City and County of San Francisco Wednesday, March 10, 2021
>>chair haney: this is the March 10, 2021 budget and appropriations committee meeting, and met haney, joined by committee members present
President Welton, supervisors ronen, safai and mar and our clerk is linda long.
I'd like to thank sfgov tv for broadcasting our meeting do you have any meeting announcements ?
>>linda wong: house emergency, employees and the public and board of supervisors in the chamber and committee, members
will be participating in the meeting remotely.
Miss Mccutchen local and state federal orders.
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>>linda wong: fiscal year 2021
2010 in two . Members of the public who wish
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>>chair haney: thank you so much Madame Clerk and we are
joined by the dph team and I believe I will turn it over I think to director koufax.
>> thank you chair and thank
you other members of the board.
I appreciate the opportunity to present our budget to the budget and appropriations
committee and thank you for your support during this unprecedented year. It's been a full year since we been in this pandemic.
And to acknowledge the many hundreds of people at dph on the front lines addressing this
and other competing health needs.
I will dive right into this and
then be available for questions as well as other members of the dph team.
I will also , we have several
other speakers during the slide
presentation who will vote in our mission at the department of public health is to protect and promote the health and well-being of all applicants and our vision is an ambitious one, to make san francisco the healthiest place on earth. You can see what we do in terms of the other bullets on this line .
We do a lot. We as assess and research the health of the community,
develop and work to prevent disease and injury, educate the
public and trained healthcare
providers to provide on complex healthcare and ensure access for all to healthcare in san francisco.
Next slide please.These
activities are reflected in the budget.
We are
, our base budget is $2.6 billion, healthcare unfortunately is quite expensive and you can see here our big bucket items include
the running and management of the san francisco general hospital with over $1 billion budgeted. Our 24 hour hospital trauma level one hospital in the city.
Another big area of it is in behavioral health, obviously a key focus is in the many competing behavioral health needs in our city which I think is only and further besides in exposed during the pandemic. And then we also have in addition to the other
components of the slide , one is the largest if not the largest skilled nursing facility in the country . And you see that is our largest expenditure.
Next slide please.
One of the key things about the health department that I think is really, has been instrumental in our work to
address the covid-19 pandemic is we are an integrated department.
We have 2 major system delivery divisions that san francisco
health network which includes the two hospitals I just mentioned as well as the hero health services and primary care these are service divisions where we're
delivering care to people and then we have to our population health division which is really when we think about public
health and disease control and
prevention we are, the environmental health protection, our community health work and so forth so we really have an integrated department which means we're
looking at issues with regard to health. Not just from a service guide or a public health side that people are at the table representing expertise in both areas. This is one of the reasons why just like we were relatively successful with our hiv work,
we were able to apply this to covid-19 and we're continuing the work in behavioral health and making the population health side and healthcare delivery side in our approach cover. Next slide. So I think like most
departments, salaries and
benefits are our greatest expenditure. Accounting for just over half of our budget. We have a large number of people working in the department, over 7000 ftes
again consistent with that
integrated department and the fact that we have 24 hour hospitals running in a wide array of service delivery systems that are operating across the city. Next slide.
So we leverage a large amount of revenue
. Our general fund numbers, this
is drawdowns from the federal
and some degrees of state including and especially medicaid dollars. You can see here the blue bars are total revenues not including general funds and orange bars are the city general fund subsidy and you see variations on this with
hospitals zoning down . None general fund dollars to a large extent as well as behavioral health.
Next slide.
So our key strategic areas or 2123 included in this budget
submission are continuing to focus on equity for our patients and staff . And also developing our new medical programs under county
which is the states program that will be basically a
modernized revised medicaid program and I'll talk more about that briefly.Then under
another , underdevelopment with
our stakeholder processes are underdevelopment with regard to
our covid response and
expanding behavioral health
programs including mental health sf which we've worked with several of you on very intensely over this year. And then our overdose response .Next slide.
>> I wonder if I could ask a
clarifying question on that. Is that possible? Chair amy? >> yes, go ahead .
>> doctor koufax, when you say
underdevelopment in the stakeholder process that means those two things are not included in the budget submission? >> that's right. And we will get into more detail about this during the rest of the presentation.
But we are working with the stakeholders to further flesh
out these components of our
budget. >> okay. I just wanted to clarify, thank you. And doctor koufax, if I could
just add through the chair, acting cfo, we are underdevelopment our new
initiatives related to covid response in behavioral health as opposed to anything already developed and included as part
of the base budget for 2123.
>> sorry if I didn't make that
clear .
>> .
>>Dr. Colfax: included is
continuing to focus on our task
including our focus on
investment to implement the
racial equity action plan and we will talk about this in more detail in a few minutes and
then implementing new programs
under county, it's still very
much in development, it's postponed a lot of the state action on this . This is going to take several
years and this is really we expect this to shift a lot of
the medicaid focus to things such as pay for outcomes and performance.
It's something that's been under discussion a number of years now but we are waiting for the state to really put some more specifics to this.
And no changes including one
year extension of fulkerson care.
Part of our proposal to meet
our target.So calaim is very much a moving target but it's something that we are definitely working with the state on very carefully to
optimize the benefits of calaim and make sure we are prepared
and ready as possible and then with regards to creating a
sustainable covid-19 response, much work going on here .
Again, I think the board members, all the board members are familiar with this presentation to.
To review particularly specific
to dph, includes committee outreach and prevention.
The all important contact tracing, the continuation of testing, isolation and
quarantine. Clinical support for the shelter and hotels, information guidance, outbreak management and our clinical capacity and
of course the vaccination rollout.
So we are continuing to work in creating this in terms of a
sustainable infrastructure support to meet the near and long-term needs. This is obviously a work in progress as things evolve and we're continuing to develop programs with an equity lens. Right now this is being
developed in conjunction with
covid command leadership and other departments that are integral covid-19 response and with the mayor's office as well .
Next slide.And just to build
on supervisor ronen's question with regard to behavioral health programs , we're continuing to roll out mental
health programs for facilities acquisition and things that we've spent a lot of time
talking to many of you about.
Key areas that expansion for 2023 included expanding services of supportive housing for people who have high behavioral health , expanding
capacity and then these multiple stakeholder processes that will be continuing this spring. With the oversight committee. The mental health implementation group, the mayor's office and florida supervisors and ceos
and other contracted behavioral health providers will be engaging in these expansion of
this work going forward and I just want to be very clear that
while some of this work was necessarily delayed because of
the pandemic , I see department sees the behavioral health
issues that have been brought in to even sharper relief
because of covid-19 as a key area of focus as we work to
transform our behavioral health system and a firm commitment to
ensuring that we both address covid-19 and strengthen our
response in behavioral health programming on the mental health side and the treatment side. And now I'm going to turn the
presentation over to jenny louis, are acting financial officer will get into detail with regards to some of our additional budget information.
Thank you.
>>jenny louie: the next two slides will talk about our February budget submission and first I wanted to go over what our strategy approach was as we
were developing our goals. First and foremost was the
revenue opportunities to meet our general fund target.
Our goal is a safety as well as
critical day service is always to maintain services and I think our proposal does not include any service reductions. Just given the constraints we
have in terms of operationally
as well as financially, we are goal is also to minimize new
initiatives affecting our key areas of focus.
Then as doctor colfax mentioned, there are two
stakeholder processes that are taking place this spring for
the development of a covid-19 response in behavioral health
services that are occurring so we wanted those processes to be complete and did not want to create initiatives into silos so those have not been included in our submission but will be
developed in conjunction with the key stakeholders. I balance a proposal that
outlines to the current year's fund balance is reported in this expense report and I can go into more detail on the next slide. You have not permitted to an a half percent contingency proposals but if required to do
so we May be required to
implement expenditure
reductions to meet that target. So specifically, in terms of what we propose, our evident
half percent reduction target
was about 50 million over two years.
In addition, a portion of our revenue process is already
assumed as part of the deficit . And so we sort of need to make good on that promise. that was protected as part of
the mayor's office and
controllers office projections and in addition we have a 2 and a half percent contingency.
That we have not proposed yet
but we are working on. In terms of revenue initiatives
our first alignment was really around the initiative that
doctor colfax mentioned and we did include the known changes and transitions that we are
aware of . I believe this is 24 million the first year and reducing to 15 million the second year.
This is because of the whole person care which was extended only for one year. We are expecting a successor program to be developed over the course of this calendar year but we do not have any details and funding allocations. Secondly, we have two baseline
initiatives, first related to general which is annual updates to
our future service and our transportation rates.
And then on the same baseline increase in year two. We already have a baseline increase in year one and at this point we are not testing additional revenue. In the first year of the
budget.The next initiative we have is related to the federal reduction to the disproportionate share of hospitals area recognizes a release that 51.6 million of deferred revenues that we have held to offset a federal
reduction that was scheduled to
go into effect December 2020
the late December, is passed
legislation delaying effective date till the year 2324 so we've released those dollars in the current year and the
mayor's office has approved to put these doors are balancing
target. So this 51 million is part of believe hundred 25 million the
controller is already projected for support. In addition we also have a one time reserve related to
behavioral health and completed
a final reconciliation of prior-year mental health cost supports and I do believe this is 8.4. With these initiatives we believe that we met the first
reduction target that we have
and we put $1 million down
payment on our contingency.
And also I apologize, on the expenditure side the only addition is that we are putting
forward is implementation dollars related to our racial equity action plan.
This is primarily around reporting the training around
our workforce and doctor bennett will be talking more
about the action plan as well
as equity in the department in the next slide.
I'll turn it over to her . >>. >>chair
haney: can I ask a clarifying question about this slide?
Your production target was 59
million but because you brought
in 101 in revenue
, you are well above that so you're not going to make any reductions to your
own budget.
Can you clarify a little bit what approach you're taking here and then what is happening to the net balancing you have their above target?
Is that included in the budget ?
I'm a little trying to see the approach you're taking, can you clarify that a little bit?
>> the reduction targets are about reducing a general fund
report so it can be achieved in one of two ways.Either we reduce expenditures on the general fund or we reduce our reliance on the general fund
through the leveraging of additional revenues. So you're correct, we're proposing approximately 101 revenue in year one and about
35 million in year 2. It's a little bit lopsided how we
actually met targets. So in the first year we sort of exceeded our target of 59 million in year one.
And we are short a little bit of our general fund reduction target in
year 2 overall, between the two years they
balance and so it's sort of in the 2 year budget period we have met our target. Does
that answer your question, supervisor.
>> so to reduce your reliance
on the general fund by not much because you're bringing in
revenues separately.
>>jenny louie: correct.
>>chair haney: donna, thank
you.
>>chair haney: arianna . >> I want to go over briefly the complicated equity that we're doing and try to open it
to questions area and this is just the framework of the equity work that we're doing in the department.
It's been out several years at
this point so much of this is in place and we're talking now about which parts we're expanding . We are working on 4 different fronts, capacity building
including roles for people, new positions, skills training, partnerships, health disparities, direct health disparity goals in our service quality improvement programs
and community engagement to set priorities for those things. Equity culture and a lot of that is workforce policy, how we're treating each other, how
to the workforce works in terms of pei goals and equity training
and accountability, how are we
recording statistics to communities and our work, what's the planning and
oversight so that the work that were doing.
In this particular budget there are resources focused a lot on what the racial equity action plan is calling for and those things are focused on training, equity training, workforce and data tracking.So training, workforce policy, all those things you will see in our
budget .
It's less focused on community engagement or health disparities but we will be continuing that work in those areas it's advancing.
Thank you. So workforce and health equity.
We have work currently in both
areas and as we know we have room to grow in both areas. In this particular budget we will be asking for funding for new training . Policies and data tracking resources, those are all required by the racial equity action plan. Some of that we have in place.
We certainly have basic trainings in place but we don't have the extent that is being asked at all levels of staff.
And in some of the areas that are being asked so we need to expand their. Policy changes and data monitoring will require something to be put in place
doesn't currently exist, in
particular data systems around
professional development,
around the hiring process and promotion, those things are reviewed but not tracked in any kind of consistent way and that will require some things to be dealt. Establishing more consistent
community engagement standards . It is asked for in the racial equity action plan, it is not as detailed as some of our own internal goals but we need to put resources to it if we want to do the priority setting with
community and some of the
communication package that's being requested. And that we agree needs to happen. Continue development of
workflows and resources to improve quality of care.
