Good morning everyone.

I'd like to call to meet uh order the special meeting of Tuesday, November 25th.

Special meeting of the Board of Supervisors for Alameda County.

Will the clerk please call the roll?

Supervisor Marquez present.

Supervisor Tam present.

Supervisor Miley.

Excuse.

Supervisor Fortunato Bath present.

President Halbert.

Present.

We have a quorum.

Thank you very much.

I note that the Board of Supervisors recognizes and appreciates in-person and online participation, those wishing to speak on an item on the agenda, which is allowed for in uh public comment on closed session items first, and then on each item listed on the agenda.

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Please limit your remarks to the time allocated.

Thank you.

Thank you, Cheryl.

We're going to um request before we take comments on closed session and before we adjourn to closed session.

We would like to take up item general administration number one from the county administrator's office to appoint Bengeria Harvey as the acting director of child support services effective 112525 for up to 120 days, pending appointment of a permanent director.

Ums Miranishi, any other comments?

President Howard, members of the board.

I would um just um, you know, again reiterate that due to the retirement of um Phyllis Nance's your child support services director.

We want to ensure uh continuity of operations.

So pending your board's completion of a recruitment and appointment of a permanent director.

The recommendation is that you appoint Van Juria Harvey, who is currently the supervising attorney in the department as the interim director effective today for up to 120 days pending your board's appointment of a permanent director.

Is there any comments from my colleagues before we take public comment on this item?

Seeing none public comment on this item number one under general administration.

There are no speakers.

See none, I'll entertain a motion.

I'll second.

Motion's been made and seconded.

A roll call vote, please.

Supervisor Marquez.

Aye.

Supervisor Tam.

Aye.

Supervisor Miley, excuse.

Supervisor Fortunato Bath.

Aye.

President Halber.

Aye.

Very good.

We'll congratulate Miss Vangeria Harvey.

Uh with that, we will uh get ready to adjourn into closed session for the first time today.

And before that, we'll take public comment on closed session items.

These are listed as conference with labor negotiators a b and c conference with legal council A and B.

Conference with legal county with existing litigation.

A and public employee recruitment A, B, and C, and Conference with real property negotiators.

Item A.

Any speaker slips for closed session items?

We have one speaker, Buffalo.

Welcome.

We do a lot of meetings and things up on the parliamentary procedure.

You all have done some interesting changes on theory and practice of parliamentary procedure.

Some of you weren't here then.

We began coming to you.

November 22nd in the last five years.

It wasn't casual, it was to remind the board of Wilmachan.

And later that the truth is the lighting.

We need to correct ourselves before we wreck ourselves.

The reasons that we're here, even when they are not clear, shall not disappear.

I'm here to help remind you of the space between political opportunism and serving the public.

As per your closed source stuff, man, they shrunk my time so funny down to where I don't even know.

Last week I came to commend y'all because you were considering uh replacing the registrar of voters.

I came to commend y'all last week because for the first time since I've been appearing before you, the soap dispenser in the men's room on the fifth floor work.

Can you imagine?

Isn't that a political metaphor?

The men's room on the board of the supervisors had non-functional soap for no less than two years.

I'm glad you got a second soap machine there.

And so those are the two things I wanted to commend you on.

Yeah.

I don't know.

Now you say uh the uh registrar of voters is not on your list of public employee recruitment, so of course I'm wondering.

Now there's some, oh yeah, there's two items we gotta bring to your attention.

First, how far do you intend to shrink public comment or out to use skates?

Commentary other than those that come in groups with signs and flags for photo ops or loud speakers, and of course, how long can you withhold minutes before you approve them?

How many minutes can you approve at one time?

Is that legal?

So, where do we go for answers to these questions since none of you thank you for your comments?

Thank you.

Closed session items.

Very good.

Thank you.

We recognize and welcome Supervisor Miley participating remotely.

Thank you, sir, for being here.

You're on the line.

You have two minutes to speak.

Thank you.

Um, it's amazing to me that you have anybody in the audience, because these people had about 24 hours and two minutes of notice, supposedly, uh more like 22 hours of notice on the real agenda.

Um, and it's also um uh truly, truly an honor to have people uh showing up uh on Zoom on teleconference.

Um now the item on the agenda that I like to talk about is uh recruitment for a closed session items.

Recruitment for a county council, as I was saying, sir.

Were you listening?

Recruitment for a county council is on the closed session, sir.

And sir, if you'll notice that that uh recruitment, the county council, basically your culture, you're you're running a uh system.

He he talked about parliamentary procedure the last speaker.

I'd like to talk about your uh procedural slop, the slop of of the way you run these meetings.

Um, especially, for example, uh you have your uh lawyers here, county council will announce when somebody shows up on the uh on the zoom, uh uh supervisor appears, but when they disappear, they the your staff remains silent.

You've you lost them to uh person on Zoom, you know.

You know, we've had one down on the uh on the on the uh membership roster.

Um, you maybe even lost a quorum.

Who knows?

Who knows?

Nobody knows what's happening because of the slop in the way you your uh your county council runs this operation.

Um, also, when supervisors get up from their seats and go wander in the crowds, go wander in the hallways, go wander off site, go wander where wherever.

Uh again, slop.

We don't we don't see that, we don't hear that.

Um the the the kind of slop that's going on in in the entire operation with uh kind of a uh you know uh wild west mentality uh for procedural uh you know uh niceties, it's very sad.

Thank you.

No additional speakers.

Very good.

With that, we're going to adjourn to close session.

But I know uh supervisor Marquez has uh yes uh announcement to make.

Yes.

Uh thank you, President Howbert.

I wanted to respectfully ask if we can continue under the general administration item number two to our next regular board meeting on December 9th.

Uh, the reason why I'm asking for this request is I know that this is a special meeting, and um the public just got the attachments yesterday, so I want to make sure there's ample time.

Even though this has been continued numerous times, hopefully they'll be the last.

I'd like to continue that to uh December 9th, our regular very good.

According to our protocols, that's perfectly acceptable.

I don't see any alternative.

So we will continue item two to December 9th.

President Halbert, I just want to make a point of clarification on item one to ensure that the uh motion is recorded as the term of the acting director for child support services is for up to 120 days.

I assume that's understood.

With that, we're going to adjourn the closed session.

Thank you.

All right, we're gonna call our meeting back to order.

I'll ask the county council is there anything to report out from closed session.

There's nothing to report, but I reserve to report later.

Okay, because we may are likely to return to closed session.

We will return to closed session at some point, and there's nothing to report out at this point.

Thank you.

With that, I'll ask the clerk to please call the roll to establish our quorum.

Supervisor Tam, Supervisor Marquez, sorry, supervisor Tam present.

Supervisor Miley here, Supervisor Fortunatabas, presence.

President Halbert.

Present.

Yeah, quorum.

Very good.

We are now at the point uh for our 11 o'clock set matter.

I note that that means we'll have to adjust our schedule and that uh item A, budget and finance update, federal state, county budget status, will have to be moved to later in the meeting.

It will either occur sometime after the 11 o'clock set matter and before the 2 p.m.

set matter, or after the 2 p.m.

set matter, it's impossible to tell at this point.

However, I note that we have several speakers who want to make comment on the budget and finance updates.

I also note that I believe many of them are interested in hearing more about our ethical investment policy and where we are with that.

While it is not on the agenda, I'd like to make some remarks that we're currently in the status of working with the auditor and controller to establish an RFP to fulfill the direction of the board at our last meeting.

That RFP rests with the county auditor at this point.

We hope will be done promptly.

After that, a selection will be made, and after that, a report will be given back to our board.

So that's where we are currently on it.

Um, if anybody wants to continue to wait for the budget and finance update while that item is not directly on point with the EIP, you're welcome to do that, but I hope that that update brief remarks from me as an update will suffice.

That being said, as I mentioned, we have to follow the 11 o'clock set matter schedule, and we'll now call on our social services director for a status update on the findings of the state auditors report to the joint committee on legislative audits, the Alameda County Social Services Department, and the Department of Children and Family Services.

Ms.

Ford.

Thank you.

Good morning, President Halbert, Board of Supervisors, and members of the community.

I'm Andrea Ford, Agency Director for the Social Services Agency, joined by Michelle Love.

Can't say yourself.

Yeah.

The assistant agency director of the Department of Children and Family Services.

Thank you for the opportunity to present our status update on the joint legislative audit findings.

We're committed to transparency, collaboration, and continuous quality improvement as we address these critical issues affecting our community's most vulnerable children and families.

Today's presentation covers several key areas.

We'll review the external assessments that led to the audit, examine the audit timeline and methodology, share our progress on all 15 recommendations, discuss our safety culture assessment results, highlight our recruitment efforts, and showcase positive outcomes and sibling placements.

We are here to be fully transparent about both our challenges and our path forward.

The path to this audit began with legitimate concerns.

The grand jury raised issues about investigation timeliness in 2022-2023.

Supervisor Miley convened a joint committee meeting in September of 2023 focusing on coordination between behavioral health and child welfare, followed by the California Department of Social Services audit of about 29 cases that reviewed among other issues our service coordination.

This audit was completed in July of 2024.

Finally, in April of 2024, Senator Dr.

Waha requested a joint committee on legislative audits, conduct a more thorough assessment of the child welfare department, which brings us to where we are today.

I will now introduce again Michelle Love, our assistant agency director, the Department of Children and Family Services.

Good afternoon, supervisors.

Just want to again review for you the timeline for this audit report.

The report was approved in May of 2024.

The California State Auditors conducted their audit from March through September 2025.

We provided a preliminary presentation of what our plan would be to mitigate the concerns listed in the audit on October 7th.

Our 60-day progress report was submitted to the California State Auditors on November 22nd.

I want to advance the slides by the chance.

As part of their process, they will review the documentation that they received and then the information will be uploaded to the public.

So I think it's important for us now to have some context about the audit findings, and we wanted to share that with you.

For example, emergency response, that data is publicly available.

So timelines reflect the totality of the emergency response program.

Our vacancy rates reflect the totality of the vacancy rates for the department.

Training reflects the training for all of the departments.

All the other measures are based on a subset of cases that were reviewed.

So for example, for the timeliness service provision, that was referencing mental health services, regional center, medical and dental, any service a youth would need.

For that, the auditors reviewed 36 cases of the 735 kids we actually have in care.

So context, it's a small review that gives the big um reflects what they saw in those cases.

So they reviewed 36 kids and the 125 possible services that may have been available to them.

Five for the family finding engagement work, where they look at how family finding was being done in the department of the 36.

They looked at five cases.

Five cases were two plus years.

Some of these youth were randomly selected, and some were what is called judgmentally selected.

So for the regional center services, we have a very small group of children that actually receive regional center services.

So they couldn't randomly select those youth.

So they looked at the list and then picked 18 of those youth to determine if the plans were available.

And with specialty and non-specialty mental health services, they actually took the list of all youth receiving mental health services, and then they selected 20 of them.

So for context, it's important to think this isn't every case was reviewed, it's a very small cohort of cases.

So progress on addressing the recommendations.

Let me walk you through our recommendation timeline.

Recommendations one through three address emergency response timelines.

We've already implemented supervisor training and are utilizing retired and new attents to assist with closing referrals.

Recommendation number four, our staff survey has complete.

The surrounding work regarding the survey will continue over the next year.

Recommendation number five, hiring additional bachelor's level staff.

That is an ongoing priority for the department and the agency, and their multiple exams that are scheduled.

So for four recommendations have been completed.

Mandatory shadowing of all new workers of seasoned workers, that is occurring.

We've enhanced the documentation in our court report to reflect the areas the auditor wanted to see present.

That began actually was pushed out to all staff this week.

The relative notification process actually began and was implemented September 29th.

The protocols they requested be written for our transitional shelter care facility have all been completed.

There's two measures that reflect reporting out, and those will occur once our transitional shelter care facility is open.

Recommendations eight and 10 regarding the sharing of MOUs.

That will be done by the end of this year, and sibling engagement work is actually in progress.

So recommendations 12 through 15 are regarding quarterly transitional shelter care evaluation.

We've done the refresher training for all staff involved with the assessment center.

Recommendations 13 and 14 focused on training accountability.

We now have a quarterly review process for all staff and management, all management is getting those reports.

They're including the information and their staff supervision conference memos and evaluations.

The recommendation 15 regarding accountability, we will have some labor discussions about that to continue to drill down.

And regarding the contracts, there are 40 contracts that actually need a timeliness measure.

We're expecting that will be complete by February 2026.

Our survey was conducted through the National Partnership of Child Safety.

It's designed to help jurisdictions assess the safety culture that is present amongst their staff.

Alameda County has been a member of the National Partnership of Child Safety since 2024, and we actually presented our work with them in January of this year for the Social Services Committee.

The Center for Helping Professions, the research organization that supports MPCH, MPCS administers the jurisdiction specific versions of the safety culture.

For our agency, our department, we have 54% of all staff participate in the survey out of 238, so it's 238 of the total number of staff of 442.

The survey was administered this summer and completed August 15th.

So the survey important pointed out some very specific things that I think are important for people to understand.

Psychological safety, mindful organizing, workplace connectedness, and emotional uh exhaustion were all very good indicators.

Those are the ones that we're going to use to continue to build a department where staff feel comfortable and safe coming to work.

Those measures look at am I able to talk to my supervisor about my concerns?

Am I able to recognize when I am emotionally exhausted from my work?

Things like that.

So those positive outcomes are something that we can build to help other staff who may not be doing as well.

Here's the timeline of the next steps for the survey.

We're currently in the process of obtaining staff feedback for the survey.

I presented it first at all staff meetings in September.

We are now going division to division to hear from our staff about what they thought of the survey and to get their initial feedback.

We will then be doing focus groups with staff, and then we'll be providing constant ongoing feedback and implementing the information they give to us about the survey.

Next summer, we will do another survey, and we'll do it annually year to year to see our improvement in these outcomes and areas where we still need to improve.

Hiring and recruitment efforts, recruitment remains a top priority.

We registered for the 2026 California Title 4E job fair on February 20th.

Title 4E is the funding that focuses primarily on child welfare.

We've launched a comprehensive social media recruitment campaign for scheduled for December 5th through January 5th through Comcast.

And we've been proactive in reaching out to potential child welfare candidates who share our commitment to child welfare.

Let me be transparent about our recruitment funnel.

From January 2023 to October 2025, we received 568 applications for bachelor level physicians.

The reality is challenging.

70% of those applications didn't meet the minimum qualifications.

Of the 202 who advanced to interviews, only 132 passed the interview.

We successfully hired 49 workers, which is actually just a 9% conversion rate from application to actual hiring.

We have an 85.7% retention rate of those that are actually hired, which is positive.

However, the high initial disqualification rate tells us we need better upfront communication about qualifications and more targeted recruitment.

Our master's level recruitment shows very different patterns.

From 1215 applications over multiple recruitment events since 2017, 59% advanced to interviews, much better than our bachelor's level.

We hired 218 workers with an 18% conversion rate.

Retention is 50.8%.

The voluntary withdrawal rate is very low at 34 candidates, indicating strong engagement.

Those experienced professionals who are critical to our service delivery.

It's a positive story we want to highlight for you.

The report shows that it didn't appear that we were doing well with ensuring that siblings have the opportunity to engage with one another and their families.

Nearly three out of every four children, youth in Alameda County that have siblings are placed with some or all of them.

In July 2025, 56.9% were placed with all siblings and 73.69 with some or all of them.

We are currently involved in a kinship navigator project with the state of California, and we expect those numbers to grow.

Because with the audit, it's easy to focus on a small set of the work being done, but there's other things happening in our department.

Quarterly, we are having reunification breakfasts with families that are actually reunifying with their children and are exiting the system.

This year we had our annual permanency celebration where we highlighted not just children who had adopted children from foster care, but also our relatives who are doing legal guardianship and maintaining the familiar relationship with the first family.

We have been working together for several years, and all our children serving providers actually came together with us.

We meet quarterly with them, but we now have an active community pathway.

So if a family needs assistance, they don't necessarily have to come through the child welfare system.

They can go to provider and receive the services they need.

We're one of eight counties in the state that we are looking at as the state moves towards a kin first culture, how do we increase our numbers of children that are placed with relatives?

And finally, for a number of years, we have had a contract to work with children to help them receive their special juvenile immigration status.

In our current environment, our provider has been really flexible so we've been able to meet the bearing needs of our children who may be immigrants that are in our system.

Our existing system improvement plan.

You guys, we will be presenting on that in March, but we've just added another strategy to look at sibling engagement.

We do quarterly management continuous quality improvement dashboards that we review to look at how are we improving various aspects of the child welfare system, and we'll integrate the current dashboard concerns into that process.

And finally, transparency.

Today's presentation where we are with the audit will be uploaded onto our agency website so that if people are concerned in the community, they can go straight to the website to get the actual information of how we are doing.

So our next steps.

I mentioned before that we presented to the California state auditors where we are and the progress we've made thus far with their recommendations.

We'll have another report due in six months.

That's March 23rd, 2026.

And then our final report to the auditors will be in a year's time, September 23rd.

So that's the body of the presentation.

But I want to go, we added some things for the appendix that we think are also important that you are aware of.

So first we have a map of our child welfare system.

It's important to know because there's such a huge emphasis on emergency response, that's just the first part of our system.

We are serving children in home with their parents, children who are placed in foster care, children who we are no longer working on reunifying their parents and our permanent uh youth connections program, and also with ILP services.

The map shows you how you walk through our system because sometimes people aren't really sure how you get from one place to another.

So you can follow the little street map and get where you're going.

Under each program though, it lists the number of children we are actually serving in the various programs.

For example, if you look at the family maintenance house, there are 584 children that are being served in home with their parents.

And so you can follow it through that way.

So that is just where I know you guys all often get questions from your constituents, so it gives you some context.

The remaining slides have more detailed information about the work that was done to move us through to the audit.

So for example, for recommendation number one, you can see what we said we would do in the plan and where we are with progressing forward.

So all the recommendations are in there through the end.

So they're for later for you.

So questions.

Before we take questions, I think Michelle, you need to make it clear that when you presented October 7th, there were 10 recommendations, and then um the state made some changes that there are now 15 recommendations, but they're not additional recommendations.

Yeah.

So they went from 10 to 15 because some recommendations make recommendations at multiple parts to finish to be completed.

The auditor recognized that there were opportunities that one thing could be finished, and it was fair to say it is not implemented.

So by spreading it out to 15, it allows for us to reach completion on some items and move those out of the way.

So, what will happen in free presentations to the board is we will begin focusing just on the areas where we have not fully implemented the recommendations.

We will note in the appendix which ones are complete for your reference, but going forward, we'll focus on just the ones that are in progress.

So if you're compare the presentation from October to now, it looks like oh, there's more recommendations.

They literally just took the work and divided it up differently.

Did I recognize I couldn't hear?

Yep.

Yes, Nate recognize you right now.

Okay, thank you.

All right.

I have a few questions, if that's okay.

Uh, Mr.

President of the staff of the presentation.

Uh, first of all, I just want to thank the staff for this uh thorough presentation.

Um, because I know um uh child welfare isn't easy, uh, and I know um folks want to do the very best job.

And you know, having served on the social services committee for about 24 years, I think you know, I I know a little bit about this, but obviously I'm not I'm not an expert, I'm not the professional.

I do think um the only supervisor I know, you know, board of supervisor I know that was really immersed in child welfare was Supervisor Gail Steele.

It was sort of like her one of her um really focused areas that she just really um drilled down on.

Um, and so first of all, I'd kind of like the staff to at least talk a little bit about the philosophy of child welfare, how it's kind of um evolved over time from you know taking kids out of the home to wanting to keep kids in the home.

So could you just talk a little bit about that?

That's my first question.

I can, I can.

I think child welfare is an ever-evolving system as people are looking at the best ways to serve children and families.

I think over the course of the time I've been in the seat, we have seen um the court and the state move from it is best to remove children, and that's how we serve them.

I think there is now a recognition that children don't do well raising systems, don't do well raising children, and children do best at home with their families.

The court also recognizes that the child welfare system is not an entity that should have the flexibility just to remove a child from their family.

That is um a basic of society that children belong with their families.

So now, if we want to remove a child from their family, you need to go to court, and we need to present why we think a child should be removed and get permission.

We have a warrant process.

It's parents are entitled to the due process of having their family with them and having a court involvement and to say if they should be removed.

Um, that's very different than it was when I was a worker 25 years ago, but that is where we are now.

Um, so it's an ever-evolving system.

Uh, the warrant process will become more defined in our count uh our county as we seek to improve that process for us as well.

Okay, and then I know in some of the slides you talked about the challenges of recruitment and the you know the staff uh shortages and the fact that um uh we need to have um a sufficient number of child welfare uh personnel.

Um, so I'm very interested in knowing, and I wasn't quite able to discern that from the slides, um, with SCIU uh 10 to 1 and with uh local 21 as well, um, the the workers, the the supervisors and yourself, is there more cohesion now so that we, you know, so that we have the necessary expertise and coverage we need, even though we have shortages.

We still do not have a number of staff we need to do all the work in the department.

No, I do think um over the last year, um it has begun to steady in terms of exits.

Supervisor Tam asked us that when we were presenting um our SIP earlier this year.

Is it starting to get better?

We can actually now look at the data and see that we are having fewer exits from the department.

I think that's the first step in stabilizing the hiring, is not having people leave, and that has begun.

So in terms of that, things are getting better.

The rate, it's a slow decline.

It's something to repair.

If you don't have as many staff, you don't need as many supervisors.

And the child welfare supervisor position is a promotional position.

So when you're pulling people, you're pulling them from your line level.

So I do believe we're stabilizing.

I do believe we have a good path forward and how we are going to bring more people to Alameda County.

And we are fortunate that in Alameda County we don't have a hiring freeze.

And as other counties in the state are experiencing a hiring freeze, we've asked the state not to give people deferments on their 4E and to acknowledge there are some counties that are still looking to hire, including Alameda County.

Yeah, because I think obviously we all recognize being a child welfare staff requires a lot of expertise and training and knowledge and sensitivity and this, that and the other.

So I just I've stated before, whatever the board of supervisors can do in authorizing your HR as well as county overall centralized HR to uh support your need for recruitment at both the child welfare level and the supervisor level.

I wanna try to encourage that as well as I wanna try to be supportive as best as possible with the promotions of folks to the supervisorial position in child welfare.

So I just want to once again go on record stating that so that you and the unions know at least where I'm coming from on this matter.

Then my next question is are we aligning ourselves with the best practices?

I know there's recommendations in the audit, and are we aligning ourselves with the best practices in child welfare?

