Minutes of the Health Commission Meeting October 2, 2001 at 3:00 p.m. 101 Grove Street, Room #300 San Francisco, CA 94102 1) CALL TO ORDER The Health Commission meeting was called to order by President Roma P. Guy, M.S.W., at 3:10 p.m. Present: President Roma P. Guy, M.S.W. Vice President Edward A. Chow, M.D. Commissioner Arthur M. Jackson Commissioner Lee Ann Monfredini Commissioner Harrison Parker, Sr., D.D.S. Commissioner David J. Sánchez, Jr., Ph.D. Commissioner John I. Umekubo, M.D. 2) APPROVAL OF THE MINUTES OF THE REGULAR MEETING OF SEPTEMBER 19, 2001 Action Taken: The Commission unanimously approved the minutes of September 19, 2001. 3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner David J. Sanchez, Jr., Ph.D.) Commissioner Sanchez chaired, and Commissioner Jackson and Commissioner Monfredini attended, the Budget Committee meeting. (3.1) PHP-AIDS Office - Request for approval of a retroactive new contract with Positive Resource Center, in the amount of $70,000, to provide employment development services targeting people living with HIV/AIDS and seeking to enter/re-enter the workforce, for the period of July 1, 2001 through June 30, 2002. Commissioners’ Comments Commissioner Monfredini requested a six-month written report to the Budget Committee regarding the performance of the contract, in light of the fact that this program is newly under the auspices of the Department of Public Health. (3.2) PHP-AIDS Office - Request for approval of the second year of a two-year contract with Black Coalition on AIDS in the amount of $246,687 to provide HIV prevention education services, for the period of July 1, 2001 through June 30, 2002, for a total contract amount of $493,374. Commissioners’ Comments During the Budget Committee, Commissioner Sanchez stated that clearly the agency has experienced difficulties, and asked the agency if they believe the have the capability to fulfill the contract requirements. Anthony Phillips from Black Coalition on AIDS responded that they are receiving technical assistance from Compass Point, and that this should help them meet the reporting requirements. Commissioner Sanchez emphasized the importance of these services, and asked that staff provide the Population Health and Prevention Joint Conference Committee with a contract update every 60 days, and return to the Budget Committee in six months with a status report. During the Budget Committee, Commissioner Jackson stated that the agency is doing well with client services, but not administratively, and asked how staff could have overlooked administrative requirements. Mr. Phillips responded that the agency has experienced a lot of staff turnover in the past year, and the new staff was not always aware of the reporting requirements. Marcia Haring from the Department of Public Health stated the Black Coalition on AIDS is one of the agencies the Department has targeted to receive technical assistance for the next three years. At the Budget Committee meeting, Commissioner Monfredini asked what specific steps are being taken to address the long-standing problems with this agency. The Department has spent money, time and resources trying to clean up the organization, and yet it is still experiencing the same problems. Steven Tierney responded that the Office of Minority Health “Project Ready” grant for technical assistance will help. Further, the Department is now tracking continuous quality improvement in ways that have not been done before. However, Mr. Tierney stated that if the agency does not solve its problems this year, the Department will work to find another agency to provide the services. (3.3) PHP-AIDS Office - Request for approval of a retroactive sole source contract renewal with Glide Foundation in the amount of $69,877 to provide HIV prevention services, for the period of July 1, 2001 through June 30, 2002. Commissioners’ Comments At the Budget Committee, Commissioner Sanchez asked when the agency would meet the Department’s performance standards. Steven Tierney responded that Glide Foundation is also receiving technical assistance through the “Project Ready” grant, and that the agency is already making progress. Commissioner Sanchez requested 60-day status reports to the Population Health and Prevention Joint Conference Committee, and a six-month report to the Budget Committee. (3.4) PHP-AIDS Office - Request for approval of a retroactive contract with Glide Foundation in the amount of $249,118 to provide HIV prevention services, for the period of July 1, 2001 through June 30, 2002. Commissioners’ Comments At the Budget Committee, Commissioner Sanchez requested 60-day status reports to the Population Health and Prevention Joint Conference Committee, and a six-month report to the Budget Committee. (3.5) PHP-AIDS Office - Request for approval of a retroactive contract renewal with South of Market Health Center in the amount of $62,100 to provide multiple session groups and prevention case management, for the period of July 1, 2001 through June 30, 2002. (3.6) PHP-AB 75 Project - Request for approval of a contract renewal with Lifemark Corporation in the amount of $190,000 to provide fiscal intermediary services for the FY 2001-02 CHIP Program, for the period of November 15, 2001 through March 31, 2002. (3.7) PHP-Housing and Urban Health - Request for approval of a retroactive new sole source contract with Tenderloin AIDS Resource Center, in the amount of $73,842 to provide HIV/AIDS Emergency Housing Program services, for the period of September 1, 2001 through June 30, 2002. (3.8) PHP-CMHS/Children’s Services - Request for approval of a sole source contract renewal with Support for Families of Children with Disabilities in the amount of $330,822 per year, for a total contract value of $1,323,288, to provide consultation and clinical support services, for the period of July 1, 2001 through June 30, 2005.   At the Budget Committee, Albert Eng from CMHS/Children’s Services stated that the total amount of the contract over the four-year term is $720,939, not $1,323,288 as indicated in the title. The amount for the first year of the contract is $330,822, and the amount for the subsequent years is $130,039 per year. (3.9) PHP-Mental Health/Substance Abuse - Request for approval of a contract renewal with San Francisco Suicide prevention in the amount of $332,027 per year, for a total contract value of $1,328,108, to provide suicide prevention services along with Family Service Agency and San Francisco Mental Health Access line coverage, for the period of July 1, 2001 through June 30, 2005. (3.10) PHP-Mental Health/Substance Abuse - Request for approval a contract renewal with Oakes Children’s Center in the amount of $493,785 per year, for a total contract amount of $1,975,140, to provide psychiatric day care services for children, for the period of July 1, 2001 through June 30, 2005. (3.11) PHP- Substance Abuse - Request for approval of a sole source contract renewal with the Latino Commission in the amount of $655,058 per year, for a total contract amount of $2,620,232, to provide substance abuse treatment services, for the period of July 1, 2001 through June 30, 2005. Commissioners’ Comments Commissioner Chow commented that the monitoring report for the Latino Commission included appropriate comments about cultural competency, and integrating these comments into the review process is a positive way of approaching cultural competency. (3.12) PHP-Mental Health - Request for approval of a contract renewal with Volunteer Center of San Francisco in the amount of $200,084 per year, for a total contract amount of $800,336, to provide mental health safety net services, for the period of July 1, 2001 through June 30, 2005. Community Health-Primary Care - Request for approval of a retroactive contract with Mission Neighborhood Health Center in the amount of $150,000 for continued primary care services at the Excelsior Clinic, for the period of July 1, 2001 through June 30, 2002. Action Taken: The Commission approved the Consent Calendar of the Budget Committee with the modification to Item 3.8 to reflect the actual contract amount. In addition, the Commission direction that status reports for the contract with Black Coalition on AIDS (Item 3.2) and the contracts with Glide Foundation (Item 3.3 and Item 3.4) be presented to the Population Health and Prevention Joint Conference Committee every 60 days, and to the Budget Committee in six months. The Commission also directed that the staff provide a written status report to the Budget Committee in six months for Item 3.1. 4) DIRECTOR’S REPORT (Mitchell H. Katz, M.D., Director of Health) (Report on activities and operations of the Department.) State Legislative Session The State Legislature completed the first year of its two-year session on September 15, 2001. Several health-related bills were forwarded to the Governor for his consideration, including a bill to provide funding for county initiatives that extend health insurance coverage to uninsured children, bills that simplify Medi-Cal and Healthy Families eligibility procedures, and a bill that would require the State Department of Health Services to establish minimum staffing ratios for nursing homes. The Governor has until October 14 to act on these bills. A detailed report of this legislative year will be presented to you at your November 6 meeting. State Budget -- Maternal and Child Health Funding When Governor Davis signed the 2001-02 State budget in July, he eliminated $2.6 million in State General Funds that support county maternal and child health (MCH) programs. To the extent that counties used these funds to increase enrollment of potential Medi-Cal clients, these monies were also used by counties to draw down an enhanced federal match, as high as 4:1 in some cases. In San Francisco, though our State MCH allocation was $66,243, our total MCH allocation was $213,908 after the federal match. Statewide, an elimination of the $2.6 million in State MCH funds would have resulted in cuts of nearly $7 million in services to needy women and children of our