we created floors designated specifically to lgbtq-friendly or welcoming floors and when we did outreach on the street and had spoke to particularly transgender folks who may have
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had questions about coming in, we wanted to create safe spaces within the hotels. having designated floors for people. it was sort of an opt-in. if they wanted to be on a specific floor, we were able to create sort of microcommunities within the s.i.p. hotel. it wasn't in every building, but it was a practice we wanted to implement to ensure that people felt safe coming in. >> supervisor mandelman: can we talk a little bit about jazzy's place? it was a priority to get it re-opened but what does that look like? what are you thinking about in terms of timing? what kinds of -- you talked about operational changes which i assume are addressing some of the concerns that were expressed by folks in the community about jazzy's place previously not always feeling like a safe space especially for transwomen. so -- >> absolutely.
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so we're continuing to partner with delores street community services on re-opening of jazzy's place as well as the broader shelter as you are aware. jazzy's place is a small designated physical space within a larger church-based shelter in the mission. and i think it's been an incredible resource for the community, particularly for the community in the mission. and jazzy's is the first adult lgbtq shelter in the country and i'm really proud of the work we've done with the partnership on delores street to run this long standing shelter. given its congregate nation that can't be used 24/7 because its alternative day use. we're excited to bring that resource back online probably early in the new year and as well as the other capacity at
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that shelter site. and then we are also looking throughout our shelter system to see if there are other resource that is we can make available and other partners more specifically that can operate shelter with an lgbtq focus. so really look forward to continuing to move that work forward and hope to have something more tangible to share on that front soon. >> supervisor mandelman: okay. thank you. two last questions for you. one, talk a little bit about -- i mean, you mentioned your view of the data is that h.s.h. may be underserving transmen and so you are trying to improve that. i mean, the numbers overall -- i think of serving folks seems
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low especially given we think the numbers of unpopulated transwomen are higher than their percentage in the general population. are you where you should be in terms of serving transwomen? >> no. i think the transgender population generally leaving a disproportionately experience homelessness and disproportionately experiences many of the challenges that exacerbates homelessness and perpetuate the experience and so we do want to ensure that not only do we have specific programming to serve this population, but that all of our programming is welcoming, inclusive, and culturally competent. and so training is a big part of that work but also who we partner with. and so we have expanded partnerships with the lgbtq center with larkin street as
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well as with tjitp to ensure we are creating more accessible pathways into social services. we are not where we need to be i think on this front and that is why we've very recently entered into some of these partnerships and were we're looking at specific reforms within the shelter system. >> supervisor mandelman: and then my last question for you relates -- goes back to that open house issue where, you know, as we dug a little bit, i think the answers that we got at the time was that there just weren't queer seniors prioritized for entry, they weren't in your system. and i think there was a feeling at the time that there was not an indication that there were not queer seniors who should have been in your system, but, you know, the addition work
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needs to be done there. i'm wondering how that has gone. we have another queer-friendly, queer-affirming senior housing building in the works and would love to not repeat that when we open up those rooms. >> absolutely. so we are seeing, you know, increases in the number of queer households for identified clients served and assessed. and we know we are learning and know now around how important it is to have these referral sources coming from lgbtq specifically trans communities to improve access. since the opening of open house, we've launched new partnerships. we are very interested in expanding who operates access points. right. that's the service that really brings people into our system and so partnering with more
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lgbtq specific service providers, certainly more senior service providers, we're looking agent a new partnership with d.a.s., so we can really be serving older adults more proactively will increase the pool of people in these housing opportunities. but targeted outreach, targeted advertising of these opportunities is really important. >> supervisor mandelman: okay. thank you deputy director cohen. have a good day. >> supervisor mandelman, if i could just jump in. i just was wondering your explanation, what's like a pretty big gap just more generally in the numbers between all the data i've seen somewhere between 25% and 30% of unhoused folks are lgbtq and
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yet the data that you're presenting around the services side seems to hover around depending on the service looking at 12%, 13%, maybe 14% of the folks served. and so i'm curious if that's a data gathering gap or an actual gap that we're very significantly underserving the population. >> supervisor, thank you for the question. i think it's both. so the data that demonstrates a very high percentage of the homeless population identifying the lgbtq is taken from a survey that we do of the sub set of the population every year. and we have sort of gradually grown in that area. and so there's some questions about the reliability of that surveyed data and that is why we set sort of the target benchmark for ourselves is between 12% which is more of a
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san francisco population standard and that 27% which is reflected in the pit count and we have -- or this year we're right at 14% to 15%. so we're in had that range but we're not near the top of it and that's exactly why we've recently contracted with so many lgbtq-focused service providers to increase who we are attracting into our program of people experiencing homelessness. and i think, you know, just to add to that, the raw number of lgbtq clients that we have served having increased by that 800 i think demonstrates that we are really reach more people and i think that 27% in the pit count is probably a bit high. so we're doing both ways. >> chairman: thank you. and i think -- and then on the looking specifically at youth where i think the estimates from the counts are what?
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46% or something in that range and i know your presentation didn't break down by youth. but i'm curious if it's a similar gap that we're seeing between the estimates from the broader count and the estimates of folks served. is that something you've broken down? >> so i don't have the exact data in front of me, but we are generally doing better among the youth population. more of our youth providers have really significant cultural competency in serving this population and certainly our numbers are stronger in that area. it continues to be an area for improvement across the board. >> chairman: thank you. >> thank you. >> supervisor mandelman: all right. let's hear from d.p.h. i believe we have dr. blake
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gregory. >> good morning. can you all hear me okay? >> supervisor mandelman: yeah. >> well, thank you so much for giving me time to present today. i'm blake gregory. i'm the primary care director of population health and quality and as mentioned, i'm subbing in for dr. ionna bennett. my focus is primary care and i will certainly do my best to answer questions about other departments, but anything i can't answer, we'll take as a followup. let's get started. we'll go to the next slide, please. and so for today, i'll be talking about the d.p.h.'s programming that we have to offer for lgbtq communities and i'll also be sharing some data about how we collect information on sogi for our patients. we'll talk about some trends over time and also highlight some gaps and barriers that
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have made sogi challenging but also areas where we've been successful and also some lessons learned. and we'll also speak a little bit to the impact of covid on our data and programming. next slide, please. and this is a snapshot just about how we collect and how we're doing with collecting data by department. specifically, as it relates to sogi. and so these are the six sort of departments that exist as part of the dph where we provide clinical service to patients and you can see our highest performance is laguna honda hospital followed by behavioral health. specialty care lagged behind other groups and i'll be speaking to reasons for that in a moment. i think you can see primary
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care, specialty care and laguna honda have increased their sogi data collection rates this year prior to the fiscal year. next slide. and this is some data about the sort of breakdown by department for sexual orientation. and, as you can see here, basically all the data points in flu represent nonsexual hetero orientation. up to 11.4% in primary care. next slide. and this is similar data reflecting gender identity results and so the boxes in green represent the percentages of clients who are nonsis
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gender orientation and that ranges from 0.9% at laguna honda up to 12% in primary care. and so i want to speak now about the history of data collection and dph and how we got to the current state. i think what we're seeing is over the last two fiscal years, our data collection has plateaued and there's lots of opportunities for improvement. as we all know. you know. the last two years have been very usual and challenging for the d.p.h. half of 2019 to 2020 was spent on emergency response and this whole past fiscal year we have been consumed with pandemic
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response. and some of the downstream includes understaffing. having to rapidly pivot practically overnight in march 2020 which impacts the flow and how we collect this data from patients. and then just a drop off in the overall member of visits that are conducted in person as opposed to telephonically. before we had the pandemic, our system had another major disruption when we transitioned to epic in august of 2019. and so that has impacted both our legacy data and also our, you know, work flows to collect daily in our new h.r. which is epic. nevertheless, we have tried to hospital our work flows.
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we focus a lot on training our staff and emphasizing data collection. we have tools to give staff feedback on how they're performing with sogi data collection which allows managers to do more coping when the procedures need to be more closely followed and we are advocating for more analytic support to return to our areas of data improvement. >> clerk: i'm sorry to interrupt, mr. chair. that was the 5-minute presentation fyi. >> chairman: do you need a minute or two to wrap up? >> yeah. if i could have one more minute. i'll go very quickly. >> chairman: thank you. >> so we'll go to this next slide. just very quickly. in terms of how we're responding to this impact of our data, as i mentioned, we are doing a lot more staff
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training and also, you know, trying to beef up our in-person visits and adapt our work flows so we can more accurately collect data. next slide. and just a quick overview of our lgbtq services. we have special clinics to serve these clients across all our services and the dph. some of the barriers i've mentioned to you include the disruption moving to h.r. and all the disruption that's happened to our normal clinical services as we try to mitigate our emergency response. next slide. and this is some data citywide about covid cases and deaths. just very quickly, i think the highlight from here is that we have a big data gap for various
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reasons. sogi is not as consistently collected and this citywide data, some of that may be because lgbtq patients may be reluctant to disclose their status and others relate to variability across different hospitals in how they collect this data. next slide. this is some data by broken down by covid vaccinations and so i think just the big gap to highlight is really we do see a disparity with our transmale patients compared to our other patients and this is an area that we're working on because we certainly acknowledge this disparity and it's really important to close this gap. next slide. and i think similarly, we have this outlier where there's a
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disparity in covid read and requires a lot of focus and our attention which we're strategizing about. next slide. and so just a quick [break]down with this data. we do have gaps because of variable work flows and collecting this data and then we'll go to the next slide and that's all i have. i'm sorry. that was very fast, but thank you for your attention. i'm happy to entertain any questions. >> chairman: thank you, dr. gregory. >> supervisor mandelman: i recognize that everything at d.p.h. has been dramatically impacted by covid and, you
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know, d.p.h. has done an extraordinary job of pursuing that top priority of the city. but it does seem to me like this report is not where i would like it to be and i would assume not where d.p.h. would like it to be in terms of collecting this data. a lot of data's not getting collected. in some ways, it's just kind of hard because we don't know what's going on in d.p.h.'s system and i guess i would like i don't know if you are the right person to answer this or dr. bennett, but you've presented some of the reasons why sogi is hard for d.p.h. and i -- but hard doesn't mean don't do it and i guess what i would like to know -- i mean,
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my main question for d.p.h. at this point is, how do you see getting to a place where you can present us with information that is meaningful and does reflect what's going on in your systems. >> yeah. thank you for that point. i totally agree. we can't make meaningful improvement unless we have data and unless we know where we stand. if it's possible to go back to the third slide. i'm not sure who's driving. on the third slide, i did share data by department about how we're collecting sogi data and the area -- sorry, go back one to number three, please. so the area where i work in which is primary care is lagging behind most of the other departments. i will say that in 2018 when we
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were in a different d.h.r. and we had a lot of focus around us, our sogi screenings were 60%. still room for improvement because we want to get as close to 100% as possible, but hopefully this data highlights just dropping from 60% down to below 40% hopefully highlights the impact of migrating to a new h.r. where not all of that legacy data pulled forward, plus the pandemic where we just started doing many telehealth visits and having to adapt our work flows to doing the screening in different ways. so we have been doing better. in the past, and we've already talked about the barriers and, you're right, it's not acceptable to say it's hard and throw up our hands and so we have to do a lot of pivoting and a lot of adopting, but one of the things like i briefly mentioned in the presentation
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is that we've developed missed opportunity reports in our e.h.r. that's going to allow our managers to do one-to-one coaching for our staff not following the work flow. so that's something we started a month ago. i think that's just one example of ways where we can really enforce the work flows and try to get to the root cause of why we're not recovering and rebounding from this collection like we should be. >> supervisor mandelman: i mean, it does seem like primary care has improved, it's just at such a low level that i'm not sure how useful that information is. you do reports on folks at laguna honda which is really the only data collector that seems to me where you have useful information kind of because you are at least apparently asking the question. if that data is correct, laguna honda is dramatically
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underserving queer people. i don't know. i think all of this is concerning to me where d.p.h. is with regard to this sogi data and i hope we're in a -- i would hope and expect that d.p.h. is in a better place next year. we are fully five years since this legislation was enacted. two of those years were covid years, but i think we -- this needs to be better going forward. i don't know. it looks like my colleagues have some comments too. >> chairman: supervisor chan. >> supervisor chan: thank you, chair preston, and thank you, supervisor mandelman, for calling this hearing. this is my first time reviewing sogi data, so i am going to try to have a better understanding. while i am learning, you know, the challenges that d.p.h. is facing collecting the data, i
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think i want to add one more layer in your data collection approach. you know, i think that there are also lgbtq and trans communities for people who may have language challenges. this could be on role. so i guess the question is that are the data being collected in english or are they actually of the languages being used to collect this this data so that it's and it's also wider range capturing a larger population that we may not otherwise capture if the data is only collected in english. >> thank you so much for that comment and i completely agree
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with you. language concordance is a huge value and priority for us. i don't oversee the other departments, i'll have to take that as a followup. i'm not sure what the work flows are for laguna honda and behavioral health, but, please let me take that as a followup and get back to you. >> supervisor chan: i appreciate it. so i agree with supervisor mandelman's concern about, you know, that we're not going enough as it currently is. so i don't mean to add another layer to say, you know, not only as it currently is that we're concerned about how it's being collected and lack of. if i were to add another layer, you know, about language access and to think about serving those who are not only facing a lot of challenges that the community already faced, but to add a layer of language, you know, in terms of providing
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this data. >> absolutely. >> supervisor chan: it's something that we need to look at. >> thank you. >> supervisor mandelman: chair preston, if you don't have any -- you're good. >> chairman: yes. you can proceed with your next presenter. >> supervisor mandelman: great. all right. well, thank you, doctor. i do think as i did say, d.p.h. is a little bit on trial today at least on this issue and i think -- hoping that the department can do better going forward. so thank you. and, with that, we will move on to m.o.c.d. and i think we have cory woo. >> hi. can you hear me? >> supervisor mandelman: yes. >> okay. i'm going to try to share my
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screen. can you see our presentation? >> supervisor mandelman: yep. we see it. >> thank you. good morning, supervisor mandelman, supervisor preston, and supervisor chan. my name is cory woo. we are here to present the sogi data for fiscal year 2019 and fiscal year 2020. maria benjamin, deputy director of home ownership below market rate home ownerships are also here from mohcd. we want to first thank you for having this hearing and thank you for the opportunity to present mohcd's sogi data. hang on one second. let me figure out how to advance my slide.