No health disparities are both about social determinants and
things that are outside of our purview that are a part of our local government or part of our social makeup but much of it is also quality of care and assistance care and those things we are continuing to work on. We're going to be working to
administer 50 million of the reallocation that's going to for the most part mental health and other resources. To reinvest in the community from those public safety dollars. Go forward. Thank you.
Here's some examples of our health disparity programming.
There are other things but these are good ones. In maternal child health area we are continuing the work on the dual program that was established with the cbo a few years ago area we're continuing to grow , we're getting additional funding this year and next year, food security
has been a major part of our work and its expanded and
growing a lot because of covid because the demand of covid
required an integration that we had been working for but had
not yet achieved and that's in fact trapped. Perinatal health disparities, we have persistent ones that we are with the rest of the country but they have not yet been fully resolved by any means.
Primary care has several around heart health and food security and other issues. Covid in particular is something they are working on, making sure we have an equitable approach and they succeeded in many ways of doing and making sure the resources they are marshaling go to the communities where it is most impactful for covid.
We have some reinvestment of public safety money, things happening with behavioral health leadership I will then decide that board. That's lots of changes around
culturally congruent care and
telehealth and other expanded methodologies that might be
more desirable to a broader array of communities. Basically those that are served and are population health ,
public health programs , things we have disparities in health education , those sugary drinks
distribution and taxes are heavily focused on correcting
and equity and all these things are focused on health
disparities and everything the apartment is expected to have those health disparity goals be expected to achieve. Next slide.
The racial equity action plan, all the departments are doing
across the city we like
everyone had multiple areas and
I've highlighted one we want to
be sure it was focus on that is particular to us as a health department and in hiring we
know we have a long persistent disparity in who are clinicians are so you come from our population itself is mostly black and brown and we look at our providers they are certainly not fast so our managers, providers need to
reflect the community that were
serving so you have initiatives
to correct those recruitment strategies and in our standardization of higher
increasing promotion of some staff that we do have in management, because he absolutely had disproportionate numbers of black and brown staff in our levels and not as much of the management management levels collecting that internally would be helpful .
Disparities in discipline have been documented that were working on that call for accountability and
standardization of management practices.
Opportunities for staff for
professional whether that's
promotional duties or simply development on track perhaps is different than the one on. Respectful workplace standards . You have problems in discipline but there are things beyond discipline that are just in the
level of disrespect for the treating each other. Some of that is racially
mediated and we know that's something we need to work on the record and equity standards , being integrated into our budget and policy decisions . We're working without permission right now on establishing an equity tool that they are going to use that we expect to have in place soon
. So I'll just talk briefly about
how equity is impacting covid. It's been an issue from the beginning and it was clear there
were disparities early I would say late March or early April. So we've been working to be sure that our services were able
to reach communities that were being heavily impacted.
That means letting amenities,
african-american
, there are disparities really across the board and parts of the city
that we traditionally have equity in other areas. So we will be working with the neighborhood and equity the command center and community branch which is to some degree
integrated in the community programs of the health department transparency and accountability and making sure
that programs continue to be weighted to help those communities that are most
heavily in the end we have seen some success in that in both testing and vaccine distribution. And we're going to talk a
little more about covid in particular. Jenny, I'm sorry. I
don't know who is muted on.
Class go back and I'll do. >> you want me to go get it?
>> sure . >> can go back to his life for
me?>> a little bit of a delay . >> that's okay.
So the continuum of care, there have over the last year to a really clear and I think
will of understanding what the
needs are from all areas of the community along the continuum of covid both from prevention
to recover and we have built I
think fairly robust programs at
each of those areas, prevention
and education is done by our
community branch within covid
command but it's increasingly community education at this department standard does. Something development, exposure screening, is part of our
health education programming and reusing community members
and spreading the word about
trying to understand those things what to do to isolate and all of those things. Actual clinical care testing, results disclosure, hospitalization and care
primary bear as well or all things is focused on.
Case investigation and facing
possible department primarily, isolation and quarantine
services both supporting that through feeding and all those other things that people require to be able to stay in their house as well as the understanding of how long people need to quarantine and giving them places the poor and
see if they are not someone who is currently has been in
recovery services that people need to get the medical care
for the sometimes long-standing impacts under covid and the
other services to get people back to their functional life.
Next slide.>> jenny, are you
trying to .
>>jenny louie: I think there is
a delay. Sleep well I'm going to talk
about . The phones for covid are mainly going into.
So we do have many outreach programs, much of that work is contracted out to various community groups.
The intention with the community members who had
trusted relationships and community had already reached groups that we May, they
support testing sites that
community member who might not otherwise be able to go to large capacity sites tested in their
area in a trusted way. Investigation contact tracing is
also something we want to use. Committee members and trusted ceos as much as possible because it is a lot of
information and somewhat interested in all this information about yourself and we need people to be honest and open to their contracting with and community care, was going to the who and who do people trust tell with any plumbing and other things. And then contact tracing, training centers training community member continue that work.
Go forward. >> good afternoon supervisors,
carefully and members of the committee, require the operating officer for dph. I wanted to respond to your message care katie but I have specific questions about contracts and our oversight of
contracts process and how it accompanies.
We've been working actively
since the controller and city
attorney review produced our recommendations over the past
year and their integrity and contracting assessment.
We have a process going around we're working very closely with
the city attorney's office to
go through each of those recommendations that were produced, evaluate what's
required from dph to meet those
recommendations also to look at
other opportunities. For where we can do better and where we can make changes to our process.
We also have in addition to what we're doing locally within dph a number of layers of
oversight due to the fact that our funding as we described it
from the previous slides is significantly comes to us through the state and federal governments and that each of
those programs comes from compliance disclosure and
activities actually but add a
layer to our programs for oversight of our contracts.
Next slide. >> one of the areas that we are working on is with our foundations.
We have three foundations that
raise funds to supplement the
mission of the department of public health and we're very
grateful for that work that they're doing to supplement our mission.
But given the recommendation and the controller and city
attorney's integrity , we are really doing a rigorous review all of our processes working with the city attorney to make sure that we are in compliance that we have the right
safeguards and controls
processes in place so those are our public health foundations for san francisco general hospital foundation and the new
name for the organization . All those organizations are
working with us and wish to be in compliance
. We with the city attorney's
office are updating our mo use , updating our internal processes
around how we interact with
foundations and the rules and
processes around accepting
gifts and how we manage that .
And we will be formalizing back
and bringing that to the health commission as we develop those recommendations so a lot of
work there normalizing mou's and our processes.
Next slide. I think this is good. Also on the acceptance , we are
changing our processes .
We do post our donors on sfdph.Org and refer to the
health commissioner on gets regularly and the health
commission as oversight over the relationships between dph and our foundations.
We've also done a number of things, I think there are a few
approaches here but they are process approaches and their changes but there's also the approach of making it part of our daily structure within dph
to be cognizant of our ethics
and the requirements of all city employees and we really are working to try to get our
staff the tools they need to know what the rules are, no one to ask and maybe to have conversations on these topics
so we updated our safe compatible income activities
and have training on online review and signatures by each employee.
We develop and then further updated our annual compliance privacy and ethics training
that goes through all of the local and state ethics rules and each employee takes
training really from the health commission throughout our organization . And then we have established a
number of communications tools
including our regular quarterly
compliance newsletter that
highlights issues around these types of rules.
For example in December we did
gets between employees of the holiday season but also gifts
generally as part of the city just so our employees have access to regular reminders
about information on this topic . Next slide. I won't go into the details on
this this is to give you a little bit of a sense of we have a real ecosystem of
oversight monitoring that is
built within our department and
that we're kind of continuously looking to develop and improve. This goes all the way from the
have multiple offices that work at various points in the contracting process.
Contract development , our office contract compliance with reviews compliance with contract requirements.
We had our financial goals
, we had our office of compliance and privacy affairs evaluates complaints for the whistleblower program and all that is to work together and our approach is to try to make
sure we have multiple eyes on multiple parts of the process and that we don't have anyone
single part of the organization
, almost like an accounting control approach. Where you have multiple parts
of the department involved in
transactions and not too much
discretion and authority in any one place.
Next slide please.
We also course at our internal
processes you're aware of. City attorney, oca, general
service division, controller's office involved in our
contracted approvals and our contracts to go to the health
commission, to the committee of the health commission for review. The majority of the contracts that dph enters into.
Next slide.
So again, you also have charity
about quality and how we monitor performance in our contracts. We also have a pretty developed system and are always looking for ways to expand and enhance and improve this.
But we have multiple points in our system .
We have you and the development of contracts so that each
contract and each rfp we are
working on thinking through
outcomes that we wish to go off
including those in contracts that a system of monitoring and
auditing to determine whether we've met those objectives.
This is always a challenge because there's so many pieces
of work that we do that are about healthcare quality and outcomes that are challenging
to measure this is a big focus for the department.We also
have our external stakeholders
in our programs and we do
client satisfaction surveys. We have structured processes
for clients or members of the
public to raise issues about quality of service provision in the department. These are normal agreements and there's always some of those
there and next slide please. On it, we had a close working relationship with the controller's office. This is a little sample of audits that the controller's office has done with us .
We always welcome audits and we often ask for audits in areas where we want to make sure that we have third set of eyes. And then we course on its with
the controller's office and we
work on those and take the recommendations seriously area
next slide please. So I think that is the end for that point. I know that's a lot of information I want to respond to the questions that were
directly raised charity on
contracting and we're happy to
provide more information for discussion on those. And I think that concludes our slides so we will be happy to
take questions on discussion. >> thank you so much, I
appreciate it . There are a number of questions.
I've got someone I will let my
colleagues go first.
>>supervisor ronen: it was nice to see the department answer
the questions enthusiastically and that was great.I had a horse a lot of questions about
the behavioral health funding and implementation of the mental health assessment and
starting with the budget, you had sent me last year when we were going through the budget process a spreadsheet on mental health ss.
That basically , I just pulled up the version I had in my home computer so I don't know if
that's the latest vision but we
appropriated $34.4 million in
implementation of mental health in fiscal year 2021 and 34.7 for fiscal year 2122
approximately and I'm just wondering what we're projecting
we will actually spend that
34.4 million fiscal year 20-21 and any money that has been spent
with that, then just
lumped into the budget for the
next year? I'm sorry, I'm not feeling articulate .
Does that make sense?
>>Dr. Colfax: it makes perfect sense. I don't have the figure on the projections for actual this year
and we can certainly: that
for you and as you know, from
discussions in this committee there are some of those funds
that are fully released to stand and other portions that
are not fully. On your question on what happens to the unspent funds, proxy
dollars which are the source of
funds for those programs are in a special fund so they are self-contained.
Any unspent dollars will carry forward .
So they won't fall to the fund balance
. They won't stay there and be
available for future use .
>>supervisor ronen: that's helpful, that's good to note. I always love to see that sort of line item budget like you
gave us before for the implementation for mental health sf and thus far what you're expecting to spend, the rest of the fiscal year and sort of look at the implementation of mental health
sf through the budget because
we know that the crisis
response team has been , that
sort of component the first fiscal year has been implemented but the implementation has gone much
slower for the rest of the
legislation in the program.
>>Dr. Colfax: sorry, I was just going to say, I didn't mean to
cut you off. You're correct. I think there will be savings
and my mind is going back to last year, I remember we had a discussion the budget process ,
where going to put it in such a
way that the budget would be
the source of any delay in implementing those programs .
That has been the case. There has not been a restriction. I know that there are some that are going slower and there will
be available balance for use for other purposes. Other piece is that of course
as you know there are crops see funds that when we passed the budget last year were not available because they were still the subject of lawsuits
and what the outcome of that lawsuit , those funds are
available so that will be an
additional pot of dollars in
the proxy fund that was not
appropriate and available and we talked about options for
those including use to acquire
sites but other options are
available .
>>supervisor ronen: I noticed on page 10 and this is
something that we can perhaps talk about in a deeper way
outside of the budget sf but
the mental health service center is not included in the list of mental health sf
. You're calling them an extension of the behavioral behavioral health center and that has been sort of a meeting
of the minds
, a meeting of the
minds has never occur on that aspect of mental health sf and it even shows up in the language
during a budget presentation. I just want to point out that
we had specifically funded many aspects of the creation of a
mental health sf service center that have not happened. It has not occurred so much so you're not even expecting that in the future looks like according to your budget presentation and that's something that's deeply concerning to me. Before I read too much into that, I want to make sure I'm reading it correctly.