state. The Administration has devised a way to restore these critical MCH funds without the need for additional funding or corrective legislation. By switching State general fund from the State's domestic violence program with federal Title V funds in MCH, counties will again have State general funds available to draw down the federal enhanced match. This methodology will restore all but $650,000 of the total $7 million in MCH funding counties receive after the federal match. Individual county allocations have not yet been announced, but it is likely that any reduction in San Francisco's allocation will be minimal. HIV Stops With Me Campaign receives favorable evaluation One of the elements of the 11 point plan to revitalize HIV prevention for gay men was to increase the prevention message to HIV positive persons. Specifically, the plan that was presented to the Health Commission on August 15, 2000, was to increase responsibility of HIV-infected individuals to avoid inadvertently infecting others. I have attached the results of the evaluation, which was very favorable. The campaign exceeded its goals for exposure. Most notably, as a result of the commercial, 24% of participants said they were more likely to believe it is their responsibility to keep their negative partners negative. TOD Planning Retreat The Treatment on Demand Planning Council (TOD) held its annual retreat at the Nimitz House on Yerba Buena Island on September 29th. The process, which also includes review and discussion of epidiemology data, research, focus groups and community forums, culminates in December, with a list of new program recommendations to the Director of CSAS. The current TOD is a diverse group of clients/advocates, governmental representatives and service providers. The group identified 20 priorities for initial consideration. Of special note is the number one priority: Maintain and support infrastructure program so units of service are not reduced. SFGH Completes Accreditation Survey and MQSA Inspection for Mammography San Francisco General Hospital has successfully completed their State accreditation survey and MQSA inspection for mammography. This survey is conducted annually jointly by the Food and Drug Administration (FDA) and the State of California. SFGH completed both the survey and inspection with no deficiencies noted. CHN/SFGH CREDENTIAL REPORT SEPTEMBER 2001 09/01___ 2001 YTD New Appointments 23 65   Reinstatements 0 5 Reappointments 28 310   Delinquencies: 0 0   Reappointment Denials: 0 0 Resigned/Retired: 3 129 Disciplinary Actions 0 0 Restriction/Limitation- Privileges 0 0 Changes in Privileges Additions 1 16   Voluntary Relinquishments 2 16   Proctorship Completed 9 118    Current Statistics - as of 09/1/01 Active Staff 362 Affiliate Professionals (non-physicians) 184 Courtesy Staff 485 Referring Staff 44 Total Members 1,075 Applications In Process 100 Applications Withdrawn Month of August 2001 2 SFGH Reappointments in Process Through February 231 Commissioners’ Comments Commenting on the HIV Stops with Me Campaign, Commissioner Chow stated that he appreciates that the Commission is receiving evaluation results, as they demonstrate the effectiveness of the program. 5) HEALTHY FAMLIES UPDATE (Colleen Johnson, Acting Director of Policy and Planning) Colleen Johnson, Acting Director of Policy and Planning, began the presentation of the semi-annual Healthy Families Report, which details the efforts in San Francisco to ensure that individuals are enrolled and retained in the Healthy Families Program. Ms. Johnson stated that the efforts of the Department are focused on uninsured children rather than any single public health insurance program, in order to capture the most individuals for the most programs. Ms. Johnson introduced Frances Culp, Health Planner for the Department of Public Health, who continued the presentation of the report. Program Expansions and Enhancements Proposed Parent Expansion Ms. Culp updated the Commission on the efforts to expand the program to parents of eligible children. In December 2000, California submitted a waiver demonstration proposal to the federal government. Initially the waiver had proposed to cover parents up to 200 percent of the federal poverty level. However, due to an outpouring of requests from many entities, including the City and County of San Francisco, the State increased parent’s eligibility to 250 percent of the federal poverty level. However, CMS has not yet approved the first waiver, and Ms. Culp said that the issue is now at a stalemate. State Budget Expansions Ms. Culp stated that the State Budget assumes an additional 250,000 Healthy Families members by July 2002. This would include parents of up to 250 percent of the federal poverty level, which assumes the approval of the waiver. The budget also allows applicants to sign a statement that will verify their income if they have no other paperwork to prove this. In addition, the budget creates a two-month bridge between Medi-Cal and Healthy Families. This allows Medi-Cal and Healthy Families recipients who no longer qualify for their respective program time to apply for the other program. State legislation Ms. Culp stated that a number of bills that affect the Healthy Families Program were introduced in the last legislative session. The bills that the Department will be paying closest attention to are those that allow for an assumption of eligibility based on enrollment in certain other programs such as free-lunch programs and the Food Stamp program. Application Data Since the beginning of the program the State has processed 472,121 applications. 