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okay. collecting sogi data is probably now more important than we've ever seen. the data shows that lgbtq americans have been hit especially hard economically during the ongoing covid-19 pandemic. for example, 33% of the lgbtq population and 32% of the transpopulation lost their jobs in the months before the survey was conducted. i think the data is available down to the state level and the proportions for this data point for california are a little higher for both lgbtq population and non-lgbtq population. this data is from the housing poll survey which is conducted every several weeks to examine the pandemic's effects on peoples' lives this year.
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the census bureau has been conducting surveys like this for over 80 years, but this is the first one to ask about sexual orientation and gender identity. i'm going to move to the next slide. and this one just talks about an overview of mohcd's sogi data collection. so we currently collect sogi data for all of our applicant and client-based programs which include the public -- i'm sorry. this is the wrong slide. let me go back. okay. so the programs include our public services program. all of our housing programs and the home buying programs. the sogi report also includes sogi data on our affordable housing portfolios. as well as the inclusionary
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ownership portfolios. the sogi data that we have for our housing portfolio households is primarily for new renters and owners since the sogi legislation went into effect. [please stand by]
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>> what is your gender and how do you describe your sexual orientation. beginning last year december 1, 2020, we added the two questions, what gender pronouns do you use and by what name do you wish to be called. in response to supervisor chan's question about language access, mohcd intake form for public services and housing application, the application are translated in other languages. i don't have the specific ones, i know for sure spanish, chinese and filipino and more, may be. i wanted to address that.
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the next slide is a summary of sogi data by program area for fiscal year '19. last four rows on the bottom below the total row are subsets. for example, presenting housing numbers are rental housing application numbers. across all mohcd programs, the proportion of clients identified at lgbtq was 13%. the proportion identified at transgender and gender non-conforming -- >> real quick, that's the five minute presentation limit. >> supervisor preston: i realized that the time is tight. we have so many departments. if you can wrap up in the next two minutes.
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that will be great. >> i have six more slides. this is the same slide for fiscal year 2020. proportions are very similar. it's about 13% of clients identified at lgbtq. similar but slightly higher, 13.2% and then 1.4% for complaints identifying as transgender, gender non-conforming compared to closer to 1%. next slides presents that specifically targets the lgbtq community. for services. this is for fiscal year 2019. we have seven of these programs. you will see that the overall proportion of client served by projects identified as lgbtq was a lot higher than the overhall mohcd programs. this was about 49% with range of
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100% by project. next slide presents the same types of projects, the ones that specifically targets the lgbtq community. this is for fiscal year 2020. the slide before was fiscal year 2019. all seven of the projects that were funded in 2019 continue to be funded in 2020 but five projects were added in those five projects are highlighted in yellow there. next slide is sum raise -- summarize number and proportion of clients identify as lgbtq for each the past three years starting with fiscal year 2018. the third row there is showing
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the proportion clients served that identified as lgbtq has increased each year. you'll see there from 11.8% fiscal year 2018, 13% in fiscal 2019. similarly, for proportion of clients that identify as trans, we also see an increase each year from about under 1% in fiscal year '18 to about 1.2% in fiscal year 2019. then juan -- 1.4%. as sogi data, last row shows if fiscal year 2018, we could not determine sexual orientation and gender identity for 28% overall number of clients served by
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mohcd program could not determine include responses in which the client answered or did not respond to both sexual orientation or gender identity question. or a response that did not specify a sexual orientation or gender identity in the blank box. the proportion could not determine went down from 28% in fiscal year 2018 to about 15% in fiscal year 2019. which is going in the right direction. unfortunately, went back up to 26% in fiscal year 2020. we think that this increase in proportion between 2019 and 2020 is likely in part due to the covid-19 pandemic and because of our partner agencies have been to quickly pivot services to meet the needs created by the pandemic as well as having to
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pivot service delivery in in-person to remote services due to the public health orders. we also identified couple of partner agencies that had high proportion of clients which sogi data was missing. we tried to reach out to partners and provide training and technical assistance around client demographic and entering data into the data system that we use for grants management. in summary, success is include a significant number. about 22,500 in fiscal year 2020 and significant proportion about 13% in fiscal year 2020. overall applicants and clients identifying as lgbtq. another success we would say are investments in 2020 in the five new lgbtq focus programs that we described earlier in the
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presentation. in terms of areas of improvement for us, the need to continue to take additional steps to ensure that mohcd programs and services are more accessible, especially to trans individuals and especially for the program areas in which the proportion of clients that identified a trans is very low or zero. another area of improvement is the need to continue to improve the quality of sogi data through training and technical assistance for our partner agencies. we did earlier this year, work with office of transgender initiative to develop a slide deck and that's posted on our website. sorry, one more slide. last one is intended to be overview of any covid related sogi data that our office
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collected and any programs that our partner agency distribute to the lgbtq community in response to the covid-19 pandemic. services specifically for the lgbtq community continues to be provided through the 12 lgbtq focus projects. also i mentioned earlier these services were quickly adjusted to meet the needs of clients during the pandemic and we're also adjusting from in-person services to remote services to meet the requirements of the public health orders. thank you again for this opportunity to present our data and three of us were available for any questions that you may have. thank you. >> supervisor preston: i want to appreciate and applaud what appear to be upward trend both
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in the collection of sogi data and serving lgbtq people, although, i am concerned about that 1920-2021 increase in the number of people who appear to be declining to answer or who are not asking or whatever is going on there. generally -- potentially seems positive. it's little hard when there's that dip in people who actually getting information from. i wanted to talk about the housing subsidy program targeting lgbtq and hiv positive folks. what are some of the challenges with those programs?
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>> good morning everyone. i'm the public services manager with mohcd. subsidy programs have been successful. there are new programs that took some focus assistance in getting launched. i think at this point, they have been very successful program in serving the trans community. >> supervisor preston: not exclusive to the trans community? >> yes. >> supervisor preston: you spoken about the scare to do more to better serve trans and
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non-binary people. sort of establish that priority and something you want to work on. do you have specific ideas or plans for how you're going to do that? >> let me jump in. good morning, i'm maria benjamin from mohcd. we're really working hard on -- working with our leasing agents, properties managers and case managers on cultural competency and increasing their marketing ability to our target population throughout san francisco. one of our target populations are the lgbtq communities
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particularly trans and black trans people. we have pretty much -- we have a lot of training that we provide our partners. incorporating cultural competency training into our regular programmatic training is something we're beginning now. including more comprehensive outreach to some of the communities -- some of these agencies that we're working with that might not know about the opportunities that are available to fully understand the opportunities available to the trans community. we're going those efforts and we're constantly evaluating and
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making and adjusting and moving pieces. we will continue to do that. >> i was going to echo exactly what ms. benjamin said in terms of looking at the data, we can look at each partner agency and the projects that we're funding. look at to see some of them is missing sogi data. if it's not missing data and it's showing they are not serving trans individuals or lgbtq, we can work with them on outreach and we can look by the area to see if there's program areas where the percentages are lower. those are the additional steps that we will continue to deal with when we need to do better. >> on the public services side, we did do procurement last year.
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we had a very strong portfolio. there's a lot of continuity between the previous year and this year cycle. we did add five lgbtq trans focused projects through the r.f.p. we added a significant number of them. we have recognized this as particularly underserved community we want to put more resources we're serving. then on the data collection said, we worked with sogi to have live training every year. which is excellent. it's not just about why the collection of the data is important, really how to have the conversations effectively with clients.
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they've been very effective. definitely wanting to continue to do that every year with our grant portfolio. so much of the data collection issue is around cultural competency and staff feeling confident in how to have conversation in an appropriate way so they understand the reason why the questions is being asked and it doesn't feel invasive. we put some real effort into working with our staff to develop our skills in that area. >> as well as information the public sees when they're filling out housing application on dalia, we worked with digital services to word the whole
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section in a way that people understand why we're asking for the information and we're noting about -- we're trying not to be intrusive in their personal lives. we evaluate that as well. if the numbers go down, may be we need adjust how we're explaining it. >> supervisor preston: thank you all. we'll check back in a year. with that, we should bring up department of children youth and their families. >> thank you supervisor mandelman. i'll be presenting our sogi data for fiscal years 19-20 and 2021.
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thank you for this opportunity. we provide grants and nonprofits to the after school program, enrichment programs and other services to children youth and their families in the city. we establish reporting requirements for grantee which they collect and report information about their activities and their clients into our online database that we call c.m.s. our approach has been to collect individual data that serves transitional participants ages 18 and up. for those grantees that serve under 18 we collect sogi anonymously using surveys. when we begin collecting sogi data per the ordinance in 2017, we started with a sub seth with grantees about 15 that serve.
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we started a new 5-year funding cycle. we attribute that drop to the impact of the pandemic. which i will talk more about on the next slide. how did the pandemic impact our grantees and data collection? our grantees rapidly shifted their programs and services to meeted needs of their communities. grantees running after school programs and enrichment programs to help their youth and family to access technology for remote learning, distribute food and supplies to meet bake needs and conduct bonus checks. on a short timeline, our grantees went from running
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in-person program to engage their participants online through zoom and creating content on youtube, tik tok and other platforms. some grantees also helped the staff upgrade to community hub. given our grantees activity, we gave our grantees of option reporting summary data rather than individual data. i will present the sogi data of grantees. this first slides sexual
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orientation 8% identified at bisexual, 8% gay and 66% is heterosexual and 13% declined to state. while we observed drop if participants from 19-20 and 2021. this slide shows that the data with -- from the two years is similar. in 2021, 42% of participants identifys at female, 49% identified at male, 6% identified as transgender, 1% as other and 2% declined to state. we saw decrease in the percentage of participants
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identifying at male and slight uptick of those who identified a transgender. on the next slide, it shows the participates identified at lgbtq. there's a slight drop of participants that identify at lgbtq from 17-18 to the following years. for example, you'll see that the percentage identify as gay, lesbian or gender loving, drops from 14% to 8% in 19-18. it remains around that percentage in 2021. we attribute that drop to a change in the mix of programs that reported sogi data to us. we started data collection with 15 grantees that serve t.a.y. it was the case in 17-18 where
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lgbtq focus. we have seen higher percentage of lgbtq participants. >> clerk: that is the minutes limit. >> ly wrap this up. this slide shows the sogi questions. there's room for improvement for us on data collection on sexual orientation. response rate to the gender identity is -- [ indiscernible ] a challenge with collecting that data for example seniors and
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high schools. we wanted to provide a look the focus programs. this slide highlights the activities of the grantees. in addition to providing grants for direct services, invest in technical assistance for capacity building for grantees. it slide shows the workshops we offer to serve our grantees. the pandemic created some gaps
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in our collection. another challenge that we're seeing is grantee staff turnover. which has increased the need for regular training on data collection quality and practices. we hear concerns from grantee staff about collecting sogi data or department's privacy policy and practices. these are issues that we've addressed in the past through training. there's a need for that training with staff turnover and nutritional knowledge. i'll end to addressing gaps. we plan to look at population
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level data to better understand trends and plan to continue directing funding to lgbtq communities to continue to meet the need of lgbt youth across the city. with that, i will take any questions. thank you. >> supervisor mandelman: thank you. i would note that it appears that dcyf doing better job serving trans youth. that's a positive thing for your department, at least. i want to thank you for the good work you do. i'm not going to ask you any more questions. if my colleagues have any? okay, thank you. we will move on to our last
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presenter. our last presenter is covering two reports. suzy smith from the human services agency and department of of disability aging services. i believe you have ten minutes. >> thank you. why we always laugh. thank you for your support and leadership on this issue. we can't do anything about this problem if we don't understand the problem. really appreciate it. i will give a call out to candace thompson.
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h.s.a. used to be d.h.s. we have over 2500 employees. we have over 60 programs, partner with hundreds of c.b.o.s that serve over 225,000 san franciscans a year. that's just a context an agency that tries to support san francisco cans in all stages of life. their strength comes from being able to connect with services. with the pandemic, we serve about one in four, now serve about one in three san franciscans. today i will go over our sogi data collection effort over the last two fiscal years. specifically the portion of sfhas clients that identify as
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lgbtq plus. talk about our progress in data collection over the last four years. discuss some of our specific programming for this population, both generally and specifically as a result of the pandemic. i will do this in ten minutes or less. we have over 80 programs and we have community partners that collect sogi data in 11 different systems. the difficulty in having a decentralized system, we were one of those agencies. we also have statewide databases that we are mandated to input our data into. there could be some discrepancy in the way the questions are asked. we don't have a practical way to share the knowledge of all the information about sogi complaint data by each of those programs.