>>greg wagner: please don't read too much into it. You're correct and you know from our discussions that there is still a lot moving around the mental health service center and I don't think there's an intentional shift in any kind of policy here.
One of our donations, those are the poor working groups that form mental health sf is around
the service center there is a lot of work going on. We talked about to some extent so that work and that finishing of the program is continuing.
I know one of the things and
I'm happy to have kelly weigh
in but just on the budget , one of the things that we can focus
on our first step is expansion which is clearly not meeting
the whole vision but that's one step and I think that maybe what's reflected in the language here but point taken.
I don't know if marlo or kelly
wants to join in.
Class I can speak more to it on follow-up questions but that was a good summary of where you stand .
>>supervisor ronen: when does the new director start?
>>greg wagner: March 29 .
>>supervisor ronen: and given
that you did not include in this budget submission to the
mayor anything new for mental health sf , does that mean more
of this 21, 22 fiscal year the
baseline that we had budgeted
last year?>>greg wagner: a 43 million we had budgeted last year where assuming will all continue.
And we're not contemplating going backwards.
It's really as Miss Louis had said earlier, it's really what
is going to be added to that
program with the additional funds or other funds that were
made available back from the lawsuit and for that, we are working with committees .
Appointing committees that are
invested in that and we are
pretty actively having
conversations about that and the next month that detail will, but we just didn't want to get ahead of that process
when there are people who have been appointed to do that partnership and that's why we
delay the process but it will
be to come over the experience .
>>supervisor ronen: thank you so much and I wanted to shift gears away from mental health for a minute.
Just to talk more about the covid response in the latin community.
Specifically we've noticed that vaccinations for example unfortunately we are not
meeting so that the population
of latin text fulton the city with
vaccinations yet. In proportion to their
population in san francisco
.
The community was hardest hit in san francisco so I'm
wondering if there is a plan to
specifically in the budget
focus in on the latin executed in
terms of continued response? >> perhaps I can provide some
context . Absolutely as part of our
community response we , it is and will remain the focus going forward . As we continue to expand aspects
of that, dph we focused on neighborhoods with greatest
need in covid-19 and if you look at the data with regards to who has been eligible for vaccine by criteria, where dph
vaccine is going, we have a higher proportion to the southeastern part of the city
and compared to vaccine administration overall, within
dph has administered vaccines we are the higher proportion of vaccine administration to
populations 65 and older and the black african-american community compared to the population overall this is obviously driven by the fact that vaccines workers implemented for healthcare
workers 65 and older so that proportionality is very much dependent on some of those numbers. And as we go forward we will continue to strengthen our relationships and communication and are access points , really every door is the door for
vaccines area our sites will continue to be key areas where
he will provide access for people to go. Our clinical sites?
For instance san francisco hospital people are eligible for the vaccine and drop in with
the highest rate, they can receive vaccine and we will also be extending our neighborhood access sites so
that in areas with the highest prevalence will have access as well to multiple sites for people who are homebound this
ecosystem of care, of vaccine administration is going to be really key and we're working
with command to make sure the community and equity branch , that the latino communities
most affected have ready access
to the vaccines . Our main issue right now as we
don't have enough vaccine right now in san francisco we are
poised to do well over 10,000 vaccines a day and again, we just need more vaccine to get into arms. Within the dph side we obviously received between a quarter and a third of vaccines coming into the city. We can certainly show this data
on follow-up within our testing supply we are appropriately
reaching the communities most
at risk . Obviously we need to continue to improve on that right now
our numbers are better than the
vaccine administration overall seen by our other health providers .
>>supervisor ronen: on monday I
was at the 24th and which is amazing and a really great
partnership between dph.
And what's striking in talking
to the latino task force on
covid-19 and you can see it everyone in line for the most
part was latino is they
literally went to every business, every food
establishment on mission
street, on 24th street, on 16th
, on valencia and said you are
eligible for the vaccine. Right down the door, and out the street and we will
vaccinate you so especially for service workers that works
really well. Just putting a vaccination site
in the middle of a hard-hit neighborhood where there are tons of service workers and dragged into the vaccination site and I'm just hoping that
more efforts like that can be placed in communities
particularly since since the 24th I know my office is
working very closely with the latino task was to put others at 15th street .
And create partnerships there at different parts of the mission given issues that exist in the neighborhood .
really hoping that we can work
together to not remove that but add additional sites. Is that something that's going to be possible and is not requested in this budget?
>> it's something we've been partnering with on the task
force from very early on , from testing canal vaccines and something we're engaging actively with them with regard
to where other potential sites both in the mission and other parts of the city where we can expand your talking to other community partners and other parts of the city where there's also a great need. That part, are vaccine
expansion, that conversation
and the budget pieces on that underdevelopment in collaboration with command and
the mayor's office and we continue to work to expand our
vaccine access so not directly reflected in these numbers yet
but while we specifically
caught up to the response and
expansion of mental health , there's work on the progress
but it's certainly shares the ,
we share your concern on these priorities anywhere working with key partners to make sure as much as we can can recognize the mission we all hold which is access for everyone who needs a vaccine as much as possible .
>>supervisor ronen: thank you, those are my only questions .
>>chair haney: supervisor safai .
>>supervisor safai: I want to start backwards in a series of questions I have to build back
to the last point supervisor ronen brought up with regard to the what tino task force.
I know they have been also done amazing work in my district as well and I know they've done tremendous work for dph but it brings the question about one of the shortcomings of dph as
doctor colfax in terms of not having a robust spanish-speaking latinx staff
to deal with this and if not for the task force stepping up
we would have been in bad shape so question becomes in terms of the equity lens that you're
looking through and some succession planning as we move
back to normal, what is the aggressive plan to ensure that we have appropriate staff at the mid-level and managerial
level and engagement with black and brown communities , appropriate staffing is extremely important and having that is extremely important to
build up many of the successes
that community driven .
>>ayanna bennett: the lack of representation for black and
brown staff at the managerial
and in our clinical services or clinicians, that means that people who May be doing these kind of treatments on activities
that we want to see.
It is not proportional where we wanted to be and we know that . What we tried to do over the last several years is look at
why that is and we have done
some work to understand that better. But that is in recruitment and
some of it is in the lack of
folks in the pool that is
reflected both in who is in the pipeline programs that we do
know . That would be some of the city
college tech programs that we could be getting people from. Some of the nursing programs that we could be getting people from. They all have lack of diversity
in them but we have more than we do so partnering with those groups and taking our hiring
and recruitment process as part
of our goal, it's part of the equity action plan and its where were going now.
Right now we're working with clinicians and with the primary
care department on whatever hires they have which are a reasonable amount to make sure that we have the kind of candidates that were looking for to fill those positions. We got a workforce equity director last year and is going to be a big project to do this. It's quite a lot of change or the apartment in terms of positions and policy so that is where we are right now and it will take some time to fix but we do not it's a problem and where building the infrastructure to fix that rent right now we were dealing with that is contracting with our community-based organizations. And trying to convert what we can of those positions to
slightly more long-term, not all civil service and as it comes up we try to get people in them. That is a band-aid right now in terms of having people represented.
>>supervisor safai: you do have in your equity plan that part
of your strategy but maybe some of it also and again, I'm not
going to tokyo at divisor equity plan, you have some one that's designed to do that and you have a staffer in an equity office
, is that correct doctor
colfax? >>ayanna bennett: >> in my team is a director of workforce equity.
>>supervisor safai: so then you
been producing the equity plan, I knew you were health equity,
I just wasn't sure if there was physically an equity officer overall for engagement of staff and so on but that's great , I
appreciate that . So then my next question would
be there's also opportunities
to do more contracted work with community-based organizations .
That already have the infrastructure so could you speak about that for a moment that could then also help fill in some of the gaps.
Besides waiting for the train of people there's already a
whole infrastructure and if you want to speak about that for a minute . >> that is the interim plan and that certainly has been the
approach that we've taken with covid, that was not going to happen if the patient was needed so it was clearly eliminated and right now some of that funding is already flowing. There are plans or how to convert more of what is being
carried by others and perhaps
not conforming staff to those
contracts and that is in the planning that we have going
forward. I don't have the details of
where the sellers are. The one.
>>supervisor safai: clinic
question would be ins instead I'm going to shift focus. You might be aware we had a
hearing in February regarding
services and safety and the
intersection now any of our
criminal justice system, repeat offenders and those with
significant substance abuse issues. One of the things we've heard a lot of as we've been doing
research leading up to the interim and after that particularly from the black community was that abstinence-based care in the
substance of your small that you all have. Our system is more based
towards harm reduction, not
necessarily about abstinence which is what from hearing from the community can be more
effective than in black and brown communities and I wanted
to hear if you're aware of this
and was there a plan to engage
and how more engagement about this type of service delivery.
>> I think I can recommend that
doctor bennett .
>>ayanna bennett: I am aware of
trying to make more culturally
appropriate and that's based on actual asking of the communities in san francisco what they want. We are making efforts to do that . That's part of the behavioral health equity plan expanding racial equity action plan within those communities and health objectives. I would not be the best person to give you the details of it, they have an equity chief of their own works with me and also bar lot maybe is the better one with the details but yes, there is a plan on how to redesign substance use
services, I don't know .
>>supervisor safai: who is the person that part of the mental
health equity plan ? That would be the right person
to have that conversation?
>>ayanna bennett: doctor hammer could be the person, sorry about that director .
>> good afternoon.
This is allie hammond, director
of care for the san francisco
health network and I'll answer
your question supervisor safai.
After the hearing that you referred to
, we had reached out
to leaders from the recovery
summit and the committee-based organizations that they represent.
To begin the conversation about
how we can explore options ,
abstinence-based substance use
treatment programs and we can
explore those two basically as
doctor bennett referred to close the identified gaps that
we have in our services, not
just in terms of treatment modalities but also treatment programs, diverse treatment
programs to serve the black and african-american communities
and that are in bayview.
We approached them and in other neighborhoods.
We approached them , I think we had a good meeting. I think we have a lot of work
to do but we are very committed to
bridging the gap.
And then you asked about who doctor bennett was referring to, she wasn't occurring to me,
she was referring to I believe
jessica brown was the lead on the office of workforce
development and equity in the behavioral health services.
>>supervisor safai: obviously we would be concerned based on my previous statement about also about the latin american
and latinx communities and how this plays itself out in terms
of abstinence care but also potentially the way you all do your rfp process and substance abuse care how can be done in such a way to make some space for that, how it could be more
inclusive for these communities .
Doctor colfax, did you want to
say something?
>>Dr. Colfax: just following up with doctor hammer
. We hear the concern that we will take this to task .
To add that abstinence is part of our continuum of recovery
program. There's a potential need to expand some of that but we do
have that component in our
recovery programs in our system of care but certainly we will take this back under consideration so thank you for
the feedback . >>supervisor
safai: I don't
think it's reflected in your rfp process when you are doing your work for substance abuse.
I think that health 360 gets a significant portion and a lot of that model is harm reduction,
a lot of the , you've all invested time and energy and
yes there is a continuum of care for accidents is arrogant talking about the pure abstinence-based peer-to-peer
alcoholics anonymous, narcotics anonymous that are in a
residential setting so we have
proposals that we're working on budget wise that we're doing
are going to bring forward and
important conversations, we just wanted to put that out there and we think it's an important part of this conversation here. I appreciate that. My next question and this will be, I only have one or two more
is with regard to mental health
as staff, I know you all have
community working group one of the things again just going
back to intersection allergy between incarceration and substance abuse and
incarceration and mental health
issues, there did seem to be a feed on the design for someone that was incarcerated. Can you talk a little bit about that and how the final working
group groups were created.
I know that you and others spent a lot of time working with their departments and it's just something that jumped out to my team and I wanted to see
what your response was.>> . >> dbh didn't like the law
supervisor.
>>chair haney: I just wanted to see
, it just seemed as though three out of four people were on probation in some form or
another and with mental health and other issues it seemed like it would be something that could be helpful. Normally incarcerated, you probably need some
representation .