8,841 of these applications were from San Francisco. 2,346 children in San Francisco who applied for the Healthy Families program were not enrolled in the program. The primary reason for non-enrollment was an incomplete or incorrect application. The State is trying to simplify the enrollment process. They are developing a joint Medi-Cal/Healthy Families Joint Application, which allows families to apply for both Medi-Cal and Healthy Families on the same application. In addition, there is a backlog of more than 2,000 people waiting to become Certified Application Assistants (CAAs), who are paid by the State to help families with the enrollment process. The State has allocated money for training and processing, so there should be more CAAs helping with the application process in the near future. According to Ms. Culp, another step that the State is taking to make enrollment easier is the development of an online enrollment program, called Health-e-App. The program has been piloted in San Diego and has received a very positive response from families. Enrollment and Retention Data Enrollment Ms. Culp stated that there are 468,349 children statewide enrolled in the Healthy Families program. San Francisco has 9,265 children enrolled in the program. The Department estimates that between 10,015 and 10,593 children in San Francisco are eligible. This implies that 90 percent of San Francisco’s children are already enrolled in the program Enrollment by Ethnicity Asian American/Pacific Islander - 82.1 percent Hispanic/Latino - 14.6 percent African-American - 1.7 percent Caucasian - 1.5 percent Native American - . .1 percent Since 1999 there has been a slight increase in Latino and African American enrollment in the program. Ms. Culp stated that the neighborhoods with San Francisco’s highest Healthy Families enrollment (representing 65 percent of the total enrollment) include the Excelsior, Outer Mission, Mission Terrace and Ingleside (94112); Portola and Visitacion Valley (94134); Mission and Bernal Heights (94110); Chinatown and North Beach (94133); Sunset (94122); and Bayview/Hunters Point (94124). Retention Ms. Culp stated that almost 3,000 children have been disenrolled from the Healthy Families program in San Francisco since the program began. San Francisco is seeing a slightly higher rate of disenrollment than the statewide average. One of the major avoidable reasons for disenrollment is non-payment of premiums. Both the State and San Francisco are focusing efforts on reducing disenrollments for avoidable reasons. At a statewide level, there are now additional, more convenient options for bill payment. San Francisco is focusing on strengthening the bond between the families and the Certified Application Assistants. In addition, the San Francisco Family Health Plan has designed a postcard that is sent to Healthy Families members who are close to the date they must submit their re-enrollment forms. And during the month of August, Health Plan staff called each of the enrolled families to see if they needed assistance. Recent Outreach, Education and Retention Efforts In San Francisco there are a number of outreach and education efforts underway, which Ms. Culp summarized: Bringing Up Healthy Kids (BUHK) Coalition. This is a collaboration of more than 20 public agencies and non-profit providers, including the Department of Public Health. Their main outreach has been through the schools. In September 2001, BUHK distributed over 65,000 Request for Information flyers, with postage-paid return envelopes to all elementary, middle and high school students in San Francisco. BUHK is also going to be contacting families 60 days, 6 months, and 10 months after enrollment to provide follow-up services. Building a Healthier San Francisco (BHSF). This is a coalition of hospitals, the Department of Public Health and the Department of Human Services. This group is working with existing school health workers to train them as Certified Application Assistants, who can then identify and sign up children for the program. Potrero Hill/Bayview Hunters Point Access to Health Care. This is a project funded by the Department of the Environment for outreach related to health access for residents of Potrero Hill and Bayview Hunters Point. Among the goals for the project is providing residents with information on free and low-cost health care options and enrolling eligible children, youth and adults into free and low-cost insurance