Yes, we are aligning ourselves with best practices in child welfare.

I think we were doing that before the audit.

We'll continue to do that.

We are one of 31 jurisdictions with the national partnership for child safety.

We've been part of the kinship accelerator since last year before this audit began.

Um we are looking at which you'll find in the appendix.

The state actually has a workforce study being led by Dr.

Anita Barbie out of the University of Kentucky that is looking at whether or not the job of the child welfare worker is too large and whether or not the duties should be divided between staff.

We are seeking to, I have a meeting at the end of this week to see if Alameda County can be one of right now.

There's four counties if Alameda County can be a fifth county to join that workforce study.

They're showing positive results.

So, yes, Supervisor Miley, when there is an opportunity for improvement in our system that benefits not only the children and family we serve, but also our staff, we have um sought to become part of it.

Okay.

Then my last question, I appreciate uh President Howard giving me the ability to ask these questions, is um what what is happening with uh child welfare and um behavioral health.

I think I'm I'm missing that that piece.

Um, I would say child welfare and behavioral health have um a good working relationship, and their director over children's systems understands that children should not have to wait for services, and that the sooner that we can get children's services, the less need they have for more extensive services, the older they get.

This audit was over a period of in time that included the pandemic, and so there were some delays initially that are raised in this audit for services, but I think as we go forward, there is a mutual understanding of the critical need for mental health services for um our youth, and the sooner the better.

And so we continue to try to drive that um and how we serve our children.

Okay.

I'm remote, I'm not in the room, so I don't know who's available and I don't know who's available online.

But I hope Anika or Dr.

Tribble can speak to that piece around the behavioral health.

Um, those are those are all my questions.

Thank you, uh President Albert.

Thank you, Supervisor Miley.

Anika is here, so let's hear from her.

Good morning, everyone.

Anika Chowdry, Interim Director for Alameda County Health.

Um, and Supervisor Miley, I can uh affirm what um uh director Love just shared is that you know our behavioral health department is committed to supporting and working with the Social Services Agency for whatever they need to help ensure um the right level of care for the children in the system.

And there's a there's a variety of uh uh teams and uh work that happens.

I think some of it also includes uh at the older level with uh ACOE, which is the county office of ed, as well as probation um and social services, and there's a uh state mandated team, which Michelle, you might have to remind me the name of.

Um, interagency leadership team, the interagency leadership team, which uh convenes regularly to uh work through on the grounds issues.

So I'm aware that there's a lot of work happening in this area.

All right.

Well, I think either through uh the health committee or the social services committee, I I would uh respectfully ask that we have a more detailed update from behavioral health.

Thank you.

Sure, thank you, Supervisor Tim.

Thank you uh so much for this presentation.

Uh we've been looking forward to it.

Uh I just wanted to follow up on some clarifications on the slides and what um Supervisor Miley was talking about.

Uh so before um I started in the board, there was the uh request from the social services committee to focus on the coordination between behavioral health and child welfare.

Did something prompt that, or was that something we normally do, and what kind of gaps were identified from that review?

That we had a um public meeting, supervisor Miley convened a public meeting.

And I think what prompted that review is a request um specifically from former Senator Dion Ariner.

Um, they wanted to make sure that we were working together with behavioral health to provide services to um children youth.

So that review was requested by the board based on a request out of that meeting.

That's the state audit that we that was the not the state audit we just had, but the review we had last year that was out of that meeting.

Uh what I'm trying to um understand is the correlation between that audit and the one we just recently had, uh, because you said we we jumped from like 10 to 15 recommendations.

Okay, so the only correlation between those two audits is over the last three years, we've had a number of reviews and audits of the child welfare system.

And if you look at the questions being asked, they're all asking the same questions.

So over a two-year period, we've had different entities reviewing the same time frame, looking at our system.

Now the recommendations from one to 15 that came out of this current audit with the California state auditors.

Initially, when they finished their report, they had just 10 recommendations.

Okay.

Um, between when I presented to you, and just it showed up on their website a couple weeks ago, there were now 15 recommendations.

The recommendations all had the same language, but instead of being condensed into 10 recommendations, they spread some of them out, um, so that instead of recommendation, this is not the right number, but instead of number nine having four things to do, it became nine and ten, and each had maybe two things to do.

Okay.

So what were some of the gaps that were identified from the first assessment review that were similar to the ones that came out of the recent state audit?

That's what I was just about to say.

Um the one thing that was consistent in both audits was documentation, okay.

Um we were a little concerned because the first audit only looked at our computer management system, it didn't look in the case files, and we felt that there was information in the case files.

What this audit showed us is we had to do a better job of improving documentation.

Staff have focused primarily on making sure they document when they see children, because that's the most important thing.

We need to know, like you did see your kids because there's a 95% um requirement.

95% of the time we have to see all children, and 51% of that has to be in their home.

But the little pieces of their work they haven't been documenting.

Like I called to get a referral for therapy, um, their dental stuff, that documentation wasn't happening.

So that's what we've changed in our enhanced court report documentation.

Because it's not just that you refer, if there's a reason why the service doesn't happen, we need that document as well.

So, for example, medical and dental um appointments for older youth.

Sometimes they don't want to go and they refuse.

No one knows why they didn't get the appointment.

We need staff to document Supervisor Tam didn't feel like going to her appointment today, and she refused to go despite the appointment.

We need that kind of case record in our system.

So if someone says why did they only get one dental exam for the course of the year, we can look at our documentation and say they had to schedule, they refuse to go to the second one.

Okay.

Um so at the social service, we talked a lot about the vacancies and uh the turnaround that's been happening, and so when I look at the um the recruitment efforts, I mean, when when you have basically 568 applicants for the exam one, and you hired like eight or nine percent of them, and similarly with the um child welfare exam two, we have 1,215 total applications, and we hired like 18% to 218.

Uh it seems to me we don't seem to be lacking applicants, right?

We don't seem to be lacking applicants, but what's also important to remember is everybody is hiring child welfare workers.

There is a decline across the country, there are fewer people that are interested in doing this work.

So this is truly a buyer's market, I think that's what it's called, where there's choice, people can choose.

I want to go to this county, they have less cases, it's the same work, and they especially in the Bay Area, we have nine, our contiguous counties we've all been hiring for the last few years, and workers actually move between counties, right?

Try it on Solano, that didn't work.

Let me go here.

So there's fluidity in that.

Um, and sometimes people are choosing to go somewhere else.

Well, uh, yeah, let's talk about that for a second because uh when we look at the the retention rate uh for exam one, you know, 85.7 percent is pretty high for exam two uh to child worker two classification uh it's 50.8 percent how does that compare with the other Bay Area counties because the retention rate seems higher for child welfare one versus child welfare worker two right so I would say not every county in the Bay Area will actually let someone with the bachelor's level do this work not every county does some counties are looking at it um and we for a number of years until we started having vacancy issues we had paused on hiring bachelor's level staff so you can't have a true comparison unlike people with a master's degree that can go to any county people with a bachelor's degree I think you maybe go to three counties in the Bay Area because no one else is hiring them some are looking at whether or not it's worth it to bring them on but there isn't the same comparison about the work.

The rate of pay for a bachelor's level person in terms of education to do social work is very high versus a master's level where there's more options for what you're doing.

Do we have uh an idea of the promotional uh rates between worker one and worker two at the county so our bachelor's level don't meet our MQs to uh become a supervisor actually you I don't think there's something in it where bachelor's level you know look at my team I'm not wrong in that there's something in how our supervisor because we haven't hired bachelor's level staff in a long time you can't necessarily promote from a our child welfare one to a supervisor because of lack of qualifications our supervisor position requires a master's degree I see okay then in terms of the team first assessment uh this is the part I didn't quite understand when you look at um the results and the scales the the one the lowest is the emotional exhaustion but then uh the note says that higher scores indicate more burnout so does that mean there's less burnout we're getting there so I can look at it I'm sorry.

So emotional exhaustion that is the one you do want to be lower because that means that people are aware that they are emotionally exhausted.

What you become concerned about in the stress recognition is that I don't recognize in theory if someone recognizes that they are emotionally burnt out we'll get them EAP they'll start doing things self-care things to take care of themselves.

So you want that score to be low that staff aren't emotionally exhausted they recognize hey I'm feeling burnout they'll go to their supervisor when that number is higher it means you have a number of staff who aren't recognizing what's happening in terms of their burnout and the stress recognition we want our staff to recognize when they're stressed Alameda County is fortunate we have programs the county um the county offers a lot of programs to assist with staff with um burnout and things so we want people to recognize it and avail themselves to those services.

Okay that's helpful to understand um my last question has more to do with um something we talked about at the last meeting on case closures uh in progress we have about as of July 200 cases that closed um how does that compare with like one year ago and then, um, secondarily, it's it's not always intuitive to know quantity versus quality.

If you close a case, is that a good thing versus um making sure that the case was thoroughly evaluated and investigated before closure.

So the audit pointed out that we had investigations that were open.

I'd say over the last two years, we've gone from 3900 open referrals, investigations that hadn't been closed to about 15, and those are averages, and those aren't the exact numbers, but it's like 3952, and I last looked, we're at like 1500, and cases are always coming in.

It is the role of the supervisors to review an investigation and make sure all aspects have been thoroughly investigated.

Um there's some things in the last few weeks that we have been working with county council to change.

Um, for example, we're expanding our warrant process to include um needing to go to the doctor to have a physical exam or get permission to view all of a child's injuries.

So there's some things that we're doing to improve the system.

Supervisors have a way in our the way the system is designed that if they review an investigation, there's concerns, they can kick it back to the worker.

Explain to them, hey, this isn't clearly addressed, I need you to maybe follow up.

Um, as part of practice, when workers are done interviewing a child, it's the expectation that they'll call their supervisor and say this is what I saw.

This is what I said, so that the supervisor, if they have any concerns, they can send them back in.

Like don't leave without asking XYNZ.

So we do have some things that are built into practice to make sure the investigations are thoroughly complete.

With that, we're all human, and we hope that every investigation is done as well as it can be done, but there is no level of perfection.

So there will be as human error, there will be errors on occasion, but hopefully we have enough things built in in terms of supervisor review of how a case is completed that that is taken care of.

That if a worker missed something, there's a supervisor that's reviewing it that will catch it in the course of either the consultation with the worker or in the review of the written documentation.

Okay, that's helpful.

Um the last thing is uh clearly uh you're making progress with implementing many of the recommendations, uh, and you're going to be updating the board on your progress.

Um we're obviously in this together to improve the child welfare system in the county.

Is there anything more that you think the board can help out with in terms of getting a lot of these recommendations implemented?

No, I think just your general support overall, um, as Michelle shared on her presentation, a lot of those findings, those recommendations have been implemented.

Um, so as we continue to bring these items forward, just wanting your support.

If there's anything outside of this general support, we will let you know in a proactive manner.

Thank you.

Supervisor Marquez.

Uh thank you, and thank you for the presentation and the updates.

Um, with respect to the team first assessment, I just want to make sure I heard correctly.

This was the first time we've conducted this assessment.

This is a first administration of this study, yes.

Okay, and then you did say this will be done again next summer.

We'll be doing it annually as long as we're part of the partnership.

Okay.

Um, and any um indications or do you can you kind of determine why there was only a 54% response rate?

Any feedback around that?

So statistically, a 54% response rate on a first administration of a survey is outstanding.

It's better than a lot of jurisdictions.

Typically, a first administration of any survey, your response rate will be about 20%.

So we exceeded the mark of what you would expect for a first response survey.

Surveys, the survey also was not mandatory.

The survey was kicked off to staff through a third party, and they were asked to complete it with some acknowledgement.

So I'm actually pleased with 54%.

Okay.

The researchers were impressed not only by the measures of strength that existed in the survey, but the amount of staff that chose to participate through across multiple classifications.

So seems like, oh, it's only 54%.

But when researchers will tell you your first administration of a survey, above 25% is outstanding.

To get more than half is exceptional.

Okay.

And how long did the survey take approximately?

We gave how long did it take to complete?

The actual duration to complete it, not the length of time it was available.

Um it wasn't long.

I think you could complete it in 20 minutes.

Okay.

And was there any uh ability to provide open-ended responses, feedback, suggestions, or was it just automatically populated for responses?

It was a variety of both.

It's a little, it was both.

Okay.

Okay.

Um, and then with respect to being a part of this initiative, are there standards and benchmarks that we should be striving for?

I think you want to continue to improve.

They don't have benchmarks, it's jurisdiction specific.

But the partnership's primary primary focus is on building a safety culture, not just within your agency, but when everybody that looks at a critical incident.

So when something bad happens, it's not just within our department that we're looking at it from a lens of what was missing that someone needed to make a better decision.

I think what happens when we have a critical incident, the natural inclination is to say, what did Andrea as my worker for lack of a better name?

What did she do wrong to make this better?

A safety culture is what you use in aviation.

When planes crash, they use safety culture to figure out why did this plane crash?

What were all the things that were happening in that moment?

And it's what's led to primarily very few plane crashes, the best example.

It is used to literally look at a scale, everything being equal, what is lacking in the system that you get used to improve.

It takes away from the focus on a person failed to do a better job, but did they have all the pieces that they needed to do their job?

And so my hope as we build in safety culture that we won't just use a lens of a safety culture when we review cases, but everyone that's responsible, Andrea, all of you that were all looking at the lens.

Do our staff have everything they need to do their job every time?

And that's how we review a critical lens.

So it helps us with death reviews, it'll help us with um media consultants.

How are we telling our story to the media, not just when something bad is happening, but all the time because unfortunately in child welfare you only hear about child welfare when there's a critical incident?

There's good work that is happening every day that is missed because it's not as exciting for people.

And so the partnership is about how do we uplift child welfare so people understand the totality of the system.

Okay.

And then with respect to uh regional center clients, do we know how many young people are also clients of the regional center?

I don't have that off the top of my head, but I can get that too.

Okay, and then has the relationship improved last time when we met in October, it was difficult to get the, I believe they're the IPPs.

We hope to have uh an MOU in place, but I've actually reached out to an organization, an organization that works with CWDA to get their assistance as well.

And how do we approve their relationship?

Uh regional center told me they hired an additional staff person to help with the responding to child welfare workers and Alamina County.

Unfortunately, I told them that wasn't sufficient because the staff person is shared between our county and Contra Costa County, and I don't really know if that's the lift.

So we'll keep pressing for the things we need so that um we get from them what we need.

Okay, um, and then with respect to documentation, there were concerns, as you mentioned earlier in your presentation, referrals have been made, um, research is being conducted, but that's not necessarily captured.

So, do we have better protocols in place in terms of like supervisor management to ensure that that documentation is updated and current?

Yeah, we've created templates that have been added to every court report we do, so that all stakeholders will see that all of these pieces are done.

Workers will also reflect that in their contact notes.

So the templates were just pushed out this week.

We had to create them and they've been pushed out, okay.

Um, so that multiple people will see all the things, not just internally, but judges, children's attorneys, parents' attorneys.

Okay, we'll all have access.

Okay, thank you for that.

And then you mentioned um working with the comms team just to basically elevate even positive stuff that's happening.

Um, some feedback I got, and I I don't have the history around it, but it was uh brought to my attention that at some point this board would acknowledge youth in our foster care that we're doing an excellent job in school work just excelling.

There was a way to um acknowledge those efforts.

Is that something that we can bring back and elevate more of those positive positive stories, specifically with family reunification as well?

We could, I think family reunification would have to see around the confidentiality of it, but highlighting youth, yeah, we could bring that back.

It used to be like youth loved it, the board would come and it wasn't the full board often, it'd be one or two members.

Okay.

We did celebrate our youth that way.

Wonderful.

I'd like to see that come back, and then um I'm I don't see like any PSAs out there.

I see a lot of information on elder abuse.

I've never heard of commercial, I've never seen anything about child abuse, the different forms, how to report it.

Does something like that exist in this county?

So we don't have PSAs on how to report, we get a number of calls.

So I don't think reporting is our issue.

Um we last did PSAs on.

It's been a while.

I'm trying to think the topic just left my head.

Um the safety, the safe sleep, we did PSAs because we were seeing a number of children suffering from sudden unexplained death syndrome.

So we did a safe sleep campaign for staff.

I mean, for clients, it was on billboards.

Um we did a big media campaign when we opened our new website for foster pay to become a foster parent.

Um we did commercials for that, but those are the last two we've had.

Okay, and when will the report to the state be uploaded to the website?

It has been uploaded, it's already uploaded.

I think they review it because they may make a no, I'm I mean on ours.

When will it be public for our website?

Um, as soon as we can make sure it's um digital accessibility, the digital accessibility is in place, then we'll upload it.

Um, because some of these documents are PDFs and that doesn't meet the digital accessibility requirement, but hopefully we can have it done within the next week or so.

Okay, will you notify the board once that's done?

Absolutely.

And if we could get a copy in advance too, that would be great.

Well, a copy of the report, the response to the auditor, the state auditor.

We will try to get that on the format as it as it currently is, doesn't allow us to download the full responses because you have to respond to each recommendation separately.

But if if there's a format we can get from the state, we'll make sure that's okay.

But what I would say is in your appendix, those uh it reflects what's in the attendance.

Okay, um, but yeah, it doesn't it let you have to do it bullet by bullet, it doesn't okay.

And then um when we receive the the last at the last presentation, there was uh concern about just the culture in the department.

So what are we doing differently to engage all of our labor groups, making sure we're hearing feedback from them?

Like what's being done differently.

This so I would say a couple of things about that.

We do engage labor, I meet with them every month, and they will call me if there's a situation in between.

But I would also say the survey that was done reflects what's the report does not reflect what we are seeing on the ground.

Our measures uh do look at if we can go back to that survey that was issued.

In terms of people feeling safe when they come to work, people feeling like they can go to their supervisor, that they feel like they are part of our team.

The survey says that what was reported in the audit is not actually what we're experiencing on the ground.

So I don't think there is a culture of a lack of safety among staff.

I think I don't know how many people the audit actually interviewed, but that seems to have been their opinion.

I don't think that opinion was widespread.

Primarily because I now have we literally have documentation that says literally it contradicts what's in the audit.

And I think we have to go with the 54% of the staff that came and said, I feel like I can go to my supervisor.

I feel like I can go to my manager.

I can go to my teammate, and I am part of a team when I come to work and I want to be here.

I think that is more reflective than maybe some people who are unhappy and are still at work.

I think that is that was more reflective of that.

Okay.

But um SEIU absolutely comes to me when they have an issue with something.

Okay, and local 21 as well.

Local 21, we have a good partnership with local 21.

Okay.

We have uh what we call the elephant in the room.

We don't believe there's any, so we have very difficult conversations when we need to have them.

Okay.

Thank you for that.

Um, with regard to recruitment, it's um continuous recruitment for welfare worker one and two, those are both currently open.

Yes, they are open.

And have we re-engage um local universities?

Their uh sociology welfare departments.

I know Behavior Health did an excellent job within the last month.

We approved two board letters, like a partnership with CSU East Bay as well as San Jose State.

I think that was focused on public health.

But have we been able to engage those universities for recruiting?

So, yeah, I actually sit on eSpace Title 4e board with people who were interested in doing child welfare, and I've done that for a number of years.

I meet as part as being a child welfare director, I meet with the coordinators from all the local universities to talk about our needs.

Child welfare directors, we do that at least annually, but quarterly, we go and say, This is what we're experiencing, this is what we need our students to have.

Um I do lectures at universities to talk about the importance of child welfare and why Alameda County should be where you choose to go.

We also have an internship program.

Interning is one of the best recruitments we have because people get to come and experience our work and then they want to come here.

So we have partnerships with UC Berkeley, San Francisco State, San Jose State, East Bay.

So engagement with the local university, we have a very strong engagement.

How many interns do we have right now?

I think we have six.

Okay.

Six.

We typically get two from each university.

And then how many annuitants do we currently have?

Right now we have two annuitants that are closing cases, okay.

But as part of our case assistant program, we have a number of staff that have left the agency that didn't want to work here full time, and we said we needed additional help.

Those staff have come back as temporary employees to assist with things like home visits and other needs on the case.

So we've engaged not only our retired and new attents, but just former employees who are choosing to do something else, but are willing to come and assist us in doing our work today.

Okay.

So I'll just uh be brief in the comment I made last time.

Um, this really is our collective responsibility to turn things around.

So I really appreciate the updates.

Hopefully, we continue in this positive direction, but echo the comments made by Supervisor Tam.

If there's anything that we haven't considered, please let this board know what else we could be doing.

That way we minimize um the harm to young people vulnerable populations in our county.

Um, I am gonna respectfully ask though that we keep the momentum going and we have another update either at the end of January or early March.

I think it's really important.

We're seeing um information uh being shared and a lot of progress being made, but I wanna make sure we continue to monitor that.

Thank you.

Um we will be committed to bringing updates to you on a regular basis before we get questions from Supervisor Force Not Albaz.

I just wanted to bring to your attention Supervisor Marquez, line number 24.

It lists the upcoming exam deadlines for both classifications for continuous hiring.

So there's a lot of additional information that's part of the appendix that Michelle didn't go through in detail, but this will be included on the public facing site of social services.

Thank you so much.

Can we make sure that this slide deck is included and uploaded on the agenda as well?

Yes, okay.

It's already been uploaded according to Honest Perkins.

I was looking for it, and my staff was asking.

Supervisor Fortunato Bass.

Thank you, President Halbert, and thank you to our staff for this information.

Um I want to just start my remarks, acknowledging how critical the work is of this department, how critical child welfare work is to the work of our county as a whole.

And I've heard our staff talk about the goals of protecting our children, supporting our families, and building public trust, and I really want that to be front and center.

Certainly with the state audit with the review of the department over the past few years, I do believe that these audits and reviews have found systemic issues that we need to remedy.

And I, you know, I appreciate the context that you provided, Ms.

Love, and I also want to make sure that the public and our clients and our staff know that we are addressing this issue with urgency and with seriousness.

Not to say that you're not, but I think it's really important for us as a board to say that and to have an approach of collective responsibility, as supervisor Marquez said.

Um I really want to make sure that all of our stakeholders feel heard.

And so again, our clients, our staff, members of the public, when we heard about this audit and it was brought to us for the first time.

Um I heard that it was really important to make sure that for our clients and the public that we're rebuilding trust and for our staff, that we are also working to improve morale.

Um, it's good to hear um so much progress is being made towards the recommendations, and at the same time, I also feel like we as a board need to see progress month by month.

I had uh an opportunity to talk with Director Ford about something very specific that I think the board could request, which is a public dashboard.