>>ayanna bennett: there's a
coalition of service providers to create mental health sf and
the working group was kept active with any interest in mind and there is some representation on that group. from organizations and people
that work a lot with
incarcerated populations so it didn't get, you know how these
working groups work out that everyone and their mother wants to see and if you put too many seats on them, no work gets
done. So that's how it happened but dph did not have a role to play
in creating this escape for
mental health sf . >> I wanted more of their, I
knew you guys had created this
is not in any way a slight. I just wanted to see what they
thought because three out of four, there seems to be a lot of intersection allergy between our incarcerated community, I want to see what they thought in terms of obviously you guys went to a large stakeholder process and there's a lot of
people weighing in but I wanted to see what dph thoughts were
on that in terms of having some type of overlap with maybe a seat that has someone normally incarcerated.
It seems to be some , it's
coming up over and over.
>>Dr. Colfax: I'm going to have
doctor hammer providers perspectives that answer your questions.
>>supervisor safai: maybe it's
a separate group of formerly incarcerated to deal with some
of these issues .
>>ayanna bennett: I'm going to divert acting director simmons
to answer that and after that i have some thoughts but I am a member of the implementation working group so I think it's more important that marlo simmons been working closely
with the group that she answer
the question .
>>marlo simmons: as you know behavioral health services as a very robust network services
were people who were involved and have grown a lot over the last 3 to 4 years and mental health sf is explicit in calling out the population coming out of jail as a priority so we work closely with the staff at our mental
health and also all of the
probation and parole folks and
in particular straight crisis
response. I'm sorry, not crisis response,
care coordination happening with the office of coordinated care. Helping people that are transitioning from jail is one
of the first groups that were prioritizing. So I don't know that,
>>supervisor safai: I think kind of a larger macro from
this and yourself and Mister
Colfax that there seems to be attention paid by only point was_in some ways there needs to be some proof that you all have a working group working with
the formerly incarcerated or some of these larger models to try to create people to work with the working groups to create a seat where there might be a dual partner and some of this is
formerly incarcerated.
Substance abuse because this is something that it's a reoccurring theme and I think that voice is missing.
That was my only point. I do have one question , one
last question for you doctor colfax this goes back to the conversations we are having
about the emt program, citywide
emt program, what division does that fall under on the slide that you had in terms of where it falls on your budget and
what section of your agency.
>>Dr. Colfax: are you talking about the ones that program? That is under population health division.
So .
>>supervisor safai: can you pull that slide back up so we can see what section of your budget that's in? I can understand a little bit
better.
>>ayanna bennett: I'm working on it right now. >>supervisor safai: you said
population health.
>>Dr. Colfax: if you look under the population health division
you see the emergency medical services. That is one of the ones in
their .
>>supervisor safai: it's hard
for me to see it .
>>Dr. Colfax: it's under population health, it's on the far right in the box on the far
right .
>>supervisor safai: got it. and
what percentage, how much
of your budget is allocated to
that emergency medical service .
>>Dr. Colfax: I don't have that in front of me but I will defer
to your chair minor and if we don't have it we can get it to you before the end of this process.
>> one of the, maybe the , one
of the things is that that hasn't always been part of your department, is that correct ? It used to be part of the
department of emergency
management.
>>Dr. Colfax: that's correct, it was part of the public health department and emergency management and it was put back in the health department. >>.
>>supervisor safai: so it hasn't always been part of your division and is that something you feel is fully integrated in the sense that you allocated
the money and there's been quite a bit of back-and-forth in the fire department and you and I have talked about that and we're going to continue to talk about that moving forward but I guess what I'm trying to get is does it seem to fit 100 percent in your department , it seems as though it's really a 911 function and I'm trying to
figure out, I guess my overall statement is you guys have a
very large bureaucracy . you have a very large system of management and a lot of that has to do with public health and I'm trying to wonder if that is the right fit for your department.
If not department of emergency management, I want you to contact comment on that for a moment. >> I'd say thank you, I would
say that the , it is an emergency response department.
It's not
, it has not melded as well as I think we have
anticipated with regards to the population health function.
And it's clear that within the department of emergency management with the responses that the 911 calls that there
hasn't been a disconnect . As a result of the transfer
between the emergency medical
services as currently constructed under the department.
And with fire. >> it seems to me it's a little incongruent based on your
stated mission with all the areas of focus you have and
your expanded responsibilities, it seems to fit more neatly under department of emergency management so I just wanted to get your thoughts on that. We can have more follow-up conversations but for the integrated approach for fire, 911 and emergency management, it might be something that fits morbidly back over emergency management and again, part of
my conversation that in this
instance is trying to not trying to reduce the responsibility that you have what you have so much responsibility and some of it is not necessarily part of your
primary core function. So anyways, that's my last statement and I appreciate it
and we can follow up.
You are on mute, Mister Chair .
>>chair haney: President Walton
and .
>>supervisor walton: the entire team, thank you for this presentation and I have a few questions. How much staff does the
department have?
>>Dr. Colfax: as we presented
on slide five we currently have
7163 ftes across our care and
delivery
.
>>supervisor walton: just so I'm clear, you have 726
thousand $300 of your 2.6 and other budgets going towards
racial equity for 21 and 22 .
>>Dr. Colfax: I believe that's correct.
I can have jenny or greg .
>>jenny louie: in addition to the current funding. The staff is already there and dollars that already existed.
>>supervisor walton: what that
amount, do we know?
>>jenny louie: I know the staff but I don't know all their salaries but we can get it for you.
>>supervisor walton: from my calculations and math has never
been my best subject we're
talking about.002 percent of
your budget for 2122 on towards racial equity.
So I'm wondering how we
implement a plan that affects
7126 employees and probably
more with.002 percent in the
budget .
>>ayanna bennett: it's a big list. I will say what you're looking
at right there does not reflect the entirety of what's available because we have not started it this year so there are designated equity staff at
both hospitals and primary care in every area there's at least one part-time and the larger
area there's some full-time. Some of them have additional staff. There certainly can be councils of champions and other staff that we designated to work on these issues. The training needs of that racial equity act with action plan accelerate what we're doing with our current resources quite a bit so it is a large left. We think we can do it with the additional staff that we are in place. There's going to be a lot of data development which for the most part we're going to try to do with internal resources and it's a lot. It's a lot in fact we do already have some resources in place . it's ambitious. You are correct in that.
>>supervisor walton: we know it's ambitious and heavy lift, what we just put more resources
into the work?
>>ayanna bennett: to we thought we needed. I did not pad it, make it extravagant but I can use whatever I can get so we
certainly can rethink it in terms of how much we have in totality and let you know what
the entire picture is and we will have a better sense that I think.
>>supervisor walton: I know we talked about a lot of our black and brown employees getting entry-level and lower-level positions. How are you going to provide a pathway or employees of color example? What's the actual plan?
>>ayanna bennett: there's several strategies. The first is that we believe
there is some element of bias that happens in all of hiring. I think that's not for us but everybody. So standardizing that process to manage that as well as we can. We already do as we started
this years ago at this point
asking people to get trained in antivirus hiring and being
aware of who's at the hiring panel so it's been in place for several years .
What is it necessarily in place
is the screening of candidates.
it's not necessarily a
standardized recruitment , it's
not a standardized so getting those things to be more
enriched with people from
different backgrounds and to make them more fully directed our internal staff, we have
black and brown staff who could fill these positions. We just don't have clear pathways. We're starting with the places we know that have gotten
trapped at one level . We have some known classes where there is a ceiling where
the lower levels of that class
we don't see promotions path
that for some kinds of staff. Particularly black staff but all staff so we're working on those in particular those will start relatively soon looking at standardizing those. The plan is still being developed with our workforce
equity director. That is what's going to start and that should expand to everyone. In terms of getting
professional development and performance reviews and other things in place, that would
help those staff know the skills that they need to get to the next level, develop those skills to manage antivirus
managers and preventing them from documenting those skills. Those are going to be worked on so there's manager training, manager for equity series coming up and putting some conflict processes and other things in place to do
possibility for managers. So in the racial equity action plan I can give you more details to move forward hiring
and promotion
.
>>supervisor walton: into 2018
and early on in conversation , we talked about the department
has a recruitment plan in place as to how they were going to hire, who they were going to hire and all these components
and has ever been developed ?
We've been talking about that for 10 years.
>>ayanna bennett: I think it has been in some areas.
So we have some plans of going forward around
clinicians.
Some have gone forward on the population health side around some of our community physicians.
I don't think , what has not happened is the standard across the department.
Those are always challenging because we have very different areas of the department operating at the hospital and
environmental health are two entirely different animals so
getting that standardization has depended on having a network infrastructure for people to be accountable for in those areas and we had just developed in the last few years so that is where we are going. >>supervisor
walton: what do you think the timeline is to have these policies developed? Is it important to have something in place that illustrates also for us as
other party leadership and support what the plans look
like .
>>ayanna bennett: I think in
terms of where we are trying to recruit from which classifications we are focusing on , I think that's a matter of months
. Right now are focusing on the hiring policy and the training
so we are trying to get those people in. Are not expending energy to pull people into a broken system will have a which has happened in the past.
We're telling people we haven't really developed antivirus hiring and support that we that's why we see people leave on probation and the separations that are out of
proportion so we're doing a little bit of internal work around making sure we have
accountability systems for managers in place.That policy about respectful workplace and complaints is in the works right now and we have to ask them to put in place in the next few months. I would say in all of that background support this fiscal year I can imagine and we can talk about who it is we're looking to hire and where were trying to get them from. I think we already know to some
degree but I don't think it's
been as articulated as it could be .
>>supervisor walton: last year I know you have several
resources for covid response, are you going to continue to support this program with
funding for vaccine clinics ? You gave resources to ceo to be able to provide those services in communities.
That included in those resources for these
organizations still included in
the budget moving forward?
>>Dr. Colfax: I will let greg
wagner had had more to this.
Basically this is exactly the
covid-19 budget that we're developing to ensure that there are various supports for the
community response and vaccine
rollout as we discussed earlier I will let greg wagner or jenny louis talk about
that process.
>>greg wagner: yes supervisor,
thank you for the question. I'll let ginny wait in we are in the process right now.The
process is being led through d3 citywide from the mayors and comptroller's office. Within each branch, evaluating
the needs and for the coming fiscal year and as you will
recall where you mentioned last year's budget we had a one year
budget and now we're refreshing
and doing some projections for what they need for the coming
year so that process lacks , the budget selection we made in February.
We will come together in the probably the late spring. With the citywide budget for
all those topics that you raise
and the funding that you raise is part of that planning process .
>> back to you this is my last question for now what do you
have in place for employees other disparities gaps in pay
and investment . >> right now I don't think
there are adequate internal support for, where this employee resource groups.
Those are at least one or two areas of the that are starting
to develop those and if we get that model going we will spread to the rest of the department so that will be peer-to-peer support. In terms of supporting people
in pay other things that they
feel are not being equitable in the area
, one of the things
we're trying to do is develop what the complaint system is outside of eeo and labor. We don't really have ways for
people other than big formal things that have real high bars
or what the real problem is to really look at those things so
that is one of the policies and developed right now. It's being wrapped around a
respectful workplace policy which is hopefully going to fill the void of all of the lack of respectful behavior
that might reach the bar of eeo, doesn't quite violate labor and that could be
expanded to include other ways in which people feel like things are not fair. They don't really have a pathway to make those complaints at this point.
So that's what we're developing
right now 's I think as one of our larger departments and one of our most resource rich departments , you should be
setting an example of racial
equity , how to address the disparities on issues that exist
.Because of the size and resources . So hopefully you all can come
up with a lot of strategies and
really start implementing how we're going to achieve racial equity . Within dph because I think that
will be important for some of our smaller departments
.
>> President Walton, supervisor mar couple of questions, actually one is pretty broad and one is specific. On the wrong question , doctor
colfax in the beginning , you
highlighted that one of the strategic priorities on the
junior budget is going new
medical health programs under calaim was in one of the slide jenny shared , if I understood it correctly the projected
revenue increase of $39 million over two years. I just throw that number down
as a result of these changes . I don't know if I understood
correctly but I realized that it's obligated but I was wondering if you could just provide a little more description about what calaim is and how it would impact services to patients in san
francisco and how that impacts
the budget again if I understood it right, I think it's going to be an increase in revenue.