programs. SCHIP Outreach Award. The Department of Public Health recently received a grant from the state to supplement existing outreach activities. UCSF CORE Project. This project, in which nine Bay Area Counties are participating, is designed to support counties in recognizing and removing barriers in county-administered Medi-Cal for Children and Healthy Families enrollment and retention processes. Public Comment Elizabeth Frantes stated that the Department should not discriminate against adults without children by only covering parents of children. We should not bring more people into the system, when there is not enough services for people currently being served. Commissioners’ Comment Commissioner Monfredini asked what happens when an application is denied because the person is eligible for Medi-Cal-how is it linked to the Medi-Cal system. Ms. Culp replied that the application is sent to the County for processing, and the person is then connected to Medi-Cal. Ms. Culp said that it is her understanding is that a letter is sent to the family to inform them of this. Commissioner Parker stated that when the program was designed, it was to be revenue neutral. Commissioner Parker asked if the Department would need more general fund money for this program. Dr. Katz responded that having people enrolled in Healthy Families decreases the amount of general fund dollars spent by the Department, because the State and Federal government are paying for their healthcare. Commissioner Chow commented that the Department has good enrollment numbers, and the focus needs to be on retention. He asked if there is data on the 10 percent who are eligible but not enrolled. Dr. Katz responded there is indirect evidence that the African American enrollment numbers are too low considering their percentage of the working poor. Commissioner Chow would like the next semi-annual report to show an increase in the enrollment numbers for underrepresented groups, including African Americans. In addition, Commissioner Chow would like the next report to emphasize the outcome of the retention efforts, and provide more detailed information about the underrepresented ethnicities, such as how many African American applicants were denied enrollment because they were eligible for Medi-Cal. Commissioner Guy stated that the next semi-annual report should include the Universal Health Care statistics. Commissioner Umekubo was gratified to see the increase in enrollment numbers since the last report. He stated that the report indicates that almost all-eligible children would be enrolled if the issue of non-enrollment due to incomplete applications were addressed. Commissioner Parker asked how many children are uninsured in San Francisco, in terms of not being eligible for any insurance program. Ms. Johnson responded that the Department has estimated 9,200 uninsured children in San Francisco. 5,000 of these children will be eligible for the new “Healthy Kids” program. Approximately 3,000 more are eligible for other public health insurance programs. The remainder of the children would be from families earning more than 300 percent of the federal poverty level, and would be ineligible for any public health insurance program. Commissioner Jackson asked how many children from families that make above 300 percent of the federal poverty level are uninsured. Ms. Johnson responded that the estimate is 1,200 children. Commissioner Jackson stated that this number seems low, given the number of working poor. Commissioner Sanchez stated that over time there will be regional shifts among the Bay Area’s populations, and asked if this was being factored into the retention analysis. Ms. Johnson responded that she would look at this issue and include it in the next report to the Commission. 6) MENTAL HEALTH ANNUAL REPORT (Jo Ruffin, LCSW, Director of Community Mental Health Services) Jo Ruffin, Director of Community Mental Health Services, began the presentation by recognizing various community partners, and said that the department’s success depends in large part on contract providers. Ms. Ruffin introduced Steve Fields from Progress Foundation, Richard Easley from the Mental Health Contractors Association, and Tim Agar from the Mental Health Board. Ms. Johnson then introduced Louise Rogers, who continued the presentation. Ms. Rogers stated that since the San Francisco Mental Health Plan started operations 3 ½ years ago, the challenge has been how to provide greater access to care for a large covered population, while continuing to manage scarce and costly resources used by a much smaller number of chronically mentally ill adults and seriously emotionally disturbed children and youth. The total Department of Public Health resources to mental health care amount to approximately $198 million. Approximately 78 percent is in Community Mental Health Services, 14 percent in the Department of Psychiatry at San Francisco General Hospital, and 8 percent at the Mental Health Rehabilitation Facility. Mental Health’s goal is to be able to offer each