I understand this information is already being collected.

Uh the report references some quarterly updates, and I do think that a public dashboard so that we could see month by month or whatever the time period is progress would go a long way in making sure that the broader public as well as uh the elected officials who called for the state audits see that we're taking this seriously, we are making progress.

Um, so some of those metrics I think could include hiring and staff retention, caseloads, uh, response times, sibling placements, to name a few, and just looking at some of the information that was presented to us today.

I know my colleagues already discuss the team first assessment of safety and culture, um, and I hear that this is really about us as a jurisdiction.

However, I am concerned when I see physical safety and one in three respondents saying they may not feel safe or intend to remain in one in three respondents saying that they may leave the county.

And so I do think we need to really um look at what are the measures of success, whether it's this or some other metrics uh that we can create for ourselves to know that we're making progress I know supervisor Miley mentioned best practices um but again you know seeing that there's um really great information about ongoing recruitment um applications hiring etc for example I don't I don't know what the vacancy rate was when the audit was first released versus today and so I don't have a sense of month by month or quarter by quarter how we're making progress and then for the sibling engagement and placement on page 15 um this one I think is really interesting because this is is certainly an area where I know we're working to make progress so it looks like the state for example has improved the placement rate but here it looks like the county's placement rate has declined between 2019 and today so my question is you know what are our goals for improvement and how can we monitor this on a more regular basis to know that we're making progress.

So with that I would just say that my you know my general ask is helping us as a board understand what those measures for success can be and also what type of public facing dashboard could we put on our website for example so that we can see month by month ideally or quarter by quarter that we are making progress towards the goals that we have and maybe I'll pause there to hear what um you know what the response is so we can have a public facing dashboard uh about all of those measures you listed there are a number of measures in child welfare that we could use um I think all of those if you want I I think data tells part of the story so if we have a dashboard we need to have the corresponding measures right there's some things that go along with it so if we are our SIP will be posted which now has a strategy about sibling placements.

So yes we can create a dashboard and at our next presentation we can give you a suggestion of what that dashboard may look like I think that may be the easiest um the timelines absolutely are public we have no problem letting people know where we are with responding and it might help to give some context one of the things I've heard recently is that 10% of the time we don't respond to all immediate investigations.

State standard is you can only respond to 90% because the information in investigation isn't always the right information information people are guessing what the address is so 90% is actually the goal for response.

So it might help to give some people education about what they should be asking for and what they should be expecting from the child welfare system versus the little tidbits they're hearing here and there.

So I think it's a good opportunity for us to educate our public and um the community about what they should be expecting from the child welfare system.

So we'll give you a draft of what we can possibly include and we'll include what the state measure is and the state expectation and by state I mean CDSS.

I don't mean the auditors because they are actually the people that administer our system we can put their measures to include.

Thank you.

So thank you, Supervisor um fortunately for the reminder.

A lot of this presentation was not only built on what came out of the audit, but also what you and I discussed about transparency and ensuring that the community and the public knows what how we're advancing changes in a department.

So in terms of what we're doing good, we talked about placement that's included here.

This presentation will be on the public facing site.

And as we continue to improve, we'll add as many dashboards as possible to help tell the story along the way.

But today I'm not, I'm not prepared, and I don't think Michelle is either, to um say what that dashboard will look like.

We can go back and see what makes sense to put out there for the public.

But um, you know, as um stated on the the cover slide, we're really about transparency now moving forward, continuous quality improvement, collaboration, whatever it takes.

Um whatever input we can get from the board members, we we will have that um in some way visualized on that public facing site, and um same for staff and any members of the community.

So we're not trying to hide anything, but we want to put things out there that make sense for everyone who's involved directly or indirectly.

And I also think it's important to note that the last few years have been difficult for the department with lack of staff and being able to make timelines and things like that.

I I'm hoping that one of the reasons why we include the number of reviews is if we continue to look at the same period of time.

So I'm glad you're looking at forward, that period of time is always gonna tell that story.

So the opportunity to tell our story going forward of not ways of improvement, some of it is going back to where we were before the pandemic.

So it's easy to look at it's always been a systemic, yeah, we beat the state and everything before the pandemic.

So to give us an opportunity to share that story of where we were and where we could be again is an opportunity.

But I think as long as we keep looking at these same periods of time, which all of our reviews seem to be focused on, the story will be consistent.

So I appreciate the opportunity to have a dashboard so the community can see where we're going forward.

Thank you for that.

And I agree, um, using it as an opportunity to educate the broader public and providing context and also looking forward.

You know, perhaps, you know, obviously we can go back to 2019 before COVID, we can also start with when the audit was released and how we are doing since then going forward.

Um, so that sounds very um important.

I mean, I do have a number of questions.

I know that we have a full agenda, you know.

Again, I'll just say that around vacancies, which was already discussed, understanding our vacancy rate over time, including going forward is really helpful, as well as hearing how um worker feedback, staff feedback is integrated into how we're adjusting going forward is important.

And I don't know if there's additional comments on that or not.

Yeah, if you look at the survey, so we're in the next phase.

So what'll happen over the next course of the year is after the survey is presented to each division in the department, we'll then begin having focus groups with staff.

What are the things they think could be different and looking at what can be implemented?

So the survey is one part, the presentation is the second part, then the focus groups.

We also have in the department other opportunities for staff to give feedback.

For example, the diverse idea work group, it's mentioned in the appendix.

They are currently looking at the pain points in the front end emergency response.

So there are different opportunities for staff to present to improve our child welfare system.

And we also have an agency-wide survey that'll um be disseminated beginning December.

Well, it's already it has been disseminated with a completion response date of December 5th.

So we'll be looking at it from that perspective as well, and we'll be sure to share those results with you.

Thank you.

Um, and the other issue that's really important as we've had this discussion is around caseloads.

So again, what is the current caseload, especially for the emergency response unit?

Um, how are the caseloads determined, and how are you addressing, you know, high versus low caseloads?

How do you make that determination?

I think that's another set of issues that's important.

Yeah, so for the current caseload count, um, the map that's part of the appendix, it lists um by division what the case load count is.

It's pretty small there, but we'll make sure to elevate that as much as possible, but it's there.

Thank you.

And since we just got the presentation today, I might follow up with some specific questions offline.

So I think perhaps the last set of questions I have is hearing a little bit more about how we're engaging stakeholders and uh community-based organizations who are providers.

So I heard that we've got 60 contracts, that's a lot of um partners.

How are they engaging in this work to improve going forward?

So some of those people are involved in our um community partnership work, but some of them aren't.

So some of the people that are participating in helping us build a better pathway that doesn't involve the child welfare system, aren't actually contractors.

They are just providers within the community.

Our current providers, they're absolutely welcome to participate, and a lot of them offer um ideas of how to improve the system and how they are engaging.

But our stakeholder group that we meet with, all of them are not actually contractors, they are actually just providers in the community that are working with children and families, and they are interested in building a better um community for all of the children and families in Alameda County.

So, um, thank you for explaining that.

Is there sort of a mechanism for stakeholders who do want to engage on child welfare issues and work with us to keep improving the system?

They could come to that.

I think we do an annual meeting as part of our child abuse prevention where we invite stakeholders to come and offer their opinion.

Um but other than those two, the one that we do quarterly, and then our annual as part of our child abuse prevention assessment where we invite the community to come and offer feedback.

Those are the two primary mechanisms.

Okay, thank you.

Um and last question.

So Miss Love, you presented the entirety of the department's work when you began the presentation.

So I'm also curious to hear about you know the positive things.

You know, sometimes we only hear about things that are challenges versus the things that are positive.

So would really love to hear how the county or we as board members can help spread the successes and the positive work that the department is doing.

Okay.

We can look forward to getting you more of our generic success stories that we can share with you.

I don't mean to create extra work.

I just want to say, you know, let's also make sure that we're sharing the good news as well as the challenges that we're continuing to address.

So thank you for that reminder, Supervisor Fortunately Bass.

And the start of that is on slide 16 under department highlights and opportunities.

And it was based on our conversation about also sharing what the department is doing well.

And so we couch it under celebrating successful client outcomes, collaboration, continuous quality improvement, and transparency.

So those are some positive department highlights and opportunities moving forward.

We will continue to build on this list.

Thank you, Director Ford.

Um, and lastly, I am also interested in continuing to have visibility on this and engagement with the full board and certainly support coming back to the board in January if possible.

Okay, is that it?

Thank you, yes.

No more last comments, lastly great questions.

Um, before we go to public comment, I have some questions.

The first one is have you presented this back to Senator Wahab and her team who came up with this audit to begin with?

Have you met with her since then?

I mean, what?

She did an audit, the audit came back to us, we issued a letter on the 24th or whatever, but have we sat down and met with them?

We've not had any engagement with Senator Hobb um at all.

She did speak at our caregiver dinner at our request, but no, there's been no direct conversation before the request of the audit since the audit's recommendations or since our presentation to you.

So if that's something that I would recommend that we maybe reach out and try to have a conversation, it's just a thought.

She's spoken with my office and me, and um, I think it's undeniable that she has a lived experience and a passion and a mission, and I think begs to be part of the solution, and I don't know that we have a choice other than to allow that to happen.

With regard to the audit, and one of the themes that I'm hearing is the audit may not be accurate, our own survey of people contradicts the audits survey of people.

So I think right away we have to get to the bottom of that somehow.

I'm assuming the survey that we did, which is on page 10, was an anonymous survey.

Yeah.

So anonymously people are telling us that they feel safe, they're not emotionally exhausted, and uh the other things here that contradict the audit.

I guess we don't have an answer for that.

It's just one of those things.

They say one thing, we say another.

No, I I wouldn't say that.

What I would say is an audit is based on them looking at a portion of whatever their measure was.

So again, like the timeliness measure.

They didn't look at every case that was available in every service that was offered to child.

They picked a sample.

So their audit is true based on their sample of what they reviewed.

We send out to everyone, and we also have a sample in terms of safety measures.

So I think that's the importance for context for the audit is except for a couple pieces, they're looking at a sample of all of the things.

So they told their story based on what their sample told them.

We sometimes, especially with um regard to staff, our sample is bigger.

We didn't interview a couple of people, we sent it out, and everyone had the opportunity to give their feedback.

So is it irresponsible to issue an audit result with a sample that is not statistically accurate?

Well, actually, in their appendix, it's buried, it's in there.

Um I do think, well, I was told that sometimes it's what people want to hear, right?

And so part of the how it's framed and written is uh I wouldn't say salacious, but it can parts of I mean some of the headlines of the audit literally were chapter headlines, and I think that's just style.

But I do think if you read it all zero to bury in with the appendix, the pieces where they say for this sample, they tell you in appendix C table C page 62 of 73 pages.

Oh, yeah, this is how many people we actually how many cases we actually reviewed.

So it is in their audit.

I don't think there's an effort to hide anything in the audit, and they aren't clear that there are samples.

They don't highlight the samples is what happens, so two things can be true, right?

All right, so I see that there are um there's a 24-hour emergency percentage of responses that we complete.

Like we get a call, it's an emergency response, we should be uh on it within 24 hours, and then there's a question of did we or didn't we?

And that leads to a percentage of how many we did and how many we didn't, and is there a benchmark for that?

The benchmark is 90 percent.

90 percent, okay.

And where are we performing 90 percent?

We typically perform, um, it's actually in our system improvement plan.

Over the last number of quarters.

We've hovered between 89 and 90.

Um, the state wants us to get more consistent with 90.

Um I think recently we had a larger drop that we're looking at, but this is one of the things in our system improvement plan where we've said for the next five years with the state, we are going to continue continue to build this so that we are consistently meeting our state's um mark.

We're at 89, we should be at 90, and they're getting at us for not being consistently at 90.

We aren't consistently, and we've had a drop recently that was a little bigger than that.

So it is a mark that we should strive to be at 90% or better.

The other metric I think is um you should be responding and investigating within 10 days.

It's not an emergency, but it's we got a call and something may be happening and we should be on it within 10 days.

Now I think it was a year ago or maybe a year and a half, where a study from Cal Berkeley said that we do not hit that 10-day mark very much uh on time.

In fact, we were like one of the lowest.

That's where are we today?

That was a year ago.

That's correct.

And so these measures are impacted impacted by staffing.

Our that measure is actually 90% as well.

Um, our number is about 37%.

That is, I think reflected more in the staff available.

I do want to say that while the state standard is 90%, the state overall hovers at about 58%.

That map that mark is not at 90% for very many counties.

In part what happens is staff focus on the immediates.

That is where there's the most urgency that we respond immediately and address that concern.

We are working to improve um our 10 days.

One of the things that's in the appendix of the slide is San Diego State.

Um, we are looking to enter into a contract to review our emergency response system.

They were able to help another county with improvement.

So we are looking to have a contract with them, and they've offered some ideas on how to improve it.

So we're we are looking at different ways that we can to improve um that system.

Recommendation seven is ensure documentation of timely services for foster youth.

I'm assuming that services like they need a dentist appointment or they need um so um we've recently successfully completed that.

It looks like September, October, November we got it done.

What's the metric of that?

Are we saying that they're going to receive services within a day, within a week, a month?

What do we mean by timely?

So that varies.

There is no metric, there is no state standard.

So some of these things that were requested, there is no corresponding state standard.

So what I would say is children should receive a dental exam twice a year.

Yeah.

So that needs to be twice a year.

The timeliness for mental health there isn't a standard.

What we're saying is 30 days from referral is when we're hoping that children receive our they get the service.

Okay.

Um, 30 days.

You you mentioned how identify, locate, and notify.

No, that's not the other one.

The other one was policies and procedures to track and minimize.

Um you talked about the the the need to document.

We scheduled two dentist appointments, but they refused to go to one, and so therefore, are we saying that up until now we haven't felt the need to document that and we know we're going to add that?

We would tell the court they only went to one.

Staff weren't repeating why they didn't go to the second one.

And I we want staff to just say in their court reports this this is why they didn't go to the second one.

Oftentimes, in the court setting, most people are aware these kids.

Our kids are fortunate to have the same attorneys, the parents have the same attorneys.

Luckily, they're in the same courtroom most of the time.

So people are familiar with them in their cases.

Yeah.

Um I I think I'm gonna echo my colleagues uh who have said thank you for the report, but we have these questions and concerns.

I'm gonna be very clear, as I have been all along, foster youth are some of the most vulnerable people in our community.

I'm I'm almost at a loss of of words that we need to do better.

I feel that we understand that.

But we need to do better.

And so with regard to that, we have a social services committee that meets, should be monthly, I believe.

I don't know.

I would like to see them meet monthly.

I would like to see a report come monthly.

I would like to see if it's not an ongoing dashboard or until one gets developed, because IT might take a while to do that, that we put together the metrics that are most important to us.

Number of vacancies, how many that have been filled in the last month, what percentage of 24 hours are finished on within 24 hours, what percentage of 10 days are finished on time, because if you can measure it, you can optimize it.

But this is so important that I would like to see that happen.

And I think you've got a majority of the board, I could be the only one, but I doubt it that would like to see that happen starting in January and February and March, that a report would go, and it could be a consent item if you want, but it's gonna have the data that's needed.

A board member can pull it off and talk about it, or you could have a five or ten minute presentation on it.

When we had COVID, we had Dr.

Moss come in and give us a 10-minute and all the data that we needed, and it took him a while to get a dashboard.

But this is that important, in my opinion, the lives of foster youth, some of the most vulnerable people in our community.

So again, we've no we recognize that we need to do better, we have a plan in place to get better.

I want to see us get better incrementally, and that it would come back to our full board more than annually, but say quarterly would be my recommendation.

But um, do you think that we can be ready by January to report to the Social Services Committee?

What percentage of 10 days and and one day emergencies we've completed and how many vacancies we have?

We will be ready.

Okay, okay.

Um I note we have public comment on this item.

Um, will the clerk please call?

Uh I guess we have to say if anybody has filled in a speaker slip on this item, uh, you can call them or now would be the time to raise your hand if you're online and wish to speak to this item, raise your hand, and the clerk will take care of it as she always does.

Oh, maybe you could let us know how many speakers we have.

So no, no speakers so far.

No speakers, the most vulnerable population in our community.

And no speakers.

I see Supervisor Miley.

Yes, you're up, Nate.

Yes, thank you.

Um, I just want to ask the agency director uh to be forthright, and maybe she is, but I just want to ask the question, because I hear that the board, there have been board members that suggested that this come to the social services committee monthly, and then you're also suggesting that there'll be a full report to the board quarterly or or something to that effect.

So I just want to make sure the agency has the capacity to do this.

I mean, I do recognize this is extremely important.

We all acknowledge that, but this isn't the only thing the agency's doing.

So I just want to I don't want to set them up for failure.

So I want to just ask the HC director, can she deliver a monthly report to the Social Services Committee, plus a full report to the board quarterly?

And if I miss, if I didn't understand it correctly, because I know all five five board members spoke, um, please clarify um somebody.

Thank you.

Andrea, Michelle.

I think it depends on the uh the breadth and depth of what those presentations will be.

So I think what you were asking, Supervisor Um Halbert, or one of the supervisors is if we can bring um like a metric to the social services committee.

If that's the case, then yes.

And I think if we do it quarterly, then it's a culmination of what we provided to the social services committee.

So as long as we're not adding it to um the month after month and then a quarterly, but we're we're actually building on it and presenting that culmination per quarter, we can do it.

But if you start asking for uh newer things every month and every quarter, that might make it more difficult.

Well, I've said it before, just like Pastor says on Sunday.

Don't tell me what we can't do, tell me what we can do.

And I'm sort of let's see what we can do, and we'll look at it over time, and we'll let you know, but I would start with what you can do.

Right.

Um, leave it to your great discretion, knowing how important this is.

I don't want to have you commit to something you can't do.

We'll see in January.

I'm committing to January, sure.

Okay.

So can I just just so for clarity is that monthly to the Social Services Committee and quarterly to the full board?

And then are there also written reports that you are providing in terms of some of the agencies' uh caseload data and metrics?

I know in the past that's been provided.

Is that something you're doing also?

Or is that data that you would bring to the committee?

That's data we would bring to the committee.

And we are also building a live dashboard, um, not related to the audit or anything else, but just to the agency as a whole.

But we're building live dashboards on our public facing site for each department within social services.

Just looking at ways to minimize some of the once that's done, you alleviate the need for monthly reporting on metrics because it's a dashboard.

You it would be a lot easier anyway, you just include it.

Uh I'm just concerned how long that might take.

If you have a whole dashboard done by January, then that should be a pretty easy thing to report out on.

Yeah, I just it just needs to be a commitment also that um, you know, you you all's request is noted, but um, I get your commitment that you look at it and you let us know what might be missing.

Um so we just won't be going down a dark hole.

I appreciate that.

We should be held responsible for giving you feedback.

Any other questions or comments?

No public comment.

Okay.

Is it ready?

Okay.

Um we're going to recess into close session at this time.

Thank you.

All right, we're gonna reconvene from close session and ask the clerk to call the roll to make sure we have a quorum.

Supervisor Marquesse, present supervisor Tam, present Supervisor Miley here.

Okay, Supervisor Fortinata Bath.

Present.

President Halbert.

Present.

All right.

Our next item up is the two o'clock set matter.

I note that it is past two o'clock.

We're gonna have uh the item be presented and introduced by our public health director, Anika Chadri.

Good afternoon, everyone.

Umika Chowdhury, interim Director for Alameda County Health.

Um, and I'm joined by uh Lori McFadden, our EMS director, as well as our EMS medical team and our uh EMS um deputy director.

So thank you all for being here.

Um, so today uh the purpose of our presentation is really to just follow up from our June 2025 meeting at the board, where the board had additional questions for us after we presented a contract for your review.

So we'll go over some background and context on how and how we got here and where we are today, followed by a comparative analysis of different EMS system types in the context of Alameda County.

And we'll finish with some recommended next steps and requested direction from your board so that we can bring back a board letter in December.

So per state statute, local EMS agencies carry significant responsibility to ensure safe, reliable, and effective emergency services in their jurisdictions.

And while we talk about ambulance transport quite a bit, I just want to note that it's only one part of the overall responsibility for the system.

Our EMS team plays a critical role in ensuring that EMS response resources match clinical best practices.

They do critical work with all of the area hospitals and trauma centers.

They ensure that the EMS workforce is appropriately trained to provide a high level of clinical care.

In the event of an emergency, and they also hold a regional role in coordinating medical response in emergencies.

And they administer a variety of programs to support community education, preparedness, and quality improvement.

So this is just a little bit of a lot of history crammed into one slide.

Alameda County has had an exclusive operating area, which we'll go into a little bit more depth about later, which requires a competitive process.

And over the past 35 years, we've conducted multiple procurements and worked with three different ambulance providers.

In 2019, when FALC initiated service, we launched at the request of the board an extensive system redesign process at the same time.

We worked with hospitals, fire agencies, CBOs, and the county agencies to reimagine our EMS system as a whole.

And this resulted in an innovative and leading-edge RFP, which sought to prioritize equitable clinical care and set the system up for long-term sustainability.

That RFP was scored by an independent panel of experts, with AMR scoring the highest, followed by Falc and then AlcoFire.

So we brought that contract forward to your board in June of 2025, and your board declined to award the contract.

And at the same time, you also posed a number of questions about options for alternative EMS system types.

Anika, just out of curiosity, what did we do before June of 1990?

I think we had multiple providers.

There were multiple providers in the system.

So not the exclusive.

And then what's that gray dot out in the middle of District 1?

Livermore, sorry, the Lawrence Labs.

I just want to make sure.

We have their own ambulance service.

They have a contract with federal Alameda County Fire has a contract with the Feds.

Okay.

Okay.

Very good.

Thank you.

And thank you for the question on the map, Supervisor.

I should have talked about that a little bit more.

So the areas that you see in gray are the we have four cities in the county that do their own transport.

So that's Albany, Berkeley, Alameda, and Piedmont, and then the Livermore Lawrence Labs.

But all of the white areas are essentially the areas that the we talk about when we talk about the contract for the ambulance.

So this is uh, you know, bringing us to today and a summary of our research and analysis that our team has undertaken since June.

So listed in the dark blue shape all the way to the left are our underlying focus and system priorities.

Um and essentially, you know, these are non-negotiables for the EMS agency to ensure a safe, reliable, equitable, and sustainable EMS system.

So with that lens, uh we did additional research on what the agency's authority is and enforcement capacity is in multiple system types, as well as the legal risk that's carried with each.

We talked with key system partners and we engaged with the counties of Santa Barbara and Sacramento for their particular experiences.