>> acting supervisor and I'll let ginny talk about the numbers simply but just with regard to calaim, we would have a lot more specific about calaim the state was working on
it's very intensely and now
it's been significant delays.
There are two key components to calaim that we are hopeful on
and again this can be worked out.
One is to think on a positive scenario would be there would
be more flexibility in how cows dollars can be spent so that services that May not have been
historically reimbursed , supportive services that we
know are so important to help whether it's mental health or behavioral health.That would be supported in a way that for
instance case management services potentially even more flexibility around food
insecurity issues and so forth. Transportation would be
supported with calaim dollars , with medi-cal dollars and there's a state conversation in
the federal administration, there's I think more flexibility could be potentially realize you the second phone it is bringing
what we call a value-based approach to care and I think we have to be awful about .
Overall we are supported and particularly with local
populations with these chronic
conditions and multiple
socioeconomic challenges, we
want to make sure it's in a
place that is basically value-based performance or pay for performance set the outcomes are tangible and
reachable and things that allow
us to draw down a positive outcome.Rather than a more of
a pay for services , there's going to be more of a focus on
outcomes and paying for outcomes and we expect that will be a transition training.
It's challenging in terms of
determining what those outcomes would look like and what the payment would be but that's the
vision of calaim going forward so the increased flexibility and in a more specific outcome focused, the medicaid program with those value-based and a4 performance programs. That's the what we've got so
far and details are going to
really matter here and that's why we're engaging with the state on this and then I'll let
denny or greg talk about the $39 million figure that you
brought up. >>. >> and happy to take the
question so as doctor colfax mentioned there's a significant change will be happening.We
don't have sufficient details to understand what impact will be our budget commissions
include three known changes
that we're essentially either
extensions of programs that we are expecting to hire an adjustment to a matching requirement that's created a benefit for counties and then the one-year extension of the
whole person care, need hs mentioned in the last presentation which is the
shared benefit we have between other city partners.
So the first year we had about 25 million in the second year
we have about 15 million so 39, I think you're looking at. We will continue to looking at what the state will provide. For the next months
, probably
the most , the program that we will likely see those details
come out , sooner rather than
later would be exploited to the
successor to the whole person
share program. We've reached initial details
but we won't get specific funding mechanisms for rate
settings which is basically county allocations until May or
June. So it's something we're going to be watching carefully and in the meantime we are assessing
our current programs and we have a broad framework and
we're trying to understand what our current programs look like and then repairing for a fundamental shift for two value-based payments. It's one thing if we're trying to focus on service outputs and
volume-based payments purses looking at outcomes and making
sure we have the infrastructure to be able to track the report
and again, where not quite sure
what the mechanisms we will
need in place to ensure that we
can draw down this but the good
news is that the current waiver that we have did have
significant focus on value-based payments and we have some of the infrastructure in place that will be required additional shifts and operations but again at this point, until the state releases additional recommendations on multiple health plans we don't have much
detail at this time. >> thank you for that and yes,
it sounds like there are pretty significant sort of shifts in
how calaim patients or folks on that will be served in our city
and they have such institutions
to be really interested in
continuing to monitor those and engage .
And can you just mention how
many folks in the city are
talking about that. And would be impacted by these changes can mark.
>> . >> it depends on how the programs are developed.
I don't have the managed-care numbers area I don't know if you have it at the top of your head . It May be defending, if not some programs May not be for
all calaim beneficiaries . That focuses on again how they
actually roll out.
>> we will get you that data in the thousands. I have in my head the numbers in our network but they are beyond that there served in other systems but I don't have, we can easily get that. It is a large portion of the population that's served
.
>> thank you and just my more specific question is about the crisis stabilization unit for
children and youth . Dph started off as. In 2014 I think it was at
edgewood center for children.
You know it's extremely important and unique services for children and youth experiencing severe psychiatric
and behavioral health crisis . So I just wanted to see area I
know there's been challenges in
sustaining that program and democrats otherwise the last few years but I wondered if you knew the status of that or whether that's continuing in
the budget.
>>greg wagner: I will have jenny get an update on the
budget piece on that and when
jenny's programming alter to
director martin.
jenny, I'm not sure, maybe marleau you could talk about the program and I don't know if you heard if you could update the supervisor on the budget
line there.
>>marlo simmons: I can add
obviously had a very tough year
couple of years ago and I can
ask for and get you information on any recent updates . I haven't heard anything since
they started opening and taking referrals.
It's been quite a while that's
been happening and there hasn't
been anything new to add so they are still in the budget
and still doing that service .
>>jenny louie: I believe the funding is in place but Mister Wagner has more details on the contract.
>>greg wagner: echo what marlo said and the funding is in place but there were issues around the process that
contract so we will as marleau said get you more details on what's going on but I know a lot of those issues and corrective action plans of the
department are required or delivered. The deliverables under the grant program in florida, supervisors approved as an interim measure. We were working with edgewood
on the corrective action plan. It has been met with the potential of the final
deliverable and we will get you
an update on that one as well
we will get a much more stable situation than last year when we were at
this point.
>>supervisor mar: I don't have any other questions .
>>chair haney: I have a few. The first thing I wanted to ask
and I noted that I have discussed this I think with many of you before and I just
wanted to flag as something that I hope to see in more
detail in your budget proposal
that comes in front of us in a
few weeks or months . And that's what we are going to
do to stop the explosion of overdose deaths , particularly
of antonello in our city .
As you know very well we have
three times as many people die of overdoses in 2020 and died
of covid-19 and of course I understand and support the huge
focus and effort we are giving
to prevent the spread of covid-19 and save lives but the explosion of deaths has continued into 2021. In fact we had a much higher number of deaths in January of
this year and in January of
last year . Fentanyl in particular is a huge concern of mine.
I really would like to see a
much more specific and built a plan to address the fence no
crisis in our city. We had 11 people die of fentanyl in 2015 and in 2020 ,
it was over five
.
that level of growth in one
cause of death I think has very
few precedents in our city and is a public health emergency
unlike many we've seen.
So I know that your slide
identified areas of focus on this including expanding
services in permanent
supportive housing and overdose prevention and response. I wonder if you could speak
especially doctor colfax, what
your sort of general plan is
around us and I know that hopefully we will see more details in the coming weeks and months but I really do think
that we need a response that matches the crisis we are
facing or we are going to just continue to see this growth that we've seen over the last
few years and it's happening right in front of our eyes and
I really look to you all as
experts to bring us forward solutions and the resources
that you need to be able to
reverse this really just
terrifying and deadly epidemic
that we are facing in our city .
>>greg wagner: just to reiterate that we share your
concern and the public's concern with regard to this
incredibly tragic and concerning crisis .
We will come back with more
specific proposals and as you know we continue to expand our
overdose prevention efforts . We have expanded our treatments
with other substitution
therapies but we certainly need to continue to do more and as
part of mental health sf and
other initiatives I think we will come back a set of initiatives that I think both evidence-based
, innovative and also trackable in terms of outcomes with regard to that
and I do think that in response
or following on supervisor ronen's questions with our new
behavioral health director
doctor hillary coons will be starting this month and comes with a wealth of expertise and overdose prevention efforts. I think we are moving in the right direction.
The covid-19 pandemic intersected with the overdose pandemic making things even
more challenging but certainly that's a priority for the
department and a priority for our team and I will turn to
doctor hammer to provide any additional comments but we will return with more specific
vocals to put these on the top of the list of the department's
response.
>>hali hammer: thanks doctor
and supervisor amy, I want to start by saying that we share your sense of urgency this is a
terrible, terrible problem. It's really a crisis we all
have to both joined together and I would say start taking
outside the box , building on the things we know work really
thinking of approaches to this problem. It's just unacceptable and also I want to say I appreciate your partnership and your working with us to figure out how we
use data , listen to the voices of the people in the communities most impacted and
develop interventions that we can evaluate and make sure they
work. One of the things I'll say and
this is certainly not the only
thing that we are hanging our hat on by any means but in 2020
we had approximately 4000
overdoses reversed by bystanders in san francisco and
that an incredible number so while we have an acceptable anticrisis point number of
people dying from overdoses and going to the hospital cause of overdoses, we also are getting a lot thrown into the hands of people who live with, you
people you've seen using
opiates and I think our teams
on the ground , incredible community efforts to teach
people how to prevent overdoses and then reverse it when it happens
. As doctor colfax said, our work
is really around both removing
barriers to treatment and we
don't make it easy enough to get into whatever kind of treatment is amenable to the
person who gets to that place of readiness so we want to remove barriers. Also want to expand treatment options as we spoke about
earlier as supervisor safai and
so we can share specifics but we really have I think a team of experts in addiction medicine and public health
experts who are developing this
new really innovative approach . I think lots of innovation but
also engaging voices and community we had heard before and have engaged before so we can bring back this work to you and show you what we're hoping to implement and that we will
be including in the budget but again, I want to end by saying
we are all just in place of
horror what you see every day in your district and what we see all over san francisco and know that we have to try some
of these things in order to let
this particular curve in terms
of reversing these trends,
reversing disparities and
ending this health disparity .
>>chair haney: thank you for that commitment from both of
you and for your work and the work of both your teams and I look forward to seeing those plans. As early as I've said many many times in many hearings and many legislation and everything else
that we've done that I really
feel that we need solutions that are as big as the crisis that we're facing.
Otherwise things will continue
to get worse .
I think we've learned a lot, I hope all of us and you all probably surely more so than me
, from the covid-19 pandemic in terms of how to respond to it as a pandemic and I hope that we can bring some of that same morning to how we approach
fentanyl and deaths from
overdoses and I really do
appreciate all of the work.
4000 reversals is extraordinary
so many people whose lives were saved.
It also suggests and reflects the fact that the problem is
much larger than the 500 people
who tragically and awfully died . This is impacting many many thousands of our residents and many thousands every single day at risk of dying.
So just the is just you and I know a lot to put on your shoulders but in reality this
is a public health academic and it's on your shoulders and our shoulders I just want to be clear that I'm not going to be able to support a budget moving
forward that doesn't this year
take the level of action and priority and strategy that is needed to confront this crisis .
>> .
[Please stand by]
App
>> Supervisor Haney: thank you talk to this a little bit, Dr. Colfax? I've brought forward treasure island as a general thing with not only covid, but I hope you and your team can keep an eye on treasure island because this is a neighborhood that has a lot of public health needs on the island, and as we're seeing from the vaccination rate on the island, that does translate into less access to help treatment and the vaccine, but it goes broader than that. So can you with sort of the funds that you have, the $5 million, how that's being distributed equitably and if you can share anything how we're responding to the crisis in the tenderloin and the high
case rates here? >> sure. So thank you, chair haney, and just a couple of things. The 5 million, those were
distributed through an R.F.A. Process where organizations
were working with the highest covid-19 burden were eligible,
and just to emphasize, that was
to supplement and augment -- that was to augment the other efforts that were going on through the many community based organizations that partnered with us in our covid-19 response during the
pandemic, so just to emphasize
that piece.
Right now, we don't have enough
vaccine, and we're going from
people most likely to die, teachers and health care
service workers to food service workers. So people who have received the
greatest number of vaccine are those who went earlier.
We are expanding vaccine access
across the city, including in your district. With regard to specifically in
the tenderloin, tom o'dell
clinic is starting -- is
vaccinating, St. Anthony's is vaccinating.
We're also allowing or
providing access to people in certain zip codes in the
tenderloin to allow them to
drop into zuckerberg general
and get vaccinated, and we're
talking to the consortium,
St. Anthony's to figure out when we have vaccine available, we can expand there.
and then, we have our mobile sites, our mobile teams that
can be deployed.
At mobile command, roland pickens, who is our san
francisco health director who
has been designated as director
of mobile command, he has been getting vaccines into arms as quickly as possible when we get enough vaccine. So you have our commitment to ensuring that, in your district
as well as in other districts in san francisco, where there are populations that don't have access to vaccines through their health care provider
and/or who will not go [Inaudible] Including right now, as you've pointed out, in
the tenderloin.
D.P.H. Has, again, control of a quarter to a third of the vaccines that are coming into
the city, so our efforts, unfortunately, are not inclusive of all the other health care providers, but we are working with the health care providers to make sure
that we have a coordinated response.