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we're trying to highlight the key programs that to the give you a sense of the overview. the following couple of slides contain the proportion of lgbtq plus clients programs. the denominator of those who responded to the sogi question. these next two slides are really key. on the left, we have our major programs and of the respondents, lgbtq plus relates to sexual orientation and it includes clients who identify as lesbian, gay, bisexual, queer or anything besides heterosexual. just for context in terms of the city population, according to
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the san francisco city survey, 12% identify as lgbtq plus we tend to see higher percentages in programs. i will go to the next slide. this is a lot of data. this is the analogous for the proportion of clients that identify as transgender. that speaks to gender identity and it includes clients who identify as transgender, non-binary, gender, queer or anything other than cisgender male or female. for context, 2017, nih student
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estimated about .11% of san francisco adults identify as transgender male. since 2017, ucla study found that .35% of california adults identify as transgender. on the next slide, i wanted to share some of our lessons learned as we've gone on this journey. we are proud to say that our efforts are data collection effort has improved significantly since the legislation went into effect four years ago. some examples of that include age and disability resource center. they have increased portion of accelerates with sexual orientation information from about 50% to 88%.
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big increase there. gender identity is now available for more than 90% of ihhs clients up from about half during the first year of reporting. when we first started only half the contractors submitted a sogi demographic report during the first year after the legislation was passed. now i'm proud to say that we're up to 100% submission. i think the staff uneasiness with collecting sogi data has loosely dissipated. training has been really important to improving our data quality and ensuring that it's collected in a respectful and professional manner. contractor compliance has slipped little bit during the
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pandemic. it was around 97% submitted fy 19-20 and seven% -- 87% in fy 20-21. regular quality control auditing of sogi data is help to identify gaps in policy and procedures and helps us to tweak our training needs. collecting data is the first step. it enables -- this is the area where we need to focus more on equity analysis and understand what's happening and what we need to do about it. this is a lot of text. i'm in the going to go into the details here. this talked about some of the challenges that we've had over
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the last few years and some strategies that we've had over the years. i wanted to share some targeted programs that we have for lgbt plus communities. i'm sure you're familiar with many of years safer-at-homes and open house, they have programs for transgender and adults with disabilities. the focus is building community, addressing unmet social service needs and gender forming manner and referring them to service. for number of years, we've also funded the san francisco lgbt centers transgender employment program, t.e.p. which helps individuals find jobs and navigate employment in
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legal services. lgbt dementia care projects which offers health and social services providers. we fund the lgbtq care navigation and peer support program which addresses social isolation as well as emotional behavioral health challenges. in the next slide, i wanted to share a few of the covid related specific response programs that we've been able to implement in the last year and a half. we use funds for the lgbtq plus communities. h.s.a. was in charge of food
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support programming. we were able to allocate $75,000 in gift cards. those are really interesting -- we were trying to get at communities that had not been served or connected to the social safety in other ways and get money out the door quickly. we learned a lot from that project. they did a tremendous job of really providing gift cards for a population that we wouldn't have been able to connect with otherwise. >> clerk: mr. chair, that was the 10 minutes. >> oh, i didn't make it. >> supervisor mandelman: go ahead and take a minute or two to finish up.
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>> we also exhibitioned with couple of foundations a study lgbtq older adults, looking at their mental health. i'm happy to share that. i will share one data point that was striking to me in that study. which is that nearly 8% of the respondents said they seriously thought about committing suicide in the past year. in general, they found in terms of depression one indicator during -- covid, it increased almost three times from the pre-covid amount to about 13.5%. we were able to fund a fund contractor position within open house which organize volunteers and connected lgbtq plus persons with food resources.
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there's a great leadership marcy and tom and others, we are piloting a mental health pilot serving lgbtq plus older adults and hiv long-term survivors. that's to provide short-term counseling to address mental health crises that were uncovered in the study and provide therapeutic services to people over 50 who self-report depression taken anxiety or trauma related to covid-19. i'm happy to answer any questions. i really appreciate your leadership on this issue. we can't do anything about it if we don't have data. it's been a journey for us. >> supervisor mandelman: thank you. thank you h.s.a. for the presentation and for the work
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that you do every day to serve lgbtq plus people in san francisco. i seen the improvement in your collection of sogi and i want to applaud that and in particular i i want to call that h.s.a. and other organizations like the open house and the lgbt center and the task force have done during the pandemic to provide support to all folks. i will not ask any questions. >> supervisor preston: i like to ask mr. clerk to please open up public comment on this item. >> clerk: thank you. just a moment please.
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we are working with maria and jason pena to bring us public comment callers. if you watching on cable channel 26, you wish to speak on this hearing matter please call in now by following the instructions displayed on your screen. dial (415)655-0001. enter the meeting i.d. 2493 244 7467. press pound twice to connect to the meeting. mr. chair, we have two listeners
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and no one in the queue to speak. we have no callers. >> supervisor mandelman: thank you. seeing no callers in the queue, public comment on this item is closed. i want to turn it back over to supervisor mandelman to you if you have any concluding remarks. >> supervisor mandelman: i have few brief final thoughts. i want to thank o.t.i. for their work and department and staff who presented here today for producing these reports and sharing them with us for their commitments to the need lgbtq people here in san francisco. i seen the progress.
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i am happy for that. i seen areas where i think we can improve. look forward to repeating this exercise next year and having better reports and more information and more clarity particularly from departments that may be aren't there yet. at the conclusion of our last sogi hearing, i thought that number of years passed since 2016 legislation was passed then i still thrill that another makes sense. we did not push saw it during
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covid. -- sogi data has become more complex over time. i still think that working group is a good idea. with that, i want to thank you colleges for getting this hearing your time and tame attention this morning. >> supervisor preston: thank you for all of your leadership on this and should you use to pursue to have half working group, i look forward to supporting it and helping any way i can. i want to thank all the presenters for all the -- this is extremely valuable information.
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this pushes everyone to do administer and in -- supervisor mandelman is it your preference to file that hearing or continue? >> supervisor mandelman: let's file it. >> supervisor preston: please call the roll. >> clerk: on the motion offered by member mandelman this -- --amendment to be filed. [roll call vote] >> supervisor preston: motion passes. next item. >> clerk: a hearing warring the availability of behavioral health services provided by kaiser permanente in the san francisco bay area and california including not limited to patient wait times for
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appointments, length of wait time between visits, efficacy of telehealth medicine. members of public who wish to provide public comment should call (415)655-0001. immediating i.d. 2493 244 7467. press pound key twice. a system prompt will indicate that you have raised your hand. please wait until the system indicates you have been unmuted. >> supervisor preston: thank you. welcome everyone on this item. vice chair chan will be leading
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this discussion. thank you for calling this hearing. i know we have lot of presenters. leave it to you to introduce folks or at least lot of folks to this hearing. and also have representatives from kaiser. welcome to everyone who's here. i will turn it over to supervisor chan. >> supervisor chan: thank you chair, preston. today we really only have two presentations. i wanted to start this hearing by recognizing the work of our
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health service system. the system really ensure that the family have vital healthcare coverage. i know the hard work that goes into putting together the best options that the city can for our workers. we're working within a fairly broken healthcare system. we have have been hearing for some time from san francisco resident who are facing barriers to getting timely treatments. this is a focus of the hearing. since that hearing pandemic has only worsened the behavioral health crises. the reason why our health
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services system provide with us with basic information. this will cover much of the information that has been provided to every one through our letter of inquiry. we will then hear from kaiser as california largest healthcare provider, but also the healthcare provider for majority of our city workers. they are also unique from our other plan providers. they are both insurer and a healthcare provider. we will hear from them about the patient wait time and challenges
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they face. we will hear to better understands experiences, difficulties about the effectiveness on the crises. i hope today's hearing will help us better understand our behavioral health landscape and what we can do as -- for those who are not going to be part of this hearing, please turn off your carn. >> supervisor preston: as you noted, if you're not currently presenting, please turn off your camera. >> thank you.
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good morning but it's almost this afternoon. very informative hearing prior to. i want to thank you supervisor chan for raising this issue again so we can begin to work together to improvements in mental health services. i wanted to acknowledge, this is a rather unique opportunity with this committee structure in that all three currently serving and
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prior members of the health service board and recognize the complexities of the delivery of healthcare services. i think that's a north wore -- noteworthy change. today i will briefly highlight the key findings that we find as a result of the supervisor chan's letter inquiry about mental health services for employees. as we all are aware, there's been a very huge increase in demand for mental health services. over the last several years, certainly in the last year and a half, this is a result of an effort to improve the number of folks that have mental health symptoms or mental health conditions gaining access to services had been grossly impacted in a negative way by
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the stigmaization of mental illness. there's been many efforts over the years to reduce the stigma. so that in itself has been part of the success story. also true that the symptoms of mental illness often appear much earlier than the severity mental health condition itself. it has -- i don't know a single
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person who is not been impacted by mental illness in their immediate family. i want to give pause to the fact that this is an emotional topic. we're all touched by it. i personally, i'm sure each one of you have stories of friends or family who had challenges with their mental health. i think we have to step back a moment to really think about how we're impacting the system, impacting our member as we talk through this to be sure we're providing all the support we can on a day-to-day basis since we build out a mental health service that meet these demandss that are necessary. so that people get the help they need earlier in their illness and in different ways than we have traditionally done.
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i think there's a lot of opportunities for us as we move forward. the key findings in this letter of inquiry, which was a brief superficial dive into this challenging area. one in which we had identified strategically for the health service system as an area we would focus on in the coming years. it's very helpful, supervisor chan, to begin this journey. we recognized that there's really variable data reporting requirements. i'll speak to those in a moment. there's not standardization in the industry at this time for how we measure mental health services. we have a tremendous workforce shortage. this is from years of issues that have compiled. we've get a workforce that's
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aging and retiring and shortage of people in the pipeline coming in and particularly those persons of color and those with adolescent care specialties. the care delivery system -- there's many different pathways that people can seek and receive the cares that they need and understanding that wide array of services is important as we rebuild systems going forward. as supervisor chan mentioned, we have three health plans that serve our active employees and these numbers represent the employees and their dependents. we do have blue shield and kaiser and united healthy serve our active membership. i spoke few minutes about the
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varying reporting requirements. this is little bit about the regulations. healthcare is the most regulated industry in the world. there are lots of regulations. when it comes to mental health, there's a variety of agencies that have regulatory both mandated and voluntary data requirements. they are all over the map. the plans are asked freeway data on their book of business. quays is a very large entity in the state of california. they have other regions across the united states. we purchase not only for the non-reelect southern california but we purchase cases plans for hawaii and the northwest and washington state and others. they're in position having back of business for their state and regulatory agency. it doesn't answer the question about services for our members.
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we are challenged and are working with our health plans to find the right data points that will help us monitor improvements mental health services for our members. that's where we sit with that data. one of the areas where there is commonality and who regulates who, the department of managed healthcare which is california requirement for some of our plans, does have some standards and standard definition around meeting the urgent standards and meeting the nonurgent standards. you can see, there's opportunity for improvement to meeting the
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standards. the workforce shortage t give -- i think we've come to recognize there's a point of solution absent telemedicine and telehealth. mental health and telehealth service have really stepped up. when you think about it, that has expanded the workforce. it has expanded the access to work force. it hasn't expanded the workforce for itself. now with telehealth, in some ways it's helpful because don't have the geographical
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limitations. telehealth helped lot of people gain access to services. it hasn't increased the workforce. it can be deceiving to is see how many telehealth providers are out there. they are all advertising everywhere. [please stand by]
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>> integrating mental health through collaborative care models as was led the way in that primary care physicians can and do refer on a regular basis to their behavioral health specialists. the measurable ... as we stated before understanding critical outcomes based on data
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reporting and patient reported outcomes is an area that we all agree needs to be better a, understood because it is transforming as new evidence comes inon different types of treatment modalities , meaning there are symptom demands of members. it goes without saying we strive to perform best practice using evidence-based treating tools to identify best treatments for particular conditions and thatthis is an ongoing process of improvement and shared learning on progression and improvement for shared conditions .next slide. i found this is an illustration to provide you, and i've spoken about the complexity of understanding the need for the demand on the inside of the spectrum of services and the
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services that can meet those demands whether they be prevention, treatment, maintenance, whereyou are in your recovery whether your in the early intervention or advanced stages of recovery in a very stable environment . all these demands and services are in play when we talk about improving and enhancing delivery of mental health systems. and as a bridge to services the health service system post the employee assistance program within our four walls and over the last several years particularly during the pandemic we have made our services available on a 24 seven basisso our members , our employees have the ability to get help outside their health plans with the assistance
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services and often what we can do and do if it's necessary is provide a bridge to that health and resource. if the need of the individual member goes beyond services that can be offered for an employee assistance program and we found ourselves in the position when we have members struggling to get the right kind of assistance with their health planour very experienced counselors have , are able to help resolve their problems and issues as far as gettingthe right connections so it's turned into a very good service that offers a bridge . but it isn't a substitution for that direct call that we encourage all members to make when they arefeeling they're in need of health services . our member services department is here 11 other months out of the year besides october to do
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enrollment and we also help members navigate their health benefits. you can go to the next slide please . and next slide. so we can help them navigate their health services and i'll just leave with the fact that we currently, our current members have three plans that can help them with mental healthservices . where adding a new offering to our selection this year that would help with canopy care that's not currently listed on our services . but i just wanted to highlight because our partners do investigatory services. so thank you. >> thank you director and i appreciate that presentation. i think the take away that i personally have on your presentation is that there is a
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lack of consistency in reporting and data collection and it's just challenging because of the requirements that our healthcare system is complex but meanwhile we also are learning from your presentation the needs for mental health services has increased in the last two years and it's a significant increase when an individual needs increase above 40 percent to even 138 percent which is meeting the city departments or in their larger group settings that we see that the mental health services is quite needed and i really appreciate your breakdown about workforce. so i do appreciate the presentation and i wanted to
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see if my colleagues have any questions. >> not at this time. supervisor mandelman? >> i'm sorry if i missed this in the presentation but how does the city as the provider of these health plans ... how do we know ... how are we gathering information from our producers about the challenges they may or may notface ? we know there's a problem in behavioral health . internationally and in california. and we also know we hear stories about different providers including kaiser permanente. do we have a way of ... it's
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hard because we have so many people participating in our system but how do we think about how these wait times are impacting the employees or retirees or theirfamilies who are trying to access behavioral health services . >> thank you forthe question . i think in my tenure here at hss we become more sophisticated about what we measure and how we measure it. indeed, this year we are in the throes of having conversations withall our plans about what a measurement plan is . in the field of mental health however and the purchaser world a very large healthcare purchaser. we talked with the pacific business group run health,
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cover cover california and others looking for standardization across all this data because we are sensitive to the fact that producing data itself is expensive and we want to make sure we get actionable data that's useful but there hasn'tbeen consensus across the board about what the right data is for measuring mental health . frankly it's been a little frustrating, waiting for that to come forward. the catalyst for payment reform has a local organization that offers different tools and they have a tool that we've looked at and have gotten results from our plans on how they measure up against some of those measures so outside of that, there's not a consensus but there is quality data that is voluntarily reported.