And then we use that research to assess feasibility of what it would take to implement different system types in Alameda County, how long it would take, and whether it would support the implementation of the EMS redesign process that we presented to you in June.

And again, that's a baseline comparative analysis that we're doing because a lot of work went into that system, and we do still want to be able to do some of that.

So then, as a quick refresher before I turn it over to Lori, these are some of the key innovations that we presented in June.

And I won't go through all of them, but collectively, these elements are designed to ensure that all Alameda County residents get a high level of clinical care and the providers held to account via equity metrics, that patients get the right care at the right time, which might not always mean going to the emergency department, and that we continue to integrate behavioral health crisis care deeply into our system.

So with that, I'll turn it over to Lori to talk through a little bit of our work to assess the different system options, and then we'll have recommendations for you at the end.

Thank you, Anika.

Good afternoon.

Okay.

So I just want to refresh that.

For EMS operate operating systems, there are two types that are allowed by regulation now.

They're exclusive operating areas or non-exclusive operating areas, which I'll refer to as an EOA or an NEOA, just for quick uh for uh easy terms.

And third service where counties administer EMS as essential service like fire and police is a system that needs further clarity and that we're we're interested in looking into.

But right now, exclusivity can only be granted through grandfathering, like our city fire departments that are doing transport or by a competitive competitive procurement and in properly awarded exclusivity risks lawsuits.

We're unable to get our plan approved from the EMS authority at the state level, injunctions and things like that.

So this is a summary, it seems like it's a lot, but I'll go through each one.

This is a summary of the EMS configurations.

And for the first one, an EOA is a single provider, public private alliance, doesn't matter, it's a single provider, and it can be authorized through an RFP competitive process or grandfathering.

And the EMS oversight is a negotiated comprehensive agreement and our policies and procedures.

Ease of clinical oversight, it's quite easy because you just have one main provider that you have oversight.

And the financial risk to the county is very low because they do fee for service, and so they bill for their services and it doesn't fall to the county.

Administrative complexity is very low as well because again it's just one provider.

Legal risk is low because we've gone through a competitive process that is required by us in regulation, and labor stability is very high because there is again just one provider, and so the workforce isn't fragmented.

And so with a non-exclusive operating area, they're going to be multiple providers, and they can either be public or private or an alliance model, it doesn't matter what flavor they are.

And it would be done with an application process where we set minimum qualifications where people would where companies would have to apply, and then we would do we would have to rewrite ordinances, policies, procedures, operational procedures, which we don't really need to do now because the ambulance providers determine their own deployment plans where ambulances are and things like that.

And then the ease of clinical oversight is actually very low.

It'd be very difficult for oversight because the care is fragmented and there are many, many providers in the system.

So just make it harder to, you know, rather than having one provider having multiple, just makes it harder.

And financial risk to the county, that comes into play in case one of the public or public providers needs help, or even if the private providers leave because of financial problems, it is it is a riskier because they don't get all of the calls.

They get part of the calls.

And administrative complexity, this is a lot of work because everything is determined by policy procedure, operational deployment plans, et cetera, that we don't normally do, we would have to do in that particular case.

But the stability would be extremely variable for labor.

So and again, I'll talk about that later.

Third service again, this is something that we would have to go through a process because it's not something that is tacitly allowed in the state of California right now.

But it would be it could be it would be a public provider with or without a private subcontractor, but it does require legislative change, so that would take some time to do that.

But in that case, the county would own the process, and while the EMS agency would not have the operational piece, that would have to be a different piece of the county government.

We would have oversight of that provider, and it would be just one provider.

So some of the things that an EOA brings, that's what uh third third service would bring as well.

The legal risk and the financial risk to the county is heightened because it is a county process, it is a county um department, so that does bring extra risk to the county.

Labor stability again would be great because they would be county employees.

So um, all right.

So now we actually met with the county of Sacramento, SAC Metro Fire Department and County of Santa Barbara.

We met with them in a couple venues, and one thing that we found from SAC Metro Fire was that um and Sacramento County LEMSA is that they have very limited EMS medical control or system-wide clinical quality improvement.

That became very clear.

But it was obviously important to have a single dispatch system for the four fire departments, as well as um a joined billing um adventure.

And um fire agencies also contract with private providers to make sure that there is coverage, and the public uses a combination of 911 and 10 digit numbers to get emergency services.

So if they choose to call 911, they get a certain set of providers, and if they know the 10-digit number, they'll get a different set of providers.

And what we understand is that SAC Metro Fire recovers about 30% of the agency's costs via three billing mechanisms, and then with the county of Santa Barbara, they developed an NEOA that conferred permits, but uh the permitting strategy was challenged in court on grounds of de facto EOA creation, which I was talking about earlier, but the lawsuit was settled, and um the private provider implemented services.

All right, now this is the next three slides have a lot of information.

I'm not going to go through every single one of these, so you can read them later, but I am going to highlight some of them, and just as a as a general overview, the check marks are things that can be done fairly easily.

The X's are not that it's impossible, it's just there's level of complexity to get them done in a way that protects our community.

So the first four I'm just going to skip because you can do them in all three.

And then I would like to talk about the no no cost to the county.

So with an EOA, again, it's fee for service and it's not something that would come to the county, but with a third service, it would be a county department.

And an NEOA, because of the reduced economy of scale for all of the providers, it would be harder for them to sustain operations.

And so that's one thing that we are concerned about because what may happen is if if a provider decides that you know this is not financially feasible, they can leave the system, and then how do we fill those gaps?

And so those are some of the things that we are concerned about.

And then the um coverage for underserved areas, we are unclear how much we'll be able to require providers to service areas they don't want to.

We're not sure about the regulations around that, and that's that's a legal discussion that we would have offline, but without having the balance of the whole system as a provider and having those costs shared for the well-insured versus the non-insured, it's hard to be sustainable.

So that's one thing that we are just concerned about.

Okay, moving on with uh 911 patient navigation, that's one of the innovations that we really thought would be a great boon for our system because we want to take the low acuity calls out of the front end of the system because those people don't need to be taken to a hospital, they don't need to go by ambulance.

So we were very interested in the in this patient navigation.

The problem is in a in a fragmented system, we're not sure who would finance the nurse navig nurse navigation, patient navigation, and right now there isn't regulations are changing.

CMS is starting to make some changes around reimbursement for treatment in place and things like that.

So I feel like the pendulum is swinging, but it isn't there yet.

So we're just not sure how we can sustain it financially.

Um, and then the behavioral health crisis management and cat, we depend on our contracted provider to furnish the EMTs for the CAT team, and we're not sure how that will be affected by having multiple providers.

Then clinical quality and equity measures, this is far more difficult with multiple providers.

I've even heard from ED docs that you know, having multiple providers coming in right now, they know everybody, and they they have relationships with management and things like that, and having different people coming in and from different providers is very difficult, and that's the same for us for oversight and making sure that we do quality improvement processes, it's harder to do that with multiple providers, it's just more complicated, and getting the buy-in has been very difficult, like in the in the area of Sacramento County, we heard some of that feedback.

Um, and then but we are committed to clinical excellence, so we'll figure out a way to do that, and then um workforce standards are very important, and one of the things that we're a concerned about with having fragmented workforce is if the fire departments are hiring for sworn paramedics, or what they call single role paramedics that aren't necessarily sworn fire, those are easy to recruit because there's you know great things, great benefits, retirement, good working conditions, things like that.

And while other companies offer that as well, they when you have a fragmented set of private providers, because even if the um if there is an alliance model, those private providers are not sworn fire and they're not single role paramedics, so they are paid by the private provider.

So what we see is a fragmentation of labor, and that they will be competing for labor, and so that they'll have to be um incentives offered to to have people come to the workforce and things like that.

And then with a reinvestment expectation, we can do that with our single EOA, but trying to figure out how to balance that across multiple providers is just a level of complexity that is difficult.

So what we have done as we looked through all of these things, for a third service, the legislative process will take 12 to 24 months if we were successful.

And then based on what we have seen recently with EMSA at the state level, their approval process takes six to 12 months at least.

And then the implementation will take 12 to 18 months, and that's very similar to a non-exclusive operating area.

The timeline is almost exactly the same, just for different reasons.

And so as I prepare to wrap up with the EMS agency's key takeaways on our future EMS system, I want to share since most of you weren't on the Board of Supervisors at the beginning of the COVID-19 paramedic pandemic, that we were the agency the county depended upon to coordinate care in an unprecedented situation.

Our staff members ran the coordination between the county emergency operations center, the public health department operations center, and the entire network of health care facilities, as well as countywide testing response and vaccination efforts while still maintaining the integrity of the EMS system.

Alameda County EMS is committed to serving our communities at the highest possible level and will always keep patients and patient care as our compass.

In that light, I'd like to emphasize our key takeaways, and first thing is strong clinical oversight and regulatory compliance are essential for safe, reliable, sustainable, equitable EMS system.

And there is no similarly sized urban area that has a feasible NEOA that we can use.

We would have to, if you know, if it was decided that we want to go down that path at a later date, there would be a lot of work to be done.

And while alternate EMS transport system configurations may be possible, like I said, much more analysis would be needed.

And so switching from an EOA to another model type would be a major shift with significant planning, and I've already hit on these, but I just want to it reiterate them again.

Impacts on patient care, legal and financial risk, ordinance policy and procedures that maintain a high and equitable standard of care, administrative cost and enforcement, dispatch and deployment control to ensure equitable and sufficient coverage, impacts on receiving hospitals, workforce impacts with limited ability for us to take care of our labor workforce in a way that we can with an EOA, system reliability and long-term sustainability, readiness of the system to ensure no gaps in service, and the added strain on the overall healthcare system due to HR1 and federal policy shifts that are constantly changing, as we know.

So the next this is my next to last slide.

So our recommendations and requested board of supervisor direction is that for right now we maintain Alameda County's EOA.

And as we continue to explore alternate system designs with stakeholders and return to the Board of Supervisors with regular updates.

But in the meantime, we need to select an interim transport provider.

We and one of the recommendations is that we go ahead and approve the AMR five-year contract as recommended in June 2025 with all of the included innovations and extend the FALC for six months to allow ramp-up time, or we could extend the existing FAUC contract for a two-year term with an option to renew for an additional year.

And so those are our recommendations.

And now do you have any questions?

And I appreciate the chance to talk about this.

Uh, before we go to public comment, but but then we'll go to public comment.

We can also bring it back after public comment if there were additional discussion and deliberations.

At this time, before we go to public comment, do we have any clarifying questions?

Supervisor Tan.

Thank you.

This is a very thorough presentation.

The only uh clarification I had is you mentioned some of the key takeaways is the added strain on the overall healthcare system because of HR one and some of the federal policy shifts.

You know, we're struggling to deal with that, as you know.

So can you um elaborate on what some of those um strains might be on the system?

Yeah, thank you for that question, Supervisor.

So what we're referring to there is that um, you know, one of the critical components of uh HR1 policy changes are essentially to uh the downstream effects of it will be that people will lose coverage, right?

So people it's making it harder for people to enroll in Medi-Cal to uh stay in in Medicaid and is reducing eligibility.

Um insurance prices are also skyrocketing, um so we just anticipate that you know a lot of people will be falling out of the system.

And if we we have lots of data from the pre-affordable care act days, where we know that uh there was a really high um uh reliance on emergency rooms because people don't go to primary care, right?

So then they if when they need something, they wait until it's really bad, then they go to the ED.

Um, for the EMS system, that's a really important nexus to consider because our hospitals are probably going to be facing a lot more people coming in for ED use.

Um, and so when we think about you know the emergency system and uh sending more people in, we have a lot of complicated work that our team does to think about how to get ambulances back into the system quickly, uh, so it has impacts for the APOT and wall times issue, uh, because if the EDs are uh are crowded, the ambulances are waiting longer, then you know it's taking longer to respond out in the field.

So that's one example.

Um another is you know, just that there's uh dramatic instability with the HR1 stuff because there's a lot of funding cuts that our healthcare provider systems is looking at, and so um it's just a lot of instability to and and we want to be wary of not adding more instability.

Okay, uh so one of the advantages advantages I hear from a municipal provider with the non-exclusive operating areas that they could get a higher reimbursement, and you're saying that that might not be the case with HR1 and some of these federal policy shifts, but I think uh you are also implicitly uh talking about some of the impacts we're seeing in the Alamia Health Systems with respect to staffing.

Yeah, I think the ones that I was talking about are a little bit more of impacts on the hospitals because the hospitals are such a critical component of the EMS system.

Um, but with regard to the reimbursement, so there are opportunities for uh public providers to be able to uh bill Medicaid and Medicare at a higher rate.

At this time, we don't have any indication that that's necessarily going away.

Um, and that was one of the things that, you know, when we talked with Sacramento Fire, they you they have about three different billing mechanisms that they use, and altogether those are bringing in, you know, about enough revenue to offset about 30% of their costs.

Um, but some of the uh I guess it just kind of in the vein of the HR1 stuff, you know, so much stuff is not normal at the federal level right now, uh, that that is a risk that you know something like that goes away.

Thank you.

Any other questions or comments, Supervisor Marquez?

Yes.

Thank you, President Hubbard.

Thank you for the presentation.

Um, with respect to the third option, um requiring uh legislative process, do you have any updates?

Do we know if any of our local legislators are in the process of working on a bill, or do you have any updates around that?

Sorry.

Uh no, so this is something that's uh we don't have um uh there have been over the past decade uh multiple bills brought at the state level um trying to do different types of uh EMS models.

Um we have had initial conversations with our lobbyists who thinks that it is something that could be feasible.

Um, but you know, we would need to put a lot more effort into it, work with our local partners, um, build whatever state coalitions, et cetera.

Um, so it's a thing that we think um is a feasible path because it you know, we heard the board loud and clear in June uh that you want to see something different, um, and that allows us to uh do something different that still maintains a high level of um EMS medical control um and and provides a path for us to create something that's specific for Alameda County.

Um, but you know, nothing is guaranteed with legislation, so it's uh it would be something that we would need to explore further as a part of number two.

Okay, yes, and then that's what I wanted to flag.

So the current contract with Folk it expires in June of 26.

Is that correct?

And can you remind me when we extended it the last time?

Was that just for one year or two years?

I'm not recalling the timeline, you know.

One year, I think it was one year at a time, yeah.

Okay, those are all my questions for now.

Thank you.

Supervisor Miley, I see your hands raised.

Yes, thank you, President Halbert.

You have a few questions.

Um is it okay for me to see everybody because she's still got the PowerPoint up?

Um, my first question is, to my understanding, if we go with a third party approach, that would include the Alliance model, is that correct?

If you're referring to the third service, it could it could be it an alliance.

Okay, that is one of the possibilities.

Okay, and also let me I just want to thank Lori uh for all of her work on this.

I know Anika, the head of the agency has been um kind of shepherding this, but I know Lori, you and your folks have probably done the heavy lifting.

I want to thank you for all for everything you've done on this thus far.

And I think your presentation was excellent.

You know, obviously having been on the board uh and been through three of these with AMR, uh Paramedics Plus and Falk over the years.

I'm pretty familiar with um stuff, but this presentation I think was excellent in terms of laying it out in the non-exclusive operating area.

I think you've indicated all the disadvantages associated with that or as well as the challenges.

If we were to go with a third party uh approach, uh we could possibly have the state legislature uh consider Alameda County as a pilot to to see how this would work.

Is that possible as well?

Uh yes, I I believe that that's the case, and the the one the huge possibility about a third service is that RFPs wouldn't be needed anymore.

It would just be an existing service that would stay and we would just have stability.

Yes.

Moving forward.

Yeah, because I think the uh chart that you use to kind of look at um each of the three approaches and the and the categories associated with each of those approaches, the check marks or lack thereof, I think uh was very informative.

Um some of that I already knew, but some of it I didn't know.

So I appreciate all the research you've done on this.

Um, in terms of the recommendations, I need to be clear on this.

This is a work session.

So are we taking action on this?

Is that a question for county council?

Okay, today's presentation is an informational presentation.

Okay, item on the agenda.

Okay, so the are recommendations appropriate today for us to take up, or would this be something that would be forwarded to the board for uh you know, uh scheduled meeting?

You could give direct the board could give direction today to bring something back to uh one meeting.

Okay, so no action day just kind of giving direction.

Because with the recommendations, um it said uh potentially doing a contract with AMR for five years or um extending Falk for two years plus a one year option for an extension.

That's three years.

But if we go with the alliance, excuse me, if we go with the third um party system approach, I thought Lori, you outlined that that would take about four years to achieve.

So if we did Falk for five years, we'd be given more time to Falk over, because it would only take four years to put this third party approach into place.

If we um if we did AMR for five years.

If we did Falk for two plus one, that's three years.

So we wouldn't have enough time to put the third party uh system in place.

So what so what do you how do you reconcile those that recommendation?

Thank you for that question, supervisor.

And I wish you could see our EMS deputy director laughing right now because he um said that the math doesn't math on that.

Um and uh so part of that is that you know the the timeline to do either a legislative approach or looking at a non-exclusive system, um, it could be as short as two and a half years and as long as four.

Um so our intent is to, you know, continue working with our system partners, and as we've done before, um, like theoretically by two and a half years, we should know what's happening.

Um so we would come back to the board with updates, and if at that time it looks like we need to extend, then we could do another extension.

But our our practice has been to, you know, do that um extension one year at a time.

Uh so we're trying to be consistent with that and um trying to uh also uh really follow up on the board's direction that you want us to explore something different, and and so wanting to give ourselves a couple of years to do that.

Yeah, so I I recognize that, but and I and I think um with a third party approach, the third system approach, um if you know let's say it takes four years, but we if we did AMR with a five-year contract, that would lock us in for five years.

Correct.

So why would we want to do that?

Um so we wanted to put these two system options forward because uh, you know, the the AMR option is based on a pretty extensive system design work that we did, uh, and we do feel that that does move the system forward in certain ways where uh it sets it sets up whoever the next provider is, whatever the next system is, it helps us kind of get to that uh because we want to see some of those system innovations regardless of who the provider is or what the system is, right?

So it just sort of is a stepping path.

Um whereas with Falc in that contract, uh we cannot add those innovations in because trying to do those things would be a significant shift from the RFP and the procurement that was done for the contract that was awarded to Falc.

So we're limited to uh continuing with them in the uh space that they are.

Uh, but again, just wanting to share both present both options with the board.

Okay, and um and I want to make it clear.

I'm not advocating at the moment for either AMR's five-year or for Falk's extension.

I'm just trying to get clarity.

Um, so we keep with Falk, if we did an extension, there is no way under God's earth that we can get those innovations implemented with Falk under an extension.

Not as we understand the procurement pieces to work.

Those are all significant changes, with the exception of CAT, because Falk is already doing CAT, doing nurse navigation, doing uh some of the other uh components that are in there.

We we cannot put those into the FALC contract.

Okay.

Well, I just want to be clear on that because I mean, you know, for myself, I guess for the other board members, we need to understand the implications of either either approach.

Um, and then uh and then like I said, I do I'm just gonna say I do like the third system model because it uh achieves more of what we're seeking.

Okay, thank you, Mr.

President for letting me ask questions.

Anyone else?

Um, just to cle clarify that on that point a little bit more, because in the presentation, I mean, the feeling I got is that we're not very enamored with the open system that we asked the team to go out and explore when we canceled the previous contract.

You declined to award the we declined to award, we voted no to a war, right?

I think the most accurate way to say it is you did not award the contract at that time.

You didn't reject all bids and you didn't cancel the RFP.

Okay.

So took no action.

So is that to suggest that if we wanted to go back and revisit that that we could approve it?

Yes, right.

Yes, yes, okay.

Um that would be a huge travesty of our intent, but that's just my opinion.

Uh next time I'll know.

So vote no, close this out, never let it happen again, and don't bring it back.

That was the intent.

Okay.

We didn't do that.

That's on us.

My bad.

Okay.

That said, the direction was to explore to do come back with us a design for an open system.

And I don't see that.

Number one.

Number two, what I see is this pay this page here that the numbers don't even reconcile, is that in one sense you say to continue to explore, but so for item two, how time bound that for me?

Alameda County EMS to continue to explore.

You've already had six months, alternate system design with stakeholders and return when.

So thank you for that question, supervisor, and I understand your frustration.

Um, with regard to uh not seeing a non-exclusive system, I think what you're seeing is that we did some extensive research, and those three pages of the check marks and X's are not necessarily to show our disenchantment with the non-exclusive system.

They're to show that all of the things that we value for our system are not easily possible in a non-exclusive.

So that last column is all of the things that would need to be in place to help make that happen.

Um and some of that information we just don't have as the EMS agency.

So that requires additional conversation with our system partners, like fire, like the hospitals, like uh other providers in the system.

Um, and so you know, so what we're proposing with the recommendations is let's not artificially throw out our exclusive area because we need to do more work.

Um, so that's number one.

Number two is that we continue to do that work and we'd be happy to come back to the board at six-month intervals at, you know, I I would vote for, I mean, I would recommend no less no no less than no more frequently than six months.

Thank you.

Um, just to give us time to do the work.

Um and then, you know, and and while we're doing that work in the meantime, we do need another provide, we we do need to continue ambulance service, right?

So, uh so we don't know how long, but you're willing to keep exploring and come back every six months if I were to add that to number two.

Yeah, right.

Uh return to the board with regular updates every six months uh until we're done with no upper limit of how long it might take.

We don't know.

We don't know, so but our our uh, you know, in that timeline it's two and a half to four years, including implementation time.

So usually when we turn over ambulance providers, it takes 12 ish months.

Okay.

Then again, with regarding selecting an interim transport provider, um, if to Supervisor Miley's point, and to your point, if we go with B, we don't get any of the enhancements that we so exhaustively studied when we did the RFB.

If we go with A, we have to award that for five years.

Could we not award that contract for a shorter period of time in order to get the goodness?

But just uh you came to us with um a proposal, we voted it down.

If we want to go say yes to that now, can we do it for two years?

We just a hypothetical.

We could hypothetically, but the innovations that are part of the RFP in the contract are not cheap.

And so I I would not imagine that we would reach agreement on a shorter than five-year contract because of the investment involved.

Yeah, the upfront costs.

So the upfront cost is largely equipment, right?

It's not just equipment, it's systems, it's a nurse navigation system costs a lot of money to go develop.

They need to build a facility with people who are in California to do it.

Okay, all right.

Every time we've transitioned the contract, there's been substantial upfront investment um of the new provider.

Like they've come in, they've rented, you know, facilities from which to operate.

That's been our experience all along.

Okay.

Uh very good.

Well, um, I'm also not advocating one way or the other.