of their members a system of care in which the full array of community support systems and outpatient services are so accessible and effective that no one must enter the system unnecessarily through institutional and emergency care. Ms. Rogers stated that accomplishing this goal requires a greater investment in community care and less in institutional care. This has started to occur. This year institutional care constitutes 27 percent of the Department’s spending (although the percentage is higher-approximately 40 percent-for adults). Ms. Rogers added that an integration of services between Mental Health and other systems of care is starting to develop. Many of the systems changes that have occurred that benefit Mental Health clients are a result of joint collaboration between Mental Health and other sections of the Health Department. Ms. Rogers stated that the activities of the last year are organized around six strategic plan goals that underlie the effort to reshape the system of care. Expand access to mental health care Expand community-based alternatives and decrease the need for institutional care Improve integration of services for individuals who need multiple services Strengthen prevention activities Create and sustain community partnerships Maximize resources and strengthen infrastructure by investing in staff recruitment, retention and training With regard to expanding access to care, Ms. Rogers stated that Mental Health’s caseload grew 39 percent between FY 1994-1995 and FY 1999-2000, including a 64 percent growth in Medi-Cal patients. The Mental Health Division increased the percentage of foster care children in mental health treatment from 20 percent in FY 1992-1993 to 40 percent in FY 1999-2000. The goal is to reach 50 percent. The Department also attempted to serve clients where they are to address unmet need. And finally, they are increasing cultural competency as a strategy to meet unmet need. In FY 2000-2001, 710 providers were trained in cultural competence areas. In response to Commissioner Chow’s question at the Joint Conference Committee as to whether the efforts translate into increased access for minority ethnic populations, between FY 1995-1996 and FY 1999-2000, there was a 31 percent growth in the Latino/Hispanic population served, a 25 percent growth in the Chinese population served, a 39 percent growth in the Vietnamese population served, and a 18 percent growth in the African American population served. Ms. Rogers then summarized the Department’s efforts to expand community-based care and decrease the need for institutional care. She described the following efforts: Strengthened the collaboration with the San Francisco General Hospital Department of Psychiatry to meet the performance objectives for acute impatient services. The strategy was twofold: first to increase intensive case management and second to increase the number of community treatment beds that serve as alternatives to hospital care. This collaboration resulted in reduced admissions through PES, maintenance of length-of-stay of no more than 15 days, and reduced utilization at private hospitals by 170 acute episodes. The Department projects over $100,000 in savings, which will be reinvested into additional beds and case management. Reduced institutional care for children and youth. Children Services System of Care Partnership has been able to reduce group home placements by 10 percent last year. Established a Continuum of Community Treatment Beds - New Acute Diversion Unit (12 beds); Broderick Street Residential Care (34 beds); Seneca Community Treatment Facility (20 beds). Increased Employment Provided access to medications Police Crisis Intervention Training Ms. Rogers then described the efforts to improve the integration of services, which primarily include collaboration with Substance Abuse Services and collaboration with Primary Care. Ms. Rogers stated that Mental Health has engaged in a number of efforts to strengthen prevention activities, including the child care mental health initiative, the Pilipino Family Strengthening grant, depression screening, high school wellness, Family Links phone line, and suicide prevention protocol. Ms. Rogers described several initiatives Mental Health has to respond to violence and crises in communities such as the Western Addition and Bayview Hunters Point, including a Family Involvement Team and a Mental Health Plan Ombudsman and Consumer Council. To meet the sixth Strategic Plan goal of maximizing resources and strengthening infrastructure, Ms. Rogers said the Department is working with the University to expand the mechanisms for psychiatric residents to be placed in the Department’s clinics. The Department is also offering multi-cultural student stipends to students in Master’s and undergraduate levels, to encourage them to pursue jobs in Community Mental Health. In addition, they are providing continuing education to staff in the Department as well as providers. Steve Fields spoke on behalf of the Mental Health Forum, which is where