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the frustration as i mentioned in my testimony is that that data is for business and not for our membership so i think we have the opportunity through our ongoing effort to define the measurements that are required by theinstitute , have that piece on mental health and work to get it for our membership where it's currently reported perhaps to some of these regulatory orvoluntary agencies . we're in conversation now with all of ourplans about how we get that for our membership . >> so short that is relying on the plans themselves toself report what they're delivering, right ? so we tried to talk with sunset
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of metrics and i guess one question is on what i'm looking at as i think it's page 6 of the presentation of the key findings of managed-careaccess data . are those mental health care waittimes or are those general ? >> we have mental health. >> what do we do, presumably if someone in our systems or employees or familymembers have an awful experience getting care , they may call you, right? or they may call your office. but what do we do? we survey our participants and i don't know what the response rate is but how do we try to understand what our ... the
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experience of healthcare inthe united states must be frustrating for everyone including supervisors, including me . and rarely do i like express that. i have actually called when i've had a question about what was going on with my healthcare but mostpeople wouldn't think to do that . and i guess i wonder how much pain and suffering is out there among our employees or retirees about challenges they're having access to care and not just thinking about the what we're giving the plans themselves to report on but what we're getting from our own participants. >> thank you forthe question. we had done quite a bit of periodic sampling , focus groups types of surveys with
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our membership over the last couple of years. we haven't dabbled yet into this particular topicarea . and one of the concerns that i have about this particular topic area i think it really takes some thought into how we go about being real assistance there. what i do know is that in fact i have this conversation with a colleague, a city employee colleague just this week telling me a story about the struggle getting their dependent into the mental health services they needed and their personal connection with somebody at the plan to get it done and i'm like why didn't you call me?so i'm sure it's partly personal. it's stigma.
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it's hard still for people to talk about needing new services so i do appreciate thechallenge . idon't have a quick answer for you . >> i think it would be worth trying to think about ways to approach our participants and solicit through focus groups or however their experience because we hear these terrible stories about people not being able to access appropriate behavioral health care for their kid and then their kid killing themselves or other terrible horrible stories. and i would just like somethin , for us to be doing some work with the people we are covering to understand what their experience of behavioral health with kaiser and theother providers is.i'm not on your board anymore .
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i would really beinterested in that . >> i appreciate that. and as i said i do think these stories are so emotionaland so highly charged . and there's many many more success stories so i do want to be and supervisor chan, i spoke about this and the biggest concern ihave about this hearing and others is that people would hesitate to call . because they think they might not get what they need and i just want to be super clear . call, call again. to get the help that you need. so we can get totally fixed. >> thanks for the questions. i did just more specific or
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technical questions and i was curious in your presentation when the distinction between urgent andnonurgent appointment . one where there's sounds like a standard or expectation of 40 hour access and another 10 business days and i'm sure we will go more into whether those are realistic time frames but i was curious. is it all just divided into virgins and nonurgent or are there additional think we can all imagine or have experience a pretty broad range of behavioral health needs something which one can wait two weeks, months and others wherethat would be problematic so can you just clarify , i guess what the actual definition is of what's urgent versus nonurgent and whether that's the only distinction that's made in terms of what we're expecting.
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>> without havingit in front of me this is adn agency data definition . and so i'd have to look that up to be able to read it exactly to you but those are, this is one of the realities of data collection is you have to be exceedingly clear on exactly what data you're collecting so i don't want to talkabout that again without having it in front of me but there defined that way . >> it would be helpful. i'm curious about the danger to self and others, that very high threshold and pretty much everything else under the sun that we can imagine is lumped into a nonurgent or whether there's further classes of need or any other attempts to further divide within that nonurgent. >> we're getting into clinical issues i would defer to my colleagues on but i do know having run an emergency
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department in san francisco that emergent is the top-tier where you really need to be in the er now. and then you've got the other categories so i don't know that the mhc has identified that. as other regulatory agencies may have. >> and then the timeline where that were identified for 48 hours on the urgent 10 busines days on the nonurgent , are those, is that statutorily required or is that someone's opinion of what is timelyaccess . like what is the source of those. >> again, it's the mhc, department of managed health care's data points and whether they take action if they don't feel you're taking the data point i'm not sure.
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>> supervisor chan.>> thank you for your questions and thank you chair peskin. i think that it will really be helpful for us to have one of our largest healthcare providers not just in california but really for our workers to have us better understand if existing structures and how they provide the care for our city workers which is interdependent which we saw from the data more than 50,000 people depending on their care which i have i see that they all now turn on their screens. is it okay if i could have the kaiser team just go ahead and introduce yourself and your title and start with their presentation. thank you.
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>> good afternoon supervisors. i am senior vice president and area manager for kaiser in san franciscoand i'll let thelust of the team introduce themselves to . kate . >> kate, vice president for strategic accounts for kaiser permanente, good to see everybody . >> leeann. >> adair, leannejones, director of quality for northern california, thank you . >> please, don't go ahead. >>. >> i'm a psychiatrist and chair of psychiatry in northern california. >> been supervisors, in the interest of time lb brief this morning as i said i'm ron grover, senior vice president for kaiser here in san francisco and we appreciate the opportunity to give a short presentation today to the
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committee. as was noted on i had any comments that the demand of th mental health system in our country have never been greater . kaiser permanente has seen a substantial rise in the demand for mental health since the crisis began. and i have these numbers certainly their reflective of that. the long-running shortage of mental health care commissions across the country was a challenge before this pandemic and have become evenmore acute now that the pandemic has progressed . we are not immune to those realities. what are have been sensitive to them and have dedicated significant resources to mental health and wellness care and we will talk a little bit about that. we are pleased to share some o our initiatives with you today and look forward to hearing from some of the other health plans in the future. i think you'll agree with us that we are all in this together and it's going to take a collective effort to solve
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this . as i said i've already introduced my colleagues here today and so without further a do, let's start with doctor maria oshi, she is the chair of the chief of six psychiatry for all of northern california and so please she does this from many different facets and i think you will find her to be a very interesting presenter. thank you for being here and i'm going to turn it over to you. >> thank you for this opportunity. to discuss this very important topic. as youstart the discussion and it's very important to note that we are in the midst of a mental health crisis . the pandemic has exacerbated pre-existing mental health challenges and is reduced access to vital social support systems. so while our country moves through broad public health crisis the ongoingnational
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shortage of qualified mental health professionals as stretched our caregivers. we empathize with every provider and patient that this experience has been made harder as a result . while far before the outset of the pandemic . the dedicated significant resources to mental health and wellness care and we've seen significant improvements in performance in that. as of now california's regularly first appointments average more than 90 percent of the time. while these results are far from average we know every important in appointment is important so wehave a dedicated line for members to use in any difficulty. next slide please . katie has faced specific emphasis in expanding the number of providers in california and hired 600 between 2016 and the end of 2020 and we continue to aggressively hire more. here in san francisco we are on track this year to hire double
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thenumber of mental health clinicians that we did in the prior three years .at the same time we're acutely aware any increases in our hiring rates necessarily resultin a decrease in the number of mental health professionals available for hire throughout the marketplace . but awareness of the providers in san francisco and throughout california is not enough. we are committedto being part of the solution. as an organization we invest in the future of mental care with initiativestotaling $30 million to increase the number of people entering mental health professions . we've launched the mental health scholars academy which maintains keyemployees interested in entering the mental health field . next slide please .despite these efforts to increase the supply of mental health professionals in the marketplace we don't believe this situation facing our
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country can be solved in traditional ways . the dependence on specialty mental health and addiction care facilities, we believe there's an alternate solution. our strategy has been to invest in our continuum of care for mental health and addiction. we suggest these plans carry holistically.kp is an integrated healthcare model that's uniquely positioned to doso. our care program allows timely care clinicians to work with mental health professionals to treat patients with diagnosis, harness the power of our integrated healthcare models . our providers partner with our patients relying ontheir ongoing input as a clinical tool that informs their care. we brought in the use of evidence-based tools that really play a big role in the last year to expand care options for patients . next slide please. prior to the pandemic 16 percent of behavioral health visits were performed virtually when the pandemic began it was critical for our patients and clinicians to transition the
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overwhelming majority of our visits to virtual visits. weaccomplished this by moving 97 percent of our visit online and 99 percent of our visits are virtual . today over 90 percent of our visits are performed virtually. we do give members the option of being seen in person and we've seen many members continue to choose in person psychiatry giventhe restrictionshave been lifted . our outcomes are comparable to in person care results . leveraging telehealth to meet memberneeds and expanding the use of thistool will allow us to continue to improve access over time . next slide please . we're not perfect and we're not done making investments. however we have a profound commitment to continuous improvement and providing quality care and accessible services to our patients . this commitment to quality care is demonstrated by several noteworthy recommendations for the quality of the care services we provide.
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kp northern california and southern california are the only plans to receive the highest rating for behavioral and mental health, five stars from the office of the patient advocate and we let the nation as a top performer in healthcare measures outperforming 90 percent of clients.next slide please. and finally we know that we can impact mental health needs ofother members without addressing social determinants of health . there are three elements of support and they're all connected. physical health which is how the body and social health which is being able to take care of basic needs such as having a safe place to live. nutritious food and relationships. kpwe know improving social health is an important factor in improving mental health of the committees we serve . for example, in 2020 we invested or $.9 million in community healthgrants in san francisco alone behavioral health is one of our funding priorities .
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there are two examples of plans we disseminated in 20 $23 million grant to them for cisco general hospital supported the zuckerberg san francisco general addiction care team and expanding evidence-based treatment linkage to care for people with substance abuse disorders and $98,000 grant to the youth programs will fund mental health services for trauma impacted students at martin luther king jr. middle school. kp we are proud of our industry leading mental health care results, our feedback care model, a comprehensive mental health care resources and the reports that weprovide. our concerns about shortage of mental health professionals still remains . we believe it is critical that all case key stakeholders including the ones in attendance here today work together cohesively to address and serve out these obstacles to accessing mental health care. thank you.