Like Supervisor Miley, I have those clarifying questions, but I'm interested to hear what our community has to say.

Let's now go to Supervisor Fort Senator Bass, and then we'll go to public comment.

Thank you, Chair Halbert.

Um, I do have a clarification based on uh some of your comments.

So for the first recommendation maintaining the Alameda County's exclusive operating area, um, I just want to clarify that, you know, from my desires of where we go, this would be until there's an alternate in place.

It's not sort of indefinite.

Correct.

Yes.

Yes, okay.

Thank you.

That's all.

Let's go to public comment.

I'll ask the clerk to count up the speaker cards that we have.

And if anybody is online, we'll give you a couple of minutes to raise your hand if you want to talk about this item, and then we'll have the clerk um uh take tally of who has their hands raised and uh go from there.

We'll just take a minute to let people raise their hands and to allow the clerk to have 12 speaker slips, 12 in person and three online.

12 in person, three online.

We'll give everybody two minutes, and those will be the speakers that we have today.

12 in person, three online.

We alternate back and forth in person first.

We have Simeon Raimi in person.

You want to call the first three?

Tori Hagan, Samuel, then Troy.

Scott White, then Scott.

Welcome.

Good evening, Adam County.

I uh here calls the eminence guys, y'all have to take care of the people in the street.

The mental health patient out there, take them to the doctor, not the doctor.

That's just job.

The human being, go over the game.

So do your document, the doctor evaluated and give an A banking cost is half.

Samuel, could you speak into the mic so we can hear you?

I want to hear it.

Okay.

Well, I'm saying is the mental health patient, they need to retreat.

Just don't turn the head, take them to doctor.

Document.

That may just be on there.

Oh, you don't need to go out and street.

They can't involve.

They can't help themselves.

They sick.

They don't know.

So take them through a doctor.

Call it Christ's team, don't be joined job.

Let's stay job.

Don't even want to street.

He's sad.

You said they just put a blow on the streets on the other day.

Real hell.

Turn for the doctor.

I'll call it trying to get to make it a doctor.

See, this is what we need to do.

We got to, you know, it'all is going to be bad as of January.

Okay.

They couldn't find all the investments soon to the doctor.

You have to society back.

Please.

Mr.

President, members of the board, my name is Troy Hagen with Falc USA, and I'm here to discuss the fundamental failures of the recent process that threatened the core of our emergency services.

The recent request for proposal was publicly deemed insufficient and fundamentally flawed.

The rejection of the staff recommendation highlighted a failure to safeguard public interest, especially regarding the people who answer the 911 calls.

Process failed to include an explicit language guaranteeing labor standards and protections in our experienced incumbent workforce and regarded people as disposable rather than a final community resource.

This flawed process created a deep dangerous instability in the field.

Our providers are left unsure about the status of the contract extension or a new RFP.

This uncertainty directly jeopardizes the careers of dedicated professionals, leading to inevitable higher turnover.

We risk losing the experienced paramedics and EMTs whose expertise is vital to quality patient care every single day.

When workforce is constantly worried about their job security and their union protections, it undermines the morale and compromises the quality of care.

They can deliver instability is a threat to public safety.

In addition, the procurement process failures change the outcome of the RFP and clearly stated that is clearly stated in their procurement report.

The board must acknowledge that the flawed process has created a crisis.

Even walking into the session today, the public and the stakeholder stakeholders had no idea of what was being presented.

And yet you're being asked to make a significant policy decision with no time to fully understand the options and the ramifications for the decisions that you're asked to make.

There is no need to rush into considering a significant model or contract change that could inadvertently decrease the level of care to the people of Alameda County, especially in light of HR one.

The system is not currently broken.

Falca's fully compliant in working with the LAMSA and FIDER stakeholders to add further improvements, including nurse navigation and patient navigation that we proposed in 2023 or 2022, actually.

So we can do many of the things that are in that RP, even though they're not contractually required, we are willing to do it and able to do it.

Yes, uh they extend the current contract to Falc for at least the three years to safeguard the system and reissue a new RFP process that commits to a transparent process that prioritizes patient safety and protects the existing experienced workforce.

Time is up.

Thank you.

Time is up.

Thank you.

Oh, sorry.

Mr.

President, uh, members of the board, my name is Scott White, and I'm here to address the most dangerous threat uh currently facing our EMS system to push for a fragmented open model, and this policy decision will shatter health equity and actively engage in union busting.

We strongly oppose any open system.

Uh it is not just about competition, it is a clear path to destroying our organized labor.

An open system incentivizes non-union or external providers whose primary business model relies on undercutting.

The direct threat to our union, the this model would directly result in the loss of our union membership, those hard working protections that they fought for, fair wages, and this is an unacceptable attack on the dedicated professionals who serve this county.

Um, in the key takeaways uh from Ms.

McFadden's presentation, which I thought was fantastic.

Um I really appreciated the point that you made about keeping the EMS system going and the vaccinations and all of these things during COVID, uh, because the people who did that are right here.

Falc employees, the men and women of Falc, and uh, and of course, Alameda County fire.

We appreciate uh them very much.

Alameda County's current unified EMS system acts as a shield of equity, guaranteeing accountability as a single provider, must take every 911 call, preventing the prioritization of one neighborhood over another.

A fragmented open system dismantles this protective foundation.

Two-tiered care trap.

Open systems create a two-tiered system of care.

They incentivize providers to cherry pick high reimbursement areas, leaving vulnerable communities, low-income neighborhoods, the elderly, communities of color, all of these residents will be waiting for ambulances.

Life-threatening discrepancies are sorry, disparities.

The risk is proven by data.

EMS response times, cardiac arrests are 10% longer in low-income neighborhoods.

We cannot, as a county, adopt a system that guarantees a worsening for these life threatening disparities.

Thank you.

You're on the line, you have two minutes to speak.

Hi.

Hi, this is Kelly.

Um, you know, your staff is feeding you with uh misinformation.

For example, they just told you there was a one-year extension on the ambulance contract.

You voted on June 18th, 2024, to give them a two-year extension.

Did you forget?

Um, then there's this idea that city fire departments are grandfathered in for ambulance service.

Why'd you send that letter cease and desist to the Hayward Fire Department?

Uh, did you forget about grandfathering them?

Um your staff has tunnel vision on structural reforms and ignores or deliberately overlooks best practices in county services.

You go to Santa Barbara County to look for best practices when Santa Barbara County is widely acknowledged not to be some kind of paragon of virtue.

The uh San Diego County is widely considered to be a leader in uh ambulance services.

Um San Diego moved away from AMR because of documented dissatisfaction with AMR's performance and slow response times, and that led uh San Diego to uh award uh the uh the city, I believe it was the city or the county, doesn't matter, to FALC in 2021 and later adopt the alliance model and bring AMR back in a support role to improve coverage.

Now San Diego has 12 exclusive franchise zones and four exclusive operators.

So they are superior to Santa Barbara County in scale and coverage in performance monitoring.

They publish their performance statistics openly.

We God knows what Alameda County is doing is how they're performing because you hide everything, contract stability, integration, and resources.

All of this is happening in San Diego, and somehow your staff has overlooked that, doesn't want to pay attention to that, and is giving extra time, lots of extra time to every speaker so far today, so that everybody can go just talk right over those those uh bells because you have no time control.

Thank you.

Let me say that into the microphone so everyone online can hear.

Cheryl, you're doing a great job.

Keep it up.

You have two minutes to speak.

My name is Adamika Meadows Arthur, and I speak today not only as a national Medicaid expert, but as a health system leader and a longtime resident of Alameda County, a mother, and a deeply invested member of this community.

I was a hospital leader in this community for well over 15 years, and with over two decades of experience as a hospital leader, a public health leader, and a Medicaid innovator, including kind of right here in Alameda County under the leadership of both Arnold Perkins and the public health department and Dave Kears and what was the Alameda County Healthcare Services Agency.

I understand firsthand how fragile and critical our EMS systems are.

I want to raise a red flag and kind of a path forward.

Our EMS systems are in crisis.

What I know at the national level, just last week, being with all of the state and territorial Medicaid leaders is that our federal policies like HR1 are going to threaten coverage, add administrative barriers, and disproportionately impact very low populations that our EMS system serve the most or low income elders or unhoused and individuals with mental health and substance use disorders.

I do want to speak to the innovations that are needed.

Specifically, I think, you know, sending paramedics and ambulances to solve complex social and non-emergent health issues are very important, but it's not sustainable for our system or all of our residents.

There is a precedent around nurse navigation innovation, which is a 24 7 nurse staff lines, redirecting non-emergent cases and reducing the unnecessary ambulance use and ER overcrowding.

This is not a luxury, it's a necessity, and it's something we are going to need in Alameda County for Medicaid eligible nurse-led EMS navigation models.

And I don't think we should wait for a system failure, wait for several years.

We need to design our solutions for our systems today, and I'd be honored to support your office with national data, case studies, and policy recommendations.

I live right here in the county.

Thank you for your time and your leadership.

David Turris, Nathan Morale, Seinburrows.

Good afternoon.

My name is David Torres.

My colleagues have already outlined the failures in this process and the real dangers of fragmentation to our system.

I'm here to focus on what comes next.

The steps required to secure our workforce and protect our patients.

What we need now is stability and accountability.

First, we need immediate action.

The most urgent step you can take is to provide stability for the incumbent workforce.

That means extending the current contract with Falc with Falc without delay.

Intermediate extension will give assistance to our workforce, stop the loss of experienced providers, and maintain the service levels our residents rely on.

With that stability, we can also begin implementing system improvements identified in the original RFP, like nurse navigation.

We did start in 2022.

We currently have that in practice at a field provider level already, and we're asked earlier this year to start at a dispatch level.

This is the first time we would have heard that we aren't allowed to start dispatch services.

Second, we need a fair and accountable RFP.

We're asking the board to direct staff to issue a new RFP that includes clear, enforceable language requiring any future provider to honor the collective bargaining agreements, the negotiated protections, and the labor standards of our unionized workforce.

Essential to ensuring fairness, continuity, and a stable EMS system.

Finally, stability allows for long-term investment.

A reliable contract is what enables capital improvements.

Facility upgrades, ambulance fleet refresh, and the leases necessary to keep our system strong.

Falk is committed to working with the LEMSA and all stakeholders to move forward on all the improvements suggested here today.

Members of the board, this decision impacts the men and women you see sitting here and the community.

Your decision will determine whether the system remains stable, accountable, and capable of protecting the people of Alameda County.

I think the only option is to extend Falc to keep the stability.

We are here.

We are serving the system, and we will continue to do so when extended.

Thank you.

Thank you.

My name is Nathan Merritt.

I'm an EMT here in Alameda County.

I work for Falk.

I was hired originally in 2003 by AMR.

I've lived and worked in this county for my entire life, except for the four years I spent in the military.

I didn't plan to stay here this long, but I found a career in EMS.

So I'm here to advocate against an open EOA.

This would harm everybody.

Of course, LP Fire wants to run calls in Livermore Pleasanton, but if nobody has to show up, who's gonna show up?

Who's gonna run the calls in Oakland?

Who's gonna go to the payer areas where only Medicaid and Medical are the payers?

It's gonna harm everybody.

But all three RFP processes, this is being my third RFP, all three.

One of the keystone foundations of the RFP was the hiring of the incumbent workforce.

So you bring on a non-EOA.

How do you make those people hire us?

What happens to myself and the other 500 employees that I work with?

What happens to the people in this county when they call and nobody's there?

I also see that uh in front of you is a vote between AMR and a continuation with Falk.

Um, I'm prejudiced because I'm currently with Falk and I would like to remain with Falk.

Uh I don't really have a huge opinion uh on either process, but I'd like you to pay attention to the RFP from uh Paramedics Plus and the protections that were provided to the workforce that are currently missing from the RFP, and I would uh advocate for you to give Falk an extension.

Thank you very much.

Good afternoon, Sean Burroughs, President of Alameda County Firefires Local 55.

Um would like to give a uh positive review to our meetings with Anika and her team.

Uh we have had some uh progressive discussions.

Uh, I would say that I'm a little disappointed in the presentation today.

It feels like it's uh quite a bit of fear, quite a bit of uh things we can't accomplish, things that may be hard.

Um, spoke about oversight.

There's oversight today.

Every single agency providing ALS services within Alam Rain County, which includes every single fire department and our uh private providers, there's regulation and oversight from our EMS agency.

Please do not be misconstrued that the oversight component will be too hard.

Financial uh issues and changes in the exclusive operating area are too cumbersome.

We've had that throughout the history of my career.

30 years I've served in this county.

You want to talk about changes in contracts midstream, going from ALS to BLF service services, changes in unit hour allocations, changes in financial makeup, it's all happened under an exclusive operating area.

So this misnomer and this fear of what would an open system be would be fragmented, it would be disjointed, it would be unregulated, is just it's just not true.

It's just a fallacy.

Um, with respect to legislation, there's legislation currently going through the California legislature, it's a heart bill on Lomita to discuss an open or a um a direct assignment.

So it's out there, there's discussions about it, it's got very little traction at the state.

I want to make one two more points.

One point at our meeting last week with all the fire chiefs in labor and uh EMS agency, Chief McDonald explicitly stated uh Alameda County Fire Department chief that he would support nurse navigation in the system and would work toward that immediately.

I was a little dis very disappointed I did not hear that in the presentation.

And then finally, I'm labor, I'm always labor.

I would never want anything to disrupt any of our labor partners whatsoever.

And what I will say is that we will work collectively and together to ensure that their benefits, working conditions, and pay are not only protected but enhanced.

Mr.

Burroughs, if you could stay to the podium, I have a follow-up question.

It's been proffered, stated, even that data suggests or data says that an open system will lead to a two-tier city system where some cities get served and some cities don't.

Somebody even asked, if calls happen in Oakland and nobody's there to answer them, who serves that community?

What's your answer to that?

This is an answer that came up last week in our meeting with our county MS agency and all of our fire chiefs and fire based labor.

The answer is if you want to be a participant in Alameda County EMS, you're a participant fully in Alameda County EMS.

Our dispatch center uses uh AVL, automatic vehicle locator.

What does that mean?

It means it knows where the closest unit is to an emergency.

So whether you're in Piedmont, you're in Oakland, you're in Fremont, you're in Pleasanton, the closest unit should be dispatched.

Whether that's a fire-based ambulance unit, a private-based ambulance unit, an alliance-based ambulance unit, it's irrelevant.

What I would implore to the board of supervisors that your direction to our LEMSA is that if you're to set up a system that is that of an open, not exclusive system, that the regulations are required that you participate in the entire entirety of the system.

There is no winners and losers here, there is only service.

That is it.

And if those uh need to be served by Alco Fire, you'll be there to serve them.

Absolutely.

That's what I understood the system to be in an open system that protects the neighborhoods that are less um economically um uh lucrative for private uh enterprise to serve, that they'll be served by our fire department.

Absolutely closed in Oakland.

So uh, from Captain Ballot, okay.

Um we're not taking comments from the audience, but you they'll be served by Alameda County Fire.

Absolutely.

So um, well, Alco Fire is the labor union that supports the city of Oakland.

Is that correct?

Alcofire goes local 55, local 55.

But you have what you have, President Albert is commitments from all of the fire chiefs, all of the labor presidents to help design and drive a system that is based on equity, that is based on service, that is based on high quality uh metrics.

All of the things that were in the RFP are all the things that are supported.

What we don't support is this notion that an open market is is fragmented and is you know a disservice to those of low socioeconomic regions and areas.

Yeah, again, to me, if you're relying on your local fire department for service, I don't see how that's a bad thing.

And so um the last one is, and you I think you addressed it, but I just want to make sure because it was stated that an open system will tear apart and destroy union labor stability, that it will encourage non-union labor.

Do you know of any data point that suggests that or what's your response to that?

You're a union guy.

This is Alameda County.

There, you're not coming into Alameda County and be in a non-labor shop, it's just not how it is.

And in my opinion, more opportunity drives up demand, drives up wages, drives up opportunity, whether that's through a public entity like a fire department or additional private entities like additional private ambulances that are in the system, the workforce will be desired, and in order to get that workforce, you may have to pay more.

That's a benefit to our labor partners.

I think you said it best, Alameda County is a labor county.

That's right.

So the last question I have is um, would you have a preference for moving forward?

Yeah, I mean, obviously the the fall contract needs an extension, but I would ask the board to give very clear direction and and um you talked about a six-month uh markers with clear deliverables, allow us to sit down with all of our stakeholders and design a system.

Very good.

Thank you.

Next speaker.

John Greaves.

Sean Tran.

Seth.

Oli OU.

Good afternoon, President Albert and honorable members of the board.

My name is Joe Greaves.

I'm the executive director of the Alameda Contra Costa Medical Association, representing over 5,500 East Bay physicians.

Thank you for the opportunity to speak.

I want to emphasize that ACCMA has no stake in who provides ambulance services.

We're not advocating for any particular vendor or for public versus private delivery.

Our concern is simply that patients receive timely, high-quality emergency care, regardless of where they live or their insurance status.

For more than 30 years, the county's EOA has been the structure that makes this possible.

It is the contract that the county holds with the provider that ensures that there are certain standards that are met and that all patients are treated equitably.

People giving assurances, promise promises, hopes, and dreams is not a substitute for a contract.

That contract is what ensures that a cardiac arrest in West Oakland gets the same response standard as one in the Hills, and it's what allows the county to maintain oversight and accountability for performance and clinical quality.

There are also serious risks to moving to an open system.

Practices like pre-hospital whole blood transfusion, something that saves lives and that our emergency physicians strongly support, depend on unified training, logistics, equipment, and data systems.

That level of coordination is extremely challenging to achieve when you have multiple providers operating in the county.

I also want to underscore that with the financial pressures ahead from HR1 and anticipated Medi-Cal cuts.

This is an especially risky moment to destabilize the system.

We are facing a cataclysmic shift in our healthcare system.

It cannot be overstated.

Your board has been on the forefront of proactively trying to get ahead of and respond to those changes.

This is moving in the exact opposite direction at the exact wrong time.

So for these reasons, the ACCMA respectfully urges you to preserve the county's EOA, and if you wish to look for alternative designs to do so over time, in a careful deliberative open process.

Thank you.

Thank you.

Good afternoon, members of the board.

My name is Santran.

I'm here on behalf of the local NAGE 721 representing the EMS captains of Falc.

We appreciate the difficult work before you and the ongoing commitment to strengthening the EMS system here in Alameda County.

I want to share that today's EMS update came as a surprise to many of our members.

There has been no recent communication from LENSA to the NAGE Local 721 about these developments, either before or after the June hearing in the EMS RFP.

We believe improved communication and collaboration would help ensure that the experience between the frontline EMS professionals is reflected in this process.

As the incumbent workforce, we have concerns about moving forward towards an open or fragmented EMS system.

From what we see every day in the field, the unified system promotes consistency, accountability, and equitable service for all communities.

We worry that an open system could unintentionally create disparities in access to care, particularly to the low-income communities and communities that are underserved.

Our goal is simply to maintain the service where every call, no matter the zip code, receives the same amount of commitment and urgency.

We want to express our concerns regarding the 2024 um EMS RFP.

Several of the labor standards and workforce protections that were included and properly weighed in the 2017 RFP were not carried forward.

Those standards support stability, retention, and high quality patient care, and their absence would have a real impact on the workforce.

With that in mind, we respectfully request the board's consideration on three points.

One, direct staff to issue a revised RFP that restores the 2017.

Oh, okay.

Uh I'll leave those other things off.

Thank you for your time.

Oh, okay.

Cool.

Uh, secondly, is to bring forward an extension for the current provider foul and ensure meaningful engagement with EMS workforce leaderships uh with the RFP.

Um, thank you.

Thank you, and uh thank you for the email letter.

I think that that came from you and your organization.

We did receive, I did receive that.

I think we all received the letter from you.

And um wait for an outreach from my team, my staff.

Thank you.

Do you want 10 seconds of my time?

You can have it.

I'm Seth Olier, president of Oakland Firefighters Local 55, and I just wanted to speak on a couple items.

One in the presentation, there was a mention of SAC Metro recovering 30% of costs.

That's incorrect.

The ambulance service provides 30% of their total revenue to the tune of over 80 million dollars of their total budget.

So, what I'm saying is, okay.

I think that's a different way to present maybe the same the same item.

It does that they're not recovering 30% of the ambulance costs, they're covering 30% of their total budget with the ambulance service, which to me sounds a lot different.

Um, and then to touch on some of the labor issues, how any issue affects any worker is of utmost concern to me as a labor leader, and I truly believe that a rising tide floats all boats, just like uh President Burroughs said, and an worker will have the opportunity to choose from a range of private and public employers comparing wages and benefits, which is the definition of opportunity.

I also want to recognize the hard work of county EMS, uh Anika and her team.

I mean, it took me six years to remodel a house and they redesigned an entire EMS system in six years, so please don't tell my wife what you're able to accomplish.

But um I also want to just say for the record that I truly believe in the skills and abilities of the ALCO EMS team, and where I heard uh issues and problems, I see uh opportunities.

So thank you so much, and I look forward to the future.

Last two speakers, Nate King, Nick McGuire.

Supervisors, my name's Nate King.

I'm an ALCA resident and an Oaklander.

I've been an EMT here in the county for the past two years.

It's cliche, but I came to this line of work from a relatively lucrative career because I wanted to help people.

Unfortunately, the NEOA NEOA proposed does anything but that.

Open health, open systems ensure worse health outcomes for the public overall.

This is nothing more than 80s era deregulation, which has gone so well in the financial and health sectors, especially for our underrepresented and under-resourced populations.

Meanwhile, Alameda County is known for having an extremely well-resourced, progressive and innovative public health system.

Why would the first link in that chain even be considered to go back to a deregulated open system?

An open system would codify a first response system of haves and have nots in this county.

With an open system, fire departments would be handling much of the EMS response.

Fire departments handling EMS is antiquated and a largely American feature, thanks in large part to a lack of federal EMS regulation and standards, leaving localities to pick up the slack.

Organizationally and culturally, local fire department C EMS is playing second field to firefighting.

It's in the name.

Could it be that EMS serves to prop up fire department budgets and relevancy, especially as instances of structure fire have dropped in half over the past 45 years?

Finally, moving to an open system would disenfranchise a dedicated unionized workforce of some 500 of us, a workforce that has done the lion's share of EMS work in this county since late 1980s, offered for peanuts and in terrible working conditions.

I would urge the board to extend the contract with Falc while exploring the feasibility of a third service.

Thank you.

Good afternoon, members of the board.