And again, for more details, we
can have Mr. Pickens or covid
command to pick up details as part of follow up.
>> Chair Haney: thank you for that.
I appreciate it. And, you know, I do think that we are going to get to a point where we're really going to
have to be meeting people where they are and particularly in
the neighborhoods who might not have enough access to technology or are disableds,
and so making sure that we're
deploying, you know, those resources and doing the outreach and those kind of
things is important in the
tenderloin and treasure island, or those two neighborhoods, and there's probably more, as well. The last thing that I wanted to
ask about, and we've had hearings on this before, is
around extort of staffing
ratios at -- at general hospital, sort of general, sort
of nursing staffing and other sorts of staffing in the more
clinical settings. Is this something that you all
are looking at in this budget or helping to address in any sort of way or filling those positions? I know there was some conversation there about hiring, as well, but I'm
wondering how you're looking at kind of general staffing and
ratios, particularly in sort of more health care settings and
how that's reflected in the budget? >> so thank you, supervisor,
and I would say -- I will say that, as we scaled up our covid-19 response, one of the things that we were able to do
was lots of work from people on this call and others, particularly as san francisco zuckerberg hospital and our
H.R. Leadership, we were able
to hire a number of nurses to
address what had been chronic
shortages there.
I can also turn to jennie and greg with more information on this upcoming budget. >> I can respond to that. Thank you, supervisor haney.
A lot of moving pieces on that question. As Dr. Colfax says at the beginning of the pandemic, and
we have been leading up to it,
we did put in an expedited hiring process in place.
There are two factors that play into, I think the question that you're getting at.
There's the budget and the funding available, and there's
our ability to get permanent
hires into our budgeted
positions, and so both of
those, we have been working on. We established the expedited
hiring process, and we have --
we'll get the updated data, but
a lot of registered nurses
through that process, reduced
our vacancy rate significantly. At the same time, one of the things that we're seeing is
since a year ago, we have had an increase in the number of
our staff on leave for understandable reasons, and so
those are offsetting factors as
we continue to try to get the
ratio of permanent staff up.
We do have funding for clinical
positions as part of the
covid-19 funding at zuckerberg, so that's additional staffing
for the covid unit, additional
staffing for other units in the
hospital where we need to enhance staff for infection
control, isolation, etc., and we're reevaluating that with the hospital right now as we go through development of the
covid-19 budget, so there's a
lot of activity around nursing, but we are trying to hold the
ground that we've made through
hiring so we can be at the
optimal level of our staff
shift and supplement with 30-Ms
as needed for surge and backfill, that we get that core
level up to where we need it.
so we will certainly send you
the updated levels on what we
have if that would be helpful.
>> Chair Haney: thank you. I appreciate that.
That would be helpful, . When you come back, if you
could let us know about the
staff levels and employee hiring, I think those were some
of the questions that I had
asked, and we can hear those in preparation or receiving those for the next hearing.
With that, colleagues, any
other final questions or comments? And we will see each other again, and we do really appreciate your whole team being here.
I know you have a lot going on,
and this dialogue with us is very important and will help us understand what you're going to bring forward to us in the
coming months, and I also appreciate everyone being here
and also for you to be here, Dr. Colfax.
We really do appreciate you
being here in person, as well. I don't see any of my colleagues -- anything you want
to say in closing, Dr. Colfax, or your team?
I know you have a lot to go do. >> well, just to thank you for
your support, and we will return with more specific answers to some of the questions that you asked, and looking forward to moving
forward together both in the covid-19 pandemic, the
behavioral health issues that
came up, and automatic the work that the public does. Thank you -- and all the work
that the public does. Thank you.
Madam Clerk, is there any callers?
>> Clerk: operations is checking to see if there are
any callers in the queue. Mr. Chair, there are no callers
in the queue.
>> Chair Haney: all right.
Public comment is now closed. I am going to motion to file
this hearing.
Is there a second?
>> Supervisor Safai: second, safai.
>> Supervisor Safai: seconded by safai.
Roll call vote, please, Madam Clerk.
>> Clerk: yes. On that motion -- [Roll Call]
>> Clerk: there are five ayes.
>> Chair Haney: great. Thank you. This hearing is now filed, and thank you, Dr. Colfax and team.
I want to thank all of you, but
there are many of you here, so collectively thank you so much for being here with us. Thank you for your work during this very challenging time, and
we will see you soon again, I'm sure. >> thank you.
>> Chair Haney: great.
Madam Clerk, can you please call item 2?
>> Clerk: item, Mr. Chair.
Item number two, hearing on the
overview of the office of economic and workforce development's but vet for
fiscal years 2021-2022 and 2022-2023.
Members of the public who wish
to provide public call should
call 415-554-0001.
meeting I.D. 187-775-3464.
Press pound, and pound again.
Press star, three to enter the queue, and a system prompt will
indicate you have been unmuted.
>> Chair Haney: all right.
Welcome to the office of workforce development, and I
believe I'm going to hand it
over to ann the director of office
of economic and workforce development. >> thank you.
I want to begin by thanking chair haney, President Walton, and members of this committee for the opportunity to speak
about this office's work to
support and empower san francisco's most vulnerable and
most impacted job seekers.
While every single person in
our city has been deeply
impacted by covid-19, it is
painfully clear that our low-income communities of color
are facing severely disproportionate health and economic impacts.
That has shaped OEWDs immediate response to the pandemic, and
it continues to shape our view
of a more equitable economy as
we move into recovery. As we will discuss further in
this hearing, the focus on
serving the most vulnerable has informed each of the $17.7 million that has funded critical safety programs for
impacted workers, including the immigrant worker fund, the
family relief fund, workers and families first, and right to
recover, which has enabled over
4,300 workers so far to safely
quarantine without risk of significant financial harm.
But still, our workers are
facing historic levels of unemployment in the jab market.
As we approach recovery, the urgency around the need to advance racial equity has never been clearer. For this department, that means
working to ensure our african american, latinx, indigenous, and A.P.I. Neighbors have
access to the resources and the
opportunities to succeed, build
wealth, and provide for their families. In partnership with our leaders
on the br ises, the office of
economic and workforce development is in a position to drive real change in those areas. We also realize that work has
to be rooted in a transparent, community accountable driven budget, and to inform their investments are formed and
shaped by community, oewd held three town halls. Their input reinforced the need
to focus on our core services
and ensure that we are taking a holistic approach to remaining barriers to employment facing our job seekers. That means strengthening our
core job readiness services and
ensuring that the city's
multiworkforce system is
available to everyone through on going interagency collaboration and cooperation.
Director arce will go into our building back stronger R.F.P.
Which has been built from the ground up to reflect community priorities at every level through an extensive outreach
and engagement process. During the time of budget reductions and immeasurable
need, we know that we must be very deliberate about serving
our most impacted communities, we must be efficient and accountable to the communities we serve.
To achieve those goals, oewd is
working to best align our
resources with other city departments.
We saw the powerful impact that
effective interdepartmental
coordination can have from oewd's collaboration with the
latino task force.
Oewd helped direct $28.5 million to specifically
aid our latinx communities specifically hit hardest by the pandemic.
>> for the $3419,000 for
nonpersonnel services, that's
related primarily to a
reduction in our rebate refund program, which offers a reduction in fees paid to the city during production of film. For our city grant programs,
the $7.9 million decrease is
primarily attributed to the
expiration of one-time add backs of 3.5 million.
With respect to the programatic
projects, the $1.7 million increase that you see there,
it's primarily attributed to an
increase for all initiative,
which provides pathway and opportunities.
The $83,000 decrease in
material and supplies [Inaudible] In the department
of labor, and $555,000 increase in other departments otherwise known as work orders is related
to an increase in our work
order primarily associated with
agreement, and lastly around
[Inaudible] Through or
revolving loan -- our revolving loan program.
so with that, I'd like to turn
it over to the director. >> thank you.
At chair haney's direction, I
will invite josh arce to go
into greater depth on the programs affecting san
francisco's workers and their
families for the remainor of the presentation. >> thank you, director, and
good afternoon, chair haney,
vice chair safai, President Walton, supervisors ronen and mar. Thank you for the opportunity
to present our budget, and as I walk-through, you'll find,
chair haney, and colleagues, we've been very intention about
responding to the list of questions to really drive into the equity goals and objectives, transparency, and
how we're making these
investments, so I'll speak to those points here at the presentation. Really quickly, I just wanted to establish a quick baseline
on this first slide with respect to how our program
areas are structured, and that will latina us into the
discussion of gaps and equities
and efficiencies and how we've
identified how we're using these resources to address
those gaps and inequities. So our program history has generally been focused on these four areas. Those are neighborhood job center, comprehensive job
center, specialized services forry
for san franciscans with particular paths to employment, and then job services stand-alone portfolio. and in addition, there's investments for youth and young adults.
Those are subsidized employment
programs. Increasingly, our work with the human rights commission around
the opportunities for all initiative. The other bucket there on the
bottom is goes to be on the bottom left, sector training, identified as areas for
opportunity both because of work and career opportunities as well as the potential for
training pathway and industry recognized potential or in the
cases we look for most, apprenticeship particularly working with organized labor to
have collectively bargained apprenticeship opportunities leads to great wages, benefits,
and career pathways.
So for these programs, citywide
program health care program is, and technology strategy for
I.T. Opportunities it tech S.F.
Basis services -- opportunities
is tech S.F. Business services, we refer out to programs and job seekers to
refer those candidates over to
the employers that are hiring.
Obviously, prepandemic, things were different, but we're preparing to come back stronger
as we prepare to open the
economy and do so equitably.
Dylan, if we could go to the
next slide.
Also, supervisors, any time that you'd like to make sure
we're doing work in your
district so we get as many proposals as possible.
This is our city's racial equity objectives and what we've outlined through a community process year-long to
get to what we call principles of employment equity identified
by community members as those
most persistent gaps based on
race, socioeconomic factors outlined in the R.F.P.
This is where you're going to
see some of the changes in the big picture areas.
These are based on a year of community meetings from community based organizations,
community leaders, employers,
educational institutions, prepandemic in the community,
post pandemic on-line and in
virtual webinars and through our workforce for economic
recovery pilots looking for the opportunities to rebuild some
enhancement to the woerk force system. There's some prompts from a question posed by the budget committee around audits.
We've had -- been the
beneficiary, I would say, of
three budget and legislative
analyst's audits to get more alignment, to get more accountability and transparency
with respect to the workforce investments both to our office
and the 21 other department that's have workforce development investments that we seek to coordinate and coordinate more effectively and efficiency and report out to the board and the public. Lastly, the historic investment
of the green keeper initiative
that's funding to support the
black community, led my mayor breed, President Walton, colleagues at the board, those are the former law enforcement dollars that are invested instead to supporting the black community.
We'll talk a little bit more at
the community level.
Generally, these are services
[Inaudible] Here today with the committee, and we prepare
ourselves for the process as it might find additional resources
or have conversations at this phase. We know that there's going to be changes as we go, but today, we've identified $22 million approximately in general funds.
That includes $6 million of the $60 million annual green keeper initiative funding allocation, which is based on community
recommendations, $4 million of
opportunities for all. The additional general fund
includes a $1 million add back
as well as an add back to the employment needs and providing services to formerly homeless
and formerly incarcerated job seekers.
Those are in that general fund
bucket.
$4.7 billion in funding work
the workforce opportunity act and cdbg funding.
That could increase based on
changes in the federal administration.
It's not guaranteed, but we're hopeful. We're taking proposals from now
through March 31, and we're answering questions that anyone
might have about the process and providing T.A. All the way through. Questions will be answered all the way through March 17, and we'll continue to provide technical assistance for
potential grantees as we go.
Next slide, dylan, please. All right.
so the -- the budget in this framework includes, we
mentioned, new areas based on community feedback and program evaluation, which was a question. The evaluation of our resources
and the impacts and where we
have our budget aligned is based on the community feedback and listening sessions. I'll give you an example of where we identified for us, which is really, I would say,
the northstar of our workforce system, which is when you look at data, community voice will
tell you about the disparities
that face communities of color,
low-income communities, disproportionately high
unemployment rates, but there's one particular unemployment
rate that stands out, and if
you look at estimated unploit
rate in the city and county of
san francisco, this is the U.S.