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>> thank you doctor. the include kaiser's presentations or do mister grover andothers have any questions . >> that includes the formal presentation and we're welcome to take any questions. >> thank you supervisor 10. >> i think the question that i have two kind of startup based on the presentation i appreciate the presentation. in a practical sense and me as a person trying to understand the system but i have a full disclosure, i am not a member of the kaiser permanente so let me try to understand better how any of our members city workers can access this. so will they be going through
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your directory to identify a doctor that they can connect to and how does it work in an everyday sense? what if i need that care, within the kaiserfamily system . i know that i have other healthcare service providers provide different systems for their members to ensure or to access the care so how was this in this case members accessing that care. >> i can start. and i invite my othermembers of my team to join in . supervisor, it's fairly straightforward to access care. you can go in throughmultiple channels .you can do go into primary care physician's office and express an interest in accessing care. we have behavioral health therapists embedded in care so they are available to provide
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care in that setting. if that's what's critically appropriate and if that's your interest. if it's deemed specialty mental health is where you need to be our primary care physicians can easily place aconsult and we will have someone from our department call you . we also take self referrals which means you don't have to go through anyone else to access mental health care. that's really key because as others have mentioned before me, the stigma isoften a barrier to accessing care and we know that people often access care much later in their episode than they should have. because of that . and other reasons. that's why we as a specialty department take self referrals meaning that you can pick up the phone and call yourself and ask for help. and then once you do pick up
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the phone and call, you are linked with a therapist who assesses your needs and looks for an intake appointment with one of our therapists. and then get receipts from them. >> what you're saying is there's not a specific intake process that just anyonecan call and access . >> yes. >> and that's an important part of our system. but within the integrated delivery system as well many ways to access and many ways to identify people who may be having issues with mental health and they may not even realize that themselves. so i know doctor kosher that's something we'reworking on greatly to make sure that there are many ways to access care >> it goes back to abby's presentation as well . within kaiser there is no wrong door. >> i think that i wanted to add
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that with that. because these there's just no wrong door at any level, is it urgent, i can't tell. is this the right person tohelp me get the right care that i need . now as a patient i'm fully dependent on wherever i'm talking to you, help me decide whether i need urgent mental health care or whatever it is i'm expecting if it's nonurgent mental health care and again, i'm not a healthcare professional. definitely not a doctor. how then can we help that determination of whether it's urgent or nonurgent but get the care necessary at that moment but most importantly when should we follow up and attribute that care at that moment, with an intake of
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actual very critical and consequential to determine what care should begin at that moment. and in terms of level of care. just a simple as this is again a laypersons comparison. 901 factor is still actually a highly trained and they are going to be able to determine bnc . help me understand the setup to be able to truly screen in a professional sense in a setting where to determine the level of care is needed. >> if you would go into some of thatdetail i think that would be great . >> i'm going to try and supervisor, letme know if this is addressing your question . so whenyou call , to access mental health care the first order of priority is looking to distinguish between the
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emergent as abby said or a routine request for care. so in order to do that i think as supervisor preston talk about this criteria of argumen imminently in danger of hurting yourself or others . are you kill that you cannot care for yourself. that is the first step is to determine the immediacy and urgency of your request for help. and then following that is followed by the booking of our first appointment and during that appointment it comes down to the clinician's diagnostic ability to assess how impaired you are with its depression or anxiety or psychosis or mania. how impaired you are at that moment and what your needs are and again it's a matter of stratifying if it's urgent or emergent or what is the treatment pathway that would
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best serve your needs. asked the question of ... i think i heard a question that maybe relates to trust and how you place your trustother individuals ?i would say it's the same way when you go to the emergency department and yousee a physician . you place our trust in that individual to help gauge what your reporting, the lab values, the entire context of the clinical situation to come up with a clinical treatment plan so it is dependent on the expertise of anindividual . and we do on our end as an employer ensure that we are working with individuals who are qualified andprovide high quality care . >> this is then now that we've got that process you in your
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presentation have talked about the u and hc data in terms of response times or with really wait time standards between non-urgent care and urgent care and you can see that just looking at it but it's a great response time for the nonurgent at 91 percent for kaiser and 91 percent for urgent care within 48 hours. and from my understanding is that encompassing all care is not specifically behavioral healthcare. do you have that data for us specifically for kaiser in terms of weight standardtimes between urgent and nonurgent care for behavioral health ? >> we do have thosenumbers, do you want to review those
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numbers ? >>sure, i can see that . for kaiser, for urgent that's48 hours . we need that at 98.7 percent. for our members and for nonurgent it's 96.2 percent. and that's within 10 business days. >> again leah those are the mhc defined measures. i wanted to survive clarify that for supervisor chan and those are mental health specific . >> that's right. >> is their data for secondary which i assume is again, it's my assumption so please correct me if i'm wrong but there's the intake and then equipment and care or you now diagnose someone so now they're officially care of treatment
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process, what is then what their secondary follow-up and when someone starts treatment and what is the response time for that four-way time in between those appointments for treatment. >> i can try to answer that. i think your question is how do we measure return access. from a quality perspective so it's not a gmac regulation. this is an internal audit process. so our internal audit demonstrates that we are meeting return appointments 84 percent of the time that's statewide numbers. and how we measure that is actually looking at the individual treatment plan and we assess how the therapist recommended their follow-up care. within the treatment plan itself. and so each person will be different as to eating that 84
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percent of the timestatewide . that'son average . so 84 percent of your patience for 84 percent of those received treatment will meet the standard wait time for wait time that deems appropriate by the clinicians or therapists in this case is what you're sayin . >> that's correct. >> it varies and work at commission means appropriate, i don't need to see you until two weeks from now or i'm able to see you and with that range, 84 percent of the time people are giving the appointments needed. >> i couldn't have said that better myself. >> i'm sure you could say it much betterthan i did . i just needed to add that in a laypersons perspective.
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>> can add supervisor chan for a second because those are certainly we track that internally because it's very important to continue to improve upon that. but there are not the mac standards at this point and it's certainly not something that i think is tracked regularly or consistently throughout the industry so that is an important piece that i think goes back to the second director comments about consistency on data that's out there. but we do track itand it's a very important part of what we track . >> if i can add a decade, agai taking a step back and looking at the bigger picture . outside of mental health and the other field ofmedicine , those who have diabetes or hypertension, one of the main ways you decidewhether or not you're being treated is by
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looking at markers . you look at your blood costs and check whether or not the meds prescribed by your doctor is resulting in a normal blood glucose so you look at blood pressure and based on that you decide whether or not you're getting good quality care. nowhere in any other field we talk about frequency of care as being a primary indicator of quality of care.so it is important definitely in the figures that we quoted as important. but going back to what missy was saying in terms of quality of care particularly how patient care as a field as a whole is not as well developed as the medical fields are. the other medical fields are so it's just something i want to point out that's more big picture. point of view. >> i think then we come to the point of where weare at , i think a critical mass perhaps
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point. i think you may not, certainly were not here for the first hearing. at least we're starting to hear the increase of the mental health and suicidal thoughts or that some of our seniors are experiencing and keep getting that acronym wrong.but anyway, again even from director yan's presentation in your yours as well to really recognize how significant of an increase for mental health services and care during a pandemic. how is kaiser and frankly this is really my question not just for kaiser. really from our e-services to and i consistently asked that question from a city services but also just all healthcare
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service providers, how do we leave that mandate at that moment in case you're here with us today for this hearing in thismoment , i want to hear from other healthcare service providers but just knowing that you really are logic and i know that you talked about your already hiring more. hiring more therapists or clinicians . but are we really making sure, i know that you continue to hire and recruit but how are we really this moment meeting that mandate in the last now almost 24 months. >> when you say supervisor, i apologize . i want to make sure play we're clear on what you say mandate. you're referring tothe demand . that has really built up during the pandemic and even before.
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>> i guess the question would be the mhc has this regulation that you really have to meet these wait time standards but at the same time it's increased significantly because of the pandemic so how are you directors at this time meeting that. >> that's a great question and i'll note that we are recording through 20/20 for the standards and verypleased that wewere able to sustain these high numbers . that we did . that being said it continues to be incredibly challenging. innovation will be key and i'm wondering if you could talk a little bit on some of the innovations including telehealth and the role that that will continue to play. i think that as we come out of thepandemic what will that new normal be . it's been incredible to have increased access to people iphone and video and will that
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comfort level, where will the numbers be as we move forward as we settle into that new normal so you want to talk a little bit about some of the innovation that we have ? >> thank you kate. and supervisor, i think what you're asking is there's a huge gap between demand and supply and it's not something that we're talking aboutin isolation,something that a national conversation and statewide conversation . in the setting of a gap between demand and supply , definitely asindividual organizations hiring is a big part of our strategy . but that's not going to be enough because without increasing the pipeline , we're not going to have enough peopl to hire and everyone in the field is trying to draw some of the same workforce and the same pool of individuals . i think the key becomes then just really looking at how to provide mental health care across the spectrum so not
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necessarily relying on just one moment of intervention but looking at early intervention , you know, developing some startups that talk about wellness coaching for really mild symptoms or you know, central presentations to help educationclasses . to individual therapy, evidence-based group treatment . case management, just really looking at the entire spectrum of care. and making sure that we are you know, really reaching people where they are on that spectrum. and in terms of innovations in ourregion , abby referred to the collaborative care. so collaborative care is a model where we have a multidisciplinaryteam composed of clinical pharmacists, therapists , supervising psychiatrists that take a population management approach
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to individuals with mild to moderate depression anxiety. it's an evidence-based model and westarted our own collaborative care program that's completely virtual in the spring of 2020 . when the when we conceived of it was innovative but it's completely virtual and by the time it startedeverything was virtual so it wasn't quite as innovative . but still a very evidence-based intervention for mild to moderate depression anxiety. going forward what we're looking at is therestructuring the existing workforce that we have because the reality is the pipeline isn't going to give us a huge increase in supply anytime soon . that's it takes time to develop a workforce that we have to look at the workforce that we have and the resources that we offer and structured in a way that provides equitable access for everyone but also provides members with a good care experience so that's where we're working to innovate
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within specialty mental health in addition to some of the other things we're doing. i'm sure we and others could last year during the pandemic we may available to all of our membersfor free . and again in an effort to really address what we knew wa going to be a rising demand . >> supervisor, i just wanted to, i have some questions as a follow-up on the line of questioning you are asking about earlier on some of the timing and weights and so forth. i don't know if you had further follow-up questions around this line or whether i should jump in just totalk about how you want to . >> thank you, please jump in. >> thank you. so i want to get back to some of the issues you were talking about regarding the expectations around 48 hours the 10 business days. what i think from my perspective and in lots of
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kaiser members i talked to what i think is a disconnect between this sort of figures showing 95 percent for various high levels of timing access with the experience of users and i'm not setting saying there necessarily come look at it but i want to drill into it because i want to know what we're talking about when we say or example that the mhc standards have this sort of 48 hour window in the urgent cases. what are those, are those tied just to the initial intake that you're describing? is that the only measurable time here? that your reporting your general compliance and numbers, is that for the initial intake appointment?>> i can start
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answering that. how we measure it is if whenever the patient calls us. we have 10 business days, this is dma's to see standards to provide that service appointment. so it is the firstappointment . for non-urgent. for urgent cases it's 48 hours. >> for an intake appointment. right, so what follows and i understand the point that sometimes depending on the details of what comes out of that appointment there may be you know, absolute time can sometimes be hard to assume that he quit with quality care so point taken that doctor cushing made the i still am trying to understand why beyond that initial intake when you get into either a second more comprehensive intake or into
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the actual treatment and you can correct me if i'm no expert on this. myterminology is wrong, maybe all ofthose are treatments . there's initial intake . but my understanding is in the initial intake potentially a more comprehensive intake. and then in the typical case treatment beginning so are there any timeline measurable either expectations from let's start with this dmh c have any definitions of timely care that go beyond what you've described around that initial intake? >> that the mhc does not have anymandates for follow-up visits at this time . however we've didn't work with them on our program and i was
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mentioning that the meetings of clinicians recommendations for follow-up care 84 percent of the time. but there's no standard measur for that right now . there's no, i don't want to this clinically but there's no if the patient needs to be seen within two weeks of their intake. it's all based on that treatment plan and what the clinician recommends but it will differ patient to patient. >> and internally, so thank you for clarifying this that the mhc doesn't have that mandate or expectation of the timeline the on that initial assessment internally for kaiser , you have an expectation i guess recognizing of course that the clinician or someone may choose a different timeline based on
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the fact but is there some kind of default where you get it's a nonurgent situation. you get your initial intake within 10 business days and further treatment is required. when does that treatmentstart, do you have an internal guideline for when is expected to begin ? >> we will talk about from a clinical perspective. >> so supervisor preston, i think this is not a direct answer to your question but what we keep an eye on is quality and outcome. actuallyafter that initial visit . i know that there's legislation was signed into law that seeks to regulate follow-up visits and create capacity and i was going to speak at but as of now we rely on the metrics that we leanne mentioned as well as quality outcomes and other
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indicators of overall health and our patient population such as inpatient hospitalization rate because if patient care is not great then inpatient hospitalization rates go down so there are other indicators of the quality of care and that's what we rely on in our system. >> i think that this is what i said at the beginning there's some of the frustration disconnect here. i understand case-by-case approach for the clinician that they may make some sense to have flex ability but i'm not heard from anyone. i've never heard from the constituents who called me up and their frustration is i wanted to have a 10 minutes 20 minutes 30 minute intake with kaiser or any other provider. and it was guaranteed in 10 days and i didn't get it. that's not to complain what i hear is i have a family member who is ... someone may be
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severely depressed. they're not suicidal and there able to perform basic self-care. there in that nonurgent category and that is an adult call. i think will hear from others but i think they get their initial assessment but when the assessment is you need therapy, they are told there is no one available to provide them therapy for three months, two months and i can't evaluate whether that is consistent with kaiser policies. whether your goal or expectation internally is that person gets a follow-up within a month and that that's not being met because of some of the challenges that you've identified. i think at this stage what i'm
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trying to get at is what the expectation is internally around these timelines recognizing there may be challenges that you have surfaced and there may be others but it sounds from like let me just ask it sounds like there is actually no expectation default rule or standard internally for kaiser as to when that follow-up appointment has to happen beyond that it isup to the clinician or the person doing the assessment . to decide when it needs to happen. and maybe i'm, that's my question. is there some guidance around the du expect that follow-up appointment to happen ? >> start and then if you want to add but i think what you're hearing again is that the treatment plan matters . so what the physician or the clinical provider determines to be the treatment plan is what
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matters and so i'll look to my colleagues. i would expect we would want t , we would aspire 100 percent of the time to meet that. and we continue to work towards that with internal measures right now showing that 84 percent of the time we are able to meet the guidelines but i think doctor cushing if you could expand. you started to talk to this but it's not about saying that someone doesn't have a follow-up in two weeks because onesize does not fit all in these treatment plans maybe talking a little bit more about that again . >> let me catch up.i understand one size does not fit all. i just want to be really specific. let's say there is an adult family member who calls up kaiser as i said suffering from severe depression.