My name is Nick McGuire.

I'm the political director for NAGELocal 510.

On behalf of the paramedics, EMTs and support staff who serve Alameda County every day, our membership strongly opposes an open EMS system.

An open EMS system would fracture continuity of care and destabilize the workforce during a national paramedic shortage.

EMS professionals will leave or retire if they must transition to another private provider.

Consistency of this workforce is critical for public safety.

That was the last time that concludes public comment.

We'll bring it back for deliberation and discussion.

I do have one clarifying question that came from the speakers.

How does that affect our third service and the need for requires legislative change?

Thank you for that question, Supervisor.

So my understanding is that Lomita is a case law from the 1980s, which essentially allows counties or indicates that counties can direct assign fire providers to provide uh transport.

I am not familiar, I haven't reviewed the bill uh closely that uh Sean was talking about, but uh happy to have our team look into that.

But I will say that you know, over the last at least five or six years, the bills that have come forward at the state level um to uh authorize uh fire participation in in the EMS transport, um, many of them have tended to sidestep the state EMS agency.

And so there's been a lot of pushback uh from the EMS agency side of things, and so what we want to present as a you know, or or we want to explore for Alameda County is something that works for our county.

We have, as you've heard, willing partners.

Um, and so it's something to explore to see is there a way for us to look at a local county saying that you know this is uh service that we want to provide, and here's how we might do it and sort of base the legislation around that rather than um what's been tried before.

Base the legislation around that, meaning local control legislative change ourselves.

Uh we would need to partner with fire on that.

Okay.

We, as in health.

Supervisor Miley asked the question uh whether the third service um model included, uh I think it was the alliance model, which is what we also call a hybrid model.

Is that also called the hybrid model?

So third third service could include that.

There's there's uh so third service, you know, right now is not uh common or as Laurie mentioned necessarily allowed in California, um, but in other places that do it, so it's essentially treating it like a um like you would fire or uh police.

The alliance model exists in Contra Costa, right?

Yes, uh, maybe through an RFP, but I don't want to talk about that.

That was through an RFP.

So I and and I think the other uh distinction that I would make is that um in a third service, and again, not to uh pin us down to any specific thing in a third service.

Uh it's essentially the county saying that the county wants to provide the service, um, and so that would have significantly more financial costs.

That's something for the board to know.

Um there's bigger risk that the county carries in terms of financial risk.

Um, but it could be that maybe the county wants to contract out.

Maybe the county wants to have a county agency run it, you know, and that county agency can also subcontract.

Okay.

Any other clarifying questions or comments before we provide direction?

Direction could be to bring this back to the board for further action or just provide direction.

You have another comment, Anika.

Can I just, I know we're not supposed to necessarily comment on public comment, but I would like to uh just correct the record on a couple of things.

Um, so you know, there have been uh RFPs are competitive processes, and there are people who win them and people who don't.

Um, but we our team uh including uh it was a we stand by the integrity of that process.

Um, and uh especially with respect to the points that have been brought up around labor standards not being included, all of those labor standards were included that were in the previous RFP.

Um, and uh after the meeting, I'm happy to re-up the information that we shared with you in June around that.

Okay.

Um final comments that I have related to public comment is that indeed um people's jobs, livelihood need to plan for their families.

Minimum minimum six months, likely, preferably a year, my opinion, for people to know whether they still have a job or whether they won't have a job if possible.

I know that a lot of people are at will and they can be gone immediately and whatever, but not as it relates to those that are keeping us alive and healthy.

So I want to echo the comments that were made by some of the speakers that people need to get on with their life.

I gather you appreciate that as well.

We 100% agree with that, and that's why we were hoping to get direction from your board on uh you know your uh preferences for which uh provider, so that we can bring back a letter, uh, a board letter in December.

I note that uh Chief McDonald is on the line.

I just wonder, uh Chief, if you have anything to add.

Welcome to um unmute and take the floor.

Uh thank you, President Albert, uh members of the board of supervisors.

Thank you.

Uh I apologize for not being able to be in attendance today, but I would like to just add that um there is a coalition of fire departments in the county that are bound together.

Uh we are proposing to be able to provide services throughout the county to provide first responder advanced life support services, uh, ambulance high quality ambulance services.

We would nurses in our dispatch center, we provide um first responder uh mental health uh services to all the residents in the county, uh and we would do that um in a collective manner that would ensure that we would have a very fully integrated system, seamless delivery system of desired and needed programs and services that would be provided to all county residents, and we uh stand behind that as the fire service in the county.

Thank you.

Appreciate that.

Any other questions or comments of the chief, Supervisor Tam, then Marquez?

Actually, this is not a question for the chief.

Um I um hold on, he's here online.

It's supervisor, did you also have a comment for the chief?

Supervisor Marquez.

I don't, I thought you wanted to speak to the chief.

Maybe I was wrong.

I didn't, but um now that he's here, we'll ask a question.

So does anybody else have any comments for the chief?

I have a question.

Okay.

Um Chief McDonald, thank you for being here.

Can you just kind of recap?

I believe um there was commentary and public comment that all of the fire chiefs within Alameda County have met.

I know there is new leadership specifically, the city of Hayward has a new fire chief.

So can you just kind of recap what those recent discussions were?

Uh thank you, Supervisor Marquez.

Um, all the fire departments in the county have been working for months on making sure that we are collective in our uh willingness to provide services, that we are committed to providing services in a seamless way, that we would uh put provide uh services through memorandums of understandings with all the agencies to ensure that services would be seamless, that we would ensure that all the services are provided throughout all the county areas, and that people would be served with high-quality medical and medical services and programs, and all the departments are uh collectively in agreement.

Thank you.

Supervisor Tim.

Um Thank you, President Halbert, and just following up on Supervisor Marquez's questions.

Uh so uh uh when you talk about the collaboration with the fire departments and the cities that we serve that are in the county.

Um so I I come from um the city of Alameda, so the model that we have is basically because we we were grandfathered in each fire station has like at least two or three ambulances that are available from every side of the island.

So how would this work in terms of the collaboration?

Which each fire station in the county, irrespective whether it's a county fire station or city fire station, would they be able to purchase 250,000 per ambulance to have two or three in each station?

Um supervisor Tim, uh members of the Board of Supervisors, we would collectively uh provide uh excuse me, contract with a subprovider that would provide most of the ambulances uh integrated into our system.

There would be uh occasion to have some of the city's stand-up ambulances uh it with employees that work for the local fire departments, and they would be incorporated in the cities, I mean into the system.

Um I would not say that there would be an ambulance in every fire station, but I would say that there would be a higher number of uh unit hours provided through our system and that we would ensure that um services are provided throughout the county.

So in that system, uh the fire department would decide who that partner is, that contracting partner that provides the ambulance transport rather than uh the county uh local EMS agency?

Yes, we we would um um we would do an RFP for a provider to work alongside of us, and we have done that um recently and have a provider that stands ready uh to work with us uh as a partner and as well.

We have talked with um Falk Ambulance as well as AMR in becoming partners with us.

Thank you.

I mean, what I hear, Chief, and what I heard um uh Mr.

Burroughs say is that the fire department is going to ensure that nobody falls through the cracks, that everybody gets served.

The how you accomplish that, as you mentioned, can be done with RFP.

If you want to be in an open system and never get a call, then you need to help the fire department by having ambulances in uh proximity.

Uh that can all be done by contract and side agreements, but um our fire department who knows our communities knows our streets inside and out, like the back of their hands, knows the people in the homes because they're there called alongside the ambulance calls are going to be the ones that make sure that they uh get uh that people get served.

And and that's what our prior discussions have centered on, chief, and that's what I'm hearing the answer be.

Yes, sir, President Halbert, and the fire departments are currently serving all the areas of the county, and we will continue to do that.

We will make sure that no area is unserved, and we will through our dispatch center, we will uh assign and dispatch ambulances throughout the county, the closest ones that are uh available to respond to the calls, and any other provider that would want to provide ambulance services in the county would be required to be dispatched by our units, but excuse me, by our dispatch center to ensure that we would have those resources available as well.

So has any of that been discussed in the last six months as we've given direction to migrate towards the open system?

Was any of that explained between you and the health team and the LEMSA team about how everybody will continue to be served?

Because it seems like there's a disconnect.

Supervisor uh Halbert, I mean President Halbert, members of the Board of Supervisors.

Yes, we've had discussions with all with all the uh Alameda County Health and the EMS agency, and we've been having those discussions ongoing uh for the last several months.

Okay.

Well, um supervisor, can I sure share on that?

Yeah, hear about more about that.

Uh so I think what um is presented in our presentation and what you're hearing and the conversations that we've had are again that yes, uh we hear that commitment from fire, but we as the agency that's responsible for regulating and maintaining a system that doesn't have gaps in coverage.

We do not feel that we have enough information to make that recommendation to go to open for you right now.

Okay, so um I'd like to proffer that uh and I'm looking at uh 3B, extend for a two-year contract.

Yet I also understand that um I would desire six months.

So a thought that I have is to extend the Falk contract for one year to go from December or June of 2026 to 2027, that's a year and a half from now to ask you to come back in six months from now, which is say June of 26, still a whole year away, and either have a plan to go to an open operating system, give you another six months to explore, or at that time, if you're not ready, we can extend another year to June of 28, but take it one step at a time to keep the momentum going to an open system, if at all possible.

That's item two, continue to explore design with stakeholders, providing regular updates.

If you can't get there by June of 26, then we can extend an additional year.

But in the meantime, to also talk with Falk, as they mentioned in public comment, about how they may be able to incorporate some of the systems and um enhancements that we have talked about at nurse navigation or whatever else, um, to fold that in.

But um I I wanna I don't want to take the focus off of marching toward either an open system or I'll entertain the third party system because it they seem pretty close.

So the third service is much closer to an exclusive operating area than to an open system.

Yeah, but it puts fire in charge.

I or could in a hybrid system.

Uh no, fire in your so I I I think that for it gives them a hybrid system that allows fire to participate.

A third service gives the county proper a lot more um say in how the full thing is run and doesn't require an RFP.

Okay.

Well, I said I'd be willing to look at it.

I'm still in the camp of an open system.

Which is what we said the other day.

Thank you.

Okay.

Yeah, and and uh get it done in six months then.

No.

You've already had six months.

We got another six months.

We can't come back and I think that's what you're hearing from us, supervisor, is that it is not something that can just be flipped on with a switch.

Um we need to know that our systems and our system partners are ready.

Um, we need to know that there's changes that we need to make to our protocols.

We need to get, we need to work with the state EMS agency.

Um, so that two-year timeline that we're proposing is the most realistic in our mind.

Two and a half years from now, a two-year extension.

I think that in our uh, you know, it provides Falk some stability and it uh allows us to do the work that needs to be done.

Can you get the enhancements that the gentleman spoke about at the dais?

I'm gonna ask counsel to talk to that.

We're not prepared to address that part of it in this open session.

Okay.

I see Nate, you got your hand up, Supervisor Miley.

Yes, thank you.

Um I've been listening very carefully to all the speakers, to the board members, and to uh the staff.

And uh I just want to say that.

You know what, local 55, you know, I've been associated with local 55 for the past 35 years, 10 years on the Oakland City Council, and 25 years as a county supervisor.

So I do respect local 55, but I do have considerable concerns about moving towards an open system.

Considerable concerns.

We're betting on the cum that there won't be any of the uh uh deficiencies that staff's pointed out.

We're betting on the cum that HR one won't impact us.

I think the prudent approach is what the staff is what Anika just mentioned.

And I think Supervisor Albert, you said this as well.

We need to get folk an extension.

I supported Nika's position and and the agency's position that it needs to be minimally two years, having been around and seen uh these situations in the past.

We need to ensure labels labor stability.

We heard that constantly from the um paramedics who've spoken today, part of the union that works with uh Falk.

Six six months or years extension doesn't provide labor stability, two years plus another year of foreign extension if it has to be three years is sufficient time.

Also, we heard from local 55 that they'd be open to working with all the stakeholders to figure this out, and we also heard from Anika and uh Laurie that alliance model is possible under a third system.

So my strong suggestion is we look at an extension to Falk for two years plus an additional one year if possible or if necessary, that we give staff time to work out and talk with all the stakeholders, that we pursue a third system, see if we can get the legislation in Sacramento, that we be a model for this uh third type of uh service in California, because I do think if we model this and we model it effectively in California as a pilot, I think we're much more likely to get uh support in Sacramento, and then we can really see how combining a third system works out, we can ensure labor stability, we can look at an alliance model, we can achieve everything that we hope to achieve without jeopardizing going down the route of an open system that might cause significant consequences if we're wrong.

That's my observation based on what I've heard today, and based on my um, you know, experience.

So thank you.

We have one for a third system and one for continuing with the open system.

What do the others think?

Uh Supervisor Tam, Marquez, and Fortunato Bass.

Um, I'm concurring with Supervisor Miley because of his long years of practical experience and how long it takes the county to get contracts, get systems, get changes.

And uh I'm the reason I say this is because I have a lot of faith in our fire department, and I have a lot of faith in the work that our physicians do, and they see this on the ground every day when it comes to patient care and um getting the the kind of redesign elements.

It took us, I don't know.

I started on the board and we kept asking uh Alameda County Health.

Oh, when are when is the state EMS agency going to approve our RFP?

When is it gonna happen?

It took two years for them to even get us to the RP.

So I the fact that we had these six elements that were part of it.

The fact that we had uh um, you know, fire partnering with a uh with an ambulance transport agency was was new.

So I I just don't think we can move on a dime uh in six months.

So but having these six elements I think is important.

So if we can find some way to understand how we can get that even in a two-year interim, I think it's going to be important for patient care, particularly when it comes to nurse navigation and mental health care response.

Supervisor Marquez.

Thank you.

Appreciate everyone's input.

So let me just start off with um the workforce and continuity of patient care.

So I think this was a very complex process.

It is unfortunate that we've had change of leadership on the board.

The majority of us were not here from the onset of this process.

We have a new uh director in the department.

So there's just been a lot of influx and change.

So I want to just primarily focus on the fact that I agree that we need to uh protect the labor protections and ensure that our workers have some continuity, stability, and predictability.

So I am in support of option B.

I believe I heard um commentary that a board letter can come back before the end of the year.

I thought I didn't know we could move that quickly.

We typically don't move that quickly.

So I'm really glad to hear that.

But before I expand on my comments, um, and I'll let you speak to that, Anika.

But but this is specific to a two-year extension, correct?

In terms of the board letter coming back.

Yes, the board letter would uh solidify the direction and it would be for two years.

Okay, and would that be any changes?

Because I also heard support about the nurse navigation.

It seems like some of the programming has all has been modified.

So generally when we extend contracts, we are not able to do uh amendments that would be so significant that it essentially requires another RFP.

Uh so our understanding is that that extension would be to continue the file contract as is.

Um, and as counsel has said, we would need to have additional conversation about what's possible if it's possible.

Okay, so that would be uh maintaining status quo, and then how do we capture if they're offering additional services?

How is that information being shared back to us in the public?

It sounds like they're already implementing.

I don't know if they are implementing those things.

I can that be clarified because it sounds like some of these services navigation is really efficient, is it?

It's different, but what what's being done now?

Because I I did hear representatives say that they are implementing some of these recommendations.

Can that be clarified?

They have offered to start looking at it, um, but there's there's no there's nothing in place, so it's just it's been a concept, and so at this point, there's nothing changed, nothing um material moving forward, and we've been working with trying to understand where we can go with county council, and we don't know yet, so we've just been um very careful.

Okay, and I know there's well talking about contracts and all the legalese and everyone's trying to proceed with caution.

So I appreciate that.

Um, and then with respect to the third option, um, I am in support of that.

I I do want to flag though uh state legislation getting that passed is not always easy.

Um, want to make sure that our um chair and co-chair of the Pell committee, and it sounds like we've already got input from our lobbyists in terms of this is on their radar.

Obviously, we would have to make it a priority for this county, um, but I I am open to that because I want to see us do things differently here.

Um I'm just gonna speak as a layperson.

I've shared this publicly before.

I worked at uh Kaiser Emergency Room when I was a teenager, and I was just confused at why are the why is the ambulance contract constantly changing, right?

In my lifetime, I've seen the three providers, and that's before me even getting involved with policy decisions.

So I just feel like it's been an issue in this county.

So I think we need to take advantage of exploring alternative options.

I'm not gonna state a position because I'm one as to I want to do my best to um protect the integrity of this process, but I do think we need to continue and to explore those options, and I agree with uh updates being provided on a six-month basis.

I want to be respectful to staff.

I know you're taking on a lot of work on top of everything else with respect to what's coming down from the federal administration and have that come to the full board.

I think we did an excellent job once we said when this date was going to be established for this meeting.

It is unfortunate that it's the week of a holiday.

And also want to flag we need to do better with posting information in advance.

This is a lot to process, and these are high level decisions.

So I would just ask that we respectfully work on that because people have the right to know exactly what we're discussing and to be more prepared for these discussions.

Also, give us a chance to ask questions in advance.

Thank you.

Yeah, I agree.

Supervisor Fort Sono Bass.

Thank you, President Halbert.

Um, and thank you to our staff for the research as well as the presentation.

So, um, you know, I believe that we are here as a board because we are not satisfied with the current system and recognize that we need to do more to make the system work for all of our residents.

Um, I do appreciate on slide six the underlying focus and system priorities, uh, quality care for Alamina County residents, equity of service, system stability and reliability, sustainability.

I would add that undergirding many of these things is making sure that we have worker standards.

So with that in mind, and even with HR1 and the destabilizing forces of this current federal administration, I still think it's important for us to make sure that we are creating a system that really provides what our residents need and that will be stronger for the long term.

Um in terms of where we go and the staff's recommendations, um, I do support number one, maintaining the current EOA until an alternate is in place, um, and I support number two.

I would, I would say that it would be important to me that we have a two-pronged approach.

Um, you know, there are there's interest on this board for an open system.

Uh there's also potential interests in a third-party system, but we recognize that that takes legislation, and I think it would be important, and I want to hear staff's uh response to this to have a two-pronged approach, knowing that we need to do more research and gather more information, engage more stakeholders to really determine what will work for our county, given the interests and the engagement of stakeholders to date.

And in terms of number three, I do support B.

Um, I hear President Halbert in terms of the the one year and the option to renew for another year, but I do think this will take time.

So I'm supportive of uh B as it is, as well as coming back every six months so that we can just really engage and and be aligned around moving forward and creating a system that will work much better than the prior systems have.

Um so that's where I am.

I realize President Halbert, we're we've articulated slightly different things, but perhaps we can coalesce um kind of with an amalgamation and perhaps a two-pronged approach.

I think my idea around extending just one year at a time was um to keep sort of the momentum going, but as um Anika mentioned, the the just one year isn't feasible period.

So I didn't I don't think I understood that.

She clarified that, and so two years.

I still see this dichotomy though, between the choice between A and B, because it seems like if we go with B, we are not gonna get any of the enhancements that we could get um if we go with A.

Um, if we go with A, it seems like it's gonna lock us in for five years.

Um which is a long time, but we get we get the benefits of the enhancements that we uh so thoroughly discussed, and so um, but we don't lock in for five years, and I I you know we're not at the negotiating table here, that's for staff.

Um somebody might say that the choice of negotiation is to see what Falk might be willing to agree to if you were negotiating with them to have the two-year extension or three or whatever to incorporate some of those enhancements, or set another way to negotiate with AMR that maybe it's not a lock-in for five years, but rather you know what I'm saying, we're not here to do that.

Um so uh it's unfortunate that we're not here to do that.

So we have to choose between these two choices here, it seems like, yeah, I think you're you're picking up on sort of the the difficulty we've been grappling with over the last few months.

Um I did want to just clarify for Supervisor Fortunato Bass that uh our intent is always to do the two-pronged.

Um it's to go into it without uh it it's to find out the external the additional information that we need from our partners, um, and if a legislative path is feasible, great, but that also requires a lot of other internal county conversation.

Um, and uh if uh you know another alternate system design is possible, we want to go for that.

Um, and there's a world that maybe the alternate system that we want to do requires some sort of legislative permission.

So there's a there's a lot of different things to to pose there.

Uh with respect to um, you know, working with AMR where we can have a conversation with them to see if they would consider something different.

We've not um we've not approached that.

Or with Fog, you have both A and B on here, talk to them.

I don't know if you can't, I if my counsel says I can then again I think that's the conversation for another time.

Okay, I we're not at the negotiating table, I get it, but I would encourage you to have the conversation with our team.

It may push the board letter a little bit later than February for I mean, sorry, December for us to have the conversation.

Okay, I believe it's your discretion.

Um I do have though uh another question, which is as we were uh it was a year, year and a half ago, maybe two years by now, there were status reports on the website that talked about service levels and times to respond and things like that.

At one point there was a discrepancy about uh at one point there wasn't compliance, another point they just went off the web, period.

We weren't putting them on the web.

And I haven't gone back to look, but can you qualitatively describe the current level of service, the reports that are supposed to be posted somewhere every month, and what are the service levels?

Are they all in compliance in all zones?

The compliant reports are up, they are, yeah, yeah, and they're compliant in all zones.

And we're in compliant in all zones.

Yes.

So that's an improvement from where we were a couple years ago.

Yes.

And if I go back to the mayors in the Triballey, who were pissed off.

They would say we have no more problems.

I d I can't possibly guess what they would say to you.

Well, they would say that we're in compliance there, and so they shouldn't have a complaint.

Okay.

Because what supervisor Tam pointed out, Alameda enjoys the city of Alameda, the city of Piedmont, the city of Albany, enjoy this sort of two-tier system because they're able to, by virtue of being grandfathered, have their own fire departments have their own transports.

Now the Tri-Valley is not able to do that.

Fremont's not able to do that because they don't have their own system.

And yet there's that demand.

So I don't want to encourage a situation where they come and say maybe they need to do that because they can do that, and we would have to work through that.

So I think what I would like to see is a more um more of an update on how the entire county is being served and how we're able to adjust for not having all the ambulances siphoned out of an area and can't get back in time because that's how it has been happened.

So when I'd like to add those into the discussions ongoing, sure, we're happy to update you both on uh the different uh metrics that we measure in terms of response times.

That's a big one.

Um, I can't say that uh all the people will be happy all the time, but it will say that we have a very complex EMS system and overall it functions very well.

That doesn't mean that there aren't reports here and there of times when things are not going well, and uh we did have to um issue a corrective action plan in the past, right?

So we have protocols in place to address those things.

Um, some of what you're talking about in terms of uh cities being able to just do the transport.