Census data, their estimates. There is a margin of error, but there are trends, and the trends you see going back five years -- and once again, the 2019 data is the newest data available to us in December 2020.
You get this sanl refrom the u. -- you get this from the U.S. Census bureau. The unemployment has remained
the highest for black san franciscans, and even last
year, still remains 2.5 times the citywide average. So for that, that tells a story that drives us by community voice and this information,
this data, to make the kind of
investment particularly around that black unemployment gap
because it's marked and accompanied by increment wealth
gap, as well, and it's
multigenerational, but it starts to tell a story because you can look at other information.
You can see here a 10.7%
estimated unploit rate from employed rate from
the american indian and native community.
The theory is that an
employment strategy, a
workforce development series of investments that are targeted
to address with intentionality
that disproportionately high
unemployment rate for black san franciscans becomes a racial
equity strategy that can lift all votes. So the principles of employment
equity goes into race, gender,
affordable housing, immigration status, language.
The -- the impacts of homelessness and job seekers exiting homelessness and provides us data information that we use that helps us evaluate if we're getting
there, if we're closing these gaps, and we look forward to getting proposals throughout
this R.F.P. Proposals to
evaluate the intersectionality of these factors.
This allows us a big system change.
It also allows us to evaluate
these program investments -- to
evaluate the program outcomes and align our programs with our portfolio and the other city agencies that we work with to align our investments in workforce development so we can have the biggest impact to alleviate these disparities
that we find and that community
members present to us based on community voice and this type of employment data. If we can go to the next slide,
please, dylan.
So we spoke of the dream keeper initiative.
It's this historic reinvestment of law enforcement dollars into
the black community, a four-month recommendation led by community members.
Educational pathways, scholarship stipend supported services for black students going into post secondary education, health services identified as an area of opportunity for career pathways
and the type of jobs and careers really necessary to make the jobs make the difference in terms of the
goals and objectives of employment equity particularly
with respect to black san franciscans.
Investments in the arts,
community arts projects in the community, as well as practices
to support careers in the arts. Industries of opportunity was where we heard from community members around the believes to get vocational and industry-recognized certifications in the tech
industry, in early child care education, in cannabis and
other areas where we're
expecting to award two to four
grants from funds we receive to community-based organizations.
And lastly, a community-based organization. This is to support employees
and job seeks who work to
address systemic racism. This is really critical for
systemic change, and for these, these representor us for us an opportunity with the workforce community to make sure we deliver on the hopes, goals, and expectations of the community.
Just a couple more slides, and chk, of course, we'll turn it back to questions from the committee.
Covid-19 impacts, this is some information we present regularly at our workforce board.
Our covid relief investments guide us to those communities
and residents hardest hit by
the pandemic which is one of the prompts from the committee.
We know we don't get the
real-time race ethnicity gender
gap, but as unemployment hit a peak of 12.6% in the early
months when we took the very necessary public health safeguards to stop and slow the
spread of coronavirus, the
impact was 12.6% unemployment. It took a modest decline in December, and we know that because of the programs that
the director outlined, we know
where the impacts are most
acute in our most disadvantaged communities.
Our workforce hot height where
line staff has fielded more than 15,000 calls. Everything from unemployment, getting access to sick leave, anything at all that community members bring. It's questions about housing food, we do everything we can to help connect. We even get businesses calling
in to find out how they can accessory sources at the
department and our partner agencies. The covid response resource
hubs, $3.2 million.
That's 1.35 out of our budget
and 1.85 out of the department
of public health of community
led partnerships partnering with the task force in the mission, bayview-hunters point, excelsior, the right to recover program, which was established
by supervisor ronen, one of the most effective in our mind interventions that we've seen. It's not just an economic
intervention, it's a health incidentvection that she led in the -- intervention that she
led in the early days of the
pandemic, and we've helped
4,740 participants who would
otherwise not have had the resources to safely quarantine. Working with supervisor walton
to get resources out to 4,923 full
vulnerable families through the
end of December, as well as the immigrant worker program to reach 5500 workers there. We have a sense, and we know
this the building right now, there was a question right now that was posed to talk about the long-term investment.
Most of those investments were one time. In the case of the covid time was add back dollars from the board of supervisors, which we
were grateful to receive and took responsibility to implement. Those resources don't exist in our budget today, but we know that the infrastructure must continue. We know that there's probably going to be conversations about
how these types of investments are made because we are hopeful that we can go to orange later
in the month, but we don't
know, so we must be ready.
Last slide, I do believe, dylan. Just want to make sure the community leaders out there and
the organizations doing the
work on the ground get recognition.
Over at the 7 alabama resource hub, the mission language
school, and the members of the
latino coalition task force, and so many organizations doing work in the mission. Of course you've got self-help
for the elderly and charity cultural center doing work in china down.
C.Y.C. Is out in the sunset and
doing work in the richmond
around organizing, young
community developers and partners. If you look closely, you May see the press of the board of
supervisors there, even
assisting with community
members, in bayview-hunters
point, potrero, working with
city build and working with
women who are escaping injustises, including domestic violence and incarceration in treasure island. This is a little bit of a highlight. Again, there was questions around the big system changes.
I spoke to the fact that it was
dechbl definitely a lot of work for us to prepare the information
requested by the B.L.A. And the board of supervisors for three different audits, but it is worth it to us because it provided opportunities for us to increase workforce alignment
to really look at how we make
our programatic investments and our evaluation tools, so that's
one of the things that's big for us. We actually have a recommendation from the economic recovery task force report to reestablish, and this has been prompted by the board of supervisors, as well, to reestablish the city's workforce alignment committee
that sunseted a couple of years ago.
We continue to meet informally, and we're proud to say that ordinance has been crafted,
it's been drafted, it's being reviewed. There's some work we need to do
with making sure that we're responsive to community input
and labor input about having
increased involvement in that committee or the oversight committee, which is established in that ordinance, as well.
I know that's something we're very much open to.
We have to navigate, for those
of you that don't know, to get talk together and talk about our funding investments and how we
need to work through. Certainly, the oversight
committee is an opportunity to really have some more input and
some more oversight the same
way we have at our workforce
development board. Multiyear grants is something that's new for us. It's based on feedback around having the opportunity to work for a longer period of time of
time with clients who might need more work and have more barriers to breakdown.
When you look at the pandemic,
it's also the pandemic rate
that was two to three times
higher than it was a year ago. We're going to need multiyear
grants and get into a long-term
cadence of billing and getting
reimbursed, and I think this is something that's been received well in the community.
Job readiness was a portfolio,
a stand-alone.
They have long-term barrier
removal work for clients who
weren't quite ready to look for
a job.
We're now proposing to coordinate those to work with job centers through collaboratives and to make sure that when someone is ready to
go, that they've got a job center connection to get
connected to a training, or an apprenticeship program.
We have a pilot program section
to make sure we're still supporting the area of
investment work. Lastly lastly [Inaudible] The
realities of covid mean the
work that was in place a year
ago isn't necessarily in place
today, and that's especially
true in the covid community, the
-- in the hospitality community.
For hotels and restaurants, those are industries where we've made a major investment
in training in the past, but based on feedback from labor unions, employers, and conversations with community,
we're not investing in training for hospitality right now,
we're investing in hospitality
workers that have lost work and
investments in tech.
Again, we're excited to see
some pilots focus on emerging
industries to see if we can
make investments with our resources, as well.
And lastly, the green keeper initiative, it's a major historic change, and this
notion that strategy to invest to address the black unemployment gap with drive us to an employment equity
strategy to lift all boats is really compelling for us. The city E.M.T. Pilot program just launched.
It's in its fourth or fifth week now.
It's funded through our initiative and has really
inspired the mayor, President Walton, the fire chief,
department of human resources,
us, certainly, and city
college, we're all proud to support this pilot program for
15 job seekers seeking to
become paramedics with the city
or with private fire companies. And with that, we're done. Thank you, and look forward to answering your questions.
>> Chair Haney: thank you so
much for that, and appreciate you answering all of the
various prompts and requests we put forward. That was impressive.
Supervisor mar?
>> Supervisor Mar: thank you, chair haney, and thank you so much, acting director and
director arce for your presentation and following the work of oewd. Your work has been especially important, you know, during the pandemic in supporting our small businesses and workers, so thank you so much. I just had a question -- well,
a few questions, but first
starting with the small
business support, and you were
talking about the different
programs that were sort of implemented over the past years.
It looks like there was $24 million invested in those
programs, and I wonder if you had support for those programs
over the past year, and just
sort of -- like, but I guess in summary, support on the
different types of businesses, and yeah.
I mean, that's something that I'd be interested in just
taking a look at, if you had that.
>> certainly -- I mean, I can certainly get back to you with a full summary, supervisor mar.
I can tell you of the 24 million, approximately about 5.2 million of that were grant programs. About 90% of that money has
been allocated or disbursed,
and a great deal of it was --
the remaining 10% is in the balance for the grants in the san francisco shines reopening program.
For programs such as outdoor barriers and furniture,
including dividers, barricade planners, pictures for health
and safety, interior configurations, physical
distancing, including counters,
furnitures, all those kinds of things, bum ae happy to get
back to you with a
comprehensive list from our -- from our grants and loans
program to account for the $24 million, as well.
>> Supervisor Mar: thank you. And then, did you say how much is still remaining to be sort
of grants or loaned out through the various programs for this
current fiscal year?
>> so in the grants program,
it's my understanding -- so in
grants, it's -- I'm trying
to -- 4.5 million of the grants
program has been distributed,
and I believe about 70% or
10.4 million of the loans have
been distributed or -- yeah.
So I can get more clarity for you on the actual distribution, but I do know on the grants
program, 90% of that have been allocated, and what's remaining
is based on reimbursement of receipts as they are received.
>> Supervisor Mar: sure, and that makes sense.
When these programs are created, we should get those
resources out to the businesses as soon as possible.
And then, I know the mayor has
sort of proposed an additional
$20 million, but there was a budget supplemental appropriation proposal for small businesses. Is that going to go to new programs or is that going to
sort of replenish some of these programs that are already
existing and the funds have
already been granted? >> I think we're looking at a combination of trying to replenish the existing
programs, enhance the existing programs and propose some
new -- you know, new small business programs.
>> Supervisor Mar: mm-hmm. Great.
And is that proposal on the allocation of the $20 million, has that already been put forward?
>> it's something I think that
we need to now cultivate or populate with programs. I think a lot of it is looking
toward recovery, including activations along corridors and
how do we, you know, reactivate our neighborhood corridors and as our businesses start to reopen so that we're drawing people back in, so it's
programs like that that we're
looking to now reestablish.
>> Supervisor Mar: mm-hmm. Thank you.
And then, looking ahead to the two-year budget, I can't remember if it showed up in the
one -- I think there's one budget slide, but what is allocated in the budget looking ahead for these similar types
of loans and grants to small
businesses or how much, I
guess, in the two-year budget? >> I'm sorry. Can you repeat that, supervisor? I'm sorry.
>> Supervisor Mar: yeah.
So how much in the two-year
budget proposal is allocated to these similar types of loans
and grants to small businesses
or, if any?
>> I would ask our C.F.O., merrick, if he can refer to that line item?
>> Supervisor Mar: and I
just -- I would say I know that
these different programs that were created over the past year
were sort of responses to the great challenges that small
businesses are facing, but oewd
has sort of on going, you know, programs that provide small
grants and loans for
businesses, so I'm just curious
how much is this type of
support for small businesses? >> supervisor mar, [Inaudible] For the office of workforce development.
I can get you those exact numbers at a later date, but
with respect to our resiliency
grants, I think a lot of that
was in response to a lot of our
covid relief programs, so we'd kind of need to look more at
what's baseline with respect to that particularly in our neighborhood division, and
around our loan program, we do have kind of an on going revolving loan program, and that's not really budgeted.
We get, I would say, investments. I would say every couple of years, we make a request to
have an influx of capital to
ultimately be lended out, and
once those principle payments are made, we take that pot and lend it back out.
So we do have that, but that's not currently in our budget for this year. I think the last request that
we had made, which was for $1
million was probably two fiscal years ago.
>> Supervisor Mar: got it.
So just so I understand this,
are you saying that there's
really no programs -- similar programs providing grants and loans to small businesses
currently in the two-year budget?