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they are not in an urgent case. they are not a threat, they're capable of basicself-care. they're not suicidal . they get in intakewithin the 10 business days . let's assume that's happening. to supervisor mandelman!, some of these patients we rely on to give us this day, that's another set ofissues. that's just how they monitor but let's assume they get that appointment . that person is aset . there course of treatment at least at the start is determined that it is going to be meeting with the therapist and having some kind of therapy. my question is what can that person expect in that situation? this is going to happen every day. it's one thing to say there may be unique cases. i can't imagine whati'm describing is not in an
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everyday experience so is it a month ? when does that personget there therapy appointment . is it a month, two months, threemonths or just as soon as possible and you have limits and it's going to happen when it happens ? i find it a little frustrating that we don't have more clarity on this and it's amazing to me there's no target. no statement that everyone who is determined based on the intent needs therapy will get an appointment with a therapist within x number of days or at least if that's the goal. >> if there is the answer is it's up to the clinician, they'll make the recommendation, and that's it, if i have that in writing that i have a follow-up question around this. am i missing something or do i have that right? there's no actualguidance as to when session is going to occur. that therapy session .
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>> the field as an entirety is not. there's no standard in the field. there are lanes of care or evidence-based treatments that are for defined period's of time and we offer those means of care so in other words that program is weekly individual appointments, pharmacist management. all ofthat . for a defined number of sessions. that's evidence-based and our local clinics, we are restructuring our care to offer means of care that are at those frequencies that are appropriate for a patient's condition. when someone is clinically urgent we have very incredibly well run outpatient programs where our patients can be referred to and they get seen
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three times a week for a few weeks until they're better. so it really is dependent on where patients is and i'm sorry that answer isn't clear or better but i'm sorry i don't have a number for you because you're looking for a number. >> i want a basic expectation but let me ask this because it sounds like there isn't one in terms of an actual timeline beyond that initial assessment and i'm just trying to get the facts out here.though i think my follow-up question then is how long does it actually take? i understand there's not a mandate coming from dmhc that says within 30 days of treatment, 30 days of intake or 60 days or 90. that doesn't exist. and we can debate the reasons for that if that's good policy, if that's not my purpose here. but you must track how long it
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actually takes. so my question would be for th nonemergency cases , what is, have you tried it out over an average amount of time right now or san franciscans who need behavioral therapy after their intake.what is the average amount of time until they meet with a therapist. >> you know, with some of the recent legislation was signed into law we are working actively to figure out how to take those standards. that was set and adapted to care. that's one thing that we're working on. >> does anyone else? >> you're referencing a particular one which is in
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july, excuse me in all health plans i'm sure we will be working towards that i think what you're asking is is there an average amount of time or an average wait for a follow-up appointment now and we're not tracking it in that way. where tracking if i'm hearing my experts correctly we're tracking against the treatment planand 84 percent of the time we are meeting the treatment plan so that is the way we track it today . legislation is stating that we need to track it in a different way from what i understand as sp2 one by july of next year and we'd be happy to come back and talk about that as we get to july of next year. >> and again, maybe this is industry-standard not specific to kaiser i was just stunned that it takes legislation to get an answer to what the average amount of time assessment to a therapy appointment is for the tens of thousands of people who are
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members or maybe other systems. but the answer is at this time it's not track. >> absolutely understand. i understand your thoughts here and again, around the treatment plan and it's really difficult again because really difficult as an industry to your out exactly whatneeds to be tracked, and how to be consistent in that . so we're all working towards that and executive director yen and our organization have conversationsabout quite regularly . >> and thank you for your candor on that. i see supervisormandelman on the roster as well and i know we got a lot of ground to cover . but i think just my last question, when we hear about the person who has an assessment and is told it's going to be 14 weeks until a therapist is available to speak
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with you, that is not necessarily a violation or problem or anything like a, it's not like there's some policy that that necessarily runs against that may well be a consistent with however that treatment plan is determined around these urgencies andso forth . is that right, because we are often telling people whether it's with hss or directly to kaiser, call and call again. follow-up, make a complaint. is there some standard is not being met when they're told come back three months later. but it sounds like that's not necessarily the case and it's fully consistent with kaiser policy based on the availability of therapists and shortage i'm sure we will hear more about that one could wait several months toget an appointment .
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>> i'll start and doctor cushing, feel free to add. i think it's important as well to know that we want to make sure that every member is comfortable with the treatment program that we've their physician has prescribed. and if they are uncomfortable with that we want them to talk to us. we set up a special number about a year and a half ago that members who specifically for the purpose if they are having issues getting an appointment that they feel they need that they call and they are assisted right away with either getting thatappointment are going back to their physician to talk about what the appropriate treatment is . so we put in place to make sure membersfeel like i have a voice here doctor, i don't know if youwant to expand upon that . i think 14 weeks can be a stretch but please . >> just to go back a couple of
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steps. again, and no other area in medical care do we have to rely on frequency as the sole indicator. now, there's many ways, many evidence-based ways to access treatment from mental health care. individual therapy is one of them. there are a lot of different ways to access care. i know that you know, as an industry really there's i don't know if any other health plan that's measuring average wait times and follow-up appointments. and you know, i'd be happy to learn if that is the case as a large system thinking of the whole health of an individual, we really do focus onquality and outcomes . so we have one of the largest tracking mechanisms for our patient reported outcomes. and every visit we endeavor to get evidence-based questions so
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that we can track. there's some things over time. and we employ feedback informed care which is a mode of care where the it fosters engagement between the patient and provider and allows them to take along-term view to their care. so we as an organization really try to look at outcomes for the whole population but even in mind every members experience is also important . sothat's where kate said that we provide is helpful if you're not satisfied , definitely call the number and we will do our best to meet your needs and then lastly i would say there are fluctuations in staffing. there's a lack of a workforce and again, if there is we are definitely doing our best to
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really meet the needs of our members and trying hard to innovate within the context we talked about which is there is a gap between supply and demand. >> thank you doctor and i will just say last comment on this before i turnit over to the supervisor . i think there's a real, i think there's a problem when you're relying on people. there's a self-selection here that favors a more privileged when you are relying on people to assert themselves again and again to get a different plan. like the idea is if people are satisfied with their appointment can 10 weeks out that kaiser will be accommodating. goback to your clinician, but i really need, that's what i'm hearing . there are ways people can say if they kind of beat down the door a little bit there may be
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ways they can advance that and i just want to identify not in those contexts but whenyou rely on the patient's , the client, others to sort of repeatedly elevate something in order to get treatment sooner that that just really tends to put at a disadvantage the more vulnerable patients. >> i agree that equity and access to mental health care is so important . in the service were all about kp when an individual provider 's fault than any one who calls themthey just say we're not accepting patients . that's the reality that we're in. so outside of kp it may take many months to start treatment. for that meetingespecially now . within kp, what i as an immigrant really appreciated
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about kp is that we are responsible for the care of all our patients so we are tasked with this goal of taking a finite amount of resources. it is not small. we employ thousands of therapists across the state but we are tasked with this resource of taking a finite amount of resources in providing care to everyone . and it is a monumental task and we are continuously in the process of improving but as supervisor preston you talk about not getting complaints about initial access. that was not the case a few years ago. we have come a very long way a an organization and we need all initial access requirements . this is a process of improvement and i don't think anyone organization or stakeholder or individual is able to tackle this. i think this is something that we have to all begin together
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and despite how i know that i sense the frustration at times in the room. the reality is it's amazing that were even having this conversation because mental health should not have gotten this kind of attention years ago and i think that is an indication that along way that we, as a culture and the system in reducing stigma. >> thank you doctor and supervisor, thankyou for your patience . >> thank you chair for trying to get a handle on the actual facts of what's going on here. i have a more i guess maybe a more basic question which is i'm hearing to narratives that i'm not sure are entirely consistent. one narrative that i'm hearing is that kaiser permanente is
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successful in providing high-quality mental health care to its members that a course there are some cases that 16 percent where people are getting the follow-ups on the timeline that they would like but in general the people who are enrolled are getting the mental health care they would like toprovide . also hearing that there is in the united states and in california huge gap between demand and supply. that our system is overwhelmed. that kaiser is not alone. that there is a problem and kaiser cannot fix it alone and youare doing some things to address it . and those two things don't seem entirely consistent to me and i'm curious if you could help me understand what seems to me
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like two different stories that are not the same and in conflict actually. >> supervisor thanks for the question and i'll start and my colleagues can add.i think you're hearing that we are providing industry leading quality care and access which is higher than others is a good enough? number i think you're hearing the entire industry is struggling. are weahead of most others ? yes and if you look at allthe third-party data it shows that . so we can celebrate that and say great, we're the best of everyone out there but that's not good enough and we all know that. and the industry shortage is not getting better. we don't want just to be a situation that gets worse as well so i don't know if the doctor would want to respond further. >> i think you said it really
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well kate and just going back to that continuous process improvement mindset, that as has always been our goal as an organization and weare not perfect . but as he said, as far as the current measurements of quality of care in the industry we are a district leading and we will continue to try and do our play a role, do our best to improve the quality of care. >> thank you doctor. chair, if i may i have one more presentation that is the last presentation. and it's, i'm very fortunate if i think we could move to that presentation and perhaps then come back if there are more questions for the team. and then i could get a time with this and it's the kaiser really were fortunate to have
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the clinicians really focusing on the ground. providing the care with kaiser as well as a patient i believe, a patient that has been in need ofcare. can we go to that presentation if that's okay ? and come back tocircle back with the questions. the supervisor, thanks for the question and we will come back to that to . i believe that we have alana. i'm going to say the name totally incorrectly. ilana marcusi morez? can you introduce your presenter inyour presentation . >> tour, i'll use myself and
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allow mycolleagues to do the same since i have to run. good morning supervisors or afternoon . my name is ilana marcusi morez and i'm a therapist at kaiser call center in san leandro. we sold all of northern california psychiatry patients so i am one of these intake clinicians mentioned to by my employer as one of the people determining when a patient needs to be seen and i hope to show you today with all of our presentations how far from the truth that really is. you just heard kaiser claim timely access isn't the proble . it's true that they have improved access for the 30 minute initial assessment i conduct at the call center. i am among those hired mentioned in the doctors presentation but month long delays for the actual indicated treatment that is medically
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necessary after my initial assessment is typical for all nonemergency patients, making treatment dangerously ineffective for most moderate to severe patients.you've asked about pain and suffering due to the wait times supervisors and as someone on the front lines of this worsening problem let me testify san francisco patients are deteriorating and very frustrated at best. let me first explain what a patient typically goes through to access treatment . and the intake process absolutely does exist. first the patient is quickly screened through psychiatry triage providers like my colleague just will be speaking in a moment who then looks at the intake assessment which is the very first scheduled appointment. that's what i do and my colleagues due at the call center . we conduct a 30 minute
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structured interview with the patient for the purpose of puttingthem on a number of treatment tracks based on diagnosis , symptoms and severity and this is where the dangerous delay exists . although kaiser may have improved access to these 30 minuteinitial interviews with the many hires i have mentioned , these hires are not providing therapy. they are not recommended. they are not doing the recommended ongoing treatment and theseappointments should not be the measure of needing treatment access . paradoxically the more severe patients typically states the longest waittimes for appointments unless they are actively seeking to commit suicide were deemed an immediate threat to themselves or others . they will have to wait months for an appointment with a training therapist . san franciscopsychiatry is by far the hardest place for me t find appointments for moderate to severe patients . which nearly always has more than three month wait . as of 11:30 am today the first
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available appointment to all booking intake therapist at the call center like myself is january 27th at 2 pm which i that has already been booked by now and i expect a current patient is likely beingasked to wait until february . i want to add that the 84 percent statistic for access kaiser provided is the result of a template problem. clinicians are asked why kaiser managers select how much tame the patient is waiting but the template says the recommended time so even when i do not recommend that time , my instruction is to choose the amount of time between now and thebooked appointments . i'd like to also share my thoughts on the workforce shortage problem that has been suggested that there aren't enough therapists industrywide
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to provide clinically recommended care. the problem is not supply. it's the willingness to be abused andexploited like systems such as kaiser . i know there is a solid supply of qualified therapists out there because many have either left kaiser or will come work for kaiser because they know the system is so strained. those that left don't want to continue to feeldemoralized and heartbroken because they have to continue telling patients they need to wait for months to receive care . and the many that won't even apply because they are too afraid of the burnout and strain that they hear all about from their colleagues here at kaiser so again the problem is and lack of supply. it's lack of commitment on workforce protection for our employer. i personally know that kaiser isn't prioritizing recruitment because i am sitting on the bargainingcommittee and a part of our contract negotiations
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that are happening right now . our union put forth a bold proposal that centered therapist recruitment and retention and addresses ithead on at the bargaining table just a couple of months ago . and kaiser rejected it and has yet to provide a counter proposal that sincerely center recruitment or retention . whenconfronted about our proposal on recruitment and retention of clinicians , kaiser's lead negotiator said and i quote, we are not interested in anything on that proposal. thank you for your time. i welcome questions so long as they are quick because my baby has a doctors appointment very soon so thank you for your time and i will defer my time to my colleagues to take it from here. >> please go ahead and continue with the presentation.
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thank you so much. >> i guess now is my time to start. my name is joffrey and i'm a licensed clinical social worker at kaiser psychiatry here in san francisco. i've been doing triage work as well as general therapy and more recently brief therapy intervention lasting a total of six weeks for clients who are determined to fitthe mild to moderate range of symptoms . so i've been doing this since 2017 and i know the system pretty well. i'm here today because i have a lot of concerns about our department's ability to provide adequate care for the patients who come to us. i'm very dedicated to my patients, very dedicated to the clinic and i've grown a lot there so that place means a lot to me.