I think that's sort of the the mess that is here is that they're part of the county's exclusive operating area, and if they weren't grandfathered in before 1980, they're not able to do that.

Um so uh there's that.

Um, and then in terms of you know how the resources are deployed, um, that's a very complex situation, and also involves uh ambulances being able to get back into circulation after they go to hospitals, which is a significant area of work that we do, but we're happy to share further updates on those with you.

Okay, that's the quote-unquote wall time, yes.

Okay, well, I would like to see this is an annual review of our performance against service times at least once a year.

Okay.

Um, well, so we're still then.

I guess we're all in agreement with the two-pronged approach, so that you're still gonna be looking at the open system and the third party system.

Is that what I'm hearing?

That we're going to.

I mean, I think I heard more around item three B, unless you decide differently between now and December 16th or January 6th or whatever.

You have support for that.

Um, but again, you so thoroughly investigated the enhancements that we won't get for a couple years with that if we don't go to a different system.

So I'll let you figure out if that's what you want to pursue.

But I guess we're we're supposed to see something back either December 9th or 16th or January because we got to get an extension going.

Not gonna go past that January 6th time frame.

We have general direction and commitment.

Is there any other comments or questions about that?

Thank you.

Do you have any questions of us?

Chief, anything else to add?

Nate, anything else?

We're good, all right.

Well, what is the direction?

Direction is to pursue um to accept these recommendations, including a two-pronged continued discussion of uh exploring a third party system and exploring an open system and extending faulk by two years, with an option for a third year.

With an option for a third year, that's what it says.

Option to renew.

I thought we were uh directing staff to also explore which option under the interim transport would provide us the best uh opportunity to get the enhancements.

Yeah, but yeah, and to come back in the next three meetings by January 6th with the board letter.

And to explore those.

I think everyone is motivated to help make this get it over the finish line.

The last comment I'll make about the open the third tier system.

And Supervisor Miley said we want to be a leader in the country.

And if that requires legislation, if that means we have to be in Sacramento pushing for that legislation, are we prepared to do that?

We'll we'll need to put together a whole strategy around that, and it's something that um EMS can't carry alone.

So it would it would be all and our local lobbyists and we'll work with the Sacramento lobbyists through the Powell Committee and with your full board in the department.

We're gonna do it, let's do it right.

President Albert, once again, I think we're we'll be more successful in Sacramento if we say we want to pilot this, be a model for this, because I think this will be cutting edge for the entire state.

And I've heard others come in from out of state, you know, visiting uh uh visiting paramedics and others who've talked about the California system, California model, um, and how the you know the the implications for you know hospitals and others and you know all the stakeholders.

So I think if we say we want to pilot this as a model, I think we'll have success in Sacramento.

Uh that's why I um proffer that as an approach.

I know it doesn't um eliminate an open system, but it does I think put us in a stronger position to do something that's cutting edge and keeps Alameda County on the forefront of providing quality service and and looking at some of the deficiencies we've experienced in the past.

Very good.

Thank you.

With that, we've concluded that item, our two o'clock, set matter.

Let's take a five-minute break.

We'll recess for five minutes.

Oh, I work with our company.

Okay, I just want to record our operator.

But all of our units, we're just uh, uh, sure.

Yeah, I would from recess.

Cheryl, will you please call roll to establish our quorum?

Supervisor Marquette present supervisor Tam present supervisor Miley.

Here, Supervisor Fortunat's presence, President Halbert, very good.

Uh thank you.

Um I note that we are over our um previously scheduled time to convene and end our meeting at five o'clock.

It's now five almost 5:30.

We're gonna keep going so as to complete our agenda.

I know Supervisor Fortunately Bass has to leave um shortly, so we're gonna get as far as we can before she has to leave.

Um, we're gonna go to a budget and finance update, a federal, state, and county budget status.

We will have public comment uh and questions and answers uh questions and comments from the board as well.

So I'm gonna turn it over to our CAO's office for a 10-minute presentation.

Thank you, President Halbert.

So we're gonna provide a brief update on the most current federal and state uh legislation and impacts to the county as well as an update on our economic and budget stats.

Okay, so you have um me, Melanie, and Anika today to share different pieces of this presentation.

I'll start with our state and federal legislative update.

So um just uh quick recap.

Um, we had a Senate leadership transition.

So uh we have Senator Limon who officially took over as President Pro TEM.

And so she will be assigning committee assignments and those important uh important roles shortly.

The legislature does reconvene on Monday, January 5th for the second year of their two-year session, and all the statutes that were passed this year will take effect on January 1st.

The governor will release his 26-27 budget by January 10th.

And I'm gonna go into the LAO budget's forecast for next year and the budget outlook.

Just as a reminder, there are several pieces of legislation that passed this uh session that do impact counties, and um we as staff are working on what needs to be done to implement them.

Most specifically SP 707 about open meetings.

There are quite a few changes that we will need to implement to be in compliance starting July 1st, and then AB 339 Ortega, which is about local public employee organizations and our MHR department is working on bringing those updates to you all about what we need to implement what we need to implement that bill.

So, in regards to the LAO's um budget uh outlook for the year, last week they released their fiscal outlook.

The overall budget problem is 18 billion dollars, it is five billion more than previously anticipated, despite our recent cash reports.

Um there are a lot of things that are contributing to this in regards to the economic context.

We have um high borrowing costs and slow business investment, we have the tariffs, we have unemployment growth being flat, but our taxable sales are stagnant, and um there's low competence, so all of this is contributing to their projections.

Um, even though our personal income tax revenue is growing, uh, there is concern that this is a bubble, an AI related bubble, and the LAO is concerned that the stock market um is exhibiting similar patterns to uh to past um past bubbles, and um in terms of the budget problem or the projected $18 billion deficit.

We have some revenue gains, but they are going to be absorbed by additional investments, both the Prop 98 minimum funding guarantee for uh K-14 education and um Prop 2 rainy day uh investments that need to be made, and then the bigger one that we've been talking about is higher costs in statewide operations, mostly due to Medi-Cal and CalFresh impacts of HR1.

Um, and so the major cost, oh I don't, it doesn't seem to be working.

Okay, okay.

Um, so the major cost drivers are $2.4 billion in statewide expenditures that are going to be increased, 1.3 billion dollar projected expenditures for Medi-Cal and CalFresh cost increases due to HR1, and then some additional expenditures and corrections, and um they are not anticipating um about 800 million of prior year solutions.

They don't think that those are going to be are going to materialize.

So it's about 6 billion in additional costs to the state budget.

Um, and then we'd continue to have a structural deficit in the state starting in 27-28.

They project it will be about $35 billion, driven by our spending outgrowing our revenue, medical and calfresh cost increases under HR1, the expiration of temporary cost savings measures and planned program expensive expansion, including child care costs and additional foster care reforms, and this structural imbalance continues through the 2930 state budget.

And we have this other looming issue in that we've already used our budget resilience, so most of the one-time spending cuts have been made.

We've already borrowed 20 billion in budgetary borrowing, which is about half of the available reserves, and we don't have very many tools left to budget the state to balance the state's budget.

So, of course, the LAO has recommendations around prioritizing ongoing solutions as opposed to temporary measures.

And we do have some serious concerns that as the state balance tries to balance these larger and larger deficits, that we as counties will continue to get the fiscal pressure of programs passed down with not enough revenue to execute them.

Just a quick snapshot.

One of the big drivers of the of the state's um gap is Medi-Cal and the growth in expenditures for Medi-Cal, part due to HR1 and part due to enrollment.

These are some charts that the LAO published as part of their Medi-Cal fiscal outlook.

And the anticipation that we have $6.7 billion in increased costs in this program, which is both enrollment and policy changes.

Now there were budget strategies to try to control the growth in the Medi-Cal program from a policy standpoint that is challenging for counties.

But there is anticipation that these federal policy changes are going to continue to drive up spending, and we don't know the full impact.

So this is a this is an estimate.

This is a snapshot of the different policy changes that are coming to Medi-Cal.

The um I think it shows up as black here are the federal policy changes, and the tan are the state budget solutions that were proposed that were enacted this past year.

I know this is something we've been talking about, but I thought this chart gives us a good sense of timing of how these um these two things interact together.

And then just a quick snapshot into Medi-Cal spending.

Um the projected LAO outlook, you can see that the general fund spending continues to increase in this program.

And then this shows the budget solutions and the federal policy changes together.

And then this is a caseload reduction snapshot, and um we can see the caseloads falling, which for the state's budget is one thing, but it does present a problem for us here as the safety net, and we anticipate that ours will show cost increases as the state's cost is decreasing.

Um, this is uh just a recap.

We um we don't know what these impacts will be on terms of caseload numbers here locally yet.

Um we know that the the state changes around the um UIS population, the unsatisfactory immigration status that the definition for that is not entirely clear yet.

Um, we have we have asset limits that are going to change who's eligible for our programs.

Um we have uh the cuts to family planning programs um for the next couple of years in regards to Medicaid payments to those providers, the cost sharing for childless adults is gonna go up.

Um, and uh recruitment of some um of some payments is also gonna uh affect the the cost of these programs.

On the plus side, our state is going to be looking into what the future of Medi-Cal looks like, and so they've we've established a uh here in the state of Future of Medi-Cal Commission.

We are well represented in Alameda County.

Um, Dr.

Noha Abolada and Bakar and Jane Garcia are all members of the commission, and their recommendations are expected in early 2027.

And there is going to be a separate advisory group to help inform the commission's work, and um applications' names are due by next Friday, December 5th.

And I believe Anika is has or plans to to throw her name uh in the ring for that as well.

They only want one member per entity to apply to that advisory group, so um we will be covered.

And then just a quick federal um update.

We are coming out of the shutdown.

Now they're on recess for Thanksgiving, and um they're working through our, they're working through appropriations bills.

They are not very close together on um figuring out uh ACA um premium solution, and it sounds like uh they're not going to make it by the end of the year.

And then two um two important things to be aware of.

There is a uh new public charge proposal.

It is even more restrictive than the last Trump administration.

Um we have we have submitted comments on this, um, uh, from the county, um, but there are concerns about uh the administration um implementing this new public charge rule.

It just is so much more broad than the previous rule and really leaves it up to the discretion of the department about what constitutes a public charge, so that it's problematic.

And now I think.

Thank you, Amy.

Uh good evening uh supervisors.

I'll move quickly through this, but we wanted to provide a brief update on a particular uh and key uh federal funding source for homelessness in Alameda County, the continuum of care program.

Uh, provide a brief overview of the changes to the program, uh, some of the implications for us locally in our local action plan and next steps.

Next slide.

So, brief background the notice of funding opportunity, also known as the NOFO, is an annual local process and a federal process for renewing federal grants that represent roughly two-thirds of all the federal assistance in our community going toward homelessness in Alameda County.

It's roughly 60 million dollars a year, so a large bucket of funding.

It has for a long time been really one of the only recurring or renewable sources in our system.

As we shared with you many times, ongoing assistance dedicated resources year over year has been the biggest barrier to for local communities developing the infrastructure and long-term impacts on homelessness.

Uh, this usually the annual process for local competition, uh, usually comes out in the June or July time frame.

Uh, was significantly delayed, uh, and it just came out uh on the 13th of November, and it is due on January 14th, 2026.

So, an extremely short timeline.

Um, either way, as we'll share, there's a significant amount of funding that's at risk, but even in the best of circumstances, grant renewals will be significantly delayed.

And as uh noted here, the NOFO profoundly shifts federal priorities for COC funding, some of which we'll cover on the next slide.

The major changes here just bucketed into the high level uh the top two being the most significant in terms of direct funding impacts is only 30% of the funding can now be protected that is guaranteed based on our local process, which is for tier one.

Usually that's 90% of the funding.

So for context, the vast majority of this funding in previous years after we went through a local process was all but secured at the federal government, and then there was an a second tier of funding that was exposed to um scoring and potential receipt or not, but they've really adjusted to say only 30% of that total funding can be in that all but guaranteed category of tier one.

The second and perhaps larger implication uh is that only 30% of the application can go toward permanent housing funding uh as defined by three different project types that I won't get into, but for context, our COC, which the county is the collaborative applicant for, but we have 47 different grants uh among community providers, some that are sub-granted through the county and some that community partners receive directly.

Right now, 86% of our funding goes toward permanent housing.

So it creates a significant hurdle in a large proportion of our current applications being disallowed from being submitted.

It's also programmatically a significant shift away from housing first models to required service and treatment models.

It advances programs and prioritizes projects in communities that align with public camping bans.

And it requires that programs and communities also align with executive orders on things like DEI, gender identity, and arm reduction.

Next slide.

Here's a quick summary of the local impacts.

I won't go through the table in detail, but safe to say, as I said, 51% of our current $60 million goes toward permanent housing of the three types listed there.

This change, the 30% cap means that we are only able to submit for 18 million of that 51 million, which creates an immediate gap in projects that are precluded from applying of 33 million dollars in permanent housing.

And it also means that because of that tier one, we have up to 42 million that's at risk and potentially all 60, which I'll get into later.

The January 14th timeline really leaves insufficient for us to do a significant long community input and involved application process that we normally do.

For context, this permanent housing funding alone currently serves to fund each year more than 2100 units and 3200 household members in those units.

The cap at 30% would mean that more than 1,400 units and 2200 individuals are at risk of losing their housing if not funded by alternative sources.

So these are people in permanent housing with disabling conditions that would be at risk of falling back into homelessness.

Again, given the late release, at the best of cases, grant awards would not happen till May 2026, given that the application is due in January when many of the grants are set to start.

So there would be significant lapses in funding even for those projects that are funded.

Next slide.

The local action plan that we're leading in partnership with our continuum of care.

We've launched a NOPA response team that's developing the local funding priorities and criteria with the explicit goal to preserve as much of this funding as possible.

We'll quickly lead the COC in submitting the most competitive and least harmful application given the constraints and implement a nimble local planning process to try to minimize administrative burden on our grant grantees as soon as possible.

That needs to be launched as soon as next week in order to comply with the NOFO timelines to be completed by mid-December to submit by mid-January.

We're also assessing the strategic use of available local funding resources to backfill what we know will be those lost dollars, also seeking to do the best we can to pivot to the new constraints and strategically solicit and evaluate new projects that may meet HUD requirements, therefore funding new services that we hadn't previously to fill local gaps and potentially offset what will be significant impacts on local investments to preserve these projects.

We're also coordinated with grantees to identify those that are most at risk to help mitigate the impacts of the late release.

Next slide.

Here is a quick screenshot of the potential implications for the home together fund.

The donut graph on the right represents the estimated average investment based on the projected revenue of Measure W of roughly 153 million dollars a year of available resources to add to our system over the next eight years to the Home Together Fund.

You can see the rough proportion of investments in our four key areas represented there.

And then, of course, this looming potential loss of anywhere from 33 to 60 million dollars.

60 million I said is our whole grant.

There is a discretionary review that HUD includes where they could, at their discretion, potentially deny whole communities any assistance if they judge that they have run afoul past or present with their current executive orders, focuses on things like equity, recognizing gender identities out aside the sex binary and practicing things like harm reduction.

Our next steps is that response team is kicked off.

They will lead an intensive planning process to complete the local process to identify projects and rank them by mid-December.

I've met with my Bay Area counterparts to learn more and strategize as to what they're doing.

They're of course in very similar positions.

We held a briefing this morning with the CEOs of all the current COC grantees for the 47 grants and provided updates and next steps as to where we're at and the planning.

The local process and timeline will be announced ASAP, and we will continue to provide updates, of course, to the board.

One late breaking significant factor that is not listed here is a lawsuit that was launched by 20 states, I believe, including the state of California against the federal administration, specifically about the HUD COC funding process that came out today.

So unclear what the immediate implications are of that, but that has also happened, and I know we're working with our county council to do new analysis of what those impacts might mean for the near and the long term.

Thank you.

I'm gonna try to move as quickly as we can, noting that we're already over time for this item.

So since the county's discretionary revenues largely property tax-based, we keep a close eye at indicators in the local real estate market.

I'll skip over that slide as uh there are pretty nominal changes.

On this next slide from the state association of realtors, the rate of unsold inventory for the month is down compared to September, but up a little over five percent compared to a year ago.

So, median time on the market was 14 days, down about 12 and a half percent as the previous month compared to the state's 32 days.

So, the important thing to note here is overall low inventory continues to keep prices high and out of reach for many prospective buyers.

We saw in headlines a couple of weeks ago that nationally foreclosure filings have jumped nearly 20% from last year, which is a sign of distress in the housing market after historic lows in recent years.

Uh, California was among the states with the most completed foreclosures, along with Florida and Texas, which suggests that those states will see more inventory coming on the market at those distress prices.

Um, moving on to the next slide.

The central bank officials are divided over whether to implement another rate cut.

Some are advocating for a rate cut in response to weak job market, while others are concerned about persistently high inflation, and that split has resulted in some market volatility.

With respect to the layoffs that we're continuing to see concentrated in the tech sector, what I'll highlight here is a number of these employers are semiconductor manufacturers.

You heard Amy talk a little bit about AI and the concern that the LAO has lifted in its forecast.

Ironically, the engineers who are building these AI tools are among the first to be displaced by the technology.

So far, AI has coincided with sweeping layoffs across tech.

We saw Microsoft Salesforce, Microsoft and Salesforce cut thousands of jobs.

Meta also cut about 600 jobs all during a period of record AI investment.

This is risky territory.

The semiconductor industry faces a talent shortage of engineers and technical professionals, and McKinsey estimates that an additional 88,000 engineers are needed by 2029.

So companies are essentially betting on smaller AI-enhanced teams, but losing irreplaceable talent as engineers exit the field.

So what I want to note here is that tech accounts for more than 20% of regional employment, and research shows that every tech job supports another four to five service positions, which means that if we look at the synopsis layoffs alone, their $2,000 job cuts or sorry, their 2,000 job cuts could trigger the loss of an additional 8,000 to 10,000 additional jobs across local economies.

I'll move quickly through the budget overview.

As you recall, we have a 6.1 billion dollar budget in the current year.

The next slide does a recap of our budget balancing strategies.

We closed 105.7 million dollar funding gap in the current year.

As far as budget monitoring, as you recall, every quarter, the CAO sends a request to agencies and departments to submit quarterly projections.

Our first quarter projections suggest savings due to a combination of projected underspending driven by high vacancy rates, but offset by underrealization of program revenues.

To the degree that we have concerns with particular program revenues, we're continuing to review uh options that we have in response to those uh revenue challenges.

In addition, you know, cost strategies that we have related to encumbrances, so that we can help mitigate uh potential impacts.

So we're going to continue to monitor that into the second quarter um and uh make any recommendations to your board if necessary um the next two slides are are largely unchanged so I'll go ahead and skip over those and entertain any questions questions comments thank you for the presentation supervisor miley has it and up go ahead Nate well can you hear me can you hear me yes no can you hear me hello yes we can hear you we can hear you okay all right thank you well first of all I just want to ask the staff can they tell us the bad news just a little levity yeah this is I mean from Amy Jonathan and um Melanie Melanie right I was trying to remember who the other staff person was yes it that this is not a good report it's all bad news all bad news um I really do think and I you know appreciate the staff keeping us apprised of the situation the board and the public because I think um people need to be cognizant of what we're up against.

First of all from the federal perspective you know elections have consequences and unfortunately we have an administration that's really effed up.

I hope I I mean I might get quoted on that but that's the way it goes um and that's cause significant um challenges for everybody that were not necessarily anticipated had another administration uh been elected and then at the state level I mean clearly it's to me this is like dejar vu um when you know when the state when the state coughs the county feels the impact of that and it looks like the state's going to be in for a world of trouble a world of hurt I know uh you know when Jerry Brown became governor he really made an effort to try to help the state build up a sizable rainy day fund um I mean I didn't appreciate Jerry uh do um dissolving redevelopment but I know otherwise he did a great job of building up the state's rating day fund.

Well we're back at a place where the state's rating day fund it might not be sufficient to cover uh the difficulties and the challenges that the state's going to be encountering uh in the future um I really think uh you know Jonathan pointed it out that I guess we're looking at measure Will we be looking at other funding streams to see what we can do uh as a result of of what this what this feds are doing relative to the um the funding we need for the continuum of care uh but I really do think uh that the county's gonna need to and I'm sure Susan's already on it we we need to come up again we're gonna be basically on in this on our own um and we need to figure out the worst case scenario if the state is having challenges if the feds are having you know imposing all these things on us what is the worst case scenario for the county over the next five years uh I know in earlier presentations Melanie shows showed us the budget forecast going out um but we really we really need to look at uh the worst case scenario and what we can do with the resources we anticipate coming in the resources we presently have to offset that and then the board really needs to be more cognizant and I throw myself into that picture as well with what we approve for uh allocations.

Because if something is not required, we might need to put that off.

Um, you know, so we can get through the storm.

Because I think the storm is going to be upon us between the state and the feds.

I think we're gonna be in for some really challenging times.

So when we look at allocations down the road, we just really need to decide is this something we want to uh approve for an expenditure at this time, or do we want to um uh put it off because we can wait or tell any value at the moment, or um it's something we can do because uh based on the forecast, we can plug this in.

I don't think we have enough information at the moment to make that determination on a case-by-case basis, uh, but I do think uh that's something we need to really look at.

And I'm talking about um the resources we have available that we have within the reserves, our designation accounts, our escrow accounts, anticipated revenue, et cetera, et cetera, et cetera, based on or just a position against the worst case scenario.

So that's all I want to say at this point in time because I know it's it's late, but um I just want to thank the staff for providing us with all this bad news.

Thank you, Supervisor Riley.

Supervisor Fortunato Bass.

I know you have to leave any pardon comments.

Thank you, President Miley.

I'm sorry, thank you, President Halbert.

And uh I I agree with uh our colleague, Supervisor Miley.

This is bad news, and I feel like under this current federal administration, the bad news and the attacks on our communities is relentless every week, sometimes every day or every few days we get bad news, and certainly at PAL, that's probably where uh it starts every single week.

Come to our committee for the bad news.

Um, I appreciate hearing about um public charge again from our staff.

We heard about it at PAL.

Uh would love to get uh have the board receive a copy of the comment letter regarding public charge.

Um also appreciate hearing that the quarterly report uh that the staff has done shows that we are projecting to be within budget.

I do think given this federal administration and the stresses on the county budget, which means stresses on our safety net, it would be good to have a little bit more of an update on our mid-year report once we complete the second quarter, and obviously we'll be um starting to work on the budget process as well at that time.

We'll bring that forward to the board after it's complete.

Thank you.