the policy discussions are taking place for the integration and delivery of mental health and substance abuse services. Mr. Fields stated that, under the leadership of Jo Ruffin and Barbara Garcia, the Mental Health system has become a true partnership with the contractors. The challenge now is to make the community-based system less reliant on institutional beds. Two areas are critical to accomplish this: develop the whole array of services including housing; and strengthen the case management system. Mr. Fields continued that the integration efforts must include both substance abuse and forensics/jail services. Richard Easley, Executive Director of Conrad House and chairman of the Mental Health Contractors Association, congratulated Jo Ruffin on a compelling and encouraging report, particularly the emphasis on partnership. Mental Health contractors appreciate the fact the Department is listening to them, advocating for them in the budget process, acknowledging them in the Strategic Plan, including them in planning processes, and inviting them to the table to talk about planning and program development issues. The Mental Health Contractors Association looks forward to working with the Department over the coming year. Tim Agar from the Mental Health Board spoke in support of the Mental Health program. Commissioners’ Comments Commissioner Monfredini asked how an individual would know how to access the system. Ms. Rogers responded that access started out as a 1-800 number and people being able to walk into any clinic. The Department realized that this was not enough-that they needed to engage and serve clients where they are-streets, schools, home, child care, primary care, etc., which they are doing now. The Department also has mobile crisis team. Commissioner Monfredini asked if institutional care is available for those individuals who truly need it, and cannot function in a lower level of care. Ms. Ruffin said that institutional care will always be part of the continuum of care, although their goal is to keep people from reaching the level where their only option is institutional care. Commissioner Parker stated that primary prevention is a priority, but the resources and efforts do not necessarily reflect this. Commissioner Parker continued that one element that impacts the community so much is substance abuse, and the Department should try to reduce use of drugs and alcohol by at least 10 percent. Commissioner Umekubo commended the Department of Psychiatry for its reduced admission rate, reduced length of stay, and reduced decertification rate (which is hovering around 15 percent). Commissioner Chow emphasized the goal of primary care integration. He is pleased with the efforts of the Mental Health Forum. He continued that the system is well on its way to becoming an integrated system. Commissioner Chow also stated that, as we move into more difficult economic times, everybody involved in the mental health system continue their dialogue and cooperation even though there may not be new resources. Commissioner Jackson is encouraged with the increased parity between mental health services and other health services. The Department is now more able to help people stay out of institutions and live independently. Commissioner Sanchez stated that the report was refreshing, particularly in terms of integration of services and partnerships with schools, community-based organizations, and other departments. Commissioner Guy commended the staff for its work to truly integrate services. Commissioner Guy stated that the challenges include refining the services, identifying where the gaps are, and determining how the new Laguna Honda will fit in to the system. Commissioner Guy continued that services to the homeless population is a particularly important part of the continuum of care, and asked how long the grant funding would be available. Ms. Rogers responded that the grant was for three years, but that the Department is hopeful that the funding will continue beyond that time period. The Commission voted to recess the meeting for 20 minutes at 5:30 p.m. The Commission reconvened the meeting at 5:50 p.m. 7) OTHER BUSINESS/PUBLIC COMMENT 8) CLOSED SESSION A) Public comments on all matters pertaining to the closed session None. B) Vote on whether to hold a closed session Action Taken: The Commission voted to hold a Closed Session. The Commission went into Closed Session at 5:50 p.m. C) Closed session pursuant to Government Code Section 54957 and San Francisco Administrative Code Section 67.10(b) PUBLIC EMPLOYEE PERFORMANCE EVALUATION: DIRECTOR OF HEALTH, DR. MITCH KATZ D) Reconvene in Open Session The Commission came out of Closed Session at 6:55 p.m. Vote to elect whether to disclose any or all discussions held in closed session (San Francisco Administrative Code Section 67.12(a).) Action Taken: The Commission voted not to disclose any discussions held in Closed Session. 9) ADJOURNMENT The meeting was adjourned at 6:56 p.m. Michele M. Olson, Executive Secretary to the Health Commission