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more to be clear the problem is not the managers at our clinic. i have found the managers at our clinic to besupportive and hard-working individuals who really care about our patients . this is a larger systemic problem. so i'm going to give you some very clear information about actual accesstimes . what you've been hearing about for the mostpart is what is called initial access and when you hear initial access , i'm going to put this as frankly as i can. my belief about this is that it is the way ... is kind of hard to say this but i believe this is how kaiser hides the problem with access. yes kaiser does provide a 30 minute assessment within a 10 day access window so that's great but that is not where therapy begins. it's not exactly a real intake point. the real intake point will
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happen many weeks from the time the person contacts the department. to hear some data and searches idid while working triage , this is on october 14 and 15th. the first secondary intake again, this is the real intake. this is their chance to sit downand have an intake assessment appointment with the person who'sgoing to be your therapist . as of october 15 appointment was three months away .so you're talkingabout a depressed , anxious or otherwise really troubled individual waiting three months . that's in a general track. if there are newer tracks or lanes which i'm really glad kaiser is doing, i givethem credit for that . one of those intakes was over a month away. it was on november 19. i was doing thesearch on october 15 . by the way i want to say i
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joined the mild to moderate treatment track because as a general therapist at kaiser i found it so demoralizingto have to constantly tell people yes , youshould be getting care next week and i cannot get it to you . so that is the environment that kaiser is asking their therapists to work with and out of more about this return access and the 84 percent think to life elana did. the second intake for severe range ofsystems was over two months away . so we're talking in december, and of december. that's a travesty. we're talking aboutpeople who are moderately to severely depressed . it's a travesty not even to mention on a humanitarian level. it's atravesty on a liability level . i should think kaiser would be
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concerned aboutthat but on a humanitarian and ethical level it's a travesty . i also take calls from concerned parents seeking care for their kids when i'm working triage and when i looked for a second intake appointment for a mom who's calling in about her kid on october15 it was a month and a half away . it is not an easy thing to tell aparent they're going to have towait a month and a half for their kid and if someone told me i had to wait or my kid i'd be furious . andpatients should be furious about this. so this idea that kaiser cannot attract and maintain staff , i don't buy it . i don't buy itbecause i know people in my therapist , other members of the therapy profession who will not work at kaiser and don't understand why i worked at kaiser because they
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know how demoralizing and when i begin therapy especially before i got onto the brief tracki've been doing because i couldn't stand the other way any longer . i would begin therapy explaining with my client while they were already disappointed in me as their provider because it's taken weeks for their appointment where they were perhaps having a sense of betrayal and nobodywas there for them when they needed it . and you don't want to begin therapy withsomebody who's angry at you . that is far from ideal when we talk about being the industry leader. like, i am very loyal to my clinic and my employer but that is not the case. if i have time i want to shift a little bit to talk about this 84 percent thing which i think elana covered very well. one of the things i like about working at kaiser is it'svery efficient . there's lots of tools that can help you to enter aprogress
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note very quickly . that's great and thatshould not change if i do an intake on someone , i type was called 8.region and that automatically the intake pops up and i just enter a little bit of data, enough to coverand capture the assessment data . part of that template says and i can quote it right here but if i managed toget it on my screen . the recommended and agreed upon amount and timeframe of initial patient contact and then we're supposed to say is it 1 to 2 contacts, 3 to 4 contacts, fiv or more contacts ? then you're supposed to say there are no additional recommendations. hold on a second. let me get backup to my slide .
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okay. then you're supposed to say these are plans will occur within one to two weeks, 2 to 3 weeks, 3 to 4 weeks, 4 to 5 weeks, 5 to 6 weeks but suppose i select 1 to 2 weeks. here's the problem with that. there are no appointments available within 1 to 2 weeks so if i don't want to get in trouble with my employer i'm going to select a number that fits with what i can offer the person. and i have talked to therapists within the system who are intimidated by the managers who tell them you need to offer this person and appointment within the recommended time frame. what are we supposed to do? are they supposed to work into the evening western mark how are theysupposed to do that?
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they are blamed for the shortcomings of the system. i hope that's understandable what i'm describing here . so kaiser is asking its therapists to make unethical decisions and documentation and if they don't comply , thereby giving kaiser this sort of like hidden success rate at offering returnappointments, if they don't comply they get in trouble . that's why it needs its return access 84 percent of the time. it's not because they're providing clinically recommended care and let me say this idea that there is not an industrywidestandard for return of access, that's not true . if you want to look in psychiatric and psychological journals you'll find plenty of evidence-based studies that feature weekly or more often individual therapy. that's the recommendedstandard of care . so let's call things what they are. this system is not meeting the demand for care and it is primarily designed to hide that fact.
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>> thank you jeff, i really appreciate that perspective and it is certainly disarming to hear the wait times but the frustration not only coming from a clinicians point of view who knows appropriate care that is supposed to be given to patients . so we really appreciate your perspective. i want to make sure we also allow time for a patient's perspective which is on deck. thank you so much and we want to make sure we give time to miss gomez to share with us your perspective from the patient perspective of kaiser patientperspective going through this process and we appreciate you being here with us . >> i hope my microphone is
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working properly. it was alittle bit on the fritz before. i'm assuming you can hear me okay . so my name is cynthia gomez and i've spoken to many of you supervisors. good afternoon supervisors. i've spoken to many of you before and the context of being a research analyst at the coworkers union but as mentioned today i'm talking to you about my own story of mental health care. i've been a kaiser member for the vast majority of my life since i was a baby and i count many kaiser members among family, friends, coworkers in the years that we work with well into the high dozens i would say.and i talk openly with a lot of these folks about our mental health issues and our needs so i got some basis for what i say but i have never known one single person who has
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kaiser and who gets regular individual therapy with a provider that they can see long enough to form a clinical relationship with. not one. including me. so i had mental health issues that went untreated for far too long and about 12 years ago they spilled over into a full on break. and i'm not going to go intothe details . it's hard to talk about but getting therapy was absolutely essential in order for me to function as a human being. and i paid for it all out-of-pocket . even as a kaiser member, even when i couldn'treally afford . sometimes borrowing money from family so i can pay for rent and therapy the same month and at the cost of paying my student loans off from working as a teacher to the cost of
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paying those loans off after whicheventually is going to be thousands of dollars extra in interest. and i finally had to stop going and i couldn't make it work with my finances . and i'm speaking to you as someone with a very good health care plan. my plan is tied to the health care plan local to members fight for and go on strike to get which means my difficulties are also shared i our members. not only is my plan equivalent but yet for all that i'mgoing without what i need . i know what kind of care i nee . i know it because it's what helped me before. i would see a provider regularly individually and as part of my life, not as a precious and limited resource i have to fight for and it gets doled out to me like ration coupons. i'm going without that now and it's at a cost to me and the people in my life who would benefit from who i could be if i could get thatcare again . i really would like to get that
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careagain . it doesn't need to be this way and it shouldn't. thank you. >> iq cynthia and i'd like to turn it back, perhaps we should open and go for public comment. >> thank you supervisors can and presenters. let's open this item up for public comment. >> i've got victor, thank you. thank you mister chair. we're checking out colors in the queue. for those of you watching this meeting or bystreaming link through sfgov.org or elsewhere if you wish to speak on this item please call in now and follow the instructions on your screen . you may dial 415-655-0001 , following that entered the
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meeting id of 2493 244 7467 and press the pound symbol twice to connect to the meeting. for those who have connected by phone please dial star 3 if you wish to be added to the queue to speak to this item and for those already on hold in the queue continue towait . you willhear a prompt informing you your line has been unmute it . i understand we had 2 callers listening on the line and oneof them is in the queue to speak could you please connect us to our first caller ? >> supervisors, i am calling because i've been with kaiser for over four years. and i've also traveled to canada, to australia, in europe, germany, italy. and what i feel is during this
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pandemic millions of dollars were given to the city and county of san francisco . money that could have been used to address this issue, this massive issue not only with kaiser, or the hospital but more importantly the san francisco general hospital. and while i admire the tenacity and fortitude of some of you supervisors, we have to be fai . why do we have so many people who are mentally challenged on the streets of the city and county of san francisco?
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i'd love you to answer this question . what ever happened to st. luke's hospital when it comes to the beds? what really is happening at the san francisco general hospital? now supervisor mandelman is looking into this situation and he knows we have a very very serious problem when it comes to the mentally challenged. weneed to find a solution . god knows the millions of dollars of the stimulus money and create a task force. >> thank you mister dacosta for sharing yourcomments . couldyou connect us to the next caller ?
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>> my name is josie randall and today i'm providingpublic comments for myself and my friend rachel . here's rachel story. when my term started in july i've been seeing if i could be a nurse practitioner for several months. the office told me i could continue to see her if i asked kaiser for a referral. after 26 days of calling psychiatry i'm dealing with customer service that hung up on mewhen they tried to transfer me or didn't put me through to the right person . iwas told i could not get the referral because my symptoms were too severe . then i went through the frustrating process of filing a grievance only to be told by referral was denied again as my symptoms were too severe. trying to navigate kaiser behavioral health exacerbated by already intense symptoms of depression and suicidal thoughts. and in my experience i had kaiser insurance for eight years. like so many others i saw behavioral self help support in
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this pandemic. i wanted to find a therapist so i message message to my tpp and on july 9 all month later i finally got to the psychiatris . he immediately gave me a prescription and referred me to a therapist in nine weeks. kaiser had been waiting 63 days toget basic treatment i needed on day one . i told my doctor i couldn't wait. she never called me about this special number i could call to get a appointment. if i had a broken arm would i be expected to wait for weeks to seethe orthopedist and another nine weeksto get cast ? i shouldn't have to wait that long to get urgent mental health care needs .what supervisor peskin are said is true. those who know howto speak up can get quicker care than the majority and this isn't right . as many can attest to kaiser patients don't have accessto
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the timely mental health care we need and are paying for in our coverage . iq. >> clerk: thankyou for sharing with the committee.do we have any further callers in the queue ? >> i'm receiving word we have nofurther callers . >> with no further callers on the line public comment on this item is now closed. colleagues, i don't know if you have additionalquestions for any presenters or comments you wish to make . >>. >> president:i'll let supervisor mandelman go first since i cut him off . >> i just want to thank supervisor chan for calling this hearing and you know, i understand the folks at kaiser are in a difficult position but i also feel like their
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presentation doesn't actually reflect what is happening on the ground for patients and i think you know, it is important and i'm glad we can hear from actual providersand patients . it is true this is a problem that is bigger than kaiser but kaiser is a huge actor in this space and i think we look to kaiser to help figure out how to solve this and to actually be a leader in solvingit . and i remain concerned after this hearing that we're not there. that kaiser does need to do more. that these wait times are unacceptable and i take a little bit of issue with the notion that wedon't look at other , we don't measure other health conditions or health conditions based on the timeliness of nonresponse.
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but if people were waiting for these length of times that people are waiting for those services i think that people arewaiting routinely for mental health services . i think we would. i think we would be talking and in some countries they do talk about the ways for the medical proceduresthat need to get done . there may be better ways of measuring people's mental health needs but it seems this system is not alone but the system is not meeting patients mental health needs. >> thank you supervisor mandelman and we've been going along here but i did have a couple of additional questions before we wrap up and just following up on some of the presentations. i did want to hear from kaiser and i'm not sure i fully understand this issue but was troubled by what ithink two of the presenters , that we spoke to witches the computer system
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issue here. if i'm understanding it right it sounds like when you are speaking as the intake clinician, when you're scheduling the appointment you are forced to make the next available time be the recommended time if i'm unless i'm mishearing whichthen becomes a self-fulfilling prophecy because of course you always can do everything within the recommended time. and i just want to make sure i didn't miss here that . i think that was what miss marcucci was saying. i think ... is how they described it accurate in your opinion or is there a dispute around that? i just wanted to get clarity around. >> do you want to start with a little bit of that ?
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>> yes, so supervisor peskin if that were true we would be meeting these metrics 100 percent of the time . we do ask that our providers consider all avenues of care when looking at follow-up care for the same reason that we use to earlierwhich is the gap in supply and demand .so i also want to go back to there were some screenshots on there and the screenshots don't the additional resources that are available in local clinics like sso. there's lanes of care from mild tomoderate illness , moderate to severeillness . there's 6 to 12 weeks in duration. there's other lanes of care that are not captured in that single screenshot but going back to your question if that
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were true and we would be meeting metric 100 percent of the time, not 84 percent of the time . >> thank you. let me switch gears a bit to one other area that i'm curious about because we've talked about the pipeline and hiring issues and i'll start by just saying my late sister was a longtime director of behaviora health clinic in the east bay, not kaiser and i'm well aware of the challenges , the hiring challenges particular in her clinics case for bilingual and so forth so i understand with the high cost of the bay area that there are real challenges. i also understand there's a time of folks in the bay area outside the system. like in terms of the supply. there's plenty of therapists providing services in the bay area and in fact asked ms.