>> I mean, there are extensions
of that within that, but i
think a large portion of what we're doing that through the covid response, a lot of that was highlighted in the pending
slide, but also in the upcoming
$20 million supplemental that
will be brought forward to the board next week, but I'll have
to confer with my invested neighborhoods team to see how
much exactly is budgeted for those programs 6789 .
It's been difficult to track
that, but we'll certainly get back to you with more detail on that. I apologize for not having that with you right now.
>> Supervisor Mar: no, no problem. Thank you for the follow up. I just had one question or a
few questions on sort of a unique fund that was also providing loans, and I think sometimes grants to small businesses, and that's the
construction mitigation program
that -- I know that was sort of
a multidepartmental effort with
M.T.A., oewd, and other
departments that was created to
support small businesses impacted by major construction
projects in the city.
It did include a business impact fund.
I know there was a $5 million
allocation to that fund.
Was that from oewd, the $5 million? And maybe just a related
question, is oewd continuing to
provide services and support to businesses impacted by the construction projects? For example, like the central
subway and vanness being the
high profile one, but out in my
district, we have the el
taraval project that -- and -- yeah.
I know oewd staff has been providing some support, but I was just wondering if that's
continuing, if that's in the two-year budget, the construction mitigation program and business impact fund?
>> so the -- we have been working with M.T.A. On the construction mitigation funding
program, and what I can do,
supervisor mar, is I can certainly get back to you with answers to some of these questions. We focused this hearing on the workforce piece, but I'm happy to get back to you with exactly
what the -- what's left in the
mitigation or how that mitigation program will move forward in collaboration with M.T.A.?
I do know that you have a request into our office
specifically about taraval, and I do have that question -- I will have my staff also reach
out to you directly on that
particular request.
It is based on M.T.A.S direct on the impact, the specific
impact on those corridors, so
I'm happy to follow up with you on that.
>> Supervisor Mar: great. Thank you. Thank you so much. >> of course.
>> Chair Haney: colleagues, any questions? Colleagues, I had one.
There was, in your budget, at
least -- and I know there are a
lot of different buckets and things from different places, but I know you had to do the
reductions from the mayor and her instruction, and your main reduction came from the city,
the grants portion. Did you have -- and you May have mentioned this, but I just
wanted to make sure that I was clear. What exactly from -- what is
being reduced from this current budget year to next year?
What are you -- what are you
removing and, you know, in particular, when you come back
with your sort of final proposal as part of the mayor's budget, I'm not sure if those cuts will still be in there,
but I just want to understand
what that exact reduction was.
>> sure, chair haney. The reduction around the city
grant programs totalled around $7.9 million.
How that's compromised, as I stated in the initial -- at
least on that slide was 3.5 million is related to
one-time add backs that we
received, and then, the
remaining is happening in invested neighborhoods.
About 300,000 is happening
through our best development
programs, and then about 2.2 is coming out of workforce.
One thing I wanted to note with
workforce is 1 million of that is general fund support. We did have, through this
current year, $500,000 work
order with the M.T.A. Around
the city drive program, and that's sng that we're currently in conversation trying to fine-tune what that program will look like, so we'll expect
to see that addition during the
mayor phase of the budget.
The other piece of that was around a $430,000 federal workforce grant around the extension of our health care
academy and programming related to that, so you'll see a lot of
these -- I mean, a lot of the
reductions, you know, have to
be deviated in terms of workforce grants.
The $3.2 million general fund support cut, approximately 2.8 of that is coming through this line.
>> Chair Haney: got it. That makes sense. So the add backs and those
kinds of things, I assume there's going to be a conversation if some folks want them to continue, or some of
the cuts there will probably be
up for continued conversation. Supervisor safai?
>> Supervisor Safai: thank you, chair haney.
I just have a couple questions. First one is directed at
director arce.
I know you did a phenomenal job with your office.
You did a great job setting up
the job center, just wondered what you might have for plans
for neighborhood job centers citywide.
I know you have plans for a potential R.F.P. I'd I'd like to have you talk about that, and then, I have a
question for the acting director. >> thank you, supervisor vice chair safai.
With respect to job centers, yes, the like view akeview A.M.I. Job
center was our seventh and most recent neighborhood job center investment. It's been very successful, and i think really timely because
there's a lot of resource coordination happening there in terms of getting covid resources out. So with respect to the budget
and the R.F.P., we have laid
out resources and prepared to
invest resources in additional neighborhood job centers.
Again, it's through the competitive process of receiving proposals.
But in terms of community feedback, we heard a lot about
the importance of a neighborhood job center in the excelsior district.
We heard about the importance
of a neighborhood job center in
the richmond or the sunset or both. When we think about the record unemployment last year and still an unemployment rate that, if you look at it today,
it's triple what it was a year
ago, but we actually think it's
five times the unemployment rate a year ago because when
you get that unemployment rate,
it does not include those that
are receiving unemployment or those that are not looking for
work, so we they the current
rate might be close to 10%
rather than the 6%.
Real quick, we did establish
the home free housing site on
treasure island.
The R.F.P., if you'll let me
take a quick look, we're
anticipating 7 to 12 grants a
range of $300,000 to as much as $900,000.
The point of the exercise is to
really many unemployed san franciscans as possible with a connection to the workforce system.
that could be a referral to a vocational training program. It can be a referral over to
city college or san francisco state. It can be directed to an apprenticeship or a job, but if we don't have you in the
workforce system, you're
disconnected, and we want to have connection.
Subject to funding, and I know from conversations with
constituents in your districts,
when you take back feedback in summary, having as many job
centers as possible would be
something that's advantageous. But generally the -- the idea
is to focus on areas of concentrated unemployment,
which is a lot more folks -- a
lot more places now than it has been in the past, but leveraging the resources we have, get everyone connected,
and we're happy to make investments.
>> Supervisor Safai: is
sound -- it sounds like, subject to funding, that there'll be some proposal coming out for people to apply. Okay. Great. Okay.
For the acting director, we had
some pretty robust services -- there was a previous staffer assigned -- I don't want to say 100% of the time, but was partially assigned to doing
work on looking for potential opportunities on the
development side or listening to, looking out for potential opportunities and how we could positively shape them in our district.
We haven't had that service, though, in some time. I don't know if you were intending, though, to kind of
beef up that type of work citywide. And then, my second question is, you know, you have your
invest in neighborhoods program.
Our support has been sporadic.
I think some of that has had to
do with covid, I think some of it has to do with covid. But as a neighborhood that has
one of the highest rates of vacancies and empty storefronts, it's been extremely frustrating for me not to have what it feels like a full court press.
I know that that's much more of probably a citywide conversation because of covid, because of businesses shutting down, because of businesses not being able to hold on, because
of rent disputes and fights with landlords and commercial property owners, all the different convenients that you know. So I just wanted to give you an
opportunity to talk about the investment neighborhood
strategy and how there's focus on business attraction,
business retention, on a citywide level. >> thank you, supervisor safai. On the development side, I will
say, you know, we have a much
leaner joint development team than we've had in the past, and I'm happy to work with you on development opportunities in
your neighborhood. I think you were -- I think
what you're referring to was a survey that our team works on with planning to identify
potential soft sites in the district for sort of smaller development opportunities, smaller housing opportunities,
which we can certainly always
partner with our planning
department and strategize on what those types of soft site opportunities look like.
It's really surveying what's available.
>> Supervisor Safai: we had [Inaudible]. I don't know.
She wasn't 100% dedicated to our districts. >> right.
>> Supervisor Safai: but it was a great model, and she was
extremely important in the first 50% affordable housing development done in the city
that was privately financed.
She also was intimately involved in the first, you
know, the largest home S.F. Project that happened in the city. Both of them happened to be in my district, and she was there
to work with -- she provided a different level of oversight. I use that as an example
because I think now that we're
transitioning, we're in this -- projection is our economy is
going to grow by 6.5%. I think the rebound will be stronger and quicker than people are anticipating, particularly with the bailout, particularly with the
accelerated vaccinations,
despite the headlines of
facebook down sizing certain footprints and so on. I think our economy's going to come back stronger, and I think
we would be missing an opportunity not to have someone -- you know, your development team focus on those kinds of things to help in the
areas of the city where those gaps are missing, so that's one.
And then, the second one, the invest in neighborhoods, the
support that we have had with some staff turnover and covid,
and myself, I just wanted to
see, on a citywide level, what the plan was because there's a
lot of businesses that are
struggling to hold on, and
they're important for the health and vibrancy of our commercial corridors. >> yes, and I'm happy to work with you on that first point, supervisor.
And then, on the investing neighborhoods, it is very true.
You know, a lot of the staff,
particularly from our invest in neighborhoods team has been
deployed through the pandemic to neighborhood command and
D.S.W. Deployment, and we are starting to get people back
into their roles in office of economic and workforce development. Investing in neighborhoods is absolutely key to our neighborhood businesses.
I think we've just recently --
jorge rivas, who is great, has
just moved to a different
position outside of the city.
Deanna ponce deleon has come back to the city.
The $20 million grant to business loans will be in front of you next week.
I think there's an opportunity for you to continue to get an
idea of what's in that program specifically for small business relief as we come out of the pandemic and into recovery? And again, you know, I think
it's really critical to us. We all recognize that our neighborhood corridors are going to be critical to our
recovery and to, you know, just
who we are as a city, and I think investing in neighborhoods is going to be a
part of that, and I know that deanna is committed to making sure that all of our neighborhood businesses and neighborhood corridors are included in that effort.
So again, 20 -- you know, the $20 million for small business relief program will be in front of you next week.
>> Supervisor Safai: thank you. I appreciate that.
I just really and truly want to underscore on the record a number of my colleagues that have corridors in the same instance that, you know, we've spent a lot of time setting up community benefits districts. We don't have one of those in
our -- but we have a strong
nonprofit community partner.
I understand your staff was redeployed. If we have the tools, but we
don't have the staff to deploy
those tools, and there's not a
strategy on how invest in neighborhoods is going to lead
in investment recovery, we've
been working for the past two months with the mayor's office to come up with a final strategy for shared spaces, we have the loan program, but there are businesses out there
that are just holding on by a thread.
I walk my corridor every
friday, if not more, but one dedicated day, and I have to tell you that there's still merchants out there that don't know about some of the existing programs or grants or the
opportunities that they can take advantage of that are drowning, drowning in debt and drowning in lack of a customer base. So I just want to underscore
and really, really overemphasize to you, please, this needs to be one of the highest priorities for your office.
There needs to be a really well articulated strategy for investing in neighborhoods and how we're going to move
aggressively because I can tell
you, it has been hit or Miss, and in my neighborhood, that was precovid. But we can talk more offline
and try to push the envelope
more for a citywide strategy. >> thank you.
>> Supervisor Safai: thank you, Mr. Chair.
>> Chair Haney: thank you, vice chair safai.
Colleagues, any other questions or comments? This was a very thorough presentation, and I know we'll be seeing you all in a few weeks or months. Madam Clerk, is there any public comment?
>> Clerk: yes, Mr. Chair.
Checking to see if there's any
callers in the queue.
Members of the public who wish
to enter press comment, please
press star, three to enter the queue. For those already in the queue, please wait until the system
has been unmuted. mr. Chair, D.T. Has confirmed
that there are no callers in the queue.
>> Chair Haney: great. Thank you so much. Appreciate it.
Public comment is now closed. Colleagues, assuming there are not any other questions or
comments, I am going to make a motion to file this hearing.
Madam Clerk, can we have a roll call vote, please?
>> Clerk: is there a second on the motion?
>> Supervisor Safai: second, safai.
>> Chair Haney: seconded by safai.
>> Clerk: yes. On that motion -- [Roll Call]
>> Clerk: there are five ayes.
>> Chair Haney: great.
That hearing will be filed, and
thank you so much, interim director and Mr. Arce. We appreciate you and your
work, and Mr. Pascal. Appreciate it, and we will see
you again soon, I'm sure. Madam Clerk -- is there anything more you wanted to say? Sorry.
I should have given you the opportunity, interim director? >> no. Thank you for giving us the opportunity and we look forward
to coming back in a couple of weeks.
>> Chair Haney: thank you. Madam Clerk, are there any other items?
>> Clerk: Mr. Chair, there are no other items.
>> Chair Haney: all right. This meeting is adjourned. Thank you all.