Um also appreciate hearing the bad news about HUD's continuum of care funding.

Uh thank you to HH staff.

We also heard that bad news at the district town halls, each of our offices is doing with our health and housing staff.

Um I you know, stepping back, um, you know, I agree with Supervisor Miley in terms of looking at scenarios, including the worst case and seeing what we can do with various funds.

Measure W is having so much pressure on it because of the federal scenario and landscape as well as some of the state uh funding budget issues.

I would like to really step back and focus on the outcomes that we articulated when we made the Measure W allocations, including for homelessness, ensuring that we are um, you know, obviously reducing homelessness, focusing on investing in places where the larger, you know, the proportion of unhoused residents reside, and also looking at addressing racial equity.

Um because there's so much coming at us, we've already released two RFPs.

There's another RFP coming out in January, there's having to adjust because of the COC funding changes.

I feel like there's a little at and we're also looking at um updating home together 2030 in the midst of all of this.

That's a lot of different tracks of work, and I'm not clear that all of this work is leading to a set of outcomes in line with the home together goals around addressing homelessness, um, where most of our residents reside and with racial equity being at the center.

So I'd like to figure out how we can have at least a work session and regular work sessions on measure W to ensure we're getting at the maximum impact, knowing that there's so many pressures on measure W for both the safety net and homelessness.

And it's Anika, I don't know if you want to respond to that.

Um, yes, so I I'll ask Jonathan to talk about this in a little bit more detail, but I do think that you're right, there's a lot coming at it.

And at least from our team's perspective, we're really trying to keep in line with the goals that we proposed for the Home Together Fund are aligned with what's in the uh Home Together 2030.

So at least from that initial perspective of where the county is trying to go and including the racial equity framework, like those are continued parts of um there's alignment in that work.

What we're struggling with a little bit is that, you know, uh, with all of the state and federal funding cuts, it keeps tromping into measure W.

And so um things that we thought we'd be able to do as additive, um, are you know it's kind of turning into a lot of backfill.

Um, but we're happy to take that back and uh think through how we can share some information with you so that you have a sense of all of the different planning that's happening.

We'll need to come back to your board, your board's done an allocation of hundreds of millions of dollars with regard to home together, but the actual specific um allocations to providers and to service areas will also we'll need to come back to your board as well.

Right.

I guess I'm saying that um one of the one of the issues that's a little bit hard for me in terms of driving towards our our goals and outcomes is that the RF this the board doesn't have necessarily input on the RFPs, so I'm not exactly sure where that comes in outside of you know the ongoing conversations we have with staff, but I'm just trying to figure out how that aligns and certainly we want to have countywide impact.

You know, I really would like us to engage all 14 of our cities and the unincorporated areas and just really ensure like this is a moment where I feel like the more we're in sync, the better the outcome will be, and yeah, the the landscape is different even from when we allocated the money in July because of all these changes.

Yeah, and and I will acknowledge we are a little bit behind on our regional meetings with the cities.

Uh, that is something that we committed to your board that we would undertake.

So uh we will get on that.

Um, and yes, happy to share more detail.

The RFPs in general are developed with um feedback and and conversations we have with the board as well as with um community partners and sort of also based on what we know is the need in the system.

Um thank you.

And then lastly, um our Alameda County Together for All, our Act for All committee is meeting next Thursday at two o'clock, and so in line with our purpose, we're gonna look again at food security and some of the um incredible work that was done during the SNAP um crisis and look forward as well as and we're also going to have an item on public charge so we can spend a little bit more time understanding what's happening there and what that means.

We might have one more additional item as well.

Thank you.

Thank you.

Other comments, Rvisor Tam.

Um, thank you.

I just have a quick question.

So on the continuum care, the programs that are related or align with um basically diversity equity and inclusion, gender identity, you know, harm reduction, those are basically core ethical values of the county.

Um how much do you expect that we will be losing out of the 33 to 60 million dollars in continuum care because our programs are slated to differ than what the president wants in his executive orders?

Yeah, thank you for the question.

Um I guess it would be it would sound snide to say between 33 and 60 million dollars.

There it is.

I use the term global because it really is a global discretionary remark around the administration's uh you know, withholding the right to say if we see any past performance in these areas around again, their specific terms are racial preferencing, which again is not my term, theirs, which I think falls under the the language of you know equity, uh racial equity focused distribution of resources, um uh acknowledgments of identities outside the sex binary, so uh uh diversity of gender identity and then also practices that they define as harm reduction, such as distributing drug paraphernalia, allowing people to use drugs, safe consumption sites, right?

Things that that we that we don't do, but they have broad discretion.

So the concern is that that could be used to uh to be clear, that's not just an Alameda County thing for context.

These were things that as most recent as 2024 were built in as requirements that we all as continuum of care wrote into our application to HUD.

So we're talking about last year's um measures and requirements and principles and practices that HUD has based its its programs on.

So technically that could apply to every single, I'm not sure, 500 COCs across the nation.

Um so I'm assuming they're not going to do that.

So it's really an opportunity for them to just use the discretion to say we think you do these things and don't.

I should also mention again, this is a primary thing that's lifted up as problematic of and of concern uh in the in the lawsuit that was just released is that ability to do so.

Um so we don't know.

I will say, in the best of circumstances, it will at least be 33 million dollars of that permanent housing funding that we can't even submit.

So we need a plan for that, those people that are housed right now, regardless.

Um, and then it could be, you know, it could be more than that if they decide to not approve even what is eligible that we go through the good college try of submitting.

So it will be significant either way.

Thank you.

Jonathan, just to confirm, those are people that are currently housed that have no ability to re-enter the workforce, no ability to take care of themselves, and will have no ability to pay rent.

That's right.

The people that are screened into this program by HUD's design now for several decades are folks that are chronically homeless, have multiple disabling conditions, physical, behavioral, mental, are on fixed incomes, older adults, often seniors, right?

All of these, all of this compound of issues that is why we say, right, from a housing first perspective, it is the best use of funds to get people in housing, wrap the services around and save the system money.

So these are not uh individuals that are um able to transition, right, or programs that are able to just flip and move people out.

So uh it's detrimental in that way.

And again, that's uniform.

We spend 80% 6% of our funding on uh permanent housing, and that's uniform across the state.

Between eight across the country, it's 85 to 90% that communities spend.

So this this cap issue, this 30% cap is is uh affecting communities universally in that way.

Again, but to confirm these are people that cannot re-enter the workforce.

Yes.

Are um completely vulnerable.

Highly vulnerable, yes.

Highly vulnerable and currently housed, many of them for many years, but still with those enduring needs for continued support.

So our priority and uh hope with with with your blessing is to make sure we are prioritizing available local resources to to keep those people housed and to keep them from flowing in in short order into our shelters and our in our streets.

Very good.

Thank you.

Um before we go to public comment, I see Supervisor Miley with his hand up yet again.

Yeah, President Howard, sorry to speak again, but um, yeah, after Supervisor Tam asked the question and Jonathan responded.

Yeah, I just really really, you know, I hate to say the sky is falling, uh, because I'm not one I'm you know, I'm always an optimist.

I always look at the glass half full as opposed to half empty, but I think the sky is falling.

I think we're we're entering uh a period of significant storms, financial storms.

Uh, you know, we've got Prop One.

We've got the issue around prevention around uh mental health, we've got this now upon us with and the continuum of care.

We've got other demands.

I I just I would just really implore uh the board to get the county administrator uh to begin to look at uh contingencies relative to you know all of this comprehensively with all of our funding streams and funding sources.

Because I um I'm I'm really afraid.

Not to be outdone, Anika would like to respond.

Oh, I'm sorry, not a response.

Oh, two minutes, okay.

I I just wanted to note that, you know, in in all of the gloom.

Um Jonathan did mention that just today there was a lawsuit on this issue.

Um, so that adds a little bit more complexity because as we've seen in other spaces, there could be an injunction, there could be a pause to it, but um, we'll continue to plan around it.

Thank you, Supervisor Marquez.

Thank you, everybody.

I really appreciate the exchange the dialogue here.

It's unfortunate to receive all of this bad news, but I I will just name it.

We are in a crisis, and so I really support the idea that we look at all of our fund balances and just kind of what our plan is moving forward.

I think we're at that critical juncture, and just for process, um, we spent well over two hours today in closed session.

So I'm also gonna respectfully ask that we look at an approach where we take internal issues on a different day.

Uh the public's been waiting for hours.

Staff could have been gone by now.

This should have been one of the first items on the agenda.

We're consistently moving things around, and obviously we have our work cut out, and I just think we spend a way too much time in closed session.

So if we could bifurcate that just so we could focus on these issues and have the information advanced, I think it would make these conversations a lot more productive.

So that's my request.

Thank you.

Oh, we have four online speakers.

How many online?

If you're online and want to comment, now is the time to raise your hand.

And if you're in person, now's the time to get your speakers listening.

Five online speakers.

Those five online plus the speaker cards we have.

Twelve speaker slipped, but I there are six.

We'll give two minutes to each speaker.

And the online in in person first, and just as a reminder.

Just on this item, and as a reminder, it's up to two minutes, meaning you don't have to speak the entire two minutes.

A friend that's the same comments.

Franco?

Jessica.

Is that it?

Okay.

Hi, thank you.

My name is Justine, and I'm a constituent of supervisor for Fortunato Boss.

I'm here to ask the Board of Supervisors to implement the ethical investment policy that would prevent our public funds from enriching companies that knowingly enable human rights violations from Israel's genocide against Palestinians.

We should all have great respect for our treasurer Hank Levy, who crafted an eloquent and expertly guided plan regarding the budget and the EIP and has already worked with consultants to put this together for the good of our community and to ensure our funds are ethically spent.

Speaking of the budget report, I'd like to highlight that the EIP says the treasurer will actively look for investment opportunities that can be tailored to have a beneficial impact on Alameda County residents.

Please implement this now.

Do not continue to stall this historic and urgent action.

Thank you.

Hi, my name is Francois Long.

I'm uh the resident of District five.

Um and the member of Eastbed DSA.

Thank you.

Uh Supervisor Marquez for your advocacy of the um ethical investment policy.

I note that the county staffer had uh highlighted Amazon as being a volatile stock right now, which is a stock that VEIP could possibly um help divest from uh a personal anecdote a week ago.

I responded to a rapid response call to rulement tree following a reports of ICE activities that I separation that led to lockdown of the school, was facilitated by data center provided by Alphabet and Amazon and communicated via devices from Cisco, all three companies that the county has investment in.

The procedural delay of the implementation is basically rendering the policy itself meaningless.

What you're telling our neighbors is that with this delay that they are expendable so long as the county's solvent.

In the words of our local illustrious philosopher from UC Berkeley, Judith Butler, once you decide that the single vulnerable minority can be psychologized, you're operating within the fascist logic.

Therefore, there is only one moral choice you can make today.

And it is to implement the ethical investment policy with the human rights language uh intact.

There can be no half measures when it comes to human rights.

Thank you.

Can I ask a follow-up question?

You mentioned Amazon, and I hadn't heard that company before.

Do you have a full list of companies that you would consider we should be divesting from?

And I say that because Hank Levy has already said, in his opinion, in his mind, with what he's proposed, there's nothing else in our portfolio to divest from.

But I thought what you said was that we do have.

So I just need to be clear.

Which companies would you say we should be divesting from and or not ever invest in?

Right.

You could not today, but just send it to me offline.

Offline.

Just send it to me in an email.

Yeah.

Okay.

We'll do that.

You have my email address.

Thank you.

I can find it on the website of the county.

No, you can't.

Thank you so much.

It would be Tim Drew.

Excuse me.

Hello, supervisors.

My name is Tim Drew.

I'm a district five resident and a member of the Democratic Socialists of America.

I'm here to urge the board to rescind its decision to subject the EIP to a wasteful, unnecessary, and additional peer review, as requested by Treasurer Hank Levy in the letter that he sent to you all on November 19th.

I think this is a good moment to highlight the grim report that we heard from staff on the budget, and to point out that the EIP were it to be adopted, does indicate that the treasurer would find uh opportunities to invest within Alameda County that improve the lives of county residents as well as other communities.

That's in the EIP.

Uh that should be adopted right away, uh in light of the uh, as I said, the grim budget report.

Uh Treasurer Levy drafted the EIP with the assistance of an independent professional investment consultant already.

Uh the two of them engaged in stakeholder meetings with over 25 community groups, uh, including pro-Israel uh community uh groups after a long and thorough engagement process uh in which they received public input.

The EIP was introduced uh and approved by the Treasury Oversight Committee back in May of this year.

Uh and I think that is uh pretty much the process that you were anticipating uh the EIP would go through by having another peer review and having it go to this uh finance committee.

Um I think uh it's important to note that you know we heard a lot about uh county procurement and and issues with county procurement for various sectors within the county.

Um I would uh anticipate that an RFP for a can for an additional consulting will will take several months.

Uh the whole procurement process uh as well as negotiating a contract.

Thank you.

Was that two minutes?

Yeah.

My God, okay.

You did a good job.

Thank you.

Colin, you're on the line.

You have two minutes to speak.

Hi, can you hear me?

Yes.

Perfect.

Good evening, honorable supervisors.

My name is Moose with care, the Council on American Islamic Relations, as well as a Tri-Valley resident.

We want to thank Treasurer Levy for crafting the ethical investment policy and the board for adopting it, including its screen against severe humans' rights violations, which by definition encompasses apartheid and genocide.

However, delaying implementation under the guise of further review is unnecessary, especially after the Treasury Oversight Committee already approved it, and Treasurer Levy debunked the spurious politically motivated financial claims that were raised on October 3rd.

Alameda County's commitment to social responsibility must mean more than maximizing returns while brutal genocides continue in Palestine, Sudan, the Congo, and elsewhere.

Supervisor Marquez requested an update on implementation, and today's item offers that chance.

Alameda County must not bankroll apartheid or genocide or invest in violent displacement here in Alameda County, in Gaza, or anywhere else.

Thank you.

Hey, can you hear me?

Yes.

Okay.

Uh, thank you so much, uh, supervisors.

My name is Rano Hamami, and I am a parent and ordained Unitarian Universalist Minister and an organizer for Interfaith for Palestine.

As a voting resident of District 5, I thank Treasurer Levy for the creation of an already well-vetted ethical investment policy, and Supervisor Fortunato Bass for voting in support of it in October.

We've heard a lot today about the challenges related to our most vulnerable community members and the financing of critical services, which indicates that now more than ever, the board has a moral obligation to rescind its decision to further review the ethical investment policy and instead immediately implement it.

This delay goes against your constituents' desires to move county funds out of investments that perpetuate violence against us and your constituents' desires to move county funds towards those investments to promote care.

We want more resources put into supporting our most vulnerable populations, including children who are dependent on social services, as we've heard today.

And we'd rather those resources not come from the investments that rely on murder, kidnapping, and traumatization of children in Palestine, Sudan and our own immigrant communities.

With Interfaith for Palestine, I have prayed and organized with thousands of people of faith in this county, the Unitarian Universalist, Jewish, Muslim, Christian, Buddhist, Hindu, Quaker, Catholic, Mennonite, and more for policies that would stop funding war and start investing in life.

You can make a difference, not only for the people of Palestine, but for your own constituents, as you've heard today.

Responsible investment that you have an opportunity to use and do can turn our prayers into real tangible and sacred change with that decision to implement the ethical investment policy today.

This policy was crafted by Treasurer Levy with input from a variety of sources and stakeholder community meetings and was approved unanimously by the Treasury Oversight Committee, the body legally responsible for reviewing the county investment policy.

That decision to delay it tells us that the board doesn't trust its people to do responsible work.

Is that the message you want to send?

Holly, you're on the line.

I am a retired investment professional.

And I want to say that with the budget crunch that we are facing, it is irresponsible to be wasting time and money on second opinions on our invest equitable investment policy.

Nate Miley said earlier this evening: if something is not required, we need to put it off.

We're not do it at all.

Please rescind your decision to hire a consultant to second guess our excellent Treasurer Levy and the Treasury Oversight Committee.

Thank you.

Laurie.

Ed and Chris.

Okay, my name is Ruth Laurie Weinstock.

I am a constituent of Nikki Fortunato Bass's district.

And I would like to again remind the Board of Supervisors that our treasurer has done an excellent job of crafting the ethical investment policy.

It was overwhelmingly approved by the Treasury Oversight Committee.

And it should be implemented immediately.

There is absolutely no reason to stall, but we have had people come in here and use phony tactics to try and manipulate the Board of Supervisors into thinking that there are risks.

When actually our Treasurer has put forward a very clear letter saying that our um that the the investments that he has done the past year are excellent and has generated close to 400 million during the last fiscal year, the highest amount ever recorded in the pool's history.

So we should put more trust in Treasurer Levy, more trust in the ethical investment policy, and as Supervisor Miley said, not waste, and Ms.

Moses said, not waste money and precious time, which is money, on all of this nonsense about another review, which is totally unnecessary.

So please remember that this ethical investment policy is supported by the largest community by and far in Alameda County.

It is supported by the immigrant communities.

It is supported by faith communities, it is widely supported by diverse people, and it is equally about human rights everywhere in the world and here in Alameda County.

And for too long, our governments in this country have prioritized things beyond the people, the better good of the county.

So please prioritize the better good of the county and its people and not the investors and the billionaire class.

Hi, my name is Jessica Gray.

My name is Jessica Gray.

I'm a taxpayer in District 5 in Oakland.

I'm grateful to Supervisor Fortunato Bus for representing my district.

Earlier today, this board heard a report about foster youth in our county and expressed the importance of these children's lives.

Meanwhile, this board is saying it cannot take a stand to prevent investing in companies whose weapons and technology are used to kill parents and children in other parts of the world.

Someone once said, focus on what you can do instead of what you cannot.

Good news, you, this board can reverse the decision made on October 3rd for peer review of the ethical investment policy and start implementation of the EIP now.

Instead of searching for non-existent reasons why we can't invest our county's funds ethically, let's focus on how we can.

The EIP is thoroughly researched and financially sound, as demonstrated in the November 19th letter from Treasurer Levy.

Our community has been demanding an ethical investment infrastructure for over a year now, and we cannot wait any longer.

Thank you.

I'm Ed, Oakland resident, and I'm with East Bay DSA and the best room apartheid campaign, and I'm here to talk about the EAP.

Supervisor for Tunato Bas is my representative, and I want to express my gratitude for her full-throated support for the EIP to have been fully passed last October 3 instead of some nebulous day into the future.

The situation we've been outrageously put ourselves into.

Uh I'm here to express my grave disappointment over the board's ultimate decision to delay implementation on this EIP, although it was a righteous decision to have adopted it back in October.

And now once again, we're presented with delays for RFPs or whatever new bureaucratic hurdles can be put in front of this simple thing.

Even now, or even more regrettable in dissolutioning is how receptive some members of this board were to concerns over our investment returns when the community has clamored for this policy as a response to a genocide being live streamed to our faces.

This is really sad and speaks to a collective American amnesia around how our profits reign supreme over the mass suffering of people invisibilized by our media and our collective gaze.

Ironically, we find ourselves today in the wake of Thanksgiving when we tell these sanitized stories that conveniently forget our own history of indigenous water and displacement.

And so it is again with Palestine with the Sudan, with the Congo, where genocides run rampants stemming from a history we continue to ignore in seemingly inextricable systems of profiteering by the West and this American empire, where systems of state oppression and terror are allowed to thrive, perpetuated by our silence.

This ethical investment policy is a working moral document by witnesses, Alameda County residents, regular people who have decided to be loud about what we're all horrified by and what our so-called great corporations enable.

It's what our beautiful people in Alameda County have put their faith in the face of our state government that continues to fund Israel's genocide to the tune of billions of dollars.

It's a start, but may all our local governments across the country adopt something like it.

Who's next, Joe?

Grace.

Last speaker.

Last in person.

How many more online?

We had five to start with.

Okay.

Whoever raised their hand before gets to speak.

Hello, supervisors.

I'm Grace, a resident of Oakland.

The EAP, as it stands, would help ensure we are not enabling ICE through ensuring we not give them money now and in the future.

Right now, we have y'all who are empathetic to this cause.

But again, we might not have you in the future to protect immigrants.

The current public charge stuffs, all the other attacks that we're seeing here in our communities have our migrant communities, their neighbors, everyone horrified.

As a social worker, as an advocate, as an organizer, I urge you to enact the EIP now.

The human rights language will help protect our immigrant communities here that you all say you really, really care for.

So please show them and show us that you do care about them.

The board's referral to the ad hoc finance committee, a body that hasn't met in years and which was not designed for view investment policies, is a complete departure from past county practice and state law.

And subjecting the EIP to redundant consultant review will yield no benefit and will cost taxpayers no less than probably 100K.

It's financially imprudent.

And as we just heard, there's a lot going on, and y'all need to take care of your money.

So we really really and our money.

So I want to remind you that the bottom line is that subjecting the AAP to wasteful or unnecessary additional peer review was based on false premises.

Rather, I really urge the board to invest that money towards addressing the crisis of houselessness, the crises that migrants are facing, and these challenges that this bad news is about to bring for all of our communities.

I really urge you to implement the EIP now.

It's more urgent than ever.

Thank you.

Please unmute your mic.

Hello, hello.

Y'all hear me?

Hello?

No, can you speak up a little louder?

Hello?

Yes, we can hear you now.

All right.

Thank you so much.

Um.

Yeah, my name is Rex.

Uh I work for FAJAF.

We're based out of uh Supervisor Marquez's district.

Um I'm here today to well, not just today, but just since this morning, uh, to strongly uh encourage the board to adopt the ethical investment policy.

Treasurer Levi has painstakingly had months of dialogue with the community and also had uh approval from independent uh independent uh treasury oversight committee.

The year is coming to an end, and I would really like that our taxes are not gonna go to funding genocide across the world.

The bay as it is is a very ethnically diverse uh place, and it will only get more diverse as the years roll by.

It's hard to really embrace this American dream when this country and county is complicit in horrendous human rights abuses that made you lee here in the first place.

And while the board diters on uh adopting the EIP, hundreds of thousands are dying in Gaza, Sudan, and a Democratic Republic of Congo.

Survivors will eventually make their way here and in the decades to come, will our country will our county tout in capacity remain a hollow forever?

Or are we gonna ratify it now?

That was the last speaker.

Okay, very good.

With that said, um we've uh completed the business before us, and our meeting is adjourned.

Thank you all.

Oh, announced out of closed session.

Do we need to go back into closed session?

Are you sure?

This this confirm this confirms that the board did not take reportable actions in closed session.

Thank you.

With that, we are now adjourned.