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gomez spoke, a lot of folks are accessing private therapist and paying for them out of pocket because they feel they can't get timely care. i wanted to ask where it is appropriate from the kaiser team more specifically a couple of questions about the hiring front. what is the limiting factor that prevents kaiser from recruiting and hiring more of the private practitioners are not part of kaiser right now? is it salary? what are the factors that permit that? >> i'll start by saying i know that we've had a significant increase in the number of providers that we have been able to hire so that's been a
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big success over the past several. i think it wasabout 600, it's a 36 percent increase . so we are proudof that fact . i'm not directly involved in the hiring. i couldn't comment further and i'm not sure if any of my colleagues could comment onthe specifics of that . we're happy to bring that back but i just don't have that. >> i think it would be great. just to know how many therapists does kaiser employee in san francisco. how does that number change, if that's from 100 to 100. >> you may have some of these numbers as well. i believe it was ... let me find my numbers. i believe it was from 2016 to 2028 36 percent increase and you referenced in your presentation that in the past year i believe you are on track
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to hire twice the amount in san francisco thatwe had in the years prior . so great news. this is all really positive news but supervisor preston as we talked about we need to continue to work towards getting more of these providers actually in the field but we are hiring as quickly as we can. i don't have more specifics about what some of the limiting factors are but there's not enoughpipeline . >> do you have a sense ofthe increase , what percent of those are being allocated to meet these targets around that versus being available for the subsequent treatment? >> i don't have theanswer to that do you have anything ? >> the increase in sf those devoted, not to intake but to care in theclinic . >> i'm glad you have that information. >> how many open positions are
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therenow for clinicians ? >> i can't san francisco. i know regionwide we posted 200 ftesthis past year . in northern california. >> iq and i don't mean to convert this but i need more details. these are huge challenges but now they need is off the charts and i think it's going to take that level of vacancy and i think the ambition to bring more folks on will take i don't want to see a different approach but prioritizing it to
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the pointwhether it's valerie , increases to make it more attractive than privatepractice for whatever those other barriers are . it's just a situation where there's not the practitioners that are around. >> and we can circle back and verify this but we have 85 in san francisco. >> even the folks in private practiceare swapped . and there helping to meet the need as well in your network. >> remember there's a finite number and so that's an important piece forus to remember as well . >> we do leverageresources in the community as well .>> i don't want to turn this into
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sort of a debate around the experience of the clinicians. i do want to recognize at least the perspective of the issues of not just recruitment but retention and the high risk of burnout when folks are experiencing what i don't think it's disputed the frustration around offering care here. >> i think what's not disputed supervisor preston is our caregivers whether they are mental health orelsewhere have gone through a tremendous amount over the past few years for sure . we value every one of these employees and i would like to leave it at that because it's unfortunate what we heard today . and you know, i know certainly as we continue marketing within you hw it's unfortunate what we
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heard. wecare about every one of these employees though . >> thank you and i want to join in really thanking all holds who are dealing with the fallout of these last couple of years in particular on the front lines and i will turn it back over to supervisor chan with my parents for your work in putting together this hearing, calling for this hearing and elevating those issues. >> thank you chairperson and of course i want to thank director abby yang for her presentation early on to help us see things in context and thank you for the being here and making your presentation as well as our kaiser clinicians and it's good to see her still here sharing her story and that's very brave to talk about your personal journey with mental health car
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. so i want to hear, i want to say that we know from sb 221 and senator scott weiner that specifically addressing the nonurgent appointments and in need of making sure there is a follow-up and knowing that it's a state law that we know that this problem gets state lines and we know we needto track this data . not just with kaiser but with all service providers. i do wanted to put this back into the context that i really am committed to working with our san francisco house service board and our staff increase, that the efforts of data gathering from our health plan
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, that health service providers on this importance subject. i believe that together we can achieve transparency and accountability for our health plans and serviceproviders . i'm committed to exploring options to provide solutions and improvements of this health care crisis that we can really support our patients, support our clinicians. and really continue to work towards the change that is really what we're looking for, this systemic change so it's not just kaiser. we should all dobetter in san francisco and california . chair preston, knowing that it's not just kaiser. that there are also other behavioral health service
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providers who provide data and information. in terms of their process and what they're doing, i would ask that we continue this hearing and again, thank you for everyone. thank you everyone for your presentation today. >> president: mister clark please call the motion. >>. [roll call vote] mister chair, there are 3 aye's. >> the motion passes, thank yo everyone and we will go to the next item . >> agenda item number three is a resolution approving an annual report for the greater union square is this improvement district focus year
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2020 submitted as required by theproperty business improvement district law of 1994 and district management agreement with the city . members of the public pushing to provide publiccomments should call the call in number which is 415-655-0001 . today's meeting id is 2493 244 7467 . press the pound symbol twice to connect to the meeting and press star 3 to speak. a system prompt you have indicated your line has been unmuted and it willgive you the opportunity to submit your comments . >> president: thank you mister clark and we are joined by chris corrigan, program director for the district for oewd as well as karen flood, director of union square improvement district and i believe we will take the two of you in thatorder . welcome and of course you are
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approved for up to 10 minutes. >> as previously stated, i'm program director with oewd on the community benefit district . we are here to hear the fiscal year 2019 2020 annual report for the union square business improvementdistrict . humidity benefit districts are governed by two laws, one being state law and can be found in streets and highways code the 3600 section at our local law whichis article 15 of the business and tax relations code . in our review process oe all bids are meeting their management plans and we conduct an annual review of reports in cva financials and provides the board of supervisors with a summary memo. the union square business
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improvement district is a property-based district with a management planassessment budget of over $6 million . the fiscal year assessment submission was$6,015,353. the district was initially formed in 1999 , renewed in 2009 and renewed recently again in 2019 for a 10 year term to expire june30 2029 . the executive director of the organization is karen flood and deputy director isben for . the service areas are clean and safe, public realmmarketing as well as management and administration of the district . oewd reviews for benchmarks for each cbd. the first iswhether the variance between the budget amount for each service category is within 10 percentage points from the management plan . benchmark to whether eight percent excuse the typo of
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non-assessment sources other than assessment revenue , benchmark three whether the variance between the budget amount for each service category was within 10 percentage points from the actual and benchmark for, whether the cbdindicates funds carry over from the current fiscal year and designating projects to be spent in the upcoming year . for benchmark one the cb id did make this benchmark between 10 percentage points. they have historically meant that benchmark as well. for benchmark 2 a rate of 11.9 percent of their budget for fiscal year 1920 from non-assessment sources and did meet mark 2 and they have historically this benchmark as well .for benchmark three the variance percentage points between the budget for the fiscal year and actual for the fiscal year or under one percentage point so they did meet the expected benchmark and had historically met itas well
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and for benchmark for the indicated their carryforward and how it would be spent in the upcoming fiscal year . our common knowledge supervisors based off the disbursement schedule is common for cds to operate on the fiscal year to carry over about half of their operating revenues to get through the period of time theydon't receive assessments from august through january until they get their next assessment . the findings and recommendations for the district from oewd is they have successfully completed their renewal for another10 year term with a high percentage of votes . they were able to post events to draw shoppers and visitors to the area before the pandemic and when the pandemic they maintain their operations as we were trying to figure out how the shelter in place order impacted as they are considere supplemental . they have been a valued partner through the pandemic and i would love to highlight this particular district as well as the next one we will be hearing about it assist oewd in
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logistics and providing ppe throughout the city and county of sanfrancisco so i do appreciate that . they did purchase meals from local restaurants and donated them to essential workers supported 14 different restaurants and donated over 300 meals and conducted a series of surveys regarding background impact and created a task force to help union square cover from the pandemic. in conclusion they have performedwell in implementing the service plan for the district , continue to sponsor and promote events in the area , maintain an active board of directors and their own well-run organization and well-placed to continue carrying on its mission . i'd like to invite karen flood fromthe union square business districts for her portion of the presentation . >> president:welcome miss flood . >> iq chair preston and vice
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chair chad and supervisor mandelman. thank you for the opportunity to speak and present our report. can you all hear me >> chair: we can . >> this is the first, presenting from home. thank you so much also chris or that excellent reportand for being such an incredible liaison . the city and county of san francisco and such a champion of all those cbid is. i'm karen flood, i'm the outgoing executive director of the union square bid. where now known as the union square alliance. and i'm also going here today by our incoming executive director who i wanted to acknowledge first. ryan rodriguez who would like to say a few words atthe end after 10 years , 10 incredible years hurting the city and our community i'm moving on to oversee our property so i still will be engaged in the community and you may see me
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again. i have about four minutes left, is that right? okay. excellent. so we can move to the next slide. essentially we cover about 30 blocks and around union square park and we deliver safe marketing and advocacy services the period i'm talking about is 2019 to 20 so that not themost recent fiscal year but the one prior to that . two thirds of the year was pre- covid and of course march covid it and we pivoted our activity. next slide please. i'm just going to keep talking and hopefully chris will catch up here.our assessment methodology is essentially based on the size of the building throughout the district.
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we spend about 73 percent of our 6 million+ dollar budget on clean and safe, 14 percent goes towards marketing advocacy, streetscape activities and 13 percent towards management and administration and as chris mentionedwe kept within those 10 percent guidelines of those budget categories .again primarily cleaning and banking services which was needed more than ever post pandemic. in mid-2019 we renewed our district with a 60 percent budget increase and i thank you all for your support and we were able to greatly expand the services and we have a customer service line that you can call for customer service. we got an overnight security which we were getting our store windows matched. we had a letter vacuum that we drive around the district.
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and we've increased pressure washing and also trash cans throughout the district as well. okay, here we are that was the lastslide . next slide please. cleaning and safety . by the numbers which is the next one. i'm always amazed by the numbers the amount of trash that we pick up andthe amount of quality of life incidents that we address . even post-áuntran4á some of the calls for service or even hospitality interactions increased because we did not see many tourists but there was a lot of graffiti to be removed and once the streets vacated there was always something to attend to. we were the main presence down there and as chris mentioned w continued our services throughout the early pandemic and the rest of the pandemic . so the redcoats as their fondly known for quite a presence looking after our buildingsand
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our districts down there . i'll let you dive in the other numbers. i know you all have this report. district marketing. we continue to promote the district. pre-and post pandemic, pre-pandemic wecontinued with a lot of events . we had a wine walk and a pub crawl where we invited members to participate to promote our businesses. post pandemic as was mentioned we delivered meals to many of the first responders in the fire stations, police stations to the hospital st. francis in general to support those workers and also to support our own restaurants through that very challenging early time. we also have a strong website and social media presence on all the channels. public realm and streetscape, pre-pandemic we tried to liven up the public spaces with food, art and entertainment.
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that will be ever so important now as we emerge from this pandemic and bring the population backdowntown, but people back downtown . post pandemic we did a lot of murals to beautify storefronts but unfortunately we had to board up a lot of our stores to protect them from the windows getting smashed. and we continued to activate the areas. in terms of advocacy we continue to fight for a clean, safe and vibrant downtown. we support various planning projects that are in the works. we constantly evaluate projects coming before us though we do appreciate development and investment in our district so as long as they are in keeping with the architecture and purpose of the district, we do support those planning projects. he heard a numberof candidates
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projects . we felt proposals come through and wegenerally supported those as well . and that brings me ... district marketing. hold on here, backlog. there we go. public realm. >> chair: which one are we on west and mark. >> the next one, advocacy. we convene an economic recovery task force ringing together 15 to 20 of our stakeholders to really think about what was going to be most important to pull us out of this pandemic and really it was about activating our public spaces. again, driving traffic back downtown . we need to fill our storefronts with retailers once again. our vacancy rates have gone way up and we know it's going to be key to make sure that not only
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is the district safe but that people perceive it to be safe. we certainly have been impacted by some negative viral videos. we need to get a handle on that first and foremost thedistrict needs to be safe and welcome and i think the retailers will come back as they see that people return and hopefully we can fill our storefronts . next slide . now it's my distinct pleasure to welcomemarissa rodriguez as our new executive director . he started monday and i am so pleased that she stepped into this role and know that she will succeed and she has all the right qualifications and skills to take over so. >> thank you karen and for the presentation and to our board of supervisors, chairperson,
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great to see you. rafael mandelman, connie chan, you blink and yoursupervisor . i'm happy to see that candidacy is vital during the pandemic and that we can activate storefronts and provide jobs i want to say more than ever the recovery is certainly very important in terms of the vitality of unionsquare to our downtown . having been in the public sector for so long understanding just how important these businesses are to our ability to function rights and our positions to be able to be innovative in the important work that we need to do every day that we have shuttered stores and we have vacant storefronts. we all suffered quite a bit and i would welcome everyone to come down and visit me, walk the neighborhood and see what's happening. i was quite surprised to be
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honest so we loveto have conversation with all of you . i'm very excited for the opportunity that situations like this present opportunities to be flexible, opportunities to think outside the box . certainly this is really important and i think right now it makes sense that i transitioned into this role with mylaw enforcement background also . i think that is critical for the vitality, the health of our downtown, our district and our terrific neighborhoods. people need to feel safe and want to participate in activities and shop and do different things especially as we are coming up on holidays so we're excited the ice-skating rink is back. we will have a christmas tree and menorah and all the goodies i'm excited and i want to thank karen flood her 10 years of service in this space and really all you've done to support our city which has been
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just so vital to thehealth of our economy so thank you . >> thank you and with that i'll open it up any questionsyou may have . >> thank you for the presentations and thank you missflood for your service and welcome . i'm sure folks will take you up on walking around the district with you. i did have just a question around the timing of thisreport . can you walk us through just the timing of the annual reports? generally when they're completed and come before the board this one is for 20/20. i assumed for covid related reasons why it's come just a little later but i was wondering if you could shed light on that but also wondering when the next round as we go back to the standard timesor what the next one would be ? >> i be happy to

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